Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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work of the larger blood-vessels and nerves, and which conjoins the
derma to

3. The aponeurosis ; which is expanded tightly over the cranium.
Under it is found —

4. The second cellular tissue, which consists of loose mashes and con-
nects the aponeurosis only loosely with

5. The pericranium, which is the immediate covering of the bones,
and which, although very thin, is nevertheless of great strength. It
transmits numerous blood-vessels into the bones.

In diseases of the scalp, all or single of these different layers may
be affected.

Erysipelas of the Scalp.

Erysipelas is a dermatitis, — an inflammation of the skin, — and con-
sists in a highly hyper semic state of the cutis ; in a prof use infiltration
of serum within the cutis and subcutaneous areolar tissue ; and in a par-
ticipation of the lymphatics in the inflammatory process.



DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 31

Sometimes it results in hemorrhage of the skin in consequence of
ruptures of capillary blood-vessels ; and in some cases even in a gan-
grenous destruction of the skin ; but seldom in abscesses.

Its local symptoms are frequently preceded a day or two by a feel-
ino- of general malaise, chilliness and feverishness. Then the part
afi'ected begins to feel hot and tense ; the skin reddens and swells, and
becomes very sensitive to the touch. At the same time the adjacent
lymphatic glands commence to swell. The inflamed portion assumes
a red, smooth and shiny appearance ; which is, however, darker and
duller on the scalp than on other parts ; and to the touch it gives the
impression of a hard, stiff, caked mass. The inflammation seldom
remains stationary, but gradually creeps on until it reaches from side
to side of the scalp, down into the face, and even to the neck and
shoulders.

On the second or third day, generally, the redness and swelling
reach their height; and, at this stage, in some cases, the epidermis
becomes raised and filled with a yellowish, limpid fluid in the shape
of large blisters — erysipelas huUosum — which either dry up, or burst
and become covered with crusts.

During the height of the disease, the patient has high fever, with
evening aggravations ; his sleep is restless and full of dreams ; he some-
times even becomes delirious. On the fourth day the redness and
swelling gradually subside on the places first attacked ; whilst those
parts which were invaded later stand yet in full bloom. By-and-by,
however, they grow paler, softer, and assume a wrinkled appearance,
as the swelling leaves ; the crusts dry off", and on the whole surface the
epidermis peals off in large flakes ; the entire process lasting about
eight days.

But this is not the invariable course. Just in its very nature to
creep on, lies the danger. As it spreads along in the skin and sub-
cutaneous cellular tissue, so it is apt to extend even to the mem-
branes of the brain, causing there an erysipelatous meningitis. Then
the external swelling and redness disappear ; or the redness changes
into a purple hue ; the patient becomes unconscious and delirious,
and his condition quite a precarious one.

Erysipelas attacks any part of the body, most frequently, however,
the sccdiJ and face, especially in its idiojMthic fo7-7n ; when it comes on
seemingly without causes in apparently healthy individuals, — -just like
pneumonia, pleurisy, laryngitis and the like. It even prevails at
certain times epidemically ; and it is apt to attack persons again and



32 HEAD.

again, thus differing entirely from other acute esanthematous diseases,
like scarlet fever, measles, &c.

When it exists as a secondary affection, its causes are —

1. Wounds, even the slightest scratch, may bring it forth, if a dis-
cratic tendency exists in the body, and especially such wounds as
favor a reabsorption of acrid and ichorous fluids.

2. Infection. This may be observed in hospitals. The irritating
poison seems to adhere not only to bandages and other surgical appli-
ances, but also seems to float in the air ; from which it is absorbed by
the lymphatic vessels when they are exposed to it.

Therapeutic Hints,

Belladonna, when on the right side, smooth and shining.

Rhus tox., when on the left side, spreading to the right, and forming
blisters.

Apis mellifica, when it spreads down to the face, and swells under
the eyes, forming reddish, watery bags there.

Graphites, when there is a tendency to repeated attacks of e. bullo-
sum, a spreading from the nape of the neck to the face, and even per-
spiration does not relieve.

Lachesis, when the swelling assumes a purplish hue, and the patient
begins to talk deliriously as soon as he shuts his eyes.

Phosphoric ac, when in consequence of wounds, by which the peri-
osteum is affected.

Ruta, in combination of wounds.

Siiicea, when the bones are injured.

