s.kuy 444]

CLINICAL PICTURE

185

packed with saponified fat. There can be no doubt that these cells have
in the past misled certain less experienced observers. Stages in the evolu-
tion of the nodules are shown in the illustrations. Fig. 20 shows the
early stage of cellular infiltration of the subcutaneous fat, and a further
stage in the process is depicted in Fig. 21. Here the saponified fat is
being removed and in Fig. 22 the process is nearing its end; the granu-
lation tissue is seen developing into young fibrous tissue.

Endocrine dysfunction has been variously invoked as a cause and the Endocrine
thyroid, parathyroid, ovarian, and pituitary glands have been incrimi- dysfunction
nated. The literature
on this subject is ex-
tensive but not con-
vincing, and in a large
personal experience L
have found nothing to
support the hypothesis
of disordered internal
secretion.
Local
conditions
fig. 22.—Terminal stage; beginning of young
fibrous tissue, x 50
The explanation is
probably to be sought
locally, the essential
factors being defective
venous return, excess-
ive fat, and the action
of cold. On clinical and
histological grounds
the lesion is identical
with the purple limb
and the "chilblains'
of old-standing severe
poliomyelitis. Furthermore, on clinical features and histological
appearances, the nodules of erythrocyanosis are identical with those of
Bazin's disease, the tuberculous nature of which is, to say the least,
very doubtful. The lesions of erythrocyanosis show a close analogy to
those of *fat necrosis'. It would, in fact, seem probable that all the
above lesions have a common basis. Saponification of fat is the first
event and the resulting nodule represents Nature's attempt at repair,
which in some cases succeeds without ulceration but in other cases
calls for the casting out of a slough.
3-CLINICAL PICTURE
After two or three winters certain secondary changes are evident; the Appearance
lower half of the leg, particularly its posterior surface, is of a purplish °J eg
hue which may be uniform or marked by scattered plaques of a deeper
colour (see Plate III). The colour is blanched by pressure, but when the