Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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Such spells are brought on from walking, bodily exertions, and men-
tal excitements. Sometimes they occur during the time of going to
sleep, and even during sleep. But at the bottom of it all lies some
organic affection of the heart of various nature, as aneurism of the
aorta, fatty degenerations of the heart, and ossification of the coronoid
arteries.

Its presence, therefore, affords no conclusion as to the nature of the
heart disease. Subjects of this disease are generally men — persons
who are inclined to grow fat, and old people. /^ ' '/^ juljut/i '

During the attack, Kali, c? Ars.? Lach.?

The patient ought to be under treatment for his chronic affection
of the heart.

V. Diseases of the Aorta.

Aneurism of the Thoracic Aorta.

Aneurism means a distension of a short piece of an artery forming a
kind of sac at that place. Such distensions are more frequently found
in the aorta ascendens than in the aorta descendens. It can be diao -

O

nosticated only when it reaches the exterior thoracic wall. In such a
case it renders that part of the chest perfectly dull on percussion and
more resisting to the touch. Also, we often observe on that part a
pulsating swelling with a peculiar kind of purring in it, which extends
up into the carotid arteries. We find this swelling on the right side
of the sternum, between the second and third rib, if the aneurism
is an enlargement of the convex part of the aorta. It makes its
appearance, however, on the left side of the sternum in the same
intercostal space when the aneurism has formed on the concave part
of the aorta. Its symptoms are : palpitation of the heart, dyspnoea,
asthma, bronchial catarrh, hasmoptoe, swelling of the jugular veins,
with cyanosis, oedema of the upper extremities, difl&culty in swallow-
ing, hyperasmia of the brain — all symptoms in consequence of its
pressure either upon the lungs or the cesophagus, and in consequence
of disturbed circulation.

The aneurism of the arcli of the aorta has its seat behind the
manubrium sterni, and a deep pressure with the finger into the fossa
jugularis may detect its pulsation and purring.

The aneurism of the aorta descendens must be very large in order
to cause a duller sound on percussion, or a swelling between the left




228 DISEASES OF THE AOETA.

shoulder-blade and the spme. Its symptoms are the same as those of
aneurism of the ascending aorta ; and, in addition, it may cause paral-
ysis of the lower extremities, rectum, and bladder.

To finish the morbid affections of the thoracic organs I have yet to
speak of the affections of the diaphragm, that muscle which forms the
partition between the thoracic and abdominal cavity, and which par-
ticipates greatly in the acts of respiration.

fl. Diaphragmitis, or Inflammation of the Diaphragm.

j^ The substance of the diaphragm being a muscular, tendinous tissue,
is scarcely ever primarily affected ; whilst its serous lining on its
upper surface, a continuation of the pleura and pericardium, and
on its lower surface a continuation of the peritoneum, frequently
participates either in inflammations of the pleura, or of the pericar-
dium, or of the peritoneum. Symptoms, like impossibility of taking
a deep breath, hiccough, yawning, risus sardonicus, pain in the
shoulders, vomiting of green masses, great difficulty in swallowing,
even hydrophobia, denote in pleuritis, pericarditis, or peritonitis, an
extension of the inflammatory process upon the diaphragm.
Physical signs are none.

Therapeutic Mints,

Aeon., hard, feverish pulse ; thirst ; anxious impatience ; restless
tossing about ; painfal cough ; difficulty in breathing, and pain and
heat in the upper region of the abdomen.

Bryon., stitching pain in the region of the diaphragm, worse from
any motion, from coughing ; white, dry tongue without thirst, or else
great thirst with drinking large quantities of water.

Cham., throbbing, burning pain in the region of the short ribs and
pit of the stomach, worse from pressure ; short and anxious breathing ;
short, dry cough ; vomiting ; belching ; great restlessness ; tossing
about ; loud complaining, &c.

Lycop., sense of constriction from the right side all around the short
ribs ; cannot stretch himself nor lie upon the back ; neither stand
upright.

Rhus t., worse when lying still; or disposition to move notwith-
standing the pain caused by it; commencing on the left side and
going to the right.

Compare Pleuritis and Peritonitis.



KUPTUEE AND PERFORATION OP THE DIAPHRAGM. 229

2. Singultus, Hiccough.

HiccougL. consists in a spasmodic contraction of the diaphragm, by
•which the air is suddenly drawn in, causing that sound peculiar to
hiccough. Its causes may be of a cerebral origin, as in diseases of the
brain ; in consequence of ansemia ; long-standing, weakening diseases
after great loss of blood and vital flaids ; after strong mental affec-
tions, like fright, anger, &c.

