Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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mation has subsided and only blennorrhoea exists.

Caust., when in consequence of long retention of urine the muscu-
lar coat becomes paralyzed ; compare Helleb., Hyosc, Ars.

Chimaphila, urging to urinate after micturition ; the urine is high-
colored, depositing a copious, mucous sediment ; constipation.

Coloc, after alleviation of the most violent symptoms, when the
pain during micturition extends all over the abdomen, and the urine
looks turbid when first voided, depositing, on standing, a tough,
mucous sediment, which can be drawn into strings.

Dulcam., in chronic cases with constant desire to urinate deep in
the abdomen ; urine is limpid when voided, but assumes an oily con-
sistence on cooling, and contains a tough, jelly-like, whitish, or red-
dish mucus, intermixed with little lumps of blood ; it smells foul.
All symptoms grow worse when the weather changes from warm to
cold.

Helleb., the inflammatory process increases slowly to the greatest
violence, with constant desire to urinate, causing spasms; little uriae
is voided ; constant nausea ; distended abdomen.

Hyosc, retention of urine, so that the bladder becomes largely dis-
tended ; urine turbid, depositing a mucous or purulent sediment ;
great thirst ; dry tongue ; delirium ; subsultus tendinum.

Lach., discharge of bad-looking mucus during micturition; dull
pain in the bladder ; sensation as if a ball were rolling in the bladder.
Lycop., dull, pressing pain in the region of the bladder and abdo-
men ; the urine is turbid, milky, depositing a thick, purulent sedi-
ment of a most nauseating smell ; chronic cases ; disposition to
urinary concretions.

Merc, fever with chilliness ; great soreness in the region of the
bladder when touching it ; violent urging ; the urine flows in a thin
stream, or only drop by drop; contains mucus, blood, even pus;
during micturition sweat breaks forth ; gonorrhoeal inflammation.



CYSTITIS. 871

Mux vom., painful, ineffectual desire to urinate, or discharge of
■urine drop by drop, with burning and tearing ; pale urine followed
bj thick, whitish, purulent matter, with violent, burning pain ; spas-
modic retention of urine ; constipation, with ineffectual urging ; after
drugs or suppressed gonorrhoea.

Pareira brava, constant urging to urinate, with violent pain in the
glans penis and straining ; the pain is so great that it extorts loud
screams from the patient ; always worse after midnight till morning ;
the urine has a strong ammoniacal smell, and contains large quanti-
ties of thick, tough mucus.

Phos. ac, when the urine looks like milk, and becomes quickly
decomposed.

Pulsat., after exposure to cold, the urine deposits a slimy sediment,
which sticks to the vessel ; tenesmus and stinging in the neck of the
bladder ; the pain continuing a while after micturition.

Sepia, in chronic cases ; distention of the lower portion of the abdo-
men ; annoying, itching sensation in- the region of the bladder, with
urging to urinate, especially in the night ; during and after micturi-
tion chilliness and heat in the head ; the discharge of mucus does not
take place at each evacuation of urine, but comes on periodically ;
sometimes pieces of coagulated mucus clog up the urethra ; admix-
ture of a kind of dark brown pigment ; constipation.

Sulphur, constant desire to urinate, day and night ; the urine drops
slowly out of the urethra; it deposits thick, tough mucus, which
sticks to the bottom of the vessel ; purulent sediment ; after micturi-
tion, the pain continues in the urethra until a new urging ensues ;
stools likewise painful; feverish and sleepless through the night;
cutaneous eruptions here and there on the body ; suppressed itch ;
gonorrhceal discharges ; hemorrhoidal disposition.

Uva ursi, frequent urging with little discharge, and a burning, cut-
ting pain afterwards ; the urine is yellow, but deposits a tough mucus ;
sometimes blood and mucus are voided at the same time, with great
straining ; constipation.

A number of other remedies may present themselves for consider-
ation : Calc. c, Capsic, Con., Erigeron, Graph., Hepar, Hydrastis,
Mtr. ac, Phos., Sarsap., Senega.

Compare also those remedies mentioned under the head of Kidney
Diseases.

When the inflammatory process attacks the serous coating of the
bladder, which is a part of the peritoneum, it is called — •



872 .BLADDER.

Cystitis Serosa,

And is nothing more nor less than a partial peritonitis, of which we
have already spoken.

When, however, it attacks all the coatings, the whole structure of
the bladder, then it is called —

Cystitis Parenchymatosa.