Its spreading to the cerebral membranes suggests, Ars., Bell.,
Camph., Lach,

But success we can have in such cases only by close individualiza-
tion, as the following case may show : A young man of about twenty
years of age was attacked by a buUosum capitis. A year previously
he had had a similar attack and got well. This time he applied a
salve, and the erysipelas struck in. I found him entirely insensible
and delirious ; the external cuticle was peeling off, but left the skin
livid and purple. After missing several times, I finally gathered the
following symptoms : " Whe7i touched ever so slightly on his feet, he jerks
them up, much frightened ; he talks of pigeons flying in the room, which
he tries to catch with his hands; he gets regularly luorse about three
o'clock in the morning;'^ and I gave him Kali carh., one dose of Jeni-
chens' high potencies about nine o'clock in the evening. When I called
there next morning, his father related to me the following account :



DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 33

" Mj son," said lie, " was very restless throngli the night. As the
clock struck three, all at once he stretched himself out, grew pale,
and we all thought that he was dying. His brother ran to the neigh-
bors, and knocked them out of sleep, to tell them that John was
dying. By-and-by the neighbors came in, and John still lay stretched
out and motionless. In going nearer and examining whether his
breath were gone, we found that he was breathing still ; indeed, he
was sleeping ; and continued to sleep for more than two hours., This
he had not done for a week or more." There was neither another
remedy, nor a second dose of the same remedy required.

Pityriasis Capitis, Dandruff,

Is a chronic inflammation of the epidermis, which is characterized by
the production of minute white scales in great abundance, or patches
of irregular form and variable dimensions. It commences usually
upon the temples and around the forehead, and thence extends to the
rest of the scalp. Its first invasion is attended with some degree of
redness, which gradually disappears, and leaves the integument whiter
than its natural hue. Occasionally it extends to the eyebrows, the
whiskers and the beard.

Seborrhoea.

■ We have all seen in little children those dirty heads, which appear
to be heaped with layer iipon laj^er of dirt. Cleanliness, of course,
will not sufier such an accumulation of layer upon layer, but still, not-
withstanding all cleanliness, it appears again and again. What is it?
It is a superabundant secretion of that fatty and oily substance, which
continually is formed in the sebaceous glands^ and which is so neces-
sary for sustaining the pliability and softness of the hair and skin.
Oozing out in too large quantity, it collects upon the head, dries in
the air, and forms those tough, hard, rosin-like and dirty-looking crusts.
As they consist of a fatty, oily nature, they are best dissolved by the
application of oil or grease ; this, and washing with castile soap, keeps
the head clean.



34 HEAD.

Eczema Capitis, Humid Tetter or Scall,

"A non-contagious affection^ characterized by the eruption of minute
vesicles in great numbers, and frequently confluent, upon a surface
of irregular form and usually of considerable extent. The vesicles
are so closely aggregated in some situations as to give rise to one con-
tinuous vesicle of great breadth." Wilson.

They dry and form thin scales, or else break and discharge a watery
or milky fluid of different consistencies, which, by concreting, give
rise to thinner or thicker crusts. It is acute and chronic in its nature,
and may appear on any part of the body. According to its appear-
ance, location, or severity and obstinacy, it has received a variety of
names, which gives a nomenclature most remarkably confused and
confounding. It is called ekthema, porrigo, tinea with various ad-
jectives, and, if chronic, psoriasis. In order to simplify the whole,
we will just remember, that eczema exhibits the following character-
istics: It is a vesicular eruption, in clusters, often confluent, discharging
limpid or turhid and mdlJcy fluid, which forms crusts of different thick-
ness, is acute or chronic, mild or severe, situated here or there.

It may be confounded with

Impetigo,

Because its appearance resembles so closely this latter as to force upon
the mind the impression of their being the same disease. And,
indeed, impetigo, derived from ah impetu — a bursting forth with vio-
lence — is nothing but a pustular eczema ; so that, in order to distinguish
between the two, we must know what is a vesicle, or what is a 'pustule.
By vesicle is understood a very small blister, containing a transparent,
limpid fluid ; a pustule means a pimple, containing pus. The differ-
ence between eczema and impetigo lies then in the pyogenetic (that
is, pus-forming) character of the latter. If both are found together,
covering large patches on the scalp, their distinction is quite difficult,
unless we say:* the hardened coverings of the excoriations of eczema
are thin scabs, because growing out of a limpid, thin fluid — lymph;
whilst those of iinpetigo are tense and thick, greenish- yellow, or hroivnish
crusts, on account of their being formed out oi pus.

Therapeutic Mints.

Calcarea, Lycopodium, when the eruption yields a thick and mild
secretion.



