REPORT OF 
TWO CASES OF ERYTHROM E LAE GIA 
(Red Neuralgia—Mitchell). 
BY 
I). W. PRENTISS, A.M., M.D., 
PROFESSOR OF THERAPEUTICS, MEDICAL DEPARTMENT OF THE COLUMBIAN UNIVERSITY, 
WASHINGTON, D. C. 
Bead before the 
Association of American Physicians, 
May 4, 1897. TWO CASES OF ERYTHROMELALGIA (MITCHELL). 
By D. W. PRENTISS, M.D., 
OF WASHINGTON, D. C. 
Case I. Female, aged fifty-eight years; left hand only affected.—Mrs. C., 
aged fifty-eight years; neurotic diathesis, but has kept up and worked hard 
in household duties, keeping a summer hotel. Before this attack was “ run 
down ” physically. Disease first began in August, 1895, with burning pain 
in first finger of left hand at angle of nail next the thumb, and continued 
for two weeks in the first finger. In the autumn of 1896 extended to second 
and third fingers, then to the fourth, and finally to the thumb. 
A large, tender swelling developed at the base of the thumb, and this 
winter there is another tender spot on the back of the hand, over the third 
and fourth metacarpal bones. Sometimes over the abductor minimi digiti 
muscle. The pain is of a severe, burning character, lasting sometimes for 
days together, with remission, but not entirely absent during the attack 
The ulnar artery was cut at the wrist several years ago by a broken lamp- 
chimney, and was tied. The patient thought, perhaps, the nerve was injured, 
and this caused the trouble. This is hardly likely, however, as the pain 
began and has been most severe in the radial side. Stimulating the ulnar 
nerve at the elbow causes twitching of the third and fourth fingers. 
The character of the pain during an exacerbation is of a severe, burning 
nature, and paroxysmal, but the parts are always tender until the attacks 
pass off, then there will be freedom from pain until the next attack. Pre- 
vious treatment consisted of local applications, as chloroform, tincture of 
iodine, blistering, etc., and general treatment in the form of tonics, and espe- 
cially for dyspepsia. 
Paroxysms of pain were in recurring attacks from three to six weeks apart. 
Pain was better on lying down. Had typhoid fever thirty years ago. No 
history of malaria or of specific disease. 
October 31, 1896. She came under my care, suffering from the symptoms 
just stated. The pain was evidently very severe, as shown by the facies. It 
was felt most severely in the thumb and first and second fingers of the left 
hand, which were of a purplish-red hue and swollen. The worst pain was 
in the ball of the thumb, which was swollen and very tender. The general 
health was impaired. Heart’s action weak, but otherwise normal. She was 2 
PRENTISS, 
very nervous and slept badly on account of the pain. There was also pain 
up the arm to the back of the neck—described as a drawing pain, extending 
also to the ears, jaws, and throat, with a dull ache of the head and blurring- 
before the eyes. 
No dizziness, but occasional difficulty in walking (ataxia). Knee-jerk 
normal. 
Dyspeptic symptoms very marked, and aside from the pain in the hand it 
was the dyspepsia which called especially for treatment. 
The character of the indigestion is that common in neurasthenia—from 
innervation—not from organic stomach disease. 
For relief of pain : 
R.—Phenacetin ........ 2.00 
Caffeine . .1.00 
M.—Ten capsules. S.—Two every hour until relieved or until six are 
taken. 
Usually one dose gave partial relief. 
She was given nitroglycerin, one and one-half milligramme, three times 
a day, with tonics and bismuth and carefully regulated diet. After two 
weeks of the treatment without benefit, galvanism Avas applied from the 
hand to the back of the neck daily—three minutes at a time. This was con- 
tinued with the nitroglycerin and tonics for a month, without apparent re- 
lief, the daily pain still continuing. It was then stopped for awhile, but 
the pain became worse, and galvanism was again resorted to. The relief, 
however, was nothing to boast of, though it appeared to be the treatment 
that offered the best hope of good result. 
