Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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Are morbid conditions, to which all glands are more or less subject.
The most noted of these inflammations is

Parotitis, Angina Parotldea, Mumps.

This affection generally seems to prevail epidemically in damp sea-
sons, and usually attacks children and young people ; but it is also
often found in cases of scarlet fever ; when, of course, it must be con-
sidered as a symptom of the latter. Miwips is an epidemic form of
this inflammation. It is very apt to be modified in its action by
metastasis; appearing in the testicles in the one sex, and in the
mammge or ovaries of the other.

It begins as a swelling in front of and below the ear, and extends
sometimes over the whole affected side of the face, involving the sub-
maxillary glands and tonsils, changing the features of the patient, hin-
dering speech, mastication and even deglutition. The color of this
swelling may be nearly normal, or pale ; but often it is very red and
sometimes purple. It is almost always attended with fever.

Mismanaged cases may end in induration, suppuration and even
mortification.



Bellad., a height-red sivellhig, especially on right side.

Rhus t., if dark red, and especially on left side.

iVlerc. fol., if 2-)cjfe.

Carb. veg., Coccu!., tuith lingering fever.

Puis., in case of metastasis to the mamse.

Carbo veg., Ars., to the testicles.

Arsen., Phos., Silic, when suppurating.

Lye, Nit. ac, Phyiol., with fistulous openings.

Baryta mur., Calc. c, Carb. veg., Sulph., wlien indurated.

Baryta mur., Kali c, Rhus t., after scarlet fever.



DISEASES OF THE SALIVARY ORGANS. 107

Ranula, Frog.

By this term is meant a swelling, which grows slowly on the floor
of the mouth under the tongue, either in the middle, or on one side of
the frtenum liuguee, and which is supposed to be a widening of Whar-
ton's duct. Scliuh, however, considers it to be an independent cyst,
not connected with that duct. Whatever it be, its objective symp-
toms are the following : it is a soft, elastic, fluctuating and transpa-
rent kind of blister or bag, whose sheath is similar to a fine serous
membrane, and the contents of which consist of a gluey, transparent,
pale-yellowish or brownish fluid, of alkaline reaction, and without
microscopic elements. It may grow to a considerable size, so as to
interfere with chewing, talking, and even breathing.

It varies considerably in size and form, the latter depending some-
what on the former. When small it is globular ; but as it increases
in size, the shape is modified by the surrounding tissues.

Therapeutic Hints, — Compare Bell, Calc. c, Fluor, ac, Merc,
Mezer., Nitr. ac, Thuya.



These are two almond-shaped glandular organs, which are situated
on each side of the fauces, between the anterior and posterior pillars
of the soft palate. They are liable to



jsillltis, Acute Inflammation^ Quinsy.

In this affection there are redness and swelling of all the adjacent
structures ; so that the aperture of the fauces seems encroached u.pon
from all sides. The aflected tonsil protrudes towards the uvula, which
is swollen and elongated ; and the whole mucous membrane of the
fauces is remarkably red and injected. Even the submaxillary region
sometimes becomes involved in this process.

Deglutition is extremely painful; the tongue has a thick, white,
and sometimes buff-colored coating. This complaint is attended by
some fever. Its course is usually rapid, ending in a few days by
suppuration, or occasionally by resolution. Persons once affected by
tonsillitis are liable to repeated attacks.

Therctpeutic Hints,

Ammon. mur,, both tonsils much swollen ; can neither swallow, talk,
nor open the mouth ; after taking cold.



108 SALIVAEY OEGANS.

Apis me!!., stinging, burning pain when swallowing; dryness in
the moath and throat ; red and highly-inflamed tonsils.

Baryt. c, liability to tonsillitis after slight cold, or suppressed
sweat of the feet ; tonsils incline to suppurate ; especially right side.

Bellad., especially right side; also swelling of the neck, externally;
painful to touch and motion ; congestion of the head.

Hepap, sticking pain as from a fishbone in the throat when swal-
lowing ; tendency to suppurate ; after mercury.

Laches., especially left side ; choking when drinking ; fluids are
driven out through the nose ; worse in afternoon, after sleep, from
slightest touch ; can't bear bed-clothes near the neck.

Merc, dark redness; fetid ptyalism; very offensive smell from
the mouth ; aphthse, or thick coating on the tongue.

Silic, in stubborn cases where abscesses form, yet don't break;
especially left side.

Sulphur, when, after the bursting of the abscess, the parts still
remain irritated, and the patient does not recover as fast as he
should.

Eecornmended without special indications, Grels., PhytoL, Podoph.,
Sanguin.

Ulceration of the Tonsils.

