Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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saliva flows from the mouth or is blown out, causing foam before the
mouth, often bloody; the patient swallows air, which causes rum-
bling in the bowels, distention of the abdomen, and passages of
flatus, and sometimes feces.

7. The urine passes off involuntarily; in some cases there are
erections of the penis, and even ejaculations of semen.

8. We frequently find the patient in a general perspiration.

This convulsive state lasts about two or three minutes, and then
follows :

9. Relaxation. Gradually the breathing, the pulse, and the features
regain their normal state; finally the patient awakes with a deep
sigh, not knowing what has happened to him. After this he usually
falls into a disturbed sleep, with moaning and restless motions of
the limbs ; or he stays awake and continues his work in which he
had just been interrupted. In some cases follow delirium, excite-
ment and violent agitation, until full consciousness returns.

I shall here subjoin what French physicians have put down as ■
characteristic of epilepsy ; 1. Shriek ; falling to the ground ; deadly
paleness ; tonic spasms, lasting one-quarter of a minute to one minute.
2. Eedness of the face ; convulsions ; insensibility, one and a-half to
two minutes. 3. Gradual subsiding of the convulsions, three to eight
minutes.

The intensity of the paroxysms varies greatly. It may consist in a

33



514 MOTOEY NERVES.

mere so-called epileptic vertigo, wlien neither a shriek, nor falling
down, nor clonic spasms, are observed, but only a quickly-passing
unconsciousness, a staggering, perhaps, and a short tremor through the
body. If it happens during sleep it may pass over entirely unnoticed.
But even such light attacks leave the patient weak, drowsy, and low-
spirited for a while. Others set in slowly with marked premonitory
symptoms, and develop themselves sometimes only partially, and
sometimes wholly, so that they form mild and hard attacks ; whilst
others show all the violence above described.

Their frequency is likewise very variable — from more than one
hundred in twenty-four hours, to only one or two in a year. They
do not keep regular time, but they most frequently recur after an
interval of from twenty-five to forty-five days. They may happen at
any hour of the day or night.

Symptoms during the free intervals. Although in recent cases the
patient shows scarcely any morbid change, yet, by-and-by, the disease
brings on marked changes in the afiected individual. The patient is
low-spirited, morose, has no inclination to work, or he becomes ex-
cited, easily angry and does things wrongly. By-and-by he becomes
forgetful, stupid, greedy, voracious, lewd, unmanageable, and corre-
spondingly his features assume a stupid, sad, and wild expression.
The face is generally pale and puffed, looking old, and more or less
distorted. The teeth are ground down or broken oft"; the tongue lacer-
ated and cicatrized ; the limbs are weak, emaciated and tremble easily.
All these symptoms, of course, develop themselves only gradually.

The cause of this disease is always of a chronic nature, and may last
through the whole life. It may commence with light attacks, which
gradually grow stronger, or the attacks may retain their character in
strength from first to last.

In little children the attacks seem more frequent ; less frequent after
the tenth year, and more frequent again about the time of puberty.
Sometimes, however, they become less frequent at that time. Ex-
cessive sexual excitement has a decidedly bad influence. Intercurrent
diseases, however, generally check the frequency of the spells.

The disease frequently terminates in apoplexy, softening of the
brain, paralysis, mania, and imbecility of mind.

Causes. — There seems to be no doubt that the disease is propagated
by inheritance. As occasional causes there have been observed :

1. Mental emotions, fright, fear, &c.; 2. Morbid changes within the brain
and its membranes; 3. Peripheric irritations of sensory nerves, which
consist either in morbid states of these nerves, or in morbid states of



EPILEPSY. 515

those organs to wLicli these nerves are distributed, or in a mere undue
functional irritation of these nerves.

In a given case it may be very difi&cult to define which of these is
the cause.

In regard to differential diagnosis, I shall here mention only its
simulation. However closely it may be simulated, the impostor can-
not prevent his pupils from contracting when strong light falls upon
them; in epilepsy light has no effect upon the pupils.

