Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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Chronic Tumor, or Hypertrophy of the Spleen.

The spleen sometimes attains a weight of 10-15-20 lbs.; filling
almost the whole abdominal cavity. Its resistance is often like that
of a board ; and its substance appears dark-brown red, and pale red.
In other forms it has as a rule the appearance of waxy or colloid de-
generation ; and consists indeed of the same homogeneous colloid



CANCER. 849

mass ^111011 tlie colloid liver presents ; and then is called amyloid
degeneration of the spleen.

A peculiar variety of this affection is the so-called —

Sago-Spleen.

In this form the whole enlarged organ appears to be infiltrated
with half-solid, transparent, round globules, which can be taken out,
and very much resemble boiled sago. It seems that the development
of this peculiar appearance depends upon the infiltration of the same
colloid mass into the vesicles of Malpighi.

The chronic tumor resulting from intermittent fevers is of a slate-
color.

The causes of this chronic enlargement of the spleen, when it is
simple hypertrophy, are, all such disorders as cause a stagnation of Mood
within the venous circulation, to wit ; heart and lung diseases, inflam-
mation and obliteration of the portal veins, and cirrhoses of the liver ;
but when it consists of an amyloid degeneration, a nuonher of diseases,
which depend upon a morbid state of the blood — so-called dyscrasias —
malaria infections, constitutional syphilis, mercurial cachexia, rhachi-
tis, scrofulosis, Bright's disease ; in a lesser degree, chlorosis and
scurvy, and leuksemia.

Symptoms. — Enlargement of the spleen, usually very great, and
characterized by its roundish apex and the notch on its inner edge.
All other symptoms belong more or less to the primary affection,
and are therefore of no diagnostic value for the tumor itself.

Therapeutic Mints must be looked for under the respective
heads of causes ; however, the following remedies have a special rela-
tion to the spleen : Arn., Asa f., Ars., Borax, Brom., Carbo veg., China,
Dulc, Ferr,, Ignat., Lach., Laur., Merc, Mur. ac, Natr. c, Natr. m.,
Nux mosch., Plat., Plumb., Eanunc. bulb., Ehus tox., Euta, Stan.,
Sulph., Zinc.

Spleen affections and obstinate diarrhea : Anac, Asa f., Bry., China,
Dulc, Ign., Puis., Ehus tox., Sulph. ac.

Cancer of the Spleen

Is a very rare disease ; is generally of the medullary or encephaloid
form, and sometimes attains a pretty large size ; it is always con-
nected with cancer in other organs, especially those of the abdomen.



350 SPLEEN.

Its diagnosis is easy, when the existence of cancer in other organs
has been proved, and when the enlarged spleen shows on palpation
that characteristic cancer-unevenness.



Echinococcus-cysts

Are of very rare occurrence ; they may exist in the spleen alone, and
also in other organs at the same time.

Its diagnosis is dif&cult, being possible only under those favorable
circumstances in which the echinococcus-cyst is accessible to percus-
sion and palpation ; when it may be discovered as a roundish fluc-
tuating tumor.

Rupture of the S

May be caused by external injuries, violent concussions of the body,
or by pathological changes of the gland itself, as in its rapid enlarge-
ment, especially in typhus, or during the chilly stage in intermittens.

Symptoms. — A sudden very intense pain in the region of the spleen,
spreading over the whole abdomen. And in consequence of the in-
ternal hemorrhage: paleness, collapsus, cold extremities, small pulse,
vanishing of sight and hearing, syncope, distention of the abdomen,
death.

Its diagnosis must be founded upon the sudden pain in the region
of the spleen, and a knowledge of the previous ailments. A perfor-
ation of the stomach or of the intestine always causes tympanites by
its air rushing into the peritoneal cavity, and peritonitis. The latter
is also caused by ruptures of the liver, gall-ducts, and of the bladder ;
and besides, the pain which is hereby produced is not in the region
of the spleen. A fatal termination usually follows in a short time.

I". Diseases of the Pancreas.

Preliminary ohservations. The pancreas, a conglomerate gland,
analoo-ous to the salivary glands, is situated behind the posterior
surface of the stomach, and discharges its secretion by a main duct
into the duodenum in the vicinity of the opening of the ductus chole-
doohus into the duodenum. Sometimes the pancreatic and biliary
ducts become united just before they enter the duodenum.

Its physiological function has been wrapped up in great mys-



PANCREATITIS. 851

tery, until, by tlie latest researches of Bernard, Frerichs, Bidder,
Schmidt, and many others, the following seems to be agreed upon :
That its juice transforms amylum into sugar ; and, in conjunction
with bile and intestinal secretions, it dissolves the fatty ingredients of
food.