The nitroglycerin to strengthen the action of the weak heart and stimulate 
freer passage of blood through the capillary system, by dilating arterioles, 
also electricity, the constant current, with positive pole in the hand and the 
negative at the back of the neck, should relieve pain in the hand and relax 
spasm. 
The treatment here outlined was carried out for three months with little 
or no relief. The patient improved somewhat in general health, but there 
was no improvement of the pain in the hand. It fluctuated—sometimes 
better, sometimes worse—until 
February 18th, when the most violent attack of all occurred, the pain being 
of an intense, burning character, extending to the whole hand, though more 
severe at the points previously indicated, and following up the arm to the 
shoulder. 
The color was purplish-red with cedematous swelling of the parts most 
affected. The last joint of the middle finger was livid, as from strangula- 
tion, and appeared as though gangrene might follow. 
During the previous night she had taken six capsules of phenacetin and 
caffeine (of the former 1.20 grammes in all) without relief of pain, but with 
profuse sweating. 
A prescription containing extract of cannabis indica, 0.03; extract of ERYTHROMELALGIA. 
3 
Fig. 1. 
Palm of hand during a paroxysm; Feb. 18, areas of pain shown by the shading. 
Fig. 2. 
Back of hand during a paroxysm ; Feb. 18, areas of pain shown by the shading. 4 
PRENTISS, 
belladonna, 0.01, and salicylate of cinchonidia, 0.20 to the dose, to be taken 
every three hours, was ordered, and at night hypodermic. 
Holding up the hands gives relief. 
A hypodermic injection of morphia and atropia was given, which later 
secured relief and a good night’s rest. 
Fig. 3. 
Palm of hand showing character of the swelling. 
Pain returned with less severity the following day. 
The hypodermic was repeated in a smaller dose the next night, with the 
same good effect, and then no longer needed. 
CASE II. Female, aged thirty-seven years. Disease in both feet.—Mrs. A., 
widow, aged thirty-seven years, a neurasthenic, with severe dyspeptic symp- 
toms. No constitutional taint, as far as known ; no history of malaria. Pain 
in the heels began three or four years ago, and has recurred at intervals of 
three or four months, the attacks lasting from two to three weeks. Dur- 
ing the interval is comparatively free from pain. 
The paroxysms seem to be brought on bv physical exhaustion or any kind 
of strain to the nervous system, especially if obliged to stand or walk more 
than usual, as on one occasion when called to nurse her mother in a pro- 
longed illness. 
The pain begins as a dull ache with burning sensation; at first with a 
sensation of pebbles under the heels. As the attack progresses the burning 
increases and extends to the sole of the feet and up the calves of the legs. 
When pain becomes severe the heels are red and swollen, and shoes cannot ERYTHROMELALGIA. 
5 
be worn, as the attack increases in severity. A peculiar sensation extends 
to the head, restlessness and hysterical symptoms, and a disposition to 
scream. When asked as to severity of pain, said it was so bad that she felt 
“ she just could not stand it another moment.” 
Lying down relieves, except when at the worst, then the restlessness 
forced her out of bed, and rubbing would give her temporary relief. Cold 
relieves. Putting the feet out from under the cover was grateful. At my 
suggestion cold water was tried with benefit. Attacks more frequent and 
worse in summer than in winter and also when feet get warm in bed. 
She is drowsy and dizzy much of the time, and frequently shows an ataxic 
gait. 
Treatment has been directed to the general condition—the dyspepsia and 
neurasthenic symptoms. 
She has an idiosyncrasy against strychnia, the latter causing dizziness 
and vertigo. 
No disease of special organs discoverable. 
Fig. 4. 
Shaded areas show location of pain. 
This disease is undoubtedly a rare one, and fortunately so, for, 
as Dr. Mitchell says, treatment is almost unavailing, though patients 6 
PRENTISS, 
often go on for years without becoming worse. It occurs almost 
always in the feet. Out of sixteen cases reported by Dr. Weir 
Mitchell (American Journal of the Medical Sciences, 1878, vol. Ixxvi.) 
only one was in the hands alone, and in two the hands and feet were 
both affected. All of the others were in the feet. He gives as the 
characteristic symptoms redness, intense burning pain, and at the 
beginning rise of temperature, but later fall of temperature, with 
probably inflammation of nerves affected. It usually commences in 
the ball of the foot, or the heel, or the great toe, and extends to the 
sole and dorsum. The disease is more common in men than in 
women—twelve out of the sixteen cases reported by Dr. Mitchell 
were men. 
