Volume 1

A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.

Date:: 1893-1894

Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.

881/962 (page 861)

$BA VA\i rD\S DISEASE. 861- A majority of tliese cases are fatal, and death may follow within three or four days. The prog-nosis as regards death is, as a rule, good, except in the more malignant forms, and, as already mentioned, the destruction of tissue is, as a rule, very much less than the a])pearance of the affected part would wan-ant. The outlook for com[)lete recovery is not very hopeful. Associated Conditions.—There are very remarkable concomitant svmp- toms in Raynaud's disease to which of late much attention has been jiaid. Hfemoglol)inuria may occur during an attack or may take the place of an out- break. The blo(xl-coloring matter is not always present. There may be only albuminuria. In a case which has been at my clinic on several occasions the local asphyxia with slight loss of substance in the ears recurred for three suc- cessive winters, always in association with hsemoglobinuria. The attacks were usually preceded by a chill, and during them he had a peculiar sallow, snbicten/id hue. The I'elations between paroxysmal luemoglobinuria and Ray- naud's disease is evidently very close, and some have regarded them as man- ifestations of one and the same affection. Colicky pains, diarrhcea, nausea, and vomiting occasionally occur in Ray- naud's disease, but are not so common as in intermittent liaMuoglobinuria and angio-neurotic oedema. Periplieral neuritis has been found in a few instances of symmetrical gan- grene, and there are instances in which the affection was associated with wrist- dro}). In a recent case the patient, an alcoholic, had had for some time numb- ness and tingling and formication in the hands and feet. This was followed by a condition of the most intense local asphyxia of the hands and of the toes, and scattered ]iatches resembling erythema nf)dosum upon the skin of the extrem- ities and the trunk. Together with these symptoms there were slight articular pains and swelling of the right knee, so that the condition resembled somewhat peliosis rheumatica. Urticaria, erythema nodosum, and scleroderma have been described in connection with this affection. Among the most remarkable are the cerebral manifestations. Mental tor- por and transient loss of consciousness have been described. In the case above mentioned with hremoglobinuria the ]iatient had epileptic seizures with the attacks. Exposure on a cold day would bring on a fit, with local asphyxia of the ear-tips and l)loody urine. Acute mania has developed, and dehisions. A case has recently been under ol)servation in win'ch during the attack there was aphasia with temporary hemiplegia. Dimness of vision has l)een noted, and retinal changes, chiefly great narniwing of the arteries, have been descril)ed. The patholog-y of this remarkalile disease is not very clear. Raynaud suggested that the local asphyxia was caused bv contraction of the vessels, which ])rol)ably in the extreme grades of local syncope involves arteries, veins, and capillaries. The asphyxia is dependent upon dilatation of the cajiillaries and small veins, ])robal)ly with the persistence of some spasm in the arterioles. Necrosis onlv follows when the condition is persistent, and in the pirolonged$