Or, it may be a mere reflex from diseases of the pleura or peri-
cardium ; or it may accompany different affections of the stomach, the
liver, the intestinal canal. If it takes place in consequence of ex-
hausting diseases, like morbus Brightii, tuberculosis, typhus, cholera,
pleurisy, with abundant exudation, large abscesses, &c., it is always a
dangerous symptom, continues for days and may be the forerunner
of a fatal issue. According to the different causes many remedies
may be indicated.

3. Rupture and Perforation of the Diaphragm.

Euptures are caused by violent concussions or heavy lifting;
whilst perforations are the result of suppurating processes either in
the thoracic or abdominal cavity. When ruptures take place from
out of the thorax they are generally attended by dyspnoea, cough,
hiccough, suffocating spells, and fainting. When from out of the
abdomen, vomiting, colic, obstinate constipation.

Perforation takes place from suppurating processes in the thoracic
cavity ; for example, in consequence of pyothorax ; when the fluid
discharges into the abdominal cavity it causes peritonitis.



ABDOMEN.



When we examine the abdomen by sight or inspection we have
to take into consideration the following conditions :

1. Its appearance in regard to size.

a. Enlargement of the abdomen may be partial or general.

Partial enlargement depends upon abnormal sizes of the ab-
dominal viscera ; either the stomach, liver, spleen, uterus, ovaries,
kidneys, glandular structures, bladder, and so on. Also, upon patho-
logical products, as tumors of all kinds, encysted exudation, extra-
uterine pregnancy, hernia, and so on.



230 ABDOMEN.

General enlargement may arise from oedematous infiltration of the
abdominal walls ; or from accumulation of fat in the subcutaneous
cellular tissue, and the omentum ; from an accumulation of gas in the
stomach and intestines ; from a collection of gas or fluid in the peri-
toneal sac ; from large tumors, "vvhich fill the whole abdominal cavity;
from pregnancy, and sometimes in consequence of frequent pregnan-
cies, the so-called pot-belliedness, and likewise in scrofulous children
from enlarged mesenteric glands.

h. The abdomen a'p'pears smaller — sunken in — sometimes to such a
degree that the spinal vertebra may even be felt through the abdomi-
nal walls. This we observe in persons who have been starving for a
considerable time ; also in cases of general marasmus ; in strictures
of the oesophagus, the cardia, the pylorus, or the duodenum ; after
severe and long-continued diarrhoea and cholera ; it is also a sign of
painter's colic from poisoning with lead, and quite characteristic in
brain diseases, especially tubercular meningitis.

2. Its appearance in regard to motion.

a. Respiratory motion. The diaphragm, moving up and down,
makes, as we know, the abdomen participate in the respiratory mo-
tions of the chest.

This respiratory motion of the abdomen is increased in such afiec-
tions of the chest as prevent a normal extension of the thorax, as
pneumonia, pleurisy, &c.

It is decreased^ or ceases altogether, in inflammation of the peritoneum,
in large effusions of fluids or gas in the abdominal cavity, in conse-
quence of large tumors which fill the abdomen, and also from inju-
ries of the diaphragm.

h. Pulsation. We observe it generally in the pit of the stomach,
sometimes lower down, nearly to the umbilical region ; rarely below
the navel, and almost always in the medium line.

This palpitation may have different causes :

1. Abnormal position of the heart, its apex lying towards the pit
of the stomach. In this case we hear, on auscultation, both ticks of
the heart, or noises, if there are any, in the pit of the stomach, and
not at the normal place below the nipple.

2. It is caused ly the right ventricle, which communicates its mo-
tion to the left lobe of the liver. In this case we hear also, on aus-
cultation, both ticks of the heart at the pit of the stomach, and at the
same time at the normal place.

3. It is caused hy the descending aorta, and the pulsation extends
then further down towards the navel. In this case we hear, on aus-



GENERAL OBSERVATIONS. 231

cultation, only one sound, or one noise, if there be any ; whicli, how-
ever, appears a little later than the impulse of the heart at its normal
place.

The causes of this abdominal pulsation may be —

a. Eelaxed and thin abdominal walls; collapsed state of the
abdomen.

h. A curvature of the spine forwards, whereby the aorta comes
nearer to the abdominal walls. •

c. A thickened left lobe of the liver.

d. Increased impulse of the heart, as in hysteric individuals ; or
hypertrophy of the left ventricle in consequence of insufficiency of
the aortic valves.

