Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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size of a lentil; inflammatory stage with all its painful symptoms,
especially violent burning in the urethra during and after micturition.

Canth,, when the inflammation has spread to the bladder, with in-
tense tenesmus ; bloody discharge and soreness of the urethra during
the flow of gonorrhoeal mucus ; violent and very painful erections at
night.

Caps., white discharge like cream; cutting, stinging pain in the
urethra without, burning during micturition.

Ferr., gleet, painless discharge like milk.

Fluor, ac, gleet, little discharge during the night, which makes a
yellow stain in the linen ; oily transpiration of the genitals with a
penetrating smell.

Hydrastis, acute and chronic form ; feeling of debility and faintness
after each passage from the bowels.



GONORRH(EA. 881

IVIerc., wlien complicated witli chancre ; or in gleet, after Cannabis,
when the discharge is yellowish-green and purulent ; discharge more
profuse at night than during the day. Phimosis, bloody pollutions.

Mezer., gleet ; h^ematuria during gonorrhoea.

Natr. mur., after injections of nitrate of silver, in gleet ; in gonor-
rhoea-like discharges from acrid menstrual discharges.

Nitr. ac, in complication with chancres, balanitis and fig-warts;
small blisters on the orifice of the urethra and inner surface of the
prepuce, forming chancre-like ulcers; painful brown spots of the
glans ; after mercurial treatment ; gleet.

Nux v., after the use of copaiva and cubebs, and after allopathic
treatment ; dull pain in the back part of the head ; hemorrhoidal dis-
position; constipation; suppressed discharge, with swelling of the
testicles.

Petroselinum, troublesome tickling and itching in the urethra, with
constant desire to urinate.

Phos., gleet ; eYerj morning a drop of watery fluid at the orifice
of the urethra, sticking its lips together ; also in case of hypertrophy
of the prostata.

Phos. ac, gleet; every morning a few drops of a white discharge
from the urethra, and in the evening discharge of prostatic juice.

Puis., in consequence of suppression of a gonorrhoeal discharge,
swelling of the testicles and prostate gland; inflammation of the
eyes.

Sarsap., rheumatism of the joints after suppression.

Sepia, gleet, no pain, no discharge, except through the night a drop
or so, staining the linen yellowish ; frequently quite important for
women.

Sulph., gleet; no pain or some slight burning in the urethra; rheu-
matic pains ; chronic inflammation of the eyes ; chronic prostatic
affections ; hemorrhoidal disturbances ; psoric cutaneous eruptions.

Thuya, gleet; condylomata; prostatic affections; discharge, thin
and greenish ; red spots and erosions on the glans ; sudden stitches
along the urethra from back to front.

Tussilago, acute stage ; fixed stinging pain in the fossa navicularis;
for persons of high living and irregular habits ; chronic stage with
inflammation of the eyes and swelling of the testicles, after suppressed
discharge.

Besides these, a number of remedies are mentioned and praised by
eclectics, (see Hale's New Eemedies,) but without the slightest charac-
teristic indications.



•S82 MALE GENITALS.

Complications and Sequelae.

1. Oechitis, Swelling of the Testicles.

Usually only one testicle is affected at a time ; but the swelling
sometimes goes from one to tlie other. At first the swelling is soft
and elastic, but soon becomes hard, red, shining, and very painful to
the slightest touch or move ; it is usually attended with fever, and
follows either upon undue exertions, taking cold, and most frequently
after the suppression of the gonorrhoeal discharge.

Therajoeutic Hints. — Compare Agnus cast., Aur,, Clematis, Merc,
Nux v., Puis., Ehodod., Ehus t., Tussilago.

'2. Peostatitis Gonorehoica, Inflammation of the Peostata,

Is of rare occurrence, and only in those cases in which the inflamma-
tion spreads to the neck of the bladder, or in consequence of suppres-
sion of the discharge by injections. It is attended with a sensation
of heat in the perinasum, in the region of the bladder, and towards the
rectum ; and with tenesmus in bladder and rectum. It may end in
suppuration and the formation of an abscess, which may discharge
its contents into the bladder or urethra, or through the peringeum, or
it may end in chronic induration of the prostatic gland.

Compare Merc, Nitr. ac, Phos., Puis., Selen., Sulphur, Thuya.

3. GONOEEHCBA VeSIC^,

That is, a transmission of the disease to the neck, or into the body of
the bladder, consequent upon suppressing the discharge by injection.
The patient feels violent pains in the region of the bladder, the peri-
nseum and anus, with constant urging to urinate. By dint of the
greatest straining a few drops only, of a turbid urine mixed with blood
and pus, are discharged.

ifam remec??/; Cantharides. Compare Cystitis.

