Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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it worse, consequently the patient abstains from drinking.

Bryon., stitching pain in the region of the stomach, worse from mo-
tion, and especially from a misstep ; tongue coated ; dry without
thirst ; or else great thirst day and night, and drinking large quanti-
ties; constipation. In warm weather, and after eating of flatulent
food.

Carbo veg., great deal of belching, sour and rancid; burning in the
stomach ; bloatedness of the abdomen ; disgust for meat ; desire for
acids ; after debauching.

Ciiam., bitter taste in the mouth; vomiting of bile or green mucus;
belching ; rumbling in the bowels ; hot and red face ; much excited,
as if beside himself; sleeplessness; after offence, vexation, anger.

China, feeling satiated all the time ; however, when trying to eat,
he can eat something, but feels bad afterwards, and cannot say how ;
fulness in the stomach and bowels ; belching ; sour rising ; cold feel-
ing in the stomach ; great lassitude and weakness.



238 STOMACH.

Euphorbia corollata, sudden nausea, vomiting and diarrhoea of watery
fluid, with sinking, anxious feeling of the stomach ; faintness ; slow
and weak pulse ; cool skin ; cool hands and feet, which become affected
with cramps.

Hydrastis, dull, aching pain in the stomach, which causes a very-
weak faintish feeling, "goneness" in the epigastric region; acidity;
constipation.

Ipec, constant nausea proceeding from the stomach, with empty
eructations and accumulation of much saliva ; easy vomiting ; diar-
rhoea; after eating sour, acrid things, sour, unripe fruit, berries,
salads, &c.

Iris versic, great burning distress in the epigastric region ; vomiting
with diarrhoea, accompanied with great prostration ; burning in the
mouth, fauces and oesophagus ; and headache.

Nux v., always after the use of tinctures, mixtures, tonics, vegeta-
ble pills, coffee, wine, condiments ; after mental over- exertions ; in
leading a sedentary life ; bitter or sour taste ; sour belching ; fulness
and pressure in the stomach ; constipated bowels ; dizziness, headache ;
irritable, cross ; all worse in the morning, in the open air and after
eating.

Podoph., food turns sour after eating; belching of hot flatus, which
IS very sour; great thirst; vomiting; the stomach contracts so hard
and rapidly in the efforts to vomit that the wrenching pain causes the
patient to utter sharp screams ; vomiting of bilious matter, mixed with
blood.

Puis., no appetite; no thirst; bitter taste in the mouth ; every thing
tastes bitter; dizziness when rising from a chair; chilliness; after
fatty substances— pork, pastry, rancid butter, &g.

Rumex, shootings from the pit of the stomach into the chest in vari-
ous directions ; aching pain in the pit of the stomach, and aching and
shooting above it in the chest ; fulness and pressure in the pit of the
stomach, extending towards the throat-pit; it descends towards the
stomach upon every empty deglutition, but immediately returns; flat-
ulence; eructations; pressure and distention in the stomach after

meals.

Sanguin., nausea, with headache, chill and heat; vomiting, with
severe, painful burning in the stomach, and intense thirst ; red tongue ;
red and dry lips ; hot and dry throat ; tickling cough.

Sepia, sensitiveness of the pit of the stomach to touch; bloatedness
of the abdomen ; congestion and heat of the head ; headache ; tongue
coated without lustre ; often sore and covered with little blisters on the



CHRONIC CATARRH OF THE STOMACH. 239

edges and tip; sour smell from tlie mouth, and likewise of tlie urine,
wliicli is clear like water, or pale-yellowisli ; constant drowsiness ;
anxious dreams, and great fever heat ; especially in children, from
takinsf cold when the weather chano;es.

Chronic Catarrh of the Stomach

Is, in many cases, only a continuation of an ill-managed, acute attack,
but it may grow out of too free a use of spirituous liquors, coffee,
chewing and smoking of tobacco ; it may have its origin in gluttony,
sedentary habits, mental exertions, long-continued mental emo-
tions, &c.