Its pathological changes, of whicb I shall speak particularly here-
after, have been brought to light by Harless, Bicourt, Mondiere,
Eockitansky, and Claessen. They are of the rarest occurrence, so
that, in hundreds of post-mortem examinations, scarcely one notice-
able pathological change of this organ is found ; but such changes as
have been found and described are acute and chronic inflammation
and their sequels : suppuration, hypertrophy, or atrophy, or fatty
degeneration, cancer.

In the works of older writers we find a number of symptoms as-
cribed to diseases of the pancreas, whilst, in fact, they are nothing
more nor less than signs of morbid states of the stomach, and, at times,
of the liver. There is not one characteristic symptom known by
which we might, with any certainty, infer that the pancreas is dis-
eased ; so that even Oppolzer with his vast experience comes to the con-
clusion that a diagnosis of pancreatic diseases is, at this time, impos-
sible. Even its enlargement is discoverable by palpation only in
some rare cases, such as the favorable circumstances of an empty
stomach and soft pliable abdominal parietes, and even then it may be
confounded with swellings of the adjacent glands, or induration of the
large curvature of the stomach and the like.

For a similar reason we know but very little about the causes of
pancreatic diseases. They are, so far as we do know, always of a
secondary nature, caused by diseases of the adjacent organs ; and I
need scarcely add that to give therapeutic hints in regard to a thing
that is not known would be rather a preposterous undertaking.

Pancreatitis, Inflammation of the Pancreas.

Patbologically, it is characterized by swelling, redness, and soften-
ing of the areolar tissue, which surrounds the lobules of the gland ;
in a higher degree it alters the whole gland into a firm mass. This
state of things results either in resolution or suppuration, or it leads
to induration of the areolar tissue and obliteration of the glandular
structure.



352 KIDNEYS.

Hypertrophy of the Pancreas

Is always of a secondary nature, in consequence of inflammation and
of infiltration of fatty deposits. Its presence cannot be diagnosticated
unless it reaches a palpable size.

/ Cancer of the Pancreas

Is, perhaps, the most frequently-occurring pathological change of this
organ ; however, it is almost always found in connection with cancer
of other abdominal organs. It causes no characteristic symptoms
besides the general cancer-cachexia, and is, therefore, not distinguish-
able from other coexisting cancerous affection.

G. Diseases of the Kidneys.

The kidneys being the organs for secreting urine^ any morbid
state within them will, no doubt, cause changes in the product of
their physiological function ; although disease of the kidneys does not
attend every abnormal state of the urine. Before we enter upon a
consideration of the different renal disturbances, therefore, it will be
expedient first to collect those symptoms which we may gain by —

Exaniination of TJrine.

1. Its EEACTioisr. Urine is naturally acid, which is easily tested
by dipping into it blue litmus paper. This acidity varies much even
in normal urine ; it is increased before meals, decreased after meals ;
during digestion it is augmented by sulphuric, nitric, phosphoric,
tartaric, and oxalic acids when taken into the system.

An allcaline reaction may take place sometimes during digestion
without being a sign of disease ; or it results from taking an excess
of fixed alkalies, such as the salts of soda and potassa. In this case
the red test-paper is colored blue and retains this blue color when ex-
posed to heat. When it exists as a permanent condition it generally
indicates nervous depression, resulting from exhaustion by mental
anxiety, spermatorrhoea, &c. It is said to be produced temporarily
by the juice of lemons and oranges. An alkaline urine may be
caused also by a volatile alkaki, such as carbonate of ammonia, in con-
sequence of decomposition. This is generally recognizable by its
smell, and the test-paper at once loses the blue color and receives
back its original red tint when exposed to a gentle heat. This
alkalinity of the urine denotes pathological disturbances, such as the



URINE.



353



presence of mucus or pus in the urine, in consequence of a disease
of the mucous coat of the bladder, or in consequence of paraplegia,
whereby the urine is too long retained in the bladder.

2. Its general appearance. A light, pale color is usually found
in chlorotic and anaemic states of the system, after hysterical parox-
ysms, then called urina spastica; in diabetes mellitus, with much in-
creased quantity and gravity, which may be discovered even by a
mere weighing with the hand ; in the chronic morbus Brightii ; in
leukaemia.