This affection is either a sequela of an acute attack of inflam-
mation, or of scarlet fever ; or else it has a scrofulous or syphilitic
origin. To define it the whole history of each case will have to be
questioned. Its treatment must therefore be determined entirely by
the totality of the symptoms of the individual case, and not simply by
the ulcers on the tonsils.

Chronic Enlargement of the Tonsils

Often occurs in scrofulous children. It is often developed to such an
extent as to impair respiration, and even the sense of hearing, in
case the swelling should extend to the Eustachian tubes. Simple
inspection discovers the whole complaint. Children affected in this
way generally keep their mouth open, and they always " sleep with
the mouth open, the head thrown back, and with loud snoring.

Therapeutie Hints. — As generally indicated, compare Bar. c,
Calc. c, Ign., Lye, Sulphur.



UVULA AND SOFT PALATE. 109

The Uvula and Soft Palate.

Botli of tliese structures are subject to inflammation, and are
always more or less involved in tonsillitis.

Inflammation of the uvula causes a swelling and elongation of tliis
little body, sometimes to sucb a degree that it lies like a little finger
upon the tongue, causing a constant hacking and hemming, except
when lying on the back. This is what in common life is styled fall-
ing of the palate. Both are subject to ulceration of different forms —
idiopathic, scrofulous, syphilitic.

Therapeutic Mints.

As acting especially upon the uvula and soft palate, compare Aeon,,
Bell,; Coffea, Crot. tigl., Lach,, Merc, Nux. v., Natr. m., Bhosph.

The Fauces.

By this term we mean the back part of the root communicating
superiorly with the posterior nares, inferiorly with the pharynx and
larynx, and anteriorly with the cavity of the mouth. They are sub-
ject to exactly similar inflammations as the adjoining parts already
considered ; and as they are lined by the same mucous membranes,
they are almost always more or less involved in those inflammatory
processes of which we have spoken. Still there may be an inflam-
mation of the fauces alone without much swelling of the tonsils or
palate, a condition which is generally termed sore throat, angina
faucium.

Angina Granulosa or Foilicularls.

This affection is generally of a chronic form and is very frequently
observed in this country. Ocular inspection discovers upon the
pharyngeal wall of the fauces little, roundish, smooth, elevated
spots, like peas split in half, which either stand singly, scattered over
that surface, or in rows or ridges extending from above downwards.
They are swollen follicles or sebaceous glands. The surrounding
surface of the fauces is always more or less inflamed, and often coated
with a thick, tough, yellowish, or greenish phlegm, which adheres
tightly to the wall and seems to come down from the posterior nares ;
.sometimes, however, the fauces appear YQyj dry. As it frequently
attacks public speakers, clergymen, and the like, it is popularly
known under the name of preacher^s sore-throat. The inflammation



110 THE FAUCES.

is not confined to the pharyngeal part of tlae fances, but may spread
down to the larynx and trachea, causing a constant inclination to
cough. The color of the fauces varies from a bright redness, with
enlarged veins radiating hither and thither, to a deeply-injected
brown-red hue.

Therapeutic Mints.

Alumina, soreness, rawness, hoarseness, dryness; or secretion of
thick, tough phlegm ', worse in the afternoon and evening ; better
from eating and drinkiug warm things.

Arum triph., constant hawking; profuse secretion from posterior
nares and fauces ; hoarseness worse from talking.

Arg. nitf., collection of thick, tough phlegm, causing gagging; wart-
like excrescences ; feeling of a pointed body in the throat when swal-
lowing, belching, breathing, or moving the neck.

Arnica, great hoarseness from preaching or public speaking.

KaSi bichr., secretion of very ropy or stringy phlegm through the
posterior nares and fauces.

Lachesis, much inclination to swallow, although it is very painful,
with spasmodic contraction of the throat ; worse on left side, and
worse after sleep ; can't bear any pressure about the neck.

Lycop., the fauces look brown-red; worse on right side ; sometimes
a hard, green-yellowish phlegm is hawked up in the morning.

Natf. m., always after a local application of nitrate of silver ; feel-
ing of great dryness in the throat, and yet a constant hawking up of
a transparent thin mucus.

Petrol,, in dry sore throat, and with mucous secretions; stitches into
the ears durins; des-lutition, and burning in the neck.

Phosph., when the throat is very dry, fairly glistening.

Plumbum, when the disease spreads from left to right.

Sapo sodse, after burning the throat by swallowing hot things.

Phytol., dryness, feeling as if a ball of red-hot iron had lodged in
the fauces, when swallowing; can't eat hot fluids; choking sensation.

Ulcers m the Fauces, Ulcerated Sore-Throat.