4. Buboes.

Inflammatory swellings of the inguinal glands, which generally
grow very slowly, and are brought on either by over-exertion or
suppression of the discharge.

Gom'pare lod., Lach., Merc, Nitr. ac.

6. Ophthalmia Gonoeehoica.
One of the most dangerous inflammations of the eyes ; which has
bereft many a new-born child of its eye-sight. The infection may be



GONOKRHCEA. 883

caused either by tlie direct contact of the poison with the eyes, by
'means of the fingers or soiled handkerchiefs, or by metastasis.

Compare Aeon., Ars., Belh, Hepar, Merc. sol. and subl., Nitr. ac,
Puis., Tussilago.

6. GONOERHCEA OF THE EeCTUM.

Pain in the rectum ; mucous membrane inflamed ; sphincter spas-
modically closed ; discharge of purulent mucus mixed with blood.
Com;pare Merc, Nux v., Puis,, Sepia, Sulphur, Thuya.

7. Strictures of the Urethra.

They consist in a fibrous or callous hardening of certain portions
of the urethra, whereby the canal becomes narrowed, and the passage
of urine dif&cult or altogether impossible. Their main seat is the
membranous portion of the urethra and the fossa navicularis, although
other parts likewise may adhere or become constricted in consequence
of inflammation.

The first and main symptom is difficulty in making water. The
stream is thin, twisted, split, and flows in jerks. The bladder cannot
be fully emptied, and there is a continued dribbling of urine for a
great while after micturition.

They are caused frequently no doubt by the use of injections, mis-
managed introduction of bougies, the long continuance of chronic
gonorrhoea, and excessive indulgence in sexual intercourse.

Gompare Clematis, Digit., Dulc, Petrol., Puis., Ehus t., Sulphur.

8. GONORRHCEAL EheUMATISM.

It is sometimes acute, attacking muscles and joints; and some-
times chronic. It has been frequently observed to follow the use of
copaiva balsam, or the sudden suppression of the gonorrhoeal dis-
charge by other means, and after taking cold. Those of a rheumatic
or gouty disposition are, of course, the most subject to it.

Compare Hepar, Merc, Mezer., Phytolacca, Sarsap., Thuya.

9. General Contamination of the System in Consequence of

Gonorrh(ea.

Although modern writers deny such consequences of gonorrhoea
upon the whole system, there is not the slightest doubt that a sup-
pression of it is followed, in many cases, by severe and deeply-seated
ailments. We find cases on record where its suppression brought on



884 MALE GEISTITALS.

tuberculosis; in others dyspnoea, lasting for many years — until, un-
der homoeopatMc treatment, an old gonorrhoeal discharge suddenly
appeared again, and the dyspnoea disappeared. Schoenlein, Auten-
rieth and others acknowledge this, whilst Eicord denies a specific
gonorrhcea-virus altogether, which seems to be driving the thing
rather to its smallest point. Grauvogl gives, in his Prophylaxis, a
whole list of constitutional disorders growing out of gonorrhoeal
poisoning, amongst which we find : glandular-like swellings upon the
membranes of the brain, on the neck and tongue ; in the axillae and
abdomen, and its viscera; deafness; paralysis and mental derange-
ment, &c.

The most important remedies which ought to be borne in mind,
and which cover this gonorrhoeal contamination of the system, as Sul-
phur does psoric^ and Mercurius syphilitic affections, are, according
to Grauvogl, Natr. sulph. and Thuya.

Chancre.

The name Chancre is derived from cancer ; by which was meant a
corrosive ulcer, with hard bottom and callous edges ; a description to
which the syphilitic ulcer frequently answers. Its seat is the geni-
tals, where the infection chiefly takes place; in males, the parts
affected are the glans, prepuce, frgenum, front part of the urethra, the
penis externally, the scrotum, and even the groins ; in females, the
labia, vagina, urethra, and even the neck of the uterus. But the
virus may also be transferred to other parts which are liable to im-
bibe it, such as the lips, tongue, nipples, and sore fingers.

There is a great diversity of opinion among old and new writers
concerning the question: Whether chancre is ever a merely local
affection, or always constitutional ? The latest opinion, which seems
to prevail among a majority of those who have specially investigated
this subject, is the following : There are two decidedly different kinds
of virus ; one, which is said never to cause any but a local complaint,
viz., at the spot where it is inoculated into the skin, which consists of
an ulcer, and sometimes an additional inflammation and suppuration
of the adjoining lymphatic glands; the other invariably causes not
only a local ulcer, but also a constitutional disease, resulting in wide-
spread and deep-seated disturbances of the whole nutritive sphere of
the organism.

