Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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808 ■ INTESTINAL CANAL.

5. The teicocephALUS dispae, or thread- ivorm, is from one to two
inches long, thin like a thread in front, whilst its posterior portion is
thicker. It is generally found in the cgecum of persons who died of
typhus. There are no symptoms known by which it could be diag-
nosticated during life.

Special SintSo

Aeon., pain in the bowels; the umbilical region is hard, and the
whole belly bloated ; urging to stool without discharge, or slime only ;
nausea ; accumulation of water in the mouth ; or restlessness at night
on account of intolerable itching and tingling at the anus, throwing
the child into fever ; (seat worms.)

Arg. n., periodical pain in the region of the liver and around the
Davel, with sickness at the stomach, retching, vomiting of tough mucus ;
menses irregular, but always discharge of thick, black, coagulated
blood ; gray -yellowish color of the face.

Bell., drowsiness; starting in sleep, grating of teeth, involuntary
discharge of feces and urine, or dysuria ; squinting.

Calc. c, headache, dark rings around the eyes ; pale, bloated face ;
thirst ; thick, bloated belly ; aching about the navel ; diarrhoea ; easy
perspiration from motion ; scrofulous diathesis.

China, pain in the belly worse at night, after eating; fulness of the
abdomen, pyrosis, pressure in the stomach and retching ; tremulous
weakness all over.

Cicuta, frequent hiccough and crying ; pain in the nape of the neck ;
spasmodic drawing of the head backwards, and tremor of the hands.

Cina, restless sleep with rolling of the eyes, dark rings around the
eyes ; squinting ; enlarged pupils ; constant rubbing the nose ; bleed-
ing of the nose ; face pale, cold or red and hot ; loathing of food, or
great hunger ; nausea ; vomiting ; pain in the umbilical region ; belly
hard and distended ; constipation ; dry, hacking cough at night ; fever-
ishness ; convulsive motions of head and limbs.

Euphorbia, loss of appetite, or voraciousness at times ; furred tongue,
feverishness ; fetid breath; bloated stomach; constipation or diar-
rhoea; emaciation, peevishness, wakefulness.

Ferr., pale, wretched complexion, easily flushing; itching at the
anus from seat- worms at night ; involuntary micturition.

Filix mas, frequently pain in the bowels, a kind of gnawing and
boring; constipation; loss of appetite; furred tongue ; pale face; blue
rings around the eyes ; itching of the nose ; irritable and cross.



WOEMS. 309

Ign., itching at the anus from seat-worms ; convulsions, witli loss
of consciousness and temporary inability to speak afterwards.

Kousso, indigestion ; loathing ; sleeplessness ; weakness with faint-
ing ; profuse and cold perspiration ; emaciation ; dull pain in the
bowels ; bloatedness ; constipation, tape-worm and other worms.

Lye, arthritic pain and stifthess; chronic eruptions; wretched,
dirty, pale, earthy complexion; flatulence, bloating the stomach and
abdomen ; sensation of something crawling and moving in the bowels
and stomach up and down ; constipation.

Merc, continuous greediness for eating ; he becomes weaker and
weaker withal ; bad smell from the mouth ; itching of the anus ;
inflammation of the vulva ; seat and round-worms.

Punica granatorum, vertigo, wavering before the eyes, enlarged
pupils ; yellow complexion ; grating of teeth ; accumulation of water
in the mouth ; changing appetite ; gulping of watery fluid ; vomiting ;
sensation of something moving in the stomach ; bloated bowels ; colic ;
palpitation of the heart ; spasms ; syncope.

Sabadiila, vomiting of round-worms, or nausea and retching, with a
sensation of a worm in the pharynx ; or, in case of tape- worm, burn-
ing, boring and whirling in the umbilical region ; accumulation of
water in the mouth ; chilliness and sensitiveness to cold ; sensation as
if the abdomen were sunken in.