This is no doubt the most serious form of all. Pathologically, its
walls are thickened, its cavity decreased, its contractility and expan-
sibility lessened, and its submucous and subserous areolar tissue infil-
trated, forming abscesses of the bladder.

It is no primary affection, but an extension either from catarrhal
or peritoneal inflammation, and it is likewise found in consequence
of exanthematic fevers, typhus, puerperal fever, pygemia, &c.

It seldom attacks the whole bladder, but generally its anterior wall.

Its symptoms are, on the whole, the same as above detailed ; and
its diagnosis is indeed very difficult.

When abscesses form, they may discharge either in the bladder —
the most favorable event — or into the peritoneal cavity, causing gen-
eral peritonitis ; or the pus may gradually work its way downwards,
and discharge through the perinaeum, or into the vagina or the rectum.

Therapeutic Mints the same as above.

Pericystitis

Is an inflammation of the loose areolar tissue which surrounds the
bladder, and is entirely analogous to perityphlitis and periproctitis, of
which I have been speaking before.

There are no other characteristic symptoms than those of inflam-
mation of the bladder, with which it is always more or less connected.

Calculi Vesicae, Stones in the Bladder.

Calculi vary from the size of gravel to conglomerations of the size
of a man's fist, and even larger. In shape they are either round, or
flat, or rough, irregularly shaped.

In regard to their chemical composition, they consist of clear uric
acid^ or a combination of uric acid and ammonia, soda, magnesia or



CALCULI VESICA. 373

lime. They are hard, heavy, brown, yellow, or grayish-white, and
are mostly smooth, roundish, rarely irregular in shape.

Next in frequency are those which consist of phosphates. They
are not so compact, but are brittle, crumbly and light ; of a whitish,
grayish, seldom yellowish color; and are of a roundish shape, 'with a
smooth but sandy surface.

Still rarer are those which consist of oxalate of lime. They are the
hardest and heaviest of all ; have a dark brown or blackish appear-
ance ; and an uneven, wart-like surface.

Such conglomerates which consist of carbonate of lime, cystine, xanth-
oxyde are of very rare occurrence, whilst mixtures of urates, phos-
phates and oxalates are quite frequently found. In such mixtures
there is usually a nucleus of oxalate of lime, around which other
earthy salts are deposited.

Such urinary concretions may be very numerous. Liston extracted
five hundred from one bladder. These are usually renal calculi,
which are formed in the renal pelvis, and which work their way
gradually through the ureters into the bladder, where they remain
and increase in size. Stones which are formed primarily in the
bladder are generally solitary. They are either movable in the
bladder, or they are entangled between the folds of its mucous mem-
brane, or they have formed by their weight an extension of the blad-
der, where they are held stationary.

Those which roll about freely in the bladder are always of a round-
ish shape and smooth, whilst those which are stationary assume an
uneven and jagged surface. Yery large stones nearly fill the cavity
of the bladder ; they have been found to weigh from five to six
pounds.

Gravel passes away without much dif&culty. Neither do smooth
and movable stones, if not too large, cause much inconvenience. But
when they are of larger size, and of a rough and irregular shape, they
cause considerable trouble.

Symptoms.

1. In rare cases the patient feels a heavy hody iii the hladder moving
about, lohen changing position.

2. Pain in the neck of the bladder when walking, standing, sitting or
during stool ; still worse when riding in a carriage or on horseback,
but much less during rest, and especially while lying on the back or
on the face. This symptom becomes quite characteristic when, after
riding in a carriage or on horseback, there follows —



374 BLADDER.

8. A discharge of bloody urine and an increase of catarrhal inflam-
mation of the bladder.

4. Sometimes the pain is not felt in the bladder at a]l, hut in the .
glans penis and along the urethra^ which constantly tempts the patient
to squeeze and pull at the penis. This condition of things with
boys leads to the habit of masturbation, and, by the constant pull-
ing, they produce an elongation of the penis, and hypertrophy of the
prepuce.

5. Strangury, which commences when the last drops of urine are
voided, and continues for a while afterwards.

•6. Sudden stoppage in thefloiu of urine (although the bladder be not
emptied) by the rolling of a calculus before the opening of the bladder.
In other positions, especially that of lying on the back, the urine flows
again.

7. Sometimes a distinct feeling, as though something were wedged
into the neck of the bladder, causing difliculty in making water, when
a calculus has been driven into the opening at the neck of the bladder.