Prognosis. — As lad signs are to be reckoned : attacks which come
in irregular groups; great frequency of the paroxysms; sudden attacks
without any premonitory symptoms; vomiting, asphyxia, half-sided
convulsions, with subsequent paralytic symptoms ; long-continued
coma, delirium, mania, stupidity after waking up.
. M.ot:q favorahle signs : short attacks and long intervals between ; pre-
monitory symptoms before the attack ; milder convulsions, with little
embarrassment in respiration; brief or only partial loss of conscious-
ness, and no disturbance of the health in the intervals. Still better is
it, when the paroxysms become less frequent, shorter and milder. The
outbreak of cutaneous eruptions and ulcers is quite favorable. In
regard to causes, we find it unfavorable when the disease is inherited,
or is not cured during the age of puberty, or comes on in middle life,
or is caused by disorganization of the brain or by continued peri-
pheric irritations of the nervous system, like masturbation. More
favorable are those cases which come on during the period of denti-
tion, or are caused by disturbances in the nutritive functions, as chlo-
rosis, anaemia, lead or alcoholic poisoning ; in fact^ in all such cases
where it is possible to remove the cause.

Therapeutic Mints*

Agaricus, nictitation of the eyelids; itching, burning and redness
of the fingers and toes, as though they had been frozen.

Arsen., jy-receded \)j a sense of warm air streaming up the spine into
the head ; vertigo ; loss of consciousness and falling down, Afieriuards
confused and stunned. During the intervals, pressive pain in the occi-
put ; burning in the spine ; sweet taste in the morning ; after eating
heavy food burning in the stomach and bowels ; stool irregular, mostly
diarrhceic, with burning in the anus; also burning in the glans penis
during micturition ; frequent cramps in the calves of the legs.

Artemisia vulgaris, when there are a number of attacks right after
each other.

Bel!., the convulsions commence in the arm ; previous, and at the



616 MOTOEY NERVES.

time, congestion of tlie head; during the intervals^ peevish, angrj,
scolding, swearing ; or fearful and full of anxiety ; vertigo ; growing
dark before the eyes ; ringing in the ears ; headache, with twitching
in the face ; flushes of heat in the face ; red face ; enlarged pupils ;
jerking and starting in sleep.

Bufo, after fright.

Calc. arsenica, pain and oppression in the region of the heart before
the fit.

Calc. c, lefore the attach : chewing motion with the mouth ; stretching
of the limbs ; great restlessness ; palpitation of the heart ; sense of
something running in the arm, or from the pit of the stomach down
through the abdomen into the feet. After the attack: headache ; dizzi-
ness ; sweat on the head ; great thirst ; canine hunger ; vomiting and
diarrhoea. During the intervals : stupid, peevish ; anxious about getting
Avell ; vertigo ; headache before breakfast ; pale, puffed face ; perspires
easily, especially on the head ; hardness of hearing ; eats a great deal
and yet loses flesh ; thick, swollen belly ; too frequent and too pro-
fuse menses ; swelling of the glands about the neck. Causes: fright ;
protracted intermittent ; suppression of chronic eruption. Worse
during the solstice, and full moon ; excited by chagrin or fear ; by
drinking cold water ; by letting the legs swing when sitting. Fre-
quently indicated after sulphur.

Caulophyllum, epileptiform spasms during or near the menses.

Caust., before the attach: imbecility of mind; heat of the head, fol-
lowed by sweat all over ; great pressure in the pit of the stomach,
extending all over the chest and hindering breathing.

During the spell: sometimes bleeding of the nose ; very red face ;
biting of the tongue. Afterioards : soporous condition ; headache ;
noise in the head; exhaustion. During the intervals: on the scalp
and glabella small, round, soft lumps ; sweats easily on the head ;
stoppage of the nose ; tongue coated on both sides tohite ; sour or sweet-
ish, badly-tasting eructation, like ink, or rotten wood ; pain in the
small of the back, and constant coldness of the shoulders and joints
of the feet ; great restlessness, which urges him to run away. Causes :
suppressed itch ; protracted intermittent ; softening of the brain.
Worse during new moon ; drinking cold water as soon as the pressure
in the stomach commences prevents the attack.

Cicuta, epileptiform spasms from venous congestions of the abdomen
in children and women. Bluish, puffed face ; eyes staring upon one
point ; electric shocks ; trembling ; difficulty of being roused from
sleep ; small, painful ulcers on the edges of the tongue.



EPILEPSY. 517

Cimicifuga, epileptiform spasms at or near the menstrual period.

Cocculus, for women of great nervous and paralytic weakness, with
suppressed or very painful menstruation.

