Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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back ; penis and scrotum drawn up ; crampy pain in the right leg
from the knee to the groin.

Phos., when it depends upon a general dissolution of the blood ;
after sexual excesses.

Secale, passive hemorrhage ; blood thin ; blood corpuscles wanting
in consequence of dissolution; or painless discharge of thick black
blood in consequence of kidney disease ; coldness of the body ; cold
perspiration on forehead ; great weakness.

Sulphur, after suppressed cutaneous eruptions and hemorrhoidal
discharges ; stinging and burning in the urethra.

Terebinthina, the blood is thoroughly mixed with the urine, form-
ing a dirty reddish-brown or blackish fluid, or a coffee-ground-like
sediment ; burning, drawing pains in the kidneys ; pressure in the
bladder, extending up into the kidneys when sitting, disappearing
when walking about ; before urination, pressing and straining in the
bladder when sitting, going ofi' when walking ; burning in the bladder,
worst during micturition ; in complication with scorbutic affections,
and if caused by living in damp, moist dwellings.

Uva ursi, constant urging to make water and straining, with dis-
charge of blood and slime; or constant straining without any dis-
charge at all, or only a few drops of urine, after this cutting and burn-
ing in the urethra, which is succeeded by a discharge of blood ; hard
stools.



360 KIDNEYS.

Zincum, vicarious bleeding througli the urethra in consequence of
suppressed menstruation, with pain in the bowels, diarrhoea, and
night-cough with expectoration of mucus.

Compare also the corresponding diseases, of which Hsematuria may
be the consequence.

Acute Bright's Disease, or Croupous Nephritis.

Its pathological character. The diseased kidneys are enlarged, some-
times even double their normal size ; their surface is smooth ; their
texture unchanged. The papillse are hypersemic; the uriniferous
tubuli, especially those of the cortical substance, are filled with coag-
ulated, cylindrical fibrin, which are discharged with the urine, (where
they may be recognized, by their cylindical form, by means of the
microscope,) in connection with epithelial cells and blood-corpusclCs.
Thus in its nature it is nearly allied with croupous inflammation of
the larynx and lungs.

Primarily this aflection is generally caused by exposure to cold
or external injuries or irritating drugs, such as cantharides, balsam
of copaiva, turpentine, &c.

Secondarily it is frequently found in connection with scarlet fever ;
less frequently with measles, typhus, intermittent fevers, and the
typhoid stage of cholera.

Symptoms.

1. Commencing with a chill, it is followed by fever, nausea, vomit-
ing, pain in the region of the kidneys, extending along the course of
the ureters.

2. Constant desire to urinate, but only little urine of a dark, dirty-
reddish, even brownish color is yielded, which forms a flocculent, yel-
lowish or reddish sediment, and contains the above-named cylindrical
casts, in connection with epithelial cells and blood-corpuscles. Boiled
with addition of nitric acid, it yields large quantities of albumen.

3. (Edema of the eyelids, face, extremities and genitals. The skin
on the oedematous parts is tense, sometimes glistening, showing the
mark of pressure only a short time.

4. Not unfrequently we find it complicated with exudations into
the pleural and peritoneal cavities in consequence of pleuritis and
peritonitis.

5. In its highest degree the oedematous swelling extends into the
lungs and glottis, causing distressing difficulty of breathing ; and even
into the brain, causing sopor and convulsions.



ACUTE BRIGHT's DISEASE. 861

Its progress is not very rapid ; after eight to fourteen days the
febrile motions cease ; but albuminuria and dropsical symptoms still
continue, which, in favorable cases, diminish after two or three weeks.

Therapeutic Mints, — In complication with scarlet fever com-
pare : Apis, Ars., Asclep. syriaca, Bell., Bryon,, Colch., Helleb., Kali
c, Lach., Lye, Merc, Ehus t,, Sec, Seneg., under the head of Scarlet
Fever.

