Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

. (page 49 of 65)
Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 49 of 65)
Font size
QR-code for this ebook


swelling is at first most conspicuous in front and at the sides of the
patella, effacing the normal depressions in that region, and replacing
them by soft, fluctuating bags. "A similar prominence, often of
great size, exists just above the joint, over the lower part of the
femur, bounded inferiorly by the patella, and on each side by the
lateral ligament, its anterior wall being formed by the tendon of the
exterior muscle. Yery little tumefaction ever occurs in the popliteal
region, even in the more advanced stages of the disease. The skin is
tense and glossy ; the subcutaneous veins are abnormally large ; the
knee is stiff, if not immovable ; and the leg, more or less flexed, is
swollen and cedematous ; while the thigh is remarkably atrophied.
In proportion as the ligaments yield, the deformity of the joint in-
creases, owing chiefly to the displacement of the head of the tibia,
which allows the muscles to draw the leg outwards, so as to give it a
twisted and contorted appearance. Occasionally, though rarely, there
is an actual enlargement of the diseased bones. The fluctuation
which constitutes so prominent a symptom in the earlier periods of
this complaint often, in a great measure, if not entirely, disappears
during its progress, owing to the adventitious deposits upon the syn-
ovial membrane, and the absorption of the redundant synovial fluid.
Whenever this is the case, the swelling, instead of being soft and
yielding, will be comparatively firm and resisting ; but it still pos-
sesses some degree of elasticity, often so deceptive as to lead to the
idea that the joint contains a good deal of fluid, and which nothing
but the most careful examination can dispel." Gross.

Lastly, though not always, the involved structure commences to
suppurate, and the matter may either be absorbed, or may escape at
different places about the knee — very rarely though in the ham —
forming numerous fistulous openings, and leading to caries and ne-
crosis of large portions of the diseased bones.



ABSCESS OF THE ANKLE-JOINT. 483

Therapeutic Hints,

Aconite, after exposure to severe cold.

Arnica, after a fall or blow, and

Rhus t., after a twist, sprain, or strain, may severally be entirely
sufficient to ward off all serious consequences.

Bellad., red, shining swelling, with throbbing pain, and enlarged
blood-vessels along the limb.

Bryon., pale swelling, with stitching pain from slightest motion.

Arsen., third stage; discharge of fetid pus; oedema of the legs;
hectic fever ; sleeplessness ; emaciation ; exhaustion.

Calc. c, scrofulous individuals ; too early and too profuse menstrua-
tion ; pot-belliedness ; looseness of the bowels ; glandular swellings.

Jodium, second and third stage ; fistulous openings, discharging a
thin, watery ichor, and being surrounded by pale, spongy edges, which
bleed easily ; feverishness ; emaciation. After the abuse of mercury.

Kali hydrojod., doughy, spongy swelling of the knee, without fluc-
tuation ; skin tense at times, red in spots, and hot. Inside, a feeling
of heat ; gnawing, boring pain at night, necessitating a constant change
of position. After a fall.

Lach., Lycop., compare the preceding chapter.

Merc, after suppressed itch ; nightly pains, &c.

Pulsat., fever, dryness of tongue, without thirst; diarrhoea; scanty
and delaying menses.

Silic, violent, lancinating pains; caries ; fistulous openings; cachectic
condition.

Sulphur, psoric individuals. Besides, compare Coxarthrocace.

Podarthrocace, Ahscess of the Ankle-joint.

Commencing with pain, this affection soon shows signs of a swell-
ing just in front of each malleolus, filling up the hollow which natu-
rally exists there. So also gradually disappear the grooves at the
side of the tendo Achillis, and the whole joint swells quite consid-
erably. By-and-by, if suppuration takes place, the pus may escape
at different places, forming, like in the knee-joint disease, fistulous
openings, and may lead to quite considerable caries and necrosis of
the affected bones.

TJierapeutic Mints. — Compare the preceding chapters. Only
one remedy, not mentioned there, I must add here, namely :

Angustura. In a case where none of the very carefully-selected



484 NEEYES.

remedies seemed to have any effect, this remedy at once did arrest
the morbid process, and brought it to a perfect cure. In this case, the
condyles of the tibia were quite seriously involved, and it was on
account of a remark of Aegidy, "Angustura acts especially upon the
long bones," that this remedy was given with so happy a result.

