Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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Thuya, syphilitic erosions in the female genitals, with profuse gon-
orrhceal discharges ; erosions between the thighs and on the sides of
the scrotum ; in the fauces, with mucous tubercles ; redness in the
fauces ; condylomata ; tubercula mucosa.

Besides all these remedies we find a number of others mentioned
and recommended in Hale's New Remedies, amongst which the follow-
ing seem to be the most important : Asclep. syr., Corydalis, Iris and
Lobelia.

Diseases of the Testes.

Hydrocele.

The testicles and epididymis are enclosed within a serous mem-
brane, like the peritoneum, from which, in fact, it is a mere continua-
tion. As such, it is a shut sac, and consists, like the pleura and the
peritoneum, of two blades, the tunica vaginalis propria and the tunica
vaginalis reflexa. Like all serous membranes, it is liable to exuda-
tion, and if that takes place, it constitutes what is called hydrocele or
dropsy of the scrotum.

It is either a symptom of general dropsical disposition, in conse-
quence of hydrsemia, as found in old age, or in consequence of tuber-
culosis or other chronic diseases, corresponding entirely to hydrothorax
and ascites ; or it is the result of some inflammatory or mechanical
irritation, in consequence of orchitis, urethritis, or in consequence of
external injuries — a bruise, a fall, a kick, &c., as found in otherwise
healthy and young persons, even in children, and then it corresponds
to pleuritic and peritoneal efiusions. This latter may become chronic,
and the secretion of serum continue so that the swelling attains the
size of a head. The scrotum then appears smooth, tense, glistening ;
the testicle is compressed, becomes atrophied, and may gradually dis-
appear ; then it presents the appearance of a transparent bladder. In
consequence of undue irritation, the testicle may grow larger, become
indurated, form into cysts ; the exuded fluid may coagulate, become
turbid by the admixture of blood or pus globules; adhesions may
form, &c. All these are circumstances by which the original nature
of the disease may become deeply concealed. The exudated fluid

26



402 MALE OEGANS.

consists chiefly of a colorless, clear or yellowisli fluid, which, however,
now and then becomes turbid by admixture of pigment blood, fibrine,
fat, mucus, epithelium and semen, so that it assumes different colors,
greenish, dark green, brown and even black.

The presence of semen is a remarkable phenomenon, the solution
of which has been found only by the latest researches of Luschka, on
the appendices of the testicles. According to Luschka, there is, under
the head of the epididymis, a roundish vesicle of the size of a pea,
which stands in immediate connection with the seminiferous tubuli of
the epididymis. It therefore almost always contains seminal fluid.
The vesicle or cyst now seems, under certain circumstances, to enlarge
to such a degree that it forms an encysted, spermatic hydrocele ; or it
bursts, and diffuses its seminal fluid into the already-existing collec-
tion of serous fluid.

In an ordinary hydrocele, the testicle always lies in the upper and
posterior part of the scrotum ; whilst the lower cavity of the scrotum
is filled with the respective fluid. In exceptional cases, however, a
previous inflammation may have caused adhesion between the tes-
ticles and the lower part of the scrotum ; then, of course, the testicle
is fastened down and the collection of fluids gathers above it. It is
well to bear this in mind. The diagnosis rests on these points which
I have been detailing. In external appearance it resembles the most
a scrotal hernia; but is easily distinguished from it, if we compare
the history of both ; the neck of the hernia, which is traceable into
the abdominal ring; the symptoms of strangulated hernia, &c. ; so
that hesitation between the two is scarcely possible.

Those hydroceles which are dependent upon a general hydrsemic
state of the blood must be treated with reference to this whole general
state and its symptoms. Hydrocele, in consequence of a blow, require
Arn., Puis.

Those of unknown causes, Aurum, Graphites, lod., Psorin., Rhodod.,
Silic.

Orchitis, Inflammation of the Testicles.