A deep, darJc color may be caused —

1. By an increase of urea in the urine ; which appears perfectly
clear and transparent when freshly voided, and its foam when agitated
is perfectly colorless. As urea is the principal product of the change
of nitrogenized substances, it may be taken as an index of the waste
and repair of tissues — hence we find it : a, after exertions of body and
mind ; b, in acute febrile states, when it gives a sediment after getting
cool; c, after vicarious secretions of watery fluids, such as profuse
perspiration, diarrhoea, &c. ; d, in consequence of high living, where
the quantity of nitrogenized substances taken as aliment cannot all be
assimilated.

2. By an admixture of blood. In this case the urine is opaque. It
is found : a, in hemorrhages from the kidneys ; b, in hemorrhages
from the bladder ; and c, during menstruation or hemorrhages from
the womb.

3. By an admixture of bile. In this case the freshly voided urine
is usually clear and transparent ; its foam, when agitated, is intensely
yellow ; white paper and linen, when dipped into it, become yellow,
even olive-green ; and a drop of nitric acid, when permitted to fall
on a thin layer of such urine, causes at once an interesting play of
colors — commencing with green and blue, passing to violet, red, and
finally to yellow or brown. It is found : a, in icterus ; b, in the high-
est state of pygemia ; c, in the acute yellow atrophy of the liver ; d, in
some cases of pneumonia, especially on the right side.

Lastly, a dark color of the urine is caused —

4. By different drugs ; such as santonin, rhubarb, senna, turpentine,
dyer's weed, beets, tar, kreosote.

A turbid appearance of the urine, when freshly voided, may be
caused —

1. From an admixture of ep)ithelium, thrust off by catarrhal pro-
cesses of the mucous linings within the urinary organs. It is of a

23



354 KIDNEYS.

flocculent appearance, and does not alter the specific gravity of the
urine.

2. From gonorrhoeal or leucorrhoeal discharges, appearing in the
otherwise transparent urine as whitish flakes.

3. From cylindrical casts from out of the uriniferous tubuli, during
the acute or subacute stages of Bright's disease. They soon settle at
the bottom of the vessel, and form a light, downy sediment.

4. From blood, as stated above.

5. From pus, which settles as an opaque, creamy or clayey mass ;
reaction, generally alkaline ; resolves itself into a dense gelatinous
mass, when agitated with an equal quantity of liquor of potassa ; and
smells foul and ammoniacal in consequence of decomposition. It is
a sign of suppuration somewhere in the genito-urinary system, or a
proof that an abscess has opened into and is being discharged through
this channel. In chronic catarrh of the bladder pus forms a layer of
grayish-white sediment.

6. From earthy salts ; generally, however, only after cooling down.
a. Uric acid settles in little red granules of a crystalline character,
visible to the naked eye ; whilst urates constitute more of a pinkish
or whitish sediment ; the urine appears dark and shows an acid reac-
tion, becomes transparent by the application of heat. If a few drops
of nitric acid are mixed with such urine, and the mixture is slowly
evaporated nearly to dryness over a lamp, the addition of a drop of
ammonia produces instantly a rich purple, (Dr. Front's Purpurate of
Ammonia.) It is found increased in leukgemia, in acute inflammation
and fevers, but mostly in acute rheumatism. It is wanting^ or at least
decreased, in the more advanced stages of Bright's disease, h . Phos-
phates — a combination of phosphoric acid with soda, lime and mag-
nesia. Such urine always yields an alkaline reaction, is usually of a
light color with whitish sediment, and is cleared up at once by a few
drops of acetic acid.

Phosphates are found in excess, and in combination with pus — 1.
In chronic catarrh of the bladder. 2. In retention of urine in the
bladder in consequence of temporary or permanent paralysis ; as in
low fevers, in hemiplegia, or in paraplegia. In such cases the urine
generally has a strong ammoniacal smell.

Phosphates alone are found in excess — 1. During convalescence
from acute disease ; 2. In general nervous debility, resulting from
exhaustion by mental anxiety, spermatorrhoea, &c. ; 3. In acute in-
flammatory diseases of the nervous structure during the existence of
the most marked febrile symptoms; and — 4. In fractures of the skull,



URINE. 855

■when inflammatory action takes place in the brain ; 5. Tn acute rheu-
matism ; and — 6. Temporarily, after eating lemons and oranges, and
the abundant use of animal food, and very active exercise.

3. The urine becomes semi-liquid, inspissated, viscid — 1. From
an admixture of grape sugar. This substance makes the urine of
greater specific gravity, and is easily detected by mixing a quantity
of such urine with caustic potash, and boiling the mixture. By de-
grees it turns reddish-brown, emits a sweetish odor, like molasses, which
becomes still more perceptible when a few drops of nitric acid are
added. There are several other tests, to detail which is not in place
here ; they can be found in Dr. Boecker's Medical Chemistry, a little
work translated and arranged by Dr.Zumbrock, to be had at Boericke's;
also in a number of other works. A large amount of sugar in the
urine occurs in diabetes mellitus, of which I shall speak more fully
hereafter.

