VARICOSE VEINS. 



i much progrefs, the coats of the afFefted veins are not unfre- 

 ' quently thickened, fvvelled, and induiated, forming a fort 

 of half canal, or folid tube, which has been regarded as an ex- 

 I cavation made by the preiTure of the varix againft the neigh- 

 bouring bone. But the fame phenomena are equally obferv- 

 able, when varicofe veins lie at a diftance from any bone, 

 againft which it can be prefled. 



As Mr. Hodgfon remarks, " the blood occafionally depofits 

 ; ftrings of coagulum in varicofe veins : when this is the cafe, 

 I the veffel is incapable of being emptied by preflure, and is 

 firm to the touch. The depolltion does not in general fill 

 : the vefiel, but, by diminifhing its calibre, it retards the flow 

 ' of blood, and caufes the dilatation to increafe in the inferior 

 portion of the vein, and in the branches .which open into it." 

 (On the Difeafes of Arteries and Veins, p. 541.) This 

 ] gentleman has feen four cafes, in which the coagulum accu- 

 mulated to fuch an extent, that the canals of the dilated 

 veflels were obliterated, and a fpontaneous cure was the 

 ; confequence. 



The exceffive diftenfion of the coats of a fuperficial vein 

 produces an inflammatory irritation, at firft in the adjoining 

 cellular membrane, and afterwards in the integuments. 

 Thefe organs become at firft connefted together by the 

 adhefive inflammation ; and if the diftenfion continue to 

 operate, they may at length ulcerate, and burft, and 

 hemorrhage be the confequence. In fuch cafes, the efFufion 

 of blood has fometimes been very confiderable ; but, fays 

 M. Delpech, we have no example of its having proved dan- 

 gerous. The fyncope following it, or a moderate com- 

 preliion, has fufficed for its ftoppage. A more common 

 occurrence than bleeding, is the coagulation of the blood in 

 the cavity of a varicofe vein. The veffel then becomes hard 

 and incompreffible, and it lofes that elaftic yielding foftnefs, 

 which renders it capable of being diminiftied by gentle 

 preffiire. If the parts be already inflamed, Delpech con- 

 ceives, that the clot in the difeafed vein may aft as an ex- 

 traneous body, and bring on ulceration, by the efFefts of 

 which it is at laft brought into view. In this fort of cafe, 

 it is extremely uncommon for hemorrhage to occur ; for, in 

 general, the veffel has been already obliterated by the pre- 

 ceding inflammation. But the ulcer itfelf is very difficult 

 to heal, and may be kept up a long while by the oedematous 

 fwelling of the limb. Varices, or rather the oedema which 

 is the confequence of them, has the fame effeft upon every 

 other fpecies of ulcer, and even upon the moft fimple folu- 

 tion of continuity. While the fwelling of the limb cannot 

 be difperfed ; while the edges of a folution of continuity 

 are kept afunder by the tenfe ftate of the {l<in ; and while 

 the divided parts are irritated by this painful tenfion ; every 

 thing is unfavourable to cicatrization. Thus, we fee the 

 moft fimple wounds, which Iiave been allowed to fuppu- 

 rate, and ulcers, which fhould have healed rapidly, continue 

 uncured a great many years, nierelv becaufe the limbs, on 

 which they are fituated, are affefted with an cedematous 

 fwelling, the confequence of varices. Such is the condi- 

 tion of things in the cafe which has been improperly 

 named the varicofe ulcer. Delpech Traite des Maladies 

 Chir. tom. iii. feft. 8. art. 3. 



