Raynaud's Disease
RAYNAUD'S DISEASE, a malady first described by P. Edouard Raynaud in 1862 in a paper on " Local Asphyxia and Symmetrical Gangrene of the Extremities." The condition is said to be of central nervous origin, and cold, fright, or emotional disturbances are predisposing causes. It is a disease of childhood or early adult life, and females are more frequently affected than males. Raynaud attributed the symptoms to an arrest of the passage of blood to the affected parts, and considered this due to a spasm of the arterioles. If the spasm be sufficiently prolonged and intense to completely close the arterial channels gangrene of the part may be the result.
The local symptoms are divided into three well-marked stages. The first is local syncope, in which the affected parts become temporarily bloodless, white, cold, and anaesthetic. The condition is familiar in what is termed a " dead finger," and is usually bilateral. After a variable time the circulation may become restored with a tingling sensation, or the disease may progress to the second stage, that of local asphyxia. In this condition some part of the body, usually a finger, toe, or the whole hand or foot, becomes painful to the touch and is noticed to be dusky in colour, or bluish-purple or even mottled, and the surface is cold. This discoloration may deepen until the skin is almost black, the tactile sense being lost. After several hours the pain may subside, the attack of lividity pass off, and warmth return to the skin. Such attacks of local asphyxia may return every day for a time. Sometimes severe abdominal pain is present, accompanied by haematuria. The frequency of haematuria in this connexion was first noticed by Hutchinson in 1871. In the third stage, that of local gangrene, the involved areas assume a black and shrivelled appearance, livid streaks marking the course of the arteries; blebs may form containing bloody fluid. The degree of destruction varies from the detachment of a patch of soft tissue down to the loss of even a whole limb, the part becoming separated by a line of demarcation as in senile gangrene.
In Raynaud's disease the patients have been noticed to be very susceptible to cold and low temperatures; every effort should be made to keep the extremities warm; woollen underclothing and stockings should be worn, and the activity of the circulation roused by douches and exercise; by these means an attack may be prevented. Should local asphyxia have taken place, one of the best treatments to lessen pain and obtain the return of the natural colour is the application of the constant current. Sir T. Barlow directs its application, the limb being placed in a bath of warm salt and water. Cushing's method of inducing active hyperaemia has been attended with much success. This treatment is only applicable when the vascular spasm affects the extremities, and consists in the artificial constriction of the limb by the application of a tourniquet or Esmarch's bandage for a few minutes daily. This is followed by hyperaemia and increased surface temperature, and affords much relief to the pain of the stage of asphyxia. Drugs which dilate the peripheral vessels, such as amyl nitrite and trinitrine, have also been recommended. When gangrene occurs in the affected part it should be well wrapped in absorbent cotton and kept dry, and all active treatment should cease until a line of demarcation has formed and the gangrenous portion separated. The disease tends towards recovery with more or less loss of tissue if the stage of gangrene has been reached.
Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)
