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tongue, and fomc lofe of appetite. In tliefe cafes, the 

 treatment confifts rather in avoiding all caufes of irritation, 

 efpecially in the way of diet, than in the aftual adminiftra- 

 tion of medicines. Where the fever is more confiderable, 

 however, not only are thefe cautions neceffary, but it will 

 be proper alfo to evacuate the bowels, by gentle means, as 

 by a little rhubarb, or neutral falts, to take diluent drinks, 

 and gently diaphoretic medicines. 



VARICOCELE, in Surgery, derived from -var'tx, a di- 

 laled vein, and hbXi, a tumour, fometimes denotes a varicofe 

 enlargemeut of the veins of the fpermatic chord ; but, more 

 commonly, a fimilar difeafe of the veins of the fcrotum ; 

 the term cirficele being ufually applied to the other affeftion. 



Varicocele, or a varicofe enlargement of the veins of the 

 fcrotum, is a fubjeft of but little importance ; becaufe 

 thefe veffels are never thus affeded, except in confequence 

 of fome other more ferious difeafe of the tefticle and its 

 coats. Indeed the varicocele is to be regarded as the 

 mere effeft of another complaint, the removal of which is 

 the only neceffary indication. This having been attended to, 

 the fwelling of the fcrotal veins, which was never itfelf a 

 fource of much inconvenience, always fubfides without far- 

 ther trouble. 



Varicocele, confidered as a varicofe enlargement of the 

 fpermatic veins, is a difeafe that demands greater attention ; 

 but as it has been explained in a previous volume (fee CiR- 

 SOCEle), we do not mean to detain the reader with it in the 

 prefent place. One remark, however, appears to merit par- 

 ticular attention : a varicofe fweUing of the fpermatic veins 

 is more frequently than any other difeafe miflaken for an 

 omental hernia. Mr. Aftley Cooper has given the following 

 rule, by which the two difeafes may be diftinguifhed. Place 

 the patient in a horizontal pollure, and empty the fweUing by 

 preliure upon the fcrotum : then put the fingers firmly upon 

 the upper part of the abdominal ring, and delire the patient 

 to rife : if it be a hernia, the tumour cannot reappear as 

 long as the prefTure is continued at the ring ; but if it be a 

 cirfocele, the fwelhng returns with increafed fize, on account 

 of the return of blood into the abdomen being prevented by 

 the preffure. See Cooper on Inguinal Hernia. 



VARICOSE Veins. The term -varix is applied by 

 furgeons to the permanently dilated ftate of a vein, attended 

 with an accumulation of dark -coloured blood, the circulation 

 of which is materially retarded in the affefted veffel. When 

 veins are varicofe, they are not only dilated, but they are alfo 

 evidently elongated, prefenting a cylinder larger than natu- 

 ral, irregular, and in feveral places ftudded with knots. They 

 likewife make a variety of windings, and, coiling themfelves, 

 form aftual tumours from the auemblage of their convolu- 

 tions in one particular place. The trunk and branches of a 

 vein, thus dilated and elongated, conftitute a very di(tin£t 

 fwelling, when they are numerous, and confined to a certain 

 part of the body. Indeed, when the difeafed veflels are 

 fituated near the integuments, the furgeon can feel, and even 

 fee the outlines of their tortuous courfe. Thefe things, for 

 inftance, are remarkably obvious in the vena faphxna interna, 

 where tlie atfeftion is particularly common. This veffel may 

 be obferved to form in its courfe feveral of thele fwelHngs, 

 in the interfpaces of which it runs in a very ferpentine tor- 

 tuous manner. 



