Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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When co7iical, Solu bills.

When dry, Thuya, Staph., Solub., Sublim., Nitr. ac, Lye

When moist, suppurating, Nitr. ac, Thuya, Sulph., Euphrasia.

When soft, spongy, Sulphur.

When intolerably burning and itching, Sabina.

The Inguinal Bubo

Consists of a swelling of the inguinal lymphatic glands, with a ten-
dency to the formation of abscesses in consequence of syphilitic
infection. It is the first sign of constitutional contamination by the
syphilitic virus. As chancres may appear on other parts besides the
genitals, so, also, do buboes appear in other parts : in the axilla, under



INGUIISrAL BUBO. 391

the maxin.n, on the neck. Buboes may also form primarily (without
previous chancre on the penis j by immediate absorption of the syphil-
itic virus. The period of time which elapses between the first appear-
ance of chancre and that of bubo varies from eight days to six weeks.

Symptoms.

Before any thing can be seen the patient experiences a painful
tension in the inguinal region, which sometimes extends into the
thigh, making walking quite difficult; soon after the patient feels
feverish, chilly, and there appears a roundish swelling in the inguinal
region, which is painful to contact and motion. It is usually hard,
grows, in the course of some days, to the size of a pigeon's egg, and
larger, and becomes dark red. If not arrested in this stage it soon
commences to assume a more doughy feel, with painful throbbing;
finally it fluctuates, breaks, and discharges a quantity of thick pus,
which at last becomes more watery ; now it heals, either like any other
abscess, or the wound assumes a chancre-like aspect, with hard, callous
edges. In bad cases, it may even assume a phagedenic or gangrenous
form, and cause terrible destruction of the surrounding parts.

All buboes do not run this acute course. The so-called indolent,
torpid or atonic buboes form quite slowly, without pain or fever, and
continue so until they reach a certain size, which they retain in a
seemingly unaltered condition for weeks, or even months, until they
finally suppurate and discharge. The so-called scirrhous bubo may
remain for years in the same condition.

Its diagnosis is easy enough, if we ascertain the pre-existence of
chancre. It may, however, be confounded with an incarcerated
testicle within the abdominal ring ; therefore, Eicord advises first to
count the testicles before pronouncing an inguinal swelling a bubo.
The inguinal glands may swell from other causes. In children,
scrofulous swellings of these glands are not unfrequent. We shall,
in some cases, no doubt, have to fall back on the history of the case,
which may tax our skill in cross-examination.

Therapeutic Hints,

Ars., when the open bubo assumes a gangrenous aspect.

Aurum, after the abuse of mercury, with nightly pains in the bones.

Badiaga, bubo stone-hard and uneven, a conglomeration of indu-
rated glands ; violent stitching pain through it at night, as though a red-
hot needle were thrust into it. Suppressed chancre by cauterization
and mercurial ointments, leaving elevated and discolored cicatrices ;
general cachectic appearance and rhagades of the skin, here and there.



892 MALE GENITALS.

Carbo an., for "hard buboes wbich threaten to suppurate; it causes
resorption where there is even some fluctuation discoverable ; old,
maltreated buboes, cut open or cauterized, presenting large, terrible
ulcers, with callous edges and a secretion of offensive ichor.

He par, after the abuse of mercury, for open buboes, which do not
heal, and when there is a psoric taint of the system.

Kali hydro]., after mercurial treatment; ulcerating bubo, with
fistulous openings, and discharge of dark, thin, offensive, and cor-
roding ichor.

Lachesis, old protracted syphilitic mercurial buboes ; hectic fever,
sore throat, and the most violent headache, either in the back or front
of the head.

Mercurial preparations, compare what has been said under the
chapter on Chancre.

Nitr. ac, after the abuse of mercury, when Carbo an. has not been
sufficient to reabsorb the swelling, and especially if the still existing
chancre presents exuberant granulations on its base.

