As regards the fifth species, I agree with Hasse, that it more deserves to be considered as a mere variety of the others than as itself distinct. Tke septa are probably not new formations.
The sixth species, whilst it evidently refers to a particular form of venous dilatation, is obviously misdescribed • the minute holes "drilled in the sides of the veins" in this spe cies being in reality nothing more than the mouths of small and dilated veins, whose di lated and attenuated walls are not easily re cognised, and thus the blood is thought to. escape into the cellular tissue.
To these may be added certain varieties of erectile tumour, which consists essentially•of modified capillaries, but on which the venous character is conspicuously impressed. In these cases there are oval or spheroidal tumours of a bluish or purple colour. They are composed of dilated capillary veins, which are supplied by enlarged arteries. The veins are stretched into saccules and crypts, and the blood is re moved from them in veins disproportioned to the size of the affected part, and often them selves varicose.
Having considered phlebeetesis in general, I may conveniently devote some remarks to a few of the special forms of varix.
Variees of the Leg. — Varices of the lower extremity usually occur after the commence ment of adult life. They are generally the result of habitual toil in the erect posture; they result also from obstruction to the cir culation ; and a not unfrequent source of ob struction has of late been displayed in the fascia luta that forms the saphenous opening. Briquet has shown that this affection is more common amongst males than females. In 258 males examined by him 71 had varix of the, leg ; in 485 females, 42 were affected.
There is another distinction in the disease as it appears in the two sexes ; in man one trunk is usually affected, or, at all events, the disease is confined to vessels of larger size; in the female, the smaller cutaneous twigs generally the subject of the disease, and then • present an elaborate series of purple ramifica tions, very superficial and distinct ; and often associated with the latter are circumscribed local varices of greater size. This is the ge
neral rule, but it is liable to exceptions ; each form may occur in either sex, but the latter is almost always confined to the female. This circumstance was, I believe, first pointed out by Hasse.
It is unusual for all the veins of the leg to become varicose ; it is usually confined to one branch of the internal saphena : the external saphena may however likewise be affected, several branches of each. It is uncommon for them to be affected symmetrically ; the right leg, according to Briquet, is most generally the subject of varix.
Varices of the leg are arranged in various forms : in some cases they consist of packets of folded and reduplicated tubes, which, not a, little, resemble, when seen through the skin, the vesicular seminales ; in other examples the varix is single, straight and prolonged. A re markable instance of this occurred under the observation of the author not long since ; it consisted in a varicose condition of the in ternal saphena on one side alone: the vessel formed one large, straight, uniform cylinder from the saphenous opening to the inside of the foot, measuring about two thirds of an inch in diameter.
Phlebitis often occurs in varix of the leg. The valves moreover are subject to peculiar malposition, dependent upon the distension of the vessel's tube : these conditions are no ticed elsewhere.
Varicocele, or varicose dilatation of the sper matic veins is another peculiar form of phle bectesis. In its general anatomy it differs in no respect from the other forms of varix.
Varicocele appears to be dependent upon sexual development, and occurs principally about puberty. Landouzy has demonstrated this as follows : 13 occurred between 9 & 15 yrs. of age. In 41 15 & 25 „ 3 f f 23 & „The influence of mechanical pressure in• causing this malady is very strikingly shown by the fact that the disease is almost confined to the left side, on account of the long and uninterrupted current of blood which bears upon the left vein, by means of the high juncture of the spermatic vein of that side with the renal vein. Breschet found in 120 cases but one on the right side.