THE SYMPATHETIC SYSTEM 347 



in the etiology of the vaso-motor disturbances which 

 characterize them. 



1. RAYNAUD'S DISEASE. This condition can be divided 

 into three stages: local anemia, asphyxia or gangrene of 

 the extremity. This is an angiospastic affection. Raynaud 

 considers this disease to be due to an extreme irritability 

 of the vaso-motor centres in the cords. 



According to him, due to a cold or to certain endogenous 

 toxins, there is produced a reflex vaso-constriction, the 

 intensity of which determines either syncopy, or asphyxia 

 or gangrene of the extremity. Vulpian claims that this 

 vascular spasm can be explained by an affection of the 

 ganglia in the course of travel of the vaso-motor fibres 

 which accompany these vessels. 



2. ERYTHROMELALGIA. This affection was described 

 by Duchenne of Boulogne, then by Weir Mitchell, and 

 is characterized by painful swelling of the extremities 

 accompanied by a reddish discoloration and an elevation 

 of the local temperature. It may be considered as just 

 the opposite to Raynaud's disease, a vaso-motor paralysis 

 of the extremities, resulting either in an inhibition of the 

 excito motor stimulation from the medullary centres or 

 of a direct or reflex modification of the juxta vascular 

 sympathetic ganglia. 



The observation of Lannois of a woman first suffering 

 from erythromelalgia, then of the syndrome of Raynaud, 

 following cerebral lesions with destructive lesions of the 

 cells of the column of Clarke at the base of the posterior 

 horn, allows us to bring these two syndromes together and 

 to interpret them as two opposed manifestations of an 

 alteration of the sympathetic centres. 



3. ANGIO-NEUROTIC EDEMA. This is characterized by 

 the appearance of circumscribed tumefactions of the skin 

 and subcutaneous tissue and occasionally affects the 



