The Raynaud syndrome.

Introduction Raynaud provides us with an accurate clinical description of the disease which now bears his name. 'Madame X, aged 26 years, has never been ill; but she has been the subject since childhood of an infirmity which makes her an object of curiosity to her acquaintances. Under the influence of very moderate cold, and even at the height of summer, she sees her fingers become exsanguine, completely insensible, and of a whiteish yellow colour. This phenomenon happens often without reason, lasts a variable time and terminates by a period of very painful reaction, during which the circulation is re-established little by little and returns to the normal state. Madame X has no better remedy than shaking her hands hard, or soaking them in lukewarm water.... This state, which I dare hardly call a disease, is local syncope in its simplest form' (1862). Raynaud clearly recognized the vasospastic nature of this phenomenon in young, healthy women and in a later paper (1874) he put forward 'the hypothesis of a contraction of the terminal vascular ramifications, varying from a simple diminution of calibre up to complete narrowing of the lumen of the vessel. To the total closure of the arterial and venous vessels would correspond an exsanguine and cadaveric state of the extremities ... whilst the arterioles only being closed and the venules open, one would see a venous stasis produced by failure of vis a tergo, whence the cyanosis and livid ap. pearance'. Unfortunately he failed to understand the widely varying pathology of the examples he described, or that necrosis or frank gangrene can only result from actual structural obliteration of the vessels and it was left to Jonathan Hutchison (1901) to point out the many different diseases which are liable to present with digital ischaemia. Hutchison also advocated the term 'Raynaud's phenomenon' to describe the intermittent episodes and showed that these could be due either to vasospasm or organic obstruction, although even today this distinction remains difficult on clinical grounds alone.