Another peculiarity of this affection is that it is aggravated by 
heat and relieved by cold. In Dr. Mitchell’s cases relief came from 
lying down, although in a case treated by prolonged rest—while the 
patient was perfectly comfortable in bed—the pain returned in full 
force on getting up aud walking. 
In the first case cold does not relieve the pain, and but little relief 
accompanies the recumbent posture, probably because it is in the 
hands instead of the feet. 
The causes of the disease are obscure. It seems to follow a de- 
pressed state of the nervous system, neglected neurasthenia, long 
standing on the feet, long marches, as of soldiers; reflex irritation, 
especially of the male urethra. But the disease is so rare aud these 
causes so common that such reference is unsatisfactory. 
As to treatment, it is equally unsatisfactory. The indications are 
to relieve symptoms and improve the general health. 
Neurotic or neurasthenic symptoms by baths, spinal douches, 
good food and air and tonics. The dyspepsia should receive atten- 
tion. 
For the relief of pain, cold applications. These cases are, as a 
rule, made worse by heat and relieved by cold. They are worse in 
summer and better in winter, so that a cool summer climate is indi- 
cated. 
Galvanism—the positive electrode at the periphery ; the negative 
to back of neck. 
Rest in bed, where pain is very severe. 
Possible surgical operation where indications are found. In the ERYTHROMELALGIA. 
7 
present case I think stretching or cutting of the nerves of the fore- 
arm should be tried if the pain continues. 
In regard to medicine to relieve the pain, Case I. has had phen- 
acetin and caffeine with good effect. Cannabis indica and bella- 
donna proved unavailing. 
From the chronic character of the pain opium and its prepara- 
tions should be avoided- if possible. But sometimes the suffering 
is of such an intense character that morphia is imperatively called 
for, preferably under the skin in combination with atropia. 
As to diagnosis in erythromelalgia, according to Dr. Mitchell, 
there is no other disease or group of symptoms in a well-marked 
case with which it can be confounded. There are many painful 
affections of the feet and hands, such as the effects of gout, rheuma- 
tism, sprain from flat-foot, nodes from syphilis, etc. ; but njone in 
which the train of symptoms found here exist. And that the dis- 
ease is rare is evident from the comparatively few cases reported, 
although Dr. Mitchell predicts that attention having been called to 
this form of nerve disease it will be found more common than pre- 
viously supposed. The pathology of these cases is involved in 
doubt. Erythromelalgia is classed among the vasomotor diseases, 
such as angio-ueurotic oedema and Raynaud’s disease. The pain 
either precedes or is simultaneous with the redness and swelling. 
In the case of Mrs. C. they came on at the same time. In the 
second case pain preceded the redness. This would seem to indicate 
that the sensory fibres of the nerves were first affected, the vaso- 
motor becoming involved secondarily as a result. This is also borne 
out by the severe pain on pressure at the points most affected. With 
the redness and swelling, however, the pain is greatly aggravated. 
The diseases to which it is most nearly allied are angio-neurotic 
oedema and Raynaud’s disease. 
In the former there are three forms described. The pale form 
(neuro-lymphangioma), due to dilatation of the lymphatics of paretic 
origin ; the red form, due to angio-paralysis, and the dark-red, pur- 
plish form, caused, according to Eskridge (Wilson’s Applied Thera- 
peutics, p. 981), by spasm of the arterioles, which “ checks the vis a 
tergo of the arterial current in propelling the current forward, and 
spasm of the small veins, which may force the blood backward into 
the arterioles.” 8 
PRENTISS, 
Some such explanation as this may apply to erythromelalgia, but 
is altogether hypothetical. 