Pathologically speaking, the inflammation may attack the testicle
itself, or the epididymis, or their lining, the tunica vaginalis.

It may be caused either by external violence or by an extension of
inflammatory processes of related organs, such as the prostata, the
neck of the bladder, the urethra, or, what is most frequently the
case, by syphilis, of which I have spoke before. There is also an
orchitis caused by a metastasis in parotitis or mumps.



VAEICOCELE. 403

The product of inflammation is either, 1. A serous exudation,
especially in epididymititis and vaginalitis, and it is the same thing
with the above-described acute serous hydrocele ; or, 2. A fibrous,
plastic exudation, which causes infiltration, swelling, and induration of
the epididymis ; or, 3. A serous hemorrhagic exudation in acute specific
inflammations ; or, 4. A purulent exudation, which takes place in the
parenchyma of the testicle itself.

The plastic exudation generally gives rise to chronic enlargements
of the epididymis ; which may reach a considerable size and hardness.

The purulent exudation may be reabsorbed, or may form abscesses,
which gradually break through the scrotum. Such abscesses heal
only very slowly, usually forming fistulous openings.

A genuine orchitis very much resembles an incarcerated scrotal
hernia. The pain is very acute, running along the spermatic cord,
causing colicky pains and vomiting. We have in such cases to ascer-
tain where the swelling commenced. In orchitis it grows from below
upwards ; in a hernia it comes from above down.

Therapeutic Hints.

Infiammation in general: Aeon., Arn., Aur,, Bell., China, Clem.,
Euphr., Merc, Nux v., Puis., Ehod., Ehus., Staph., Spongia, Zinc. ;
from bruises: Arn., Baryt., Puis., Zinc; from taking cold: Clem.,
Puis., Ehus t. ; from gonorrhoea : Cann., Clem., Merc, Puis. ; looking
hright-red: Bell; dark-red: Ehus t., Euphorb. ; chronic hardening
and swellings: Aur., Baryta, Bell., Clem., Con., lod., Lye, Silic,
Sulphur.

Carcinoma Testis.

The most frequent form is the medullary cancer, which generally
attacks young persons, even children. The fibrous cancer, or scirrhous
testis, is found more in old age.

Cancer usually attacks but one testicle. Its causes are not known.
Bell.? Carb. an.? Con.?

Varicocele, Cirsocele.

This consists of a varicose enlargement of the veins of the sper-
matic cord, and gives rise to a knotty swelling, which feels between
the fingers like a convolution of earth-worms. It gets smaller in a
horizontal position, and enlarges again when standing upright. It is
almost always formed on the left side ; its exciting causes are unknown :



404: MALE OEGANSi

it has no connection witli varicose swellings of other parts ; for ex-
ample, on the legs, in the rectum, &c. In some cases it causes no
inconvenience ; in others it is very troublesome, causing a drawing,
dragging sensation, extending from the loins into the limb, especially
when walking or standing, and in hot weather ; weakness ; prostra-
tion ; paleness, and great dejection of spirits.
Fluoric ac, Collinsonia; surgical operations.

Diseases of the Prostata.

Prostatitis, Inflammation of the Prostate Gland.

Primarily it is of rare occurrence, but is occasionally brought on by
traumatic causes, as a blow, riding on horseback upon a hard saddle,
or by sudden suppression of perspiration, excesses in venere, mastur-
bation.

Secondary forms are much more frequent, and are then an exten-
sion of inflammatory processes from neighboring organs ; for example,
urethritis, stone in the bladder ; gout ; rheumatism. Its most frequent
cause, however, is gonorrhoea, and the abuse of irritating medicines,
like cubebs, balsam copaiva, turpentine, &c.

Symptoms.

