That which is particularly termed a Variz is either a mass of dilated and tortuous veins, or a single saccular and circumscribed dilatation of a vein, analogous to the circumscribed aneurism of an artery. This circumscribed dilatation is a very rare disease, but in its consequences does not differ from ordinary dilatation. An aneurismal varix is pro duced when, a communication being made, either by a wound or by ulceration, between an artery and a vein, the latter is dilated by the force of the arterial blood into a circumscribed sac. [AisEunissi.] The most serious disease to which the veins are subject is acute inflammation, or phlebitis. It sometimes occurs after the slight wound made in ordinary bleeding; it is more common after operations upon varicose veins; and yet more frequently occurs after amputations, of the limbs. Slight cases of phlebitis not unfrequently come on, as if spontaneously, or after exposure to cold, in varicose veins. The dilated veins become hard, like knotted cords beneath the skin, and very painful; the skin around them inflames, and the parts below become oedematous; and sometimes a slight erysipelas spreads over the limb. Such affections are usually uf little moment ; leeches, rest, and external cold are sufficient to subdue the inflammation, and it often has the favourable result of obliterating the veins, and thus curing the disease by which they were previously affected.
The more severe phlebitis is a most dangerous disease. Lymph is effused into the cavity of the 'vein, and into the tissue of Its walls, rendering them thick and hard ; the vein and the tissues immediately around it become exquisitely tender, and the parts whose blood should be returned through the diseased vein are usually oedematous. In a further stage pus is effused into the cavity of the vein, and, mixing with the blood, it may pass into the general current of the circulation, though more commonly the vein is obliterated above the chiefly inflamed part by lymph deposited on its walls, and thus the passage of pus into the circulation is prevented. With the local inflammation of phlebitis a state of low typhoid fever, with muttering delirium and great exhaustion, is usually combined ; and under these the patient dies.
In connection with suppurative phlebitis a condition often occurs to which the name of purulent diathesis has been given. Its chief characteristic is, that collections of matter form coincidently in many different parts of the body, most frequently in the joints, lungs, and liver, accompanied by a kind of fever similar to that which attends phlebitis. It has been thought that this state depends on pus formed
in an inflamed vein being carried into the circulation, and deposited again in some remote part; or that there is a kind of metastasis of suppuration from the vein to the parts secondarily affected. But cases occasionally happen in which all the signs of the purulent diathesis are well marked, although no vein is diseased ; so that there is no necessary connection between the disease and phlebitis, although in the tendency to suppuration the veins generally take a prominent place The most probable explanation of the disease is, that some morbid matter, such as is formed in the decomposition of the discharge from sores or wounds, is introduced into the blood, whose chemical composition it impairs, engendering a state in which pus is apt to be formed, and in which, as in typhoid fever, every function is seriously disordered.
The treatment of these cases of acute phlebitis and purulent diathesis cannot be laid down in general terms. Very commonly the former requires the coincident employment of large local bleedings, and of medicines and regimen calculated to maintain the patient's strength. The due observance of the indications for one or both of these pro ceedings affords the only prospect of success ; but must frequently the best directed means are ineffectual.
One of the most fatal forms of phlebitis is that which affects the veins of the uterus and the neighbouring parts after labour, and which chiefly constitutes one of the diseases included under the name of puerperal fever. Phlegmatite dolma, or phlegmasia alba, is due to phlebitis of a less severe kind affecting the iliac or femoral vein, or both, and many others adjacent to them. By obliterating the venous trunks, and preventing the circulation through them, the disease gives rise to the firm oedema, accompanied by the tightness and glossy paleness of the skin of the leg and thigh, which peculiarly indicate it. It occurs sometimes, but rarely, after exposure to cold : its usual origin is in a comparatively slight Inflammation of the veins of the pelvis of women during pregnancy, or after delivery, which extends from them to the veins of the lower extremity. lt is attended by the same tender ness and hardness of the diseased veins as exist in other cases of phlebitis ; and in its treatment, as in theirs, the general state of the patient's health, and the degree and extent of the local affection, considered together, must determine the measures to be adopted.