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.

    1187/1256 (page 1145)
    cause, especially the effect of cold, and no matter how skeptical we may be, was undoubtedly the etiology in a number of cases. Under these circum- stances, it is frequently only the parts of the body not covered by clothing, therefore, the face and hands, which are attacked by edema. I recently saw a woman in whom edema developed after exposure to a severe hail-storm. Only the parts which the patient could not protect were affected. Here, in addition to the influence of cold, local trauma may have played a role, as it has occasionally in other diseases. In a closely related affection, designated epidermolysis bullosa hereditaria, the causative effect of slight trauma is well known. Anger and excitement also favor the appearance of edema. The chief symptom of the disease is a rapidly developed swelling, which is more or less sharply defined, is pale or of normal color, in rare cases some- what red, and soon produces a feeling of tension, sometimes with marked itching; the impression of the finger does not cause pitting, or for but a very brief time, and the swelling declines after a few hours or days. When it disappears in one part, it reappears in others, and the disease is usually not exhausted in one attack, but there are intermissions followed by a varying number of renewed attacks. The extent of the swellings may vary. They may be as large as a pea or hazelnut, at other times the size of a plate or even larger. They are situated in the skin and in the subcutaneous connective tissue, but apparently may also be in the deeper parts and in the periosteum. In consistence they are coarse, elastic, somewhat like a contracted muscle, and, as previously mentioned, the pressure of the finger produces no prolonged pitting. The color of the skin is usually paler than normal, occasionally there is a slight or marked red discoloration. The temperature of the skin usually corresponds to the degree of redness. In rare cases there are extravasations of blood which cause the edema to assume a blue or bluish red color. There may also be severe cutaneous hemorrhages, yet the edema be slight. Such cases, however, should be regarded as purpura. The acute development of the swelling is an important symptom. In a few moments decided edema may appear; as a rule, however, hours elapse before the maximum is attained. The swelling remains at its height for some time, and then disappears without leaving a trace except that, should this area be re-attacked, permanent changes may gradually take place, but are usually not very marked. Subjective symptoms may be entirely absent. With decided swelling there are, of course, some symptoms such as stiffness and difficulty in moving the affected parts. Sometimes, however, the edema is accompanied by intense burning and itching, hence the pathologic picture closely resembles ordinary urticaria, especially if, instead of pallor of the skin, we have dark red, burn- ing edema, therefore true urticaria. By transitional stages the two diseases merge into each other. Edema may appear in different areas; some portions of the body are more commonly implicated than others, but no part is exempt. According to Collins,1 among 71 cases in 29 the first swelling was in the face, in 22 i Collins, “Angioneurotic (Edema.” Am. Journ. of Med. Sciences, 1892, CIV, p. 654.