MEMORIAL FUND TO SIR DAWSON WILLIAMS.

1189 her transference to the L1.B. Hospital on June 2nd. Dr. A. Randle and Dr. C. Marian have kindly supplied clinical histories of these two cases, embodying a number of interesting features, which we hope to A Series of Special Articles, contributed by invitation, publish next week. A case of typhus notified in the on the Treatment of Medical and Surgical Conditions. we learn of Herne district frcm urban Bay was, Dr. A. M. Watts, that of a patient residing in a neighbouring rural district. There is, he adds, some CCLXXIX.-THE AMBULATORY TREATMENT doubt as to the diagnosis, although the clinical OF VARICOSE VEINS. condition justified the notification. 1.* GENERAL CONSIDERATIONS AND TECHNIQUE. A Small Epidemic of Typhoid at Bcrth.-As will havee THE results obtained in the treatment of varicose been seen from our sunnnarv of the Weeklv Returns veins by means of injections show this method to have a number of cases of typhoid fever have been notified from Somerset during April and May. Twenty-six of a permanent place as a therapeutic measure. Many these cases have occurred in an outlying part of the different substances are in current use as intravenous city of Bath, known as Bathwick. situate too high sclerosing agents, but the object of all of these is the on the hillside to be reached by the ordinary waterproduction of a phlebitis in the vein wall. This supply of the city. It is now regarded as probable phlebitis is primarily either physical or chemical, that the outbreak has been due to the pollution by depending upon the agent employed. A gradual thrombosis of the vein occurs ; this is followed by a faulty drain of the highest of three water tanks on the hillside, as there has been no evidence of organisation and eventually fibrosis of the thrombus, further infection since this drain has been put right. leaving a thin fibrous cord in place of a dilated and The last case, notified on June 4th, was that of a tortuous vein. The treatment is throughout ambulatory and need in no way interfere with the patient’s patient who had been under suspicion for ten days, work Considerable discussion has or recreations. and we understand that Dr. J. F. Blackett, the medical officer of health, regards the epidemic as recently centred around questions of technique, nature and amount of the substance over. Unfortunately, two of the cases have proved notably the injected, the posture of the patient, and the use of a fatal. tourniquet. The method is not yet old enough to have become stabilised in detail; but the technique set MEMORIAL FUND TO SIR DAWSON WILLIAMS. out below has proved convenient and easily workable. With the exception of patients in whom contraindications exist, the method is applicable to all SINCE the first list was published in these pages cases of varicose veins, even in old patients or in the subscriptions have been received from the following. presence of complications such as dermatitis or ulceration. LIST OF SUBSCRIBERS. .—Dr. Peter Abercrombie ; Dr. Theodore Dyke Acland; The Circulation in T7aricose Veins.

Modern Technique in Treatment.

