Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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down, the cramps, and general reaction have ceased ; when the
patient lies in a sopor, and is pulseless, with cold breath, cold tongue,
or coldness all over, a picture of perfect collapse.

Cicuta, violent cramps ; tonic spasms of the muscles of the chest ;
eyes turned upwards ; soporous condition.

Lach., vomiting renewed by the slightest motion, and nausea at-
tended by a great flow of saliva.

Croton tigl., gushing out of watery discharges mixed with whitish
flakes, with rumbling griping in the bowels, and afterwards burning
in the anus ; discharges always brought on after drinking ; great ex-
haustion ; faintness, and dizziness.

Hydpocyan. ac, when there is a rapid progress of the disease
towards asphyxia ; marble coldness of the whole body ; pulseless-
ness ; cessation of diarrhoea and vomiting ; hiccough ; paralysis of
the oesophagus; when drinking, the fluid runs gurgling down the
oesophagus ; long fainting spells ; trismus ; tetanus.

Jatropha, violent vomiting of a whitish, jelly-like substance, re-
sembling the white of an egg; discharges from the bowels in gushes ;



278 INTESTINAL CANAL.

gurgling noise in the abdomen, sounding as if a bottle were being
emptied ; cramps in the calves of the legs, drawing them flat ; at the
same time the mind is in a kind of ecstasy and takes little notice of
these painful spasms ; burning of the abdomen ; belly drawn in ;
marble coldness of the body ; pulselessness ; cold, sticky perspiration.

Ipec, in light cases, where the vomiting predominates over the
alvine discharges ; vomiting mostly of a sour fluid, without diarrhoea.

Phos.j tongue coated white; excessive thirst; vomiting after the
water has become hot in the stomach ; belly bloated ; rumbling and
rolling in the abdomen; the rice-watery evacuations contain grains
like tallow ; oppression ; great sinking of strength.

Secale c, dizziness, deafness; painful retching; profuse diarrhoea;
unsuccessful urging to urinate ; skin wrinkled ; tingling in the limbs ;
cramps and coldness ; aversion to heat and being covered.

Sulphur, first recommended by Dr. Hering; diarrhoea and vomiting
at the same time ; wakens the patient after midnight ; the body grows
cold and blue, with intense cramps in the calves of the legs and soles
of the feet ; pain in the region of the liver.

Tabacum, cold perspiration, with constant, deadly sickness and
vomiting now and then ; cramps and tearing in the limbs.

Gonsecuiive symptoms may call for —

Aeon., if there be high, inflammatory fever ; hard, strong pulse ;
congestion of the head or lungs ; great restlessness ; fear of death.

Bell., congestion of the head with violent delirium; visions and
illusions of senses.

Bryon., typhoid symptoms ; pain in all the limbs on moving.

Canth., excessive sensitiveness of the abdominal walls; burning in
the umbilical region and deep in the pelvic cavity ; rumbling in the
abdomen and tenesmus followed by bloody evacuations ; urination
drop by drop, with great burning.

Mur. ac., difficult speech; moaning and groaning during sleep;
sliding down in bed.

Phos. ac., indifferent ; without pain; delirium; drowsiness; sopor.

Rhus tox., typhoid condition; red tip of tongue; pain in all the
limbs on lying quiet.

Cholera Morbus.

The attack comes on almost always suddenly, and frequently in the
middle of the night. It consists of vomiting and purging, spasmodic
pain in the abdomen, sometimes cramps in the legs, rapid loss of
strength, and coldness of the skin. The thirst is great, the vomiting



. CHOLERA MORBUS. 279

constant, and the purging consists of fetid fluid discliarges containing
a large quantity of bile at first, which, however, soon diminishes,
until, at last, the discharges approach the rice-water appearance with-
out smell. It prevails mostly during summer heat, although there
are cases in other seasons ; and it seems to be incited especially by
exposure, checked perspiration, drinking large quantities of ice
water, or imprudence in eating. It differs from Asiatic cholera in
not being caused by a specific poison — in not being to such a degree
epidemic and violent. It differs from poisoning with arsenic by its
purging and vomiting setting in at the same time ; whilst in cases of
poisoning the vomiting almost always precedes the purging.