Pain in the region of the neck of the bladder ; heat, pressure,
throbbing in the perinseum and rectum ; frequent stitches from the
perinseum into the pubic and lumbar regions and down into the limbs.
Constant desire to urinate, with annoying, sharp pains around the
corona glandis; the urine, after long straining, flows slowly, drop
after drop, a quantity remaining still in the bladder, and, therefore,
micturition is never attended with a feeling of entire relief. Severe
cases cause perfect retention of urine. The discharges from the
bowels are likewise painful and diflicult, especially hard stools, on
account of the swollen and inflamed gland pressing upon the rectum,
where it may easily be detected by the introduction of a finger
per anum.

In favorable cases prostatitis ends in resolution. Badly-managed
cases suppurate and form abscesses, which perforate, either into the
rectum, bladder, or urethra, and discharge accordingly. Still other
cases assume a more chronic form, and, in consequence of exudation,
infiltration and deposition of tubercles and cysts of calcareous sub-
stances, produce a permanent



ENLAKGEMENT OF THE PKOSTATA. 405

Enlargement and Tumors of the Prostata.

The gland may, in this way, become in whole or in part hyper-
trophied. A total hypertrophy may reach the size of a fist or more,
whilst the normal gland is not larger than a chestnut ; it may be so
uniform that the normal shape of the gland remains unaltered, or it
may become quite considerably deformed. Partial hypertrophy alters
in size and shape only single lobes of the gland.

As the prostate gland surrounds the urethra, reaching, with its base,
over the neck of the bladder, and with its anterior extremity to the
pars membranacea of the urethra, it is obvious that an increase of
its size or an alteration of its form must likewise modify the mechan-
ical proportions and relations of the prostatic portion of the urethra,
of the neck of the bladder and the ejaculatory ducts. For example,
an uniform enlargement of the gland necessarily pushes the bladder
further back and upwards, elongating, in this way, the involved part
of the urethra quite considerably, which explains the fact, that in old
people sometimes the neck of the bladder can scarcely be reached by
the longest catheters.

The enlargement of a lateral lobe, or an irregular enlargement of
both lateral lobes, causes irregularities in the direction of the enclosed
part of the urethra, compressing it more or less here and there, thus
forming a kind of zig-zag passage. Or the posterior part of the
enlarged lobe presses into the bladder, and from without shuts thus
the neck of the bladder inside, or gives it an oblique direction.

The enlargement of the middle lobe or isthmus, which is the de-
formity most frequently found in old age, is capable of closing the
neck of the bladder partially or entirely, thus preventing the passage
of urine in part or entirely.

Symptoms.

An examination per anum reveals the swollen gland, and, on intro-
ducing a catheter into the urethra, we find more or less obstruction in
its prostatic portion. There is diflEiculty in urinating, and, in a stoop-
ing posture, even retention of urine ; dribbling of urine, and frequent
discharge of prostatic fluid during stool. The form of alvine dis-
charges is often flat or irregular, instead of being cylindrical. Old
age is particularly subject to chronic enlargement of this gland.

Tlierapeutic Mints, according to Lippe.

Pulsatilla, inflammatory origin^ painfulness in the region of the
bladder ; frequent desire to urinate ; dull stitch in the region of the



406 MALE OEGANS.

nech of tlie hladder ; after micturition spasmodic pains in the bladder^
extending to the pelvis and thighs ; feces flat^ of small size.

Thuya, syphilitic origin, especially siqypressed, or badly-treated gon-
orrhoea ; stitches in the urethra from behind ; also from the rectum
into the bladder.

Digitalis, fruitless effort to urinate, or discharge of only a few drops
of urine, and continued fulness after micturition ; throbbing pain in
the region of the neck of the bladder during the straining efforts to
pass the water ; increased desire to urinate after a few drops have
passed, causing the patient to walk about in great distress, although
motion increases the desire to urinate. Frequent desire to evacuate
the bowels at the same time ; very small, soft stools are passed without
relief.

Cyclamen, in and near the anus and in the perinseum, drawing, press-
ing pain, as from subcutaneous ulceration of a small spot, while walk-
ing or sitting.

