Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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puffed ; soporous sleep, with screaming and starting ; nostrils dirty
and dry ; lower jaw sinking down.

Opium, soporous condition with half-open eyes; snoring; iris
insensible to light.

Sulphur, heaviness of the head, sinking involuntarily backwards ;
sweat on the head, with a kind of musk-like smell ; frequent change
of color in the face ; sour smell from the mouth ; after suppressed or
dried-up eruptions on the head, behind the ears, or elsewhere.

Zincum, eyes sensitive to light ; nose dry ; gagging and vomiting,
and yet a voracious appetite ; scanty, turbid urine,

Argentum nitr., according to Grauvogl, in the last stage. He gives
it in the sixth dilution every two hours, and at the same time
Calcarea phos., second trituration, night and morning.

Apocynum cannabinum, sutures opened; forehead projecting; sight
of one eye totally lost, the other slightly sensible ; stupor ; constant
involuntary motion of one leg and arm ; urine suppressed. Compare
with Helleborus.



Hydrocephalus Chponicus

develops itself, in grown persons, of acute attacks of different forms
of meningitis ; which may have been brought on by irritations of
the brain from exposure to heat or cold; external injuries ; the abuse
of intoxicating drinks, or too great mental exertion. In children,
even if it originates after birth, it is nevertheless identical with the
affection galled



10 HEAD.

Hydrocephalus Congenitus,

that form which children are born with. It is probably the conse-
quence of an iaflammatorj process of the lining of the ventricles
during foetal life ; perhaps it is a deficiency in the proper assimilation
of calcareous substances which form the bones. Why it is we do
not know in either case. Some women have given birth to hydro-
cephalitic children, several times in succession, without any apparent
cause.

As the water collects in the ventricles whilst the sutures of the
bones have not yet united, its constantly increasing bulk drives the
bones asunder and enlarges the head to an enormous size. Or, if we
take the other view, which is perhaps the more plausible of the two,
we might explain it in this manner : The insufficiently-developed bones
are not capable of restricting the growing brain within its proper
limits ; they give way here and there, and the brain gains entirely too
much space within the skull. As, however, a vacuum can never exist,
it is at once filled up with the general equalizing medium, tvater or
serum. In this way the inner pressure becomes still stronger, and the
still deficient bony structure becomes still less capable of restraining
the increased internal pressure ; it gives way again and again ; and
for the same reason the effusion of water must increase still more,
until at length the whole cranium attains to an enormous size.

The disease can be recognized at once, although it may not have
come to its full development. There is a disproportion between the
size of the skull and that of the face ; the fontanelles' are much wider
than usual, and the frontal opening may be traced down into the
frontal bone; and laterally, doAvn between the parietal and frontal
bones. The bones themselves feel thin under pressure of the fingers;
and externally the veins appear greatly enlarged, shining through the
skin.

All these external changes appear only when the collection of water
is very considerable. There have been found from six to ten lbs. of
serum within the ventricles, which then appear enormously distended
and thickened ; whilst the substance of the brain in their neighborhood
is wasting away. A small amount of serum does of course not change
the external form of the cranium ; neither is it changed should the
effusion take place at a later period, after the sutures of the skull
bones shall have closed ; to this there are a very few recorded ex-
ceptions.



DISEASES OF THE BRAIN" AND ITS MEMBRANES. 11

Children born with this complaint die frequently during birth or
soon afterwards. Others show in the first weeks no signs of this
malady; even during the whole of the first year it may be over-
looked, until the inahility of the child to hold up its head calls atten-
tion to it. But even then there may be no enlargement of the head
visible ; yet the child is sIoav in all its mental developments ; it does
not make any attempt to talk or walk ; it remains uncleanly, and its
actions look strange ; when in joy or fear it makes antics and straggles
with its extremities ; frequently such children are thrown into con-
vulsions.

The progress of the disease is either a steady one, going on from
bad to worse, until at last general paralysis ends the scene ; or it is
interrupted by stationary states ; or it remains for years seemingly un-
altered. It is rare, however, for such patients to live beyond the
age of puberty ; a few only have been observed to live to the age of
twenty.

Therapeutic Mints. — The most important remedies for this
afi'ection are : Ars., Calc. c. and phos., Helleborus, and Sulphur.