DISEASES OP THE CRANIUM AND ITS INTEGUMENTS. 85

Arsenicum, Natrum mur., Rhus t., when it looks angry, excoriated.

Baryta c, Graphites, Natrum mur., Rhus t., when it causes falling out
of the hair.

Lycopodium, Psorinum, when it smells very badly and causes lice.

Natrum mur., when situated on the boundaries of the hair on the
nape of the neck.

Clematis, Petroleum, when on the neck and occiput.

Hepar sulph., when the eruption itches worse in the morning, when
rising, with burning and smarting after scratching — likewise after
external application of salves.

Clematis, Graphites, Hepar sulph., Lycopodium, Natrum mur., Rhus t.,
Staphisagria, Thuya, when mioist eruptions.

Arsenicum, Calcarea, JVlercurius, Sepia, SUicea, Sulphur, when dry
crusts.

Favus, Honey-comh Ringworm^ Tinea favosa or Maligna,

Is a vegetable parasite. " It used to be classed among the pustular
eruptions, because it first appears as a small yellow spot, the sheath
of the hair being filled with the fungous growth ; but it has no ten-
dency to suppurate. It grows with great rapidity, and forms large,
hard, dry crusts, which have a peculiar mouse-like odor. It is most
liable to be confounded with impetigo, but it requires only moderate
care to determine whether the crust be hardened pus or an independent
groivth. The distinction is based upon the presence or absence of
secretion ; be the crust of impetigo ever so dry, some trace of puru-
lent secretion is sure to be met with ; and if removed by a poultice,
the moist, exuding surface cannot be mistaken. Knowing this fact,
we have no need to particularize the rounded form, the cracked,
broken-looking surface, and all the other characters resembling
honey-comb ; which the older writers were obliged to enumerate."
(Barcley.) The scalp is its most usual place of development, but it is
sometimes found upon the nape of the neck, or in front of the ear.
To this may be added —

Tinea, or Porrigo DecaSvans,

The hair falls out in a patch of a circular form, leaving the skin of
the head perfectly smooth. It is a microscopic fungus, that invests
the roots of the hair and destroys them.

Cases are reported as having been cured by Graph.^ PIios.



SQ HEAD.



The Wen

Is an encysted tumor of varying size ; from that of a small pea to tlie
size of a walnut, and even a small orange.

" The sebaceous or fatty substance in these sacs or cysts is variously
altered in its qualities and appearance. Sometimes it is a lympid
fluid like serum, and contains crystals of stearine ; at other times it is
soft and white, of a pappy consistency ; again, it is yellowish, and re-
sembles beeswax. Sometimes it contains epidermal scales and hairs.
Sometimes the contents of the cyst are exceedingly fetid ; and the
fetor is increased when the tumor inflames." Wilson. Under the
pressure of the finger they feel elastic, and are movable under the
skin.

TJierapeiitic Mints. — Thus far have been successfully applied:
Baryt. c, Bell., Calc. c, Oaust., Clematis, Phytolacca, Sil., Sulph.,
Thuya.

The Cornua Humana, or Human Horns,

Are found on the hairy scalp and on the forehead. They mostly de-
velop themselves out of tvens, and especially out of such as contain
hairs, (dermo-cystoides ;) sometimes, but seldom, out of morbidly-
extended sehiparous glands. They are found mostly in old age, and
oftener with women than men.

External application of poke-berries (Phytolacca decandra) is said
to have removed them.

The Telangiectasia, or Vascular Naevus, Mother's Mark,

Is a dilatation of a portion of that fine net-work of capillary vessels
which everywhere pervade the derma, and cellular tissue. They may
be situated in either of them. They form red, easily compressible,
fiat tumors, of different sizes. Vascular najvi are sometimes station-
ary, but more frequently they increase slowly in size ; and we often
find enlarged blood-vessels in their vicinity. They generally appear
on the scalp, and still oftener on the forehead.

Therapeutic Hints, — Fluoric ac, Stroot., Sulph., Silic.



DISEASES OF THE CEANIUM AND ITS INTEGUMENTS. 37

The Hair.

Alopeoisi— its falling off— may originate in various conditions. It
frequently occurs after severe illness,— especially typhoid fever,—
chronic headaches, chronic eruptions of the scalp, etc. In order to
ascertain the cause, the scalp ought always to be critically examined.
Also, so-called cosmetic means may bring it on.

Baldness is more or less an attribute of advanced age ; it is founa
more in men than in women. Castrates or eunuchs never get bald.

