Try this:
$first_4="Howdy!";
$a="first";
$b=4;
$c=$a."_".$b;
print $$c; Note the double $$
Unfortunately, you've got to add a few steps to what you want to do. For instance, this:
$x=3;
$size_3="medium";
print $$size_$x;
won't work quite right, but if we add a line, it will:
$x=3;
$size_3="medium";
$tmp="size_".$x;
print $$tmp;
What you're trying to do is handled by something called variable variables. But you may do better with arrays, which are faster.