Spigelia, nausea every morning before breakfast; always better after
breakfast ; dilated pupils ; squinting ; pale face ; smarting in the nose ;
sensation of a worm rising in the throat ; better after eating ; or vom-
iting of all she takes, with sour rising like vinegar from the stomach ;
pain in the bowels ; dry, hard cough at night ; palpitation of the
heart.

Silic, colic in children from worms.

Sulphur, after Aeon, or Merc. ; creeping in the nose; creeping and
biting in the rectum ; passage of lumbricoides, ascarides and tgenia ;
nausea before meals, and faintness before dinner ; restlessness at night.

Stannum, Hahnemann and others have mentioned it as palliating the
symptoms caused by tape and round- worm.

Teucrium is said to be specific against the terrible itching in the
anus from thread-worm.

In addition the following remedies may be merely mentioned as
vermifuges : Apocyn. andr., Asclep. syr. and tuber., Chelone, Dolich.
pruriens, Gelsem., Gnaphal, Helonias, Pod.

Kafka recommends Extractum filicis maris JEthereum^ from one
to five grains per dose every hour or two hours, not, however, on an



310 PERITONEUM.

empty stomacli, but after eating a plateful of fat water-soup ; at tlie
same time injections of milk every liour or two. The setherial extract
benumbs the tape-worm, makes it weak and sick, the fat soup it does
not like, and so it withdraws itself instinctively from the small intes-
tines into the colon, where the smell of milk acts as an invitation.
After three or four doses of the extract, he administers a quick-
acting purgative (jalapine) in from two to three grains. After the
expulsion of the worm, the patient is allowed to partake of a cup of
coffee, or a glass of wine and soup, and go to bed, if he feels weak.

Kurtz recommends Cupr. ac, 10 gr., dissolved in 1 oz. aq. dist.
From this solution he orders to be taken on the first day five, on
the second six, and so on up to twenty-five drops, in half a cupful of
water, night and morning.

For my own part, I don't think such perforce-cures required. A
careful selection of the remedies for the individual ailments will
always relieve the patient ; the parasite then leaves of its own accord
an organism which is no longer adapted to its further development,
or it is made, after the system shall have become renovated, a per-
fectly harmless inhabitant.

Diseases of the Peritoneum.

The peritoneum is a serous membrane, and therefore a shut sac,
with a single exception in the female, in which case the peritoneum
is perforated by the open extremities of the Fallopian tubes, and is
continuous with their mucous lining. It invests and envelops all
the different viscera of the abdomen, and is then reflected on the
parietes. Hence it is perfectly analogous to the pleura in the chest,
and the arachnoid membrane in the cranium. Its pathological disor-
ders will, therefore, as we shall see, correspond very closely to affec-
tions of the above-named membranes.

Peritonitis.

Its pathological character is like that of pleuritis or of meningitis
— injection of the capillary vessels followed by exudation. This exu-
dation is either —

1st. Of a serous nature^ and then generally profuse, distending the
abdomen to a considerable extent. Owing to its serosity, this kind
of fluid is very easily reabsorbed. Or the exudation is —

2d. Of a fibrous nature, coagulable lympli^ at least predominantly so.
This is apt to cause adhesion, not only between the layers of the peri-



PEEITONITIS. . 811

toneura at different places, (thus forming sacs wherein the remaining
fluid is retained,) but it may create, also, strings or bands of fibrin,
which fasten one portion of the intestine to another, and which may
give rise to strangulations of portions of the intestines. Or the exu-
dation is — •

8d. More or less mixed with hlood- globules, and then it is called
hemorrhagic; and is mostly found in diseases which predispose to
bleeding in different organs: like scurvy, typhus, delirium tremens,
exanthematic fevers, and so on. Or the exudation is transformed —

4th. Into pus or ichor^ and then it is called purulent or ichorous.
The latter takes place only under the most unfavorable conditions,
where there exists a generally depraved state of the blood : as in
puerperal fevers, pyasraia, or when urine passes into the cavity of the
abdomen.

