#Gangrene associated with Spasm of Blood Vessels.#—­#Raynaud’s Disease#, or symmetrical gangrene, is supposed to be due to spasm of the arterioles, resulting from peripheral neuritis.  It occurs oftenest in women, between the ages of eighteen and thirty, who are the subjects of uterine disorders, anaemia, or chlorosis.  Cold is an aggravating factor, as the disease is commonest during the winter months.  The digits of both hands or the toes of both feet are simultaneously attacked, and the disease seldom spreads beyond the phalanges or deeper than the skin.

The first evidence is that the fingers become cold, white, and insensitive to touch and pain.  These attacks of local syncope recur at varying intervals for months or even years.  They last for a few minutes or even for some hours, and as they pass off the parts become hyperaemic and painful.

A more advanced stage of the disease is known as local asphyxia.  The circulation through the fingers becomes exceedingly sluggish, and the parts assume a dull, livid hue.  There is swelling and burning or shooting pain.  This may pass off in a few days, or may increase in severity, with the formation of bullae, and end in dry gangrene.  As a rule, the slough which forms is comparatively small and superficial, but it may take some months to separate.  The condition tends to recur in successive winters.

The treatment consists in remedying any nervous or uterine disorder that may be present, keeping the parts warm by wrapping them in cotton wool, and in the use of hot-air or electric baths, the parts being immersed in water through which a constant current is passed.  When gangrene occurs, it is treated on the same lines as other forms of dry gangrene, but if amputation is called for it is only with a view to removing the dead part.

#Angio-sclerotic Gangrene.#—­A form of gangrene due to angio-sclerosis is occasionally met with in young persons, even in children.  It bears certain analogies to Raynaud’s disease in that spasm of the vessels plays a part in determining the local death.

The main arteries are narrowed by hyperplastic endarteritis followed by thrombosis, and similar changes are found in the veins.  The condition is usually met with in the feet, but the upper extremity may be affected, and is attended with very severe pain, rendering sleep impossible.

The patient is liable to sudden attacks of numbness, tingling and weakness of the limbs which pass off with rest—­intermittent claudication.  During these attacks the large arteries—­femoral, brachial, and subclavian—­can be felt as firm cords, while pulsation is lost in the peripheral vessels.  Gangrene eventually ensues, is attended with great pain and runs a slow course.  It is treated on the same lines as Raynaud’s disease.