2. From the presence of albumen. Such urine, when agitated, foams
more than any other urine. The albumen is easily detected — by heat,
which coagulates it, and by nitr. ac., which causes a white precipitate.
Large amounts in the urine constitute what is called albuminuria, of
which later. This semi-liquid state is likewise in some degree caused
by an admixture of blood, pus, bile, of which I have spoken above.

The sediments of the urine may be distinguished in the follow-
ing manner :

1. A light, flocculent, cloudy deposit is commonly mucus, entangling
epithelial cells or spermatozoes.

2. A yellow, orange, or pinkish deposit, dissolving by the application
of heat — urine acid — is almost always due to urates.

3. A dense, abundant white deposit, dissolving by the addition of
acetic acid — urine alkaline — consists of phospliates.

4. A granular or crystalline deposit of reddish color and small in
quantity is uric acid.

5. A darh, sooty and dingy-red deposit is blood.

The quantity of urine changes, even in health, considerably. It
is increased, however, in diabetes, chronic diuresis, hysteria, drinking
of much water. Decrease: Fevers of all kinds, deep functional dis-
turbances, profuse excretions other ways, such as sweat or diarrhoea ;
in consequence of heart diseases, liver diseases, dropsy. Its secretion
ceases altogether in cholera and typhus.



356 KIDNEYS.



Diabetes.



This affection consists of an increased proportion of saccharine
constituents in the blood ; at the same time the blood contains more
water and less fibrine than is normal.

The disease is characterized by excessive thirst, and excessive secre-
tion of urine; which contains grape-sugar, {diabetes mellitus,) or a
substance nearly related to sugar, {diabetes insipidus?)

We are yet quite in the dark concerning its origin. Bernard has
succeeded in producing diabetes artificially in animals by thrust-
ing a needle into the fourth ventricle of the brain, directly between
the nervus vagus and acusticus. Lately it has been observed that
sugar appears in the urine after cutting both nervi vagi ; likewise in
any disease which disturbs the respiratory functions, the introduction
of oxygen, and also often etherization.

As this diabetic sugar is normally found in venous, but never in
arterial blood, it follows that in healthy conditions this sugar must be
changed, or transformed, or annihilated within the lungs, for the
venous blood Avhich enters them contains it, whilst the arterial blood
which returns from the pulmonary structure contains none. Some
have, therefore, attributed the origin of diabetes to the lungs ; and,
indeed, tuberculosis of these organs is almost a constant complication of
this disease. On the other hand, however, it is as possible that the liver
fabricates this sugar in such quantities that it would be impossible for
the lungs to transform or destroy it all ; in which case it would like-
wise come into the general circulation, and be excreted by the kidneys.
Bernard has shown that the liver does fabricate this sugar, and it is
his opinion that diabetes has its seat in the liver.

But even if so, we still do not know why the liver produces it in
such quantities, nor, in the first case, why the lungs do not destroy it.
Its cause may exist in some morbid state of a certain portion of the
brain, since the piercing of a certain part of the brain has produced
it in animals, according to Bernard.

Symptoms.

Excessive quantity of urine, containing sugar ; excessive thirst,
especially at night, and great hunger ; dry skin ; feces small in quan-
tity, and hard ; want of natural warmth ; constant wasting away of
flesh; sexual desire and power entirely' gone ; mind depressed and
peevish ; at its height the mouth becomes hot and sore, and super-
added phthisis puts an end to the scene.



DIABETES. 357

Tfierapeutic Mints, — The old school has recommended total
abstinence of starchy and saccharine food, and the exclusive use of
meat, fish, eggs, &c. This, of course, decreases the amount of sugar
in the urine, because it takes away the materials for its formation ;
but it has not the slightest power to stop the tendency to that forma-
tion.

According to 0. Mueller, the folloAving remedies have produced
sugar in the urine of healthy persons : Canth., Chloroform, Curare,
Morph., Uran. nitr., and Asclepias vincetoxicum.

Argent. Hahnemann says, some forms of diabetes may be cured by
silver, if the other symptoms correspond to the symptoms of this
remedy. Rlickert mentions a case which he cured by Argent., but
which died of phthisis afterwards. He mentions : urine turbid, of a
sweetish taste, and profuse ; especially at night ; scrotum and feet
oedematously swollen ; anxiety and pressure in the pit of the stomach
and want of breath.

