VEIN. 



1390 



little, resemble, when seen through the skin, 

 the vesiculaj 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. 



Varicoccle, or varicose dilatation of the sper- 

 matic veins is another peculiar form of plile- 

 bcctesis. 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. 

 20 



(. 



15 25 

 25&3S 



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. 



Haemorrhoids, in their relation to phlebecte- 

 sis, consist merely of dilated veins, situated in 

 the vicinity of the anus, and in which chronic 

 inflammation and thickening of the external 

 coat and surrounding areolar tissue is very 

 conspicuous. The dense covering of areolar 

 tissue, and the comparative smallness of the 

 enclosed vessel's calibre, have given rise to 

 different explanations of the pathological 

 origin of piles. 



Le Dran, Racamier, Delaroque, Cullen, 

 Chaussier, and others have considered them 

 as encysted coagula of extravasated blood. 

 Delpech and Cruveilhier describe them as 

 tumours of erectile tissue. But by far the 

 most numerous and reputed pathologists, 

 among whom may be mentioned Andral, 

 Stahl, Petit, Morgagni, Hodgson, Lobstein, 

 Froriep, and Brodie, concur in the now gene- 

 rally received doctrine of the origin of hae- 

 morrhoids in varicose veins. 



Haemorrhoids consist of ova', ovoid, or 

 round masses with broad bases, situated either 

 just within, or just without, the sphincter ani. 

 On examining the texture of these tumours, 

 they are found to consist of cells or cavities 

 of various sizes, surrounded by layers of red, 

 dense, areolar tissue. These, which vary in 

 shape, are lined internally by the smooth 

 lining membrane of the vein, and are perfor- 

 ated here and there with the apertures of 

 small communicating and tributary veins. 



The absolute continuity of these cells with 

 the venous cavity has been proved by Hasse 

 and Brodie, who have injected them from the 

 arteries ; the former has also injected them 

 by the veins. 



They are very apt to inflame and become 

 lined with lymph, or stuffed with coagula. 



Varices occur in all situations and in every 

 variety : instances are on record where they 

 have occurred in the veins of the oesopha- 

 gus, lips, eyelids, bladder, heart, &c. : indeed 

 there appears to be no region which is free 

 from the occasional development of this dis- 

 ease. 



Rupture or Perforation of Veins. -~ A number 

 of pathological examples, in which perforation 

 of the vessel's walls is the conspicuous cha- 

 racter, may be conveniently, though, it must be 

 confessed, not very naturally, classed under 

 this head. Either with or without previous 

 change, and that change very various, the 

 lesion may occur, so that the only condition 

 common to these instances of morbid change 

 is a breach in the venous cylinder. 



A rupture, without previous morbid change 

 in the vessel, and which may occur in any 

 case where the tissues of the vein are thin and 

 weak, may be produced by an unusual amount 

 of internal tension of the contained fluid. So 

 again, an attenuated or ulcerated state of vein 

 may yield btfore an amount of distension that 

 is neither excessive nor unusual : rupture is 

 the result in either case. 



Destructive disease may, as well in veins as 

 elsewhere, attack the tissues of the organs in 

 question, suppurative inflammation, ulcer- 

 ation both extrinsic and intrinsic, extension of 

 malignant disease, &c.: perforation is here 

 the issue. 



In the rupture of a previously healthy vein 

 the change consists in a rent or tear of the 

 structure, the surrounding tissues being nor- 

 mal : the rent is sharp, and more or less re- 

 gular. In perforation from ulceration, &c. the 

 aperture is rough, irregular, and jagged; the 

 parietes of the vessel are thinned down towards 

 the hole, are much thickened more remotely, 

 and the orifice is ragged and shreddy. 



Sudden or extreme obstruction to the cir- 

 culation, thus causing excessive distension, 

 has produced rupture of the healthy veins. 

 Bichat mentions instances of rupture of the 

 veins of the lower extremities during preg- 

 nancy ; Lee, those of the labia during labour. 

 Violent muscular exertion has ruptured veins, 

 by producing local congestions : Hodgson, 

 for example, has witnessed rupture of the 

 veins of the leg during cramp of the gastrocne- 

 mius ; I have three times seen rupture of a 

 vein on the dorsum of the foot during strong 

 exertion. Andral narrates an example where, 

 during a violent struggle, the vena cava in- 

 ferior was ruptured ; " the borders of the 

 perforation seemed as if they had been torn 

 asunder, and the coats of the vein in the 

 neighbourhood were perfectly healthy." The 

 peculiar bloodlessness of the surface, and con- 

 sequent deep-seated congestion which occurs 

 during rigors or the sudden application of cold 



4; u 1 



