VARICOSE VEINS. When a vein be comes dilated at a certain part of its course, for no apparent physiological object, such as relieving the venous cir culation elsewhere (as, for example, in the case of the superficial abdominal veins enlarging in order to relieve a com pressed vena cava), it is said to be vari cose, 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, how ever, are of common occurrence in the sub-mucous veins of the rectum (consti tuting hemorrhoids or often piles), in the spermatic veins, giving rise to vari cocele, and in the veins of the lower ex tremities. They are occasionally (but very rarely) found in other veins. Cer tain conditions of the system favor the formation of varices, among which may be noticed an indolent temperament, and a debilitated condition of the general system, accompanied by a relaxed state of the walls of the veins; and possibly also a congenital predisposition or her editary tendency. Persons with such a disposition are more likely to suffer from this affection if their occupation is one which involves much standing or walking; and cooks, washerwomen, and foot-soldiers have been selected as speci ally 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 high living, which is especially liable to induce hemorrhoids. Direct pressure on the veins, e. g., by the use of garters, or by habitual constipation, is often an important factor in their production. From the researches of Andrei, it ap pears that in varicose veins the coats of the dilated vessels may become thickened or may become thin; that they be length ened so that the veins become tortuous; and that the dilation may be unequal, giving rise to the formation of pouches; and that, in consequence of the enlarged caliber of the vessels, the valves only act imperfectly, and gradually undergo degeneration.