Milk Leg. Phlegmasia Dolens. Crural Phlebitis.
THE popular idea is, that in this disease the woman's milk has fallen into her leg, which has inflamed. This is of course absurd. As to the real nature of the complaint, there are various opinions, some holding it to consist in inflammation along the sciatic, crural, and pubic nerves; others, that it is an inflammation of the lymphatic of the groin which causes it; others, that it is an inflammation of the crural veins. The fact of the matter is that this disease is one of the many evidences of septic matter entering the circulation and setting up local trouble where it is deposited. It is, in other words, a mild form of pre existing blood poisoning.
Symptoms. The disease begins in from two to seven weeks after delivery, with pain in the lower bowel, groin, or thigh. The pain is more violent when the thigh is extended. In a day or two, the pain diminishes, and the limb begins to swell, frequently in the calf of the leg first, thence extending upward; but generally in the groin, and extending gradually down. The skin becomes entirely white, smooth, and glossy, does not pit when pressed, is painful to the touch, and is hotter than the skin upon the other limb. In connection with this local disease, there is general fever, with small and rapid pulse, thirst, etc.
Treatment. The patient must lie flat upon her back, with the swelled limb placed upon pillows, or a bolster, raised so that the foot shall be a little higher than the hip, and then charged not to put her foot down upon the floor until she is very nearly well.
Take a large piece of flannel, Dr. Meigs says an old flannel petticoat, with the hem and the gathers cut off and dip it in vinegar and hot water, equal parts; wring it out, and cover the whole limb with it. Put a piece of blanket or oiled silk over it to keep it from wetting the bed. Repeat this and keep it up for six hours. When it becomes tedious to the patient, remove it, and bathe the limb with warm sweet oil, two parts, and laudanum, one part, and cover it with flannel. In two or three hours, return to the first application of hot water and vinegar. Continue this for five or six hours, and then take warm sweet oil and laudanum; and thus pass from one to the other until the inflammation is subdued, or, as Dr. Meigs says, till the calf of the leg can be shaken.
If the bowels are confined, let them be gently moved by some mild physic (13), (14), (18), (25), (27), (41).
In many cases, diuretics and cathartics combined will be proper (302), or diuretics only (128), (130).
While the inflammation lasts, and there is fever, the tincture of veratrum viride must not be forgotten.
If recovery does not take place after the active inflammation has subsided, the limb should be bandaged from the toes to the groin.
Wrap up the leg in wet flannels, covered air tight with rubber cloth, and great quantities of water will exude from the leg.
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