Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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affected ; after the abuse of mercury.

Bismuth, nitp, the most excruciating pains are somewhat relieved
by taking cold water in the mouth and walking briskly about.

Caust., right side, from the cheek-bone to the mastoid process,
worse at night ; chilliness ; scanty menses.

Cham., the pain causes hot perspiration about the head, and extorts
screams ; the patient is wild and unruly, tossing and rolling about ;
menses usually profuse.

China, the pain is in the infra-orbital and maxillary nerves, worse
from the least touch, lying down, and in the night ; great weakness
after the paroxysm.

Chinin. sulph., the paroxysms set in at the same hour every day ; the
intervals are free of pain, and there is no complication with gastric
or other derangements.

Cimicifuga, especially when the neuralgia is a reflex-pain dependent
upon ovarian disturbances.

Coloc, tensive tearing with heat and swelling, especially left side ;
motion and touch increase the pain ; better in perfect rest, and from
external application of warmth ; brought on by chagrin and indigna-
tion.

Feppum, during the paroxysms the face gets fiery red, sometimes



NEUEALGIA OF THE FACE. 493

only in one spot ; cannot keep tlie head quiet ; at the intervals the
face looks earthy and pale.

Gelsemln., orbital neuralgia in distinct paroxysms of acute pain,
accompanied with contractions and twitching of the muscles near the
portion of the face affected ; with extreme general nervousness and
loss of control over the voluntary muscles, giving rise to odd,
irregular motions.

Hepar, in chronic cases; the pain streaks from the cheek-bone into
the temple, ear, al^ nasi, and upper lip of the affected side ; it is
worse in the fresh air, and better from wrapping up the face ; at the
same time coryza, hoarseness, much sweating and rheumatic pains
elsewhere ; especially after the abuse of mercury or metallic prepara-
tions.

Iris, pain in the head, temples, and eyes, attended with most dis-
tressing vomiting of a sweetish mucus ; and occasionally (if attended
by much straining) with a trace of bile.

Lachesis, left side, orbital neuralgia ; lachrymation ; previous to
the paroxysm rising of heat to the head ; during the intervals a weak,
nauseous feeling in the abdomen.

IVlercurius, tearing pains, worse at night in bed ; it often starts from
a decayed tooth and involves the whole side of the face, which may
be red and swollen ; profuse secretion of saliva ; constant inclination
to perspire ; restlessness and sleeplessness. Brought on by taking
cold.

Mezer., boring, pressive pains, coming like lightning, which leave
the parts numb ; they are worse from eating warm food, also from
entering a warm room after walking in the fresh air ; they are at-
tended with chilliness and shuddering ; twitching of the muscles of
the affected parts, flow of saliva, redness of the fauces, burning in the
throat, stiffness of the masseters, red spots on the nape of the neck,
and formication in the skin of the chest ; after the abuse of mercury,
or in syphilitic patients.

Natr. mur., pain in the molar bones, worse when chewing; falling
off of the whiskers; intermittent prosopalgia; after the abuse of
quinine.

Nux vom., tearing pain in the course of the infra-orbital and middle
branch of the trigeminus, with redness and watering of the eye ; flow
of clear water from the nostril, and numbness of the aft'ected side ; the
patient is morose, irritated, belches a great deal, and is. constipated ;
after the abuse of coffee, liquors, quinine, &c. ; also intermittent
prosopalgia.



494 SENSORY NERVES.

Phos., drawing and tearing pain in the jaws, root of the nose, eyes
and temples, attended with bloatedness of the face, congestion of the
head, tearing on the top of the head, vertigo, and ringing in the ears ;
from taking cold over the wash-tub.

Platina, boring pain, cramp-like ; painful feeling of numbness in the
molar bones and the mastoid processes and chin, as if the parts were
between screws, attended with anxiety, weeping, and palpitation of
the heart ; profuse menses.

Pulsat., twitching, tearing pain, worse in the evening and in a warni
room ; in persons of a mild, tearful disposition, and phlegmatic tem-
perament ; inclination to looseness of the bowels ; scanty menses ;
after getting the feet wet ; after the abuse of quinine.

Rhus t., drawing, burning, tearing pain in the face, and a feeling as
though the teeth were too long, attended with great restlessness, ne-
cessity to move about ; relieved somewhat by the external application
of cold ; dysenteric stools, with jelly-like evacuations ; after exposure
to rain.

Sepia, intermittent prosopalgia, with congestion of eyes and' head ;
also during pregnancy; jerking, like electric shocks, upwards.

