Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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arises from unknown causes, (Becquerel, Eodier;) still others con-
fine chlorosis to that kind of anaemia which we find especially in the
female sex during the time of puberty.

Chlorosis, in the most limited sense of the word, is an angemia,
which arises spontaneously, without any known causes, in the lemale
sex during the age of puberty.

Its symptoms are manifold:

1. Blood and circulation. There is, in all cases, a decided decrease
of red blood-corpuscles. The pulse is usually slow, weak, soft, but
the slightest exertion causes palpitation of the heart and irTegular
contractions of the arteries. Sometimes the palpitation of the heart
becomes habitual and is one of the most prominent, and, at the same
time, most annoying symptoms. Physical signs are those of anaemia,
bellows-sounds of the heart, murmurs of the arteries ,and veins. The
latter are the most constant.

2. Color of the skin. A conspicuous paleness, sometimes clear,
sometimes yellowish, greenish, waxy. Even the lips and other
mucous membranes appear pale ; dark rings around the eyes. In
some cases there is oedema of the feet, face, and eyelids ; temperature
decreased ; breath cool ; lips, nose, ears, hands, and feet cold. The
patient is sensitive to cold ; seeks a warm room.

8. Muscular system. Great weakness ; easily tired.

4. Nervous system. Dizziness ; headache ; noise in the ears, espe-
cially in the right ear ; pains in the different parts of the body, espe-
cially in the stomach, back ; (spinal irritation;) even hysterical spasms ;
sad ; without energy ; frightful dreams ; nightmare ; melancholy,
and even mania, and inclination to self-destruction.

5. Digestion. Want of appetite ; digestion slow ; sour and foul
eructations ; desire for sour things. This morbid appetite may in-
crease to a desire for the most unnatural things, such as chalk, paper,
ashes, coals, even excrements; or it may amount to. bulimia. Often
the most undigestible things — pork, beans, pastry, &g. — suit better
than light soups, meat, &c. However, these digestive symptoms are,
in some chlorotic persons, entirely wanting, and are, perhaps, de-
pendent rather upon a morbid condition of the spine than upon that
of the blood.

6. Ees'piration is frequently interfered with, especially after any
exertion ; they sigh and cough occasionally.

7. Genital sphere. There is generally amenorrhoea or irregular



CHLOEOSIS. 535

menstruation with pain ; thin, watery leucorrlioea in place of the
menses.

Therapeutic Minis,

Ant. crud., menses commence at an earlj period, are profuse and
cease afterwards ; great deal of headache ; peevishness ; loss of appe-
tite ; irregular stool ; excessive laziness and weakness ; must lie
down for hours ; deep and unrefreshing sleep at night.

Arsen., trembling ; frequent fainting ; excessive debility.

Bell., laziness and indisposition to work or stir, great general
debility, with weariness and a desire to sleep in the afternoon ; short-
ness of breath ; extreme paleness of the face changes instantaneously
to redness, with cold cheeks and hot forehead.

Bryon., all the symptoms worse from the slightest motion.

Calc. c, scrofulous diathesis; disposition to colds and diarrhoea;
great weakness or curvature of the spine ; vertigo, especially on going
up stairs ; disgust for meat ; craving for sour and even indigestible
things, (chalk, coal, &c. ;) after eating, swelling of the stomach and
palpitation of the heart ; menses sometimes too often and too profuse
or wanting; leucorrhoea; great shortness of breath; great weakness
of the muscles; walking wearies and makes the heart palpitate;
sitting causes severe backache and headache ; therefore constant in-
clination to lie down; hands and feet are cold; the fingers sometimes
appear dead. The mind is generally full of concern about imaginary
things that might happen to her.

Carbo veg., when complicated with itch and fluor albus; gums
swollen, scorbutic and receding from the teeth; the teeth are loose;
feels wretched all over ; can scarcely walk.

