Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

. (page 30 of 65)
Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 30 of 65)
Font size
QR-code for this ebook


external hemorrhoids; when their internal ramifications above the
sphincter ani become widened, they are called internal hemorrhoids.
When, during au effort to evacuate the bowels, one of these vari-
cose veins bursts, they are called Heeding piles; when they do not
bleed they are called blind hemorrhoids ; and when, in consequence
of a chronic catarrh of the mucous membrane, a slimy, mucous secre-
tion oozes from the anus, they are called white or slimy hemorrhoids.

These enlarged veins form tumors of different sizes, from a pea to
a cherry or walnut, and sometimes encircle the whole anal opening
like a bunch of grapes. Being pressed out through the sphincter
they become strangulated by its contraction, and assume a bluish-dark
appearance.

But then the hemorrhoidal veins are not always in such turgescent



288 INTESTINAL CANAL.

state. A longer or shorter interval intervenes between these spells
of turgor, when the patient feels comparatively free from any incon-
venience. The repeated recurrence of turgescence, however, causes a
gradual thickening of the walls of the veins, and thus old hemor-
rhoidal tumors assume a more skinny, paler and harder appearance.
These varicose veins, which, by each evacuation, are pressed down,
become gradually elongated, and, uniting with the likewise elongated
mucous membrane, develop into little, stationary, soft bags outside
of the sphincter ani. These occasionally inflame, in consequence of
a new spell of turgor in the hemorrhoidal vein within. They are
called marisci, and must not be confounded with condylomata or fig-
warts.

For ages piles have been believed to be of great benefit to the
organism, and they were therefore called the golden vein ; and, indeed,
if we consider all the kinds and amount of mischief which may be
done in the body by the suppression of hemorrhoids, this expression
would seem to be founded upon sound observation, and would at once
remove those superficial assertions, that piles are a mere local disease.
Still, after all, they may have proved a golden vein! but to the attending
physician, rather than to the poor suffering patient, whom v/e fre-
quently find trying the most absurd things to rid himself of this
torment.

The principal predisposing cause of piles seems to be the position
of the hemorrhoidal veins, as the lowest branches of the abdominal
vessels, and in their want of valves to sustain the return column of
blood in its course towards the vena porta. AVhen a retardation or
stagnation by some means or other in this backward moving column
takes place, it is obvious that its whole weight must press downwards
upon its last branches, overfilling and widening them, and causing a
varicosity in these branches, which is known under the name of
hemorrhoids. Such retardation of the refluent stream of blood may
arise from different conditions :

1. From tumors within the abdominal cavity, which press upon the
veins of the rectum ; a gravid uterus, &c.

2. From diseases of the liver, which obstruct the vena porta.

8. From diseases of the lungs, by which its capillaries become
either obstructed or destroyed.

4. From diseases of the heart, by which the veins become over-
filled with blood.

5. From a general relaxation of the abdominal veins, in conse-
quence of using too much wine, coffee, tea, or leading a sedentary life.



HEMORKHOIDS. 289

The fact, Taowever, that all the members of a family frequently suffer
with this complaint, seems to favor the assumption that piles are of a
hereditary nature.

Symptoms.

As forerunners to their local appearance, we observe a fulness
and pressure in the epigastrium, disturbed digestion, bloatedness
of the abdomen, costiveness, dull pain in the small of the back,
also in the head and nape of the neck, hypochondriacal disposition,
disinclination to work, and especially to mental occupation, all of
which are symptoms that denote a disturbed action in the abdominal
organs. After a shorter or longer duration of these symptoms, we
find a gradual development of those local symptoms at the anus — the
beginning of varicose veins, their gradual growth, their turgescence
and their collapse, alternating in longer or shorter intervals. Thus
the whole complaint is of a very slow and tedious nature, changing
constantly from better to worse. The occasional spells of bleeding are
frequently attended with a feeling of relief, though they do not better
the morbid process itself in any way; they become in some cases
habitual, assuming a regular type of from three to four weeks
intervals.

In such cases the organism becomes so much habituated to them,
that when these hemorrhages are suppressed in consequence of mental
emotions, taking cold, external medical applications, &c., other dis-
turbances at once set in; as, congestion of the head, lungs, stomach,
liver, kidneys, &c., which may even result in nose-bleed, hemoptysis,
bloody urine, apoplexy, &c. But there are still other sequelee
attending this disease. In consequence of the stagnation of the reflu-
ent stream of blood, which is caused by liver, heart or lung diseases,
there arises, especially in older individuals, a varicose state of the
veins of the neck of the bladder, uterus and vagina, causing hemor-
rhages from these organs, or slimy discharges, painful micturition, &c.
Sometimes the hemorrhoidal tumors inflame ; suppurate ; form fis-
sures of the anus ; cause painful contractions of the sphincter, or pro-
lapsus ani. This is a list of the most annoying, and frequently the
most depressing, features of the so-called golden vein^ which is far
more appropriately called "piles."