Tuberculosis may localize itself in still other joints ; for example,
in the different joints of the vertebree, known under the name of

SPONDYLAETHEOCACE or SPONDYLOCACE or POTTS'S DISEASE ; or in

the shoulder -joint, causing omaetheocace ; or in the elbow-joint,
giving rise to oleceanaethrocace ; or in the wrist-joint, causing
CHIEAETHEOCACE. As, however, these affections are of rare occur-
rence, as they consist entirely of the same nature as the above-
described, differing merely in location, and as, in regard' to thera-
peutic hints, I could not add many new things, I refer to the foregoing
chapters.



NERVES.



Pathological organic changes in the nerves, as found in post-mortem
examinations, comprise inflammation, hypertrophy, atrophy and tumors
of the nerves or neuroma.

These conditions are, however, of a more anatomico-pathological
than practical importance. We know little about their causes, and
their symptoms are not so definite that we could build upon them a
sure diagnosis. I shall, therefore, not enlarge upon this subject, but
shall at once commence a consideration of those forms of nervous dis-
eases which are groups of certain symptoms of the nervous apparatus.

As this apparatus consists of sensory and motory nerves, we shall
have to consider two series of affections ;

1. Symptoms of sensory^ and, 2, SynojjLoins of the motory nerves.

I. Morbid Affections of the Sensory Nerves.

1. Hyperaesthesia, Increased Sensibility^ Morbid Sensitive-
ness^ Nervousness.

By means of the sensory nerves we receive external impressions.
Light affects the optic, sound the auditory, perfume the olfactory,
sapid substances the gustatory nerves, palpable things the nerves of
touch, and heat, cold, &c., the nerves of general feeling.



NEURALGIA. 485

These nerves are so constituted that they bear such external influ-
ences to a certain extent with perfect ease, although we find in even
healthy individuals a great difference in this respect. Some perceive
the slightest, others only more powerful influences ; but, as a general
rule, the ordinary influences of the outer world are borne by all with
equal ease.

In this disease, however, it is often different. We observe that
ordinary light, the slightest noise, the least touch, &c., are unbearable.
This condition is called morbid sensitiveness. It is frequently in com-
bination with a state of fidgetiness and restlessness, and then it is
called nervousness.

Post-mortem examinations do not reveal the least alterations of the
nerves, and its seat may just as well be referred to the primary
faculties of the mind, of which the corresponding nerves are merely
the bodily organs, by which the mind lies open to external influences.

Torpor of the sensory nerves is the opposite to morbid sensitive-
ness — a want of natural sensibility ; to which we might add numbness,
pithiness, either in consequence of pressure upon a nerve, or in con-
sequence of central disturbances, by which its normal action is inter-
fered with.

Therapeutic Sints. — Compare Boenninghausen's Eepertorium.

Sensitiveness to light, (principally,) Aeon., Arseu., Bell., Euphr.,
Merc, Rhus t., Sulph.

Sensitiveness to noise, Aurum, Coffea, Lye, Sepia, Spigel.

Sensitiveness to smell, Aurum, Bell., Lye, Merc, Phos., Sepia.

Sensitiveness to taste, Bell., China, 'Coffea.

Sensitiveness to touch, Arn., Bell., Coffea, Hepar, Lye, Nux v.,
Puis., Sepia, Spig.

Nervous debility, China, Cocc, Nux v., Puis., Silic.

Fidgety disposition, Anac, Bell., Hyosc, Merc, Rhus t., Sepia,
Staph., Stram.

Pithy, numb feeling, Cocc, Hyosc, Lye, Oleand., Opium, Phos.
ae, Stram.

2. Neuralgia.

Neuralgia literally means a pain of the nerves. In this sense of
the word, any and every pain would be a neuralgia ; because there is
no pain possible without sensitive nerves.

This is not the sense in which the term neuralgia is used.



486 SENSOEY NERVES.

Hasse defines it in the following language: "Neuralgia character-
izes itself physiologically as an irritation in the course of one or sev-
eral sensory nerves, which irritation may exist on any part of the
nerve from its origin down to its termination, and which irritation is
felt as pain ; not, however, only in the place where the irritation ex-
ists, but also in different other places of the same nerve ; sometimes
even through its whole length." Such irritation and consequent pain
may be occasioned by the most different causes, so that neuralgia may
be a symptom of very different conditions. Structural changes of the
nerves themselves, however, are very rarely found, and then only in
paralytic conditions. Those coarser structural changes which we
have called tumors of the nerves, or neuroma, may exist without any
neuralgia ; and the most violent neuralgia may not show a trace of
structural change on post-mortem examination. We cannot, there-
fore, so clearly define neuralgia pathologically as other forms of dis-
ease; as, indeed, it is only a symptom of the most different con-
ditions.

