Case histories in neurology : a selection of histories setting forth the diagnosis, treatment and post-mortem findings in nervous disease / by E. W. Taylor.
- Taylor, E. W. (Edward Wyllys), 1866-1932
- Date:
- 1911
Licence: Public Domain Mark
Credit: Case histories in neurology : a selection of histories setting forth the diagnosis, treatment and post-mortem findings in nervous disease / by E. W. Taylor. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![Case 106. L., a married man of thirty-three, a blacksmith by occupation, a year before had begun to suffer from pain in the sole of the left foot; this had lasted for about three months and then ceased; nine weeks before being seen the toes and the foot became perfectly white and cold. This appearance changed from time to time to a distinct flushing of greater degree than normal, with a persistence of the sen- sation of cold, though not so extreme as when the foot was pale. In general the foot was apt to be flushed indoors, and pale out of doors. The pain occurred for the most part at night, starting about nine o'clock, and often assumed a high degree of severity. The other foot and the hands had not been affected. He had never frozen his feet but had noticed a tendency to sweating; he had worked in a dry place. Ten days before his visit, he had noticed a blister on the under side of the right great toe. Pus formed; the ulcer was opened but had not healed since. Examination showed pupils normal to light and accommoda- tion; normal wrist and knee jerks; a normal and regular pulse of 80. The right foot was flushed; the dorsalis pedis artery was not palpable; sensibility was unimpaired; all movements were possible. There was a large open ulcer on the under side of the right great toe surrounded by much dead skin. Between the small and next toe, there was also an ulcerated surface of similar character. He had twinges of pain during the examination. Diagnosis. This case is to be classified as a trophic (vaso- motor; disturbance analogous to, if not identical with, Ray- naud's disease. Its unusual feature is its limitation to one foot. Raynaud's disease, or so-called Symmetrical Gangrene, ordinarily begins in the hands and is bilateral in distribution. It occasionally happens, however, that a similar process occurs in a single extremity, as in this case. The trophic di orders of tabes do not involve the vasomotor system in this way. The formation of painless ulcers in that disease is < ommon, w ith Bmall tendency toward healing, but in such cases the genera] sensibility of the foot is involved, and other signs pointing to tabes are present, as, for example, pupillary changes, lost deep reflexes, and general sensory disorders.](https://iiif.wellcomecollection.org/image/b21001698_0278.jp2/full/800%2C/0/default.jpg)
