Historický přehled názorů na povahu a léčení varixů a bércových vředů

Historical Review of Opinions on the Nature of Varicose Veins and Leg Ulcers and their Treatment

The development and changes of opinions conceming the nature and treatment od varicose veins and varicose ulcers are summarized in this article covering a long period from the Greek antiquity till the 20^th century. Whereas in the ancient times (Hippokrates, Celsus, Galen) the meanings did not contradict the contemporaneous knowledge, curious opinions dominated from the 11^th till the half of the 19^th century, obviously influenced by the humoral theory of Avicenna. The official teaching claimed that black bile and other bad humours collected in varicose veins. Bandaging was thought to push back these humours into the body and cause madness or other serious illness and, therefore, was refused. On the contrary, ulcers were considered to be a favourable condition because their function was to drain the bad humours.

The fundamentals of modern surgical treatment of varicose veins were presented by Madelung, Trendelenburg and Babcock at the end of the 19^th and the beginning of the 20^th century. Trendelenburg deserves acknoledgement of having introduced physiological and pathophysiological reasoning into the field of phlebology. The conception of the role of incompetent calf perforators for the development of leg ulcers advocated by Cockett and others represents a derailment on the way of evidence based medicine. The substance of this theory, although supported by most autors till the present time, have been repeatedly confuted by exact hemodynamic measurements. Evidence based medicine whose basement was laid by Trendelenburg more than 100 years ago cuts a difficult way through the field of phlebology.

Key words:
varicose veins – leg ulcers