Secondarily, it has been observed accompanying heart, liver, lung
and pleura affections ; anemia, chlorosis, Bright's disease, marasmus,
.tuberculosis, gout, cancer, hemorrhoids.

Its most permanent symptoms are, helching after eating, mostly sour,
and attended with heartburn ; pressure and full feeling in the epigastric
region, with actual distention of the same.

Other symptoms are, nausea and vomiting, loss of appetite, or, after
fasting, ravenous hunger, with gaping and faintness; after eating
always pain in the stomach. Such patients always feel weak ; they
are morose, irritable and quite sleepy through the day. By-and-by
their skin becomes pale and dry, and they become emaciated.

Its progress is a slow one, and whether curable or not curable,
depends entirely upon its combination with other diseases.

On the authority of Kafka I shall give the following therapeutic
remarks :

Aching or hurning pain in the pit of the stomach ; increased from pal-
pation or pressure of the clothes; and distention of the epigastric region,
Bell., Phos., Arn., Ars.

Aching in the pit of the stomach, not much increased by external
pressure, Bell., Phos., Hepar, Ign., ISTux. v., Arn., Calc, Zinc.

Aching in the pit of the stomach, not increased by external pressure,
Carbo veg., China, Chinin. sulph.. Caps., Natr. m.. Lye, Sulph.

Sour stomach, with sour belching and taste; heai'thum; guljnng up
and vomiting of sour matter, Nux v., Calc. c, China, Phos., Sulph., Kali
C; Carbo veg.

Sour stomach always after eating, Nux v., Kali c, ISTatr. m., Sulph.,
Phos., Sepia.

Rancid belching. Puis., Carbo veg., Magn. mur., Sulph., Asa foetida.

Foul belching, Sepia, Phos., Ars., Arn., China, Ferr. ac, Merc.



240 STOMACH.

Much mucus in mouth and stomachy Puis., Amm. mur., Natr. m.,
Am., Sulpli.

Accumulation of bile in the stomach, ivith hitter taste^ hitter belching,
and vomiting, Cham., Puis., Ars., Ipec, Nus. v., Yer.

Iluch wind in the stomach, with distention, Nus v., Carbo veg., Ign.,
Arn., Sulph., Ars., Phos.

Distention of the abdomen, Carbo veg., Nux v., CMna, Arn., Natr.
m., Pbos., Sepia.

Belief from eructations, Lacb., Carbo veg., Ign., Lye, Tart, em., Nux
v., Sulpb.

Relief from wind passing down, Nux v., Carbo veg., Puis., Cbina,
Cbam., Lye.

Worse from accumulation of flatulence, Nux v., Carbo veg., Puis.,
Ign., Natr. m., Pbos., Arn., China, Cham., Kali c., Coloc.

Slow digestion, Nux v., Ign., Phos., China, Opium.

Total loss of appetite, Nux v., China, Sepia, Natr. m., Ars.

Feeling of emptiness and hunger in the stomach without desire for
food, Natr. m., Opium, Ars.

Ravenous hunger, Nux v., Calc. c, China, Jod., Natr. m., Phos.

Worse after eating, Nux v., Calc. c., Phos., Natr. m., Sepia, Sulph.

Disgust against meat, Sulph., Sepia, Petrol., Muriatic ac, Natr. m.,
Carbo veg., Ars.

Sleepiness in the day-time, Natr. m., Puis., Sepia, Calc. c, Carbo veg.,
Chinin., Kali c.

Great weakness and loss of energy, China, Chinin. sulph., Ars.,
Phos., Jod., Ferr. ac.

Gastritis Toxica seu Caustica, Inflammation of the
Stomach in consequence of Poisoning.

Such poisoning is caused by concentrated or diluted mineral
acids, caustic alkalies, salts and metals, acrid, vegetable, or animal
poisons, and eetherial oils.

