§ 248. Phlegmasia alba dolens.

This is a species of phlebitis, with the following symptoms: In some the labia swell, in others the crural or the obturator vein. The swelling is tight, painful, of a strikingly white colour. The pain is tensive-tearing, increasing periodically, the part becoming rigid and immovable. Sometimes the pain commences in the bend of the knee, or in the calf, but never near the foot; the swelling never extends to those parts. Generally only one side is affected. In a few days a swelling and tension are perceived in the groin, extending as far as the labia, where the swelling terminates very sharply, and afterwards follows the inner border of the lower limb, as far as the bend of the knee and foot. As soon as the tension is experienced in the leg and foot, the thigh and afterwards the leg swell, after which the pain abates. The swelling now becomes general, and the limb frequently acquires double the natural size. It cannot be moved without great pain, is hot and very painful; the swelling is smooth, shining, pale, or of a milky white, opaque, homogeneous, and continuous all over; frequently, however, glandular indurations are felt in the groin, bend of the knee, or calf; at first, the swelling is elastic and unyielding, but afterwards pressure leaves pits. The fever commences with a violent chill, followed by heat, with a full, irritated, at first hard, and afterwards soft pulse. The disease is attended with bilious phenomena, such as jaundiced colour of the eye-ball, bitter taste in the mouth, loathing, sometimes vomiting, and affection of the liver.

The character of the disease is sub-acute. The disease terminates in recovery, suppuration, death, in consequence of pus getting into the circulation, and inducing a suppurative fever. The prognosis is not very favourable, particularly when the treatment commences late.

The last case which occurred in my practice was attended with a tertian fever, and a debilitating diarrhoea, and was completely cured in six days, by means of Arsenic. Arnica is said to have been employed by some with success, upon the supposition that the disease arose from the pressure of the foetus upon the lymphatic vessels, as it passed through the pelvis. Rhus tox. and Nux vom, are likewise to be recommended. Bryon., Merc, China, Bellad., Veratr., Puls., Chamom., Sulphur, Calc. curb., Lycop.. may likewise prove useful.