Cuprum, hefore the attach: nausea, retching, and throwing up of
phlegm ; bloated abdomen ; drawirig sensation in the left arm ; aura
epileptica ; the arm is drawn involuntarily close to the body ; formi-
cation and tearing in the right hand ; shuddering ; goose-flesh ; pal-
pitation of the heart ; or sudden shriek and falling down, without any
premonitory signs. During the spell: the fingers become dead; in-
voluntary discharge of urine ; bluish color of the pit of the stomach
aud chest; chest and head covered with perspiration. After the
spell: weeping; headache; profuse discharge of a clear watery urine ;
long trembling and shaking of the right hand ; sleep. During the
intervals: anxiety, tendency to be frightened; burning in the chest
and abdomen, with chilliness of the remainder of the body ; burning
and tearing in the small of the back ; numbness of the arms. In
clearly idiopathic cases, with no organic lesions ; worse about new
moon ; after mental excitement.

Digitalis, when caused by excessive nightly emissions or onanism,
with great weakness of the genital organs.

Gelsem., epileptiform convulsions after suppressed menses, with
severe spasm of the glottis ; epilepsy, with dull feeling in the fore-
head and vertex, and some pain and fulness in the region of the
medulla oblongata before the attack.

Glonoin, great congestion of the head and heart ; during the spasms
he spreads his fingers and toes asunder.

Hyosc, before the attack : vertigo ; sparks before the eyes ; ringing
in the ears ; gnawing and sensation of hunger in the pit of the
stomach. During the spell: purple, bluish face; projecting eyes;
shrieks ; grating of teeth ; foaming ; discharge of urine. After the
spell: soporous condition, snoring. During the intervals: tearing and
beating in the right eye, which weeps and seems projected ; constipa-
tion. Causes: jealousy; disappointed love; grief. The attempt to
swalloAV fluids renews the attack,

Hypericum, epileptiform spasms, always after knocking the body
against any thing,

Ignatia, epilepsy caused by fright and suppressed grief; and espe-
cially suitable for children,

ipecac, epileptiform spasms, with shrieks; opisthotonus; pale,
puffed face, and gastric derangements,

Lachesis, in those cases which are caused by onanism, or are in



518 MOTORY NERVES.

connection with a morbid excitement of the sexual organs; fluor
albus ; frequent emission of semen ; also after jealousy.

IMux vom., painful spot in the abdomen in the region of the solar
plexus ; pressure upon this spot renews the attack.

Opium, nightly attacks; combined with mental derangements.

Plumbum, heaviness and numbness of the legs before the spell ;
swollen tongue; afterwards: long-continued stupid feeling in the
head, and want of clear consciousness.

Secale shows toxicologic effects, which hint strongly to it, but its
sphere of action has not yet been defined.

Silic, hefore the attach: feeling of great coldness of the left side of
the body ; shaking of the left arm ; slumber, with starting. The
spasms spread, undulating from the solar plexus up towards the brain ;
violent screaming ; groaning ; tears drop out of the eyes ; foam before
the mouth. Afterwards : warm perspiration ; slumber ; paralysis of
the right side ; for scrofulo-rhachitic individuals ; during sleep at
night ; worse about new moon.

Stannum is recommended as one of the most important remedies,
without particular indications ; except that its sphere of action is said
to have a strong bearing upon the genital organs of both sexes.

Stram., epileptiform spasms; thrusting the head continually in
quick succession to the right ; continual rotatory motion with the left
arm ; pain in the pit of the stomach ; obstinate constipation ; deep,
snoring sleep ; low-spirited ; fear of death ; desire to be alone.

Sulphur, hefore the spell ; crawling and running as of a mouse down
the back and arms ; or a sudden feeling as if a mouse were running
from the right foot up the leg to the right side of the abdomen.
After the attack, which consists of various convulsive motions, he
wipes the tears from his eyes ; soporous sleep ; great exhaustion.
Chronic cases always of psoric taint ; suppressed itch.

Veratr. viride and Zizia are likewise recommended.

Eclampsia Acuta.

This is an affection entirely analogous in its external symptoms to
epilepsy — sudden loss of consciousness, frequently setting in with a
shriek ; tonic and subsequently clonic convulsions, which are followed
by a comatose sleep. But it is entirely different from epilepsy, in
that it always accompanies some other morbid derangement, with the
cure of which it either ceases, or ends fatally. According to the
individualities which it attacks we find in books different forms of
eclampsia mentioned.