Diluted mineral acids change the epithelium and the superficial
layers of the mucous membrane of the stomach into a soft, brownish,
even blackish mass. Concentrated mineral acids change all layers of
the mucous membrane into a blackish mass ; the other coats of the
stomach become softened, and, in some rare cases, perforated — eaten
through. The blood in the vessels of the stomach and in the ad-
joining larger vessels is black and tough, like tar. Caustic alkalies
— for example, the kali causticum or ammonium causticum — change



GASTRALGIA. 2-11

the epithelium and the mucous membrane of the stomach to a pappy,
discolored mass ; they destroy and perforate the coats of the stomach
much more frequently than acids do.

Salts of metals, like verdigris, corrosive sublimate, argentum
nitricum, tartarus emeticus, likewise arsenicum and phosphorus,
cause brown scurfs, surrounded by injected and swelled portions of
the mucous membrane of the stomach. Acrid, vegetable, and animal
poisons, and getherial oils cause a highly-inflamed state of the
mucous membrane of the stomach.

Poisoning is characterized by the following symptoms: violent
pain in the stomach and bowels ; vomiting of slime or bloody masses ;
slimy, diarrhoeic discharges from the bowels mixed with blood ; and
tenesmus ; the features of the face become distorted ; there is sudden
loss of strength; coldness of the extremities; and cold, clammy per-
spiration ; the pulse is small and thread-like.

If the patient informs us what he has swallowed our diagnosis is
safe enough. If not, the ejected masses will have to be examined.
Mineral acids and caustic alkalies leave their traces also upon the
mucous membrane of the mouth and fauces.

Therapeutic Hints. — If we see a case soon after the swallow-
ing of poison, this poison must be neutralized — acids by alkalies and
alkalies by acids.

Chronic consequences require after acids, Calc. c. ; after alkalies.
Nitr. ac, ; after setherial oils, Nux. v., Ars.; after metals, Hepar.

Gastralgla, Cardialgla Nervosa, Cramp of the Stomach.

This affection is characterized by attacks of great pain in the
stomach, which come at intervals, leaving the patient free from pain
between the attacks ; there is no structural change of the stomach
effected by it. We frequently find this complaint, however, in con-
nection with anaemia, chlorosis, tuberculosis, or great loss of vital
fluids ; also with chronic catarrhal affections of the stomach, the
round perforating ulcer, and cancer of the stomach ; also with dis-
eases of the womb, as falling or dislocation of the womb ; catarrh or
ulceration of the mouth of the womb ; too scanty or too profuse
menstruation ; also, with diseases of the spine, especially such forms
as present an intermittent character ; and finally we observe it fre-
quently in consequence of depressing mental emotions ; chilling the
stomach by drinking ice water or eating ice cream whilst being heated ;

16



24:2 STOMACH.

or after the use of lemon-juice, or other acid fruits, coffee, fresli
bread, and hot cakes, and other things which are difficult to digest.

The attack usually commences with a feeling of pressure in the pit
of the stomach, frequent yawning, coldness of the extremities, and
an uncomfortable feeling in the middle of the spine, which induces
the patient to bend backwards frequently. Sometimes, without such
premonitory signs, a violent pain in the stomach sets in at once, which
may be various in character — pressing, drawing, burning, boring,
gnawing, cramp-like, &c., amounting, sometimes, to such a degree of
severity that the patient faints away ; his face appears collapsed, his
extremities become cold, and his pulse small and thready. The pain
seems to radiate from the spine and reflects upon the chest, where it
causes asthmatic symptoms ; or, it reflects upon the oesophagus, caus-
ing the so-called globus hystericus ; or, upon the larynx, causing
choking ; or, upon the sympathicus, causing spasmodic laughing
and crying ; or, upon the nerves of the cranium, causing hemi-
crania ; or, upon the intestines, causing pain in the bowels and diar-
rhoea. The pain is oftentimes relieved by hard pressure upon the
stomach, but sometimes the patient cannot even bear the pressure
of the clothing. The pit of the stomach is, in some cases, distended ;
in others it is drawn in ; often we observe a pulsation in the epigas-
trium.