The difference between the two is said to consist in the following :
The simple chancre develops itself out of a macula or papula, the sur-



CHANCRE. 885

face of ■wLic'h continually peels off until the skin appears excoriated ;
or we see at first a sm^all vesicle or pimple, which gradually bursts ;
or we observe, what is perhaps the most frequent, a sore, chafed spot,
which does not heal, but becomes covered with a dirty exudate, thus
gradually forming, in all instances, an ulcer ; it may be of quite dif-
ferent aspects. It may eat away the substance upon which it grows,
in different directions, and cause sharply-defined edges, as though the
substance had been cut out by a sharp instrument, the basis appearing
covered with a dirty, fatty-looking substance — the common, diphtheritic
chancre; or it may be much more superficial, appear only as an ex-
coriation of the external skin, spreading in circumference, but never
in depth — the superficial chancre ; or it may develop itself in a seba-
ceous gland, when it shows a very small circumference, but appears
comparatively deep — the follicular chancre. All these different forms
of simple chancre may assume a phagedenic or even a gangrenous
character, but neither of them ever develops any induration or hard-
ening at their basis or circumference, and are therefore called soft
chancres.

To distinguish a soft chancre from other ulcers is not always an
easy matter, unless the history of the case decides it at once. To be
entirely sure of its nature, it has been proposed to inoculate its secre-
tion upon the thigh of the patient. If it takes, it proves to be a soft
chancre. The time of incubation is short ; in the course of thirty-six
or forty-eight hours the effect of inoculation makes itself already
apparent.

The constitutional chancre develops itself in the following manner :
we observe at first a hard papula or a hard knot, may be of the size
of a pea or that of a bean or hazelnut.

This induration consists, according to microscopic examination, of
an accumulation of cells and granules, without any characteristic
peculiarities, which lie imbedded in the normal tissues. The epider-
mis covering the induration shows at first no morbid appearance, but
becomes after repeated exfoliations thinner and thinner, and finally
excoriated ; now we have an open ulcer, which secretes a scanty, thin
fluid. Sometime*s it covers itself with a crust, underneath which the
hardened place is still progressing to suppuration. It, too, like the
soft chancre, may vary in its external aspect.

Constitutional Syphilis.

Niemeyer says : It is a most peculiar fact, that sometimes infection

with the syphilitic poison causes quite unmistakable symptoms, and

25



386 MALE GENITALS.

at other times none, except, perhaps, a swelling of some lymphatio
glands. After the healing (I should say suppression) of a primary
ulcer, there elapse, as a rule, several weeks before condylomata, exan-
themata or other consequences of the syphilitic infection make their
appearance. After they disappear, another period of comparatively
good health prevails, when again a second series of syphilitic affec-
tions develops itself. Such a treacherous change of growing better
and worse during the progress of the disease is far from being explain-
able yet. The interval of time which supervenes between the first
healing (suppression of the primary affection) and the appearance of
the secondary affections is variable in the different cases. We do not
know the influences which shorten or prolong these free inter va,ls ;
only so much appears evident : a strong constitution and high living
seem to shorten these intervals, and, also, the kind of treatment has
some influence in that respect.

Bgerensprung asserts that under a non-mercurial treatment the free
intervals never amount to over six weeks, and that, therefore, any one
who had been treated without mercury and remained well for three
months, would be declared positively free from constitutional syphilis.
A latent state of the disease for ten or twenty years would, therefore,
be attributable to mercurial treatment. Such cases, of course, are
rare exceptions, if they happen at all, as it is likewise of rare occur-
rence that secondary symptoms appear whilst the recent chancre yet
exists. As a general rule the secondary symptoms do not appear
before the lapse of from eight to twelve weeks after the infection, and
the same space of time also intervenes between the succeeding states
of secondary and tertiary aggravations.

The order in which the constitutional symptoms appear is, as a
general rule, the following: indolent buboes, condylomata, exanthe-
mata, superficial ulcerations of the mucous membrane, iritis, all of
which are called secondary affections. Later, syphilitic lupus, affec-
tions of the bones, induration of the subcutaneous, submucous and
interstitial tissues, affections of the muscles and inner organs appear,
and are called tertiary affections. There is, however, in reality no
such sharp line of demarcation between these two stages of the dis-
ease. Sarcocele, for instance, seems to stand between both of them.
There are also cases in which destructive processes in the bones belong
to the first, or at least earlier affections of the constitutional contami-
nation, though this may often have its cause in the abuse of mercury.