It is thus clear that a peritonitis is not necessarily cured simply be-
cause the inflammatory symptoms have passed away; its product,
the exudation, is still there, and may give much trouble before it is
removed.

Peritonitis does not always involve the whole peritoneum, is not
always a general or diffused peritonitis, but much more frequently it is
only partial, circumscribed^ attacking only single portions of it; for
example, those parts which cover the liver, spleen, kidneys, uterus,
or portions of the intestines, being more or less complicated with
inflammations of these organs.

Its causes are various. Primarily, it is most frequently brought on
by external injuries: a blow, a fall, a penetrating wound, or by sur-
gical operations, or by exposure to cold and wet.

Secondarily, it may be a mere continuation of an already existing
inflammatory process of the liver, spleen, womb, bladder, caacum, &c.,
or it may arise in consequence of ulcerative processes within the in-
testines, and subsequent perforations ; also childbed fever and men-
struation are frequent causes of peritonitis.

Symptoms.

Owing to these diverse causes, it is obvious that peritonitis, consid-
ered as a general form of certain morbid processes, must exhibit a
great variety of manifestations when we come to consider individual
cases. Indeed that is so with all forms of diseases. I can point out
only those symptoms which are characteristic of all forms.

1st. Pain is never absent, and always severe ; it is described as
sharp and lancinating, and is increased by the slightest motion or



312 PEEITO]!TETrM.

toucli. Therefore tlie patient lies quietly on his back, with his thighs
flexed, breathing only with the thorax, instinctively avoiding all ac-
tion of the diaphragm. The slightest pressure increases the pain ;
even that of the bed-clothes seems sometimes unbearable — a distinc-
tive sign between peritonitis and colic.

2d. Vomiting ; at first, of the usual contents of the stomach, then
of slimy and bilious, and lastly of great green masses, as though ver-
digris had been taken into the stomach. It becomes stercoraceous
only when the peritonitis is caused by an obstruction of the bowels.
The vomiting never relieves, but increases the pain considerably.

3d. Singultus sets in especially if the serous lining of the diaphragm
becomes involved in the inflammatory process.

4th. Constii^ation — owing to the paralyzed state of the intestines —
is a frequent symptom ; but in cases of peritonitis puerperalis, or in
combination with catarrhal inflammation, or ulceration within the
intestines, there is almost always diarrhoea.

5th. Meteorismus and distention of the abdomen in consequence of
accumulation of gas and fluid.

6th. Constant desire to urinate; 'painful micturition or retention of
urine ; always where the serous lining of the bladder is involved in
the inflammatory process.

7th. Fever ; more or less intense according to the extension of the
inflammation. Gradually, however, as the disease progresses, the
pulse becomes small and flickering ; the extremities cool, and covered
with cold sweats ; the features collapse.

8th. Physical signs are not very readily elicited, as the patient can
bear neither touch nor motion ; although, of course, we may expect a
dull sound on percussion where there is effusion, and a tympanitic
souad where there is meteorism. Auscultation gives no signs, except
rumbling in the bowels, which may be heard a yard ofl".

That it is a dangerous disease we may conclude, if we consider for
one moment its nature ; and, again, that this danger varies according
to the cause and complications of the disease. Simple cases, caused
by bruises, taking cold, without other complications, are the least
dangerous. Those caused by wounds are more or less dangerous, ac-
cording to the nature of the wound. And the danger of those which
are caused secondarily by other inflammatory processes depends upon
the nature of these processes.

It is a good sign when, in the progress of the disease, the pain
gradually abates and the pulse rallies. It is a bad sign when the pain
abates and the pulse gets weaker and quicker. It is a sign of immi-



PERITONITIS. 313

nent danger wlien tlie pain suddenly subsides and the pulse becomes
flickering and the features collapse.