The attack generally ends with belching of wind; vomiting of
watery, sour fluids ; passing of watery urine, and with a gentle per-
spiration. In some cases there is a great accumulation of wind in the
stomach, so that the pit of the stomach and the bowels are greatly dis-
tended, with constant belching and rumbling in the bowels. Belch-
ing and passing wind generally brings relief.

Therapeutic Mints,

Arg. nitp., in the middle between the xyphoid cartilage and the
navel a small spot, which is very sensitive to the slightest pressure ;
from this spot a very severe pain spreads to the hypochondriac region,
into the back, up into the shoulders, even to the head ; gradually in-
creasing in intensity, and as gradually leaving again.

Arsen., burning pain, as of red-hot coal^ pit of stomach sensitive to
slightest touch ; vomiting of ingesta as soon as taken ; anguish ; rest-
lessness; fainting; face pale, earthy; worse from eating and touch-
ing ; better from warm applications ; after eating ice cream, ice water.

Asa feet., pressing, cutting, stitching pain in spells ; eructations of a
smell like garlic, or feces ; accumulation of gas ; constantly pressing



GASTRALGIA. 243

upwards, none downwards ; gulping up of rancid, acrid fluids ; ob-
stinate constipation.

Bell., gnawing, pressing, crampy, drawing, wrenching pain, which
compels the patient to bend backwards, and to hold his breath ; great
thirst, but worse after drinking ; face hot, red, bloated ; pupils en-
larged ; especially for the female sex, when the menstrual period has
been disturbed.

Bryon., pressing pain, as of a stone or a load in the stomach ; worse
from eating or drinking ; from any motion ; better when lying quiet
on the back.

Calc. c, pressing pain, as of a load or stone in the stomach ; or from
the abdomen rising up into the throat ; sour belching and vomiting ,
better from motion ; too profuse catamenia.

Carbo veg., after Nux v. j burning pain, extending down to the
small of the back, and up to the shoulders ; sour, rancid belching ;
cold limbs ; cold sweat ; worse from lying down ] after rich living ;
drinking of spirituous liquors.

Chelid., gnawing, grinding pain, ameliorated by keeping on eating
something constantly.

Coloc, violent cutting, tearing pains, which, from different parts of
the chest and abdomen, concentrate in the pit of the stomach ; re-
lieved by hard pressure and bending double ; after vexation and in-
dignation.

Ferr., pressure in the stomach ; vomiting of ingesta, and better
afterwards; worse after drinking milk; chlorotic and anaemic indi-
viduals.

Gelsem., sensation of a heavy load with weight ; tension and dull
pain ; sometimes with empty, faint sensations in the epigastrium, and
a false hunger — a kind of gnawing.

Ign., gnawing, cutting pain in the stomach; faint • feeling ; false
hunger ; collection of water in the mouth ; nausea, and vomiting of
mucus ; poor digestion ; bloated stomach ; pale, watery, profuse
urine ; after grief or poor living ; habitual smoking.

Leptandra, sharp, cutting pains at intervals in the lower part of the
epigastrium ; constant aching distress ; worse from drinking cold
water; after rising; great desire for stool, that cannot be retained
one moment.

Nux v., pressing, constricting, clawing pain in the pit of the stomach,
extending into the chest, or towards the small of the back to the anus,
which is drawn in; worse after eating and drinking; better from
belching; after vomiting; from bending forward and rubbing the



244: ■ STOMACH.

pit of the stomacli ; headacTie ; loss of appetite ; or "hunger, with fear
of eating ; belching, vomiting, and gulping up of sour substances ;
constipation ; hemorrhoids ; suppressed menstruation ; complaints
from the use of coffee or liquors ; sedentary life ; night- watchings ;
anger and worriment; always after previous use of nostrums.

Petrol., pressing, drawing pain, ameliorated by keeping on eating
something constantly. Compare Clielid.

Phos., a singular rising of the swallowed food by mouthfuls; pain
worse after eating ; during the presence of morbid hunger eating
relieves for a short time ; decidedly better when keeping warm in
bed.

