VARICOSE VEINS. 



Inflammation of the integuments covering a varix, or va- 

 ricofe tumour, cannot invariably be prevented by compref- 

 fion, nor vsrill this treatment always fucceed even in remov- 

 ing the intolerable pain which fometimes attends numerous 

 clufters of varicofe veins. In the firll; cafe, reft and re- 

 laxing applications will often fucceed ; and in the fecond, 

 the topical ufe of fedatives frequently gives relief. It has 

 been propofed to punftiire and empty varicofe veins ; but if 

 a temporary emptinefs and relaxation of thefe vefTels, which 

 are rendered painful by their diilenfion, could remove the 

 pain for a time, things would fall into the old ftate again 

 in the courfe of a few days. If it (hould appear alfo, that 

 the clotted blood had the effeft of keeping up the unfavour- 

 able fymptoms, it would be necefTary to make a very confider- 

 able opening into the dilated vein, in order that the coagulum 

 might be extrafted. In fuch a cafe, it would be ufelefs to 

 tie the veflel above and below the opening, as has been re- 

 commended : the flighted compreffion is afterwards fufli- 

 cient for the iloppage of the bleeding, and by the fubfe- 

 quent inflammation the vefTel is certain of being obliterated. 

 We learn from Celfus, that the ancients were accuftomed 

 to remove varices by excilion, or deftroy them with the 

 cautery. (De Re Medica, lib. vii. cap. 3.) When the 

 vein was much convoluted, extirpation with the knife was 

 preferred ; but in other cafes, the dilated veflel was ex- 

 pofed by an incifion, and then cauterized. Petit, Boyer, 

 and many furgeons in this country, have alfo fometimes 

 praftifed the operation of cutting out clufters of varicofe 

 veins. 



Delpech remarks, that the extirpation of tumours com- 

 pofed of numerous varices, has been praftifed either for the 

 purpofe of removing the pain in the fituation of the difeafe, 

 or other inconveniences. This operation has been fuccefs- 

 fuUy performed ; but it appears alfo not to have conftantly 

 had the effeft of preventing the formation of new varices, 

 and it has fometimes proved tedious, difBcult, and feverely 

 painful in its execution. In faft, an erroneous judgment 

 muft neceflarily be formed of the extent of thefe fvvellings, 

 when they are judged of only from the appearance which 

 they prefent under the fkin. When we attempt to operate, 

 fays Delpech, we may be led to organs which ought not to 

 be meddled with, and a long and extremely painful diflettion 

 may be found requifite. Befides, varices are not always 

 confined to the fuperficial veins, and a relapfe would be in- 

 evitable. Thefe refleftions tend to the conclufion, that 

 operations of this fort fliould never be undertaken, except 

 when the difeafe is accompanied with perilous fymptoms, or 

 nearly deprives the patient of the ufe of his limb. 



It has been thought, that one of the eftabhfhed principles 

 in the treatment of aneurifms might be advantageoufly ex- 

 tended to the cure of varicofe veins. By tying the princi- 

 pal venous trunk above the point to which the varicofe 

 affeftion reaches, it is faid that the courfe of the blood in 

 the morbid veflels may be totally ftopped ; the column of 

 this fluid contained in them made to coagulate ; and the con- 

 fequent obliteration of the veflels themfelves accompliflied. 



