47 Pharmacology, Therapeutics, and Materia Medica, pp. 229-360. Lea Bros., 1886.
Symmetrical Gangrene.
SYNONYMS.—Local asphyxia, Asphyxie locale, Raynaud's disease; Symmetrische Gangrän.
DEFINITION.—Symmetrical gangrene is an affection of the nervous system characterized by arterial or venous spasm appearing in symmetrical parts of the body, especially in the phalanges of all the extremities, which may result in trophic changes or in gangrene. There are various stages in the disease, which have given rise to the various names by which it is known. The stage of local syncope, in which there occurs a moderate contraction of the arterioles and consequent pallor of the part, may be followed by a stage of local asphyxia, in which the complete contraction of the arterioles cuts off entirely the supply of arterial blood, and the regurgitation of venous blood produces cyanosis of the part; and this, if continued, may result in the gangrene of the part, which is then thrown off. Instead of a condition of local asphyxia, there may be a spasm of the smaller veins, resulting in a local erythema, which may go on to capillary stasis and then to gangrene. The spasm of the vessels may cease at any stage as suddenly as it began; and if this occurs in the first or second stage, no gangrene results.
HISTORY.—While isolated cases of this affection had been recorded as curiosities during the past two centuries,48 the disease was first studied with care by Raynaud in his Thèse de Paris in 1862. He collected twenty-eight cases which had been described with accuracy or had been personally observed in the hospitals of Paris, and after a thorough analysis of the symptoms defined the disease as “a neurosis characterized by an exaggeration of the excito-motor power of the cord presiding over the vaso-motor nerves.” He called particular attention to the condition of spasm in the vessels, and proposed the name asphyxie locale to designate the peculiar appearance of the parts affected. He also noticed the resulting gangrene as a new variety of gangrene, not dependent upon embolism or upon changes of an atheromatous nature in the coats of the vessels.
48 Schrader, 1629; Hertius, 1685; Bouquet, 1808; Moulin, 1830; Racle, 1859—cited in full by Weiss, “Symmetrische Gangrän,” Wiener Klinik, 1882.
The condition was at once recognized by others, and several cases had been reported prior to 1873, when Raynaud published a more complete article on the subject in the Dictionnaire de Médecine et de Chirurgie under the title gangrene symmétrique; in 1874 he recorded five new cases in the Archives générales de Médecine, vol. i. pp. 5 and 189.
The disease, having been thus established as a definite nervous affection, began to be noticed in other countries than France; and Billroth in Vienna,49 Weir Mitchell,50 Mills,51 A. McL. Hamilton,52 and J. C. Warren53 in this country, and many other careful observers, published cases, together with more or less complete articles upon the disease. In 1882, Weiss produced a monograph54 upon the subject containing references to all the cases which had appeared; and this is still the most complete article to be found, although the essay of R. Lauer55 and the discussion of the disease by the Berlin Medical Society,56 as well as the short articles of Schulz57 and Lutz,58 deserve mention, for they contain additional observations of cases and numerous facts not to be found elsewhere.
49 Wiener Med. Wochensch., 1878, No. 23.
50 Amer. Journ. of the Med. Sci., 1878, July.