RAYNAUD'S DISEASE, a malady first described by P. Edouard Raynaud in 1862 in a paper on "Local Asphyxia and Symmetrical Gangrene of the Extremities." It is a disease of childhood or early adult life, and females are more frequently affected than males. Raynaud attributed the symptoms to an arrest of the passage of blood to the affected parts, and considered this due to a spasm of the arterioles. That the skin capillaries in the various stages correspond with this view has been shown by G. E. Brown but the more fundamental aetiology is unknown. If the spasm be sufficiently prolonged and intense to close com pletely the arterial channels, gangrene of the part may result.
The local symptoms are divided into three well-marked stages. The first is local syncope, in which the affected parts become tem porarily bloodless, white, cold and anaesthetic. The condition is familiar in what is termed a "dead finger," and is usually bilateral. After a variable time the circulation may become restored with a tingling sensation, or the disease may progress to the second stage, that of local asphyxia. In this condition some part of the body, usually a finger, toe or the whole hand or foot, becomes painful, bluish-purple or mottled, and cold. The discoloration may deepen until the skin is almost black, the tactile sense being lost. After several hours, the attack may pass off. Such attacks of local asphyxia may return every day for a time. Sometimes severe abdominal pain is present, accompanied by haematuria. In the third stage, that of local gangrene, the involved areas assume a black and shrivelled appearance, livid streaks marking the course of the arteries ; blebs may form containing bloody fluid. The
degree of destruction varies from the detachment of a patch of soft tissue down to the loss of even a whole limb, the part becom ing separated by a line of demarcation as in senile gangrene. In Raynaud's disease the patients have been noticed to be very susceptible to cold; the extremities must be kept warm ; and the activity of the circulation roused by douches and exercise ; by these means an attack may be prevented. Should local asphyxia have taken place, one of the best treatments to lessen pain and obtain the return of the natural colour is the application of the constant current, the limb being placed in a bath of warm salt and water. Cushing's method of inducing active hyperaemia has been attended with much success. This treatment is only applicable when the vascular spasm affects the extremities, and consists in the artificial constriction of the limb by the application of a tourniquet or Esmarch's bandage for a few minutes daily. This is followed by hyperaemia and increased surface temperature, and affords much relief to the pain of the stage of asphyxia. Drugs which dilate the peripheral vessels, such as amyl nitrite and trinitrine, have also been recommended. The disease tends towards recovery with more or less loss of tissue if the stage of gangrene has been reached.
See G. E. Brown, Arch. Int. Med., 1925, xxxv. 56.