The above-described inflammation of the follicles may terminate in
ulceration ; or the ulcers may be in consequence of a scrofulous diath-
esis ; or they may have a syphilitic origin. The diagnosis of these
different conditions might be accurately determined by a correct his-
tory. Besides, the diagnosis will be facilitated by considering that
catarrhal ulcers are superficial; the scrofulous ulcer is deep, but has



DISEASES OF THE FAUCES. Ill

flabby, perhaps jagged edges, whicli do not project; tlie syphilitic
nicer, however, is deep and rounded, with elevated serpiginous and
defined borders.

Therapeutic Miuts. — Compare Angina faucium.

Alumina, the inflamed parts are spongy ; the ulcerated surface secretes
a yellow-brownish, badly-smelling pus , a boring pain from the fauces
to the right temple and head.

Aurum, putrid, cheese-like smell from the mouth; deep ulcers affect-
ing the bones ; after the abuse of mercury

Baptisia tinct., putrid, dark-looking ulcers; fetid breath; great pros-
tration.

Hydrastis can., extensively used by western Homoeopathic physi-
cians for ulcerated sore-throat ; no characteristics given.

Kali bichr., deep ulcers, eating even through the velum palati ; bones
of the nose affected ; fetid discharge from the nose ; syphilitic origin.

Lachesis, spasmodic contraction of the fauces when swallowing, &c. ;
compare Inflammation of Fauces.

IVSerc, ptyalism, fetid smell; secondary syphilis.

Nitr. ac, after the abuse of mercury ; syphilis.

Sanguin., rush of blood to the head; flying heat; throbbing in the
head from the nape upwards; distended veins in the temples,

Retro-pharyngeai Abscess.

This is a gathering behind the posterior wall of the fauces, be-
tween its pharyngeal portion and the cervical vertebra. It com-
mences with swelling, stiffness of the neck, and an inability to carry
the head erect. At the same time swallowing becomes more difScult,
and, in the attempt to swallow fluids, they return through the nose.
The breathing becomes difl&cult, noisy, and rattling, and the patient
talks through the nose and very indistinctly. On examination, the
whole fauces appear highly inflamed, and a swelling is discovered
protruding from the pharyngeal wall of the fauces on one side of
the median line. It sometimes attains the size of a hen's Qgg, and
thus impedes respiration, sometimes dangerously. It is often con-
nected with caries of the cervical vertebras. This affection may be,
and has no doubt been, often confounded with tonsillitis^ and I do not
knov/ whether the popular term ^' quinsy''^ has not just as often been
applied to this kind of abscess as to tonsillitis.

The difference between retro-pharyngeal abscess and tonsillitis
lies in their respective location. The first is situated further back



112 MUCOUS MEMBEANE OF THE MOUTH IN GENEEAL,

and lower down, altliougli almost always above the level of tlie
epiglottis ; whilst tonsillitis appears more anteriorly on the sides,
precisely in the position of the tonsils. A careful ocular inspection
will teach this.

From croup it is easily distinguished by its appearance, its nasal
voice, and its aggregation in a horizontal position, whilst croup
has its peculiar-sounding cough, a hoarse voice, and amelioration
in a horizontal position, or even backward inclined position of the
head.

Therapeutic Hints. — Main remedies, Hepar, Silicea.
In the attempt to swallow fluids they regurgitate through the nose :
Aurum., Bell., Lach., Lye, Merc, Nitr. ac, Phos.

The Mucous Membrane of the Mouth m General.

This is a continuous membrane covering tlie inside of the cheeks
and all the organs within the cavity of the mouth except the teeth,
lining the fauces, and extending thence upwards into the nose and
downwards into the oesophagus, stomach, and intestines, and by way
of the larynx and trachea into the finest bronchial tubes.

Its Special Diseases.

The Sore Mouth of Infants — Thrush.

This affection appears on different parts of the mucous membrane in
the mouth, on the lips, tongue, pharynx, and even in the oesophagus,
but scarcely ever in the stomach; more or less extended, in the
shape of whitish, somewhat elevated points or patches, covering,
sometimes, the whole mucous membrane like a creamy, cheesy
crust. If we remove this coating the mucous membrane underneath
appears sound and unhurt, or only slightly reddened. On exam-
ination by the microscope these creamy masses appear to consist of
accumulated epithelial cells, fat-globules, &c., and a vegetable sponge-
like parasite, which branches out tree-like in every direction, and,
if very numerous, mats the whole coating into a thick, dirty -yellow-
ish mass. This is the thrush of infants in their first days or weeks,
seldom in the second month of their lives.

