Nervous and mental diseases / by Archibald Church and Frederick Peterson.

  • Church, Archibald, 1861-1952.
Date:
1908
Catalogue details

Licence: Public Domain Mark

Credit: Nervous and mental diseases / by Archibald Church and Frederick Peterson. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    few phalanges. The disease may appear in other portions of the body, as in patches over the deltoids, inner aspect of the calves, the heels, maleoli, nates, cheeks, and on the abdomen, rarely, however, going on to gangrene. The genitals and tongue are exceptionally attacked. Constitutional symptoms rarely default. Intermittent hemoglobi- nuria, uremia ^ with diminished urea and a lessened quantity of urine, and uremic convulsions are frequently noted. Attacks of colic have been met with during the angiospastic attack. There is no fever at any period except from coincident febrile disease. Cerebral disturbance is very common. ^ Irritability, depression, aphasia, unconsciousness, coma, convulsions, and mania have all been noted. The kidney symp- toms and the brain disturbance are apparently due to the angiospasm, which further shows in the narrowed retinal arteiy, dimness of vision, occasionally occurring hebetude, tinnitus, ageusia, and iridoplegia. Course and Prognosis.—The attacks are of variable duration and intensity. A few hours is usually sufficient for the local synco])e and asphyxia to develop and subside, but ordinarily another exposure to cold or the incidence of any mental strain or physical fatigue occasions a return. When gangrenous changes have developed, several months are usually consumed in exfoliation and cicatrization, as the process is extremely slow and healing very tardy. In infants the disease is of rapid course and may terminate in death in a few days. In older patients recovery is the rule, but uremia may cause death. Diagnosis.—The diagnosis in a typical case is not difficult. The causes of ordinary gangrene are lacking, but nephritis may be present in Raynaud's disease. Repeated symmetrical local syncope, followed by regional asphyxia and passing away in a few hours, can scarcely be mistaken. Several bouts of lesser degree usually precede the gangren- ous variety, often appearing during the winter for years in succession. Hemoglobinuria or retention of urea greatly assists the diagnosis. Treatment.—The principal indication is to improve the nutrition and reestablish the general health. Locally, during the attack, the use of warm applications is indicated. The parts may be w^rapped in cotton and the temperature properly maintained by artificial heat. Trinitrin and amyl nitrite sometimes give prompt relief. Morphin, hypoder- matically, is sometimes required to relieve pain. The local use of the constant electric current has been much advocated, but the warm salt solutions, in which the extremities are directed to be immersed, probably are as active as the electricity. Cushing^ strongly recommends tlie application of an elastic or Esmarch bandage to relieve tlie attack. When the bandage is removed, the parts rapidly fill with blood and the vascular spasm subsides. The treatment of the gangrene is surgical, but it is especially needful to wait for the demarcation line, as it often includes comparatively little of the threatened extremities. 1 Aitken, Lancet. Sept. 2Ci, \mc^. 2 Osier, Amer. Jour. Med. Scienoes, Nov., 1896. 3 Jour. Nerv. and Ment. Dis., Nov., 1902.