Sulphur and Silicea are especially indicated for old discharging
buboes which do not heal, although other syphilitic symptoms have
disappeared.

Besides these remedies, there have been recommended Buboin,
PhytoL, Sanguin.

Balanitis, Gonorrhoea Spuria or Praeputialis.

This affection is a profuse secretion of mucus between the glans
penis and prepuce, which is formed only in men with a long foreskin.
It is sometimes associated with genuine gonorrhoea; but may just as
well originate from uncleanliness, frictions, coitus with women who
suifer with acrid fluor albus. Much more often it is altogether an
innocent affair; although in some cases it may be of a poisonous

nature.

Symptoms.

Itching underneath the prepuce, which appears red and moist. In
a few days there appear heat, pain, and swelling of the prepuce, with
considerable discharge of a yellowish, purulent mucus. Sometimes
it is very difficult to push back the prepuce, in which case the glans
appears excoriated. If allowed to remain, adhesions and abscesses
may form between the glans and the prepuce, and cause considerable
trouble. If of an innocent nature, it is easily managed by cleanliness
and perhaps one dose of Merc. ; if it is in connection with gonorrhoea



SYPHILITIC SKIN-DISEASES. 893

or chancre, it of course assumes the habits and manners of its com-
panions, and requires the same treatment. Compare also Jacaranda
caroba.

ikin-Dlseases.



Soon after the outbreak of the disease, during the middle ages, the
skin affections succeeding syphilis were of a much more violent
character than they are now, so that they frequently disfigured the
face in a terrible manner. In after years they lost this violence,
until, towards the end of the eighteenth century, in cousequence ot
those revolutionary wars which mixed all nations together, syphilitic
skin-diseases seemed to become more frequent again. Since that time
they have been studied more closely, and divided into different
classes.

The premonitory symptoms to their appearance, after the syphilitic
poison may have lingered for years in the system, are often : wasting
away ; pale, dirty, and icteric color of the skin ; rheumatic and gouty
affections; hemicrania or clavus ; indigestion; bad breath.

Their color is mostly livid or copperish, although this may be
wanting in some cases, and be present in others of no syphilitic
origin.

Their form is usually roundish, although they assume various
shapes when the eruption is confluent.

Their seat is especially the scalp, forehead, al^ nasi, corners of the
mouth, chin, cheeks, whiskers, and ears. Less frequent, the palms
of the hands, soles of the feet, roots of the nails, the shin-bones,
wrist-bones, and ankles of the feet. Finally, every part of the
body may become invaded. They are always of a chronic nature —
portions of them die away, and fresh groups appear ; and, what is
quite characteristic, they change their forms frequently — one kind of
eruption disappearing, and another kind taking its place. These
symptoms are neither very painful, nor do they itch much. In their
later stages they frequently form thick crusts, which are said to
spread a peculiar specific odor ; which may be true of the worst forms
of the disease.

The general appearance of the shin is, in light cases, not altered ; in
deeply-seated cases, however, it appears dirty, pale, yellowish, or as
if covered with iron-rust. The latest writers on this subject distin-
guish the following forms of syphilitic eruptions ;

1. Macule, or syphilitic discoloration of the skin in spots, roseola
syphilitica.



S9-i MALE GENITALS.

2. Papula, or syphilitic pimples — lichen syphiliticus.

3. Pustule, or syphilitic pustules, resembling small-pox; where-
fore the French call syphilis also verole grosse, or, shortly, verole —
acne syphilitica.

4. SQUAMiE, or syphilitic squamous slcin-diseases, which are char-
acterized by patches of unhealthy cuticle, on an inflamed base —
'psoriasis syphilitica ; its seat is generally in the palms of the hands
and on the soles of the feet.

5. Vesicular eruptions and bull^, large vesicles, are of rare
occurrence, but are found here and there as rup)ia syphilitica and
pemphirjiis syphiliticus.