Selenium, while sitting, and also while walking, a drop of viscid,
transparent fluid presses out of the urethra, occasioning a peculiarly
disagreeable sensation ; the same sensation is experienced shortly
before and after stool.

Causticum, pulsations in the perinEeum ; after a few drops have
passed, pain in the urethra, bladder, and spasms in the rectum and
renewed desire.

Lycop., pressing in the perinseum, near the anus, during and after
micturition ; stitches in the neck of the bladder and anus at the same
time.

Copaiva balsam, urine is emitted by drops.

Apis mellifica, frequent desire and pressing down in the region of
the sphincter.

Discharge of prostatic fluid during a stool: Agnus cast., Alum,
Anac, Calc. c, Carbo veg., Con., Corall., Hepar, Ignatia, Natr. c,
Sep., Silic, Staph., Sulph., Zinc.

Fulness in the perinseum : Alum, Berb., Bry., Cycl., Nux v.
Sensation of heaviness in the perinseum : Copaiva, Graph.
Pulsation in the perinseum : Caust.

Continued desire to urinate: Amm. c. and m., Anac, Apis, Asar.,
Aur., Bell., Canth., Colch., Cop., Dig., Guaj., Ign., lod., Merc, Millef.,
Mur. ac, Phos., Puis., Sepia, Scilla, Sulph., Sulph. ac, Thuya.
Impossibility to urinate: Dig., Sepia.

The desire to urinate continues after micturition : Bar. c, Bov., Bry.,
Calc. c, Caust., Carb. an., Croton tigl., Digit., Guaj., Lach., Merc,
Natr. c, Euta, Sabina, Staph., Thuya, Viol, tri., Zinc



SPERMATORRHCEA. 407

While urinating, burning in the region of the nech of the bladder;
Cham., Nux vom., Petr., Sulphur.

The stream of urine is small: Graph., Olean,, Nitr. ac, Sars., Spong.,
Staph., Sulphur, Tax., Zinc.

Difficulty in voiding urine — must press a long time before the urine
flows : Alum, Apis, Hep., Naph., Sec, Tax.

Escape of urine involuntarily, drop by drop: Arn., Bell., Mur. ac.,
Digit., Petr,, Puis., Sep.

Diseases of tlie Vesieulae Seminales.

The vesiculas are two little, oblong bladders, sometimes divided
into two or three branches, which lie on the posterior and inferior
surface of the bladder, and consist of an external contractile and an
internal or mucous membrane. Thej are receptacles of semen,
'whence the latter is ejaculated during sexual excitement. In conse-
quence of their location near the bladder and their functional relation
to the sexual organs, it frequently happens, that affections of the blad-
der, urethra, prostata, and testes are communicated to these seminal
vesicles. Thej are, like all mucous membranes, prone to inflamma-
tion and consequent derangements. Their morbid secretions mix
with the semen, which loses its healthy appearance and nature. A
clear diagnosis of such affections is seldom possible during life ;
although bloody, yellow, involuntary emissions, attended with acute,
cutting, and burning pains, may lead us to suspect the existence of
inflammation in these vesicles.



Which means an involuntary flow of semen, is altogether different
from such catarrhal affections of the seminal vesicles, although it also
may have its cause, at least in part, in some morbid affection of these
vesicles. It is, however, more the consequence of a general disorder
of the sexual system.

Amongst the causes of spermatorrhoea especially to be mentioned
are : excess in venere, masturbation, and sexual excitement, even by
imagination ; irritation of the penis by diseases of that organ ; itching
eruptions on the penis, scrotum, perinseum, and anus ; worms ;
habitual costiveness ; syphilis, &c. Such continuous irritation at
first stimulates the testicles to perform over-duty ; it causes a hyper-
gemia, swelling, and excessive sensibility of the testes, spermatic cord,
seminal vesicles, ejaculatory ducts, and the prostate gland. Eeactiou



408 MALE GENITALS.

soon follows with great exhaustion, atrophy, and paralytic state of the
muscular apparatus of these organs. The seminal ejaculations, which,
at first, are voluntarily induced, become oftener repeated, until they
finally occur involuntarily. For a while, yet, these emissions issue
during an erection of the penis; sometimes, during sleep, nocturnal
emissions. Coitus is still possible, although the semen passes off too
quickly, and the act is a fruitless one. After a time even these short
erections cease, and the semen flows out of the lax, flabby penis in-
voluntarily, induced by the slightest sexual excitement, a mere ex-
ternal pressure or friction, even during an evacuation of the bowels
or bladder, and without any voluptuous sensation.

