VARICOSE VEINS. When a vein becomes dilated at a certain part of its course, for no apparent physiological object, such as relieving the venous circulation elsewhere (as, for example, in the case of the superficial abdominal veins enlarging in order to rclievea compressed vena cava), it is said to be varicose, the actual dilatation being called a varix (a word used in this sense by Cicero and Celsus). Some veins seem to be unaffected by varices, which, however, are of common occurrence iu the sub-mucous veins of the rectum (constituting hemorrhoids or piles), in the spermatic veins, giving rise to rani cocele (q.v.), and in the veins of the lower extremities. They are occasionally (but very rarely) found in other veins. Certain conditions of the system favor the formation of varices, among which may be noticed an indolent temperament, and a debilitated con dition of the general system, accompanied by a relaxed state of the walls of the veins; and possibly also a congenital predisposition or hereditary tendency. Persons with such a predisposition are more likely to suffer from this affection if their occupation is one which involves much standing or walking; and cooks, washer-women, and foot-soldiers have been selected as specially prone to varicose veins. Varices may occur at almost any period of life, but are chiefly developed during middle age. Their formation is aided by any condition of the system which impedes the circulation, as certain diseases of the heart, lungs, and liver; and by continued in:qh tiring, which is especially liable to induce hemorrhoids. From the researches of Andral, it appears that in varicose veins tho coats of the dilated vessels may become thickened or may become thin; that they may be lengthened so that the veins become tortuous; and that the dilatation may be unequal, giving rise to the formation of pouches; and that. in consequence of the enlarged caliber of the vessels, the veins only act imperfectly, and gradually undergo degeneration. Varices occurring in the leg, to which our remaining observations apply, commonly give rise to deep-seated aching pain in the limb, with a sense of weight, fullness, and numbness, before there is any external appearance of the affection. In a more advanced stage, the ankles swell in the evening, and the feet are always cold. After a time, a small tumor of a bluish tint appears, which disappears on pressure, but returns on the removal of the pressure, and is caused by a dilating vein. This dilatation extends, and forms knotty, irregular tumors, soft to touch, diminishing on pressure, or on the patient's assuming a horizontal posture, and giving a bluish tint to the adjacent skin. These tumors com monly occur in the middle of the leg, along the track of the saphena veins, but they often extend along the whole of the leg and thigh. With regard to treatment, it may be meutioned that old varices cannot be cured, except by operations dangerous to life, although much may be done for their relief. In their earlier stages, they are, how ever, more amenable to treatment. As the disease is a very common one, we shall
enter somewhat in detail into the palliative treatment which any one may adopt for himself. The venous circulation of the limb should be as much possible facilitated by the disuse of garters; by keeping the limb (if the means and condition of the patient permit it) in a horizontal position for a month or six weeks; by prohibiting walking, and allowing only carriage-exercise, with the leg elevated to the horizontal position. The limb should also be carefully bandaged from the toes to.above the knee, the band age being replaced daily, and the limb then well rubbed with the hand, or will, a flesh brush, for ten minutes or more, from below upward, so as to stimulate the circulation. When the circumstances of the patient hinder this treatment, elastic stockings may be tried during the day, or ordinary bandages, with a pad of lint placed on each varicose cluster before the bandage is applied. In eases where only one or two trunks are affected, the disease may be prevented from extending by the application of pieces of wash-leather spread with soap-plaster firmly over them. At the same time, the general must be attended to. I11-nourished, feeble patients must be treated by tonics and -nourishing diet; while over-fed, plethoric patients require mild but often repeated purge thres to relieve the portal circulation. In the numerous cases in which there is a relaxed e&udition of the veins, the tincture of sesqnichloride of iron may usually, be given with advantage in half-dram doses thrice daily in half a tumbler of water, with a colocynth pill every second night, to obviate the constipating action of the iron. Among the means of effecting a radical cure, by causing coagulation of the blood in the dilated ,veins, when they shrink and contract permanently, are (1) caustic potash applied over the course of the vessel, (2) subcutaneous incision of its walls, and (3) compression of the vessel between a steel pin and a twisted suture. We believe that the cases are rate in which the pain of the varix is so great as to disqualify a patient from his ordi nary work, and these arc the only ones in which any of these operations should be ree,,mmended; "and the patient," says Mr. Callender, "if wise, will be contented with the palliative measures of a more simple character."—Hohnes's System of Surgery, vol. di., p. 021. Among the troublesome consequences of varicose veins are the obstinate ulcers, known as varicose ulcers, to which they give rise: and it must be borne in mind that oceasicnally, when the skin gets thinned by prolonged pressure, the varices burst through it, and give rise to hemorrhage, which, if not promptly stopped, may cause fainting, and even death. When such an accident occurs, the patient should at once ho placed in a horizontal position, and the leg raised, in which case the bleeding will probably If it continue, a pad of lint must be pressed upon the mouth of the bleeding vessel Iy means of a few turns of a bandage round the limb.