secondary foci of
suppuration--pyaemic abscesses.

_Clinical Features._--Infective phlebitis is most frequently met with in
the transverse sinus as a sequel to chronic suppuration in the mastoid
antrum and middle ear. It also occurs in relation to the peripheral
veins, but in these it can seldom be recognised as a separate entity,
being merged in the general infective process from which it takes
origin. Its occurrence may be inferred, if in the course of a
suppurative lesion there is a sudden rise of temperature, with pain,
redness, and swelling along the line of a venous trunk, and a rapidly
developed oedema of the limb, with pitting of the skin on pressure. In
rare cases a localised abscess forms in the vein and points towards the
surface.

_Treatment._--Attention must be directed towards the condition with
which the phlebitis is associated. Ligation of the vein on the cardiac
side of the thrombus with a view to preventing embolism is seldom
feasible in the peripheral veins, although, as will be pointed out
later, the jugular vein is ligated with this object in cases of
phlebitis of the transverse sinus.

VARIX--VARICOSE VEINS

The term varix is applied to a condition in which veins are so altered
in structure that they remain permanently dilated, and are at the same
time lengthened and tortuous. Two types are met with: one in which
dilatation of a large superficial vein and its tributaries is the most
obvious feature; the other, in which bunches of distended and tortuous
vessels develop at one or more points in the course of a vein, a
condition to which Virchow applied the term _angioma racemosum venosum_.
The two types may occur in combination.

Any vein in the body may become varicose, but the condition is rare
except in the veins of the lower extremity, in the veins of the
spermatic cord (varicocele), and in the veins of the anal canal
(haemorrhoids).

We are here concerned with varix as it occurs in the veins of the lower
extremity.

_Etiology._--Considerable difference of opinion exists as to the
essential cause of varix. The weight of evidence is in favour of the
view that, when dilatation is the predominant element, it results from a
congenital deficiency in the number, size, and strength of the valves of
the affected veins, and in an inherent weakness in the vessel walls.
The _angioma racemosum venosum_ is probably also due to a congenital
alteration in the structure of the vessels, and is allied