Therapeutic Hints.

Aeon., bleeding piles ; stinging and pressure in the anus ; abdomen
feels full, with tensive, pressive and colicky pains ; bruised feeling in
the back and sacrum.

19



•290 INTESTINAL CANAL.

Aescul. hipp., protruding piles, bleeding slightly, attended with con-
stipation ; severe fulness and bearing down ; aching pain and lame
feeling in the back.

Aloes, protruding piles, like bunches of grapes ; hot and sore ; re-
lieved by cold water ; when urinating he has a feeling as though some
liquid discharge from the bowels would take place at the same time.

Alumina, stools hard, and of the shape of laurel-berries, attended
with cutting pain in the anus, as if it were too narrow ; succeeded by
a jet of blood from the rectum, followed by soreness in and along the
rectum.

Amm. c, varices protrude during stool, and without stool ; they are
moist, and with a pain as from excoriation; discharge of blood during
and after the evacuation ; burning pain in the rectum, itching of the
anus.

Ant. cr., tingling, itching, and burning of the varix; mucous secre-
tion from the rectum, staining the linen yellow ; alternate constipation
and diarrhoea.

Apis, small protruding varices, which sting, burn, and smart intoler-
ably, making one very irritable and fidgety ; stool constipated, urine
scanty.

Arsen., varices, which burn like fire, particularly at night ; fissures
of the anus, with impossibility of voiding urine ; urine bloody ; small
of the back feels as if broken ; impossibility of stooping ; burning in
the skin and veins ; great weakness and restlessness.

Bell., bleeding piles with severe pain in the small of the back, as if
it would break ; incarcerated varices by a spasmodic contraction of
the sphincter ani, with great pain from the slightest touch ; on this ac-
count the patient must lie with the nates separated ; dysuria ; conges-
tion of the head ; feverish restlessness.

Calc. c, profusely bleeding piles ; protruding ; painful when walk-
ing, better when sitting; too early and too profuse menstruation;
habitually cold, damp feet ; after suppression of the hemorrhoidal
flow, constant giddiness, especially on going up stairs; heaviness and
fulness of the head ; swelling of the pit of the stomach ; palpitation
of the heart ; oflensive sweat on the feet, making the soles of them raw.

Caps., the varices bleed a long time ; the flowing blood causes a
burning pain in the anus; the stool is mixed with bloody mucus;
there are drawing pains in the back and cutting pains in the belly,

Carbo veg., protruding piles, blue, even suppurating, emitting a
terrible smell ; burning in the rectam ; oozing of humor from the
rectum ; flatulence, congestion of the head, and nose-bleed.



HEMOREHOIDS. 291

Cascarilla, frequent and excessive bleeding from the rectum during
and after hard, brown stool in large lumps, and without stool.

Caust, varices large, painful, stinging; burning when touched,
hindering stool ; increased by walking and reflection ; fistula ani.

Cham., bleeding hemorrhoids with colic ; frequent urging and
diarrhoea ; pain in the back, worse at night ; ulcerating fissures at the
anus ; great restlessness, crying, screaming, tossing ; sweating ; angry,
peevish and ill-humored.

Collinsonia, flowing piles, incessant, though not profusely, or pro-
truding piles without bleeding ; sensation in the rectum as if sticks,
sand or gravel had lodged there; growing worse as evening ap-
proaches till late at night, better in the morning ; constipation of the
bowels and pain in the epigastrium, with loss of appetite ; or diarrhoea.

China, bleeding piles ; burning and burning-itching ; tingling in
the anus, with creeping and itching extending into the urethra, at-
tended with burning in the glans.

Erigeron, bleeding piles ; hard, lumpy stools.

Graph., varices and prolapse of the rectum, even when there is no
desire for stool, as if the rectum had lost its contractile power and had
become paralyzed ; painful, burning cracks (rhagades) between the
varices ; chronic constipation with hardness in the region of the
liver ; stool hard, knotty, with blood and slime ; scanty and delayed
menses ; leucorrhoea like water.

