The Treatment of Varicose Veins

Young examined the remove(l lobe, and reporte(d that histologically the epithelial lining of the bronchiectatic cavities was largely desquamated and that the submucosa or wall was the seat of subacute inflammatory changes. The lung showed irregular areas of dense fibrosis. The arteries exhibited well-marked arteritis, evidently the effects of a chronic inflammatorv lesion. 'rhere was no evidence of tuberculosis. This man wrote recently that he was feeling very well and anixious to obtain work. So far as I know, this is the first successful case of lobectomy for bronchiectasis recorded in Ireland. Apart from lobectomy, the treatment of bronchiectasis is only palliative anld the results are far from satisfactorv. Artificial pneumothorax is useless, except in children, and eveni then it requires to be kept up for an indefinite perio(l. Broncho-scopic lavage an(d medication gives great relief in the type of bronchiectasis associated with much purulent spuitum, but would be inapplicable to the treatment of the h-emorrhagic type. To deal fully in a short space with the treatment of varicose veins is difficult. I intend to consider only the injection method. Ten years ago the pendlulum swung so far in favour of injection for all cases, that there is now the natural swing back to the ol0(method for certain patients. In time a stable position will be reached, when it will be realized that certain veins, e.g., those in the calf, etc., are suitable; whereas, of those on the thigh, injection will be successful for some, and for those unsuitable ligature of a vein will be the onlv safe method. Before dealinlg with the techlnique of injectioni, one or two facts must Lbe coto-sidered. The first of these is the circulation in the limbs. 'I'he blood reaches the part through the arteries, having beeni pumped there by the heart's actioln. 'I'he return flow is carried to the heart by the veins, and(i of these there are two main types-(a) the superficial, lving subcutaneously; andl (b) the deep, centrally placed, surroutnded by muscles. The force causing the return flow is complicate(l, and probably is a combination of several factors (1) The heart's action extending through arteries and capillaries to the veins-the so-calle(d vis a tergo. This, although doubte(d by some, must exist, as can be seen by the steady flow from the distal end of a completely severed vein. (2) The aspiration or suction exerted by the heart and lungs-iis a fronte. …