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.

    1182/1256 (page 1140)
    cardiac and vascular nervous systems are sometimes most intensely damaged, and we also see the symptom-picture develop upon the base of marked hysteria. It is also noted in organic diseases of the brain: In multiple sclerosis (Col- lier), in tumors (Schlesinger), in gliosis spinalis (Pospelow), and in tabes dorsalis. Finally, there are cases in which the symptoms of erythromelalgia are limited to the region of one or a few definite peripheral nerves without other symptoms of neuritis being discernible. The regions of the median, the internal plantar, the posterior tibial, and the radial nerves have thus been found diseased. Pathologic anatomy has furnished no conclusions regarding the nature of the disease, although a few investigations have been reported. Changes have been found in the peripheral nerves of the posterior roots and in the small arteries, but there is no unanimity between the individual reports. The symptoms appear, as a rule, to be the expression of irritation in definite vasomotor (dilator), sensory, and secretory tracts and centers. In one group we may assume that the pathologic focus is situated in the peripheral nerves, and these are the cases in which the symptoms are limited to a circumscribed region of one nerve. In the future we must observe whether this is not, on the contrary, a root distribution; disease of the posterior root appears to be a very plausible theory for these cases. In the second group the assumption of a central nervous genesis appears to be best founded. The areas attacked are apparently of the same physiologic importance as those of the first group: Vasomotor, secretory, and sensory elements. Here then we are dealing with a central (spinal or bulbar) neurosis with vasomotor, trophic, sensory, and secretory symptoms. Whether the posterior gray substance is, as Eulenburg and recently also Lannois and Porot have believed, the point of lesion is still undecided. That a disease of peripheral vessels may produce similar phe- nomena I cannot deny. In this instance it may be as it is in various forms of muscular atrophy in which the primary muscular and primary neuropathic symptom pictures closely resemble one another. At all events, it appears to me necessary to regard a number of cases of erythromelalgia as nosologic entities. The diagnosis is not difficult if we bear in mind that we are dealing with a combination of vasomotor and sensory symptoms which form the picture of the affection. Vasomotor disturbances alone are not sufficient basis for a diagnosis. From them may result .such pathologic pictures as erythroder- mia, erythromelia and the like. Nor are merely sensory symptoms sufficient. Here we must differentiate between the more or less substantive topoalgias of the foot (tarsalgia, talalgia, etc.). As a rule, the differentiation between certain vascular processes causes the greatest perplexity. Reflex disturbances of innervation apparently occur in a vessel changed by arteriosclerosis, and this leads to active hyperemia and thence to pain. This furnishes an ex- planation of the many points of similarity which exist between this affection and intermittent claudication. The course is usually very protracted, but improvement may take place even after a long duration of the affection. In a purely symptomatic sense, we attain most in the treatment by keeping the member in a horizontal position, and by the application of cold in some form. Electrical treatment