The pra&ice of tying veins for the cure of varices ap- 

 pears to have been employed in the days of Pare and Dionis, 

 (Cours d'Operations de Chirurgie, p. 610.) who have ac- 

 curately defcribed the operation of tying and dividing the 

 vein between the two ligatures. Sir Everard Home has 

 related many cafes of varicofe veins in the leg, fome of them 

 being accompanied with tedious ulcers, in which, after ty- 

 ing the vena faphsena major, where it paffes over the infide 

 of the knee, not only the dilatation of the veins of the leg 

 was relieved, but the ulcers were readily healed. This 

 proceeding has unqueftionably been fometimes followed 



with fuccefs ; but it has alfo had its failures. Amongft 

 other evils, an inflammation of the tied vein has been ob- 

 ferved extending very far in the veflel, and fucceeded by 

 convulfions and death. Indeed, the dangers arifing from 

 an inflammation of the internal coat of the veins are now 

 generally acknowledged, and every endeavour (hould be 

 made to avoid them. A cafe which lately happened in one 

 of the large hofpitals of this metropolis, has fully proved 

 them : we allude to the example, in which the femoral vein 

 happened to be wounded in the operation for aneurifm, and 

 had a ligature applied round the fmall aperture accidentally 

 made in it. Inflammation of its internal coat took place to 

 a confiderable extent, and the patient is fuppofed to have 

 died of the indifpolition refulting from it. 



As Mr. Brodie obferves, it feems to be now eftabhfhed 

 by the experience of modern furgeons, that a mechanical in- 

 jury inflifted on the trunk of one of the larger veins, is 

 liable to be followed by inflammation of its internal mem- 

 brane, and a fever of a very ferious nature : and the occa- 

 fional occurrence of thefe fymptoms after the ligature, or 

 even the fimple divifion of the vena faphaena, has made fur- 

 geons lefs confident than formerly, of the propriety of at- 

 tempting thefe operations for the relief of a varicofe ftate 

 of the branches of that veflel in the leg. Certain refleftions, 

 however, induced Mr. Brodie to think, that the fame ill ef- 

 fefts would not follow a fimilar operation performed on the 

 branches themfelves. " Where the whole of the veins of 

 the leg are in a ftate of morbid dilatation, and the diftrefs 

 produced by the difeafe is not referred to any particular 

 part, there feem to be no reafonable expeftations of benefit, 

 except from the uniform prefTurc of a well-apphed band- 

 age. But not unfrequently, we find an ulcer which is 

 irritable, and difiicult to heal, on account of its conneftion 

 with fome varicofe veflels ; or without being accompanied 

 by an ulcer, there is a varix in one part of the leg, pain- 

 ful and perhaps hable to bleed, while the veins in other parts 

 are nearly in a natural ftate, or at any rate are not the fource 

 of particular uneafinefs. In fome of thefe cafes, I formerly 

 applied the cauftic potafti, fo as to make a flough of the 

 llcin and veins beneath it ; but I found the relief which the 

 patient experienced from the cure of the varix, to afford 

 but an inadequate compenfation for the pain to which he 

 was fubjefted by the ufe of the cauftic, and the inconve- 

 nience arifing from the tedious healing of the ulcer, which 

 remained after the feparation of the flough. 



" In other cafes, I made an incifion with a fcalpel 

 through the varix and Ikin over it ; this deftroyed the varix 

 as completely as it was deftroyed by the cauftic, and I 

 found it to be preferable to the ufe of the cauftic, as the 

 operation occafioned lefs pain, and as, in confequence cf 

 there being no !ofs of fubftance, the wound was cicatrized 

 in a much fliorter fpace of time. I employed the operation, 

 fuch as I have defcribed it, with advantage in feveral in- 

 ftances ; but fome months ago I made an improvement in 

 the method of performing it, by which it is much fimpHfied, 

 rendered lefs formidable, not only in appearance, but alfo in 

 reality ; and followed by an equally certain, but more 

 fpeedy cure. 



" It is evident," fays Mr. Brodie, " that the extenfive 

 divifion of the Hdn over a varix, can be attended with no 

 advantage. On the contrary, there muft be a difadvantage 

 in it, as a certain time will neceflarily be required for the 

 cicatrization of the external wound. The improvement to 

 which I allude confifts in this ; the varicofe veflels are com- 

 pletely divided, while the fliin over them is preferved entire, 

 with the exception of a moderate punfture, which is necef- 

 fary for the introduftion of the inftrument with which the 



incifion 