Coloc, urine when voided is white and turbid ; when getting cold
it coagulates and becomes a milk-white, jelly-like mass, which, when
poured out, glides, as a compact jelly-cake, out of the vessel.

Nux v., most urine is voided through the night; other Nux symp-
toms. At first mere Tiuct., and later X. Prie.

Phos. ac.', urine like milk, mixed with jelly-like, bloody pieces, or
clear, like water ; pain in the back and region of the kidneys ; con-
stant urging to make water ; sleeplessness ; excessive emaciation ;
great prostration.

Plumbum, excessive emaciation; suppuration of the lungs; hectic
fever ; complete impotence ; obstinate constipation ; great hunger ;
sweetish taste in the mouth ; sweetish belching and vomiting.

Besides, the following are recommended: Ars., Bovista, Cuprum,
Eupat. purp., Digit., Helonias dioica, Kreos., Lach., Lycopus virg.,
Magnesia usta, Sulphur, Trillium.

Haematuria, Passing Blood with the Urine. ^^^^^^pCt^^^^yi^^

The blood comes either from the kidneys, ureters, bladder or the . ' j f'

urethra. According to its quantity, it colors the urine more or less, ^U/f/^, ^^^
and forms a more or less thick sediment in it. "W^ ^ ^*^^ ^

It may arise from quite different causes — injuries, inflammation, Z' ^ JtZr
typhoid and exanthematic fevers, Bright's disease, irritating drugs, '

calculi, ulcers, cancers. In yellow fever, plague and scurvy, it seems







858 KIDNEYS.

to be dependent upon a general dissolution of the blood. Sometimes
it is vicarious bleeding.

In reiial hemorrhage the blood is thoroughly mixed with the urine,
and it is preceded or accompanied by such symptoms as denote a
disease of the kidneys, especially pain in the region of the kidneys,
dysuria, albuminuria.

In hemorrhage from the ureters we generally have symptoms of col-
icky spells, as it usually originates in consequence of incarcerated
calculi within these tubes.

In vesical hsematuria the blood is not so thoroughly mixed with
the urine, and is discharged with the last of the urine. At the same
time we have the symptoms of the diseased bladder, as, pain in the
region of the bladder ; strangury ; discharge of mucus and pus ;
paralytic states of the bladder.

In hemorrhage from, the urethra the blood oozes out of it without
passing water, and is generally caused by external violence.

Hsematuria is rarely attended with the known signs of a profuse
loss of blood. Only in debilitated persons it may cause anaemia, and
attendant symptoms.

Those cases of ha3maturia, in consequence of a dissolution of the
blood, are of course the worst.

Therapeutic JSints*

Arn., when caused by external violence.

Arsen., hemorrhoids of the bladder; very painful micturition;
scanty secretion ; burning pain in the urinary organs ; paralytic
symptoms of the bladder ; great anguish and restlessness.

Calc. c, in chronic cases; hemorrhoidal aflEections; polypous affec-
tions ; leucophlegmatic persons.

Camph,, after irritating drugs, especially cantharides, and exanthe-
matic fevers.

Canth., violent cutting, pressing and crampy pains in the bladder,
♦ * ' extending into the urethra and into the kidneys ; strangury, burning
pain before, during, and after micturition ; cylindrical exudations in
the urine ; pain increased from drinking water ; even from the sight
of water.

Chimaphiia, in consequence of severe and long-continued gonorrhoeal
inflammation.

Epigepon, empirically used, without any characteristic indications.

Hamamelis, ditto.



, ♦



HuEMATURIA.



359



I pec, profuse bleeding, with fainting, deadly paleness, sickness of
tlie stomach ; oppression of the chest.

Lycop., especially in connection with gravel or chronic catarrh.

Merc, painless discharge of blood; also very violent urging to
urinate, and painful micturition, whereby sweat easily breaks out.

Mezer., crampy pain in the bladder ; and, after that, bloody urine
is voided.

Millef., pain in the region of the kidneys, with chilliness, necessity
to lie down ; the blood forms a sediment in the vessel like a bloody
cake ; pressive pain in the urethra during the flow of blood.

Nitr. ac, according to GouUon, specific in active hemorrhage ; also
after mercury ; urging after micturition, with shuddering along the
spine during micturition ; gonorrhoeal affections.

Nux v., after the abuse of alcoholic stimulants, allopathic drugs,
suppression of hemorrhoidal and menstrual discharges ; full, tensive
feeling, pressure, and distention in the abdomen, loins, and region of
the kidneys ; signs of stagnation in the portal circulation.

Puis., drawing, cutting pain around the navel into the small of the



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 36 of 65)