Angio-neurotic oedema is supposed to be a form of urticaria — 
“ the greater urticaria”—a functional nervous disease, caused by 
indigestion or transient nervous excitement. In some of the cases 
which I have seen it has been attributed to a spider bite—I need 
not say without cause. The element of pain is secondary in angio- 
neurotic oedema, and not important. 
This disease cannot be confounded with the one under considera- 
tion. 
The diagnosis for Raynaud’s disease, though still more marked, 
deserves special notice, since many of the cases of erythromelalgia 
reported by Mitchell were pronounced by high authority to be cases 
of Raynaud’s disease (Osier’s Practice of Medicine, 1892, p. 962). 
The two diseases in many respects are the opposite of each other. 
This is perhaps best shown in the comparison in parallel columns 
given by Lannois (article on “ Erythromelalgia,” 1880, p. 71; Weir 
Mitchell’s Clinical Lessons on Nervous Diseases, 1897, p. 179). 
Local asphyxia (Raynaud). 
Sex, four-fifths females. 
Begins with ischeemia. 
Affected part becomes bloodless and white. 
In certain cases there is the deep, dusky 
congestion of a cyanosed part, with or with- 
out gangrene. 
Pain may be absent or acute, and comes and 
goes; has no relation to position ; may pre- 
cede local asphyxia. 
Unaffected by seasons. In many cases all the 
symptoms can be brought on by cold. 
Anaesthesia to touch. 
Analgesia. 
Temperature much lowered and unaltered by 
posture. 
Gangrene local and limited ; likely to be 
symmetrical. 
Erythomelalgia (Mitchell). 
In twenty-seven cases two were females. 
Little or no difference in color until foot hangs 
down in upright posture, when it becomes 
rose-red. 
Arteries throb and parts become of a dusky 
red or violaceous in tint. 
Pain usually present; worse when part hangs 
down or is pressed upon. In had cases 
more or less at all times. 
Worse in summer and from heat; eased by 
cold. 
Sensation of all kinds preserved. 
Hyperalgesia. 
Temperature greatly above normal; depend- 
ency causes, in some cases, increase of heat; 
in others lowering of temperature. 
No gangrene; asymmetrical. 
This comparative statement should make it clear that erythro- 
melalgia and Raynaud’s disease are distinctly separate. 
Two other conditions are mentioned as belonging to diseases of 
the vasomotor system, namely, adiposis dolorosa (Dercum’s disease) ERYTHROMELALGIA. 
9 
and acromegaly, both attended with peculiar changes of nutrition 
and without doubt from disease of the central nervous system. 
In acromegaly there was found “ enlarged pituitary body, with 
enlarged sella turcica, persistence of the thymus gland, and hyper- 
trophy of the fibres and glands of the vasomotor system (Wilson : 
American Text-book of Applied Therapeutics, 1896, p. 988). These 
facts are mentioned as having a bearing upon the plausibility of 
erythromelalgia being essentially a central disease. 
There is more reason for this hypothesis in the fact that a number of 
the cases reported developed into well-marked disease of the cerebro- 
spinal axis and ran their course to a fatal result (Mitchell). Dr. 
Mitchell wTas disposed at first to this opinion, but in his recent work 
(Clinical Notes, 1897, p. 180) he “inclines rather to some of that 
new clinical perplexity, peripheral neuritis.” 
The action of ergot (ergotism) in producing gangrene of the 
extremities is of interest as bearing upon the general question of 
causation of vasomotor affections by central disease. 
Ergot acts upon the vasomotor centres—in small doses by stimu- 
lating, in large doses by depressing (H. C. Wood’s Therapeutics). 
Dr. H. C. Wood mentions a case (loc. cit.) of fatal ergot-poisoning 
in which there were gastric irritation, thirst, diarrhoea, burning pain 
in the feet, and convulsions. 
The principal vasomotor centre is in the medulla oblongata, be- 
tween the corpora quadrigemina and calamus scriptorum (Ludwig 
and Thiry, Owsjannkow ; and Dittmar, Erb-Dis. Medulla Oblong.). 
