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.

    1181/1256 (page 1139)
    the bandage being kept on for about ten minutes. Courtney reports favor- able results after the application of a tourniquet. The symptomatic treat- ment of the pain and gangrene requires no special description. Erythromelalgia.—In 1872 Weir Mitchell1 described a pathologic condi- tion characterized by the paroxysmal appearance of pain, reddening and swelling of the feet, to which he gave the name erythromelalgia, “red, painful limbs.” Lannois 2 added to our knowledge of this affection by his description in 1880 of this unquestionably very rare affection; up to the present time perhaps 90 to 100 cases in all have been reported. In regard to the age and sex of those attacked by the disease, nothing noteworthy is reported. As deleterious agents, thermic influences are especially to be con- sidered. The predominant symptom of the disease is peculiar pain, a burning and stabbing sensation of great intensity, “ as if living fire were under the skin.” The pain either sets in with great severity or develops gradually to its height; it is increased by letting the painful member hang down, by heat, and by exertion. Simultaneously with the pain or a little later redness and swelling appear. The redness is that of active hyperemia, the affected areas are light red to purplish red, the arteries pulsate, the veins are dilated. The temperature in the diseased parts is increased, being 5° to 8° F. higher than in the normal parts. In contrast with this, during the subse- quent course or sometimes with the appearance of cyanosis, the temperature declines. The sensitiveness of the affected areas is increased, even the pressure of the bed-clothes annoying the patient; stockings and boots can no longer be worn. Otherwise, sensation is usually normal. The disturbances occur periodically, and are produced by a number of causes: By heat, by a pendant position of the affected portion, and by movements. Most frequently the feet are implicated, sometimes the toes, sometimes the ball of the foot, some- times the heel. Usually both feet are symmetrically affected, more rarely both hands, or merely one foot or one hand may be involved. Sometimes the disturbances are limited to the region of a single nerve. As accompany- ing symptoms I must mention disturbances in the secretion of sweat, usually hyperhidrosis. Not rarely trophic disturbances are present, although this was formerly denied. There are usually dystrophic changes which are only slightly conspicuous; hyperplasia of the connective tissue, changes in the nails, and either thickening or atrophy of the skin. Gangrene has also been mentioned. In my opinion the cases in which gangrene appears do not belong to this affection. I believe they should be attributed to endarteritis obliterans or to intermittent claudication. In a few instances, however, true neurotic gangrene was present. These then are the transitional cases of Ray- naud’s disease. I observed a case in which the symptoms of both neuroses were combined. The pure cases in which only the local symptoms are present form about one-fourth of all the cases reported. Those which show signs of a general neurotic diathesis may be determined in about the same proportion. The 1 Weir Mitchell, “ On a Rare Vasomotor Neurosis of the Extremities.” Philadel- phia Med. Times, 1872, p. 81. 2 Lannois, “ Paralysis vasomotrice des extremitßs on erythromelalgie.” These de Paris, 1880,