To relieve the pain, warm fomentations or lead and opium lotion should be applied.  Later, ichthyol-glycerin, or glycerin and belladonna, may be substituted.

When, at the end of three weeks, the danger of embolism is past, douching and gentle massage may be employed to disperse the oedema; and when the patient gets up he should wear a supporting elastic bandage.

The infective form usually begins as a peri-phlebitis arising in connection with some focus of infection in the adjacent tissues.  The elements of the vessel wall are destroyed by suppuration, and the thrombus in its lumen becomes infected with pyogenic bacteria and undergoes softening.

Occlusion of the inferior vena cava as a result of infective thrombosis is a well-known condition, the thrombosis extending into the main trunk from some of its tributaries, either from the femoral or iliac veins below or from the hepatic veins above.

Portions of the softened thrombus are liable to become detached and to enter the circulating blood, in which they are carried as emboli.  These may lodge in distant parts, and give rise to secondary foci of suppuration—­pyaemic abscesses.

Clinical Features.—­Infective phlebitis is most frequently met with in the transverse sinus as a sequel to chronic suppuration in the mastoid antrum and middle ear.  It also occurs in relation to the peripheral veins, but in these it can seldom be recognised as a separate entity, being merged in the general infective process from which it takes origin.  Its occurrence may be inferred, if in the course of a suppurative lesion there is a sudden rise of temperature, with pain, redness, and swelling along the line of a venous trunk, and a rapidly developed oedema of the limb, with pitting of the skin on pressure.  In rare cases a localised abscess forms in the vein and points towards the surface.

Treatment.—­Attention must be directed towards the condition with which the phlebitis is associated.  Ligation of the vein on the cardiac side of the thrombus with a view to preventing embolism is seldom feasible in the peripheral veins, although, as will be pointed out later, the jugular vein is ligated with this object in cases of phlebitis of the transverse sinus.

VARIX—­VARICOSE VEINS

The term varix is applied to a condition in which veins are so altered in structure that they remain permanently dilated, and are at the same time lengthened and tortuous.  Two types are met with:  one in which dilatation of a large superficial vein and its tributaries is the most obvious feature; the other, in which bunches of distended and tortuous vessels develop at one or more points in the course of a vein, a condition to which Virchow applied the term angioma racemosum venosum.  The two types may occur in combination.

Any vein in the body may become varicose, but the condition is rare except in the veins of the lower extremity, in the veins of the spermatic cord (varicocele), and in the veins of the anal canal (haemorrhoids).