uish hue,
as a result of the _deposit of blood pigment_ in the tissues, and this
is frequently a precursor of ulceration.

_Chronic dermatitis_ (_varicose eczema_) is often met with in the lower
part of the leg, and is due to interference with the nutrition of the
skin. The incompetence of the valves allows the pressure in the varicose
veins to equal that in the arterioles, so that the capillary circulation
is impeded. From the same cause the blood in the deep veins is enabled
to enter the superficial veins, where the backward pressure is so great
that the blood flows down again, and so a vicious circle is established.
The blood therefore loses more and more of its oxygen, and so fails to
nourish the tissues.

The _ulcer_ of the leg associated with varicose veins has already been
described.

_Haemorrhage_ may take place from a varicose vein as a result of a wound
or of ulceration of its wall. Increased intra-venous pressure produced
by severe muscular strain may determine rupture of a vein exposed in the
floor of an ulcer. If the limb is dependent, the incompetency of the
valves permits of rapid and copious bleeding, which may prove fatal,
particularly if the patient is intoxicated when the rupture takes place
and no means are taken to arrest the haemorrhage. The bleeding may be
arrested at once by elevating the limb, or by applying pressure directly
over the bleeding point.

_Phlebitis and thrombosis_ are common sequelae of varix, and may prove
dangerous, either by spreading into the large venous trunks or by giving
rise to emboli. The larger the varix the greater is the tendency for a
thrombus to spread upwards and to involve the deep veins. Thrombi
usually originate in venous cysts or pouches, and at acute bends on the
vessel, especially when these are situated in the vicinity of the knee,
and are subjected to repeated injuries--for example in riding.
Phleboliths sometimes form in such pouches, and may be recognised in a
radiogram. In a certain proportion of cases, especially in elderly
people, the occurrence of thrombosis leads to cure of the condition by
the thrombus becoming organised and obliterating the vein.

_Treatment._--At best the treatment of varicose veins is only
palliative, as it is obviously impossible to restore to the vessels
their normal structure. The patient must avoid wearing anything, such as
a garter, which constricts the limb, and any obvious cause of direct
pressure on the pelvic veins,