China, in such cases as result from loss of vital fluids, menstrual
or vicarious bleeding, suppurations, &c.; or which set in after severe
and protracted illness, such as intermittent fevers, typhus, cholera,
&c.; showing in either case a tendency to dropsical effusions and
cedematous swellings. Besides, we observe sour belching, poor
digestion, bloated abdomen.

Cina, on drinking wine she shudders as though it were vinegar ;
spasmodic yawning; headache, pain in the chest and back, caused by
fixing the eyes steadily upon some object, as, for example, when sew-
ing ; all these pains are aggravated by external pressure ; spells of
intermittent fever every afternoon at four o'clock, with thirst and
coldness of the hands and feet; colic and vomiting of ingesta; after-
wards heat and sweat, followed by deep sleep.



536 THE BLOOD.

Conium, menses wanting; genitals very sensitive; constant dry "heat
all over, without thirst ; stitching pain in the region of the liver, and
heaviness in the limbs; weeping mood; restlessness; great concern
about any little thing that may happen ; anxious dreams.

Cyclamen, suppressed menses; or scanty, painful menstruation;
headache ; vertigo ; swollen eyelids ; pale face, lips, and gums ; loss
of appetite; no thirst; constipation; palpitation of the heart; con-
stant chilliness ; dread of fresh air; disinclination to move and to
work; constant drowsiness; wants to be alone, and weeping does her
good. Is very similar to Pulsatilla, differing, however, from it, by
its dread and disinclination for fresh air.

Ferrum, ansemia, characterized by great paleness of all the mucous
membranes, especially that of the cavity of the mouth, by the bel-
lows-sound of the heart and anaemic murmur of the arteries and
veins ; by great paleness of the face, which, however, is very apt to
become suddenly fiery red, with vertigo ; ringing in the ears ; great
palpitation of the heart and dyspnoea ; thus showing a disposition to
congestion and fluxion of blood to these parts of the body. All the
muscles are feeble and easily exhausted from slight exertion; there
is frequent vomiting of ingesta, especially after eating, and from mo-
tion; cardialgia ; the menses are either suppressed or watery; we
observe general emaciation; oedematous swelling of the body; cool
skin ; constant chilliness, and evening fever, similating very closely
hectic fever.

Graphites, scanty, pale, delaying menses, or they do not appear at
all ; cool vagina ; aversion to coitus ; oedema of the eyelids, external
genital organs and abdominal parietes, leaving on pressure the imprint
of the finger ; face pale and yellowish.

Ignatia, sensitive, nervous, hysteric women, who are inclined to
spasmodic and intermitting complaints, and where the trouble is in-
duced by mental emotions, such as fright, grief, disappointed love, &c.

Ipec, headache, as though the brain were mashed, with nausea and
vomiting; miliary eruptions on the forehead and cheeks by spells;
pale face and pale mucous membranes ; scanty and short menses ;
weak pulse ; 'Cold hands ; morose, enjoys nothing.

Natp. m., in chronic cases and cachectic individuals, with dead,
dirty, withered skin ; frequent palpitation and fluttering of the heart ;
suppressed menstruation ; leucorrhoea ; diminished sexual desire ;
oppression and anxiety of the chest; sadness.

Nux V.,. especially in those cases in which the functions of the stom-
ach, intestines and liver are principally affected, and we may observe



CHLOEOSIS. 537

a train of symptoms like the following : irritable, angry disposition ;
great, anxious concern about little things ; headache, with bilious or
sour vomiting, worse in the morning ; pale, earthy face; feeling badly
after eating bread or sour things ; sour taste in the mouth ; nausea and
vomiting in the morning or after eating ; cardialgia, with wind in the
stomach ; better from drinking something hot ; obstinate constipation ;
running of the nose through the day, and stoppage of it at night ; sore
feeling all over in bed in the morning ; dreads motion and fresh air ;
gets awake early in the morning, then dozes again and wakes up
finally, feeling much worse than at any other time.