eclampsia. 519

1. Eclampsia Geavidaeum et Paetueientium, Pueepeeal Con-
vulsions.
Its occurrence is rather rare — one in about five hundred pregnan-
cies, and perhaps less than that. During pregnancy it is of a very
rare occurrence, and even then is scarcely ever noticed before the
sixth month. It occurs most frequently during the act of parturition ;
seldom during the lying-in period. Primaparse are most subject to
it, and it sets in -mostly during the dilatation of the os uteri, or im-
mediately after the expulsion of the child. According to Frerichs, it
has been observed that such women suffer frequently with albumi-
nuria during pregnancy, though this is not invariably the case.
During the lying-in time these convulsions are generally the com-
mencement of inflammation of the womb. The attack itself is charac-
"terized by the same convulsive features as are described under \^^», ,
epilepsy. When setting in during pregnancy, these convulsions
generally cause contractions of the womb and abortus ; when at the
beginning of labor-pains, they frequently retard the natural progress ;
but when towards the end of parturition, they are apt to hasten the
expulsion of the foetus. After the birth of the child the contractions
of the womb generally cease ; and this may give rise to hemorrhages,
retention of the placenta, and inflammatory processes of the womb.
The convulsions themselves may continue for hours afterwards,
though they are mostly of less intensity. The influence upon the
child is, according to Scanzoni, not necessarily fatal ; about one-half
of them are said to die. The later the convulsions begin the greater
is the chance for the child, and vice versa. The prognosis is doubt-
ful ; the earlier they commence the more so.

Therapeutic Mints. — As albuminuria is frequently a forerunner
of this terrible complaint, the patient ought to be carefully treated
during pregnancy.

Compare Albuminuria.

Bellad., deep red face; enlarged pupils; screaming; jerking and
general convulsions ; all which are signs of cerebral congestion.

Chinin. sulph., albuminuria ; tetanic spasms with loss of conscious-
ness during parturition and afterwards ; swollen veins on the head
and neck; pulse frequent, intermittent, and weak.

Cuprum, during the lying-in time ; sour-smelling sweat ; miliary
eruption; anxiety; easily frightened ; heaviness of the head; soreness
of the abdomen to pressure; burniag in the small of the back ; numb-
ness of the arms.



vV j|,^._



Qj^AA.0uu^t^ ^^^""^^^



520 MOTOEY NERVES.

Gelsem., during pregnancy, and where there is an anemic condition
present ; protracted labor ; rigid os uteri.

Hyosc, cold perspiration ; pale face ; suffocating spells and con-
vulsions during parturition.

Opium, during parturition ; cessation of labor-pains ; coma ; reten-
tion of stool and urine ; after a fright.

- Platina, after parturition; profuse hemorrhage; yawning; convul-
sions.

Veratr. viride, during parturition; also after blood-letting, during
the puerperal convulsions, causing furious delirium; cold, clammy
perspiration.

Also, compare the hints under the head of Epilepsy.

2. Eclampsia Infantum, Convulsions of Children.
/o ^^_^,^^z_7 Sy this term is understood convulsions of children, during which
they lose their consciousness more or less completely, which come on
in spells, run an acute course, and which are generally connected with
some other morbid process. There exists no stricter definition as yet.
Eclampsia attacks by preference boys during the first years —
stout as well as sickly — especially during dentition. It often breaks
forth at the commencement of exanthematio fevers, also instead of the
chill in intermittent fever ; succeeds a sudden fright of the mother in
the event of her suckling the child immediately. It may be caused
by fright, fear of punishment, strong light, tickling, or violent pain ;
intestinal irritations from worms, indigestible food, such as raisins,
cakes, the pulp of oranges, &c. These convulsions are characterized
by loss of consciousness ; spasms all over ; congestion of the head ;
cyanotic appearance of the face, or, in anaemic children, paleness of
the face; snoring; rattling breathing; sometimes vomiting, or in-
voluntary discharge of urine and feces. They sometimes follow each
other in rapid succession, and may terminate life in consequence of
asphyxia unexpectedly; as a rule, however, they yield readily to the
appropriate homoeopathic remedy.

Tlierapeutic Hints,

Aeon., great restlessness; high fever; dry skin, after fright; from
irritation of seat- worms ; from taking cold : in consequence of inflam-
matory affections of the spine ; during teething.

Apis, shrieking ; boring the head into the pillows ; inflammatory
affections of the brain.

Arsen., spasms, preceded by burning heat of the whole body, with
constant licking of the dry, cracked lips ; wants to drink constantly,



CONVULSIONS. 521

but little at a time ; is hasty in all its motions ; grasps tlie tumbler
or any thing it wants eagerly ; is very restless, with anxious expres-
sion of the face.

Bellad., glowing-red, as well as a pale face, with enlarged pupils;
great heat in the head ; great vascular erethism ; drowsiness, with
inability to sleep ; starting and jerking during sleep ; grating of teeth;
especially during dentition ; scrofulous diathesis.

