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

  • Fox, Howard, 1873-1947.
Date:
1907
Catalogue details

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.

    5/16 (page 3)
    During the last two winters the tips of the ears have become “ dead ” on exposure. The tip of the nose on a few occasions has become stiff and cold. At times the cheeks and chin become mottled with reddish and bluish areas, and at the same time are swollen and stiff. On two occasions the patient noticed that the tip of the tongue became stiff for a short time. Several times a year at intervals the patient has had attacks of dizziness and blurring of vision. At such times reading becomes im- possible. These attacks last about an hour as a rule. June 27, ’06—Her condition is now worse than it has been dur- ing any previous summer, though of course it is not as bad as in winter. She feels nervous, suffers from nausea in the morning upon rising, and vomits occasionally after eating. Recently the attacks of “ dead fingers ” have included the thumbs. Physical examination—Patient is well nourished, of a short, stout build. Marked internal strabismus of right eye. Pupils react to light and accommodation. Pleart action is regular and there are no murmurs. Lungs apparently normal. There is more or less gen- eral abdominal tenderness, especially high in the epigastrium. The urine shows nothing abnormal. The appearance of her face, hands and feet has varied greatly on different occasions on which I have seen her. On her first visit to the Vanderbilt Clinic (on a cold, stormy day) she presented a most classical picture of “ dead fingers.” The fingers were icy cold, numb and of a leaden, cadaverous appearance. The radial pulse on this occasion was also markedly reduced in volume. On subsequent occa- sions she has presented var3ung degrees of coldness and w’hiteness of the fingers. The spasms have invariably passed off after remaining a few minutes in a warm room. For this reason, repeated attempts to photograph the hands during a spasm of “ dead fingers ” have failed. Except upon her first visit the radial pulse has never shown an}^ reduction in volume and has always been regular. There has been no increased arterial tension. There is no appreciable thicken- ing of the arteries. The index fingers show a slight tapering of their distal portions, and the tips of all the fingers except the ring fingers present slightly thickened, depressed areas. April 24, ’07—During the past winter the thumbs have taken part in the paroxysms, being alternately whitish and bluish. The ears and nose are at times cold and white, and at others bluish. Dur- ing the past year she has at times had pain in the breasts, and upon examination has found the nipples to be white and bloodless. Finally, it maA be mentioned that the patient’s husband is being treated at the present time for a tubercular SA^philide upon his right