Plumbum, the patient bends backwards during the spell ; gets better
from hard external pressure upon the stomach ; afterwards yellow
appearance of the white of the ej^es ; badly-smelling sweat of the
feet.

Puis., dizziness when rising ; loss of appetite ; no thirst ; sour or
bitter vomiting ; after eating fat meat, cakes, pastry, and drinking
whiskey.

Ulcus Ventrsculi Perforans, (rotundum, chronfcumj) the

Round Perforating Ulcer of the Stomach.

The seat of this lesion is mostly at the pyloric portion of the
stomach, on its lesser curvature. It was also frequently observed in
the duodenum, in cases of Chickahominy diarrhoea. Only one ulcer
is usually found ; sometimes, however, there are two, three, or more.
Its size varies : it may be smaller and larger than a three cent silver
piece ; its shape is round, sometimes oval ; and in cases where several
ulcers join, it' is irregular. On the inside of the stomach it is largest,
and grows smaller in its progress of eating through the different
layers of the stomach, so that it assumes a funnel-shaped appearance.
AVhen it reaches the serous membrane of the stomach, it causes peri-
toneal inflammation and fibrinous exudation, which cause adhesions
with the adjoining organs, as the pancreas, liver, omentum, and colon.
When even this last or external membrane is eaten through it causes
peritonitis and hasmatemesis.

This ulcer may heal in all its different stages, in which event new
granulations are formed, and the whole is shut by a flat, radiated cica-
trix. In consequence of which it sometimes happens that the pylorus
becomes constricted, so that the exit of the food into the intestines is



BOUND PERFORATING ULCER OF THE STOMACH, 245

impeded. Such a cicatrized induration of the pylorus can generally
be detected by palpation in the pit of the stomach as a hard swelling.

In regard to its origin we are quite in the dark. Eokitansky con-
siders as the nest cause hemorrhagic erosions. They consist, accord-
ing to Virchow, in obstructions of arterial vessels, in consequence of
which the mucous membrane becomes deprived of its necessary nutri-
ment and dies off, and by the corroding effects of the acids of the
stomach is eaten out deeper and deeper.

The symptoms are as follows : pain^ exactly as in nervous gastral-
gia, in the pit of the stomach, coming in spells before and after eating,
ameliorated, sometimes ceasing, after vomiting of slimy, tough or
watery, clear, tasteless or sour fluid, often containing blackish or
brownish flakes. Sooner or later the patients become of a pale or
yellowish aspect in the face. They fall away in flesh, and are sad and
morose, in this respect differing from mere nervous gastralgia.

Vomiting is not only found during the cardialgio spells, but also
between these spells, although in exceptional cases vomiting is not at
all a prominent symptom. It generally happens soon after eating, and
frequently without previous nausea, and without great exertion.
Acrid, sour, indigestible food causes it most frequently. It fre-
quently contains particles of decomposed blood in the form of blackish
or brownish flakes and masses, and sometimes even clear blood in
large quantities.

Indigestion. In some cases the appetite is little or not at all
changed, but in severer cases it is usually diminished, or altogether
absent. Eating most frequently causes pain, and digestion is very
slow. Milk and white meat are best digested. We find, also, fre-
queilt eructations, nausea, pyrosis or waterbrash. The saliva seems
to contain much less rhodan kalium than usual ; costiveness.

When perforation takes place, which may happen either spontane-
ously or in consequence of a strong concussion of the body, or from
overloading the stomach, or during a hard attack of vomiting, we have
in a very short time all the symptoms of a peritonitis. The patient
soon feels a stitch-like or cutting pain, altogether different from that
of a cardialgic spell ; he is seized by a violent chill and vomiting, and
his features become collapsed, distorted, pale, expressing deep pain .
and agony. The abdomen is distended and very painful, especially
when touched. Eespiration is short, superficial, without any respira-
tory motion of the diaphragm. There is singultus ; violent action of
the heart ; frequent, small pulse ; fainting spells ; decrease in natural
temperature ; great prostration.



246 STOMACH.

Bifferential Diagnosis.