In the inveftigation of the caufes of varices, it is ufual to 

 dwell very much upon the mechanical obftruftions which 

 may afFeft the circulation of the blood in the veins. Sur- 

 geons have thought themfelves juftified in regarding this as 

 the only caufe, becaufe a circular, moderate compreflion in- 

 conteftibly retards the coorfe of the blood in thefe veffels, 

 and produces a temporary dilatation of them. The opinion 

 has feemed alfo to derive confirmation from the knotty ap- 

 pearance of varicofe veins, a circumftance which has been 

 Vol. XXXVI. 



accounted for by fuppofing, that the diftenfion is greateft in 

 the fituation of the valves. Laftly, the idea is further fup- 

 ported on the well-known faft of the frequent occurrence 

 of varices during the ftate of pregnancy. But it has not 

 been remembered, that the ufe of garters, for example, is 

 extremely common ; but varices of the legs infinitely lefs 

 frequent ; that very large varices are met with in perfons 

 who have never employed any kind of ligatures, to which 

 the origin of the complaint can be imputed ; that when 

 the dilatation of the veins extends to the thighs and pa- 

 rietes of the abdomen, no caufes of this defcription even 

 admit of fufpicion ; that varicofe veins are obfervable round 

 feveral kinds of tumours, efpecially fciiThi, when there is 

 no poffibility of pointing out any mechanical obftruftion to 

 the circulation of the blood ; that varices fometimes make 

 their appearance at the commencement of pregnancy, and 

 long before the enlargement of the womb can impede the 

 free return of the blood through the veins in the pelvis ; that 

 nothing is more unufual than a varicofe dilatation of the 

 veins of the lower extremities, in confequence of fwellings 

 of the abdominal vifcera ; and laftly, it has been forgotten 

 that the knots of the dilated veins are far too numerous to 

 admit of being afcribed to the refiftance of the valves. It 

 cannot be denied, that preffure applied in the track of the 

 veffels, tends to promote their dilatation j but it can neither 

 be confidered as the only caufe, nor as the principal one. 

 The foregoing obfervations made by Delpech, render it 

 probable, that fome unknown general caufe is concerned 

 in producing varices, the formation of which may alfo be 

 facilitated by the impediments to the free return of the 

 blood, occafioned by certain attitudes, and particular articles 

 of clothing. 



Mr. Hodgfon conceives it probable, that in fome in- 

 ftances, the valves are ruptured in confequence of mufculat 

 exertions, or external violence, in which cafes, the preffure of 

 the column of blood is the firft caufe of the dilatation of 

 the veins. Sometimes, alfo, the difeafe appears to arife from 

 preternatural weaknefs in the coats of the veins, as in thofe 

 inftances in which, without any evident caufe, it exifts in 

 various parts of the fame perfon. Treatife on the Difeafes 

 of Arteries and Veins, p. 537. 



Experience proves, fays Delpech, that there is no cer- 

 tain mode of curing varices, ftriftly fo called, which he 

 thinks cannot be wondered at, fince the nature and caufes of 

 the difeafe are completely unknown. The fame fource of 

 knowledge, however, alfo proves, that the increafe in the 

 dilatation of varicofe veins may be retarded, and that the 

 oedematous fwelling attendant on the complaint may be 

 beneficially oppofed. But thefe effefts cannot be produced 

 by refolvent, tonic, aftringent applications, nor by aperient, 

 diuretic, and purgative remedies, as fome even of the lateft 

 writers fo inconfiderately aflert ; but only by means of me- 

 thodical and permanent compreflion. When the whole of 

 a limb affcfted with varices is fubjefted to this laft mode of 

 treatment, the dilated veins fubfide, the circulation is more 

 regularly performed, and the oedema and pain ceafe. There 

 is not, fays Delpech, any better method of healing the folu- 

 tions of continuity in the foft parts produced or kept up, 

 by the varicofe ftate of the limb and its confequences. But 

 as foon as the compreflion is difcontinued, the varices make 

 their appearance again, the pain recurs, the oedema returns, 

 and the ulcers which were healed break out afrefh. Com- 

 preflion, therefore, which abfolutely required to be con- 

 ftantly employed, can be regarded only as a palliative, the 

 more ufeful indeed, inafmuch as the changes which it brings 

 about in the flate of things are nearly equivalent to a pcr- 

 feft cure. 



4 L Inflam- 