6. The worst forms are the syphilitic skin tubercles, which, if
they inflame and dissolve, constitute the lupus syphiliticus ; destroy-
ing the cutis to a smaller or larger extent. Sometimes they are
single, and may form into deep ulcers, or become absorbed, or
calcinated, when the external skin sinks in at that place ,• sometimes
they are found in clusters upon the extensor side of the extremities,
and in the region of the shoulder-blades.

7. Falling out of the hair; and

8. Deformities of the nails, which either grow crooked, or split,
or are thrown off altogether. The principal remedies from which
to select are the different mercurial preparations, Nitr. ac, Thuya,
Aurum, Lye, Staph,, Kali hydroj,, Lach., Sulph., Hepar, Sarsap.

Syphilitic Affections of the Mucous Membranes.

Their most common seat are the tonsils, the uvula, and the velum
palati. But they frequently spread to and upon the fauces, through
the posterior nares into the nose ; or, in front, over the roof of the
mouth. Their appearance differs little from that of primary chancres
on the genitals. Their development is slow, and in this way they are
distinguishable from acute sore throat. Mercurial ulcers are chiefly
found on the inner surface of the cheeks, whilst scorhutic ulcers gener-
ally attack the gums, which are swollen and of a dark-red appearance.
Cancer of the tongue is found mostly on the edges of the tongue,
whilst syphilitic ulcers form more on the middle or under the tongue.

Syphilitic affections of the mucous membrane of the nose may be
confounded with c/i?'omc coryza ; but then the discharge soon takes on
an ichorous form.

In svphilitic ulcers of the rectum there is a purulent discharge ;
and in syphilitic affections of the bladder it takes the forni of a chronic



SYPHILITIC AFFECTIONS OF THE PERIOSTEUM. 895

cystitis. In all such cases the ascertaining of previous syphilitic
infection is an indispensable requirement for a sure diagnosis. In
secondary ulcers of the throat and nose the most important remedies
are : Kali bichrom., Sanguin., Aurum, Nitr. ac. Lye, Cinnab., Sublira.,
Thuya, Laches., Kali hydroj,, Mezer.

Britis Syphiliticac

The sclerotica and conjunctiva are inflamed; there is quite a dis-
tinct red ring around the cornea. The cornea grows opaque, and the
iris loses its natural color, and grows paler. The pupils are drawn
together, or into an irregular shape. The patient cannot bear the
light; has great pain in the supra-orbital region-, worse at night.
Exudation in the anterior chamber of the eyes takes place ; in con-
sequence of which the pupullge are gradually shut up.

Therapeutic JB;mfs.— Sublim., Nitr. ac, Thuya.

Syphilitic Affections of the Periosteum, of the Bones and

. Cartilages.

They are always attended with severe pains in the bones, of a
boring, grinding nature, and always worse at night from nine o'clock
in the evening till towards morning, when, with a slight perspiration,
they usually abate. Gradually a structural change is observable ;
the periosteum commences to swell, forming so-called to^j/w", and when
the inflammation spreads to the bones, causing s.welling of the bones,
[exostosis,) which may terminate in necrosis and caries. Such struc-
tural changes attack the skull bones, which, when they are on the in-
side, may cause convulsions, paralysis, amaurosis and deafness. Those
which attack the bones of the nose cause horrible disfiarurations of
the face. It also attacks the vertebra, destroying portions of them,
and cartilages, although not so frequently. The cartilage of the nose
is destroyed as well as the bones, and instead of the nose, nothing is
left but a hole in the middle of the face. The cartilage of the sternum
and the cartilages of the larynx have been found destroyed.

Therapeutic Hints. — Pain in the hones, Aurum, Guajacum,
Mezer., Nitr. ac, Phos., Phos. ac, Staphis.

Tophi and exostosis, Aurum, Fluoric ac. Lye, Mezer,, Phos., Phos.
ac, Staphis., Sulphur.

Caries and necrosis, Aurum, Fluoric ac. Kali hydroj., Nitr. ac, Silic.



39 6 MALE GENITALS.

