1907/10/01 by Lewellys F. Barker, T J Sladen
Medicine · #Systemic Sclerosis and Related Diseases
paper · doi:10.1097/00005053-190710000-00004
The paper reports a case of chronic anesthetic acrocyanosis with gangrene of the end of two toes in one foot and malum perforans of the great toe of the other foot.Instances of acrocyanosis in connection with the other syndromes mentioned are given, and the relations of allied symptom-complexes are discussed.(The paper will be published in this journal.)Dr. A. Gordon said that two or three weeks ago lie exhibited before the Philadelphia County Medical Society a case almost identical in its clinical manifestations to that of Dr. Barker and Dr. Sladen's.andhis conclusions were almost identical with those of these gentlemen.It was a case of a young man of twenty-two.who had a redness of both hands.He was a carpenter by occupation.There was no alcoholic history what¬ ever.He noticed about five weeks prior to his coming to Dr. Gordon gradual on-coming redness of the hands, limited just at the level of the wrists Of course the first thought was tliat cf crythromelalgia, but the patient presented a number of little ulcers or sears which .were the result of old ulcerations.Dr. Gordon thought of Mitchell's disease and of Ray¬ naud's disease.However, a close examination showed that while ap¬ parently the ease presented some features of crythromelalgia, on the other hand it presented signs which were antagonistic to Mitchell's disease.Dr. Gordon concluded that the case could not he classified as,either of the two forms.It is allied to these two types, and it goes to show that the two extreme types of crythromelalgia and Raynaud's disease are not always 1 present.There are many cases of so-called intermediary types.Dr. E. Riggs said he was very much interested in Dr. Barker's paper .because of a recent experience of his own.A man of forty-seven years of -age had had for several years what he supposed were rheumatic pains in the, feet.When lie came under Dr. Riggs' observation there was a large ulcer of the left big toe, a -light congestion of the foot, and a cyanosis of the little toe.Dr. Riggs did not know how to classify the ea=e.He did not regard it as one of-Mitchell's disease; he could not regard it as typical of Raynaud's condition.However, the toe amputated itself, the pain dis¬ appeared (Dr, Riggs forgot to say that the pain was atrocious), and the man made an apparent recovery.