Such conditions are either 'peripherical or central,

1. Peripherical causes are either organic changes of the nerves
themselves — most frequently in consequence of external injuries — or
organic changes in neighboring parts of the nerves, as inflammation,
caries, and ex;ostosis of the bones, especially in the neighborhood of
the foramina, through which the nerves make their exit ; also tumors
— especially carcinoma and aneurysma — and affections of the liver,
■uterus, ovaries, kidneys, &c.

2. Central causes are structural changes in the brain and spinal
cord, and their membranes ; consisting of tumors, softening, sclerosis,
and deposits of morbid products. Besides these causes we may also
mention exposure to cold, metallic poisoning — especially by mercury
and lead — and miasmatic influences, which latter cause a periodical
type, like intermittents.

Symptoms.

1. Pain. It is of various kinds : boring, cutting, tearing, burning,
like lightning ; but always described as excruciating. It generally
comes in paroxysms, and is felt in many cases distinctly running
along the course of a certain nerve. It is often provoked or aggra-
vated by softly touching or stroking the parts, whilst hard pressure
frequently relieves it.

2. Reflex symptoms. They consist in affections of the motory nerves,
causing spasmodic motions in those parts in which the affected sen-



CEPHALALGIA. 487

sory nerve brandies out, so prosopalgia almost always causes distor-
tions of the face. The reflex upon the vaso-motory nerves manifests
itself in paleness of the skin and chilly sensations, followed by heat
and turgor, and sometimes profuse perspiration or profuse secretion
of urine, or the latter may be scanty and saturated. In some cases
we find the affected portion of the body constantly disposed to cuta-
neous eruptions, like pemphigus, urticaria, and zona.
The most important special forms of neuralgia are:

I. Cephalalgia, Migraena, Nervous Sick Headache.

This complaint, which is so frequently met with, returns periodically.
It generally commences in the morning slightly, increases during the
course of the day as the sun ascends, and reaches its culmination in
the evening ; very often it attacks only one side of the head, or passes
from one side to the other, or is confined to the top of the head, or to
the forehead or occiput. It often reaches an almost unbearable pitch,
is associated with nausea, and generally ends with gagging and
vomiting of bitter, greenish, or slimy masses. In some cases one
thorough vomiting is sufficient to relieve the pain ; whilst in others
both retching and pain continue for several hours, until, finally, a
sound sleep relieves it all. During the paroxysm the patient is very
sensitive to light, noise, strong smells, and touch ; he seeks a dark,
quiet place where he can lie undisturbed.

Cephalalgia is most frequently met with in women of a hysteric,
chlorotic, or anaemic tendency, and a weak and nervous constitution ;
also in married women who have no children, and in young widows.
Men of weak constitution, who read and study much in the night, or
who lead a loose life, are likewise subject to migrsena. In all, it
seems that the abuse of coffee and tea has a great deal to do with its
periodical recurrence.

Therapeutic Ilints.

Aethusa cyn., pressing pain in the forehead as though it would
split ; eyes appear protruded and the face is pale ; great anxiety and
restlessness drives into the open air, which relieves. At its height,
vomiting, belching ; hiccoughing ; finally diarrhceic stool ; some hours
sleep and pain in the stomach for several days.

Aranea diad., when the spells come at regular hours ; fliramering
before the eyes ; dizziness in the head, which obliges the patient to
lie down; on rising a feeling as though the head and hands were
bloated and swollen.



488 SENSOEY NEEVES.

Argent, nitr., pressive pain in the foreliead on getting awake in tbe
morning, gradually extending from the supraorbital ridge upwards
to the coronal suture, with heaviness in the head and vertigo, which
does not turn in a circle, but inclines the patient to reel to the one or
the other side ; dimness before the eyes ; ringing in the ears ; sense
of relaxation in the stomach, as though it were hanging down loosely ;
all the symptoms better after eating a good dinner and drinking a
glass of wine; worse after drinking coffee ; or the pain is half -sided
in one of the frontal protuberances, or close to the side of the glabella
near the supraorbital ridge, or in one of the temples, sometimes ex-
tending down into the bones of the face ; the pain is of a pressive,
screwing, throbbing nature, and is always preceded by general indis-
position : chilliness ; loss of appetite ; growing dim before the eyes,
and nausea. At its height it is attended with trembling of the whole
body and a deadly nausea, which ends with vomiting.

Arnica, periodical spells, commencing in the morning slightly in
the forehead, with flickering before the eyes, which is aggravated by
reading or writing, gradually extending through the temples into the
occiput, and reaching its acme in the afternoon. A warm room is
unbearable, but the open air does not ameliorate ; must lie perfectly
quiet, stretched out upon his back ; worse from any motion, quick
walking, bending, going up stairs, talking, thinking, and after eating.

