OBSERVATIONS ON THE SURFACE ĊAPILLARIES IN MAN FOLLOWING CERVICOTHORACIC SYMPATHETIC GANGLIONECTOMY 1

Abstract

Quantitative studies on the capillaries of the skin of human beings have been made both before and after cervicothoracic sympathetic ganglionectomy. Nine cases of advanced Raynaud''s disease, 4 of vasomotor forms of scleroderma, 4 of primary sclero-derma, 2 of thrombo-angiitis obliterans, and 1 of arthritis of the hands have been studied. The operation did not cause dilatation of the capillaries (the usual physiologic effect) in any case. On the contrary, there was consistent narrowing of the dilated atonic capillaries in Raynaud''s disease, and an increase in the number of visible capillaries. This could be explained on the basis of a diminished concentration of a theoretic chemical dilator substance in the tissues. Following sympathetic ganglionectomy in 8 cases of vasomotor and primary forms of scleroderma, there was definite reduction in the caliber of the capillaries. The number of open capillaries for each sq. mm. of skin increased. There was quantitative evidence of arteriolar dilatation and lessened response on the part of these vessels to cold. Clinical improvement of some degree occurred in every case. In the cases of thrombo-angiitis obliterans and arthritis, in which the capillaries were of fairly normal caliber and tonus, following operation no change in the width of the capillaries was noted. The intermittent slow flow of cyanotic capillary blood changed to one that was rapid, regular, and of normal color. The number of open capillaries was increased. The major effect of sympathetic ganglionectomy is exerted on the arterioles. There is a sharp, maintained increase in the surface temp. of the skin of the hand in every case. These studies add some confirmation to the opinions of those who hold to the importance of chemical factors in modifying tonus in the capillaries of the skin of human beings. Chemical control of these vessels seems, under certain conditions, more effective than nervous control.