Such a constant drain from the system of its most vital fluid must,
unavoidably, cause a complete exhaustion even of the strongest con-
stitution. The semen, too, becomes altered, thin, containing less
and less spermatozoa, and the urine always looks turbid and cloudy
from the admixture of semen, and has a peculiar, insipid smell. Such
an unfortunate individual loses his muscular and sexual powers,
manly character, and intelligence ; in short, he ceases to be a man.

Therapeutic Mints. — First rule, stop the cause.

For great irritability of the genital organs, Canth., Camph., Gelsem.,
Iris, Nux v., Sulph.

Want of irritability, China, Clematis, Con., Digit,, Phos. ac.

After emission, pain in the head and back, between the shoulders,
Calc, c.

After emission, burning pain in the back, icy-cold hands, Merc.

After emission, great weakness in the arms, and dark ring around
the eyes, Staphis.

Bloody emissions, Merc, Cann,, Ledum.

Pale face, sunken eyes, depression of spirits, heavy dragging gait,
excitable sexual desire : Gelsem., Iris, Phos.

Emission of semen during a stool : Phos, ac, Gelsem,, Nuphar.

Great general weakness : Camphor, China, Hydrast,

In connection with hemorrhoids and constipation : Collinson.

Impotence, Want of Virile Power.

This is either a mere transient inability, or a total want of virile
power. The first may have its cause in a weakened state of the
sexual organs — compare spermatorrhoea — or in certain mental states :
bashfulness ; fear of not being able to succeed. There is either no



OOPHOEITIS. 409

erection of tlie penis at tlie proper time, or it is unsufficient ; or tlie
penis relaxes in tlie midst of the sexual act ; or the semen is dis-
charged before the introduction of the penis can have been effected.
Total impotence has its cause in a functional weakness of the genital
organs ; then erections do not take plq,ce at any time. In some cases
we find the testicles small, atrophied, soft ; the scrotum relaxed and
hanging down ; the penis shrivelled, cool, and very small. In other
cases, however, do such objective signs are apparent, and the cause
may lie in affections of the brain or spinal marrow. We find it com-
plicated with diabetes ; and in other cases we can ascertain no cause.

TJiercipeutic Hints, — Compare the preceding chapter, espe-
cially in regard to those transient forms : Agar., Agn. c, Baryta,
Calad,, Lycopod., Natr. mur., Nitr. ac, Selen.

Among the new remedies : Eupat. pur., Gelsem., Hamam,, Helonias,
Phytolacca, Stillingia.

Total impotence may call for Lye, &c.



PEMALE GENITAL ORGANS.
Ovaries.

Oophoritis, Inflammation of the Ovaries.

This affection has its seat either in the Graafian follicles, paren-
chyma^ or the peritoneal covering of the ovary.

