Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1173/1256 (page 1131)
    I once saw a child aged 7, and at another time a lady of over 70, who presented the same symptoms. Our patient stated that the first symptoms appeared after washing clothes. This is in conformity with other experi- ences. Occupations which necessitate the use of much water, particularly cold water, are important factors in the development of the disease. Other forms of hard manual labor, also over-use of the hand, may predispose to it. In women there are additional etiologic conditions in the sexual life, the influence of the climacterium, the puerperium, pregnancy, etc. It is especially interesting to note, as I did in four or five cases, that acroparesthesia occurred after operative removal of the uterus and the ovaries with and without other symptoms of climax prcecox. Several of my male patients were alcoholics. Sometimes trauma may be the cause, compression of the fingers, or a fall upon the elbow as in one of my patients. Sommer also describes a case with traumatic etiology. The symptoms in my patient were unpleasant or even painful sensations in the fingers, hands and forearms. These are the main symptoms of acro- paresthesia. There is a sensation of formication, of itching, burning, or numbness, a feeling as if the finger or the entire hand were swollen. But there may be every transitional stage between these unpleasant sensations and actual pain, which, as in the history just quoted, may disturb the rest at night. Usually the paresthesia and pain are not continuous, but occur in attacks which are most marked toward morning. Then the fingers become stiff and clumsy, and they can be used only after rubbing, squeezing, or patting them. As a rule, the patients cannot sharply define their sensations. Sometimes the fingers of both hands, sometimes of one hand only, and occasionally the indi- vidual fingers, are said to be painful or numb. Exceptionally the upper arm is implicated as high as the shoulder. In my patient there was a conspicuous disturbance of sensation affecting the terminal and middle phalanges of all the fingers of both hands uniformly including their sensory qualities. Here, as elsewhere, the hyperesthesia was by no means limited to a peripheral nerve or its root area. This is important, for both Dejerine and Egger have re- cently reported cases in which the objective sensory disturbances were limited to the tract of certain posterior roots, and Pick had formerly observed a similar distribution of subjective disturbances. According to my experience, this is by no means the rule. Objective sensory disturbances may be entirely absent, and they are generally neither so frequent nor so well developed and extensive as in the patient whose history was just related. In many cases the only symptoms are these objective and subjective phe- nomena. Other cases, however, may show the following symptoms: Pallor of the fingers and of the hands simultaneously with the previously mentioned paresthesia, in which sensations of cold frequently predominate. The history of a patient presenting this type, which unquestionably is more rare than the first, is the following: A servant girl, aged 16, was compelled to work in a cold kitchen. For eight weeks she complained of distress in her hands, numbness, a loss of sensation, and burning of the fingers, especially in the morning and after carrying heavy loads. Frequently the fingers became deathly pale and so stiff that she could not move them. This condition lasted several hours, formication extending to the shoulder.