408 SURGICAL APPLIED A NATO My. rchap. XKII. 



sharp |,in in the calf during exertion, to which the 

 French give the name " coup de fouet." 



Vessels. The large arteries of the leg, being all 

 in near proximity with the bones, are apt to be injured 

 by sharp fragments in fractures of the limb. This 

 especially applies to the peroneal artery, which rims 

 along the fibula, and is in considerable risk of being 

 wounded in fractures about the middle of that bone. 

 It is at the point of bifuraction of the popliteal artery 

 that emboli are peculiarly apt to lodge. They plug 

 the vessel and practically block the three main arteries 

 of the leg. Gangrene, therefore, not infrequently 

 follows the occurrence. Billroth states that in all the 

 eases of gangrene of the leg due to embolism that he 

 has met with, the plug was found situated at the 

 bifuraction of the popliteal trunk (" Clinical Surgery," 

 1881). According to some French surgeons, aneurism 

 of the commencement of the posterior tibial artery 

 is more often associated with gangrene of the leg than 

 is a popliteal aneurism. The reason they assign is 

 the following : The aneurism on the former vessel 

 not only interferes with the passage of the blood into 

 the posterior tibial and peroneal arteries, but also 

 compresses the anterior tibial vessel and with it the 

 anterior tibial recurrent, an artery that is of so great 

 importance in establishing the collateral circulation. 



Varicose veins are more commonly met with in 

 the leg than in any other part of the body, save, per- 

 haps, in the hsemorrhoidal and spermatic veins. This 

 depends upon the great length of the veins of the lower 

 limb, the large columns of blood their valves have to 

 support, their vertical position, the liability of the 

 great trunks (iliac), into which they ultimately enter, 

 to be compressed, and upon the fact that the superficial 

 veins, being outside the fascia, lose that assistance to 

 the circulation derived from muscular contraction. The 

 use of garters especially affects the long saphenous vein, 