The Graafian follicles are enlarged and filled with bloody fluid,
and their surfaces injected. If in the parenchyma, we find the areolar
tissue of the ovary hypersemic, cedematous and infiltrated, which ter-
minates in suppuration only in rare cases, much oftener in hardening
and shrivelling of the ovary. An inflammation of the peritoneal cov-
ering is either a primary affection, or a continuation of a parenchy-
matous inflammation. In both cases we find the ovary covered, as
in all inflammations of serous membranes, with a fibrinous exudation,
which may be the cause of subsequent adhesions between the ovaries
and the Fallopian tubes, or the broad ligaments. Its causes are : either,
taking cold ; getting wet during menstruation ; sexual intercourse
during the period ; onanism ; or, secondarily, inflammatory processes
of neighboring organs — the peritoneum, or the uterus. It is there-
fore most frequently found in serving girls, who are exposed to all
kinds of rough influences, (scrubbing of pavements, washing, &g.,) in



410 FEMALE OEGANS.

prostitutes, and other lewd women. Girls wlio bave once Lad an
attack are liable to a repetition during their menstrual periods.
After the cessation of menstruation, the disposition to it ceases like-
wise. It always attacks a single ovary.

Its symptoms are not at all rnarked, when the parenchyma alone is
the seat of the disease. We meet with symptoms of partial peritonitis,
however, if the serous covering becomes inflamed; violent, sharp,
colicky pains, vomiting, fever, &c. ; and so also may the bursting of
a Graafian follicle be attended with inflammatory symptoms. As the
ovaries lie deep in the lesser pelvis, covered completely by the small
intestines, pressure downwards, from above the symphysis pubis, will
reach the sore spot only when the abdominal walls are greatly relaxed.
It may be more easily reached by an exploration per anum. We may,
however, diagnosticate an oophoritis pretty safely when the above-
mentioned symptoms appear to have set in during menstruation, after
an exposure to cold or wet, followed by a sudden cessation of the
menstrual flow. Where the inflammation spreads over adjoining
organs, we find it accompanied by painful urging to urinate and to
evacuate the bowels ; by utero-vaginal blennorrhoeaS; or a numbness
in the lower extremity of the affected side.

An acute attack rarely lasts longer than eight days, generally sub-
siding within twelve to twenty-four hours. In unfavorable cases it
becomes chronic, and may terminate in the formation of serous cysts,
induration of the ovary, or in suppuration.

Thercipeutic Mints,

Aeon., headache, backache, colic, fever, great restlessness and toss-
ing about ; after exposure to cold winds, or a sudden fright during
the monthly period, by which the flow ceases ; painful urging to
urinate and to evacuate the bowels.

Ant. cr., when menstruation has been checked by taking a bath;
nausea and vomiting, white tongue ; great thirst at night ; alternate
costiveness and diarrhoea.

Apis, right side ; swelling, with stinging pains from sexual inter-
course during the monthly period ; numbness in the right side of the
abdomen, extending into the thigh, or upwards to the ribs ; scanty
urine ; retarded stool ; cough, with soreness in the upper portion of
the left chest.

Arsen., drawing, stitching pain from the region of the ovary into
the thigh, which feels numb and lame, worse from motion, bending
or sitting bent ; burning pain in the back while lying quietly upon it ;



OOPHORITIS. 411

the menses consist of a thin, whitish, badly-smelling discharge ; pale,
yellowish face ; emaciation ; febrile action ; thirst, with drinking little
at a time ; restlessness.

Bell., hard swelling of the ovary, with stitching, throbbing pains ;
constant bearing down, as if every thing would issue out ; fever, with
perspiration; glistening eyes; red face and delirium ; after child-birth.

Bryonia, stitching pain, worse from the slightest motion and con-
tact ; suppression of the menses, with bleeding of the nose, inclined to
constipation.

Canth., stitches, arresting the breathing; or violent pinching pains,
with bearing down towards the genitals ; or great burning pain in the
ovarian region ; constant urging and straining to urinate, with painful
discharge of but a few drops of urine, which sometimes is bloody ;
after suppressed gonorrhoea,

Coloc, cramp-like pain in the left ovarian region, as though the
part were squeezed in a vice ; colicky pain all over the abdomen,
which causes the patient to bend double ; pain in the left foot ; worse
before menstruation, which is more profuse.

Conium, chronic cases ; induration: lancinating pains ; pain in the
mammas before the menses, which are feeble ; smarting, excoriating



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 41 of 65)