RAYNAUD'S DISEASE.
Much may be done to prevent the seizures by keeping the patient in a uniformly warm' atmosphere, hence in all severe types of the disorder, when means permit, removal to a warm equable climate for the winter should be recommended. Body clothing is of importance; woollen garments alone should be worn next the skin, thick woollen stockings, heavy-soled boots and knitted wool or loose fur-lined gloves should be worn when the patient ventures out in the open air in cold weather. In severe frost he had better keep indoors entirely when possible.
As an attack may at any time be brought on by washing the hands in cold water, this must never be used for ablution; warm but not hot water should always be employed. Gentle Massage of the limbs and Swedish movements or regulated exercises should be carried out in cold weather when the patient is unable to take walking. The diet should be liberal, and in lean subjects animal fats may be freely used. As probably the attacks are of toxic origin, the eliminatory organs should be kept in an active state, and this may be assisted by a generous use of liquid articles of diet and an occasional saline purgative.
Drug treatment should consist in the administration of tonics and Cod-Liver Oil, and in the exhibition of agents which tend to correct any underlying condition with which the affection is sometimes found to be associated. Thus in malarial patients Quinine may be freely prescribed, and in syphilitic subjects large doses of Iodides are clearly indicated, and aniemic individuals should be saturated by a non-astringent Iron pre paration.
During an attack of local asphyxia (dead fingers) the parts should be gently rubbed and enveloped in a layer of wool. Barlow recommends Galvanism. He immerses the affected limb in a vessel of tepid salt
solution, and drops one pole of a constant-current battery into the liquid and places the other pole in contact with the skin of the limb above the water level, using as strong a current as the patient can bear with frequent breaks of contact, the patient being also directed to make voluntary movements with his fingers or toes. In chronic cases shampooing and Swedish movements are added to this method.
When the pain is excessive Opium will be indicated internally, but Antipyrine, Aspirin and Indian Hemp may first be tried. One large dose of Alcohol in hot water is also efficacious, but for obvious reasons should only be resorted to very occasionally. Vasoconstrictors and vaso dilators have been tried with but little success, but the plan of interruptin the circulation by applying a tourniquet for a couple of minutes to the affected limb in order to arrest the vasu-motor mechanism for two or three times daily has been followed by good results.
Gangrene, which is liable to occur and involve the pads of the fingers and toes or the ears, must be met by the appropriate surgical measures mentioned under Gangrene.
The treatment of the somewhat allied condition known as Erythro inclalgia or Red Neuralgia must be carried out on the same lines, but when the pain of the attack is at its height during the acme of the bright redness, the local application of cold water affords considerable relief. An important point in the treatment is absolute rest in the horizontal position and elevation of the affected limb. Sometimes this strange affection occurs in patients subject to attacks of Raynaud's disease.