Spigelia, tearing, shooting, jerking or burning pain in all directions,
attended with dark redness of the affected side ; flow of water from
the eyes and nose ; twitching of the muscles in the face ; difficulty of
breathing; palpitation of the heart; rheumatic pains elsewhere;
worse in damp weather, from touch and motion.

Staph is., the pain starts from a decayed tooth ; is worse from slight
and better from heavy pressure ; it is attended with swelling of the
gums, cold sweat in the face, and cold hands.

Stram., prosopalgia, with many nervous symptoms : spasms of the
chest hindering breathing, swooning, weeping, twitching of the mus-
cles of the face; frowning; jerks through the whole body; delirious
talk, with open eyes.

Sulphur, chronic cases, when other remedies relieve, but do not
cure ; psoric tendency ; scanty, black, tarry menstrual discharges.

Thuya, after suppressed gonorrhoea or eczema on the ear.

Veratr., drawing, tearing pain, attended with bluish paleness of the
face; sunken eyes; coldness of the extremities; trembling and jerk-
ing ; cold perspiration ; great exhaustion ; nausea and vomiting.

Verbascum, violent pain, jerking, like lightning, or pressive numb-
ing ; brought on by pressure, sneezing, talking, chewing ; appears at
the same hour every day, and is attended with headache, redness of the
face, vertigo, belching, and a discharge of tough saliva from the mouth.



INTERCOSTAL NEURALGIA. 495

Zincum, burning, quick stitches, and jerking along the course of
the infraorbital nerve, right side, attended with bluish eyelids ;
numbness of the tongue; constricted sensation in the throat; worse
from the sliohtest touch and in the evenino;.

3. Cervico-OccipStal NeuraSqia.



Its seat is the sensory fibres of the first four spinal nerves, chiefly
only on one side, extending, therefore, over the upper part of the
nape of the neck and the occiput, over the lateral region of the head
and in front towards the lower jaw.

Compare Aeon., Bell., Calc. c, Caust., Ign., Kalmia lat., Lach,,
Nux v., Puis., Spigel., Sulphur.

4. Cervico-Trachial Neuralgia

Extends over the whole trachial plexus, the shoulder and shoulder-
blade, and down the arm.

Compare Aeon., Arn., Ars., Ferr., Graph., Ign., Lye, Phos., Ehus t:,
Sepia, Staphis., Sulph., Ver.

5. Intercostal Neuralgia

Has its seat in the dorsal nerves, and not unfrequently affects both
sides of the chest, but most frequently the left side between the fifth
and ninth intercostal spaces. There is a feeling of tension, as though
the patient were tightly bound around the chest, and occasional
shooting pains in the direction of the intercostal nerves are occasioned
by taking a long breath, by coughing, sneezing, sighing, or certain
motions of the body ; by pressure of the clothing or a slight touch,
which generally is relieved again by hard pressure.

There are certain localities where pressure upon regularly excites
the pain. These are :

1. The region near the spinous process of the vertebr£e, where the
dorsal nerves emerge from the spine.

2. The middle portion of these nerves ; and,

3. The region between the cartilages in front near the sternum and
in the epigastrium.

Diflferential Diagnosis.

Pleurisy differs by its crepitating sound and fever.
A ngina pectoris by its fits of sufibcation.



496 SENSORY NERVES.

Rheumatism of the muscles of the chest by its more general diffasion
over the chest and its aggravation by slightest movement.

Compare Arnica, Arsen,, Borax, Bryon., Calc. c, Carbo veg.,
Canst., China, Merc, Ehus t.. Sepia, Spigel., Sulphur.

6. Lumbo-Abdominal Neuralgia

Has its seat in the lumbar nerves, and consists in pain in the lumbar
region and on the abdomen, which is easily excited by raising a fold
of the abdominal skin, or by touching it slightly, and by pressure upon
the region near the lumbar vertebrae. Frequently we find associated
with it a pain in different places of the crest of the ileum, and on the
seat ; and also pain which extends from the inguinal region to the
symphysis pubis and down into the scrotum or into the labia majora,
which are referrible to those superficial branches of the lumbar
nerves which extend into these parts.

Compare Argent., Bell., China, Nux v., Puis., Ehus t., Spigel.,
Staphis., Sulphur.

7. Mastodynia, Neuralgia of the Mammce,

Its seat is the mammary glands, which, at intervals, become very
painful without any visible change of these organs.

In some cases, however, small tumors have been observed, which
soon disappear again. The pain radiates sometimes into the axillae,
into the back and down into the hips, and may be attended even with
vomiting. Lying on the affected side is impossible. It seems to be
mostly connected with irregularities of menstruation, at which time it
is most generally the worst. But also external pressure of these organs
seems to have been the cause of it. Its most frequent occurrence
seems to lie between the ages of sixteen and thirty.