Cases which have become chronic terminate frequently in marasmus
and a variety of consecutive sufferings.

Therapeutic Hints,

Aeon., hot, dry skin ; quick, hard, small pulse ; high, inflammatory
fever ; mouth and tongue dry ; great thirst ; bitter taste ; vomiting ;
no stool ; urine scanty, red, and hot ; lower extremities cool ; short,
quick breathing ; very restless ; anxious expression in the face ;
burning, cutting, darting pain in the bowels, worse from slightest
pressure, motion, and on lying on the right side ; abdomen hot to the
touch. After taking cold, drinking cold water when being heated.

Apis, burning, stinging pain in the bowels, very sore to the touch ;
when exudation has taken place ; urine scanty, dark ; oedematous
swelling of the feet ; burning, stinging in the region of the ovaries ;
metritis.

Arsen., later, when there is a sudden sinking of strength, cold,
clammy perspiration, anxious, internal restlessness, insatiable thirst
with drinking but little at a time ; constant vomiting ; burning in the
bowels ; all worse in the middle of the night.

Bell., after Aconitum, great congestion to the head ; strongly pul-
sating carotid arteries ; light and noise unbearable ; colicky pains in
the bowels ; painful retching and vomiting, worse from motion and
contact ; great anxiety and dyspnoea. Especially when in complication
with metritis or perityphlitis.

Bryon., stitching pain or pressing, lancinating in the bowels, worse
from slightest motion ; when exudation has taken place ; tongue white
and dry ; great thirst ; bowels constipated ; the patient lies perfectly
still, don't want to move. Especially in complication with dia-
phragmitis.

Calc. c, when about the seventh day a red rash appears; also when
the pain is alleviated by cold water applications, so that the patient
wants them renewed constantly.

Canth., abdomen burning hot ; tympanitic distention in its upper
region ; lower portion yields a dull sound ; bloody, slimy stools,
painful, extorting cries ; tenesmus of the bladder ; strangury ; great
anguish and restlessness ; distressed face ; sunken features ; cold ex-
tremities. Especially when the serous lining of the bladder is the seat
of inflammation.

Lachesis, abdomen hot and sensitive to touch ; painful stiffness



314: PERITONEUM.

from the loins down into tlie thighs ; scanty, turbid urine with red-
dish sediment; strangury; constipation; necessity of lying on the
back with drawn-up knees. Especially in complication with typhlitis.

Lycop., in complication with diaphragmitis or hepatitis ; when lying
on the left side, a feeling as if a hard body were rolling from the navel
to that side ; or when after three or four days the face assumes a yel-
lowish color ; troublesome flatulence and constipation ; sleeplessness,
and constant loathing.

Merc, at a later period, if the exuded fluid becomes purulent, with
frequent starts; creeping chills; perspiration without relief; pale,
wretched complexion ; foul smell from the mouth ; vomiting of slime ;
and slimy stools with straining; oedematous swelling of the feet;
great weakness and emaciation. Especially when in complication
with typhlitis and the formation of abscesses.

Natrum, stitching and sticking pains ; predominating coldness of the
lower extremities ; kind of numb and stiff' feeling in the affected parts,
as if they were made of wood.

Opium, distention of the abdomen; anxiety, with a feeling of fly-
ing heat internally, and stupefaction of the head ; somnolence ; anti-
peristaltic motion of the intestines ; constant vomiting and belching ;
retention of stool and urine ; complete inactivity of the lower bowels.

Rhus t., great restlessness; changing position, notwithstanding the
pain it causes ; tongue red at the tip ; pressive, cutting pain in the
abdomen ; typhoid symptoms ; febris lenta ; metritis.

Sulphur, after Aeon, and Bryon., or when the disease takes a pro-
tracted course.

Veratp., vomiting and diarrhoea; coolness of the skin; sunken fea-
tures ; pulse small and weak ; thirst great ; restlessness and anxiety.

Ascites, Dropsy of the Peritoneum.