Hydrocephalus Senilis

Is that form of hydrocephalus which is found in old age, the second
childhood of man. It seems to be developed from the following con-
dition of things : The brain in old age is apt to shrink, which neces-
sarily would* cause an empty space Avithin the skull. As no vacuum
can exist, the would-be empty space is at once filled up with serum.
The same takes place when, from some cause or other, only a portion
of the brain becomes atrophied. The space which hereby is vacated
is at once taken up by an exudation of fluid. Hence this sort of
hydrocephalus is termed hydrocephalus ex vacuo. It sometimes
happens that the exudation of serum takes place so suddenly and so
profusely, that it causes all the symptoms of an apoplectic stroke^ when
it is called aipoplexia serosa.

In most cases it is impossible to make a differential diagnosis be-
tween it and apoplexia sanguinea ; neither have we any certain signs
by which to diagnose hydrocephalus senilis.



12 HEAD.



GEOUP III.



INFLAMMATORY AFFECTIONS OF THE BRAIN A^D ITS MEMBRANES,
WITHOUT EFFUSION.

As the brain is surrounded by tbree membranes — the dura mater,
the arachnoidea, and the pia mater — post-mortem examinations have
revealed inflammatory processes in each of them. An inflammation
of the dura mater is called pachymeningitis^ an inflammation of the
arachnoidea is called arachnitis^ whilst an inflammation of the pia
mater is meningitis 'proprit sic dicta^ i. e., a properly so-called meningi-
tis. Pachj^meningitis and arachnitis are never primary affections, but
always secondary to other inflammatory processes. They produce no
characteristic symptoms, and they are therefore not capable of being
diagnosed during life. The inflammation of the pia mater has been
treated of under Group II.

Encephantls, Inflammation of the Substance of the Brain.

This is a rare disease, and may be caused —

1. By external injuries ; a blow or fall upon the head. In such a
case the inflammation may start at first at the membranes, and spread
from thence into the substance of the brain. Or the concussion may
cause at once an extravasation of blood within the substance of the
brain, and thus a subsequent inflammation. This seems to be the
condition in those cases in which the cerebral symptoms develop them-
selves only when several weeks, sometimes five or six, have elapsed
after the injury. In this class we must also reckon that inflammation
of the brain which originates in consequence of apoplexy.

2. By diseases of the skull, especially by caries of the petrous por-
tion of the temporal bones ; the inflammation spreading by contiguity
of tissues.

3. By different infective diseases: pygemia, typhus, syphilis, glanders ;
for the intimate connections between which we have no plausible
explanation.

4. By some entirely unhnown conditions ; as it would appear from
cases in which the disease is developed from previous states of appa-
rently perfect health.

Encephalitis never attacks the whole brain at once, but only a spiall,
circumscribed portion of it. These places are swollen, which may be



DISEASES OF THE BRAIN AND ITS MEMBRANES. 13

known from the circumstance tliat the surface of the brain above ap-
pears even — not dipped in, as is usual; they are infiltrated and
softened, and in consequence of extravasation speckled with red dots.
If resolution take place, all well and good ; if not, the inflammatory
process continues on to the formation of an ahscess ; in which case the
pus may be absorbed, or the suppurative process spread to the mem-
branes of the brain, and cause a violent meningitis.

From the great variety in the nature of encephalitis, it can be easily
understood that there must result, likewise, a great variety of its
modes of utterance ; and we need not wonder that, in certain cases,
encephalitis is not recognizable at all by its symptoms, as there are
indeed cases on record, in which during life no particular manifesta-
tions of cerebral disturbance existed ; yet post-mortem examinations
revealed large inflamed spots and abscesses in the substance of the
brain. This obscurity depends entirely upon the peculiar locality and
extent of the diseased spot. In other cases we are not able to dis-
tinguish it from meningitis, with which indeed it may be combined,
either preceding or succeeding it. Thus encephalitis is sometimes,
especially in chronic cases, involved in much obscurity ; and again it
may be complicated with meningitis or apoplexy.

Meningitis Cerebro-spinalis Epidemica, Spotted Fever.

This is an inflammation of the pia mater of the brain and spinal
cord, resulting in an exudation of purulent matter. In the cere-
brum, it is found chiefly at the base, about the pons, the optic nerves,
and the medulla oblongata; in the spinal cord, chiefly about the
dorsal and lumbar vertebrse. The brain is generally swollen or dry ;
sometimes there are small foci of softening.

