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INTRODUCTION

This chapter presents a perspective of venous insufficiency through the viewpoint of long past experience. Here we look at the slow progress over the centuries toward understanding of the disorder and of the ways people tried to cope with its consequences. The story recounts some of the discoveries, insights, and misadventures that tell of a fascinating drama in the history of medicine.

Progress in medicine throughout the centuries was insufferably slow. Indeed, scant headway was made from ancient times to well past the Middle Ages. Even afterward, it evolved in a succession of small, often tenuous steps, interspersed with giant strides, and always dotted with countless detours. Understanding venous pathophysiology and learning to treat a failing anti-gravitational vascular system shares this hesitant procession.

THE CIRCULATION

Physicians of ancient times were preoccupied with the more immediate and obvious afflictions: casting fractures, draining abscesses, stopping bleeding, and delivering babies. In fact, they became pretty good at it. When it came to diseases of the internal organs, however, their approach to treatment was based upon speculation and, accordingly, it floundered in a quagmire of medicine-by-guesswork. Symptoms from circulatory disorders seemed most baffling of all. Looking back, treatment over the centuries was at best naïve and at worst disastrous. Yet, no one can accuse early physicians of not trying; the “everything-but-the-kitchen-sink” approach to medical care has been universally practiced since antiquity.

Centuries before Christ, Greek physicians believed that the blood vessels connected the heart to all the other organs. They recognized two types of blood vessels which became smaller and smaller as they left the heart. Finally (it was believed), both ended blindly in the various organs. One type of vessel (the arteries) had thick walls; they pulsated beneath the fingertip; they contained bright red blood; and, when cut, the blood “leaped out.” Furthermore, the arteries held their prominent shape even after death. The other type (the veins) had much thinner walls; they were easily compressed; they were pulseless; they contained dark red blood which flowed slowly when the vessel was severed; inexplicably, they collapsed after death. Thus, the heart was central but wedded to two types of vessels, one playing a major and the other a minor part in the scheme of things.

Physicians of ancient Greece did not grasp the essential concept that blood flowed in a continuous and circuitous pathway. Anatomical differences aside, they assumed that blood moved from the heart to the organs in all the blood vessels; it then flowed directly back again to the heart through the same vessel in shuttle fashion. Speculation ventured about blood being carried to the vital organs during waking times and flowed back to the heart during sleep.

The ancient Greek concept of the causes of illness involved an imbalance of the body fluids of which there were four distinct “humours.” The means of restoring health ...

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