Two cases of Raynaud's disease with ocular symptoms : one case complicated by scleroderma / by George Howard Fox.

  • Fox, Howard, 1873-1947.
Date:
1907
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Licence: In copyright

Credit: Two cases of Raynaud's disease with ocular symptoms : one case complicated by scleroderma / by George Howard Fox. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    traded. There is general atrophy of the subcutaneous fat and of muscle. Movement in the elbows is • restricted, complete extension, especially in left elbow, being impossible. There is no restriction of movement in any other joints except the fingers. This case, in addition to exhibiting the visual phenomena above described, is interesting on account of its complication with scleroderma. Three types of this latter affection are generally recognized. Hardy divides the disease into the (1) oedematous form; (2) sclero- derma in patches and bands; and (3) scleroderma of the extremities. Thibierge speaks of generalized, progressive, and localized sclero- derma. The generalized form is the oedematous variety of Hardy, where the disease begins as a more or less generalized hard oedema, this type being frequently seen in children. The localized form refers to scleroderma in patches and bands, otherwise known as morphoea. The progressive form is the one that attacks the extremities, and is frequently associated w'ith Raynaud’s disease. It is this latter form of scleroderma, often called sclerodactylia, which alone concerns us at present. The name sclerodactylia, as Thibierge points out, does not refer to a process solely involving the fingers, but to the type of scleroderma that begins in the fingers and later frequently involves the upper extremities, face, and portions of the trunk. The relation between scleroderma and Raynaud’s disease is the subject of an inaugural thesis by Favier. Both diseases, as pointed out by the latter, are found chiefly in the upper extremities, the toes being very rarely attacked. The fingers frequently assume a taper- ing form, the terminal phalanges atrophying, and may be reduced to one-third or less of their former size. The skin apparently adheres to the bones. The nails are partly destroyed, and the articulations become deformed. The skin assumes a violaceous aspect, and finally bull® and superficial ulcerations make their appearance. In his thesis, Favier quotes fourteen cases where scleroderma and Raynaud’s disease were associated, and concludes that there is a close relationship between the Uvo affections. They are both met with frequently in the female sex (11 out of 14 were women), chiefly in youth and adult age. Emotion seems to be an etiological factor in both affections, the majority of the cases having occurred in nervous and hysterical persons. The exciting causes are further almost alwavs cold, mental emotions, or uterine disorders, acting either singly or in combination.