THE LAWS OF HEALTH. 199 



following are examples : Varicose ulcers from dress ; skin-diseases 

 from want of cleanliness ; chest-diseases and fevers from defective 

 ventilation. The vast number of ulcerated legs treated in the out- 

 patient department of hospitals, in workhouse infirmaries, and in 

 private practice, arise from varicose veins. Now, a varicose ulcer is 

 caused by a distended condition of the veins of the leg, which have 

 to sustain the pressure of the blood caused by gravitation. In vari- 

 cose veins, the valves which help to support the column of blood are 

 to a great extent destroyed, through the veins having been distended 

 by mechanical obstruction to the free return of the blood from the 

 extremities, thereby distending the lower 'veins and separating the 

 edges of the valves. Thus, the weight of an uninterrupted column 

 has to be borne by the veins. This, of course, causes further disten- 

 tion, giving rise to congestion of the capillaries of the skin, and caus- 

 ing swelling, eczema, and ultimately ulceration. This is the varicose 

 ulcer so common in the laboring-classes. It is always difficult to heal, 

 and often impossible, except by prolonged rest in bed. Hence it is 

 the dread of the surgeon, and the cause of misery to thousands. Vari- 

 cose ulcers are seldom admitted into general hospitals, so that hun- 

 dreds of poor families are driven to the workhouse, and such cases form 

 a majority in the workhouse infirmary. The most frequent and fla- 

 grant cause of obstruction is the ordinary elastic garter. Children 

 should never wear them at all, as the stockings can be perfectly well 

 kept up by attachment of elastic straps to the waistband. If garters 

 are worn, it is important to know how to apply them with the least 

 risk of harm ; at the bend of the knee the superficial veins of the leg 

 unite, and go deeply into the under part of the thigh beneath the 

 ham-string tendons. Thus a ligature below the knee obstructs all 

 the superficial veins, but if the constriction is above, the ham-string 

 tendons keep the pressure oft' the veins which return the blood from 

 the legs ; unfortunately, most people, in ignorance of the above facts, 

 apply the garter below the knee. Again, in nine out of ten laboring- 

 men, we find a piece of cord or a buckled strap tightly applied below 

 the knee, for what reason I could never learn. Elastic bands are the 

 most injurious. They follow the movements of the muscles, and never 

 relax their pressure on the veins. Non-elastic bands during muscular 

 exertion become considerably relaxed at intervals, and allow a freer 

 circulation of the blood. 



2. The habit of tight lacing again predisposes to varicose veins, 

 in consequence of the abdominal viscera being pushed downward into 

 the pelvis, causing undue pressure on the veins of the lower extremi- 

 ties when they enter the pelvis. Physicians also have reported nu- 

 merous cases of heart and lung disease caused by this pernicious habit. 



3. The use of dress is often misunderstood. Most persons evidently 

 study and practise it with regard to appearance, or only to keep out 

 wet and cold. The hygienic use of clothes, however, is not so much 



