Nervous and mental diseases . iters insist, and ifgenerally recognized would soon present agenerous material. Etiology.—The female sex furnishesabout three-fourths of all cases. Generalizedscleroderma is most common in adults, butmay be encountered between ten and twentyyears of age, and the discrete form beginsperhaps more commonly before twenty-fivethan later in life. It has been attributedto various infectious fevers, to traumatism,exposure to cold, rheumatism, and to prettymuch every incident of human life. Itprobably has a relation to disease of the ^. „„^ ductless Q^lands, and particular
Nervous and mental diseases . iters insist, and ifgenerally recognized would soon present agenerous material. Etiology.—The female sex furnishesabout three-fourths of all cases. Generalizedscleroderma is most common in adults, butmay be encountered between ten and twentyyears of age, and the discrete form beginsperhaps more commonly before twenty-fivethan later in life. It has been attributedto various infectious fevers, to traumatism,exposure to cold, rheumatism, and to prettymuch every incident of human life. Itprobably has a relation to disease of the ^. „„^ ductless Q^lands, and particularlv to disorder derma, showing fades, sclerodacty-/. .1 .1 •! 4 ^ , . ,., . lie and hide-bound state (Grasset). ot the thyroid. A neuropathic constitution is of such striking frequency in these cases that it cannot be overlooked. Spinal cord and cerebral lesions are sometimes associated, and in the generalized form Raynauds disease is iJour. Nervous and Mental Dis., April, 1918, p. Brit. Med. Jour., June 1, 540 NEUROSES. a frequent concomitant. I have seen it associated with a progressivemyopathy. Insanity is sometimes present, especially melancholia. Symptoms.—In the generalized form of scleroderma at first thereis irritation followed by induration and thickening that may be red andsuffused by vascular stasis and present blebs and bullae. Factitiousurticaria and dermographia are commonly easily demonstrated.^ Onthe broad surfaces of the trunk the skin feels stiifened and is found to be bound down to the underlying parts, giving rise to thehide-bound descriptive title. Atrophy occurs later. All the dermalstructures become thinned and present a cicatricial appearance, and maybe glistening white. The hands and face are especially affected. Thefingers are reduced to their slightest proportions, and the bones, coveredby the atrophic, glistening skin, which fixes the joints and limits motion,are lessened in size. Raynauds disorder is often present. Ov
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