After the abuse of cantharides, balsam of copaiva or turpentine,
the best antidote is Camphora.

Aeon., high fever ; restlessness j dark scanty urine ; consequence
of exposure to cold. ^

Canthapis, high fever; pulse frequent and hard; drawing, tearing
pain in loins and testes, worse from motion; sometimes in spells, stop-
ping breathing ; micturition exceedingly painful, drop by drop ;
scanty, dark urine, with burning in the bladder and urethra; the
urine contains cylindrical casts of fibrinous exudation, epithelial cells
and blood, and is therefore easily coagulable ; constipation ; urgemic,
cerebral symptoms, like stupor, numbness; after exposure to cold, or
mechanical injuries; complication with prostatic derangements, in-
flammation of the bladder, and stricture of the urethra.

Balsam of copaiva and cubebs have been observed to cause inflam-
mation of the kidneys, though their sphere of action is not known
yet.

Hepap is recommended by Kafka on the ground of its having a
decided relationship to croupous exudations.

Kali c, tensive pain in the region of the left side ; swelling of the
inguinal glands ; cedema of the left foot, extending gradually to the
right foot and upwards over the whole body ; blackish urine, which,
on shaking, foams, and on standing leaves a thick, reddish, slimy sedi-
ment ; frequent, soft, palish evacuations from the bowels ; after a blow
upon the left side and staying for hours in wet clothes.

Kali hydpoj., scanty, dark urine ; painful micturition ; sediment
dirty, yellowish; great thirst; heat in the head. Likewise recom-
mended by Kafka on the same ground as Hepar.

Phos., the skin is pale and anaemic ; frequent watery diarrhoea ;
in complication with pneumonia, bronchial catarrh, ulceration of the
bones, amaurosis.

Rhus tox., tearing pain in the region of the kidneys ; oedematous
swelling all over ; after exposure to wet.

Tepebinthina, scanty secretion of dark, (occasionally,) bloody urine,



362 KIDNEYS.

wliicli coagulates on addition of nitric acid under the application of
heat ; oedema all over ; intestinal catarrh and diarrhoea ; bronchial
catarrh, with expectoration of much mucus.

Parenchymatous Nephritis, Albuminuria, Chronic BrigMs

Disease.

In accordance with its pathological character it has been divided
into three stages :

1. Hypersemia and exudation ; the kidneys appear enlarged ; the
uriniferous tubuli of the cortical substance contain a fibrous exudate ;
the epithelial cells are not much changed ; corresponding thus with
croupous nephritis.

2. Transformation of the exuded matter into a fatty mass. The kid-
neys enlarge still more, because the uriniferous tubuli become dis-
tended by epithelial cells which swell, and the cylindrical casts of
fibrin which collect therein, all of which undergo a gradual fatty
degeneration.

3. Atrophy, in consequence of the discharge of the destroyed epi-
thelial cells, and of the exuded and transformed cylindrical casts and
fatty matter, and the final obliteration of the uriniferous tubuli.

The following are recognized as principal causes of this disease : 1.
Exposure to cold and wet; it is therefore found much more frequently
on coasts in cold climates than in warmer and dryer countries. 2. The
abuse of acrid diuretics, as cantharides, balsam of cubebs, turpentine,
&c. 3. Alcoholic drinks ; it seems to be caused by their abuse as fre-
quently as cirrhosis of the liver. 4. Long-standing suppurations, caries
and necrosis of the hones ; in fact, all sorts of cachectic states of the
system. And 5. Different dyscrasias: gout; rhachitis^ scrofulosis^
syphilis, and malaria-cachexia.

Symptoms.

1. Pain in the renal regions ; but there are exceptions to this.

2. The piatient feels weak ; the sldn and mucous membranes groiopale,
ansemic, without an apparent cause. This should draw the physi-
cian's attention to the —

3. Urine. It may not be much out of the way as to its quantity,
though generally it is diminished in its first stages, and in the latter
increased ; but it has changed much in regard to its quality, always
containing more or less albumen. It is commonly of a pale, yellow
color ; foams easily when agitated ; and retains its foam for a longer



ALBUMINURIA. 863

time tlian any otber urine ; bj adding a few drops of nitr. ac, it
coagulates on being heated.