Hamam., profusely bleeding hemorrhoids, characterized by burn-
ing, soreness, fulness, and weight ; at times rawness of the anus ; the
back feels as if it would break off'; pricking pain, worse from pres-
sure, from the wrist to the shoulder along the course of the superficial
veins ; the same pricking pain in the region of the heart.

Hepar, inflammation and suppuration of the hemorrhoidal tumors.

Ign., bleeding piles; violent, shooting pains high up in the rectum;
prolapsus recti during stool ; cutting, tearing in the rectum, continuing
for hours after stool ; for quiet people, or such as get easily excited
and easily depressed.

Kali c, in consequence of constipation with too large stools ; the
hemorrhoidal tumors swell and become large and painful ; they
bleed, especially during micturition, and emit slime afterwards ;
riding on horseback ameliorates the pain considerably for the time
being.

Lachesis, protruding hemorrhoids, very painful ; a stitching pain
is felt to go through the hemorrhoidal tumors, especially during



292 INTESTINAL CANAL.

coughing or sneezing ; also at the critical age with scanty menstrual
flow.

Leptandra, frequently bleeding piles; constipation and distressing
pain beneath the sacrum.

Lycop., protrusion of varices, painful when sitting ; distention of
the whole abdomen, and rumbling after stool ; cutting in the rectum
and bladder ; itching eruption around the anus, painful to the touch ;
grayish-yellow color of the face ; depressed spirits ; frequent urging
to urinate ; slimy or reddish-sandy sediment in the urine.

Merc, large, bleeding piles during stool, which is watery ; hemor-
rhage from the rectum during micturition ; falling of the rectum,
which is black and bleeding ; inflammation and suppuration of the
hemorrhoidal tumors.

Mur. ac, largely protruding piles, which look bluish and are ex-
ceedingly painful to contact — even the sheet is insupportable ; pro-
lapsus recti on passing off of loose stool during micturition.

Natr. mur., varices, painful, stinging, and humid ; protrusion of the
rectum ; smarting and beating in the rectum ; burning at the anus ;
herpes about the anus ; herpes on the boundaries of the hair in the
nape of the neck ; cutting pain in the urethra after micturition.

Nitr. ac, bleeding piles, protruding after each stool ; the sharp-
cutting pain in the rectum lasts for hours after an evacuation, and is
much worse after a loose stool,

Nux v., all sorts of piles after purgative medicines and external
and internal allopathic treatment ; in persons of sedentary habits, or
addicted to the use of coffee, wine, liquors, spices, &c; ineffectual
urging ; constipation ; headache ; sleeplessness early in the morning ;
hypochondriac mood ; fissures of the anus, with great sensitiveness of
the rectum.

Petrol., burning and stitching in the anus and rectum ; scurf on the
border of the anus ; titillating and smarting ; itching herpes on the
perinseum.

Phos., varices protrude during emission of flatulence; mucous dis-
charges from the anus, which is constantly open ; discharge of dark,
coagulated blood ; vertigo, especially on looking up or down.

Phos. ac, bleeding piles, with intolerable pain in sitting.

Podoph., piles and prolapsus ani, with diarrhoea of long standing;
worse in the morning ; or constipation with flatulence and headache.

Puis., blind and flowing hemorrhoids ; discharge of blood and
slime with the stool ; colicky pain ; painful pressure upon the hemor-



METEORISM. 293

rhoidal tulnors ; ■backache ; fainting spells ; mild, gentle and tearful dis-
position ; dryness and bad taste in the mouth every morning ; no thirst.

Ratanhia, protrusion of the varices after hard stool, with straining
and violent pressing in the rectum; burning at the anus before and
during a diarrhceic stool ; fissures of the anus, with great sensitive-
ness of the rectum.

Rhus t., sore, blind hemorrhoids protruding after every stool ; draw-
ing in the back from above doAvnwards, with tension and pressing
in the rectum, as if every thing would come out ; labor-like drawing
towards the nterus, when standing ; pain in the small of the back, as
if bruised, when lying or sitting still ; going off when moving about.

Sepia, protrusion of piles and rectum, even after soft stool ; worse
after drinking milk ; continual straining pain in the rectum ; difficulty
of urinating, especially in the morning ; a feeling as if drops came out
of the bladder, which is not the case ; heat, burning and swelling of
the anus ; the varices become hardened ; oozing of moisture from the
rectum ; soreness between the buttocks.

Silic, inflammation and suppuration of the hemorrhoidal tumors.