It may easily be confounded with chronic catarrh of the stomach.
The round -ulcer, however, generally has a clean, red tongue ; much
more frequent vomiting, very often containing either fresh or decom-
posed blood.

It may be easily confounded with nervous cardialgia. The round
■ulcer, however, has a falling away of flesh and change in features,
pale, yellowish face, and vomiting between the cardialgic spells, which
we do not observe in gastralgia.

It may be confounded with cancer of the stomach ; cancer, however,
comes at a later period of life ; tells much quicker upon the general
constitution, as wasting away in flesh, and by its hard swelling in the
pit of the stomach, which is observed in cases of round ulcers, only
when the pylorus becomes cicatrized.

Therapeutic Hints. — Compare Gastralgia.

Arsen., vomiting of black, decomposed blood ; burning pain ; always
worse after eating or drinking ; gray-yellowish color of the face.

Atropin, pressing pain after eating; and vomiting of acrid, sour
masses which set the teeth on edge ; hard swelling in the region of
the pylorus, just above the navel towards the right ; very sensitive to
touch ; excruciating pain in the stomach ; constant vomiting ; deadly
paleness of the face, with cold perspiration ; hands and feet icy cold ;
pulse very small. Peritonitis in consequence of perforation of the
stomach.

Carbo veg., gray, yellowish face; dry tongue; vomiting of sour,
bilious or bloody masses ; burning in the stomach ; worse after eating ;
better from drinking cold water ; eructations ; distortion of stomach
and bowels ; costiveness.

Conium, Coniin, vomiting of black masses like coffee-grounds in
clear, sour water ; violent pain in the stomach, always two or three
hours after eating, but also at night ; somewhat relieved in the knee-
elbow-position ; swelling in the region of the pylorus.

Kali bichr., ulcers are oval ; they corrode and become deeper with-
out spreading in circumference ; pressure and heaviness in the stomach
after eating ; giddiness, followed by violent vomiting of a white, mu-
cous, acid fluid, with pressure and burning in the stomach ; vomiting
of sour, undigested food ; of bile, bitter ; with pinkish, glairy fluid ;
of blood, with cold perspiration on the hands ; burning in the stomach;
heat of the face ; all which symptoms decidedly suggest its applica-
tion in the round perforating ulcer of the stomach.



CANCER OF THE STOMACH. 24:7

Lycop., earthy color of the face; rising of sour, acrid fluid; vomit-
ing of sour water and mucus ; fulness of stomacli and abdomen ;
pain in the stomach after eating ; rumbling and gurgling in the abdo-
men ; constipation ; scanty urine ; worse from sitting bent ; better
from rising and walking about ; no pain at night, when warm in bed.

Mezer., constant, violent pain and pressure in the stomach after eat-
ing, no matter what, even simple things like broth, milk, bread ; a
constrictive squeezing pain ; under much belching from one to two
hours after eating ; the pain reaches its height and ends with vomit-
ing and gulping up what has been eaten ; constipation ; circumscribed
redness of the face ; skin cool; pulse very small and frequent; chilli-
ness alternating with flushes of heat.

Sepia, yellow bridge over the nose ; earthy complexion ; sour taste
in the mouth after eating ; vomiting of mucus ; pain in the stomach
after eating the simplest kind of food ; hardness in the region of the
pylorus ; constipation ; stitching all over the body, with breaking forth
of little pustules ; menses scanty.

Silic, yellowish complexion ; screwing, pressing, twisting pain after
drinking ; pyrosis and vomiting after eating.

Sulphur, constant pain in stomach and back after suppressed itch ;
sour taste in the mouth and sour vomiting ; constipation ; piles ; cold
legs. •

Carcinoma op Scjrphus Ventriculi, Cancer of the Stomacli.

According to pathological researches, cancer of the stomach has
been divided into three different forms : 1, Scirrhus, which is a fibrous
growth, and which generally originates in the submucous cellular tissue;
2, Carcinoma medullaris, which is a marrow-like growth ; forming
round isolated lumps in the mucous membrane of the stomach, and



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 25 of 65)