1922 Journal of the American Medical Association  
giant capillaries became fuller, especially in their venous portion and exhibited changes in contour, such as pro¬ jections and strictures. The blood appeared to be pushed through the vessel by a peristaltic-like wave. In a severe attack the blood became completely stagnant and blue. These observations correspond strikingly to the explanation originally offered by Raynaud.9 Fig. 3.-Appearance of capillaries in case of acrocyanosis. I myself have not observed evidences of contractility of the
more » ... ractility of the capillaries in patients with vasomotor disturb¬ ances of the hands, but I have not had the opportunity of studying a case with a typical Raynaud's syndrome. However, changes in the form of the capillaries are very striking, as is apparent from the table and from the accompanying illustrations. It is difficult to describe the normal appearance of the capillaries at the base of the finger nail, because of their great variability in structure. Figure 1 represents perhaps the usual pic¬ ture in healthy persons. Here are seen one or two rows of simple loops near the cuticle, and below them many rows of shorter, more comma-shaped vessels. In patients with chronic vasomotor disturbances of the extremities, the capillaries are usually longer and thicker than normal, particularly in their venous por¬ tion, and not infrequently exhibit many convolutions and quite a bizarre arrangement. The rate of the blood flow varies in different vessels, and usually is slow. The streaming may be completely arrested in groups of capillaries. Some experiments of Lapinsky 10 suggest a possible cause for this alteration in structure. He studied the capillary circulation in the web of a frog's foot after the corresponding sciatic nerve had been severed. For a short period after the nerve had been cut, the blood flow was slow and the vessels empty. In a few days the capillaries became dilated, and the blood stream became rapid. Later the capillaries became wide and tortuous, and the blood flow again became slow. Lapinsky attributed the change in the form of the capillaries to a loss of elasticity and contractility, which resulted in a widening and a lengthening of the vessel. The coirvolutions are thus dependent on an increase in length of the capillary, just as the tortuosity of one of the peripheral arteries is dependent on an increase in length. It seems rational to suppose that the mor¬ phologic and functional changes in the capillaries of patients with vasomotor disorders are due to a dis¬ turbed innervation, which affects them in a similar manner. CONCLUSIONS In patients with vasomotor disturbances of the extremities, the capillary blood pressure in the fingers is low and the capillary flow is retarded during the period of ischemia or cyanosis. With the return of a normal color of the hands, the capillary pressure, as well as the blood flow, rises and approaches the normal. In most of these patients the capillaries of the fingers are longer and wider than in healthy persons, and often exhibit mam' convolutions and a bizarre architecture. BOSTON Cardiologists in private and institutional work are coming closer and closer to their colleague the roentgenologist, in an effort to isolate certain cardiac anomalies Seven foot plate with seidlitz powder technic. The clavicles were included in the original plate. This important landmark was lost m the process of reducing, together with much of the detail. = MR + ML. by means of the cardiogram. It can safely be stated that few internists now call the cardiac examination complete until an accurate measurement of the heart's silhouette has been made. There are two schools for the examination of the heart by means of the roentgen ray. The French,
doi:10.1001/jama.1922.02640170032010 fatcat:dgxkvmpaxreedbf65i3m3z344y