aq REGIONS OF THE LEG. 
Se agen veins are without this important 
p- Their sides are supported, on one hand, 
by the yielding layer of the fascia and muscles, 
and, on the other, by the integument. When, 
_ therefore, any impediment presents itself to 
the free transmission of the blood through the 
femoral, popliteal, or iliac veins, or even by 
the mere weight of the ascending column of 
lood, in persons who stand much, it is the 
uperficial veins that suffer most, and a perma- 
“nently dilated state is the frequent result. 
__ The pathology of varicose veins has not re- 
‘ceived the attention which it deserves, and 
hence the conflicting opinions as to the precise 
‘nature of their origin; we must even now con- 
ss with Delpech that the nature and causes 
the disease are unknown. It is quite clear 
at that state of disease of the veins commonly 
ermed varicose comprehends more than one 
lathological condition, and probably has more 
than one mode of origin. Every instance of 
an enlarged vein cannot be considered as a 
varix, unless we confound under the same 
denomination a condition of the vessel natural 
and healthy except in regard to its size, neither 
originating nor terminating in a morbid condi- 
on, with every variety and degree of disease 
iecompanied with enlarged capacity of the vein. 
We have seen the veins of the abdomen en- 
arged so as to fulfil the office of the vena cava 
‘inferior, which was obliterated. But there was 
ot the slightest mark of disease in these super- 
tial vessels. The uterine veins, also, in preg- 
ancy become enlarged in a similar manner, 
hus answering to the call for the increased 
reulation of blood in the uterus. This state 
the vessels has been aptly termed hyper- 
tophy, and the term varix has been restricted 
© permanently dilated states of the veins, at- 
nded with the accumulation of dark blood, 
hich more or less generally becomes coagu- 
ed and adherent to the parietes of the vessels. 
this latter species Andral enumerates six 
rieties: ist, simple dilatation without any 
change, such dilatation affecting either 
whole length, or occurring at intervals ; 
d, dilatation, either uniform or at intervals, 
th a thinned state of the veins at the dilated 
ints; 3d, uniform dilatation with thickening 
Of the venous coats; 4th, dilatation at inter- 
vals with thickening of the dilated points ; 5th, 
dilatation, with the addition of septa within the 
vein, whereby the cavity is divided into little 
cells in which the blood lodges and coagulates ; 
6th, a similar disposition combined with per- 
forations in the parietes of the veins, which 
communicate with the surrounding cellular 
issue in a more or less diseased state by nume- 
small apertures. From repeated observa- 
of its practical importance we should be 
ned to add to this list one other variety, 
via when the varicose state had extended into, 
r existed distinctly in, the capillaries of the 
We believe that in those troublesome 
ilcers known as varicose we shall frequently, 
f not generally, find this state of the minuter 
eins and capillaries, and we are more inclined 
© attribute the pain and the obstinate character 
f these ulcers to the pathological condition now 
“VOL, III. 
: i 
pi 
, he 
- 
a. 
neli 
KIN, 
129 
mentioned than to the mere vicinity of an en- 
larged vein as it passes through the superficial 
fascia. The causes of the diseased state in 
question have been variously stated, nor do 
Opinions yet agree upon it, some attributing it 
to mechanical influence, and others supposing 
a morbid tendency. Both these causes pro- 
bably act in different instances, or even co- 
operate in the same case; we shall now only 
“mention in illustration of the effect produce- 
able by the mechanical influence of too much 
standing, that it is not necessary to suppose 
that the valves are either destroyed or even 
materially injured in structure to nullify their 
agency in supporting the column of blood 
above them, since ever so small a communi- 
cation between the two columns, the upper 
and the under, is sufficiept to destroy all the 
beneficial agency of the salves as supporters of 
the gravitating fluid in the veins. ‘Therefore © 
a dilatation of the vein merely enough to draw 
the opposed edges of the’ valve ever so little 
apart, or even a thickening of the valves pre- 
venting the accurate coaptation of their edges, 
will be sufficient to prevent their power of 
support to the superincumbent column, and 
as far through the vein as this defective state 
of the valves may exist, so far will the gravi- 
tating column of blood be virtually unbroken 
and entire, and in the same proportion will the 
tendency to the varicose state be increased. 
This reasoning will explain many, probably 
the majority of cases where the eabid dila- 
tation having once begun goes on to increase 
rapidly by the continued operation of this ex- 
citing cause. That there are other causes 
capable of producing this state of the veins 
cannot be disputed ; indeed the occurrence of 
it in parts not likely to be affected by the up- 
right position, and even in several different 
parts of the body of the same subject, shews 
that there is occasionally a morbid tendency in 
the venous system to this particular state, 
which acts independently of any mechanical 
cause; but we believe that this predisposing 
cause is not necessary to the production of the 
disease, and that the morbid tendency, when it 
is met with, should be regarded rather as the 
exception than as the rule. 
In considering the causes of the disease in 
question, we should not lose sight of the rela- 
tive proportion of the deep and superficial 
venous circulations of the lower extremities, a 
preperrien varying in. almost every individual. 
n one, the superficial veins are large and nu- 
merous, and lie immediately under the skin; 
in another, they are few and small. Tt is ob- 
vious, that in the first case the blood retained 
by this route bears a large proportion to that 
passing through the deep set, much larger than 
it would in the latter case. In the first in- 
stance, therefore, these vessels will have a 
greater proportional weight of blood to sustain 
and transmit, than in the second ; while, in 
those individuals who have the superficial cir- 
culation small, the blood is chiefly returned by 
the deep set, which, from circumstances before 
mentioned, are more equal to the task, and in 
such persons the diseased state in question 
K 