The outbreak of these constitutional affections is generally preceded
and attended by febrile motions of the organism, and when relapses



CONSTITUTIONAL SYPHILIS. 387

occur repeatedly, wTien the violent pains in the bones prevent the
nightly rest, when ulcerations and mercurial treatment drain the system
of its strength, the patient falls into a state which is termed syphilitic
cachexia. Its induration may be quite thin ; in which case we get the
impression, if we pinch up the sore spot into a fold, as though there
were a piece of parchment inserted below the ulcer ; it is called the
superficial constitutional chancre. Or we observe an excoriated surface,
which is higher than its surroundings, secreting a very scanty, thin
fluid, or being almost entirely dry ; but exhibiting underneath a more
or less deep induration ; this is called the elevated constitutional chancre.
Or we observe finally, that the ulcer has not only a hard basis, but
also raised hard and callous edges ; so that it appears deeper in the
middle than on the edges : this is called Hunter's constitutional chancre.

As this constitutional chancre always exhibits an induration at its
basis — in fact grows out of an induration — it is likewise called, for con-
tradistinction with the soft chancre, the indurated chanqre.

The stage of its incubation occupies from three to four weeks ; and
if its secretion be inoculated upon the thigh of the patient, it never
taJces, thus showing that the virus is pervading the whole system. In
this respect it seems entirely analogous to small-pox virus. Neither
does it take when the system has been already pervaded by its action ;
thus procuring an immunity against later infection. The indurated
chancre also differs from the soft in the following particulars : it is
indolent, not painful; generally appears solitary, except when the
virus entered the system at different places at the same time, and on
healing scarcely ever leaves a cicatrix, as the soft chancres almost
always do.

The susceptibility to both kinds of virus seems alike great in all
ages, sexes and constitutions ; neither does an infection with the one
hinder an infection with the other ; hence we may find both kinds of
chancre in one and the same individuum at the same time. The infec-
tion generally takes place in consequence of impure coitus, but also
utensils, cloth, &c., if they be soiled by the virus and brought into
contact with any sore or denuded part of the body, may produce the
same effects. The constitutional poison is likev»rise carried by the
blood ; and so it may happen that a healthy child may become infected
by vaccination, if the vaccine matter is taken from an infected child,
and should contain some blood of that child. The natural secretions —
for example, the saliva, or morbid exudates of intercurring diseases —
seem not to contain the virus ; whether milk does or does not, is still
a mooted question.



888 MALE GENITALS.

The first sign of healing in a soft chancre is the cleansing of the
dirty-looking basis, and the forming of new granulations upon it, by
which the ulcer gradually closes, leaving almost always a more or less
marked cicatrix. The indurated chancre gradually loses its hard-
ness; or, what is quite remarkable, the induration commences to dis-
appear as soon as secondary symptoms of the disease develop them-
selves on other parts of the body ; it leaves a discolored spot on its
site, which is of a brown-red or coppery color, and which does not dis-
appear as long as the syphilitic poison exists in the organism.

Therapeutic Mints. — This new view in regard to the double
nature of the chancre virus has brought about a great change in the
allopathic treatment. Where the old school formerly poisoned almost
every one who had any kind of chancre, by massive doses of different
mercurial preparations, they now try to destroy all so-called soft
chancres by external applications of some caustic, and apply the mer-
curial treatment onl}^ to the so-called indurated chancres. Such crude
ideas of the organism as that a poison could be stayed to one small
part only, and thrive there, and do all kinds of mischief without
involving more or less the whole organism, are altogether incompatible
with Homoeopathic experiments. It matters little to Homoeopathic
treatment whether the new theory be right or wrong. All such
general views furnish no indications for it. We have here, as in all
other cases, to individualize; and if we find, with Hahnemann and
the allopathic school, that mercury is, up to the present time, the most
specific in this complaint, it is on account of its ability to bring on a
similar state in the healthy organism.

Merc, sol., in all simple, recently-acquired soft chancres, of a super-
ficial and regular form, and a free secretion of thick pus.

Merc. subl. corr., when the chancre assumes a phagedenic appear-
ance, and secretes a thin, ichorous pus.

Merc, precipitatus ruber, when Solubilis effects no change within _
eight or ten days ; indurated chancre, old, obstinate chancres ; indu-
rations after cauterization ; excoriations on the glans ; extuberances
of the ulcers ; and inflamed buboes.

