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Varicose

leg, veins, blood, disease, dilated, ulcers and period

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VARICOSE VEINS.—Anything that prevents or impedes the flow of the blood which is being returned to the heart causes congestion of the veins involved ; and in consequence of the yielding character of their walls, they become unduly dilated. Such dilated veins are called varicose veins, and are found especially in the scrotum (see VARICOCELE), in the rectum (see H.EMOR RnUIDS), and on the leg, involving the saphenous vein and its branches.

The most frequent cause of varicosities in the veins of the leg is long continued standing or walking, which is aggravated by wearing tight garters. Severe constipation may also be a factor. The veins gradually become tortuous, and appear like thick, bluish strands, which can be seen and felt externally (see Fig. 427). Pouch-like expansions (varices) appear in various places ; and the blood may coagulate in these knots and become hard, forming the so-called veinstones, or phleboliths.

The congestion of the blood not only retards its return to the heart, but also exerts an unfavourable influence on the nutrition of the parts involved. This may give rise to skin eruptions. Extravasations of blood into the skin cause it to assume a brownish appearance ; and dropsy may develop. Chronic ulcers, which rapidly increase in size, are also liable to be formed (see ULCER OF THE LEG ; also Fig. 427). It sometimes happens that a very much dilated vein ruptures, causing extensive hRmorrhage.

The treatment of varicose veins requires, above all, the removal of the cause. If constipation is present, it must be relieved. The affected leg should be kept at rest, propped in a horizontal position to favour the return flow of blood. If ulcers are present, they require special treatment (see ULCER OF THE LEG). To avoid, as much as possible, congestion of blood in the veins of the leg, they may be carefully bandaged, from the toes to the thighs, before rising. Rubber stockings are not well borne by some patients. Rest in bed, and an elevated position of the leg, are necessary in the treat ment of obstinate ulcers with painful varices. Operative removal of the entire dilated vein, with its branches, usually leads to a rapid cure of the ulcers, and to relief from all other disturbances.

VARIOLA (SMALLPDX).—An acute, infectious, febrile disease, accom panied by a pustular eruption. The disease—called smallpox in contradis tinction to grand-pox, or syphilis—has been known from the most ancient times. It is thought to have been introduced into Europe from Asia in 180 A.D., during the reign of Emperor Marcus Aurelius. At that period the disease was known as the " long plague." Then, as well as later, the malady desolated every place it visited, as it attacked (as it still attacks) every one who, unprotected, exposed himself to contagion. A person who has recovered from smallpox is, as a rule, immune to a second attack as long as he lives. In this respect smallpox resembles a number of other diseases, such as measles, scarlet fever, etc. In former times, the malady was known also as " infantile pox," because it was largely a disease of children, adults being usually immune, having had the disease during childhood. Beginning with the introduction of VACCINATION (which see) in 1796, and in proportion to the extent to which this preventive measure has been employed, this scourge of mankind has gradually lost most of its terrors.

The mode of infection in smallpox is unknown. Inhalation of the con tagium may be responsible. After infection, in a non-immune, a prodromic period of from to to 12 days constitutes the so-called incubation period. Then, in most cases suddenly, an extremely violent fever sets in, which lasts four days, and is accompanied by extremely severe backache and pain in the limbs, headache, vomiting and delirium ; in some cases a red eruption, resembling scarlatina, appears at this time, mostly on the abdomen. Some patients die during this period of fever, as a result of severe infection. On the third or fourth day of the active stage of the disease, the eruption appears. At first it occurs on the face, and later breaks out over the entire body, the fever subsiding at the same time.

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