Sulph., all sorts of piles; constant ineffectual urging to stool; or
thin, bloody stools; worse in the morning, with soreness of the anus,
or single violent stitches in the rectum, also between stools ; arresting
the breathing and causing him to start ; prolapsus recti during stool,
particularly when hard ; tensive pain and stiffness in the small of the
back, as if the parts were too short ; inability to stand erect ; burning
micturition. After suppression of habitual bleeding : congestion of the
head; dizziness; palpitation of the heart; pain in the pit of the
stomach, with difficulty of breathing; loss of appetite; sudden hun-
ger, with faintness before dinner ; sleepiness.

Thuya, the hemorrhoidal tumors are painful when touched ever so
slightly; sycosis.

Flatulency, Bloatedness, Meteorism of the Abdomen.

We mean by these terms an abnormal collection of gas in the intes-
tinal caned. It may be caused :

1. By certain hinds of food, as, not well-fermented beer, sweet cider,
fresh bread, green peas, unripe fruit, cabbage and the like.

2. By a niorhidly changed condition of the digestive juices, which cause
fermentation of the intestinal contents.

8. By a relaxed state of the muscular coat of the intestines, in conse-
quence of which the contents of the bowels are not properly moved



294 INTESTINAL CANAL.

forwards, and become decomposed into gaseous substances. For this
reason we frequently observe meteorism in severe cases of typhus,
pneumonia, acute exanthematic and puerperal fevers, after tlie abuse
of purgative medicines, in diseases of the brain and spine, also in hys-
teria and hypochondria.

4. By ineclianical obstructions of the intestinal canal, as, strangulated
hernia, intussusceptions and twistings of the gut around its own axis.

Symptoms.

The abdomen appears bloated, puffed out, feels either elastic,
or more or less inelastic and hard, according to the degree of com-
pression of the gas within. Percussion generally yields a tympan-
itic sound, unless there be a greater tension of the gas within than
of the external air, in which case the percussion sound is not tympan-
itic, and may be even dull. Auscultation reveals here and there gurg-
ling noises, and even the metallic tinkling may be heard when the
fluid contents move within the expanded guts.

Such abnormal expansion of the intestines drives the liver, stomach,
and lungs higher up into the thoracic cavity, causing, in this way, op-
pression, dyspnoea, palpitation of the heart, anxiety, fainting, and con-
gestion of the head. The expansion downwards causes pressure upon
the bladder, dif&cult urination, pressure upon the rectum, and fre-
quent desire for stool, and pressure upon the uterus. This abnormal
collection of gas is frequently associated with spells of violent colic,
loss of appetite, nausea, &c. Belching, or the passing off' of flatus,
gives always great relief. The gas passed consists mostly of carbonic
acid gas, or hydrogen gas, or sulphuretted hydrogen gas.

It is obvious that the prognosis depends entirely upon the cause,
of which meteorism is the consequence. Meteorism is of little conse-
quence if caused merely by improper food, or the improper condition
of digestive juices. It becomes a more serious symptom when caused
by a relaxed state of the muscular coat of the intestineS; and is most
serious when caused by intestinal obstruction.

Therapeutic Sints,

Carbo veg., much belching, sour and rancid ; bloatedness of stomach
and bowels ; oppression of the chest ; palpitation of the heart ; conse-
quences of high living.

China, distention of the abdomen; oppression of the stomach;
eructations, especially after eating; great fermentation in the bowels;
after new or sour be.er and fruit.



COLIC. 295

Cham., attended with severe colic ; tlie abdomen is swollen like a
drum; the gas passes oft' constantly, but in small and insufficient
quantities.

Lachesis, eructations of air affording relief; distended stomach ;
incarceration of flatulence.

Lycop., constant rumbling and gurgling of wind in the bowels,
especially in the left hypochondrium ; incarcerated flatulence, which
bears downwards upon rectum and bladder, causing a number of bad
feelings.

Nux v., pressure towards the chest and head; oppression of the
chest ; constipation, with constant, ineffectual urging ; after spirituous
drinks, coffee, condiments, &c., in consequence of sedentary life.

Pulsat., especially in consequence of spoiled stomach from eating fat
things, pastry, warm cakes, fruits, &c.
■ Besides, compare Gastric and Intestinal Catarrh, Costiveness and
Colic.

Colica Enteralgia,

We understand by this term a paroxysmal pain in the abdomen of
a purely neuralgic character without any discoverable pathological
change within the structure of the intestines, although it may attend
different morbid processes which consist of such pathological changes.
The causes are numerous ; they may be classed under the following-
heads :

1, Such as are dependent upon anomalies of the intestinal contents :
as abnormal quantity or quality of food, colica sahurralis ; or abnormal
development of gas, colica fiatulenta^ loiiid colic ; or accumulation of
hard feces, colica stercoracea ; or foreign irritating bodies, like worms,
colica verminosa ; or metallic bodies, like lead; colica saturnina] or
copper, colica seruginosa.