Phos., in deep-seated, chronic cases, with tubercular diathesis;
brought on by depressing mental influences, such as grief, worriment,
disappointed love, or by exhausting bodily causes, such as night-
watching, loss of blood, diarrhoea, night-sweats, onanism, &c. We
• observe, in such cases, puf&ness around the eyes, dry hacking cough,
great weakness in the sexual organs, consequent upon previous irrita-
tion of these parts ; leucorrhoea of a whitish, watery slime, especially
profuse during the time of the menses ; sometimes acrid and corrod-
ing ; a total loss of energy in all the organic functions of the body.

Plumbum, want of breath and great oppression of the chest from
motion ; palpitation of the heart ; obstinate constipation ; oedema of
the feet and anasarca ; great muscular weakness.

Puis., great weakness and sluggishness in the circulation, manifest-
ing itself in constant chilliness, coldness and paleness of the skin and
extremities; soft, irregular pulse and palpitation of the heart, oppres-
sion of the chest and shortness of breath ; disinclination to move and
a sad and tearful disposition ; the appetite is generally absent, and
there is no thirst: the whole digestion is disturbed, and consequently
the assimilation of nutriments for the blood does not take place prop-
erly. We observe, therefore, signs of ansemia, such as dizziness,
especially when rising, and amenorrhoea, or scanty, slimy menses,
which appear too late ; in general the patient feels better in the open
air. This distinguishes Pulsatilla from Cyclamen. It is frequently
indicated after Calc. c, Ignatia, Sepia or Sulphur, and is followed
well by Ferrum.

Sepia, bearing-down as if every thing would issue out of the geni-
tals; prolapsus uteri and vaginee; brown-reddish color of the vagina;
diphtheritic ulcers in the vagina and on the labia ; leucorrhoea, yellow-
ish and passing away in starts ; swelling of the external genital organs,
with itching, burning and soreness ; stitching pains in the ovarian
region; palpitation of the heart; intermitting pulsation; occasionally



538 ' THE BLOOD.

a hard thump of the heart; frequent sickness of the stomach, brought
on even bj the smell of cooking.

Sulphuf, heat of the head, with cold feet; inclination to religious
reveries ; inflammation of the eyelids ; frequent, unsuccessful desire
for stool ; leucorrhcea ; oppression of the chest with palpitation of
the heart ; exhaustion even from talking ; feels worse while standing ;
cutaneous eruptions ; sleepy in the day-time, restless at night ; per-
spires easily ; feels faint before dinner. Is often necessary as a
foundation for the better action of other remedies.

8. Gholaemia.

It consists in an impregnation of the blood with gall ; which takes
place when, by obstructions in the gall-ducts, the bile cannot be emptied
into the duodenum, and thus becomes absorbed into the blood; or
when, by diseases of the liver or the portal veins, the elementary
constituents of the bile are not separated from the venous blood, but
by some unknown process become transformed into gall within the
veins themselves.

The highest form of this disorder we observe in the acute yellow
atrophy of the liver. Its symptoms are always icterus, sopor, and
other symptoms of brain-affections. Compare Icterus and Diseases of
the Liver.

9. Uraemia.

This consists in an impregnation of the blood with urates, which,
according to Frerichs, are decomposed into carbonate of ammonia.
It takes place when the secretion of urine is prevented ; especially in
Bright's disease, cholera, or other disturbances, by which the urine is
held back in the bladder.

Symptoms. — Besides those which the original disease causes, we find
a urinous odor in the breath, sweat, vomit, and stool. There are also
deafness, amaurosis, sleepiness or sleeplessness, sopor, coma, delirium,
and convulsions.

Compare Diseases of the Urinary Organs.