Also in spinal cord, secondary centres in gray matter as far down 
as the lumbar vertebrae (Goltz, Vulpian, loc. cit.). 
Dr. Schenk, in an article published recently in the Medicinische 
Presse, states the disease is no doubt due to vasomotor disturbance 
consequent on an ascending degeneration in the posterior column of 
the cord. Woodnut has also described a case of erythromelalgia, 
attributing it to myelitis (London Lancet). 
Referring again to Mitchell’s Clinical Notes, he says : 
“At the time I wrote (1878) I should, if driven to be positive in statement, 
have inclined toward considering this malady as due to some form of spinal 
disorder. 
“ But at present the reasonable explanations incline rather toward some 
form of that new clinical perplexity—peripheral neuritis.” (Loc. tit., p. 180.) 10 
PRENTISS, 
In Case LVIII. (of Clinical Lessons, not the fifty-eighth case of 
erythromelalgia) the disease was the result of an injury—a stone 
falling on the foot. 
This case is reported in great detail, and serves to strengthen the 
theory of peripheral neuritis, from the fact that it was caused by 
(or followed) a local injury. Dr. Mitchell further goes on to say : 
“ I use the word neuritis, nerve-end neuritis, with more or less doubt. 
Some such distinct affection of the smaller nerves does seem to me probable, 
but whether it is congestion, neuritis, or some other of the undescribed 
changes in the lesser nerves or in the ultimate nerve-plates, we may not as 
yet decide with certainty.” 
Again (loc. cit.), “ Neuritis is becoming a sad puzzle. We may have it 
with paresis and little pain; we may have it without notable paresis and 
horrible pain. It exists with or without notable myositis.” 
Again, “ It may give rise to causalgia, joint-troubles, and alterations of nails 
and hair. It may fail to disturb nutrition, or greatly to alter local heat. 
And, lastly, if erythromelalgia be a neuritis it may cause pain and flushing, 
and to these increased enormously by dependency of the part may add such 
a rise of temperature as is rarely seen in acute local inflammation.” 
Dr. Mitchell continues to discuss the possibility of the existence 
of neuritis of such a character as to single out individual elements 
in a nerve containing fibres of sensation, motion, nutritiou, and vasal 
control-—affecting some and not others. Such an hypothesis seems 
untenable. 
In Case LVIII., previously referred to, the excised portions of 
the musculo-cutaneous and internal saphenous nerves were examined 
microscopically and found “ absolutely normal.” 
To sum up the pathology of them, we have the choice between : 
1. Disease of the central nervous system, or 
2. Peripheral neuritis affecting principally or only the smaller 
nerves or nerve-endings. 
In the former we should expect the disease to be located in the 
medulla oblongata between the corpora quadrigemina and calamus 
scriptorum, or in the posterior segment of the spinal cord as far 
down as the lumbar vertebrae. 
The central theory seems the more plausible, but at this time is 
purely hypothetical, there beiug no dissections to support it. 
The opinion of peripheral neuritis of a peculiar character is given ERYTHROMELALGIA. 
11 
a show of plausibility from two cases reported by Dr. Mitchell which 
followed local injury. 
However, in both of these cases operated on, the nerves were 
exsected, and the nerve-trunks thus removed found normal. 
This fact would locate the neuritis in the nerve extremities. 
We will close this report by a reference to treatment, which, un- 
fortunately, can be shortly disposed of. Thus far curative treatment 
has been of no avail, except in one case, by surgical interference. 
The treatment divides itself into three indications: 
1. That of the general health—neurasthenia, nervous dyspepsia, 
and hysteria especially. 
2. The relief of pain. For this purpose phenacetin protected by 
caffein seems of first value. Cannabis indica and belladonna in the 
first of the present cases proved useless, as did also the phenacetin 
in the most violent paroxysms. 
During the latter subcutaneous injection of morphia is imperative, 
but the objection to its frequent use is obvious. Rest in bed and 
cold applications have their place. Wendel reports a case cured by 
liq. acidi arseniosi, together with general treatment (New York Medi- 
cal Record, 1890, vol. xxxviii. p. 545). 