2. Such as are depenclerit upon a disturhed innervation, either — a. Pri-
marily within the great centres of innervation themselves ; from men-
tal emotions, in case of hysteria or hypochondria and spinal diseases —
colica nervosa ; or, h. Secondarily, in consequence of diseases of other
organs, which may cause a pain in the bowels sympathetically on the
principle of " reflex action." Hence, authors speak of colica hepatica
when the liver, of colica uterina when the womb, of colica renalis
when the kidneys, are thought to be the starting point of the colic.
Still, we ought to remember that in such cases the pain may not be
an intestinal colic at all, but merely an irradiation from the primarily
affected parts.



296 INTESTINAL CANAL.

3. Such as are dependent upon structural changes in the intestines,
among which we may reckon colicky pains in dysentery, catarrhal
affections, typhlitis, hernia, intussusception, strangulation, twisting,
&c., in the various abdominal disorders. There is also a kind of colic
produced by taking cold, especially of the feet and abdomen, and
which is called colica rheumatica.

Symptoms.

1. Pain. It is of a crampy, severe griping, or twisting nature,
coming and going in paroxysms, either in the umbilical region or in
the side of the abdomen ; oftentimes shifting from one place to
another. External pressure sometimes gives relief and sometimes
aggravates the pain ; in other cases it shows no influence. External

^ application of warm things relieves in a majority of cases, whilst cold
things almost always aggravate the pain.

2. Boiling and gurgling in the ahdomen, occasioned by irregular
contractions of the intestines and the moving of their fluid and
gaseous contents, which may be felt by the examining hand.

3. Bloatedness of the ahdomen where there is a great collection of
gas, or contraction of the ahdomen, especially in lead colic.

4. Constipation ; it is only in rare cases that colic is attended with
diarrhoea.

6. Nausea^ vomiting^ and helching.

6. Gold perspiration and extremities ; small pulse.

7. Anxious, frightened expression of countenance, contraction of eye-
hrows, and cotnpression of the lips.

8. Great restlessness ; the patient tries all possible positions to ob-
tain relief — now lying on the stomach, now drawing up the limbs,
now bending and pressing the abdomen against a hard object, a chair,
table, or bed-post; now sitting down, now walking about, now trying
to evacuate the bowels, «&c. In some cases, however, the slightest
motion increases the pain.

The spells usually last some hours, in some cases longer.

Wind colic ceases as soon as the incarcerated gas finds vent or
passes off.

Colic from indigestion is relieved by vomiting or diarrhoea ; colic
from hard feces passes off as soon as there is a sufficient evacuation
from the bowels.

Colic from taking cold is always relieved by a general warm per-
spiration.

As there are so many causes for, and so many different affections



COLIC. 297

witli wMcli colicky pains maybe associated, it is absolutely necessary
in each particular case which comes under our observation, to make
as close an examination as possible, in order to find out what lies at
the bottom of the painful affection.

Colic from indigestion^ ovcolica sahiirralis, is brought on either from
overloading the stomach or from improper or unhealthy nourishment.
Here are indicated —

Nux vom., after coffee, brandy, large meals.
Pulsat., after fat food, pastry, and flatulent food.
Ipecac, after sour and acrid fruits and salads.
Arsenic, after ice water and ice-cream.

flatulent colic is characterized by distention of the abdomen, gurg-
.ling and rolling in the bowels or pressure upwards towards the tho-
racic cavity, causing pain there and shortness of breath, or pressure
downwards upon bladder and rectum.

Here are indicated —

Belladonna, if associated with congestion of the head,

Carbo veg., when there is a great deal of sour and rancid belching,
without much relief.

Cham., when the abdomen is distended like a drum, and wind passes
off only in small quantities without relief.

Lycop., in cases of habitual costiveness and great pressure down-
wards upon rectum and bladder.

Nux vomica, when there is great pressure upwards toward the tho-
racic cavity.

Opium, when there is great pressure downwards upon bladder and
rectum, without any passing off of feces, gas or urine.

Rheumatic colic follows upon suddenly taking cold, gettino- wet, &c.
Here are indicated —

Aconite, after suppressed perspiration, exposure to sharp northwest
wind.

Colooynthis, cutting, pinching, contracting pain, with hot or cold



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 30 of 65)