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.

    1177/1256 (page 1135)
    and has been attributed to certain individual conditions. For example, I saw a case of this kind in which there appeared to be a congenitally weaker development of the arterial vascular system of the affected arm. The seat of the gangrene is usually a finger, a toe, the margin of the ear, more rarely the nose, the tip of the tongue, the nipple, or the lips. The nutrition of the affected areas may also be modified in another manner. These changes belong largely to the realm of sclerodactylia, a condition to which I shall revert later. But the parts may become larger, hemorrhages may take place into the skin or into the subcutaneous tissue, changes in the nails are common, whitlow which runs its course with intense pain has often been observed, and this is important in the differential diagnosis. I I saw a patient, aged 32, who was suddenly attacked by ulcers in the fingers, the tips of the fingers became black, the superficial areas and even portions of bone sloughed away, and there was very severe pain; recovery was extremely slow. Since that time pain in the fingers has persisted although there has been no whitlow for seven years. The hands are now deformed; bilaterally a- considerable part of the terminal phalanx of the second finger is absent. An X-ray picture shows that the bone also is implicated. In the pulpae of most of the fingers there are superficial cica- trices, the fingers in toto are bluish red, cyanotic, and cold, and in them sensation is somewhat below normal. Always prominent among the symptoms is pain, which in fact occasion- ally appears to be excruciating; Raynaud says: “ I have known persons, other- wise quiet and patient, to howl with pain, their bodies bent and contorted as they sit in bed. These unfortunate subjects appear to pass their entire time in seeking a position which will afford some relief/’ Sometimes the pains are not severe, and like the very slight objective sensory disturbances, they are usually not circumscribed. Occasionally secretory disturbances, particularly liyperhidrosis, accompany the vasomotor symptoms. Motor phenomena are here very inconspicuous, but no doubt localized motor symptoms, particularly atrophy of a non-degen- erative character in the muscles of the hand, do arise in the course of Ray- naud’s disease; I have reported such an instance. In one case Raynaud observed a very peculiar ophthalmoscopic picture. The patient called his attention to the fact that while he was able to see during the attack after it passed away there was disturbance of sight. Oph- thalmoscopic examination showed that during the time in which the sight was affected there was an abnormal contraction of the central artery of the retina at its origin in the vicinity of the papilla; Weiss, as well as a few later observers, saw a similar condition, but, upon the whole, such findings are rare. Periodic contraction of the arteries has also been noted in other iso- lated areas. Usually, however, the pulse shows no change; this may be proven graphically. Interstitial abnormalities are sometimes observed in the secretion of urine. The coincidence of paroxysmal hemoglobinuria and Raynaud’s disease is peculiar. The relation of these symptom-complexes to each other varies; sometimes the symptoms of Raynaud’s disease are prominent and hemo- globinuria is scarcely noticeable, at other times the reverse is true. Here it must be noted that the pathologic picture of paroxysmal hemoglobinuria is in many respects similar to paroxysmal symmetric gangrene. It would lead 73