1398 



VEIN. 



The first species simply includes a general 

 predominance of the venous system, a dis- 

 proportionate size of the veins. It is of very 

 frequent occurrence, and is indicated by a 

 plethora or distinctness of the veins of the 

 subcutaneous system. This is often seen in 

 the veins of the back of the hand. It is not 

 to be considered strictly morbid, it is in 

 many individuals an original conformation, 

 and in others merely temporary, the result 

 of warmth, strong exercise, pressure on a 

 venous trunk, &c. It is common, nay gene- 

 ral, in old people, though the healthiest. It 

 may be here observed that the capacity of 

 veins, as well as that of arteries, increases 

 with age. 



The second species represents a condition 

 unquestionably morbid. It consists in a dila- 

 tation of the vein at the expense of its walls, 

 they becoming attenuated in proportion to the 

 increase of the vessel's calibre. This appears 

 to consist essential!}' in a separating of the 

 longitudinal fibres of the outer coat, by which 

 the internal membrane is permitted to dilate 

 or protrude. The dilatation is seldom cy- 

 lindrical, it is usually unequal and in pouches. 

 These pouches are usually more or less globular 

 or oval ; sometimes, however, they are con- 

 stricted, or form pear-shaped, or even pedun- 

 culated, tumours. 



The third and fourth species of Andrei's 

 division are modifications of the same condi- 

 tion, and seem to be in many cases the direct 

 but gradual result of the first. Whether the 

 dilatation be general and equable, or partial 

 and irregular, the thickening is confined to 

 the dilated portion, and is doubtless a re- 

 parative condition, an effort to resist by 

 increased strength of the vessel's walls 

 any further stretching ; and it may be ob- 

 served that in this thickened form of phlebec- 

 tesis, those large, pouch}', and tumour-like, 

 dilatations do not occur. In these forms the 

 dilatation is more regular and cylindrical, or 

 increasing somewhat evenly in passing from 

 one part of the vein to another. In almost all 

 these cases there is increased length, some- 

 times very considerable, so as to make the 

 vein assume a serpentine or tortuous course; 

 in some instances the vein remains perfectly 

 straight. The increased thickness arises from 

 the superaddition of fibrous tissue in the ex* 

 ternal coat, probably developed from a sub- 

 inflammatory plastic exudation among the 

 normal tissue of the outer coat, itself an effect 

 of the stretching, in the dilatation of the vein. 

 The amount of thickening varies in different 

 cases : in those fully formed it is often very 

 considerable. The increased thickness of the 

 vessel's walls prevents it from collapsing when 

 cut through : it remains patent like an artery. 

 The colour of its tissue differs, however, from 

 the arterial; it is reddish white; and pale, like 

 the normal venous tissue. Besides thickening 

 of the coats of the veins, they become inde- 

 finite and very hard ; the outer coat becomes 

 completely blended with the areolar tissue of 

 the sheath of the vessels ; by this means the 

 walls, which are often thicker than those of 



an artery of the same size, are with difficulty 

 pressed together. 



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 phlebectesis in general, 

 I may conveniently devote some remarks to a 

 few of the special forms of varix. 



Varices 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 lata that forms the sapheuous 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; whereas 

 in the female, the smaller cutaneous twigs are 

 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, or 

 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 