8. Reflected pains, as spasms in the rectum, vagina, testicles, kid-
neys, perinseum, legs, &c.

9. In rare cases, when there are many stones in the bladder, on
succussion of the body, they may even be heard and felt rattling in
the bladder.

10. Examination by the metallic sound reveals a hard body, which,
on being struck, gives a metallic sound.

Therapeutic Hints. — Large stones, it is true, cannot be dis-
solved again, but belong to the domain of surgery. But it is a ques-
tion whether we cannot do something to p)reve7it their formation.
According to our records a number of remedies have shown them-
selves efficacious in expelling gravel, and in restoring a normal
secretion of urine. If such be the case, is it not equal to preventing
larger conglomerations ? and is not one pound of prevention worth
more than ten pounds of cure ?

Moreover, it is true that all who suffer with gravel need not neces-
sarily become affected with stone in the bladder ; just as every one
who falls need not necessarily break his neck. But who can tell
beforehand the result in either case ? The remedies, after the use of
which gravel and small stones have been observed to be discharged,
are : Aspar., Calc. c, Calc. urinaria, Cannab., Ipomeanil, (Jeanes,) Lye,
Nitr. ac, Nux v., Petr., Phos., Puis., Sarsap., Sulph., Tabac, Uva
ursi.



MicTURiTioisr. 375

Amoiig;st the new remedies are mentioned, Alnus rubra, Cliima-
phila, Collins., Corydalis, Brigeron, Erjngium, Bupator. arom. and
perf., Frasera, Galium, Gossypium, Podoph.

For particulars, study renal colic, catarrli of the bladder, and the
materia medica.

As I have commenced the diseases of the urinary system with an
examination of the urine, so shall I conclude this chapter by a short
commentary on Micturition, or the voiding of urine.

A full,, energetic stream is a sign of a normal condition of the blad-
der and urethra.

A thin stream, with difficulty in passing^ indicates narrowness, con-
striction, stricture in consequence of inflammation, or obstruction by
foreign bodies, or compression by the swollen prostata, or spasm of
the neck of the bladder, or stone in the bladder.

'•A feeble stream is found in old age, during general exhaustion, in
consequence of beginning paralysis of the bladder, from mechanical
obstruction in the bladder or urethra.

A divided stream may originate in a partial sticking together of
the orifice of the urethra, in inflammation, mucous secretion, ulcer-
ation or constriction of the urethra, or in consequence of diseases of
the prostatic gland.

An oblique, crooked stream is caused by a diseased state of the
urethra near its orifice ; also by swelling of the prostata and by stone
in the bladder.

An interrupted stream always denotes mechanical obstruction, as
stones, blood-coagula, &c., or spasmodic action in the urethra or
bladder.

A stream in jerks is caused by spasmodic action of the bladder and
sphincter.

Frequent^ almost constant urging to make water, although there is only
little urine voided, is a sign of inflammatory or spasmodic conditions
of the urinary organs, and occurs likewise in consequence of using
various medical drugs.

In women it is frequently a forerunner of the monthly period, and
after coitus, a sign of conception, or incipient leucorrhoea. During
pregnancy, in the first month it is observed, especially in the morning
after getting up ; and in the last month it is caused by the pressure
of the enlarged uterus. So it is also frequently found during par-
turition, or in threatened abortus. If it continues after birth it is a
sign that the neck of the bladder and the urethra have been bruised
during parturition. A constant urging to urinate, with but little dis-



876 BLADDER,

charge, in small-pox, is a bad sign; and in scarlet fever, if it sets in
suddenly, denotes a disturbance in the eruptive process and a metas-
tasis to the brain.

In chronic diseases it is a forerunner of dropsy.

Difficidt urination, dysuria, is found in all inflammatory affections
of the urinary organs. When the passage of urine is possible only
with the body bent forwards, legs far asunder, it denotes an enlarge-
ment of the middle lobe of the prostatic gland, especially if it com-
mences and ends with urging, and leaves the feeling as though a hard
lump of feces ought to be discharged still. The urine generally flows
more freely the less the patient presses. When the urine passes most
easily while lying on the back, it is a sign of stone in the bladder,
tumors in the rectum, or anteversion of the womb.

When the urine is voided only by external pressure upon the
lower part of the abdomen it indicates a paralytic state of the bladder.

Involuntary discharge of urine is most frequently found in women
from a concussive exertion of the body when coughing, sneezing,
vomiting, or laughing ; from mental emotions, like fright, the hearing
of music, or strong smells. It seems to be an irritated state of the
sphincter vesicae, and is found especially frequent during pregnancy.