It has been described under different names, as hrain fever^ per-
nicious fever, ship and jail fevers, congestive fever, •malignant typhus,
exanthematic typhus^ and has been observed as an epidemy in South-
ern France in the year 1837, later in Italy, Spain, Ireland, Germany.
In 1848, it was prevalent in Alabama, Missouri, and Arkansas; in
1850-51, in Massachusetts and the State of New York ; and a few
years ago in Pennsylvania and other States. It is usually epidemic,
and chiefly confined to children and youth — more boys than girls,
though not exclusively. Its causes we do not know. It seems,
however, to occur more frequently in the latter part of winter and
spring than in any other season of the year, and much oftener in
warm, damp, wet seasons.



14 HEAD.

It is characterized by the following symptoms :

It frequently sets in suddenly, and commences with a chill, which is
followed by fever ; violent headache; restlessness; extraordinary pros-
tration of strength ; great aching in all the limbs, and sensitiveness
to touch; quick, irregular pulse; stupor; convulsions; contraction
of the nape, or one side of the neck, throwing the head backwards
or sideways ; convergence of the eyes ; double vision, and flabbi-
ness of the enlarged tongue. The name spotted fever was suggested
by irregular, purplish, ecchymosed spots, from the size of a pin's
head to larger patches, which appear upon various parts of the body.
These spots do not grow white under pressure ; they make their
appearance generally on the second day of the disease ; first on the
upper eyelids, gradually extending over the whole body. Still, these
spots do not appear in all cases.

Therapeutic Mints. — The disease has proved, so far, very
fatal ; and we need not wonder, as it attacks such vital organs with
such violence.

Aconite, chill ; fever ; restlessness ; dry skin ; great thirst.

Argentum nitr., recommended by Grauvogl.

Arnica, sopor; soreness in all the limbs; ecchymosed spots.

Belladonna, violent headache ; dilated pupils ; double sight ; de-
lirium.

Bryonia, bursting headache; stiffness of neck ; great pain in joints
and limbs, not allowing motion.

Cimicifuga racemosa, intense pain in the head, as though a bolt
were driven from the neck to the vertex with every throb of the
heart; stiffness in the back; tonic and clonic sjMsms ; intense pain in
the eyeballs; tongue swollen.

Crotalus, pain in all the limbs ; horrid headache ; red face ; de-
lirium, with open eyes ; ecchymosed spots everywhere.

Chininum sulph., great prostration; involuntary closing the eyelids
from debility ; violent, throbbing headache ; heat in face ; vertigo.

Gelseminum, great prostration; complete loss of muscular power,
of vision and speech ; pulse very feeble ; respiration labored, feeble ;
nausea; vomiting.

Hyoscya mus, c?o^i5?e szf/Ai!; convulsions; delirium.

Lycopodium, sopor; sinking of the lower jaw; fan-like motion of
nostrils ; jerkings of the limbs and body.

Opium, stupor ; spasms ; drawing the body backwards and rolling
it first to one side, then to the other ; deep, slow breathing ; very



DISEASES OF THE BRAIN AND ITS MEMBRANES. 15

quick or else very slow pulse ; after violent mental emotions, fear,
grief, fright, which act like a blow, stunning the whole nervous
system.

Still other medicines have been administered, other medicines may
have been beneficial. The accounts are not yet closed upon this
subject.



GROUP IV.

■ STRUCTURAL CHANGES V/ITHIN THE BRAIN,

Apoplexla Sanguinea

Is a hemorrhage within the brain. In this disease, two conditions
of the brain may obtain. In the first, blood oozes from the capil-
laries ; in which case the substance of the brain appears dotted
with numerous little bloody spots, diffusing themselves into the
surrounding parts of the brain, which assume a reddish color ; and,
in case of breaking down of the tissue, form a reddish, soft mass,
which is known under the name of red softening of the orain. In the
second condition, the blood gushes out from some of the smaller
arteries^ and forms a large clot of blood in the brain. In this case
there are sometimes smaller clots of extravasated blood in its im-
mediate vicinity; but it is very rare that equally large clots appear
in different parts of the brain at the same time. Such hemorrhages,
however, frequently take place, one after the other, at shorter or
longer intervals, which is in accordance with the popular notion,
that a man will not live through a third stroke of apoplexy.