The thrush of adults is of rare occurrence, and is found only in con-
sequence of long and exhausting diseases shortly before death. Its
pathological character is identical with that described above.



APHTHA OF THE MOUTH. 113

Thevapeiitic Hints.

Wash the mouth always after nursing with a rag dipped in water
or a mixture of wine and water.

Arsen., in adults, great burning, exhaustion, deep illness.

Borax, great heat and dryness in the mouth,

Mercup., confluent thrush, changing into cankers; ptyalism; bad
smell from the mouth ; feverishness ; green slimy stools.

Staphis., thrush changing into canker-sores with a bluish-red or yel-
lowish bottom ; more or less flow of saliva and bad smell.

Sulphur, sour smell from the mouth ; stools slimy with much
straining, or painless ; worse in the morning.

Sulph. ac, after borax, increased flow of saliva, yellowish color of
the skin.

ae of the Mouth.

According to Bednar, aphthse are roundish or oval shaped patches
of exudation of the mucous membrane of the mouth, usually situated
at the angle v/hich is formed by the roof of the mouth with the upper
alveolar processes of the soft palate ; but are sometimes dispersed in
considerable number all over the mucous membrane of the mouth,
and on the tongue. There appears at first a network of injected
blood-vessels ; and a day or two later, exudation takes place, of the
size of a pin's head. This exudation enlarges to the size of a lentil,
is grayish or yellowish-white, and is surrounded by a red, inflamed
areola. As they enlarge, some of them coalesce. By-and-by the ex-
udation dissolves, and leaves an excoriated surface of submucous cel-
lular tissue, circumscribed by the excoriated mucous membrane. It
heals again without a cicatrix.

Thrush and aphthse exist simultaneously; and this is, no doubt, the
reason why we also find them mixed up iu books. We must remem-
ber, however, that nature does not follow books, but has her own
notions ; so that, under certain circumstances, thrush too might leave
excoriated spots, and show thus a connecting link between itself and
aphthie.

What Bednar describes under the name of aphthse seems to me to
correspond more or less to what is commonly called cankers of the
raouth.

Tlierapeiitic Hints.

Calc. c, canker-sores, especially during teething.

Helleb., canker-sores, flat, yellowish, with raised edges upon an



114 MUCOUS MEMBRANE OF THE MOUTH IN GENERAL.

inflamed basis ; ptyalism ; fetid smell from the m.outh ; glands swollen
on the neck and under the jaw.

Lachesis, canker-sores on tip of tongue.

Lycop., canker-sores under the tongue, near the frjenulum.

Mercup., thrush confluent, changing into cankers; ptjalism, bad
smell from the mouth, feverishness.

Nitp. ac, canker-sores; saliva fetid and acrid, causing new sores
on lips, chin, and cheeks ; pustules, with red circumference, here and
there on the body.

Nux vom., canker-sores, gums inflamed, putrid smell from the
mouth, constipation.

Staphis., thrush, which changes into canker-sores with a bluish red
or yellowish bottom ; more or less flow of saliva and bad smell.

Sulphup, canker-sores ; after Nux v. or Merc, , gums swollen, bloody
saliva runs out of the mouth.

Diphthena, Diphtheritis.

This disease has been observed and described by medical writers
of all nations under different names. Its history has indeed been
traced back as far as Homer. In the sixteenth century it was
epidemic in Holland, and was described by P. Forrest. Towards the
end of that century it raged in Spain, killing a great number by suffo-
cation ; whence it was called garoiilla. Since then it has been observed
everywhere, more or less violent ; and in this country within a few
years.

It consists of a croupous or plastic exudation from the mucous mem-
brane of the fauces, mouth and nostrils ; commencing with febrile sen-
sations, chilliness and some difficulty in swallowing. The fauces look
inflamed ; of a dark mahogany color ; and soon become covered (usu-
ally after the first or second day) with a dirty-grayish, or gray -yel-
lowish exudation of various thickness ; commencing in spots and
patches, generally on the tonsils at first ; spreading over the soft palate
and fauces into the posterior nares and cavity of the nose, and in some
cases into the oesophagus and larynx. When this skinny exudation
is loosened and removed by external means, it shows a merely inflamed-
looking, sometimes an excoriated or ulcerated surface of the mucous
membrane beneath, which soon is covered again by the same skinny
mass. Where it loosens itself and is thrown off' spontaneously, it gen-
erally does not renew itself In malignant cases this pseudo-membrane
dissolves into an ill-looking ichorous mass,' under which the mucous



DIPHTHERIA, " 115

memlDrane appears in decayed shreds or dark-colored crusts, emitting
a most oflensive odor. Mostly there co-exists a swelling of the sub-
maxillary and parotid glands and of the lymphatics. The great pros-
tration of all the vital power, which accompanies it from the first, is
quite characteristic of this complaint.