Varices are moft commonly obferved in the lower extremi- 

 ties, reaching fometimes even as far up as the abdomen. They 

 have, however, been noticed in the upper extremities, and it is 

 probable that the whole venous fyllem is fufceptible of the 

 affeClion. As a well-informed writer obferves, " the great 

 venous trunks fometimes become varicofe. When the difeafe 

 zs iituated near the heart, it is attended with pulfation, which 



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renders it liable to be miftaken for aneurifm. Morgagni ob-* 

 ferved that the jugular veins were occafionaUy very much di- 

 lated, and poflefled a pidfation. ( Letter xviii. art. 9, i o, 1 1 . ) 

 He aUb relates a cafe in which the vena azygos, for the length 

 of a fpan, was fo much dilated, that it might be compared 

 with the vena cava. The patient died fuddenly in confe- 

 quence of the rupture of this varix into the right fide of the 

 cheft. (Letter xxvi. art. 29.) A fimilar cafe is related 

 by Portal, who alfo mentions an inftance, in which the right 

 fubclavian vein was exceflively dilated, and burft into the 

 cheft. ( Cours d' Anatomic Medicale, tom. iii. pp. 354. 373. ) 

 Mr. Cline defcribed in his leftures the cafe of a woman who 

 had a large pulfating tumour in her neck, which burft, and 

 proved fatal by hemorrhage. A fac proceeded from the in- 

 ternal jugular vein ; the carotid artery was lodged in a 

 groove at the pofterior part of this fac. The veins of the 

 upper extremity very rarely become varicofe. Excepting 

 cafes of aneurifmal varix, the only inftance of this difeafe 

 with which I am acquainted is mentioned by Petit. ( Traite 

 des Maladies Chir. tom. ii. p. 49.) In this cafe a varix was 

 fituated at the bend of the arm : the patient was fo fat, 

 that no other vein could be found for the purpofe of vene- 

 feftion, which operation Petit repeatedly performed by 

 punfturing this varix. The fuperficial epigaftric veins fome- 

 times become varicofe ; but the moft frequent feats of this 

 difeafe are the venae faphenae, the fpermatic and hemorrlioidal 

 veins." (See Hodgfon's Treatife on the Difeafes of Ar- 

 teries and Veins, pp. 538, 539.) The deep -feated veins of 

 the extremities feldom become varicofe. 



The difeafe rarely occurs before the adult period of life, 

 and its progrefs is extremely fiow. It is very frequently re- 

 marked in pregnant women, who have pafted a certain age ; 

 but it is particularly unufual for it to happen in young 

 women, even during a feries of repeated pregnancies. Sur- 

 geons have not hitherto made out any very precife inform- 

 ation refpefting the places, climates, and kinds of conftitu- 

 tion which promote the occurrence of a varicofe enlarge- 

 ment of the veins. Nor has it been well proved, that the 

 difeafe often proceeds from fwellings of the abdominal vifcera, 

 or any other fpecies of tumour capable of mechanically ob- 

 ftrufting the venous circulation. One or more veins of the 

 fame limb are at firft moft commonly affefted with a flight 

 degree of dilatation, without pain, or any fenfation of un- 

 eafinefs. This beginning change ordinarily advances with 

 great flownefs, except in cafes where it accompanies preg- 

 nancy, in which circumftance one or both the lower extre- 

 mities, as early as the firft months, are frequently feen co- 

 vered with largely dilated veins, or even with tumours formed 

 by an affemblage of varices. The veins gradually become 

 more and more diftended, lengthened, coiled up, and tor- 

 tuous. The patient then begins to complain of a fenfe of 

 heavinefs, numbnefs, and fometimes of very acute wandering 

 pain through the whole of the affefted limb. In a more ad- 

 vanced ftage, in proportion as the varices increafe, and efpe- 

 cially when the dilated veins aftually form tumours, the limb 

 fwells, and becomes more or lefs oedematous, according to 

 the extent of the difeafe, and the time which it has exifted. 

 M. Delpech thinks, however, that the oedema in this cafe is 

 not fuch as to juftify the conclufion, that the increafed fize of 

 the veins, and the way in which they diftend the integu- 

 ments, produce a mechanical interruption of the funftion 

 of the abforbent fyftem. For, fays he, we meet with, 

 though not often, enormous varices, which are not attended 

 with any fwelling of tlie cellular fubftance ; and we ftiU 

 more frequently fee cafes, in which there is a confiderable 

 degree of oedema, while the varices are fcarcely remarkable^ 

 When the latter have prevailed a long while, and made 

 8 much 



