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Ideas concerning physiologic mechanisms in vasopastic hand disorders aare represented by two points of view. Lewis (18) summarizes one, believing from his studies that a local fault of the digital arteries is responsible for the abnormal reaction to cold and that the sympathetic nervous system operates only by maintaining general vascular tone. If abnormal stimulation by the autonomic nervous system were the basis of vascular contraction, he states, the disease would occur primarily in the legs where vascular tone is the highest.
The other point of view is represented by the various investigators who indicate that sympathectomy produces marked benefit to all cases and cure in most (2, 4, 15, 17, 22). It is concluded that cooling (16) or emotion (6, 13) is a trigger mechanism to an already active sympathetic nervous system. This fails, however, to account for the peculiar local distribution of the contraction which occurs in response to general, as well as local stimuli.
A third set of ideas which must be integrated into this consideration is the relation of these diseases to the general and constant emotional status (6, 13). Older reports are reviewed by Stokvis (24), who mentions cases of Raynaud's disease in hysterical persons, or following “psychic trauma” or “shock.” The statement that 7.5% of cases of Raynaud's disease show some emotional disturbance; cases are cited in acute psychoses and in manic-depressive states. (One wonders what is meant by this term in kind and degree. This would seem a low incidence for the population in general as “emotional disturbance” as understood by present day usage.) Likewise, these were cured by hypnosis: acroparesthesia in hysteria, “dead fingers” following a fall downstairs without bodily injury in a 35 year old nurse and the same syndrome in another woman of 27 years. A later paper by Mufson (19) is of more critical import in that six cases adequately diagnosed are reported, concluding that cooling is a trigger mechamism which