4. Hydrops. This, like the albuminous urine, is one of the most
characteristic signs. The oedema generally commences first in the
eyelids and face, or on the feet ; later, on the upper extremities, the
abdominal parietes, and the scrotum. It frequently changes loca-
tion: so that whilst in the evening the feet are the parts mostly
swollen, we find in the morning the swelling greater on the back,
arms, hands and face. Ascites, hydrothoras or hydropericardium
set in at a much later period, if at all.

Frequent complications of this disease are : pleuritis, pericarditis,
peritonitis, and meningitis ; also, catarrhal affections of the bronchial
tubes and of the intestines ; hypertrophy, and valvular derangements
of the heart.

There are yet to be mentioned as symptoms which have been
observed in some cases: vomiting, sopor, and convulsions — conse-
quences either of a general poisoning of the blood ; ureemia, where
the secretion of urine ceases altogether ; or of oedema of the brain,
and consequent capillary anaemia of this organ, when the secretion of
urine is rather increased than decreased. Such conditions have been
seen to be followed by a decrease, or even entire loss of sight, which,
according to the latest observations, has its causes in a degeneration
of the retina, or in an extravasation of blood within this organ. The
duration of the disease may be from several months to as many
years, depending upon its causes and complications.

Therapetitic Mints, — Compare, according to its different causes,
as follows :

When in consequence of exposure to cold and wet: Calc. c, Dulc,
Kali c, Merc, Nux v., Ehus t, Sepia.

"When in consequence of acrid drugs: Oamph., Nux v.

"When in consequence of alcoholic drinks: Arsen,, Bry., Carb. veg.,
Lach., ISTux v., Puis., Sulph. Milk diet.

When, in consequence of suppuration, cachectic states of the system :
Asa, Aurum, Calc. phos., China, Ferr., Hepar., Mezer., Phos., Silic,
Sulph.

When in consequence of a dyscrasia, the different chapters apper-
taining thereto must be consulted.

Amongst the new remedies are named : Cauloph., Chimaph., Eupa-
tor. pur., Helon., Phytolacca.

Compare likewise the remedies mentioned under the head of Acute
Bright's Disease.



S64z KIDNEYS.

Nephritis vera, suppwQWvQ, or Interstitial Inflammation of

the Kidneys.

The above-described inflammations have their seat in the nrinifer-
ous tubuli ; nephritis vera attacks the interstitial tissue, which con-
joins the uriniferous tubuli and the capsules of Malpighi.

The kidney appears enlarged, soft and dark red; its capsule
injected, thickened and easily separated. On cutting through the
substance, its structure appears indistinct and yields on pressure a
thick bloody fluid. In the further progress of the disease the paren-
chyma assumes, in consequence of exudation, a dirty brown and grayish
color; and lastly it suppurates, giving rise to abscesses in different
places, which may severally become encased or unite : if the collec-
tion of pus be too great it may be discharged, either into the renal
pelvis, or, like abscesses of liver and spleen, into the abdominal
cavity, or in consequence of previous adhesions even into the thoracic
cavity, intestines or externally. It is caused by external injuries;
renal calculi ; gravel ; pieces of bone in consequence of canes of the
spine; inflammatory processes in neighboring tissues; exposure to
cold and wet ; or, especially, by infection of the blood by ichor.

