Varicose Veins. When a vein becomes dilated at a certain part of its course, for no apparent physiological object, such as relieving the venous circulation elsewhere (as, for example, in the case of the superficial abdominal veins enlarging in order to relieve a compressed vena cava), it is said to be varicose, the actual dilatation being called a varix (a word used in this sense by Cicero and Celsus). Some veins seem to be unaffected by varices, which, however, are of common occurrence in the sub-mucous veins of the rectum (constituting hæmorrhoids or Piles, q.v.), in the spermatic veins, giving rise to Varicocele, and in the veins of the lower extremities. They are occasionally (but very rarely) found in other veins. Certain conditions of the system favour the formation of varices, amongst which may be noticed an indolent temperament, and a debilitated condition of the general system, accompanied by a relaxed state of the walls of the veins; and possibly also a congenital predisposition or hereditary tendency. Persons with such a predisposition are more likely to suffer from this affection if their occupation is one which involves much standing or walking; and cooks, washerwomen, and foot-soldiers have been selected as specially prone to varicose veins. Varices may occur at almost any period of life, but are chiefly developed during middle age. Their formation is aided by any condition of the system which impedes the circulation, as certain diseases of the heart, lungs, and liver, and by continued high living, which is especially liable to induce hæmorrhoids. Direct pressure on the veins, e.g. by the use of garters, or by habitual constipation, is often an important factor in their production. From the researches of Andral, it appears that in varicose veins the coats of the dilated vessels may become thickened or may become thin; that they may be lengthened so that the veins become tortuous; and that the dilatation may be unequal, giving rise to the formation of pouches; and that, in consequence of the enlarged calibre of the vessels, the valves only act imperfectly, and gradually undergo degeneration.
Varicocele occurs as a tumour in the scrotum, most often on the left side, generally and aptly described as feeling under the fingers 'like a bag of worms.' It is rarely serious or painful, but often causes much anxiety and mental distress. The use of a well-fitting suspensory bandage and free bathing with cold water are generally efficient in keeping it in check; but it is often removed by operation, particularly when it prevents the patient's entrance into one of the public services.
Varices occurring in the leg, to which our remaining observations apply, commonly give rise to deep-seated aching pain in the limb, with a sense of weight, fullness, and numbness, before there is any external appearance of the affection. In a more advanced stage the ankles swell in the evening, and the feet are always cold. After a time a small tumour of a bluish tint appears, which disappears on pressure, but returns on the removal of the pressure, and is caused by a dilating vein. This dilatation extends, and forms knotty, irregular tumours, soft to the touch, diminishing on pressure or on the patient's assuming a horizontal posture, and giving a bluish tint to the adjacent skin. These tumours commonly occur in the middle of the leg, along the track of the saphena veins, but they often extend along the whole of the leg and thigh. Amongst the troublesome consequences of varicose veins are the obstinate ulcers, known as varicose ulcers, to which they give rise; and it must be borne in mind that occasionally, when the skin gets thinned by prolonged pressure, the varices burst through it, and give rise to hæmorrhage, which, if not promptly stopped, may cause fainting, and even death. When such an accident occurs the patient should at once be placed in a horizontal position, and the leg raised, in which case the bleeding will probably cease. If it continue, a pad of lint must be pressed upon the mouth of the bleeding vessel by means of a few turns of a bandage round the limb.
Treatment must in the main be palliative; pressure on the veins by garters, constipation, &c. must be removed; the general health must be attended to, liberal diet with tonics, or restricted diet with mild purgatives, being enjoined according to the patient's requirements. The weakened veins must be supported when the patient is going about by suitably regulated pressure; the application of a domett or india-rubber bandage every morning before rising is the most satisfactory method; but an elastic stocking is less trouble, and is more commonly used. The obliteration of one set of varices by operation is generally followed by the dilatation of adjacent veins. If, however, the varicose veins give rise to much discomfort, or prevent the healing of an ulcer, operation is often justifiable, and is followed by great relief. The operations employed may consist in the use of caustics, subcutaneous division of the veins, compression by ligatures or metal pins, or excision.