3. Surgical treatment. Exsection or stretching of the nerves was 
contemplated in the first case, but there being no precedent for it, 
and fearing serious nutritive changes, it was not determined on. 
This was before reading Dr. Mitchell’s Clinical Lessons, 1897, in 
which he reports two cases thus treated, the first one with success 
in relieving the patient. In the second case, however, gangrene, 
resulting fatally, followed. 
The operation in the former cases, the first of its kind in this dis- 
ease, I quote from Dr. Mitchell’s book (loc. cit., p. 192): 
“ Dr. Keen operated on April 10th. He exsected two and a half inches of 
the muscular cutaneous nerve and the same length of two branches of the 
internal saphenous. The two end branches (plantar) of the posterior tibial 
nerve were stretched at the internal malleolus with a traction of fifteen 
pounds thrice used. The result next day was remarkable. There was almost 
immediate relief. The foot could be squeezed, pinched, or pricked without 
pain. Anaesthesia was not as extensive as we were led to expect it might 
be. The day following the operation the temperature—right, 95° ; left, 
93.5°; mouth, 99.5° (it was the right foot operated). On the right clonus 
still present, and knee-jerk was still extensive. The wound healed in a 12 
PRENTISS, 
few days. On May 4th the patient was able to walk on crutches. Clonus 
had disappeared and reflexes were no longer exaggerated. There was still 
some flushing when pendant, but no pain nor hypersesthesia. When dis- 
charged—May 6th—he could walk well, but was ordered to continue the 
use of crutches as a measure of precaution, and had also a bandage applied 
daily. 
“ Dr. Kyle reports culture of blood and nerves obtained at the operation 
as yielding purely negative results. . . . June 7th, S. is reported well, 
and walking easily without crutches. Six months later he was at his work, 
as a stonemason, and entirely free from pain.” 
Thus it appears that at least one was cured by surgical procedure. 
The second case thus treated (Case LIX. of Clinical Lessons) was 
more unfortunate. I will only mention the operation and result. 
Operation April 12, 1894, by Dr. T. P. Morton. Four inches 
of the musculo-cutaneous nerve aud five inches of the internal saph- 
enous excised. The posterior tibial behind the internal malleolus 
stretched with force of twenty-eight pounds. On the fifth day gan- 
grene developed. A week later amputation was performed, with 
death on the operating-table. 
Commenting on this case, Dr. Mitchell says: “As to operative 
relief I think that in future I should stretch all the nerves and 
leave the section of their trunks to be resorted to if milder means 
gave no fortunate results” (loc. cit., p. 204). 
In conclusion I append titles of bibliography of erythromelalgia, 
taken from the card catalogue of the Library of the Surgeon-Gen- 
eral’s Office. These titles do not appear iu the large published 
Index Catalogue. 
The disease had not been differentiated at the time the volume of 
the Index Catalogue, in which they would have appeared, was com- 
piled. 
Bibliography. 
Mitchell, S. Weir. Philadelphia Medical Times, 1872-1873, vol. iii. pp. 81 and 113. 
The American Journal of the Medical Sciences, July, 1878. 
Clinical Lessons on Nervous Diseases, 1897. Philadelphia, Lea Bros. & Co. 
Fischer, E. Ein Fall von Erythromelalgie. St. Petersburg, med. Wochenschr., 1895, n. F. 
xii. 70. 
Senator, H. Ueber Erythromelalgie, 8vo. Berlin, 1892. Refr. from Berl. klin. Wochenschr., 
1892, No. 45. 
De Sauctis, G. Contributo alia casistica della eritromelalgia. Incuabili, Napoli, 1895, xi. 
144-156. 
Bignone, A. Contributo alio studio clinico dell’ eritromelalgia. Gaz. d. Osp., Milano, 1894, 
xv. 1122-1124. ERYTHROMELALGIA. 
13 
Nolen, W. Erythromelalgie. Nederl. Tijdschrift von Geneeskunde, 1894, t. 2, xxx. pt. 2, 
521-529. 