Arsen., hemicrania in persons with affections of the liver ; alter-
nating bilious colic and migrsena ; great sensitiveness of the head to
the open air ; during the spells the patient is very restless, constantly
moves the head and limbs to and fro, and imagines that he gets some
relief from so doing ; better from external warmth ; from wrapping
the head up in warm cloths ; he feels extremely prostrated ; thinks
he must die ; feels chilly and hovers near the stove.

Bellad., one-sided pain, especially on the right side; throbbing,
beating, attended with vertigo, congestion of the head and eyes, and
throbbing of the carotid arteries ; or great paleness of the face ; pain
worse on lying down.

Bryon., headache on first waking in the morning, gradually in-
creasing until evening; pain as though the forehead would burst;
worse from any motion, coughing, or sneezing. Tongue thickly
coated; violent thirst or only dry feeling in the mouth; gastric
derangement ; constipation or diarrhoea in the morning ; the patient
is very irritable and cross ; gets angry easily.

Cactus grand., pain in right temple by spells, brought on often by
a glass of wine ; by attending the opera ; after getting his dinner at



CEPHALALGIA. 489

too late an hour ; it commences in tlie morning and grows as tlie day
advances to an awful height, with vomiting. He must lie perfectly
quiet ; any attempt to keep up, any noise, light, or exertion increases
the suffering terribly ; constant dry nose.

Calc. c, chronic cases; after suppressed eruptions; strange feeling
of coldness in some part of the head, or in the whole head ; pain
worse from early in the morning after getting awake until afternoon ;
sweaty hands and feet.

Camphora, throbbing pain like a hammer in the cerebellum, syn-
chronous with the beats of the heart.

China, the pain is increased from slight touch ; from opening the
eyes ; or from keeping them shut ; sometimes the pain is relieved by
lying down ; at other times the patient cannot lie down ; better
while moving about gently. Nursing females after loss of vital
fluids.

Chinin. sulph., intermittent neuralgia at regular hours.

Cocculus, the pain is worse after eating and drinking, and attended
with a sense of emptiness and hoUowness of the head.

CofFea, when the pain drives to despair and the patient runs wildly
about the room.

Coloc, pain, tearing, and screwing together ; great restlessness and
anxiety, with sweat, which smells like urine ; urine scanty and fetid ;
after chaOTin and indigestion.

o o

Ferrum, congestion of the brain; throbbing; crimson face, which,
at other times is quite pale and earthy-looking. The pain drives one
out of bed.

Glonoin, congestion of the brain; throbbing, pulsating pain from
below upwards, with fulness and feeling of enlargement of the head ;
it feels like the motion of waves in the brain ; congestion of the eyes ;
ringing in the ears; palpitation of the heart. During pregnancy,
before the menses, or when the menses do not appear.

Ignatia, throbbing pain in the occiput, worse from pressing at stool ;
from smoking, from the smell of tobacco-smoke ; for nervous subjects
who get frightened easily, feel hurt easily, &c.

Laches., temporal nerves of one side painful, with throbbing in the
temples ; heat in the head ; vertigo with paleness of the face ; pain in
the left ovarian region; bloatedness of the stomach.

Natr. mur., commencing in the morning when getting awake ; it gets
worse from reading, writing, and talking ; and is frequently indicated
when school-girls, who apply themselves closely to the learning of
their lessons, get a severe headache.



490 SENSOEY NERVES.

Nux v., pressive, boring, dull pain, commencing in the morning,
increasing through the clay, growing milder in the evening, attended
with dimness of sight, stoppage of the nose, sour and bitter vomiting;
constipation ; palpitation of the heart ; worse from mental exertion,
light, and noise ; in the open air ; after eating ; brought on by mas-
turbation ; hysteria, with profuse menses ; sedentary life ; close men-
tal application ; abuse of coffee ; hemorrhoidal disposition ; constipa-
tion ; disturbances in the ganglionic system.

Phos. ac, dreadful pain on the top of the head, as though the brain
were crushed, after long-continued grief.

Platina, cramping pain, as though the part were in a vice, especially
above the root of the nose, with heat and redness of the face, tearful
disposition, and too early and profuse menstruation,

Pulsat., tearing, pressing, stitching pain, worse in the evening and
at night ; in the warm room ; better from external pressure and in
the open air, with aversion to eating and drinking; water tastes bit-
ter ; nausea ; vomiting ; oppression of the chest, and chilliness ; mild,
yielding disposition ; scanty, delayed menses ; disposition to looseness
of the bowels.