10. Septicaemia.

In some conditions of the system, the blood seems to undergo cer-
tain changes in the living organism, similar to those which it under-
goes w^hen extracted from the body — a kind of putrescence. This state



PYEMIA. 539

of the blood has been called Sepiicwmia ; ■wLicb means, tlierefore,
putrid dissolution of the blood. By chemical analysis of such blood,
the alterations have been found to be various:

1. There have been found in it acids in excess ; which seem to dis-
solve the blood-corpuscles.

2. There has been found in it carbonate of ammonia, which dissolves
the fibrin and coloring matter of the blood-corpuscles.

8, Also sulphuretted hydrogen.

4. The blood is deprived of fihrin ; not coagulable,

5. The blood-corpuscles have lost their power to ahsorh oxygen ; and
thus cannot sustain their nutritive functions.

6. The blood- corpuscles are destroyed, their coloring matter is dis-
solved in the serum ; which, for this reason, becomes dark red or
dirty brown.

7. The extractive matters are augmented and changed.

The causes are likewise various. It has been observed after violent
exertions of mind and body; in endemic diseases; typhus, yellow
fever, puerperal fever, pest, &c. ; likewise in consequence of ichorous
wounds, gangrene, &c. In other cases it seems to be produced by ex-
ternal poison, such as contagious and miasmatic influences; mercurial
and alcoholic poisoning.

Its symptoms and consequences vary according to its degree and
its complication. In higher degrees we find the dissolved con-
stituents of the blood-excreted by the kidneys, intestines, &c. ; the
changed blood-serum is infiltrated into the subcutaneous cellular tissue,
serous membranes, &c. The nerve-centres are irritated ; causing de-
lirium, prostration, sopor, paralysis, &c. The pulse is small, weak,
accelerated. The intestinal canal is inflamed, giving rise to ulcerative
processes. Spleen and mesenteric glands are swollen. The skin is
stinging hot, calor m.ordax.

In some cases of septic£emia its products, when transferred to
other organisms, cause the same dissolution of blood in them; and in
this way septicaemia may spread by infection and assume an endemic
character. It is frequently combined with —

10. Pyaemia,

A morbid process, which, in its strict sense, is characterized by its
tendency to a formation of multiple and lobular abscesses, or so-called
pysemic foci, in different parts of the body, especially in the lungs,
spleen, liver, kidneys ; in the subcutaneous cellular tissue, skin, and



540 THE BLOOD.

brain. In a more general sense it is more or less combined with
symptoms of septicsemia, and then mostly the consequence of profuse
local pus-formation after amputations or other surgical operations ;
or in consequence of internal abscesses, carbuncles, phlebitis, puer-
peral fever, gangrene, &c.

Symptoms. — 1. It usually sets in with a violent, shaking chill,
which is followed by heat, or the chill alternates with heat. 2. The
pulse is accelerated, very frequent, small and soft. 3. Prostration,
headache, sleeplessness, delirium, coma. 4. Appetite is lost, thirst
increased, stool irregular, sometimes diarrhoea of a most offensive
character. The spleen is generally enlarged. 5. Lips and nostrils
are dry and are covered with blackish sordes. 6. There is cough,
dyspnoea, and symptoms of pleuritis and pneumonia. 7. The skin
becomes discolored, yellowish, icteric, dry and hot, sometimes inter
rupted with profuse sweats, which are accompanied by miliary
eruptions. Sometimes there is infiltration of the subcutaneous cel-
lular tissue, which terminates in erysipelatous inflammation and
ulceration of this tissue. 8. Sometimes there is purulent infiltration
into the joints. 9. Local ulcerations secreting ichor instead of pus.

Therapeutic Mints, — Compare Arsen,, Carbo veg., China, Lach.,
Phos., Silic.

tf. Scurvy.