Tlierajyeutic Hints. — Compare Cholera and Cholerine, Besides
the remedies there characterized may be indicated :
• Ant. cp., vomiting and diarrhoea, watery or slimy ; great thirst for
cold water, especially at night ; tongue coated white ; after sour wine.

Cham., after sudden taking cold ; severe, cutting pains in the
abdomen; vomiting of bile; painful, bilious evacuations; great irrita-
bility of mind ; impatience ; restlessness ; child wants to be carried
about; also after chagrin.

China, discharges mostly painless, containing undigested food ; worse
in the night, with great fermentation in the bowels, which are bloated ;
fulness of the bowels ; sour eructations, and better for a while after- ''"t> > W
wards ; especially after new or sour beer. ^t

Dioscorea, vomiting and purging of watery stools, with painful ^, ^ ,»>»• -^
cramps in the stomach, bowels, and extremities.

Euphorbia cor., forcible vomiting and diarrhoea of watery fluid,
with sinking, anxious feeling at the stomach ; faintness ; slow and
weak pulse ; cool skin, feet, and hands, which become affected with
painful cramps ; painful spasms in the intestines ; cold sweat on the
body and extremities ; death- like sensation, with anxiety of mind ; no
desire to live unless relief comes soon.

fris vers., vomiting and diarrhoea, with violent pain in the pit of the
stomach, or around the navel, or still lower down in the abdominal
region, at or hefore every fit of vomiting or purging ; burning in the
rectum and anus; periodical spells of aggravation about two or three
o'clock A. M.

Veratr. is the most important remedy.



280 INTESTINAL CANAL.

Cholera Infantum, Summer Complaint.

A disease found every summer prevailing among children under
two years of age, especially in large and densely -crowded cities. It
generally commences with diarrhoea, followed by vomiting. The
discharges are whitish, ash-colored or yellowish, changing into green,
or greenish, and having sometimes a very penetrating, and at other
times a peculiar sweetish, fresh sm.ell. The vomiting sometimes ceases
for a while and comes on again. There is generally a great deal of
thirst present, but the liquid is not retained. The child soon becomes
weakened and emaciated ; the abdomen sinks in, and the constant loss
of fluids causes gradual and general anemia, with symptoms of hydro-
cephalus. The child grows restless ; utters now and then plaintive
cries; rolls the head, commences squinting, and falls into stupor — a
state of things which Marshall Hall has called " hydroceplialoid^'''' in
contradistinction to hydrocephalus acutus, which is of an inflamma-
tory nature. This complaint, generally occurring during the period
of dentition, most probably has its deepest cause in the rapid growth
of the brain at that time, when it needs for its development an abun-
dance of fresh air. We see, therefore, that a change of air alone some-
times recruits the little sufferer.



/i^iAUx^ A Thevapewtic Hints,



^.-oamJ*^



y Aethusa, stools watery, greenish, without smell ; vomiting ; the milk



M_ AJA^



'^^^^^^MtLA^iiwAA^ikirit.fii^



which the child drinks is thrown up in coagulated lumps ; after

"^^'/v cries, and again commences to doze; its face is pale, with a painful

expression around the mouth.

Borax, constant vomiting ; stools painless ; at first frothy, thin and
brown; later cadaverous-smelling, containing little bits of yellow
feces, or colorless and slimy; belly soft, flabby and sunken in; gen-
eral emaciation ; sopor ; child makes an anxious face, when carried
down stairs, or put from the arms into the cradle.

Calc. c, stools whitish, watery, most frequent in the after part of
the day ; often of a sour smell ; sour vomiting ; great emaciation ;
greatly bloated abdomen ; old, wrinkled face ; retarded dentition ; cold
face ; arms cold to the elbows. Child makes an anxious face, when
being lifted up from the cradle.