Christiani, A. Due casi di eritromelalgia (paralisi vasomotrice delle extremita) in alienati 
di mente. Riforma med., Napoli, 1894, x., pt. 4, 4-8. 
Charles, M. Sur un cas d’erythromelalgie. Pratique med., Paris, 1892, vi. 207. 
' Wendel, A. V. Erythromelalgia. Medical Record, New York, 1890, xxxviii. 545. 
Lombroso. C., and Ottollenghi, S. Eritromelalgia in una truffatrice. Arch, di psichiat., 
etc. Torino, 1888, ix. 593-596. 
Berbez. Note sur un cas d’erythromelalgie. Bull. Soe. clin. de Paris, 1887 (1888), xi. 1-4. 
Mitchell, S. Weir. A Case of Erythromelalgia. Polyclinic, Philadelphia, 1884- 85, ii. 110. 
Case of Erythromelalgia. Journal of Nervous and Mental Diseases, New York, 1884, 
n. s. ix. 638-641. 
Auche and Lespinasse. Sur un cas d’erythromelalgie ou nervose congestive des extremites. 
Rev. de med., Paris, 1889, ix. 1049-1055. 
Van Millingen. Contribution a l’etude de l’earythropie. Ann. d’ocul. Paris, 1892, cviii. 
417-419. 
Eulenburg. Ueber Erythromelalgie. Deutsche med. Wochenschr. Leipz. u. Berl., 1893, 
xix. 1325-1329. 
Staub, A. Ueber Erythromelalgia. Monatsh. f. prakt. Dermat. Hamb., 1894, xix. 10-14. 
Montschnit, A. Deuch. eritromelalgie zuzhno-rusk. Med. Gaz., Odessa, 1894, iii. 97-99. 
Lewin, G., and Benda, T. Ueber Erythromelalgie ; kritische studie auf Grand der eigener 
und der von den Autoren publicirten Falle. Berl. klin. Wochenschr., 1894, xxx. 53-56; 87- 
90, 17-119, 144-146. 
Dunges. Ein Fall von Erythromelalgie. Prakt. Arzt. metzlar, 1893, xxxiv. 217, 219. 
Mitchell, S. Weir. Erythromelalgia ; red neuralgia of the extremities; vasomotor paralysis 
of the extremities ; terminal neuritis (?). Medical News, Philadelphia, 1893, lxiii. 197-202 
Haslund. Et Tilfaelde af Erytromelalgi. Hosp.-Tid, Vyxbeuh., 1893, 4, 2, i. 649. 
Gerhardt, C. Ueber Erythromelalgie. Berl. klin. Wochenschr., 1892, xxix. 1125. 
Senator, H. Ueber Erythromelalgie. Berl. klin. Wochenschr., 1892, xxix. 1127-1129. 
Bernhardt, M. Ein Fall von Erythromelalgie. Berl. klin. Wochenschr., 1892, xxix. 1129. 
Gerhardt, C. Ueber Erythromelalgie. Deutsche med. Wochenschr., Leipz. u. Berl., 1892, 
xviii. 865. 
Staub. Ueber Erythromelalgie Verhandl. d. deutsch. dermat. Gesellsch. Wien u. Leipzig, 
1894, iv. 429-434. 
Dehio, K. Ueber Erythromelalgie. Berl. klin. Wochenschr., 1896, xxx. iii. 817-821. 
Pajor, S. Az erythromelalgiarol. Zyogyaszat, Budapest, 1895, xxxv. 607-610. 
Dehio, K. Ab eretromelalgii. Russk. arch, patol. klin. med. i bakteriol. St. Petersb., 1896, 
i. 145-157. 
Wendel, M. D. Newark, N. J. [Med. Record, 1890, xxxviii. i. 45.] 
Mitchell, S. Weir. Polyclinic, Philadelphia, 1884- 85, p. 110. Record of case (hospital) as kept 
by notes at time. Very explicit and instructive. Severe case. No treatment mentioned. 
Journal of Nervous and Mental Diseases, New York, 1884, etc. This article identical 
with the above. 
Medical News, 1893.