Sarcocele Syphilitica,

An exudation of coagulable lymph into the substance of the testicles,
whereby the tubuli uriniferi become gradually obliterated. It man-
ifests itself as a gradually growing, sometimes entirely painless swell-
ing of the testicle, commencing at the testicle itself, not like in
epididymis gonorrhoica, at first in the epididymis. It is indicative
of its syphilitic origin, that both testicles, one after the other, are often
attacked. Sometimes it is combined with hydrocele.

Syphilitic Contractions of IVluscles and Tendons.

These take place in rare cases, where the syphilitic virus attacks
the muscles and tendons, causing plastic exudation within and around
them, and thus shortening them.

Gummata in the Cellular Tissue.

These usually form at a later period, and appear as little, painless,
movable kernels under the skin. They grow slowly and commence
finally to suppurate, leaving deep, cicatrized holes, or chronic ulcers.

Syphilitic Affections of Inner Organs.

a. Brain affections. They manifest themselves by various affec-
tions, as, violent headaches, hemicrania, sleeplessness, dizziness; as,
hemiplegia, imbecility of mind, amaurosis, deafness, epilepsy, cata-
lepsy, and are caused either by chronic inflammation of the mem-
branes, or formations of tubercular masses, or syphilitic exostosis on
the inner plate of the skull bones.

The diagnosis is difficult. We may suspect such changes, if we
find a right to do so from the history of the case.

h. Lung affections set in frequently in consequence of suppressed
chancres, either as tuberculosis, as ulcerative processes, as bronchitis
and asthma.

c. Liver, spleen, intestinal affections, of which we have
spoken above.

Syphilis Infantum Congenita et Haereditaria.

In some cases the child is destroyed by syphilitic infection whilst
yet a foetus; in other cases the child is born with all signs of



SYPHILIS INFANTUM. 897

syphilis; and in still other cases the child seems apparently well
after birth, when some weeks and months after, and in some cases
not before the age of puberty, the concealed disease breaks forth.
The infection may take place in different ways;

1. Both parents are affected with syphilis at the time of generation.
In this case the foetus dies, usually between the fifth and seventh
month of pregnancy.

2. The father only is affected with syphilis, and lays by his con-
taminated semen the root of syphilis of his offspring. In this case
the child may be born apparently healthy, being sustained by the
healthy blood of its mother ; still the inherited germ will show sooner
or later.

3. The mother only is affected, and by her poisoned blood the foetus
becomes thoroughly imbued with the syphilitic virus and is de-
stroyed, either before birth, or it comes into this world with visible
signs of the dreadful malady.

4. The child may be infected by primary or secondary syphilitic
ulcers of the nipples of the wet-nurse.

5. The child may become infected by the milh of the nurse just as
well as by the blood of the mother.

6. The infection may take place during the act of parturition, if
the mother contracted towards the end of pregnancy the terrible
disease.

Symptoms.

When a deep-seated syphilitic dyscrasia is transferred to the foetus,
the child, if born alive, has a peculiar oldish appearance ; a weak,
plaintive voice ; its nose is stopped up 5 the corners of its mouth are
sore; its small body is covered, or soon covers with copperish
spots, which generally appear first in the palms of the hands and
soles of the feet, gradually spreading over the whole body ; they fill
in a short time with a turbid fluid, and raise the epidermis into blis-
ters, which burst and leave excoriated places.

This malignant affection has been described in books as "pemphigus
neonatorum. Sometimes the only apparent symptom is a stoppage
of the nose with discolored, purulent discharge, excoriating the ex-
ternal nose and upper lip, and covering with black crusts.