Calc. phos., symptoms of Hydrocephaloid.

Kreosote, constant vomiting and greedy drinking ; stools grayish or
white, chopped, very fetid ; belching or hiccoughing, especially when



INTESTINAL OBSTEUCTION. 281

being carried ; the cliild moans constantly, or dozes with half-open
eyes ; face cold, with a pale bluish tinge, especially on the temples
and around the nose and mouth ; rapid emaciation ; quick, scarcely
perceptible pulse.

Natr. mur., vomiting and diarrhoea, worse during the day ; great
thirst ; general emaciation, most conspicuous around the neck, which
appears thin and shrunken.

Besides, compare those remedies which have been characterized
under the head of Cholera Morbus, Gastric and Intestinal Catarrh ;
especially Arsen., China, Euphorb., Ipec, Iris, Lept., Phos., Yeratr.

htestmal Obstruction.

Under this general head we shall have to consider quite different
.pathological states, which, however, when developed, cause a certain
array of symptoms that are common to all. By obstruction we un-
derstand any mechanical hindrance by which the normal passage of
the intestinal contents is intercepted.

1. Such obstructions may consist in partial closure of the gut^ in
consequence of adhesions, or cicatrices of healing ulcers, or by
hardened fecal matter ; by foreign bodies adhering to the walls of the
gut, or in thickening of the mucous membrane in consequence of
chronic catarrh ; by cancerous growths or polypi within the gut ; or
by tumors within the abdominal cavity; or by enlarged uterus or
ovaries, compressing part of the intestinal canal.

2. It may exist as a total closure of the gut, cansed either, a. By
strangulated hernia, (umbilical, inguinal, scrotal ;) or, b. By incarcerated
internal hernia into the foramen Winslowii, or foramen ovale, or into
any abnormal fissure or opening which has been formed by inflam-
mation and consecutive adhesion, and formation of bands and strings
within the cavity of the abdomen ; or, c. By a twist of the gut around
its own axis or around another 'portion of the intestines ; or, d. By an
intussusception or invagination of one portion of the gut into the
cavity of another portion next below it.

The symptoms of partial closure are as follows : Habitual constipa-
tion. The excrements are of smaller size than natural, perhaps only
finger thick, or in shape of little lumps like sheep's dung, or appear
flattened and angular.

2. The portion of the intestine above the stricture becomes widened,
in consequence of accumulation of feces. This accumulation causes a
large amount of gas, which gives rise- to partial and general meteor-



282 INTESTINAL CANAL.

ism. In consequence of this the diaphragm is pressed upwards, caus-
ing difficulty in respiration ; and as the motus peristalticus down-
wards is interfered with by the stricture, the effort of the bowels to
rid themselves of their contents causes a reverse motion — a motus
antiperistalticus ; and thus we find in bad cases-of this nature, belch-
ing, vomiting even unto ileus or miserere; that is, stercoraceous
vomiting.

The symptoms of total closure come on either suddenly or slowly.
When suddenly, we find — 1. A fixed jpain more or less violent in one
or the other region of the abdomen. This pain is sometimes continual
and sometimes intermitting ; the place where it is felt is very sensi-
tive to the touch.

2. Vomiting, at first, of such things as the stomach contains ; later
of a watery, bilious substance ; and, at last, of stercoraceous matter,
ileus, miserere.

3. The face collapses, the pulse becomes small and quick, and
respiration superficial.

4. Symptoms of peritonitis — no stool, and, at last, singultus; the
forerunner of fatal termination.

When the symptoms appear slowly^ we find — 1. A pain fixed to
some part of the abdomen, from where it radiates in all directions ;
still it does not increase to such a pitch as in the other case.

2. Vomiting, but much less frequent, perhaps only two or three
times a day, yet also terminating in ileus or miserere if an evacuation
from the bowels cannot be produced.