Its pathological character is like that of hydrothorax, a collection
of fluid within the peritoneal sac, which is of a yellow, or yellowish-
green ; or (if blood be mixed with it) of a reddish color ; contains a
great deal of albumen, saline constituents, and flakes of coagulated
lymph. The quantity of fluid sometimes exceeds forty pounds. The
peritoneum is opaque, without lustre ; thickened, but without any sign
of inflammation. Liver and spleen are pale^ sometimes smaller than
normal ; the kidneys appear aneemic ; and the diaphragm is pushed
upwards into the thoracic cavity.

Dropsy of the belly is never a primary disease, but always the con-



. ASCITES. 815

sequence of some morbid action, such as diseases of t"he lungs, heart,
larynx, blood-vessels, liver, spleen, kidneys, intermittent fever, and
cancer- cachexia.

It may result from mere local troubles, such as impediments of
circulation within the peritoneum by obstructions of the vena porta;
cirrhosis, and tumors of the liver ; tubercular and carcinomatous degen-
eration of the peritoneum. Frequently several of these causes are in
operation.

Symptoms.

1. Sivelling of the abdomen. This alters its form according to the
position of the patient. When standing, the hypogastric region swells
out the most ; when lying, the most dependent portion of the abdo-
men bulges out. This distinguishes ascites from any other swelling,
within the abdominal cavity.

2. Fluctuation^ which is easily discovered by palpation.

3. Diminution of urinary secretion and alvine evacuations.^ (the latter
excepted, where there is an intestinal catarrh co-existing.)

4. Dull percussion sound, also variable according to the patient's
positions.

5. Pressure toivards the thoracic cavity, with dyspnoea and palpita-
tion of the heart.

The prognosis depends entirely upon the nature of its cause. If
that is not removable, it is hardly to be expected that its consequences
will be.

In our thera'peutic management of each individual case, therefore,
we shall have to select remedies from those which are indicated for
dropsical affections in general ; as. Apis, Ars., Bry., China, Dulc, Led.,
Lye, Phos., Puis., Khus t., Sep., Stront.

Vomiting and diarrhoea suggests Ant. cr.. Tart, em.. Apis, Arg,,
Ars., Asar., Borax, Cham., Cupr., Ipec, Merc, Phos., Senega, Sulph.,
Yer.

Ulcers on the legs, Ars., Graph., Hell., Lye, Merc, Ehus t., Scilla,
Sulph.

(Edema of the loiver limbs, with constant oozing out of the water
from sore places without formation of pus, Ehus t., afterwards Lye

Cough, with dropsy, Amm. c. Apis, Ars., Colch., Hell., Nitr. ac

Special Hints,

Apis, urine scanty, dark, like coffee-grounds ; thirstlessness ; great
soreness of the abdominal walls ; stinging, burning pains in different
parts of the body ; can't get breath except when sitting ; even lean-



316 PERITONEUM.

ing backwards causes suffocating feeling ; in complication with scarlet
fever, uterine tumors, and inflammatory processes of the bowels.

Apocyn. cann. has been given abundantl}^ by western physicians
for "dropsy" of all kinds; it seems to be indicated by a sinking feel-
ing at the pit of the stom.ach ; an irritable condition of the stomach,
that cannot retain even a draught of water ; muddy urine ; diarrhoea ;
bloatedness of the face after lying down, passing off after sitting up ;
dropsy after scarlatina.

Arsen., complexion pale and earthy, or greenish ; great weakness,
exhaustion ; faint feeling from slight motion ; tongue dry ; great
thirst, with frequent drinking, but only little at a time ; suffocative
spells, especially at night ; great anxiety ; must jump out of bed ;
skin cool ; burning heat inside ; post-scarlatinal dropsy ; in compli-
cation with heart diseases.

Aurum has been recommended when ascites is the consequence of
functional disturbance of abdominal organs, in combination with
albuminuria.