Symptoms. — 1. Chill followed by fever is the commencement. 2.
Pain in the aifected kidney ; as generally only one kidney is affected.
This pain is aggravated by pressure, motion, coughing, sneezing,
deep inhalation ; it extends along the ureter into the bladder, and to
the thigh, and upward into the shoulder of the affected side. 3. Con-
stant painful urging to void urine, which passes off in very small
quantities only ; is dark, thick and usually mixed with blood. In
high degrees of inflammation, or if both kidneys are affected, there
may ensue a complete suppression of urine, in which case soon
follow: 4, Delirium, sopor, convulsions; 5, Nausea and vomiting are
always present ; 6, A reoccurrence of chills at the height of the dis-
ease denotes commencing suppuration.

In such cases the disease takes a slow chronic form, and ends like
liver and spleen abscesses, either in encasement and absorption of the
matter, or in rupture and perforation with its various consecutive
symptoms.

The prognosis depends entirely upon these different conditions.

Therapeutic Hints,

In the inflammatory stage, Aeon., Bell., Camphor, Canth., Con., Hep.,
Magn., Merc, Nitr. ac, Puis., Scilla, Sulphur.



NEPHRALGIA. 865

If delirium and sopor he present^ Hyosc.
In the suppurating stage, Canth., Lye, Merc, corr., Puis,
Abscesses, Ars., Canth., China, Hepar, Lye, Merc, Pals., Silic.
Compare also Acute Bright's Disease.

Nephralgia, Colica Benalis,

Is in most cases caused by the passage of calculi through the ureter
into the bladder, whence they are usually discharged through the
urethra. These urinary concretions form in the calices of the pelvis
of the kidneys, and vary much in size and form. It is a singular fact
that sometimes comparatively large stones pass through the ureters
without giving any pain ; whilst at other times much smaller concre-
tions, although they are not rougher than the larger ones, cause a
most excruciating pain along the ureter into the bladder, and in males
into the testicle, which is generally drawn up, of the affected side.
This locality, direction, and violence of the pain, distinguishes such
attacks from all other painful affections of the abdomen.

It is generally attended with vomiting, cold perspiration, cold ex-
tremities, small pulse, great agony and collapsed features. It ceases
quickly as soon as the calculus enters the bladder. Only in rare,
quite bad cases, the calculus stays incarcerated, plugging up the ureter
and causing a bursting of it, or ursemia.

These same spells may be brought on by blood-coaguljB, or para-
sites, which enter the ureter.

As the pain does not seem to depend upon the size or shape of the
concretion which is passed, it must depend upon a greater sensitive-
ness or irritability of those tender tubes at the time they suffer the
insult. For this reason I deem it a very crude assertion, which we
find promulgated, even in homoeopathic literature, that renal colic
would scarcely be reached by medicine ; as the concretion had to
make its way at all events, and could not be hastened in its progress
by any means. If that were so, why do even large concretions pass
without any pain ? Why do some require only several hours and
others again three or four days in reaching the bladder ? This shows
beyond any doubt that the calculi encounter now more, now less ob-
struction on their road, which consists in a greater or less spasmodic
contraction of the ureter, dependent upon a greater or less irritability
of these tubes. And just this very morbid state of the ureters is
amenable to medicine.



366 KIDNEYS.

TFierapeutic Mints,

Bellad., spasmodic, crampj straining along the ureter, througli wMcli
the calculus makes its way.

Lye, after Nux v. ; colicky pain in the right side of the abdomen ;
extending into the bladder ; with frequent urging to urinate. Urine
incrusting the vessel with red sand.

Nux v., always the best remedy after the palliative use of so-called
anodynes ; pain, especially in the right kidney, extending into the
genitals and right leg ; nausea ; vomiting ; constant urging to urinate ;
insufficient urging to stool ; inability to lie on the right side ; better
while lying on the back ; rising and walking about increases the pain.

Opium, or morphine is given by the old school in large doses, to
lull the pain ; it is indicated where there are pressive, squeezing
pains, as though something had to force its way through a narrow
space ; shooting pains from different places into the bladder and tes-
ticles ; vomiting of slime and bile ; obstinate constipation ; dysuria ;
greatest anxiety and restlessness ; constant changing position ; face
hot ; pulse slow.