Thercvpeutic HJints.
Kali c, with great dryness of the hair.
Hepar s., Phos., Sep., Sil., after chronic headaches.
Kali c, Nitp. ac, after nervous fevers.
Phos. ac, after great anxiety and grief.

Besides these compare Ambra, Am, c, Baryt. c, Calc. c, Con.,
Graphit., Lye, Natr. m., Sulph., Zinc.

The cutting of the hair is often attended with great effect upon the
general system. Colds in the head are a very frequent consequence,
and in children even spasms may result therefrom. But there are
also cases on record where it proved beneficial to patients, relieving
them of headache, and in one case even from a sort of mania.

The changing of color into gray and white is usually a process of age;
but grief, sorrow, and Avorriment may bring it on much before its
time, and sometimes in a very short time. There are a number of
cases related where this change took place during one night in con-
sequence of terror, or other violent emotions of the mind, so that
the poet says : " nox ! quam longa es, quse facis una senem !" (0
night ! how long art thou, that colors black hair gray !) But of late,
these instances have been much doubted, because they are not well
authenticated. However that may be, so much is certain, that
strong mental emotions have a great effect upon the discoloration
of the hair.

Therapeutic Hints. — Bad consequences of cutting the hair are
mostly removed by Bell, or Bry.

The process of growing gray and white we best leave undisturbed,
unless we choose remedies for its next causes. All of the so-called
cosmetic means are hurtful, sometimes dangerous ; and the vain will
be punished for his vanity.

The plica polonica — matted hair — as is here and there found in
Poland, is, according to Hebra, an eczema of the scalp, forming crusts,
and matting the hair together in a most hideous manner.



38 EYES.



EYES, ,
Foetal Development of the Eye.

The eyes are first seen as two little vesicles, whicli protrude from
tlie sides of tlie anterior or the first segment of the embryonic brain,
which consists itself of three such segments, or cells ; the primitive
eye-cells being protrusions out of the anterior cerebral cell ; each of
them remains connected Avith the anterior brain segment by a hose or
tube, which is the beginning of the optic nerve. The eye-vesicles
themselves move gradually down to the lower portion of the anterior
brain segment; and, after this has become divided into the proper
anterior and middle brain, they are seen located on the lower portion
of the latter.

In its further progress, the eyeball develops itself partly out of
the primitive eye-vesicle, forming the retina, partly out of an inver-
sion of the external skin, forming the lens and vitrous body, and
partly from the middle layer of the primitive ovulum, forming the
sclerotica and cornea.

The eyelids are first seen about the commencement of the third
month, and originate out of a fold of the external skin; whilst the
lachrymal ducts are, in the beginning, mere grooves in the corre-
sponding bones, which are gradually converted into closed channels.



Considering the eye as a whole, we find its general appearance
frequently altered by disease. Without dwelling upon the language
which the mental emotions — fright, terror, joy or sorrow, love or
hatred — speak through them, we observe —

An unnatural lustre of the eyes in fevers ; and

A brilliancy in consumptives.

Glassy eyes are characteristic, in children, of inflammation of the
mesenteric glands; and, if accompanied with dark, dry lips and
tongue, dry skin, and great restlessness, of an acute inflammation of
the stomach. In fevers they indicate great danger, or critical changes.

Dull eyes are frequently observed in febrile conditions of the sys-
tem ; during catamenia, in catarrhal, and other afiections.

Sunken eyes are the consequence of an absorption of the fat cush-
ions, whereupon the eyeballs rest and turn in their sockets. This
takes place in all diseases which are accompanied with great loss
of blood or other vital fluids.



DISEASES OF THE EYES. 39

in treating of the particular diseases of tlie eye, I hope to embrace
all that a Homoeopathic physician — without being a special " eye-doc-
tor" — may need in his daily practice, and under the following heads :

I. — Inflammatioii.

The old definition of inflammation — calor, dolor, rubor, tumor —
(heat, pain, redness' swelling) does not exactly cover all ground ;
because an inflamed cornea does not look o-ed^ but dull- grayish, and
an inflamed iris changes its hlue color into a greenish tint, and its
brown into a reddish color. But inflammation is always characterized
as a local irritation, a continued congestion, causing a change of structure,
through the agency of exudation.

This process may go on in any part of the eye ; and the several
inflammations have received names in accordance with the tissues
involved : blepharitis, in inflammation of the lids ,• corijunctivitis^ of
the conjunctiva; iritis, of the iris; choroideitis, of the choroidea;
capsulitis, of the capsule of the lens ; retinitis, of the retina ; and pan-
ojphtlialmitis, when the whole eyeball is involved.