Therapetitic Mifits, — Painfulness of the mamrn^ during men-
struation. Argent., Calad., Calc. c, Canth., Cimicifuga, Con., Kali c,
Murex purp., Nitr. ac, Ehus t., Tabac.

8. Neuralgia ischiadica, Sciatica, Ischias postica, Malum

Cotunnii.

Its seat is in the N. ischiadicus, though not always in its entire
length. Most frequently we find the pain extending from the nates down
the posterior part of the thigh to the bend of the knee, down along



SCIATICA. 497

the fibula to the external ankle, heel and external portion of the foot ;
sometimes the pain is felt only in the sole of the foot, (neuralgia plan-
taris,) and seldom in the dorsum of the foot and toes.

It may affect both extremities at the same time, but this is not
usual. The pain generally commences mildly and gradually grows
worse and worse ; sometimes it is paroxysmal, generally worse towards
evening and in the night. Slight touch aggravates or provokes the
pain, whilst a hard pressure sometimes gives relief With some, the
pain is ameliorated by moving about constantly, whilst others cannot
bear the slightest motion, so that coughing, sneezing, pressing at
stool are almost killing operations to them. Sometimes the pain is
attended with a cold sensation in the aftected extremity, followed by
heat. In other cases we find even reflex symptoms of the motory
nerves, manifesting themselves as cramps in the calves of the legs
"and in the soles of the feet. It has even been observed, during the
most violent paroxysms, that the heel was drawn up towards the but-
tock of the affected limb. In regard to its causes we are very much
in the dark. Atmospheric influences, however, such as damp, cold
weather, seem to be very apt to bring it on. Therefore we find
amongst the exciting causes, getting wet, sleeping on the damp ground
or within moist walls, or taking cold in general. Likewise are men-
tioned, a direct influence upon the nerves, as, pressure of narrow boots,
wounds from blood-letting, carcinoma, aneurisms, pressure of the
pregnant uterus, foetal deliveries by the forceps, diseases of the ver-
tebrae and neuroma.

Therapetitic Mints,

Arnica, when caused by over-exertion, marching, &c., with formica-
tion and lame feeling ; necessity to change the position of the limbs
constantly, because every thing upon which he lies seems too hard.

Arsen., the pain is attended with great restlessness, and is worse
about midnight; brought on by staying in cold, damp cellars; it is
somewhat relieved by external warm applications,

Bellad., feverish; inclined to weep; wants to sleep and cannot sleep;
pain worse from touch and motion.

Bryon., better during rest, and worse on motion.

Cham., pain excruciating; the patient acts as if beside himself.

Calc. c, if caused by working in water; or in case of complication
with affections of the spinal bones ; the pain starts from the small of
the back ; extends down into the limbs and keeps them in constant
uneasiness.

32



498 SENSORY NERVES.

Cimicifuga, causes many reflex pains in different parts, dependent
upon ovarian or uterine irritation.

Coffea, tearing, stitching pain, in irregular spells, worse in the
night, with restlessness and sleeplessness.

Cocculus, pain, as if the hip were screwed together ; or shooting
pain, like lightning, down the whole limb ; worse from motion ; at-
tended with cold extremities; chilliness with perspiration; chills
alternating with heat ; wretched complexion; sleeplessness; emacia-
tion ; after the pain, the parts affected feel numb, with formication
and as if going to sleep.

Ferrum, remitting pains ; worse in the night, driving him out of
bed ; although at first scarcely able to stand upon the affected limb,
by continued motion and walking about, the pain gradually dimin-
ishes; pain in the left shoulder; the face is pale, emaciated, but
flushes easily.

Gnaphalium, intense pain along the sciatic nerve, which is continued
to its larger ramifications ; feeling of numbness, occasionally taking
the place of the sciatic pains, and then exercise on foot is excessively
fatiguing,

Hepar, the pain is worse from motion, touch, and exposure to air;
better from being wrapped up and keeping quiet.

Ignat., throbbing pain in the hip, as though the joint would burst;
intermittent at first every other day — later daily; attended with
chilliness and thirst, followed by heat without thirst ; disappearing
during the summer season, and in the winter reappearing.

Lachesis, pain constantly changing locality, now in the head, now
in the teeth, now in the sciatic nerve; attended with nervousness;
palpitation of the heart ; burning like fire in the hypogastrium, lum-
bar region, and behind the sternum ; flushes of heat ; suppressed
menses ; constipation.

