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THE INJECTION TREATMENT OF VARICOSE VEINS.
467 - ---
THE INJECTION TREATMENT OF VARICOSE VEINS.
of THE LANCET. out of sympathy with the altogether SIR,—Though To the Editor
injection method of treatment of varicose veins, I have been content hitheito to remain silent on the subject, on p. 408 of your last to do more than merely register a silent dissent from the conclusion there advanced. In this annotation it is assumed that the case for the injection treatment is now proved beyond question, and the reader is left to infer that this point of view is now generally accepted. I quote from the article :-
but in view of the annotation issue I feel
impelled
This treatment is so simple, so effective, that it has ousted almost completely the treatment by operation. On the whole, it can be said that the injection methods now generally adopted are suitable for routine use. The risk is less than operation and the results are better.
But apart altogether from actual fatalities, it is certain that there have been many more failures of cure than are generally admitted, even as there have been very many more cases of sloughing of the skin over the injected veins than the writers on the subject I have myself seen seem to be prepared to confess to. a number of these, and the resultant ulcers are nasty enough, and difficult enough to get to heal. Further, in more than one of these cases which I have seen the injection treatment had been carried out upon veins that called for no such active procedure at all. This supports the view, which I stated earlier, that the numbers of cases submitted to injection have been artificially swollen ; that many quite young girls, who might happen to have an odd superficial vein, causing no trouble whatever, but perhaps showing as a bluish streak through the diaphanous silk of the modern female hose, have been able to induce someone to try to remove the offending streak by the medium of injection. Indeed, my suspicion in this direction is more than a suspicion ; it is a definite conviction. I have several times been asked myself to do the deed -and have refused. In all probability someone more complaisant came to the rescue. For these and other reasons, therefore, I wish to make it clear that there are still those-and I am one of them—who regard the injection treatment of varicose veins as an unscientific procedure, and therefore unsurgical-certainly not free from risk. It may not be out of place here to say that the same arguments as I have advanced above against the injection of varicose veins-and other arguments perhaps even more potent-I would put forward in respect of the injection treatment of hæmorrhoids. I am, Sir, yours faithfully, ARCHIBALD YOUNG. The University, Glasgow, Feb. 25th, 1929.
This is a general statement that should hardly be made without a simultaneous presentation of the proofs upon which it is based. As one who not merely does not believe in the injection method, but, indeed, profoundly disbelieves in it, may I say that I am prepared to accept only one part of the statement-namely, that the treatment is simple. To my mind its simplicity is one of its chief drawbacks, in that it tempts the inefficient and perhaps the less scrupulous members of the profession to carry it out too often without any, or sufficient, justification. I do not admit as proved that the method is as effective as operation in cases that really require treatment. I am not concerned with the other cases that have so enormously swelled the statistics of recent years, cases many of them that required no active treatment. Nor am I prepared to admit that it has yet been decided whether the risk of injection or of operation is the greater. I am not desirous of initiating a correspondence on OSTOCOPOS. the subject, nor am I inclined to take part in any To the Editor of THE LANCET. correspondence that may emerge, but in view of your SIR,—There is a curious word which is found in article, and the assumption therein that the matter has been settled now beyond dispute, I feel that it is Theophrastus (Physica, 7) as an adjective, &sgr;∈&kgr;&pgr;&sfgr;, necessary to make this protest. I profoundly believe, translated in Liddell and Scott as bone " shattering." and I am accustomed to teach my students, that the It occurs in Hippocrates 396, 9, and in Galen as a which Liddell and Scott translate injection method of treatment is unsound scientifically, substantive, " a sense of weakness, as if one’s bones were giving and therefore unjustifiable surgically. I shall be told It next appears in Latin under the form that I am not entitled to express an opinion on the way." " " Ostocopos but only twice, in Serenus Sammonicus, subject because I have not personally put the method to the test of trial-which is true. But I reply that Cap. XLVIIL, 892, and in Pelagius Vegetius, de Arte I have not put it to the test because it is unsound, and Veterinaria III., 10, and it is given in Du Cange’s therefore surgically unjustifiable. The avowed purpose Glossarium ad Scriptores Mediæ et Innmae Latinae of the method is the obliteration of the lumen of a vein (Paris, 1688), but it only cites Sammonicus and by the production of thrombosis. It is my considered translates it " Dolorem sentiens in ossibus." opinion that the deliberate production of thrombosis Sammonicus, who wrote about A.D. 225 in the reign by the surgeon-or