Tabacum, constant deadly sickness of the stomach and retching,
with cold perspiration ; usual violent colicky pains in the region of
the ureter ; right or left side.

The following may also be mentioned: Calc. urinaria, Cann.,
Erigeron, Eupat. perf., Galium, Sassaf., Silic, Zinc.

Pyelitis, Catarrhal Inflammation of the Renal Pelvis.

Its mucous membrane appears reddened and swollen, sometimes
ecchymosed, and incrusted with urinary concretions. It secretes
purulent matter, and in most cases spreads through the ureters into
the bladder. The inflammation of the ureters causes often strictures
of these ducts, and, in consequence, distentions above the constricted
parts. Its most frequent cause is calculi within the renal pelvis ; not
unfrequently it is an extension of gonorrhoeal inflammation from the
bladder through the ureters.

Symptoms.

It commences often with a shaking chill, which is followed by
fever. There is pain in the region of the kidneys, and constant
desire to urinate. The urine is bloody, and yields, on standing, a
purulent sediment, which sometimes is mixed with sand.

In chronic cases, we observe an alternate increase and decrease in



PERINEPHRITIS. 867

the intensity of tlie fever, and always a heavy sediment of pus in the
urine. When only one side is affected, the other secretes normal
urine ; when both, it soon wears the patient out.

In cases of rupture in consequence of strictures, ensuing peritonitis
soon brings the scene to an end.

Therapeutic Hints,

Purulent sediment^ Canth., Merc, corr., Nux v., Petr., Phos., Puis.,
Sepia, Sulph.

Gravel in the urine, Lye, Sars. Compare the preceding chapter.

Pepsnephpstis, Inflammation of the Renal Capsule.

The capsule appears injected and infiltrated with exudation, or
covered with purulent secretion ; in consequence of which, adhesions
are formed with neighboring organs. This state of things may lead
to a thickening of the capsule, and to abscesses.

Primarily, it is caused by external injuries, and exposure to cold.

Secondarily^ it may be a continuation of an inflammatory process
in its vicinity, or of pyeemia.

Symptoms.

They resemble very much all other inflammatory affections of these
organs.

1. Chill, followed by fever.

2. Acute pain in the region of the kidney or kidneys.

3. Constant desire to urinate, with but little discharge ; urine highly
colored and hot ; but it contains neither blood, thus differino- from
nephritis, nor does it form a purulent sediment, thus differing from
pyelitis.

4. Vomiting.

5. If in consequence of this inflammation an abscess is formed, it
may discharge into the peritoneal cavity ; or, in consequence of adhe-
sion, the pus may gradually burrow downwards in different directions
between the different fascias ; or may work towards the surface and
discharge exteriorly. In this case we observe a gradual swelling in
the region of the kidneys, which fluctuates, points, and bursts.

Therapeutic Hints, — Compare Nephritis.



368 BLADDER.

H. Diseases of the Bladder.

Cystitis, Inflammation of the Bladder,

As the bladder consists of a muscular coat, whicli is lined inside
by a mucous membrane, and, exteriorly, is nearly covered by the
peritoneum, it is clear that inflammation of the bladder may have its
seat either in the mucous membrane, or in the serous covering, or
pervade the whole structure. "Where it attacks the mucous lining it
is called cystitis catarrhalis or mucosa, or catarrh of the Madder. This
characterizes itself pathologically, like all other catarrhal inflamma-
tions, by redness, swelling and mucous secretion ; and when becoming
chronic, by a livid appearance of the membrane, with slate-colored
spots. The mucous membrane becoming more or less disorganized,
is found either softened, thickened, or infiltrated, and covered with a
thick, grayish, purulent secretion. The inflammatory process spreads
not unfrequently to the muscular coat, and makes it hypertrophied.
Its causes are, exposure to cold and wet ; external injuries ; irritating
drugs, (cantharides, copaiva balsam, &c. ;) irritating calculi ; retention
of urine ; extension of inflammatory processes in neighboring organs,
(diseases of the prostata;) strictures and inflammation of the ure-
thra, &c.

