Persistent hereditary oedema of the legs with acute exacerbations : Milroy's disease / by W.B. Hope and Herbert French.

  • Hope, Walter Bayard.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Persistent hereditary oedema of the legs with acute exacerbations : Milroy's disease / by W.B. Hope and Herbert French. 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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    We have no record of measurements previously to this, but clinically the left leg had always been considerably more bulky than the right hitherto. There were no abnormal physical signs in the lungs nor in the abdominal organs. The only abnormal physical sign noted in the heart was a faint blowing systolic murmur, which was heard both at the impulse and at the base; it was thought not to indicate any valvular disease. Next dayt June 11, 1904, the temperature had fallen to 100° F., the pulse rate to 106, the respiration rate to 40. The right lower limb was still hotter than the left, the redness above the knee had disappeared, and that below the knee was fading markedly. Pain was also much less. On June 12, 1904, the systolic bruits were scarcely to be detected. The temperature was 99° F., the pulse rate 100, and the respiration rate 20 per minute. The right lower limb was desquamating, and the pain in it was almost gone. By June 16, 1904, the attack was quite over, the temperature was 98° F., the pulse rate 60, and the respiration rate 20 per minute. Measurements showed:— Maximum circumference measurements. Right leg. Left leg. Instep 11| inches. 10^ inches. Calf 14 -i „ 14* „ Knee 17 „ 16-| „ Thigh 21 „ 21|- „ Both legs had diminished in size, as was always the case, to some extent, when the patient lay in bed for a week. The third 1 acute attack’ occurred on Aug. 22, 1904, and was very similar to the second. It may be noted that up to this time there had been no breach of surface in either leg, no boil nor sore place that could be detected, and no enlarged lymphatic glands in the groins or elsewhere. The urine had a specific gravity of 1010; it was pale and clear, with a neutral reaction, and it contained neither albumen nor sugar. The first breach of surface that was noticed was some time after the patient had been up and about after recovery from the third ‘ acute attack’ ; on Nov. 1, 1904, there were numerous small superficial ulcers in the skin about both knees. These ulcers were mostly no more than an eighth of an inch in circumfer- ence, the largest measuring half an inch across ; each had a sloughy base, an indefinite edge, and a thin serous discharge, which was small in amount. Each excoriation was surrounded by an area of redness due to inflammation. There was nothing suggestive of syphilis in the appearance of the very shallow sore places; they seemed to be pyodermic from accidental infection of the poorly nourished skin. The fourth ‘ acute attack ’. On Nov. 4, 1904, about 3 p.m., the patient complained of shivering, and of severe pain down her left side. Half an hour