3. Its appearance in regard to the elasticity of its external walls: we
find it greatly relaxed, hanging down like a loose sack, in old women, or
in those who have given birth to many children ; also after absorption
of large quantities of fluids, by which the abdominal parietes had
been largely distended.

A similar effect is produced by a large accumulation of fat within
the subcutaneous cellular tissue.

Large distention of the abdomen, especially pregnancies, sometimes
causes the straight muscles of the abdomen (the m. recti) to be driven
asunder, so that a space of several inches occurs between them, which
is very thin, consisting merely of the fasciaa of the oblique muscles,
the peritoneum, and the external covering ; whilst the recti muscles
lie on the sides of the abdomen, forming there a pad-like protruber-
ance. The thin, yielding space in the middle between them, however,
bulges out as soon as the person assumes a standing position, not being
strong enough to keep the abdominal viscera in their normal position.

4. Its appearance in regard to the development of its subcutaneous veins.
We observe these veins largely distended whenever there exists an
obstacle to the free circulation of the blood through the vena cava
inferior. This may be caused by stricture or obliteration of the vein
itself, or by pressure of enlarged abdominal organs, or abdominal
tumors upon it. Some of the blood which cannot pass there is
brought by way of the ven^ intercostales, mammariss or axillares, from
the lower portion of the body into the superior vena cava.

The so-called Caput Medusse^ which is a network of enlarged veins
around the navel, arises from the umbilical vein, which has not become
obliterated.

5. Its appearance in regard to changes of color. Here I have to men-
tion the straight line which we observe in pregnant women, extending



232 ABDOMEK

from the navel to tlie sympHsis pubis, either pale yellowisli, brownisli
or even blackish. This line has been observed quite exceptionally,
however, in men, children and also such women as never had been
pregnant. "We sometimes observe, also, whitish or bluish-white stripes
like cicatrices on the sides of the abdomen, which are generally signs
of previous pregnancy, as other distentions of the abdomen rarely
cause them.

On further examination of the abdomen by means of palpation, we
may learn, 1, the seat of the affection.

a. If in the abdominal walls, we are able to raise the affected part
during a relaxed state of the abdomen ; or, if the abdominal walls be
put upon the stretch, we shall observe the swelling in it becoming
more prominent.

b. If the seat of the affection is in one of the abdominal organs, the
swelling feels deeper and cannot be raised by lifting the relaxed
abdominal walls. In order to decide which organ is affected, we, of
course, must be entirely clear in regard to the normal positions of these
different organs.

Palpation teaches further the nature of the swollen parts in the abdo-
men.

A solid swelling we feel as such, whilst a fluid exudation gives to
the examining hand the sense of fluctuation ; provided the sac which
contains it be not too much distended, in which case it feels as solid
and hard as a stone, and without any fluctuation.

Palpation is also important to become certain of the character of
pain which the patient experiences on pressure.

If the pain is increased by slight pressure and ameliorated by grad-
ual deeper and deeper pressure, the affection is mostly of a nervous
nature. When, however, the pain increases as the pressure is increased,
generally it indicates an inflammatory affection. Pressure upon the
stomach frequently causes sickness and belching ; pressure upon the
colon, desire for stool; and pressure upon the bladder, desire to
urinate.

Percussion gives a tympanitic tone whenever there is gas or air in
the abdomen, unless the enclosed walls are too greatly distended ; and
an empty tone wherever there are solid bodies or fluid effusions in the
abdomen.

In this way we are enabled to determine the extent of the enlarged
liver, spleen, hardened stomach, tumors and fluid effusions of the peri-
toneum or ovaries ; also, the accumulation of gas in the stomach and
intestines, or the peritoneal sac, called tympanites.



DYSPEPSIA. 233

Ausculation teaches very little, except what I have mentioned
already, in regard to the visible pulsation of the abdomen. Foetal
pulsations.

Special Forms of Abdominal Disorders.

"We have again a long run before us. The organs in the abdominal
cavity are many ; each of them may be differently affected ; conse-
quently the special forms of abdominal affections must amount to
quite a considerable number.

I shall speak at first of the 'pathological conditions of the stomach.



Dyspepsia, Indigestion,

What a common-place word " dyspepsia" has become amongst the
people, and the common run of practitioners ! So common, indeed,
that it is almost nauseating to be obliged to hear everywhere the con-
jugation of the present tense of the word dyspepsia: "I am dyspeptic,
thou art dyspeptic, he, she or it is dyspeptic ; we are dyspeptic, you
are dyspeptic, they are dyspeptic !" What under the sun could have
made it so popular, if it were not its extreme convenience to put almost
any sort of bad feeling about and around the pit of the stomach into
one common big bag, so that again Goethe's words become verified :
" There, where we haven't got the right idea, a splashing word is oft
our saviour."

