such as a tumour, persistent
constipation, or an ill-fitting truss, should be removed. Cardiac,
renal, or pulmonary causes of venous congestion must also be treated,
and the functions of the liver regulated. Severe forms of muscular
exertion and prolonged standing or walking are to be avoided, and the
patient may with benefit rest the limb in an elevated position for a few
hours each day. To support the distended vessels, a closely woven silk
or worsted stocking, or a light and porous form of elastic bandage,
applied as a puttee, should be worn. These appliances should be put on
before the patient leaves his bed in the morning, and should only be
removed after he lies down at night. In this way the vessels are never
allowed to become dilated. Elastic stockings, and bandages made entirely
of india-rubber, are to be avoided. In early and mild cases these
measures are usually sufficient to relieve the patient's discomfort.

_Operative Treatment._--In aggravated cases, when the patient is
suffering pain, when his occupation is interfered with by repeated
attacks of phlebitis, or when there are large pouches on the veins,
operative treatment is called for. The younger the patient the clearer
is the indication to operate. It may be necessary to operate to enable a
patient to enter one of the public services, even although no symptoms
are present. The presence of an ulcer does not contra-indicate
operation; the ulcer should be excised, and the raw surface covered with
skin grafts, before dealing with the veins.

The _operation of Trendelenburg_ is especially appropriate to cases in
which the trunk of the great saphena vein in the thigh is alone
involved. It consists in exposing three or four inches of the vein in
its upper part, applying a ligature at the upper and lower ends of the
exposed portion, and, after tying all tributary branches, resecting this
portion of the vein.

The procedure of C. H. Mayo is adapted to cases in which it is desirable
to remove longer segments of the veins. It consists in the employment of
special instruments known as "ring-enucleators" or "vein-strippers," by
means of which long portions of the vein are removed through
comparatively small incisions.

An alternative procedure consists in avulsing segments of the vein by
means of Babcock's stylet, which consists of a flexible steel rod, 30
inches in length, with acorn-shaped terminals. The instrument is passed
along the lumen of the segment to