Where the syphilitic dyscrasia of the parents is not so intense, the
children of course are not so intensely affected, and the infection may
not show the first six weeks, or previous to dentition, or even before
the time of puberty. In such cases syphilis is often mistaken for
scrofulosis, and its occurrence has been denied altogether. But there



\



898 MALE ORGANS.

are undoubtedly such cases. When the child becomes infected after
birth by the nurse, the first symptoms appear on the lips and corners
of the mouth ; these form pustules and ulcers in the face, later in the
throat, and at last on the genitals, and condylomata around the anus.
By-and-by, if the disease is allowed to progress still further, super-
added to all this are blennorrhoeas of the eyes, nose, ears — in girls,
of the vagina, followed by hectic fever, emaciation, and colliquative
diarrhoea. The little sufferers contract that peculiar oldish appear-
ance, and die at last of atrophy, with convulsions.

The horrid disease may be spread by such an innocent victim
through whole families, if the greatest care and cleanliness be not
exercised.

Therapeiitie Mints for Constitutional Sypliilis.

Arg. nitr., chancre-like ulcer on the prepuce; urethra swollen, hard
and knotty ; sexual desire gone ; the genital organs having become
shrivelled ; cock's-comb-like fig- warts around the vulva.

Arsen., gangrenous and serpiginous ulcers ; tubercular syphilitic
skin diseases.

Aurum fol. and muriaticum, after the abuse of mercury ; secondary
ulcers on the scrotum; nightly pain in the bones; swelling of the
skull-bones ; swelling of the periosteum of the fore-arms and shin-
bones , caries of the roof of the mouth and nose ; ulcers on the
tongue; falling out of the hair, and great nervous weakness; utter
despair and prostration of soul and body.

Badiaga, whole convolutes of hard glandular swellings, buboes.

Carbo. an., buboes; gummata; skin tubercles.

Caustic, fistulous ulcers ; corrosive ulceration of skin tubercles;
lupus ; complication with gout and scurvy.

Corallea rubra, syphilitic erosions, exuding a thin, badly-smelling
ichor ; constant trickling of mucus from the posterior nares into the
fauces.

Euphras., old, broad condylomata at the anus, with much burning,
especially at night.

Ferrum jodat., recommended for mercurial cachexia.

Fluor ac, skin tubercles on the forehead and face, even when ulcer-
ating ; squamous eruptions on the body, (psoriasis guttata ;) syphilitic
erosions, mucous tubercles ; exostoses and nightly pains in the bones.

Guajac, tearing and stinging in the limbs; aching in the bones
with swelling ; tearing pains in the skull and bones of the nose ; itch-
ing, tetter-like eruptions.



SYPHILIS. 899

Hepar, after the abuse of mercury ; falling out of tlie hair; painful
lumps on the head, and nightly pain in the skull-bones; soreness of
the nose on pressure, with red, inflamed eyes ; eruptions around the
mouth ; ulcerated gums, with flow of saliva ; swollen tonsils and hard
glandular swellings on the neck, with sticking when swallowing,
coughing, breathing, or turning the neck, as though a fish-bone had
stuck fast; suppurating buboes in the inguinal region and axilla;
green, slimy, bloody stools; inflammatory swellings of the knees
hands, and fingers ; ulcers, with nightly burning, throbbing and
stinging, bleeding easily; nightly pain in the limbs, with chilliness;
great nervous weakness.

■odium, mercurial cachexia ; salivation ; ulcers in the throat.

Kali bichpom., deep ulcer on the edge of the tongue ; ulcer on the
velum palati, eating through ; fetid discharge from the nose ; caries
of the bones of the nose, with profuse purulent discharge from the
nose ; suppurating, solitary skin-tubercles, forming deep holes.

Kali hydroj., after the abuse of mercury ; deep chancres, with callous
edges; buboes, ulcerating, with prominent edges; tuberculous pus-
tules in the face ; roseola on chest and extremities •, discolored, large
ulcers on the skin ; swelling of the bones ; nightly bone-pain ; bloody
stools, with tenesmus ; falling out of the hair.