Sanguinaria, the pain commences in the back part of the head, rises
and spreads over the head, and settles especially above the right eye,
with nausea, vomiting, and chilliness ; the patient is obliged to seek
a dark room and to lie perfectly still.

Sepia, the pain is jerk;ing upwards, like an electric shock; or bor-
ing ; worse from motion ; better from holding the eyes shut ; pale,
yellowish, dirty color of the face ; white tongue ; aversion to food ;
sour taste after eating ; constipation ; leucorrhoea between the menses ;
bearing down in the womb.

Silic, throbbing pain in the occiput upwards, worse from every
quick exertion, pressing to stool, &c. ; better from getting warm, and
after sleep ; the pain is attended with a peculiar exaggeration of the
mind ; when crossed, he has to restrain himself from doing violence ;
appetite good; while eating the pain is much milder, but grows so
much the worse again afterwards; brought on by exposure of the
back to any slight draught.

Spigelia, different sorts of pains, frequently extending into the eye
and side of the face, always worse from stooping, slightest motion,
concussion, noise, and during stool ; they are apt to appear at regular
hours, either in the forenoon or in the night, and are mostly attended
with paleness of the face.

Sulphur, pain in the forehead and top of the head; heat in the head



NEUEALGIA OF THE FACE. 491

and coldness of the feet ; flying heat in the face ; nightly sleeplessness ;
itching of the skin; suppressed eruptions; looseness of the bowels
early in the morning, driving one out of bed ; hemorrhoids, &c.

Thuya, hemicrania of sycotic origin.

Veratr., pain very violent, driving one to despair ; or prostrating,
causing fainting ; cold sweat and great thirst ; great nausea, vomiting
and diarrhoea, or obstinate constipation.

Zincum, in chronic cases of cerebral affections ; great weakness of
sight ; stitching pain in the right eye ; paleness of face ; now and then
vomiting.



2. Neuralgia of the Trigeminus, Prosopalgia, NeuraSgia
Facialis, Dolor Faciei Fothergillii, Tic douloureux.

It attacks one or the other branch of the trigeminus, sometimes the
n. supraorbital or infraorbital, n. facialis, n. inframaxillaris ; and,
therefore, some authors speak of a neuralgia supraorbitalis, neuralgia
infraorbitalis, &c. The affection is almost always confined to one
side ; rarely does it attack both sides, but there appears to be no
difference in favor of one or the other side. An extension from one
side to the other has been occasionally observed.

The pain is generally spoken of by the patient as indescribable,
excruciating; coming on in paroxysms of shorter or longer duration;
sometimes irradiating into the back part of the head and neck, down
into the shoulder, intercostal spaces, breast, and even the lower ex-
tremities.

We likewise find the motory nerves affected, causing jerking of
different muscles of the face, spasmodic closing of the eyelids, bend-
ing of the body double, trembling of the whole body, &c. We also
find the vaso-motory nerves affected, causing pulsation of the arteries,
swelling of the veins, redness, or paleness, and heat of the face. The
whole affected side of the face assumes a different expression, becomes
shining, glistening, greasy, sometimes appearing puffed, and at other
times emaciated.

When the ramus ophthalmicus is affected, we observe a reddening
of the conjunctiva and flowing of tears ; if, at the same time, the sec-
ond branch is also affected, we observe a watery and slimy discharge
from the nose ; and when the second and third branches suffer, it is
often attended with a flow of saliva.

Sometimes there has been observed a partial sweat in the face



492 SENSORY NERVES.

during the paroxysm ; the hair of the affected side grows "brittle, and
splits, or falls out.

Therapeutic Mints.

Aeon,, cheeks red and hot; the patient seems beside himself for
pain ; screams and rolls about in the bed or on the floor.

Arg. nitp., during the paroxysms unpleasant, sour taste in the
mouth. Wolf mentions Arg. nitr. as of general importance in this
complaint.

Arsen,, burning, stinging pain, as of red-hot needles, worse about
midnight ; face pale and distorted ; puffed around the eyes ; great
restlessness ; ameliorated by external warmth ; typic paroxysms of a
miasmatic origin.

Bellad., cutting, tearing pain, shooting from the side of the face up
into the temple, into the ear, and down into the nape of the neck ;
worse from touch and motion ; hard pressure sometimes relieves ;
the paroxysms mostly occur in the afternoon ; the face is generally
flushed ; the eyes water and the muscles of the face twitch ; the pa-
tient cannot bear light nor noise ; the right side is the most frequently



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 49 of 65)