8. Through the abdominal walls we feel the inflated portions of the
bowels, like round bags, in which gas and fluids roll about, and which
the patient /ee/5 and others liear. These are the signs of partial and
total closure of the intestinal canal, and which I have summed up
under the general head of intestinal obstruction.

We can diagnosticate partial from total obstruction ; in the first
case there is still some evacuation, no matter how difficult and out of
shape it may be, whilst in the latter there is none at all ; but whether
in a given case the intestinal obstruction consists of an incarcerated
internal hernia, or in a twist of a portion of the intestine around its
own axis, or in an invagination of the gut, we scarcely ever can diag-
nosticate with any certainty.

Partial obstruction takes on a chronic, slow course.

Total obstruction must terminate either favorably or fatally in the
course of a few days.



coNSTiPATioisr. 283

Therapeutic Mints, — Partial obstruction, in consequence of
cicatrices or clironic catarrli of the mucous membrane, or cancerous
grov/tli or polypi, or tumors or enlarged abdominal viscera, miist, of
course, be treated individually. Compare the corresponding chapters.

Total obstruction, if caused by strangulated external hernia, suggests
Aeon., Alum, Aur., Bell., Calc. c. Caps., Cham., Coloc, Lach., Lye.,
Nitr, ac, Nux v.. Op., Plumb., Rhus t., Silic, Sulph., Sulph. ac., Yer.

Ileus, Ars., Bell., Cham., Coccus, Coloc, Lye, Nitr. ac, Nux v., Op.,
Plat., Ehus t., Silic, Sulph., Thuya, Yer., Zinc.

07ily the uncovered parts of the body perspire, Thuya.

Chronic constipation, as a general symptom, may indicate :

Aescul. hipp., dry, uncomfortable feeling in the rectum, as if it were
filled with small sticks ; very painful hemorrhoids, with little bleed-
ing ; aching and lame feeling in the small of the back, extending to
the sacrum and hips ; worse when getting up after sitting.

Alumin., the rectum is inactive ; the evacuation can be effected only
by straining the abdominal muscles ; stools very hard, knotty and
scanty ; ailments from lead.

Am. mur., hard stools ; crumbling to pieces when evacuated ; requir-
ing great efi'ort to expel them, followed by soft stools.

Anao., urging without b^ng able to expel any thing; the rectum
feels as if stopped up with a plug; the expulsion not taking place
immediately, he experiences a painful twisting and turning in the
intestines across the abdomen.

Bryon., hard, dry stools, as if burnt ; of large size and passed with
difficulty ; rheumatic tendency ; irritable and prone to fits of ano-er ;
after castor oil.

Calc. c, hard, large, partially undigested stools ; after stool feeling
of faintness ; oozing of a fluid from the rectum, smelling like herring-
brine ; too early and too profuse menstruation ; restless sleep after
three o'clock A, M, ; scrofulous diathesis.

Capsio., after drinking urging to stool, but only slime is passed ;
feeling of heat in the abdomen.

Carbo veg., urging with tingling in the rectum and pressure on the
bladder ; labor-like pain ; discharging feces in fragments, which are
tough and scanty.

Caust., frequent and unsuccessful urging, causing a good deal of
pain, anxiety and redness of the face ; stool comes off' in pieces ; at last
soft, and of the size of a goose -quill.



284: INTESTINAL CANAL.

China, laro-e accumulation of feces in tlie intestines, witTi dizziness
and heat in the head ; dif&cult stool, even when papescent.

Conium, frequent urging without stool, or a small quantity being
expelled at a time ; chilliness during stool ; palpitation of the heart
and tremulous weakness afterwards ; the flow of urine suddenly stops
and continues after a short intermission ; dizziness when turning in
bed.

Graph., hard, knotty stools, with tenesmus and stitches in the rec-
tum ; sometimes the stool is only of the size of lumbricoides ; a quan-
tity of mucus is expelled with the stool ; itching blotches about the
body, which emit a glutinous fluid.