Merc. Cinnabaris, in old, neglected, or badly-treated indurated
chancres, when even Prec. ruber is of no avail ; elevated chancres ;
exuberant granulations of the base of the ulcers ; hard, callous, raised,
indolent edges of the ulcer ; mucous condylomata on the genitals,
anus and lips ; indolent buboes.

Merc, jodatus and bijodatus, when a great deal of mercury has been



SYCOSIS. 389

taken ; when, after tlie healing of the ulcer, there still remains an
induration ; indolent buboes ; indurated glands and indurated chan-
cres ; indurated superficial chancre.

Merc, nitposus, in old, obstinate cases; dry fig- warts on thread-like
pedicles ; also soft, pointed condylomata.

Nitr. ac, in old cases after the abuse of mercury ; unpainful ulcers,
with gray, everted edges, easily bleeding ; or superficial or elevated
ulcers, with zig-zag edges; or ulcers with hard, callous edges; or
ulcers with a dark, bluish, dirty basis, covered with a crust, from
under which is issuing ichor, or with exuberant granulations, forming
a red, spongy basis, like raw flesh ; mucous, moist and other condyl-
omata, like cauliflowers or pin-heads on thin pedicles; inflamed
buboes.
■ Kali bichr., when the ulcer is round and deep.

Kali hydroj., after the abuse of mercury ; deep ulcers, with hard
edges ; buboes ; mercurial diarrhoea, with tenesmus ; nightly pain in
bones ; falling out of the hair.

Lachesis, when the areola of the ulcer assumes a bluish color,

Arsen., when the chancre assumes a gangrenous aspect.

Thuya, mucous and cauliflower-like excrescences (condylomata)
which are moist ; elevated ulcers, with exuberant granulations ; after
Nitr. ac. ; erosions on the female genitals, with abundant mucous secre-
tions ; also erosions and rawness between the legs and on the sides of
the scrotum, constantly oozing a moisture ; suspicious-looking ulcers
on the penis, cavity of the mouth and throat.

Besides, the following are recommended : Jacaranda caroba; Myrica
urifera, Phytolacca, Sanguin.

Condylomata, Sycosis, Fig-warts.

These excrescences are a morbid growth of the skin and mucous
membrane, or, better defined, of the subcutaneous and submucous
cellular tissue. They are of different external appearance, according
to their coating. When they are covered by the epidermis, they
appear dry, hard, horny, like common warts ; when covered with thin
epithelium, or when they are entirely bare and excoriated, they appear
soft, moist, and secrete more or less of a slimy, acrid, badly-smelling
fluid. These latter are the genuine syphilitic condylomata or tuhercula
mucosa.

Their forms are likewise various ; some are flat, upon a broad basis ;
others are conical, growing on a pedicle ; others appear like a cock's-



390 MALE GEJSriTALS.

comb. The Jlat fig- warts are claieflj found around the anus, between
the glutseus muscles ; on the peringeum, scrotum, external skin of the
penis, glans penis, and on the external surface of the labia in women ;
whilst the conical and pediculated are usually formed in the entrance of
the vagina, on the clitoris and even far back in the vagina, and on the
neck of the womb ; in males on the interior surface of the prepuce ;
also between the nates. They sometimes grow so luxuriantly that
the whole vagina and interior surface of the prepuce is covered by
them. A third kind is quite small, in the shape of pins' heads, which
are generally formed around the corona in men, and on the interior
surfaces of the labia in women. In secondary syphilis they appear
also in other localities, especially on the tongue, corners of the mouth,
chin, face, forehead, eyelids, iris, scalp, meatus auditorius, axillae, nip-
ples and between the toes. Soon after the outbreak of this pest in the
middle ages, we read of condylomatous excrescences in the face,
which were a finger's length, and which caused for their bearers more
ridicule than compassion.

TJierapeutic Mints. — For the mucous tubercles the main reme-
dies are Cinnabaris, Sublimate, Nitr. ac. Thuya.

Fig-warts, when complicated with gonorrhoea, require Thuya, Sub-
limate, Cinnab., Nitr. ac, Sul., Lye.

When complicated with chancre, Cinnab., Nitr. ac, Phos. ac, Staph.,
Thuya.

'When fiat, Magn., Nitr. ac.

When exuberant, like cauliflowers or mulberries, Thuya, Staphis.

'WhQn fan-shaped, Cinnab.

When growing on pedicles. Lye, Nitr. ac



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 39 of 65)