It is mostly of a chronic nature, and in its graver forms very
similar to the symptoms of septicasmia. Its development is generally
gradual. We observe at first general debility, getting easily tired,
sleepiness, depression of spirits; sad-looking, pale, cachectic face, with
blue rings around the eyes ; pulse slow, soft ; appetite gone, except
for fresh, green, or sour things ; stool slow ; urine scanty ; skin dry.
Soon after these symptoms the appearance of the gtims changes ; they
become bluish, swollen, spongy, and bleed at the slightest touch.
There is a bad taste in the mouth and a fetid breath. The general
debility increases ; the patient suffers from acute pain in the extremi-
ties ; ecchymosed spots appear on the skin ; first on the legs, later all
over the body, from the size of a lentil to that of a half dollar and
larger, at first looking purple, in severe cases black ; later, changing
into all the different hues which extravasated blood undergoes ; fre-
quent nose-bleed. All these symptoms may reach a still higher
degree ; the weakness may augment to prostration, so that even the



SCURVY. 541

sligTitest exertion or motion may cause fainting ; tlie gums may issue
a fetid, ichorous, bloody fluid; the ecchymosed spots may change
into blisters, filled with ichorous fluid and forming ulcers.

The pain in the extremities may grow still severer, and their joints
and bones may swell ; effusions of fibrin beneath the skin may harden
the legs like boards. All appetite is lost except that for sour things.
The hard stool changes into a thin, ichorous, bloody diarrhoea, with
colicky pains. The spleen is usually enlarged. Epistaxis increases,
and there are even bloody secretions from the conjunctiva, respira-
tory organs, stomach, (by vomiting,) and from the urinary organs, in
the form of bloody urine.

If to all these symptoms there be added extravasation of bloody
serum into the pleura, the pericardium, the lungs, the brain or its
membranes, the patient generally dies; either suddenly, or gradually,
in consequence of increasing prostration and hectic fever. Of course,
all cases do not terminate thus. Its duration, however, is long, last-
ing months ; and convalescence is very slow, if left to nature.

Scurvy has been divided into sea and land scurvy, but there is in
reality no difference between the two. Its causes are: Want of
fresh vegetable food ; exposure to damp, cold weather ; bad water ;
cold, rancid meat ; depressing mental emotions, fear, anxiety, want
of confidence, &c. It has been found everywhere in our army where
these conditions exist ; soon ceasing, however, on the mere removal
of the conditions.

Therapeutic Mints,

Agave Americana, countenance pale and dejected; gums swollen
and bleeding ; left leg, from ankle to groin, covered with dark, purple
blotches ; leg swollen, painful, and of stony hardness ; pulse small
and feeble ; appetite poor ; bowels constipated.

Ammonium carb., hectic fever, vast hemorrhages from the intestines,
nose and gums ; falling out of the teeth ; muscles soft and flabby ;
emaciation.

Arsen., the gums bleed readily; there is fetid smell from the
mouth ; violent thirst, which obliges him to drink frequently,
although but little at a time ; offensive diarrhoea ; excessive debility ;
stiffness and immobility of the knees and feet, with violent tearing
pains, worse about midnight ; better from external warm applica-
tions ; great despondency and restlessness.

Canth., pains in the gums; coagulated blood in the mouth, early in
the morning, in bed; bloody urine.



542 THE BLOOD.

Carbo veg., swelling, receding, and bleeding of the gums; readily-
bleeding ulcers; general physical depression; attacks of sudden
weakness, like fainting.

China, inertia; excessive debility; hemorrhage from the mouth,
nose, and intestines ; great desire for sour things ; diarrhoea.

Hydrastis, physical prostration; faintish, weak feeling; ulcers on
the legs.

Merc, spongy, bleeding gums, of a sickly appearance ; they look
white along the upper border and recede from the teeth ; bluish color
of the inner cheeks ; fetid smell from the mouth. Sinking with an
indescribable malaise of body and soul, obliging him to lie down ; fetid
ulcers on the legs, which become speedily putrid ; spongy, bluish,
readily-bleeding ulcers.

Mur. ac, swelling of the gums; scorbutic gums.

