veins, and in such cases it is spoken of as the _varicose ulcer_ (Fig. 14).
The presence of varicose veins is frequently associated with a
diffuse brownish or bluish pigmentation of the skin of the lower third
of the leg, or with an obstinate form of dermatitis (_varicose eczema_),
and the scratching or rubbing of the part is liable to cause a breach of
the surface and permit of infection which leads to ulceration. Varicose
ulcers may also originate from the bursting of a small peri-phlebitic
abscess.

Varicose veins in immediate relation to the base of a large chronic
ulcer usually become thrombosed, and in time are reduced to fibrous
cords, and therefore in such cases hæmorrhage is not a common
complication. In smaller and more superficial ulcers, however, the
destructive process is liable to implicate the wall of the vessel before
the occurrence of thrombosis, and to lead to profuse and it may be
dangerous bleeding.

These ulcers are at first small and superficial, but from want of care,
from continued standing or walking, or from injudicious treatment, they
gradually become larger and deeper. They are not infrequently multiple,
and this, together with their depth, may lead to their being mistaken
for ulcers due to syphilis. The base of the ulcer is covered with
imperfectly formed, soft, œdematous granulations, which give off a thin
sero-purulent discharge. The edges are slightly inflamed, and show no
evidence of healing. The parts around are usually pigmented and slightly
œdematous, and as a rule there is little pain. This variety of ulcer is
particularly prone to pass into the condition known as callous.

In _anæmic_ patients, especially young girls, ulcers are occasionally
met with which have many of the clinical characters of those associated