by anyone-is unjustifiable. of Alexander Severus, devotes a whole chapter to it, Every surgeon knows of the disastrous effects of the but his work has never attracted any attention in thrombosis and embolism which occur occasionally England though widely known on the continent in after any surgical procedure. Can it then ever be the seventeenth and eighteenth centuries. I think it is clear that he is describing dengue, justifiable deliberately to encourage such a happening ? I shall be told that the type of clot which is sought and this is the only description of that disease in -and perhaps obtained-in the injection treatment of ancient writers. He says : " Sometimes a new cause veins is different, and behaves differently, from the of sudden pain makes its appearance, of which the thrombus we fear so much in other conditions. I am origin is quite obscure, and it must be controlled by not convinced that it is in any essential way different, well-established lines of treatment "...." but if or can be trusted to behave differently. I shall be fever with a very high temperature calidae) told that obliteration of veins produced in this way waste the tissues, &c.," and, again (901), " besides is an imitation of Nature’s method of cure. I am still which it dries up the excessive chyme in the stomach, tissues are unconvinced. And even if this be admitted, I would which more and more forebodes that the " humbly point out that even Nature makes mistakes done for," and he winds up by saying, but in cases sometimes. Most of us could cite cases of death of prolonged fever fresh chicken broths made from following upon simple thrombosis of varicose veins, an old cock are very useful, being restorative to The heading of his with resultant embolism, where no operative procedure limbs that show subsultus." " On Sudden Pain and Bone Aching." of any kind had been carried out. I dare to suggest chapter is We have here a description of an acute and sudden that even now we have not got a full or a true record of the ill-results, and even of the fatalities that have disease of epidemic occurrence (nova causa) in which followed upon the injection treatment of veins ; but pain in the bones is the most marked symptom. these will yet emerge. Only the other day the public The gastric symptoms in dengue are well known, press contained the account of an inquest on a fatal " gastric oppression is urgent and vomiting may case of the kind, though, of course, the medical evidence occur," Sir Patrick Manson in Allbutt’s " System of made much of the comparative infrequency of such Medicine," II., p. 380. Dengue has been known on the Mediterranean coasts since 1779 when it was first an untoward happening.
(febres
....
THE INJECTION TREATMENT OF VARICOSE VEINS.
of THE LANCET. out of sympathy with the altogether SIR,—Though To the Editor
injection method of treatment of varicose veins, I have been content hitheito to remain silent on the subject, on p. 408 of your last to do more than merely register a silent dissent from the conclusion there advanced. In this annotation it is assumed that the case for the injection treatment is now proved beyond question, and the reader is left to infer that this point of view is now generally accepted. I quote from the article :-
but in view of the annotation issue I feel
impelled
This treatment is so simple, so effective, that it has ousted almost completely the treatment by operation. On the whole, it can be said that the injection methods now generally adopted are suitable for routine use. The risk is less than operation and the results are better.
But apart altogether from actual fatalities, it is certain that there have been many more failures of cure than are generally admitted, even as there have been very many more cases of sloughing of the skin over the injected veins than the writers on the subject I have myself seen seem to be prepared to confess to. a number of these, and the resultant ulcers are nasty enough, and difficult enough to get to heal. Further, in more than one of these cases which I have seen the injection treatment had been carried out upon veins that called for no such active procedure at all. This supports the view, which I stated earlier, that the numbers of cases submitted to injection have been artificially swollen ; that many quite young girls, who might happen to have an odd superficial vein, causing no trouble whatever, but perhaps showing as a bluish streak through the diaphanous silk of the modern female hose, have been able to induce someone to try to remove the offending streak by the medium of injection. Indeed, my suspicion in this direction is more than a suspicion ; it is a definite conviction. I have several times been asked myself to do the deed -and have refused. In all probability someone more complaisant came to the rescue. For these and other reasons, therefore, I wish to make it clear that there are still those-and I am one of them—who regard the injection treatment of varicose veins as an unscientific procedure, and therefore unsurgical-certainly not free from risk. It may not be out of place here to say that the same arguments as I have advanced above against the injection of varicose veins-and other arguments perhaps even more potent-I would put forward in respect of the injection treatment of hæmorrhoids. I am, Sir, yours faithfully, ARCHIBALD YOUNG. The University, Glasgow, Feb. 25th, 1929.