Calc. c, the anterior fontanel remains wide open ; glandular swell-
ings about the neck; teething process is either very slow or else too
rapid ; great perspiration about the head ; greatly inclined to take
cold ; hard, swollen abdomen ; rather inclined to looseness of the
bowels ; often indicated after Belladonna ; one of the most important
remedies during dentition ; scrofulous diathesis.

Camphora, ansemic subjects ; coldness of the whole body.

Chamomilla, one cheek is red, the other pale ; hot perspiration on
the head, especially on the hairy portion ; great thirst ; bloated
bowels ; colicky pains ; greenish discharges ; sour vomiting ; constant
moaning and groaning ; restlessness ; the child wants to be carried
about all the time. During sleep a suspicious working of the muscles
of the face, as if smiling ; during dentition ; also, after nursing the
breast of a woman laboring under the eft'ects of a recent fit of passion.

Cicuta, especially when the child, without any premonitory signs,
becomes suddenly stiff, with his eyes fixed upon one point; also in
violent spasms of the head and the upper portion of the body ; with
bluish and puffed face ; also in convulsions from worms.

Cuprum,in aneemic conditions; shrill cries during the attack; drowsy
and stupid condition during the intervals, with nausea and vomiting
of slime ; bloated abdomen, with involuntary, thin discharges from
the bowels ; also when the child from crying loses its breath and
draws its feet spasmodically upwards and backwards upon the nates.

Cypripedum pubescens, in the premonitory stage, when there is a
morbid irritability of the brain, in consequence of which the child is
very excitable, laughs and plays at unwonted hours; is very wakeful
and laughs even in sleep.

Gelsemin., during dentition, with sudden loud outcries ; feverish-
ness.

Hyosc, congestion of the head; bloated and dark face; protruding
eyes ; shrieks ; foam at the mouth ; involuntary discharges of urine,
from fright or fear.

Ignatia, violent convulsions; often tonic spasms predominant; ner-
vous temperament; during dentition ; during the commencement of



522 MOTOEY NEKVES.

exanthematic fevers; after fright; or when children have been
punished, and go to sleep soon afterwards.

Ipecac, pale face; nausea; vomiting; almost always when caused
by eating indigestible food: raisins, pound-cake, the pulp of an
orange, &c. ; or when the eruption of an exanthematic fever strikes
in by taking cold.

Opium, trembling of the whole body, convulsive motions of the
extremities; soporous condition with snoring; retention of stool and
urine; after a fright; or from nursing soon after a sudden fright of
the mother.

Platina, in anaemic subjects; tonic spasms without loss of conscious-
ness; trismus; pale, sunken face; after the spell the child lies on its
back, draws up its limbs and spreads its knees.

Stannum, renewal of convulsions with the cutting of every tooth;
also in consequence of worms.

Stramon., congestion of the head; heat all over the body; red
face; spasmodic thrusting of the head in all directions ; profuse
urine ; deep, snoring sleep.

Sulphur, often when all other remedies fail ; after suppression of
eruptions; diarrhoea in the morning; during the eruptive state of
scarlatina.

Veratr. vir., convulsions with opisthotonus; anaemic subjects in con-
sequence of diarrhoea.

Zincum, screaming and starting in sleep; anxious look when
getting awake ; heat of the body and nightly restlessness ; twitching
and jerking of different muscles, more on the right side than on the
left; irritable mood; great appetite; bloated abdomen; involuntary
discharge of urine. According to Kafka, during dentition in chil-
dren with pale blood.

Tremor, TremhUng.

This affection is of very frequent occurrence, and of various forms.
Sometimes the head trembles, whilst the motions of the arms go on
normally. Some persons tremble during rest as well as when in
motion; others, only during rest; a majority, however, during mo-
tion. During sleep all trembling ceases ; also frequently when in a
horizontal position, or in a position in which the trembling extremity
rests firmly upon support elsewhere. Keflex motions are performed
sometimes tremblingly, sometimes normally, whilst all automatic
motions almost always remain undisturbed. Exertion of the will



TREMOR. 523

sometimes aggravates, sometimes masters the tremor ; and during
intense interest upon a subject it may cease entirely. Trembling
may be partial, confined to the upper extremities, or extend over
all animal muscles; so that even the muscles of the face and jaws
are involved. It is mostly of a transient character ; sometimes part
and parcel of a disease ; sometimes, however, it becomes habitual,
chronic, life-long. In children, it is found only occasionally ; never
of long duration. Old age is especially subject to it, (tremor senilis.)
We find it likewise more amongst women than men. Brain and
spinal diseases (softening and atrophy) are mostly attended by it.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 52 of 65)