Ledum, laming pain in the hip-joint, worse in bed, when getting
warm; the affected limb is cooler than the remainder of the body;
general coldness and chilliness. The pain frequently commences
below and ascends.

Lycop., pain in the hip, stiffness and weakness, and formication of
the affected limb; cold feet; incarcerated flatulence and constipation;
urine high colored, turbid, or depositing a red, sandy sediment.

Merc, drawing, tearing pain, worse at night in bed; restlessness;
great inclination to sweat, without any relief.

Mux vom., the pain is drawing, tearing, from below upwards; con-



ANESTHESIA. 499

stipation ; during stool, great pain along the affected limb down into
the foot.

Plumbum, drawing, pressive pains in the sciatic nerve in the pos-
terior part of the thigh, down to the* knee, with difficult walking and
great exhaustion after walking ; tubercular diathesis, with dry, hack-
ing cough.

Phytolacca, neuralgic pain on the outer side of the thigh; pressing
and shooting, drawing and aching; worse from motion and pressure,
and worse in the night.

Rhus t., the pain is attended with numbness, formication, paralytic
stiffness of the affected limb ; it is worse during rest, and when com-
mencing to move ; better from dry heat ; it is mostly brought on by
exposure to wet, by straining and lifting.

Sepia, during pregnancy, pain in paroxysms from three to five
o'clock A. M., with considerable swelling of the veins of the affected
limb ; also in chronic cases, when the pain localizes itself in the heel
of the affected limb ; better during rest.

Sulphur, in chronic cases, when all other remedies seem to fail;
after the suppression of tetters.

Tellur., worse when lying on the affected side.

Valeriana, the pain is unendurable whilst standing, with a feeling
as if the thigh would break off'.

9. Crural Neuralgia, Ischias Antica.

Its seat is the crural nerve ; the pain is felt on the inner and lower
portion of the thigh, on the inner portion of the knee, down the inner
ankle, and on the inner portion of the foot to the big and second toe.

As causes, there have been named : uterine swellings, especially of
a cancerous nature ; inflammation of the hip-joints and crural hernia.

Therapetitic Hints. — Coff'ea, Phytolacca.
Compare Neuralgia Sciatica.

These are the most important forms of Xeuralgia, belonging to
morbid sensitiveness of the nerves. Now we shall have to consider
their counterpart — a want of proper sensitiveness, which is called —

Anaesthesia.

Anassthesia takes place from two causes :

1. Either from an inability of the sensory nerves to convey the ex-
ternal impressions to the central organs ; or —



500 SENSORY NERVES.

2. From an inability of the central organs to perceive external im-
pressions.

The first is the case, for example, where a nerve has become cut
through. Any irritation below that cut, towards the periphery, is not
perceived any more by the central organs ; that part may be pinched,
burnt, &c., but it is not felt. The latter may have its source in a
disease of the spine or of the train. In both cases the want of feeling
is chiefly associated with paralysis of the corresponding parts.

The degree of such anaesthesia varies from a mere numbness to
torpor and deadness of the part. Its influence upon the vegetative
functions in the affected parts shows itself as: decrease in natural
warmth ; slowness of capillary circulation ; want of perspiration ; sub-
cutaneous oedema ; livid color of the skin ; brittleness of the nails ;
ecchymosis, and blisters filled with bloody serum, especially on the
toes and fingers.

Of the different forms of this affection I shall mention only the
following :

Anaesthesia of the Trigeminus.

According to the extent to whicb this nerve has lost its ability to
convey external impressions to the sensorium, we find a want of feel-
ing in the corresponding portions of the skin and mucous membranes.
The patient does not feel any external irritation in these parts ; when
eating, knows not whether he holds any thing in the affected side of
the mouth or not; the saliva runs out of the mouth without his
knowledge ; and the glass held on his lips seems to him broken off
where it touches the affected side. In addition, there is likewise
found weakness of sight, loss of smell and taste.

The reflex motions of the muscles of the face are gone, the eyelids
do not shut when the conjunctiva is touched, and the patient does not
sneeze when the mucous membrane of his nose is irritated. Also
the voluntary muscular motions of the affected side are more torpid,
and the pupil is contracted and immovable.

The seat of the affection is, according to Eomberg's observations,
more towards the periphery of the fifth pair of nerves, when the
angesthesia is limited to some of its fibres.

When, however, the aneesthesia affects not only the external surface
of the face, but also the corresponding cavity of the eye, then the
cause lies in one of the main branches of the trigeminus ; either before
or after its exit from the skull. When the anaesthesia extends over



SPASM. 501

tlie wliole ramification of the trigeminus, the cause of the affection
then lies in the ganglion Oasseri or immediately below it in the
nerve.