Lachesis, mercurial syphilis, with ulcerated sore throat, causing a
constant provocation to cough, with retching ; painful deglutition ;
regurgitation of drink through the nose ; earthy, yellowish appear-
ance of the face, with small red blood-vessels shining through the
skin ; coryza, nose red and sore ; terrible headache ; nightly pain in
the limbs,

Lycop., secondary, tettery-like eruptions and ulcers in the throat
of a dark, yellowish gray color ; cough and hoarseness, from similar
affection of the larynx ; coppery eruptions on the forehead, and ca-
chectic appearance of the face; dry, pediculated, painless, condylo-
mata on the sexual organs ; nightly pain in the limbs during wet
weather ; low-spirited ; desponding ,= nervous weakness.

Mercurial preparations, compare Chancre.

Mezereum, mercurial syphilis, with or without affection of the
bones ; chronic sore throat ; dark redness of the fauces ; worse every
winter, with burning dryness extending into the larynx ; hoarseness ;
hawking of phlegm.

Natp. sulph., granulated inflammation of the inside of the eyelids-,
swelling and suppuration of the axillary glands ; ulcer on the outer
side of the thigh ; knotty, wart-like eruption on the anus ; between



400 MALE OEGAJSrs.

the thighs; on the forehead, scalp, back of the neck, and chest;
swelling of the ribs near the sternum ; stiffness of knees, and cracking
of joints ; pain in the bones. Compare Thuya.

Nitp. ac, mercurial syphilis; tonsils red and swollen, uneven,
covered with little ulcers of the size of a pin's head; soft palate,
highly inflamed; deep, irregular- shaped ulcer on the edge of the
tongue ; single, moist sores on the scalp, burning ; suppurating pus-
tules all over the face, with broad red circumference, forming crusts ;
large, soft protuberance on the wings of the nose, covered with a
crust ; brown spots on the glans, of the size of a lentil, peeling off;
squamous eruption, like psoriasis; hard, brownish, little knots on the
scrotum and perinseum, which suppurate.

Phos. ac, mercurial syphilis ; ulceration of the lips, the gums, and
the soft palate; swelling of the bones; pain in the bones; condylo-
mata, carbuncle-like ulcers of the skin, with a copper-colored cir-
cumference.

Phos., syphilitic psoriasis in the palms of the hands and the soles
of the feet ; syphilitic roseola ; squamous eruptions ; mercurio-syphil-
itic ulcers on the prepuce ; bone-pain and exostosis.

Phytolacca, sore throat ; ulcers on the genitals ; severe pains in
the arms and legs, from the elbows and knees down to the fingers and
toes, with oedematous swelling of the affected parts; pain aggravated by
motion and contact ; feet and legs covered with pale, red spots, about
the size of a dime ; more scattered on the arms, face and neck ; pre-
vious use of mercury.

Psorinum, moist, itching and burning condylomata on the prepuce ;
sore corners of the mouth ; dry, tetter-like eruptions in the hollow of
the knees.

Sabina, fig- warts, with intolerable itching and burning; exuberant
granulations.

Sanguin., roundish or oval, whitish and raised patches on the mucous
membrane of the mouth, nose, prepuce and anus ; a diphtheritic exu-
dation, which, when wiped off, leaves a raw surface behind ; conges-
tion of the head ; throbbing headache from the nape of the neck to
the head ; swollen veins in the temples.

Sarsap., mercurial syphilis; squamous eruptions ; bone-pain.

Sepia, syphilitic erosions in women.

Staphis., mercurial syphilis ; dry, pediculated fig-warts and mucous
tubercles ; nervous weakness.

Silicea, mercurio-syphilitic ulceration of skin and bones.

Sulphur, mercurial syphilis ; itching ulcers, which are soon covered



HYDROCELE. 401

with a crust ; thick crusts on the prepuce discharging pus from under-
neath ; cock's-comb-like excrescences on the glans, soft, spongy, easily
bleeding; moist condylomata on the genitals; excoriations on the
genital organs, with burning ; copper-colored spots on the forehead ;
hard, large and inflamed buboes ; obstinate gleet.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 40 of 65)