Involuntary discharge of the last remaining portion of urine seems to

be characteristic of strictures of the urethra ; whilst if it commences to

flow from a pressure upon the lower part of the abdomen it indicates a

paralytic state of the bladder. In children it may be bad habit or

weakness.

In fevers it denotes great prostration and a rather precarious state
of things.

After injuries of the head and spine it is always a bad sign.

Constant dribbling of urine is a sign of paralysis of the sphincter
vesicae ; or, after external injuries, a sign that the continuity of the
parts is broken. It is likewise found in inflammatory diseases of
the bladder, in stone-diseases, in consequence of the pressure of large
tumors upon the bladder. In young girls it is sometimes a forerun-
ner of the beginning of menstruation ; it ceases afterwards by itself.
After childbirth it is a sign that the neck of the bladder has been
violently bruised during the act of parturition. In fevers, especially
typhoid, it belongs to the most serious symptoms, indicating a general
exhausted state and beginning of paralysis.

Unconscious fioiu of urine we find frequently in children during
deep sleep, also during sopor and fevers, in the highest degree of ex-
haustion and prostration, in paralysis of the lower extremities.



GONORRHCEA. 877

Retention of iirine — no flow at all — has its cause either in the
ureters, as when thej are plugged up or constricted ; or in the blad-
der, as when it is either paralyzed or its sphincter spasmodically con-
tracted ; or in the urethra, from obstructions by stones, foreign bodies,
swelling or stricture.

Wherever the trouble may be, it is easily revealed by the intro-
duction of the catheter.

For therapeutic hints compare the foregoing chapter.



ORGANS OF GENERATION.

A. MALE GENITALS.

Venereal Diseases.

"We understand by this term all those morbid affections of the geni-
tals in particular, and of the whole system in general, which originate
ex usu veneris in consequence of the absorption of a specific poison.
The nature of this poison is as little known as that of small-pox virus,
or the infection of scarlet fever and measles ; only that it is not vola-
tile, but fixed to the morbid secretion. As to the rest, like either of
them, it produces, when introduced into a healthy organism, a certain
series of symptoms specific in their nature, by which process the
same virus is again produced anew, capable of further propagation.
The principal forms caused by this specific contagion are, gonorrhoea,
chancre, and constitutional syphilis in all its various forms.

It lies entirely beyond the limits of this work to go into any details
in regard to the different views about the identity or non-identity of
the venereal virus and its effects, as have been set forth in the last
fifteen years by a number of renowned syphilodologists. Their works
alone would make up a small library. I shall give merely what
seems to be the result of these controversies adopted by the majority
at present.

(. Gonorrhoea.

We understand by it a virulent catarrh of the genital organs, which
in appearance is entirely analogous to any other catarrhal inflamma-
tion of any of the mucous membranes; but which entirely diflers



378 MALE GENITALS.

from all tlie others by being the result of a specific virus, acquired
during coition with an individual thus affected.

Its seat is usually the fossa navicularis, and that portion of the
urethra which lies back of the glans; sometimes, however, the inflam-
mation extends further back to the bulbus, the membranous portion
of the urethra, and even to the neck of the bladder.

In women the inflammation and secretion extend over the vulva,
vagina, and urethra ; sometimes spreading even into the womb.

Symptoms.

The first symptoms generally appear from three to eight days after
the infection, although in some cases even within twenty-four hours,
and in others after two or three weeks, and even later. They consist
of a, tickling sensation at the orifice of the urethra and in the fossa
navicularis. Soon there is an increased secretion of mucus in the
urethra, which pastes the lips of the orifice together; the tickling
changes into burning, and the mucus, at first transparent, becomes
thick, whitish, yellowish, greenish, or even bloody, and is more or
less profusely discharged. The orifice of the urethra is inflamed and
swollen ; a tensive pain extends all along the urethra into the testicles
and the inguinal regions ; micturition becomes very painful and fre-
quent.

In some cases, the so-called synochal or j)hlegmonous gonorrhoea, the
inflammation extends into the parenchyma of the glans, which ap-
pears darkened and swollen ; and into the corpus cavernosum, with
exudation, which forms hard places in the penis. This gives rise to
the so-called chordas, by which, during erections, the penis is bent
either downwards or sideways. The urine can be passed only drop
by drop, with the most intense pain and great straining. The dis-
charge becomes still more discolored — dark or bloody, even ichor-
ous ; or it is not discharged at all, on account of the high state of in-
flammation. The prepuce is contracted, and cannot be brought back
over the glans — phimosis; or it is contracted behind the glans, and
cannot be brought forward — paraphimosis.

