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Show .62 or ANEURISMAL VARIX. or TYING 'rnn SAPHENA vent. the hole of communication with the artery, the median and cephalic veins become empty bags. The most striking peculiarity in this kind of aneurism is, that the blood which escapes from the artery finds a ready passage into the circulation, a free vent ; and, consequently, there is neither coaguluni nor very great distension of the tu- or rrlxc THE VARICOSE vnrss or THE LEG AND rnron. mour. When the trunk of the artery is compressed, and the bag of the vein emptied, the veins become full again the instant the communication from the artery is left free. When a ligature is put tight about the arm, above and below the dilated veins, the blood can be pressed into the artery again, and the artery will be found distended ; which great distension of the artery again subsides on the removal of the pressure from the tumour. In this kind of ancurism, no operation is required. It has been proposed to tie the communication betwixt the artery and vein; but that would certainly endanger the growth of a common aneurism ; for the blood no longer having a free passage, might dilate the cellular communication. Compression '» HWIR is not likely to do good, and it only remains for us to perform the usual operation, as for the simple aneurism, if any were at all necessary, which happily is not the case. The patients have not even a weakness in that arm ; and. I have never heard n .. "Yaw-‘2 -.--., ., of any bad consequence, as of hmmorrhagy, following the , - -_.~' r-"-:-- .. _-_(.,.;.7- snow 63 Tun branches of the great saphena vein in the leg, and the vein in its whole course in the thigh, are sometimes greatly distended, and irregularly hard ; the valves have lost their action, and no longer support the column of blood. This dis, ease often produces, or is complicated with, ulcers of the leg. When we consider the great frequency of ulcers-the appearance which they present-the manner in which they are affected by the erect posture, becoming evidently darker- and their frequent combination with dilated and varicose veins, we must perceive how much the debility of the vascular system is apt, in the first place, to shew itself, by the yielding of the column of the veins to the pressure of the blood. The consequence of this we perceive to be a debility and interrupted state of the action of the small vessels of the leg and foot, and a tendency to ulceration on every trivial injury. We know in general, that the supporting of a part diseased, conduces to restore a healthy action. We conceive how a ll bandage by compressing, in a certain degree, the trunks and branches of the veins, restores the agency of the valves, made useless by the dilation of the veins, to such a degree {IS-t0 prevent the valves from any longer meeting across the cavrty of the veins. "'6 perceive the correspondence between this View of the state of the circulation of the lower extremity with disease. When I say compression is not likely to do good, I am aware the practice of Mr. Baynton, in his treatment of ulcers of the of the practice of Brambila. ngS, by adhesive straps and bandage. ( Vidc Am; Acad. Vindobon. tom. 1.) In two cases, by the Graduated compress and bandage he succeeded in a cure ; in one he failed. Stiffness and wasting of the arm will be the consequence of that degree of The parts surrounding ulcers are thickened ; for when the veins are dilated, their coats and the surrounding cellular membrane become thick and firm, from being stimulated by compression continued for a length of time, which is suliicient to obliterate the dilated vein. distension, and by the pressure and weight of the blood ; and pressure relieves them both. For such ulcers with dilat- I have no doubt, however, that in some cases a slighter de- ed veins, the operation described below, has been resorted to. gree of bandaging may be necessary to support the parts, and But much more frequently I have seen patients come for relief on account of the mere painful distension of the veins in the log and thigh: a disease more frequent in womeniaa to keep a check upon the motions of the arm. yank * I imagine that straining and retention ofthe breath, is apt to d|r,it‘lld, the femoral "3i": and to destroy the effect of the higher rah" «, \Mnicn ., , M"! Ill |