Bryonia, congestion of the head ; giddiness when rising after stoop-
ing ; loss of breath when moving in the least ; lower eyelids oedema-
tously swollen ; lips bluish ; great thirst and scanty urine, with burn-
ing in the urethra, passing off' drop by drop ; obstinate constipation ;
after scarlet fever.

China, indicated in organic disturbances of liver and spleen, and
after loss of blood.

Convulvulus arvensis, constipation ; abdominal disturbances, weak-
ness, appetite good ; he would eat more if there were more room, the
abdomen being filled with water ; urine almost entirely suppressed.

Digitalis, difficult micturition; pale face; intermitting pulse; cold
skin; doughy swelling, which easily yields to the pressure of the
finger.

Fluor, ac, enlarged and indurated liver, in consequence of drinking
whiskey.

Helleb., in acute cases; after scarlet fever; drowsiness; slow in
answering questions; griping in bowels, with jelly-like discharges;
frequent but scanty micturition ; great thirst ; fever.

Kali c, in complication with liver and heart affections.

Laches., in complication with liver, heart and spleen diseases,
scarlet fever; hlach, scanty urine.

Lycop., liver affections ; abuse of alcoholic drinks ; after venesec-
tion; intermittent fever; oozing out of water from sore places in
the lower extremities, without formation of pus ; urine scanty, with



TYMPANITES. 817

red sediment ; upper portion of tlie bodj emaciated, lower enormously
swollen ; one foot cold, tlie other hot ; restless sleep ; cross when get-
ting awake.

Manganum oxydatum, intermittent fever; cachexia; palpitation of
the heart, strong, irregular, tumbling, without abnormal sounds.

Merc, in consequence of organic lesions of the liver and other
abdominal viscera ; the swelling of the abdomen is tense, hard ; thirst
not prominent.

Senecio, abdomen very tense ; lower extremities oedematous ; urine
scanty and high colored, or alternating with profuse and watery dis-
charge ; pain in the lumbar region and in the ovaries.

Sulphur, after suppressed itch, rough skin; bluish spots; sleep,
with moaning ; quick pulse ; cold feet ; easily sweating, especially in
the face; painless diarrhoea ; drawing together of the fingers; very
"forgetful; inclination to sit still and to lie down.

Tympanites Abdominalis

Corresponds to Pneumothorax, and consists of a collection of gas
within the peritoneal sac. It is caused by ruptures or perforations
of the stomach, or of the intestines, in consequence of which the gas
which is contained therein diffuses itself within the peritoneal sac.
More rarely, the air finds its way into the abdominal cavity from out
of the lungs, (in consequence of abscesses and pneumothorax ;) and
still more rarely, it enters from the uterus or the vagina in conse-
quence of destructive processes in these organs. Cases have been
observed where the gas originates within the peritoneal sac itself, in
consequence of a decomposition of ichorous fluids contained therein,
especially in combination with puerperal peritonitis.

V Symptoms.

Swelling of the ahdomen. Its development is rapid if it be caused
by perforation ; slower, if by gradual decomposition.

Full tympanitic sound all over, even in the region of the liver. This
organ is pressed backwards, if it be not adherent to the diaphragm ;
this is quite characteristic, and serves to distinguish tympanites from
meteorism, i. e., a collection of gas within the intestines.

All signs of peritonitis, which develops itself soon after the entrance
of air into the peritoneal sac.

Thercipeutic Mints — Compare Peritonitis and those other affec-
tions of which it is a mere consequence.



318 LIVEE.

Diseases of the Liver.

Physical examination. The upper part of tlie liver extends into the
space between the fifth and fourth, sometimes even to the edge of
the fourth rib. Being, however, overlapped here by the lower edge
of the right lung, which reaches down to the sixth rib, we find on
percussion the perfect, dull liver- sound, commencing only from the
sixth rib, whilst above it to the fourth rib the dull sound can be



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 32 of 65)