Symptoms.

1. Pain in the region of the bladder, which is worse from external
pressure and motion ; frequently this pain extends along the ureters
into the kidneys, and downwards through the urethra.

2. Frequent 'painful micturition. The urine is voided drop by drop,
under great straining, and a feeling as though scalding fluid were pass-
ing. It is highly colored, hot, and occasionally mixed with blood and
mucus.

3. At its height it causes high fever, vomiting^ prostration, cold per-
spiration, singultus, &c.

■ 4. In the cHronic form it is not so painful, but always attended with
frequent desire to urinate, and the passing of turbid urine; which,
after standing, always yields a heavy, thick, glairy, viscid sediment of
mucus, which, if poured from one vessel into another, draws strings.
It smells more or less aramoniacal, and has an alkaline reaction,

5. The chronic form sometimes leads to hypertrophy or dilatation
of the bladder ; in which case the patient cannot entirely empty the
bladder. In some cases there is a paralysis of the sphincter, and
the urine flows ofi' involuntarily.



CYSTITIS. 369

6. The chronic form is frequently subject to acute exacerbation from
any irritating cause ; and is generally found in advanced age.

Therapeutic Mints,

High fever ; restlessness ; constant urging, yet fearful of voiding
the urine on account of the painfulness of the act, Aeon., Bellad.

Violent burning in bladder, Aeon., Ars.

Burning and pressure in bladder, Nux v.

Violent tenesmus and burning, Canth.

Bladder largely distended, Ars.

Congestion of the head ; tongue red and dry, Aeon.

If attended with vomiting, and cold perspiration, and anxiety, Ars.

Vomiting and nausea, Canth. ; great thirst, Ars., Canth.

Frequent small pulse, Canth.
■ After a fall, blow, &c., Arn.

After taking cold. Mere., Puis.

After irritating drugs, Camphora.

In chronic cases, Calc. c, Carbo v., Coloc, Dulc, Ly<^, Phos., Petr.,
Sulph., Sars., Uva ursi.

Aeon., in all acute catarrhs, characterized by high fever; restless-
ness ; and brought on by exposure to cold, dry winds. The urine is
scalding hot ; dark red or turbid ; micturition painful, difficult, some-
times only drop by drop ; children reach with their hands to the
genitals and cry out.

Ars., burning pain, especially at the commencement of urinating;
fever ; great restlessness ; cold perspiration ; face and extremities
cold; or in chronic cases with inability to void the water; bladder
greatly distended and paralyzed ; urine turbid, mixed with pus and
blood.

Bellad., if not better some twelve hours after Aeon.; rapid sinking
of strength ; the region of the bladder is very sensitive to the touch ;
the urine hot and fiery-red ; clear at first, but soon becoming turbid
on standing, and depositing a copious, slimy, bright-red bran-like
sediment.

Camphora, if caused by cantharides, balsam of copaiva, turpen-
tine, &c.

Cann., if not better after Cantharides within about twelve hours;
gonorrhoeal inflammation.

Canth., spasmodic pain in the perinseum along the urethra down
into the testes, which are drawn up ; intolerable burning pain in the

24 1



870 iBLADDER.

bladder ; crampmg pain in the thighs ; cutting through the abdomen ;
burning pain in the glans penis, the orifice of which is reddened;
micturition difficult, only drop by drop, Avith a feeling as though
melted lead were passing through the urethra, with violent straining,
which increases the pain; urine at first clear, but afterwards turbid,
bloody, scanty, or only blood ; painful erections of the penis ; great
restlessness and fever ; thirst, but drinking or even the sight of water
increases the pain.

Carbo veg.,in old people and chronic cases where the acute inflam-



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 37 of 65)