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.

    1180/1256 (page 1138)
    ential diagnosis from syringomyelia, above all from one of its secondary forms, Morvan’s disease, is important. I must emphasize the fact that in the latter the course is a chronic and progressive one, that the whitlow is usually painless, and that motor disturbances and sensory phenomena are more prominent. Some cases of leprosy resemble Raynaud’s disease, perhaps also certain forms of beri-beri. When gangrene appears in the course of a cardiac or vascular affection, the differential diagnosis from senile gangrene and gangrene due to endarteritis obliterans also raises the question of the differential diagnosis from Raynaud’s disease. The paroxysmal, preceding, vasomotor symptoms, the slight extent and the localization of the gangrene, will usually point to Raynaud’s disease. The differential diagnosis from intermittent claudication (limping) sometimes necessitates careful consid- eration. The long persistence of sensory symptoms and the dependence of the disturbances upon the use of the legs are typical of this affection. Gangrene due to ergot produces a picture similar to Raynaud’s disease. A careful history is of the utmost importance, and this also is true of the differentiation from chilblain. The disease in itself does not threaten life, but it may become very dis- tressing, and last for years or decades. The treatment must be of two-fold nature: First, prophylactic measures, which consist mainly in the avoidance or decrease of thermic deleterious agents, particularly of the effect of cold. The period of suffering for these patients is winter. Second, constitutional treatment which is directed against the under- lying neurotic or, rather, the vasomotor neurotic diathesis. Quinin has been especially advised, in solution (2.0:180 = a tablespoonful three times daily, Herz), as a tincture, or in combination with ergotin, strychnin, or iron. From the vasodilators, amyl nitrite, nitroglycerin or trinitrin, not much is to be expected; occasionally they mitigate an attack, but for this purpose alcohol has the same effect and is a much better remedy ; its beneficial effect was praised by one of the patients whose history I have quoted. Hot drinks, as I know from experience in other patients, are likewise beneficial. Adrenal extract is highly recommended by Solis-Cohen; I have not had much experi- ence with it; at all events, it is not harmless, and we should be cautious in its use. Cocain has been advised by Herz (0.1:60 = a teaspoonful three times daily). Derivatives may also be tried. But the greatest care is necessary in making local applications to the diseased part. Raynaud once saw asphyxia of the hands immediately change to gangrene while in a local mustard bath. Treatment by laxatives is better: Laxative waters, Carlsbad salt, Marienbad tablets, etc. Hydriatic procedures are often of advantage. I have repeat- edly seen good results from lukewarm hand baths, sometimes with the addition of table salt; Tallermann’s hot air apparatus may be tried. Mild massage is also beneficial. Electricity was praised by Raynaud; but a remedy to attack the affection at its root we do not possess. Sometimes amelioration follows the use of the faradic or galvanic hand bath. Herz advises galvaniza- tion of the head, the intensity of the current to be gradually increased. In the last few years I have several times seen good results in a form of local hyperemia from bandaging the upper arm with a firm flannel bandage so that distinct venous stasis appeared. This was done daily for a few weeks,