As to its causes, all writers agree that it is the effect of some specific
poison, the nature of which we know just as little as that of cholera,
typhus, or yellow fever ; and as all persons are not attacked by it, it
requires a predisposition of the organism to it. We do not know,
however, in what this consists. Besides, the atmospheric influences
upon its spreading are not clearly understood : it seems, however, that
it is rather more prevalent in spring and summer than in winter, and
more in damp, rainy weather than in a uniformly dry temperature.

Diphtheria is not contarjious, like the eruptive fevers, (scarlatina,
measles, small-pox ;) there is no evidence that it ever was conveyed
hj fomites ; but we can easily conceive of an epidemic cause, which
may bring about more or less contamination of the atmosphere, thus
rendering susceptible persons liable to contract the disease from
breathing the atmosphere ; or it may be propagated by an immediate
inoculation of a portion of the vitiated secretions to an absorbent sur-
face of another person, provided this person afford a congenial soil in
which the specific cause may develop its specific effects.

1, Symptoms of the fauces are soreness and redness of the throat.
The latter symptom may be confined to the uvula, velum palati, one
or both tonsils ; or it may extend all over the fauces. The redness
may be of a dusky hue ; mottled, or of a light mahogany or pinkish
color. The parts are generally swollen ; the tonsils to such a degree
as even to interfere with swallowing. Usually after the first or second
day we observe some small whitish-gray spots on one or both tonsils,
which either soon coalesce or stay separated through the whole
morbid process ; or there may be a uniform deposit of this whitish-
gray exudation over the entire throat. At first it is easily de-
tached from the mucous membrane, but is soon replaced by a new
deposit ; later, however, it becomes thicker, more tenacious, leather-
like ; and adheres more firmly to the subjacent tissue, leaving,
if it be detached, a bleeding surface behind it. On or about the
sixth day it usually dislodges itself spontaneously, and may then hang
down in shreds and strings into the pharynx, or from the posterior
nares clown into the fauces ; after which, no new formation usually
takes place. In malignant cases this pseudo -membrane dissolves,
as stated above^ into a bad-looking, ichorous mass, under which the



116 MUCOUS MEMBEANE OF THE MOUTH.

mucous membrane appears in decayed shreds or dark-colored crusts,
and it is not unfrequent that whole parts of the soft palate become
thoroughly destroyed. As regards the nature of this membrane it is
believed to be more of an albuminous, whilst that of croup is more of
a fibrinous character.

Diphtheritic membranes may be found also in other localities, as in
the vagina; or on cutaneous surfaces, when wounded, ulcerated or
abraded.

2. Symptoms which accompany this affection of the throat are : Dif-
ficulty in siuallowing, especially cold drinks ; this symptom, however,
may be altogether wanting, even in very severe cases. Difficulty
in hreathing^ especially when the tonsils are much swollen, or when
the nose is filled with exudation and discharge. A peculiar odor of
hreath, which is more easily smelled than described; in malignant
cases it becomes almost unbearable, scenting the whole room.

3 Nasal symptoms. Thin yellowish-white mucous discharge, at
first scanty, but becoming profuse, acrid, excoriating. Epistaxis —
unfavorable. The deposition of the pseudo-membrane may commence
in the nostrils before any is seen in the fauces.

4. Symptoms of the larynx. As the disease progresses, we may/
observe hoarseness, total loss of voice, cough, croup, (in all its dread-
ful utterances,) sufibcating spells; livid complexion; embarrassed,
sawing respiration, up to the final fatal issue.

5. Glandular affections. The tonsils are almost always considerably
swollen, and upon them the pseudo-membrane makes, as a rule, its
first appearance. But the parotid and submaxillary glands swell
also, and all the surrounding lymphatics enlarge.

6. Brain symptoms. In light cases the cerebral functions remain
undisturbed ; in severe cases we find that the mental faculties rather
brighten up, except where there is a hindrance to the free circulation
of blood to and from the brain by those abnormal swellings about
the neck, under which circumstances the patient sinks gradually into
drowsiness and stupor,

7. Gastric symptoms. Mostly entire loss of appetite, great thirst ;
sometimes vomiting of ingesta ; diarrhoea. But in a number of cases
there is neither vomiting nor diarrhoea.

8. Eruption. Eash on the skin, resembling sometimes measles, at
other times scarlet fever; it breaks forth sometimes at the beginning,
sometimes at a later period ; in a number of cases it does not appear



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 12 of 65)