But, moreover, inflammation has been divided, according to its
origin, into idiopathic, and specific, or dyscratic inflammation.

Idiopathic inflammation is that form which is caused by external
influences, as, mechanical or chemical irritation, too cold or too hot
air, sharp winds, too strong light, too great exertion of the eyes.
And as, by these agencies, any part of the eye may become affected,
idiopathic inflammation will therefore be subdivided, according to its
seat, into blepharitis, conjunctivitis, and so on.

Specific or dyscratic inflamw.ation is that form which originates in
individuals of an already-diseased constitution, so that such an in-
flammation, set up, perhaps, by some slight exciting cause, soon
assumes the character of the general diathesis of the system, and
becomes, according to the prevailing nomenclature, either a catarrhal,
scrofulous, or a syphilitic ophthalmia, as the case may be ; or, it bursts
forth without any external provocation, a natural development of
such diseased organization, the product of a specific or dyscratic
state of the system.

The most frequent forms of inflammation of the eyes with which
we meet in practice are —

Blepharitis, Inflammation of the Eyelids.

It commences on the edge of the eyelid, and thence spreads over
the whole lid to the margo orbitalis, where it abruptly ceases. By



40 ■ EYES.

this it is distinguislied from erysipelas, whicli is apt to diffuse itself
further and further. The lid is hard, swollen, and red, sometimes
covered with little blisters.

Its terminations are : resolution, the most frequent ; formation of an
abscess, rare ; "Wiortification, scarcely ever met with under good Ho-
moeopathic treatment.

Therapeutie Hints.

Aconite, red, hard, swelling ; discharge of mucus from the eyes and
nose, brought on by exposure to cold northwest winds.

Apis, cedematous swelling ; burning and stinging ; lids turned in-
side-out; granulations on their edges; falling out of eyelashes.

Belladonna, lids inflamed inside, mostly right side; photophobia ;
lachrymation.

Hepap, affection of the Meibomian glands; suppuration; styes.

Rhus t., from left to right, swelling ; dull redness ; watery vesicles.



Dacryo-cystStis, Inflammation of the Tear-hag^

AnchiSops, Inflammation and Swelling at the inner cor-
ner of the Eye and Nose,

Are two complaints, which resemble each other very much. Both are
swellings of the inner corner of the eye, where the saccus lachrymalis
is situated ; both may gather and break, and both may be the cause
of a fistula lachrymalis, by their attacking the lachrymal duct, which
swells, closes, and by suppuration forms an opening in the eye corner,
through which issue lachrymal fluid and pus.

They may, however, be easily distinguished. Dacryo- cystitis is an
inflammation of the lachrymal sac ; anchilops is an inflammation of
the skin and the subcutaneous cellular tissue of the inner corner of
the eye, which affects the interior wall of the lachrymal sac, but only
secondarily. Dacryo -cystitis is a swelling, which is easily pressed
together, discharging a lachrymal fluid; anchilops, however, is a
hard swelling, which does not discharge any fluid, when pressed
upon. When dacryo-cystitis breaks, it discharges slime and tears;
the discharge from anchilops is pus only, except at a later period,
when the lachrymal sac has become involved, and the discharge
becomes mixed with slime and lachrymal fluid.



INFLAMMATION OF THE EYES. 41

TJierajyeufic Hints,

Dacryo cystitis, at the beginning, Puis.
Anchilops, at the beginning, Bell., Hepar s.

Fistula lachrymalis, in consequence of either of them, Calc. c, Fluor,
ac, Graph., Lach., Petr., Puis., Silic, Staphis., Stann., Sulphur.

Conjunctivitis and Ophthalmia Catarrhalis

Are inflammations of the conjunctiva, which, in practice, there would
be difficulty in discriminating, even if there were any practical use in
it, which there is not. The first we find spoken of in books as idio-
pathic, and the latter as specific or dyscratic inflammations. Bach is
an inflammation of the conjunctiva, either of the palpebras or bulbus,
or of both together. There is considerable redness of the white of the
eyes, the blood-vessels become enlarged, run in parallel lines towards
the cornea, and form in its margin a net-work of capillary vessels.
As the inflammation goes on, an exudation of lymph takes place,
which distends and swells the conjunctiva to a kind of bladder, sur-
rounding the cornea like a wall. This state of things is called chemo-
sis. Still later the capillary vessels may burst, and the conjunctiva
becomes dark red and solid, swelling to such a degree that it may



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 5 of 65)