Natp. mur., scorbutic, putrid inflammation of the gums; bloody
saliva ; difficulty of talking, as if the organs of speech were weak.

Nitr. ac, swelling and bleeding of the gums; the teeth are loose;
bloody saliva; putrid smell from the mouth; after abuse of mercury,

Nux vom., putrid bleeding; swelling of the gums; putrid ulcers
in the mouth; cadaverous smell from the mouth; bloody saliva;
spitting of blackish, coagulated blood ; and blowing blood from the
nose ; pain in the limbs ; great weariness and languor.

Phosph., the gums bleed easily and stand off from the teeth ; sore,
excoriated spots on the skin ; ecchymosed spots.

Staphys., the gums are painful to the touch and bleed easily on
being touched ; scorbutic ulcers.

Sulphur, swelling of the gums, with throbbing pain in the gums ;
bleeding ; fetid smell from the mouth ; sleeplessness at night ; desire
for brandy.

Besides, compare Caust., Chin., Sulph., Cistus, Hepar, Sepia,
Sulph. ac.

The old school have put their reliance on lemon and lime-juice;
and there is no doubt that after the Englishmen commenced using
sauerkraut on board of their vessels, scurvy diminished to a considera-
ble degree on sea, and thus one might say, jokingly, that the great
power which England attained at sea was founded upon sauerkraut.

12. Purpura, Morbus MacuSosus WerlhoHL

This affection corresponds to scurvy in so far as its characteristic
symptom consists, like that of scurvy, in an extravasation of blood



HEMOPHILIA. 543

from the capillaries of the skin and mucous membranes ; hut it differs
from it, as it has none of those peculiar affections of the gums, nor
any of those jfibrinous exudations into the subcutaneous and intermus-
cular tissues, neither hemorrhagic inflammation of the serous mem-
branes, by which scurvy is characterized.

Its causes are unknown. We find it most frequent in weakly per-
sons; during convalescence, and in persons who live in poor circum-
stances and damp places ; but yet robust persons, in good circum-
stances, are not exempted.

The outbreak of the disease is generally preceded by disturbed
digestion and general weakness and debility; this may last several
days, or even weeks; then we observe little purple spots coming out,
especially on the extremities and trunk; less frequently on the face.
Whilst still new ones are forming, the first gradually become green
and yellow ; in some cases these spots discharge blood. As on the
external skin, so do we see ecchymosed spots on the mucous mem-
branes of the mouth and fauces ; and it happens oftener in purpura
th3,n in scurvy that profuse hemorrhages from the nose, stomach,
bowels, and kidneys take place, in consequence of which ansemia,
sjmcope, hydrops, and even death may ensue. As a general rule the
patients get well after two or four weeks.

Therapentie Hints. — Compare, as the most important reme-
dies, PJios., Ledum, Bryon., Arn,, Arsen., Lach., Sulph. ac. ; and in
cases of Epistaxis, Heematemesis, or Heematuria, the corresponding
chapters.

13. HaemophHia.

By this name is meant a congenital hemorrhagic diathesis, in con-
sequence of which even the slightest wounds, no matter where,
always bleed very profusely. The cause is unexplainable ; we only
know that this tendency to bleed exists in certain families, and is
propagated to three or four generations ; sometimes leaping over one
link and appearing again in the following. The female members of
such families are generally, although not always, exempt.

There are no objective signs by which this diathesis could be
recognized before the bleeding sets in. Such persons, however, are
described as having always a very fair skin, with the blood-vessels
shining through, blond hair and blue eyes. In some cases it shows
itself immediately after birth, as an uncontrollable bleeding of the



54:4: THE BLOOD.

navel; oftener during the first or second dentition, and in other
cases still later. Then the blood oozes uninterruptedly from the
slightest wound, as out of a sponge, until the patient becomes ex-
hausted from loss of blood. Mere bruises cause large effusions of
blood into the cutaneous and subcutaneous tissues. Spontaneous



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 54 of 65)