Arteritis obliterans of the lower extremity with intermittent claudication ("Angina cruris") / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Arteritis obliterans of the lower extremity with intermittent claudication ("Angina cruris") / by F. Parkes Weber. 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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    and has to rest on account of cramp-like pains in the muscles of the instep or the calf. If examined at that time the foot appears pale but not so white as it does after only a few movements. The blanching of the foot can be to some extent lessened by making the patient inhale amyl nitrite but vaso-dilator drugs (trinitrine and amyl nitrite) fail to bring back pulsation to the left dorsalis pedis and tibialis postica arteries, although they distinctly increase the pulsation in these vessels on the sound side (right foot). There is no anaesthesia and the electrical reactions are normal and equal on the two sides. A Rontgen-ray photograph of the two feet shows that the bones of the little toe give less shadow3 in the left foot than in the right. There is no evidence of any disease elsewhere in the body. The radial arteries feel normal. The pulse is about 84, of moderate size and fair pressure. The brachial blood pressure (estimated by the Riva-Rocci apparatus 4 5 * * * with a broad band) is 135 millimetres of mercury in each arm. A blood count gives 4,175,000 red cells and 9000 white cells in the cubic millimetre of blood, and the haemoglobin value is 90 per cent, of the normal (by Haldane’s method). Microscopical examination of the blood films shows nothing abnormal. The urine is free from albumin and sugar. The knee-jerks and plantar reflexes on both sides are natural. The pupils are equal and react naturally to light. Ophthalmoscopic examination gives no evidence of disease. On the patient’s admission to the German Hospital (August 8th, 1907) there was ulceration on the little toe of the left foot, but the ulcer has since then slowly healed np. The treatment in hospital has consisted in rest in bed (at first), the application on alternate days to the affected ex- tremity of local hot-air baths9 and Professor Bier’s light 3 The Rontgen rays have shown that a certain amount of bone- absorption or decalcification undoubtedly sometimes occurs in parts affected by Raynaud’s symptom complex or arterial ischsemia of any kind. * Owing to the absence of pulsation in the affected foot the blood pressure in the lower extremities could not be compared by the Riva- Rocci method. Unfortunately, I was unable to employ plethysmograph methods. 5 In a case of commencing slight arterio-sclerotic gangrene (a man, aged 59 years) under treatment by local hot water baths W. Ropke (Miinchener Medicitiische Wochenschrift, 1907, No. 14, p. 666) had the satisfaction of observing return of pulsation in the dorsalis pedis and tibialis postica arteries of the affected extremity; the returning pulsation was at first only intermittently, but afterwards permanently, present.