Dyspepsia means nothing more nor less than an indigestion. If you
DOW consider for a moment all the circumstances by which indigestion
may be caused, you will comprehend at once the wide mouth and the
wide belly of that bag which is called dyspepsia. Still if, according
to Pope, "One truth is clear, whatever is, is rightl^'' I shall not attempt
to destroy this convenient bag, but shall merely endeavor to divide it
for a more intelligent use, into the following four departments :

1. Dyspepsia may be caused by anatomical changes in the digestive
apparatus, as, catarrh, inflammation, thickening, ulceration, eruptions
of the membranes of the stomach.

2. Dyspepsia may be caused by quantitative or qualitative altera-
tions of the digestive secretions, as, alteration of the gastric juice, of
the juice of the pancreas, of the secretions of the liver and of the
intestines.

3. Dyspepsia may be caused by an abnormal condition of the nerv-
ous system, as we observe to be the case in consequence of mental



234: STOMACH.

excitements, of too great mental exertions, and all such influences as
disturb the normal actions of the nervous system.

4. Andj lastly, dyspepsia may be caused by the use of irritating
or stimulating food or drink ; so that we find a whiskey-dyspepsia,
a pepper-and-mustard-dyspepsia, a coffee-dyspepsia, and all sorts of
other dyspepsias, among which we ought not to forget the ice-cream-
dyspepsia and the sugar-dyspepsia.

The symptoms of such a disease, which has such different causes,
must, of course, be variable, and I shall try to give you only the most
prominent of its features.

Dyspepsia is characterized by —

1. Want of ap^^etite, or morbid appetite; craving for sour, acrid, spicy
things, &c.

2. Accunnulation of ivind on the stomachy and, in consequence of
which, belching, oppression, palpitation of the heart.

8. Formation of acids in the stomach, and, in consequence, sour, ran-
cid eructations, pyrosis, or heartburn, waterbrash.

4. The food does not digest at all ; causing vomiting or diarrhoea.

5. The pit of the stomach is mostly sore to the touch ; very sensi-
tive to the pressure of clothes ; it feels full, and is oftentimes swollen.

6. The patient feels unfit for mental and bodily work; he is morose,
irritable, sleeps badly ; and, if asleep, his sleep is full of dreams.

7. His face shows a relaxed, tired, weary, sad expression, with
sunken, dull eyes ; pale-grayish or yellowish color and pale lips,

8. His hands and feet are generally cold, and he is very sensitive to
the cold,

9. Gradual falling away in flesh and strength.

Therapeutic Mints. — One thing, however, I must mention.
"When we find, in an acute disease, a patient strongly craving a par-
ticular thing to eat or drink, it is well and wise for the physician to
satisfy this desire. In chronic cases, however, such as dyspepsia,
which may have grown big by yielding to such morbid desires, it is
absolutely necessary to strictly forbid the use of all such irritating
nourishments, otherwise wcsfeed the animal which we want to kill.

For special hints compare Gastric Catarrh, acute and chronic ; Liver
Affections, Pancreatic troubles, &c.

Vomiting.

Yomitiug consists pathologically in an antiperistaltic contraction of
the stomach, and a spasmodic contraction of the diaphragm and



VOMITING. 235

abdominal muscles, caused either by a direct iufluence of the brain,
or, which is much more frequently the case, an irritation of the nervus
vagus, either in the stomach or in the pharynx, or by irradiation —
(syiJijKithetic.)

In cases of sudden and violent vomiting, especially if it happens to
otherwise healthy persons, we ought to think :

1. Of poison: to ascertain which we must examine chemically what
the patient throws up or what remains of what he partook. It may
be arsenicum, corrosive sublimate, nitrate of silver, zincum, or stan-
num, tartarus emetic, phosphorus, iodine, different kinds of acid,l
sulphuric, nitric, or muriatic, alkalies, as caustic potash, or vegetable!
or animal poisons.

2. Of p-e^?ia??c?/.- it sets in sometimes immediately after conception,
sometimes not before the first menstrual discharge should come on
and does not. It lasts, in many cases, through the first half of preg-
nancy ; in some longer, and in some it passes over quickly or does
not set in at all. During parturition I have frequently observed
vomiting shortly before the birth of the child,

3. Of incarcerated hernia, intussusception^ or invagination^ which is
generally attended with obstinate constipation.

4. Vomiting from affections of the stomach may have its cause in a
simple overloading of the stomach with indigestible food, or in
catarrh of the mucous membrane of the stomach ; for example, in
drunkards; or, in an ulcerated state of this membrane, in cancer of
the stomach,

5. Yomiting may also be caused by diseases of the peritoneum
and intestinal canal; from affections of the liver, spleen, pancreas, and
urinary organs.