When, however, the affection is combined with disturbances of other
cranial nerves, its seat lies in the base of the brain. A central anses-
thesia affects crosswise, and involves at the same time other sensory
and motory nerves of the head and body.

Central causes are : apoplexy, softening, and tumors of the brain.

Peripheric causes : inflammation ; softening; hardening and atrophy
of the nerve and of the ganglion Gasseri. Likewise the severing of
the nerve or of one of its branches by surgical operations, or other
external injuries, blows, wounds, &c. ; or pressure upon it in conse-
quence of tumors or foreign bodies like musket balls, or fracture of
the petrous portion of the parietal bone.

These causes show at once all that might be said about its prognosis
and curability.

II. Morbid Affections of the Motory Nerves.
Just as the sensory nerves may be morbidly affected in a two-fold
manner, either by an increase or a loss of their sensibility, so also are
the morbid affections of the motory nerves of two kinds, either spasm,
cramp, hy per kinesis ; or paralysis, akinesis — that is, increased or lost
contractility.

f. Spasm, Convulsion, Cramp, Hyperkinesis.

Spasms manifest themselves under different forms: 1. Either as short,
slight jerks of certain muscles ; or, 2. As violent, frequently-repeated
contractions of the same or different sets of muscles ; or, 3. As hasty
motions ; which, although regular, are deficient in purpose and rhythm
or are automatically repeated ; or, 4. As irregular, misdirected mo-
tions ; or, 5. As trembling or tremor ; or, 6. As a continuous rigidity
of one or more sets of muscles, even of all muscles ; and, 7. As a
permanent contraction of certain muscles. Their violence and extent
are very different, and do not always correspond to the importance of
their cause. Grave disorders in the central organs may be attended
with but slight spasms; whilst, vice versa, a slight reflex irritation
may cause the most violent convulsions.

Their causes are various ; I may mention as predisposing ones, the
age of childhood — the younger the child, the greater the predisposition.
Almost any acute disease may be attended by spasms at this age ; and



502 MOTORT NERVES.

frequently is preceded by tliem. Even in chills and fever, little
children have spasms instead of a chill. As special forms of spasms
in this early age I may mention eclampsia and trismus. In later years,
up to the time of puberty, we find a predominating disposition to the
different forms of chorea; stammering 201^ squinting ; and likewise the
beginning of epilepsy. From the time of puberty to middle age we
find hysteria, epilepsy, eclampsia and tetanus. In still later years we
find writing spasm, and tremor. The female sex seems to be more
disposed to spasms than the male.

As exciting causes we may reckon — '

1. Mental emotions: fear, fright, anger, terror. Even the sight of
convulsions has caused them in others. Epileptic fits have become
endemic in this way amongst the pupils of a whole asylum.

2. Diseases in the central organs and their membranes, like apoplexy,
softening, encephalitis, myelitis, tumors, tubercles, inflammation of
the cerebral and spinal membranes, and morbid processes in those
bones which encase the central organs.

3. Perip)heric irritations of the nervous system, by strong light, tick-
ling ; also by wounds, blows and bruises of some organs like the tes-
ticles or the uterus, or by irritation of large surfaces like the mucous
membranes — for example, the intestinal canal by indigestible food or
worms, or the external skin by sudden taking cold, &c.

4. Different conditions of the blood, as, (according to Marshall Hall,)
great loss of blood or stagnation of blood within the brain ; so, also,
various qualitative changes of the blood in exanthematic fevers, in
pyaemia, uraemia and- cholsemia.

5. Certain poisons: alcohol, narcotics, strychnine, secale, lead and
mercury.

The prognosis of spasms depends entirely upon their causes. When
they appear in consequence of organic lesions in the central organs,
they are of a much graver nature than when in consequence of a mere
peripheric irritation.

Spasms which appear during the beginning or during the course of
other diseases, like exanthematic fevers, are a sign that the disease
with which they are combined is of a violent character, but are not
quite so bad a sign when they occur in children as in grown persons.
Spasms from blood-poisoning in ursemia and cholsemia are always a
bad prognostic sign.

I shall now speak of the different forms of —



MIMIC SPASM OF THE FACE. 503

Spasmodic Diseases.

I. Spasmus Facialis, Mimic Spasm of the Face.

It affects those muscles of tlie face.«whicli are supplied by the seventh
pair of nerves, either on one or both sides ; some or all of these nerves.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 50 of 65)