VAEICOSE VEINS. 281 



The whole length of the vein is supplied with valves, the last 

 of the series being usually just below the passage of the vein 

 through the saphenous opening. Hence it is that in some cases 

 of varicosity a fluid swelling is found in this region simulating 

 somewhat a femoral hernia. In varicosity the position of the 

 valves is frequently evidenced by the greater dilatation of the 

 vein opposite them. The pain felt is in some cases due to 

 pressure upon neighbouring filaments of the internal saphenous 

 nerve. 



The short or external saphenous vein may also be alone 

 varicose. This vessel begins on the outer side of the dorsal 

 venous arch, passes behind the external malleolus, up the outer 

 and posterior part of the calf, to pierce the deep fascia in the 

 popliteal space and empty into the popliteal vein. 



In the second variety, varicosity is not confined to the internal 

 or external saphenous, but affects almost the whole of the super- 

 ficial venous tributaries of the limb, including the radicles beneath 

 the skin. Ulceration of the skin is peculiarly liable to be 

 associated with this form of varicosity. It occurs typically in 

 the lower half of the leg, and usually close above the ankle and 

 on the inner side. This selection of position for the varicose 

 ulcer is probably due to the fact that the veins of the foot itself 

 are supported by the wearing of boots or shoes, but just above 

 the upper limit of the footgear much strain is thrown upon the 

 veins, considerable stagnation occurs, failure in the nutrition 

 of the skin results, and often precursory eczema puts in an 

 appearance. Then it has to be borne in mind that the lower 

 third of the leg is open to frequent injury, and once there is 

 abrasion of the congested skin staphylococci gain entrance and 

 play havoc with the part. 



The exquisite tenderness of some varicose ulcers is due to the 

 exposure of the fine nerve terminations by the ulceration of the 

 surrounding tissues. 



Copious haemorrhage sometimes occurs by the erosion of a 

 large vein, such as the internal saphenous, during the course of a 

 varicose ulcer. Whilst the limb is vertical the blood lost comes 



