VEItf. 



1397 



Phlebectesis Varix. Dilatation of veins 

 is not only the commonest morbid change in 

 veins, but is the most frequent single patho- 

 logical condition that occurs in the human 

 body. 



Varix is a condition of vein which occurs 

 in every possible variety of degree, and in va- 

 rious localities, and is generally developed by 

 the superaddition of some mechanical exciting 

 cause upon a constitutional predisposition, 

 by the operation of some local physical in- 

 fluence upon veins, which, in common with 

 the other veins of the body, already possessed 

 an abnormal laxity or softness of texture that 

 favours their dilatation. 



The structure of veins, already described, 

 pre-eminently favours their dilatation: a 

 structure consisting almost solely of longitu- 

 dinal fibres, with comparatively few in a cir- 

 cular direction to brace up its calibre, pre- 

 sents little to restrain its dilatation beyond 

 the lateral adhesion of the contiguous fibrous 

 rods and their matting together by a certain 

 amount of lateral branching. The coats of 

 veins moreover are very thin, and the amount 

 of distending force applied to them often very 

 considerable. 



The anatomical relations of certain veins 

 give them, when in a state of varix, consider, 

 able peculiarities, and various distinctive ap- 

 pellations have been conferred upon such local 

 affections, varicocele^ , hcemorr/ioids, &c.: their 

 pathological identity is, however, indisputable. 



Though varicosity of the veins is, for the 

 most part, confined, in one individual, princi- 

 pally to one locality, it nevertheless appears to 

 depend upon a vice pervading the entire 

 venous system, the effects of which are more 

 particularly called out in one locality by the 

 existence of some mechanical excitant there 

 present. 1 cannot at all agree with Hasse 

 and Landouzy, " that the full development of 

 this disposition in one locality prevents its out- 

 break in another." This doctrine has, how- 

 ever, been supported by a show of argument. 

 Thus it may be truly said that haemorrhoids, 

 varicocele, and varicose subcutaneous veins 

 very seldom exist together in the same indivi- 

 dual : the concurrence of either two of them 

 is unusual, and much less frequent than their 

 solitary development ; and moreover the dif- 

 ferent forms are met with, as a rule, in different 

 classes of society : thus haemorrhoids are 

 most frequent in the affluent, varicocele in the 

 sensual, and varix of the lower extremities in 

 the labouring classes. Again, the different 

 forms appear at different periods of life, 

 varicocele about or soon after puberty; hasmor- 

 rboids and other varix usually about man- 

 hood. But all these arguments fail, when it 

 is recollected that in each of these suggested 

 instances there is some special circumstance, 

 which, acting as an excitant, superadded to a 

 previous constitutional disposition, might ac- 

 count for the particular locality in which the 

 disease makes its appearance, and the parti- 

 cular time at which it occurs. If in all these 

 instances obstruction to the circulation cannot 

 be made out, there is some cause of greater 



vascular activity, which is also seen to be 

 efficient in the production of phlebectesis. 

 Haemorrhoids are most frequent in the af- 

 fluent, because their mode of life leads to 

 greater vascular activity in the alimentary 

 canal, and to frequent portal obstruction : 

 varicocele in the sensual, from the greater 

 stress of blood upon the spermatic veins ; at 

 puberty aUo, from the same cause : the la- 

 bouring classes likewise are afflicted with 

 saphenous varix on grounds similarly expli- 

 cable. It is because there is particular em- 

 phasis laid on one particular organ in each of 

 these eases that the specific form of phlebec- 

 tesis is assumed in the separate examples. And 

 where such influences have been compound, 

 other effects have followed, combining more 

 or fewer forms of varix. It cannot therefore 

 be said that one form of phlebectesis prevents 

 another, or even diminishes the chance of its 

 formation ; the truth is, that the same indivi- 

 dual is not liable to be exposed to the exciting 

 cause of more than one form, that the pre- 

 disposing condition of the veins may be uni- 

 versal, but in one set alone is the morbid 

 change called forth.* 



Phlebectesis may conveniently be divided 

 into several forms. Andral has made the fol- 

 lowing division : 



" First species. Simple dilatation, unat- 

 tended by any other alteration, either affect- 

 ing the whole length of the vein, or existing 

 only at intervals. 



" Second species. Dilatation of the veins, 

 either uniform or at intervals, with thinning of 

 the parietes at the dilated points. 



" Third species. Uniform dilatation of the 

 veins with increased thickness of the parietes. 



" Fourth species. Dilatation of the veins at 

 intervals with thickening of the parietes at the 

 points where the dilatations exist. 



" In these two latter species, the vessel in- 

 creases in length as well as in breadth, and in 

 consequence becomes quite tortuous in its 

 course. 



" Fifth species. Dilatation of the veins, with 

 the development of septa or partitions, which 

 divide the interior of the vessel into small 

 compartments, that allow the blood to stag- 

 nate or to coagulate, &c. 



" Sixth species. Dilatation of the vein, its in- 

 terior being divided into a number of separate 

 compartments, as in the preceding species, 

 and in addition its parietes drilled by a number 

 of minute holes, which allow the blood to 

 pass from the vein into the surrounding cel- 

 lular tissue," &c. 



These include all the forms of phlebectesis 

 as far as systematic division is concerned. 



* This may be very pointedly illustrated by in- 

 stancing the two spermatic veins in varicocele re- 

 spectively. It cannot be said that varix of the left 

 prevents varix of the right spermatic vein ; for 

 both, not unfrequently, occur together. It cannot 

 be said that there is any difference in structure or 

 constitution between the two veins in the same in- 

 dividual. Then, why should the left, and the left 

 alone, be, in nine out of ten cases, affected ? Simply 

 because a strong mechanical inHuciice operate.-; on 

 one and not on the other vein. 



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