______________

Dr. C. J. H. Aitkin (Kilnhurst) ; Dr. A. Gunn Auld. B.-Dr. Bernard Batt (Bury St. Edmunds); Dr. A. T. Bazin (Montreal) ;Major-Gen. Sir Alfred Blenkinsop (Frensham); Mr. C. J. Bond, F.R.C.S. (Leicester). C.-Dr. J. N. Cameron (Toronto); Dr. Wayland C. Chaffey (Hove) ; Dr. David Clow (Cheltenham) ; Dr. Alice Sanderson Clow; Dr. T. T. Cockill (Milford); Sir W. Collins, F.R.C.S.; Dr. Sidney Coupland (Oxford) ; Lt.-Col. D. G. Crawford, I.M.S. (Ealing); Prof. J. R. Currie (Glasgow); Mr. H. Morriston Davies, F.R.C.S. (Ruthin) : Dr. W. F. Dearden (Old Trafford) ; Dr. Henry Devine (Virginia Water). E.-Col. R. H. Elliott, F.R.C.S. F.-Dr. Thomas Fawsitt (Oldham) ; I-1. N. Fletcher, F.R.C.S. ; Dr. Louise Fraser (San Remo, Italy); Prof. Andrew Fullerton, F.R.C.S. (Belfast). G.-Dr. R,. P. Garrow (Chesterfield) ; Dr. R. A. Gibbons ; Dr. F. W. Goodbody ; Dr. T. A. Goodfellow (Manchester) ; Mr. Gordon Gordon-Taylor, F.R.C.S. ; Dr. W. Gosse (Parkstone) ; Dr. A. E. Gow; Mr. A. M. H. Gray, F.R.C.S. H.—Mr. C. D. Hamilton, M.R.C.S. (Athens); Dr. C. B. Heald; Dr. W. E. Hempson(Tunbridge) ; Mr. E. E. Hughes, F.R.C.S. (Manchester) ; Dr. W. Hunter. J.-Dr. A. J. Jex-Blake (Nairobi). K.-Prof. Mary F. Lucas Keene ; Dr. Lawrence gilroe (Rochdale) ; Dr. V. Ridman King (Swindon). L.-Dr. E. E. Laslett (Hull) ; Dr. R. D. Lawrence ; Dr. T. W. P. Lawrence (Tadworth) ; Dr. A. A. Lendon (Adelaide); Sir John Lynn-Thomas, F.R.C.S. (Llechryd). M.—Lt.-Colonel R. and Mrs. McCarrison, (Coonoor, India); Dr. S. Morton Mackenzie (Dorking); Dr. Elizabeth MeVail; Sir Philip Magnus, Bt. (Chilworth) ; Lady Mott (Bournemouth). N.-Mr. H. W. Nott, M.R.C.S. (Guildford). O.—Dr. Joseph O’Connor (Woking); Lt.-Col. F. O’Kinealy; Mr. Robert Ollerenshaw, F.R.C.S. (Manchester). P.-Dr. George Parker (Clifton) ; Mr. Norman Patterson,

F.R.C.S.

R.—Mr. H. H. Rayner, F.R.C.S. (Manchester); Mrs. Sophia M.D. (Cheltenham). S.-Dr. D. W. Samways (Mentone) ; Dr. S. Gilbert Scott; Dr. W. W. Shrubshall (Brighton). T.-Dr. Edward Thompson (Omagh). W.—Dr. Chalmers Watson (Drem, East Lothian) ; Dr. W. Watkins-Pitchford (Bridgnorth); Dr. G. N. Wauchope (Hove) ; Dr. J. W. Weir (E. London, S. Africa). Incorrectly entered in previous list.-Afr. Eric Watson-Williams, F.R.C.S., should read Dr. Patrick Watson-Williams.

Richardson,

Those who may have overlooked the matter

are

invited to send their subscription before Saturday, June 16th, when the list must be definitely closed.

The organising committee will then draw up recommendations for the disposal of the fund, and all subscribers will shortly afterwards be requested to attend a meeting to consider them. The hon. treasurer is Sir StClair Thomson, 64,

W. 1.

Wimpole-street,

A considerable body of evidence both clinical and goes to show that there is marked of the venous circulation in varicose conditions. On the whole, this evidence suggests that in patients with severe varicosity of the internal saphenous vein and in whom the Trendelenburg sign is positive, the blood flow in this vein is directed away from the heart when the patient is in the posture, but if the limb be raised to 45° or higher the flow is either stationary or sluggishly towards the heart.

experimental abnormality

upright

Experimentally, this has been shown by the use of the hæmadromometer and by radiographic studies. That there is similarly a reversal of the blood flow in the skin capillaries of the leg under these conditions has been shown by Magnus using the skin microscope. In severe varicose states, therefore, the blood coming from the deeper parts of the limbs passes upwards in the femoral vein, reaches the level of the saphenous opening, and a certain amount of it passes into the internal saphenous vein and travels distally along this. From the lower part of the saphenous vein area the blood returns to the deeper system either by way of anastomotic veins, or after having passed through the capillary bed once more, in a reverse direction. Under these conditions certain areas of skin will be supplied with blood which has already once circulated through the capillary bed. These factors of the venous circulation are of fundamental importance in the development of varicose dermatitis and ulceration, in their chronicity and their resistance to purely local treatment. This theory of the venous circulation is supported by clinical observation of the conditions under which varicose ulcers may be cured. Healing may be attained by adequate rest, by bandaging the affected limb to secure competent valve action of the veins, by surgical extirpation of the diseased veins, or by All of these methods their intravenous thrombosis. lead to the breaking of the vicious circle which permits of venous stagnation and capillary reversal. * Part II., dealing with Reactions, Complications, and Results, will appear in our next issue.