Hydrastis, constipation, headache and piles ; after stool, for hours
severe pain in the rectum and anus ; colic pains with fainting turns,
and heat in the bowels.

He par, sluggishness and inactivity of the bowels, in consequence of
which the abdominal muscles must bear down in order to effect an
evacuation, which is hard or not, but insufficient; after mercurial
dosing.

lod., desire for stool, without evacuation; it takes place with great
facility after taking some cold milk ; discharges of thick mucus, or
purulent matter ; part of the feces being retained.

Kali bichr., stools dry, scanty, knotty ; |liinful retraction of the anus ;
debility, headache, coldness of the extremities ; tough secretion from
any of the mucous membranes.

Kali c, too large-sized feces; inactivity of the rectum; severe,
lancinating, tearing and cutting in the anus ; violent pain in the small
of the back, as if broken.

Lach., constipation of years standing; the anus feels closed; the
feces press against it all the time without passing ; only single flatus
are passed ; the feces have a cadaverous smell ; hemorrhoids, with
stitching pain in the varices when coughing or sneezing.

Lycop., ineffectual urging, owing to contraction of the rectum,
(sphincter ani ;) distressing pain in the rectum for hours after evacu-
ation ; excessive and painful accumulation of flatus in the abdomen ;
red, sandy deposit in the urine.

Magn. m., urgent pressure in the rectum ; the stool comes out in
small pieces, and seems as if burnt ; shuddering for a short time after
stool.

Natr. c, insufficient stool, with tenesmus, followed by burning in
the eyes and urethra, with great sexual excitement.

Natr. m., pressure from the navel downwards into the pelvis, or a



CONSTIPATION, 285

leaden heaviness tTirough tlie pelvis and across tlie bladder, worse
when walking, and better when sitting in a bent forward position ;
hard, dry stools Assuring the anus, makes it bleed; a number of bad
feelings in the anus after stool ; also cutting in the urethra after mic-
turition.

IVlitr. ac, hard, scanty stools ; long pressing when going to stool ;
painful burning in the rectum, especially after micturition; urine
emitting an intolerably strong smell.

IMux v., constant, ineffectual urging to stool; large, hard feces;
piles; headache; unrefreshing sleep ; after previous use of purgative
medicines; coftee and liquor drinkers; use of high-seasoned food;
sedentary habits.

Opium, stools in hard, black, round balls ; decided torpor, even
paralysis of the rectum ; vomiting of stercoraceous substances in con-
sequence of intussusception ; incarcerated hernia.

Phos., stools narrow, dry, long, and difficult to expel ; exceedingly
painful cramps in the rectum after stool.

Phytolacca, constipation of long standing ; pain shooting from the
anus and lower part of the rectum along the peringeum to the middle
of the penis.

Platina, difficult expulsion of scanty stool, adhering to the part
like soft clay ; after poisoning with lead ; travelling in the cars.

Plumbum, stools consisting of small hard balls; constriction and
drawing up of the anus ; frequent, violent colic ; drawing in of the
abdomen in the region of the navel.

Podoph., constipation with great difficulty ; prolapsus ani ; fre-
quent micturition ; weakness and soreness of the back ; especially
after washing.

Prunus spinosa, hard stool; intermitting stool, looking like the ex-
crements of dogs, in small lumps, with stitches in the rectum, extort-
ing cries.

Ratanhia, urging sensation in the small of the back, as if there
would be stool ; hard stool with straining ; fissures of the anus.

Ruta, scanty, hard stool ; frequent urging to stool, with protrusion
of the rectum, also during stool; the rectum protrudes when stooping
ever so little, and especially when squatting ; a considerable quantity
of flatulence is emitted whenever the urging takes place.

Sabadilla, violent urging to stool, with noise like the croaking of
frogs ; necessity of sitting a long while, then passes an immense quan-
tity of flatulence, which is followed by an enormous evucaution, after
that, burning pain in the abdomen.



