THE GENESIS OF VARICOSE VEINS

Summary In review, at the early stage of varicosis there is in an area, a dilatation, sometimes of sudden onset, without valvnlar in competence, with centripetal pulsation and without involvement of the proximal part of the veins. At this stage the veins are capable of contraction, that is, the muscle is not degenerate nor intrinsically weak; yet dilatation does occur. These phenomena are explained by the action of some chemical factor, possibly a hormone or hormones of the oestrogen group, which have been shown to produce relaxation of smooth muscle in other tubes. Once the condition has developed, then, just as with other structures such as bones, mechanical factors come into play and produce the various secondary changes which are clearly the effect of hydrostatic stresses. These give rise to the structures which are “ill‐faced”, worse bodied, shapeless everywhere. The distinction between the two stages is of paramount importance in distinguishing between primary aetiological factors and those responsible for the more obvious and, in some respects, the more important secondary changes.