ER YTHROMELALGIA                                   941

ERYTHROMELALGIA

Under this title Weir Mitchell¹ described, in 1878, a peculiar con­
dition of the extremities characterized by burning, aching, and neuralgic
pain, and associated with, subsequently, the development of redness of
the affected parts. Since then other contributions on the subject have
been made by Lannois,² Senator,³ Gerhardt,⁴ Bernhardt,⁵ Dehio,⁶ Eulen-
berg,⁷ Staub,⁸ Pezzoli,⁹ Carslaw,¹⁰ and others. The malady may involve
one or both hands or feet or all four extremities, and may be limited to
one or several of the toes or fingers. It begins usually in a limited area,
and gradually, but as a rule slowly, extends. The temperature of the
affected part is generally increased, and there is sometimes an exagger­
ated sensibility or hyperesthesia, while in other instances this is intact.
The pain is noted to be augmented when the part is warm. In extreme
development the parts are somewhat swollen, and may present a pseu-
dophlegmonous appearance, and, especially during the pain attacks,
there may be noticed venous engorgement and arterial throbbing felt.
The paroxysms may come on suddenly, and sometimes are excited by
pressure or a knock. There is no regularity, however, as to painful
attacks nor to their duration; sometimes frequent, and lasting from
several minutes to an hour or more, exceptionally more or less con­
tinuous. In occasional instances, as in a case reported by Morel-
Lavallée,¹¹ nutritive disturbances of the nails of the affected part were
noted. In some cases attacks of local sweating are noticed.

Etiology and Pathology—The malady is rare, and may effect
either sex and almost all ages. Lannois’ analysis shows a marked pre­
ponderance of males. According to Hallopeau and Leredde,¹² it is much
more common during adolescence and youth. It is apparently in some
cases an idiopathic affection, in others a part or symptom of central ner­
vous disease. Machol¹³ saw it in a paralytic, and in Gelpe’s¹⁴ case symp­
toms of meningitis and cardialgia had already presented. Collier’s study¹⁵
shows multiple sclerosis in 6 cases, tabes in 2, myelitis in 1, and traumatic
necrosis in 1; and he cannot, therefore, from his observation as well as
an examination of the literature, accept the view of its being an idio-
pathic vasomotor neurosis, but is of the opinion that it is merely a symp­
tom of central nervous disturbance. This conclusion is not, however,

¹ Weir Mitchell, Philadelphia Med. Times, 1872, pp. 81 and 113, and Amer.Jour.
Med. Sci., 1878, vol. lxxvi, p. 17 (presentation of a number of cases and discussion of
its relation to allied conditions).

² Lannois, Paralysie vasomotrice des extrémités on Erythromélalgie, Paris, 1880 (with
citations and references).

³ Senator, Berlin, klin. Wochenschr., 1892, p. 1127.

⁴ Gerhardt, ibid., p. 1125.

⁵ Bernhardt, ibid., p. 1129.

⁶ Dehio, ibid., 1896, p. 817.

⁷ Eulenberg, Deutsche med. Wochenschr., 1893, p. 1325.

⁸ Staub, Monatshefte, 1894, vol. xix, p. 10 (with some references).

⁹ Pezzoli, Wiener klin. Wochenschr., 1896, p. 1263.

¹⁰ Carslaw, Glasgow Med. Jour., 1898, vol. 1, p. 438.

¹¹ Morel-Lavallée, Annales, 1891, p. 708.

¹² Hallopeau and Leredde, Dermatologie, 1900, p. 769.

¹³ Machol, Berlin, klin. Wochenschr., 1892, p. 1319.

¹⁴ Gelpe, Correspondenzbl. f. Schweitzer Aerzte, 1899, p. 14 (case demonstration).

¹⁵ Collier, Lancet, 1898, vol. ii, p. 401 (10 cases).

942

NEUROSES

in accord with Mitchell and Spiller’s¹ study and histologic examination
of the tissues in one instance, who found in this case that the malady
could be ascribed to a peripheral neuritis, with degenerative changes in
the nerves, although they also state that it may have its origin in involve­
ment of the sensory fibers anywhere between the peripheral ramifica­
tions and the spinal cord. Morel-Lavallée’s case was associated with a
mild type of Raynaud’s disease.²

It is not improbable that the division of the cases of erythromelalgia
into three groups, made by Lewin and Benda,³ is justified by the clinical
and etiopathologic facts: (1) Central organic disease; (2) central func­
tional disturbance; (3) peripheral irritation or disease; the last repre­
senting the idiopathic erythrodermias with purely local symptoms.

Prognosis and Treatment.—The outlook for the malady is
not a very favorable one, although in some cases the symptoms are
slight and not very troublesome. Treatment is purely expectant.
Cooling applications, such as menthol and salicylate of methyl, give
variable relief; favorable influence from faradization (Duchenne, Siger-
son, Brocq) and from the continued current (Eulenberg) has also been
observed. Weir Mitchell tried stretching and cutting the nerves sup­
plying the affected part, and amputation of the involved toe, but with
variable result; the former curing in one instance, but in another gan­
grene resulted. Sloughing followed amputation in one case, with partial
eventual recovery as to the local symptoms. Of internal remedies,
some influence is reported from sodium salicylate, antipyrin, acetanilid,
and suprarenal substance.⁴ Kanoky and Sutton⁵ gave relief in a case
with brief x-ray exposures, using a soft tube.

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