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.

    1174/1256 (page 1132)
    Examination revealed absolutely normal conditions except for the paroxysmal numb- ness of the fingers. Here, in addition to paresthesia, we note local syncope. This form of the clinical picture, as already remarked, is rare, and should be differentiated from the first mentioned variety; it forms a transitional stage into one of the incomplete forms of Raynaud’s disease. The affection usually begins with slight attacks and develops gradually, but an acute onset has also been observed, and this was the case with our first patient. When the disease has appeared it usually proves very intractable. This acroparesthesia is not uncommon in persons who present other symp- toms of a general neuropathic condition. The patiönts are easily irritated or frightened, they are anxious, they cry readily, and are often bad-tempered. Especially do they show the signs of the so-called neurasthenia vasomotoria, namely, a tendency to flushes and heat in the face, to vertigo, palpitation, and syncope; I, as well as others, have seen this neuropathic state combined with migraine; on the contrary it must be stated that such a neuropathic diathesis is not invariably present. I shall not discuss the pathogenesis of the disease. In my opinion we are dealing with a sensory or vasomotor sensory neurosis, and, as a rule, the peripheral, sensory, cutaneous, and vascular nerve terminations, also the peripheral vaso-constrictor nerves and ganglia are the seat of the disease. The diagnostic difficulties are not great; but we must he careful not to overlook other severe pathologic centers than those referred to by the patient, for acroparesthesia may be a partial symptom of severe organic affections of the nervous system. Not infrequently have I listened to the complaints of patients in whom investigation revealed the signs of tabes, usually of be- ginning tabes. Sometimes these proved to be (a fact which I can confirm) the early symptoms of acromegalia, a disease first described by Sternberg. Beginning polyneuritis may at the onset also develop similar symptoms. Latent cases of tetany may cause confusion. Most difficult is the differentia- tion from occupation neurosis. I recently saw a cigarmaker who for weeks had suffered from paresthesia of the tips of his fingers. His occupation obliged him to roll wet tobacco. Suspension of his work in a short time brought about a cure, and this beneficial effect of rest is certainly in the majority of cases a valuable differential guide. Positive differentiation is not always possible, for some occupations are very influential in the development of true acroparesthesia. The avoidance of these deleterious pursuits must often be advised in therapeutics, particularly the prolonged use of the hands in cold water should be interdicted; on the contrary, warm water in the form of local baths with or without additions (salt, various extracts) often has a beneficial effect. The symptoms of the patient are sometimes relieved by the use of the faradic or galvanic hand bath. Raynaud’s Disease.—The pathologic picture next to be discussed, Ray- naud’s disease, is much more rare. This was first reported in 1862 1 under the name of “ local asphyxia and symmetrical gangrene of the extremities.” The chief symptoms and the course of this remarkable disease are briefly as i Raynaud, “ De l’asphyxie locale et de la gangrene symetrique des extremites.” Paris, 1862.