6. Sometimes it may be merely the ' effect of the mechanical con-
cussion during hard coughing, laughing, &c,

7. Vomiting from affections of the brain is found in consequence
of external injuries of the head and concussion of the brain; may be
caused by strong impressions upon the sensorial and sensitive nerves ;
the swinging motion of a ship, sea- sickness, &c.; is found in hyperasmia
and anaemia of the membranes of the brain ; in inflammation of the
brain and its membranes ; in different organic diseases of the brain ;
in megrim and sick headache.

Therajwutic Mints.— If vomiting is caused by poison it is
necessary that the poison be removed or neutralized.



236 STOMACH.

I sliall not undertake to specify all the antidotes of tlie different
poisons. These you will find in the Materia Medica, and they are
very well arranged in Dr. Hering's "Domestic Physician."

If it is caused by an incarcerated hernia it is necessary that the
hernial sac be put back by manual operation.

Aeon., Nux v., Sulph., Lye, Opium.

For vomiting in pregnancy, Nux v., Yeratrum, and others.

For all other kinds of vomiting we must select the remedy in ac-
cordance with the indications in each individual case.

Acute Catarrh of the Stomach, Gastritis.

Pathologically gastritis is similar to a catarrhal inflammation of any
other mucous membrane. We observe redness and velvet-like
swelling of the mucous membrane, which is oftentimes covered with
a tough, transparent, or whitish-gray slime. In severe cases the
mucous membrane is so softened that it may easily be scraped off like
a mushy covering.

Primarily, this catarrh may be caused by taking cold or getting
wet, like any other catarrh ; but principally it is caused by either too
cold or too hot food or drink ; or certain kinds of food, like too fat or
old meat and fish, pork, sausages, cheese, alcoholic drinks, ice cream,
ice water, etc.

Starvation is not less a cause of it. Also mental exertions and ex-
citement, fright, grief, worriment, and the like, may cause it.

Secondarily, we find it in combination with the perforating round
ulcer of the stomach ; cancer of the stomach ; as a continuation of in-
flammation of the fauces and the oesophagus ; inflammation of the in-
testines; or as a concomitant of typhus, pneumonia, exanthematic
fevers, and erysipelas.

The heat of the summer is most favorable for its development ; no
doubt on account of the free use of ice water in a heated stomach;
but it also frequently occurs in spring and fall.

Syraptoins.

The patient gets morose ; feels weak and chilly, with paleness of
the face and cool extremities. The chilliness alternates with flushes
of heat, red face, and febrile motions. The pit of the stomach feels
full, and sore to the touch, so that even the pressure of garments feels
uncomfortable. The appetite is gone ; thirst, however, is generally
present. At the same time the patient feels nauseated; frequently
gulps up a sour or flat- tasting fluid; and generation of gas in the



GASTRITIS. 237

stomacli swells tTie region of tlie stomacli and causes belching of wind.
In the cases in which the catarrhal affection extends into the bowels,
it causes rumbling flatulency, escape of fetid flatus, and mushy, fetid
discharges. At the commencement of the disease the bowels are
mostly constipated, and urine is dark-colored. Toward the close we
frequently observe the formation of herpes labialis or hidroa.

Therapetttic Hints.

Aeon., after taking cold; stitch-like, burning, and pressing pain in
the pit of stomach, with anguish and fear of death; great thirst and
vomiting.

Ant. cp., total loss of appetite ; tongue thickly coated, yellow or
white ; great thirst at night; nausea ; belching, with taste of what
had been eaten ; vomiting ; after bad, sour wine ; bathing.

Apis, painful sensitiveness in the pit of the stomach, with burning ;
painless, yellow diarrhoea.

Arnica, after a blow or fall; sense of fulness in the pit of the
stomach ; belching, with taste of putrid eggs ; hot head, remaining
body cool.

Arsen., nausea and vomiting, worse from rising up ; quick pros-
tration ; anxious restlessness ; great thirst, but drinking little at the
time ; after abuse of ice, ice water, ice cream, vinegar, sour beer,
tobacco, (chewing,) alcoholic drinks.

Beil., cutting pain in the stomach, worse from motion and pressure ;
vomiting ; gagging ; hiccoughing ; great thirst, but drinking makes



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 24 of 65)