286 INTESTINAL CANAL.

Sarsap., obstinate constipation, with violent urging to urinate;
urging to stool, with contraction of the intestines, and excessive pres-
sure from above downwards, as if the bowels would be pressed out ;
during stool violent tearing and cutting in the rectum ; afterwards a
repetition of the same symptoms.

Selen., stool so hard and impacted that it has to be removed by
mechanical aid ; the feces contain threads of fecal matter like hair.

Sepia, unsuccessful urging to stool, only wind and mucus being
passed, with sensation in the rectum as of a hmvp having lodged in it ;
contractive pain in the anus ; thence in the perinseum and vagina ;
oozing of moisture from the rectum.

Silic, stools composed of hard lumps ; after long straining the pro-
truding feces suddenly recede into the rectum.

Sulphur, constant urging, pressing on the rectum as if it would pro-
trude, with pressing on the bladder ; prolapsus ani ; palpitation of the
heart ; after stool excessive stinging and sore pain in the anus, pre-
venting lying or sitting down ; rush of blood to the head ; cold feet ;
faintness regularly, shortly before dinner.

Sulph. ac, hard stool, consisting of small, black lumps mixed with
blood, and with such violent pricking in the anus that she has to rise
on account of the pain; climacteric age; constant flashes of heat;
tremulous sensation in the whole body without trembling.

Tabac, constipation ; tympanitic bloating of the abdomen ; dysp-
noea.

Thuya, obstinate constipation, fever, inactivity, or intussusception;
hard balls ; violent pain in the rectum, which prevents the passage ;
offensive perspiration at the anus and in the perinseum.

Verbasc, scanty discharge of stool, like sheep's dung, with straining.

Veratrum, chronic costiveness with heat and pain in the head ; stools
large and hard, or first portion of the stool of large size, the latter
coming out in thin strings, although of the same consistence and color.
During stool turning pale and feeling very weak.

Zinc, dry, hard, insufficient, and difficult stool.

Hemorrhagia Intestinalis, Bntestinal Hemorrhages,

Malaena,

Takes place in consequence of either — 1. Obstructed circulation of
Mood through the vena porta, as in the case of cirrhosis of the liver,
diseases of the heart and lungs, compressions of the blood-vessels by
large abdominal tumors ; or, 2. Erosions or degeneration of the blood -



HEMOERHOIDS. 287

vessels from intestinal ulcers during typhus, yellow fever, scurvy, &c, ;
or, 3. Lesions caused hy corroding or cuUing substances, luoicnds, &c. ;
or, 4. Suppressed, normal, or habitual bloody discharges, as menstrual
or hemorrhoidal. A copious, internal hemorrhage is characterized
by sudden paleness, coldness of the body, collapsed features, weak
pulse, fainting, fits of chilliness, and discharges of blood from the
bowels. The discharged blood, when it comes from the upper portion
of the intestines, is generally dark and mixed with intestinal contents
like tar. It is generally red and fluid when it proceeds from the
lower portions. The exact seat of the hemorrhage, however, cannot
be determined, as physical examination gives no hint whatever in
regard to it. The bleeding may occur even within the stomach, as I
have mentioned when I spoke of hjematemesis ; and a black, tar-like
appearance of stool is not a sign that it contains blood, as it may be
■ colored by bile. This, however, may soon be settled. Throwing the
passage into water it colors the water red when it contains blood ; and
when it contains bile the water is colored green or yelloioish.

Tlierapeutic Hints, — Compare the above-stated morbid con-
ditions, which are the causes of the intestinal hemorrhage.

As generally indicated, the most important remedies are, Ars., Carbo
veg., China, Erigeron, Hamam., Ip., Nitr. ac, Sulphur.

Hemorrhoids, Piles,

Consist of an enlargement of the hemorrhoidal veins, which are
situated in the mucous membrane outside and inside of the sphincter
ani. When their outside ramifications are swollen they are called



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 29 of 65)