This is a general statement that should hardly be made without a simultaneous presentation of the proofs upon which it is based. As one who not merely does not believe in the injection method, but, indeed, profoundly disbelieves in it, may I say that I am prepared to accept only one part of the statement-namely, that the treatment is simple. To my mind its simplicity is one of its chief drawbacks, in that it tempts the inefficient and perhaps the less scrupulous members of the profession to carry it out too often without any, or sufficient, justification. I do not admit as proved that the method is as effective as operation in cases that really require treatment. I am not concerned with the other cases that have so enormously swelled the statistics of recent years, cases many of them that required no active treatment. Nor am I prepared to admit that it has yet been decided whether the risk of injection or of operation is the greater. I am not desirous of initiating a correspondence on OSTOCOPOS. the subject, nor am I inclined to take part in any To the Editor of THE LANCET. correspondence that may emerge, but in view of your SIR,—There is a curious word which is found in article, and the assumption therein that the matter has been settled now beyond dispute, I feel that it is Theophrastus (Physica, 7) as an adjective, &sgr;∈&kgr;&pgr;&sfgr;, necessary to make this protest. I profoundly believe, translated in Liddell and Scott as bone " shattering." and I am accustomed to teach my students, that the It occurs in Hippocrates 396, 9, and in Galen as a which Liddell and Scott translate injection method of treatment is unsound scientifically, substantive, " a sense of weakness, as if one’s bones were giving and therefore unjustifiable surgically. I shall be told It next appears in Latin under the form that I am not entitled to express an opinion on the way." " " Ostocopos but only twice, in Serenus Sammonicus, subject because I have not personally put the method to the test of trial-which is true. But I reply that Cap. XLVIIL, 892, and in Pelagius Vegetius, de Arte I have not put it to the test because it is unsound, and Veterinaria III., 10, and it is given in Du Cange’s therefore surgically unjustifiable. The avowed purpose Glossarium ad Scriptores Mediæ et Innmae Latinae of the method is the obliteration of the lumen of a vein (Paris, 1688), but it only cites Sammonicus and by the production of thrombosis. It is my considered translates it " Dolorem sentiens in ossibus." opinion that the deliberate production of thrombosis Sammonicus, who wrote about A.D. 225 in the reign by the surgeon-or by anyone-is unjustifiable. of Alexander Severus, devotes a whole chapter to it, Every surgeon knows of the disastrous effects of the but his work has never attracted any attention in thrombosis and embolism which occur occasionally England though widely known on the continent in after any surgical procedure. Can it then ever be the seventeenth and eighteenth centuries. I think it is clear that he is describing dengue, justifiable deliberately to encourage such a happening ? I shall be told that the type of clot which is sought and this is the only description of that disease in -and perhaps obtained-in the injection treatment of ancient writers. He says : " Sometimes a new cause veins is different, and behaves differently, from the of sudden pain makes its appearance, of which the thrombus we fear so much in other conditions. I am origin is quite obscure, and it must be controlled by not convinced that it is in any essential way different, well-established lines of treatment "...." but if or can be trusted to behave differently. I shall be fever with a very high temperature calidae) told that obliteration of veins produced in this way waste the tissues, &c.," and, again (901), " besides is an imitation of Nature’s method of cure. I am still which it dries up the excessive chyme in the stomach, tissues are unconvinced. And even if this be admitted, I would which more and more forebodes that the " humbly point out that even Nature makes mistakes done for," and he winds up by saying, but in cases sometimes. Most of us could cite cases of death of prolonged fever fresh chicken broths made from following upon simple thrombosis of varicose veins, an old cock are very useful, being restorative to The heading of his with resultant embolism, where no operative procedure limbs that show subsultus." " On Sudden Pain and Bone Aching." of any kind had been carried out. I dare to suggest chapter is We have here a description of an acute and sudden that even now we have not got a full or a true record of the ill-results, and even of the fatalities that have disease of epidemic occurrence (nova causa) in which followed upon the injection treatment of veins ; but pain in the bones is the most marked symptom. these will yet emerge. Only the other day the public The gastric symptoms in dengue are well known, press contained the account of an inquest on a fatal " gastric oppression is urgent and vomiting may case of the kind, though, of course, the medical evidence occur," Sir Patrick Manson in Allbutt’s " System of made much of the comparative infrequency of such Medicine," II., p. 380. Dengue has been known on the Mediterranean coasts since 1779 when it was first an untoward happening.
(febres
....