282 CLINICAL APPLIED ANATOMY. 



from the proximal portion of the vein, that is the long tube on 

 the cardiac side, and this is owing to the fact that the valves 

 have become incompetent because of the dilatation of the vein 

 without any corresponding increase in the size of the valve 

 itself. Hence it is that elevation of the limb tends to imme- 

 diately bring about the temporary cessation of the flow of blood. 



The operative treatment of varicose veins in the lower limb 

 usually consists in the obliteration of lengths of the vein, so as to 

 force the blood to be returned by the deep veins, which have free 

 communication with the superficial. The operation of tying the 

 internal saphenous just below the saphenous opening has as it 

 were the effect of placing a competent valve high up, and of thus 

 cutting off the weight of the column of blood. 



Varicocele. Several anatomical considerations show the 

 reason why varicocele, and particularly left varicocele, is such a 

 common affection. 



The blood supply of the testicle, entering through the spermatic 

 artery, is returned by the spermatic veins. These commence by 

 a number of venous radicles in the hilum of the testis and soon 

 form the pampiniform plexus in the anterior part of the cord. 

 Passing upwards through the superficial abdominal ring they 

 unite into a smaller number of veins in the inguinal canal, 

 and entering the extra-peritoneal tissue at the site of the deep 

 ring, they join to form the two vena comites of the spermatic 

 artery. On the right side, these unite to form a single vein 

 which opens into the inferior vena cava at an acute angle, at a 

 varying distance below the entrance of the right renal vein. On the 

 left side, the two spermatic venee comites join to form a single 

 trunk which opens into the left renal vein at a right angle. 



The length of the veins implies a considerable column of blood 

 to support. Valves are either wanting or very imperfectly formed, 

 probably owing to the fact that the vessels are in reality stretched 

 veins, the testis pulling them out in its so-called descent. There 

 is little or no external support in any portion of the length of the 

 vessels. The vis a tergo is slight, owing to the great length and 

 small calibre of the spermatic artery, in comparison with the large 



