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.

    1178/1256 (page 1136)
    us too far from our theme were we to discuss this interesting subject. Paroxysmal albuminuria and paroxysmal melituria have also been observed. In such cases the diagnosis of Raynaud’s gangrene must, of course, be cau- tiously made in order to prevent confusion with gangrene due to vascular disturbance, particularly when an intermission of the symptoms is observed. A moderate excretion of uric acid has also been noted. English authors have ascribed great etiologic importance to the uric acid diathesis. My experience leads me to assume that gouty persons and members of gouty families show a great tendency to variations of the vasomotor innervations. The heart and the vascular system usually show no organic changes. In a few cases, besides typical Raynaud symptoms, an organic cardiac affection existed, apparently, independent of these. I saw an instance of this. There are also a few cases reported in which, besides arteriosclerosis, the typical symptoms of Raynaud’s disease appeared intermittently. But all of these are exceptions, the diagnosis of which necessitates special care. As a rule, the general condition of the patient is not below par.. Dis- turbances occur gradually, and are usually due to the pain, the processes which cause gangrene, etc. As has been several times reiterated, the course of the disease is typically intermittent. An attempt has been made to divide it into different stages, but this adds little to our knowledge of the affection. Vasomotor symptoms usually precede the gangrene which appears with an increase of pain. The acme of the disease appears to be reached in the area first affected, but paroxysms may develop in other areas. The disease is often exhausted in a single attack which comprises several paroxysms. This was the case in the two patients whose histories I quoted; the various later disturbances were merely sequelae; but renewed attacks may appear at shorter or longer inter- vals. In the subsequent course the paroxysmal type gradually becomes oblit- erated, and the intensity of the symptoms decreases. There are, however, cases in which the vasomotor symptoms (from the onset) show a chronic and progressive development; certainly the local asphyxia points to such a form. In addition to the other deviations from type we frequently note that the gangrene and the pains become less marked, but, in their place, other trophic disturbances are observed, enlargement of the fingers or other peripheral parts, in which, however, the bones are not involved; in other cases objective sensory disturbances are very conspicuous. I have described such cases as acroasphyxia chronica, and have attempted to separate them from the ordinary cases of Raynaud’s disease. Other authors (Hirschfeld, Pehu) .have observed similar cases, but their number is small. Unquestionably there are many cases in which only vasomotor disturb- ances persist, in which gangrene never occurs, or, at least, only in the later course, in which there are slight trophic disturbances, such as thickening or enlargement of the terminal phalanges, and hardening of the skin. Some of these types are the forms which undergo a transition into Nothnagel’s vasomotor neurosis, some are closely allied to sclerodactylia, and perhaps are cases of the last named affection. The fact that we not infrequently meet with a combination of Raynaud’s disease and diseases of the central nervous system is especially interesting. Among the latter is tabes dorsalis, particularly gliosis spinalis, syringomyelia