The principal cause of hemorrhage is degeneration of the coatings
of the arteries^ which may be either a fatty degeneration or the result
of any inflammatory process, as in endarteri'itis deformans. Softening
and atrophy of the Irain may also cause apoplexy. When such pre-
disposition exists, the attack itself may be brought on by any exer-
tion which increases the quantity of blood and consequent pressure
within these degenerated vessels ; thus, a rupture may be occa-
sioned by hard spells of coughing ; vomiting ; laughing ; strain-
ing when at stool, or in the act of parturition ; and by mental ex-
citement. A particular habitus apoplecticus does not exist. Obser-
vation proves that, not only those who have a short neck, broad
shoulders, wide chest, large abdomen, and strong muscles (the so-



16 ■ . HEAD.

called plethoric lial)it) are liable to this affection, but also those of a
meagre and slender shape. Apoplectic strokes generally occur after
the fortieth year, as Hippocrates had already observed ; and this for
obvious reasons, when we consider its principal cause.

The attack is always sudden, if caused by the bursting of any
considerable artery. The person, when attacked, falls suddenly to
the ground, if he should be standing ; he loses all consciousness ; his
face is deadly pale, but changes gradually into a purplish hue ; the
respiration is labored and snoring, and blowing during expiration ;
in such cases, congestion of blood towards the face soon takes place,
whilst in those cases in which the respiration is not impaired, the
face remains pale to the end. All voluntary motions cease ; the
limbs hang motionless ; the skin is sometimes cool and pale, and
sometimes dry and covered with sweat.

In cases of capillary extravasation, however, no such sudden
attacks take place. It results in a mere partial paralysis. This
condition may exist, therefore, during life, without our being able
to diagnosticate it with certainty ; as paralytic conditions may be
the result of a number of other conditions.

The most frequent seat of hemorrhages is the coiyus striatum and
the thalamus opticus. The destruction of these parts, or of the
pedunculi cerebri, always causes a paralysis of the opposite side of
the body.

If the patient survives the first attack, he gradually returns to
consciousness; but now symptoms of inflammation of the brain
develop themselves, and necessarily, because there is an actual
wound inside to be healed. The signs of this inflamm^ation are:
acceleration of pulse, fever, headache, delirium, jerking, and con-
tortions of the paralyzed limbs. In those cases, in which the de-
struction by the hemorrhage is not too great, this stage of reaction
causes the injured parts to cicatrize, or to absorb the effused blood,
and, by means of fibrous exudations, form a cyst — apoplectic cyst —
containing serum, which usually remains for life. We observe
now, according to these remaining external lesions, one-sided par-
alysis, stammering, or total inability to talk. In light cases, where
total absorption of the serum takes place, without destruction of
substance, there is gradual recovery^ In most cases, however, we
observe a gradual decrease of mental capacity and activity, espe-
cially a loss of memory, which no doubt corresponds to that general
atrophy of the brain which is necessarily consequent upon such a
destructive process.



DISEASES OF THE BRAIN AND ITS MEMBRANES. 17

Therapeutic Hints,

Aconite, head liot; carotids throbbing; skin hot; pulse full and
hard, but not intermittent ; also after fright.

Arnica, head hot and rest of body cool; paralysis of left side;
pulse intermittent, or irregular.

Baryta c, can't speak; childish; no clear sensorium; and in old
age.

Belladonna, loss of consciousness ; red face; dilated pupils; loss
of sight, smell, and speech ; spasms in the face ; thick tongue ; dif
hcult deglutition ; involuntary emission of urine ; reaching with the
hands to the genitals ; moaning ; paralj^-sis of limbs right and left ;
coma, and sopor.

Cocculus, face red and hot; eyes closed, with the balls constantly
rolling about; pupils dilated; breathing without noise; stupor; left
or right extremities paralyzed.

Geiseminum, passive congestion ; nervous exhaustion.

Hyoscyamus, sudden falling down, with a shriek; soporous con-
dition ; inability to swallow ; involuntary discharge of feces ; face
red ; numbness of the hands.

Lachesis, left side mostly affected ; blowing expiration ; cannot
bear any thing to touch his neck ; when conscious, talks and jumps
abruptly from one idea to another ; after the use of liquors or mental
emotions.

Laurocerasus, palpitation of the heart; scarcely perceptible pulse;
cold, moist skin ; convulsions of the muscles of the face.

Nux v., unconsciousness; snoring; paralysis of lower jaw and
(mostly) of the lower extremities, which are cold and without sen-
sation.

Opium, coma ; stertorous breathing ; open eyes ; dilated pupils ;
red face; sinking of lower jaw; slow, irregular breathing; slow
pulse; jerking of muscles in the face; convulsive motions of the
extremities, or tetanic stiffness of the whole body ; hot sweat on the
head ; foam before the mouth.

