A system of medicine / by many writers.

Date:: 1911

Credit: A system of medicine / by many writers. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

111/944 page 87

$disease. The aftected part becomes intensely hyperaemic, its colour vary- ing from red to purple. Cyanosis and oedema occur in varying pro- portions, and when the oedema is great and the cyanosis slight, over the back of the hand, for example, it may well be mistaken for the result of suppuration in the palm. In my experience this error has occurred more than once, and once at least led to a fruitless operation. Type (i) does not differ essentially from («). The swelling in its character 'and distribution is the same, but the vasomotor phenomena are absent; and instead of hyperaesthesia there is commonly some degi ee of anaesthesia, or more particularly analgesia. There is no doubt that in both types the symptoms have frequently been unjustly ascribed to constriction applied by the hysterical patient. It will be noted tliat the differentia of the class is found in the presence of definite neurotic symptoms. 2. Acute circumscrihed oedema {Quincke's disease) has affinities rather with the urticaria group of dermatoses than with the angioneuroses, though transitional forms to the latter may be found. Since Quincke's description was published in 1882 a large number of cases have been reported. The symptom-group has a strong tendency to occur in families —for example, in the series recorded by Dr. Ensor, in which 49 cases were met wdth in a family of 141 members, spread over seven generations. But even where the precise form of the disease is not reproduced, there is in the large majority strong evidence of a neuro- pathic inheritance. The symptoms may appear at any age, and in an intermittent form may persist till death. They consist in the rapid or sudden development of swellings, which may affect either the skin and subcutaneous tissues or the mucous membranes. They may affect either the trunk or limbs, and in rare cases prol)a])ly the brain (cf. Osier (37)). The swellings are firm, do not readily pit on pressure, and do not, as a rule, present any circulatory change, though this rule is by no means absolute. AVhen the sw^elling affects mucous membranes, the consequences niay be serious ; oedema of the larynx has been repeatedly the cause of sudden death, and this termination may occur in several members of a family, Fritz records a family in which eight Avere afi'ected in thi-ee generations, and of these five died suddenly from respiratory obstruction; 12 of Dr. Ensor's 49 cases died from sufibcation due to oedema of the glottis. AVhen it is the intestinal mucosa that is affected, the intense pain caused thereby may be not only serious in itself, l)ut may lead to an erroneous diagnosis. The following case, which recently came under my observa- tion, is an epitome of the disease :— The patient is a man in the prime of life, and of fine physique, being an adept at all outdoor sports. In early life he siiff'ered from asthma, and is evidently of the neurotic temperament. For several years past he has been liable to attacks of abdominal pain, which are often associated with sudden swellings in various parts of the body. Sometimes it is a leg, which swells up to sucli an extent that he can hardly get his trousers on, sometimes an arm. The attacks are becoming more frequent and more severe, and now occur every$

A system of medicine / by many writers.

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