The inflammation spreads even to the neck of the bladder and the
neighboring areolar tissue, in consequence of which abscesses may
form and break through the perinasum, giving rise to fistula urin^.

Other cases, the so-called indolent or torpid gonorrhoea, are attended
with very little pain ; and the only symptom which is of any incon-
venience to the patient is a more or less profuse mucous discharge.
This indolent form is usually found in persons who have had the



GONORRHCEA. S79

disease several times. It seems, that the system gets accustomed
even to the most violent poisons, as may be seen in prostitutes. Yet,
innocent as it seems, it is generally very obstinate, and is apt to
become chronic ; and if transferred to other persons not quite so
hardened, it may cause the most virulent symptoms. In still other
cases — the so-called erysipelatous gonorrhoeas — the glans and prepuce
are oedematously swollen and inflamed, as in erysipelas. The pain
is not so great as in the synochal form, and the discharge is of a more
watery, ichorous nature.

Mild forms of acute gonorrhoea are said to run their course in
about five or six weeks ; but most cases assume a chronic form and
are then called gonorrhoea secundaria or gleet. This form is usually
without pain ; when there is any, it is a fixed pain in the fossa navicu-
laris. The discharge is mostly watery, sometimes thick and yellow-
ish. Usually there is only a single drop, and that to be seen in the
morning ; at other times the lips of the meatus urinarius merely stick
together ; sometimes, however, the discharge continues to be more or
less profuse. This state of things may last, with various degrees of
severity, for months, even years.

In the female the symptoms of gonorrhoea are nearly the same ;
generally, however, they are less painful, because the vagina, the part
principally affected, is wider and less sensitive than the urethra in the
male. Still, in high degrees of inflammation, and when extending to
the female urethra, the clitoris and the labia, it may become quite as
painful. The discharge is then quite profuse and discolored, excori-
ating the external parts. Frequently it is associated with condy-
lomata on the inside of the thighs and around the anus. Excoriations
and ulcers also exist on the neck of the uterus, and sometimes the
morbid process extends into the womb and ovaries, causing chronic
catarrhal affections there. Its cause is, as stated above, an infection
by a specific virus.

Catarrhal inflammation of the mucous membrane of the sexual or-
gans may be brought on by a variety of causes — irritation by foreign
bodies, sexual excesses, coitus with menstruating women, or such
women as suffer with acrid leucorrhoea. Even drinking new wine
or sour beer may cause strangury and a gonorrhoea-like discharge.
Such inflammations are of a much lighter nature, and cease in a
few days without medication ; but as we cannot distinguish between
a chronic gonorrhoeal discharge and a mere acrid leucorrhoea, it is
very well to know that a gonorrhoea-like discharge may he caused by a



380 MALE GENITALS.

mere acrid leucorrboea, if for nothing else that it may preserve tlie
peace of a family.

The gonorrhoeal virus is transferrable by the muco-purulent dis-
charge of a gonorrhoeal patient, whenever it comes in contact with the
mucous membrane of the urethra or vagina of a healthy person.
None are proof against the contagion, although some persons are more
easily infected than others ; and frequent exposure to it seems to harden
against it.

Therapeutic Mints. — The number of recommended remedies
for this complaint is great, but yet the curing of it is often a difficult
task. For its very first stage, Grauvogl has recommended Natr.
sulph, ; Jahr, Sepia ; "Wahle, Bryonia ; Baehr, Merc, sol ; Kafka,
Sulph ; a number of others, Cannab. Who is right ?

In this, as well as in all other cases, we must closely individualize.

Agave americana, excruciating, painful erections; chordaB ; stran-
gury ; drawing in the spermatic cords and testicles, extending to the
thighs, so violent that he wishes to die.

Agnus castus, gleet, yellow purulent discharge; old sinners with
sexual inability.

Alum. P. S., gleet.

Arg. nitr., burning in the urethra during micturition, with a feeling
as though the urethra were swollen and sore inside ; the last portion
of the urine remains in the urethra.

Calc. c, gleet, after Sulphur ; fat, lymphatic persons.

Cann., great swelling of the prepuce, approaching to phimosis ; dark
redness of glans and prepuce ; light red spots on the glans, of the



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 38 of 65)