Sepia, after previous attacks ; in men, who have been addicted to
drinking and sexual excesses, with a disposition to gout and hemor-
rhoids. Forerunners : dizziness in walking, with staggering ; things
fall out of their hands; forgetfulness ; the use of wrong words when
writing; cold feet; intermitting pulse.



18 HEAD.

Encephalomalacia, Softening of the Brain.

This is never a primary, but always a secondary affection ; and its
symptoms vary according as the cause varies. The causes are :

1. Partial ansemia of the brain. If any part of the sj^stem be-
comes deprived of its necessary supply of blood, it dies — mortifies.
The brain forms- no exception. If, by emboli, or by tying the ca-
rotid artery, the afflux of blood to one portion of the brain becomes
obstructed, this portion changes into a moist, soft, jelly-like substance,
which is generally, of a whitish, grayish-white, or yellowish color,
and is known in the books under the name of necrotic or yellow
softening of the brain.

2. Capillary hemorrhage within the brain. It destroys the con-
tinuity of the substance of the brain. The extravasated blood mixes
with the brain-substance, and makes it a reddish, soft, moist mass,
which is known in books under the name of hemorrhagic or red
softening of the brain.

3. Hydrocephalitic effusions. Their pressure causes an anasmic
state of the neighboring portions of the brain, which appear quite
white, and often so soft as to be nearly of the consistency of cream.
This is called the hydrocephalitic or white softening of the brain.

A little reflection will convince one that the symptoms of this
affection must vary altogether with the nature as well as the seat
of the destruction. And there is, indeed, no characteristic complex
of symptoms by which we are enabled to diagnosticate either the
one or the otber, or any form of this disease with any certainty
at all.

Therapeutic Sints cannot be given, for the same reason.
Sclerosis, Hardening of the Brain,

This affection involves only small portions of the brain. It takes
place, as we have seen, in consequence of inflammatory processes in
the brain, by which cicatrices are formed. But indurations are like-
wise formed by an infiltration of fibrous elements within the substance
of the brain, seemingly without any previous inflammation, the causes
of wHch we do not know.

Such hardened places are formed more frequently in tbe white than
in the gray substance ; their number varies : sometimes only one is



DISEASES OF THE BRAIN AND ITS MEMBRANES. 19

found, at other times many. They are of an irregular shape, and
vary in size from that of a lentil to that of an almond. When dis-
sected, they present within a milk-white appearance, and in their
centre blue or gray-reddish dots, which are the residues of destroyed
capillary vessels.

The disease bevelops itself but slowly, and its symptoms are not
at all characteristic. Paralysis, however, is its most frequent con-
sequence ; and as its morbid process is confined to small portions of
the brain, so are also its paralytic consequences almost always at first
confined to certain groups of muscles ; to those of one extremity only,
and always, at first, that of a lower extremity. The paralysis gradu-
ally, but quite irregularly, proceeds to other parts ; paralyzing finally
even the muscles of deglutition, respiration and circulation.

Therapeutic Mints^ for obvious reasons, are absent.

Hypertrophy of the Brain

Means an overgrowth of the brain. However, we ought to know,
that it is probably not the cerebral substance itself, which develops
more largely, than naturally, but that this enlargement consists
rather in an undue growth of that interstitial, fine tissue which binds
the nervous elements together. It is confined mostly to the cerebrum.
This abnormal growth is either congenital, (and then is frequentlv
combined with an imperfect growth of the body,) or it develops
itself after birth, mostly during early childhood, rarely afterwards.
In the latter case, we find it frequently associated with rhachitis and
enlarged lymphatic glands. Its causes we do not know. Its external
symptoms are : a considerable enlargement of the head, if it takes
place before the sutures of the skull are perfectly closed ; a condition
entirely similar to that in the enlargement of the head in consequence
of hydrocephalus. When it takes place after the closure of the
sutures, such extension is impossible, but the skull bones grow
thinner and their inner layer becomes roughened by absorption. In
the first place it can be distinguished from hydrocephalus by this
fact : that children having this affection are rather forward in their
mental development, whilst in hydrocephalus the reverse always
obtains. A hypertrophy after the closure of the sutures is never
recognizable with certainty. One of its most frequent symptoms,
however, is frequent attacks of fits, which resemble epilepsy.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 3 of 65)