Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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and for the observant homoeopathic physician of the highest impor-
tance. Just these mauifestations may present to him the hints
which will lead him to the discovery of the required remedy of the
case.

When an intermittent fever develops its paroxysms in these three
stages, and in this order, it is called intermittens completa ; when,



554 FEVEKS.

however, one or the other of the stages is wanting, it is called inter-
mittens incompleta ; and when the order of its stages is reversed, so
that, for example, the paroxysm commences with sweat and ends
with the chill, it is called intermittens inversa.

The apyrexia is, in different cases, of different duration. It may
last only six, eight or twelve hours, so that the new paroxysm sets in
after twenty-four hours from the one preceding, then it is called a
daily or quotidian fever ; if twice twenty -four hours elapse between
the paroxysms, it is called a tertian fever ; and if three times twenty-
four hours intervene, it is called a quartan fever. Sometimes it recurs
only every seventh day — intermittens septiana.

The most frequent are the quotidian and tertian. Sometimes it hap-
pens that the paroxysms keep no regular times ; they either set in each
time earlier, {anticipating,) or later, [postj^ning.) In such cases it may
come to pass that the original type is altogether changed into another ;
for example, a quotidian by postponing into a tertian, or a tertian by
anteponing into a quotidian. When a fever-paroxysm lasts so long
that its end reaches to the beginning of a new paroxysm, it is called
a febris intermittens suhintrans. When, however, the intervals of a
quotidian, tertian, or quartan fever are again interrupted by another
paroxysm, then it is called a frehris intermittens duplicata. The
double quotidian consists of two paroxysms within twenty-four
hourS; the intervening being generally lighter than the original.
The double tertian has one paroxysm every day, mostly at differ-
ent hours, and again the intervening lighter than the original ; whilst
the double quartan has two paroxysms in three days, and in this way,
that two successive days are fever days, and the third day is free.

A long-continued, oftentimes suppressed intermittent fever fre-
quently terminates in dropsy in conoequence of existing functional
disturbances of the spleen, which gradually become an organic lesion,
or in chronic parenchymatous nephritis, or scorbutic affections and
general ague cachexia.

Therapeutic Hints,

Aeon., in recent cases of young individuals of a full habit; all the
stages must be sharply marked, with a prominent congested state of
the head and chest. The pulse is full, hard, and frequent. During
the chill internal heat, with great anxiety, sensitiveness and restless-
ness ; the pupils are contracted. The heat is confined mostly to the
head and face ; great thirst for cold water and inclination to uncover.



INTERMITTENT FEVER. 555

The siueat is most prominent on the parts covered, and is attended
with earache and profuse micturition.

Ant. cr., predominant gastric symptoms: thick-coated tongue;
bitter taste ; nausea ; belching ; vomiting ; loss of appetite ; little or
no thirst ; pain in the bowels, diarrhoea or constipation. Sweat breaks
out during the heat but soon disappears, and is again followed bj dry
heat.

Apis, according to Wolf, it is one of the most important remedies
in all kinds of intermittent fevers, and indeed it has been used every-
where with great success. Chill about three or four o'clock p. m.;
worse in the warm room or near the stove ; renewed chilliness from
slightest motion, with heat of the face and hands. Heat, especially
in the chest, pit of the stomach, bowels, female organs, and hands,
with muttering and unconsciousness ; diarrhoea ; shortness of breath ;
drowsiness or sleeplessness. Sweat alternates with dryness of the
skin. During the ai^yrexia, pain under the short ribs, worse on the
left side ; great soreness of all the limbs and joints ; great debility ,
enlargement of the abdomen ; swollen feet and scanty urine. Apis is
therefore indicated, not only in recent but also in protracted and
badly-treated cases. After it Natr. mur. follows well.

Arn., before and during the chill great thirst ; drinks a great deal,
and vomits afterwards ; pain in all the bones ; bed and sofa feel too
hard ; the chill is felt worst in the pit of the stomach ; cold hands
and feet, with heat in the head and face, and redness of one cheek ;
Tieat, with indifference, stupor; drinks less; the sweat smells sour;
during the aj)yrexia stitching pain in the region of the spleen-, sore-
ness of the spleen on pressure ; aching in all the limbs as though
beaten.

Arsen., intermittens incompleta. Before the attack : vertigo ; head-
ache ; yawning ; stretching ; general discomfort ; weakness ; pain in
the pit of the stomach and empty eructations ; cutting pain in the
bowels. The cMll is frequently intermixed with heat ; or heat and
chilliness follow each other in rapid succession ; or the patient feels
cold inside and burning hot outside. During the chill : generally no
thirst ; if there be any, drinking increases the chill and causes vomit-
ing; oppression and spasms in the chest, with hacking cough; bloat-
ing of the pit of the stomach ; pain in the pit of the stomach ; anxiety,
restlessness ; blue nails. The heat is either wanting, or mixed up
with the chill, or is very great, with delirium, unconsciousness and
headache ; restlessness ; anxiety ; pulsation through the whole body ;
tension and pressure in the left hypochondrium ; burning in the



556 FEVERS.

stomach ; mostly great thirst, but drinking little at a time ; oppres-
sion and short breathing ; palpitation of the heart. The sweat sets in
some time after the heat, or does not appear at all ; during the sweat
the thirst is often the greatest, and the patient drinks large quantities
of water; the symptoms of the former stages become ameliorated.
The apyrexia is never clear. The face is pale, sunken, earthy, sallow,
bloated ; the lips are pale, cracked, swollen and crusty ; the tongue
is white and dry, or yellowish-coated ; the taste is gone, without bad
taste, only after eating bitter taste ; the appetite is sometimes in-
creased for a while, satisfying it causes heat and nausea, and not
satisfying it causes an unpleasant sensation of discomfort ; the hypo-
chondriac regions are swollen, especially the left, the abdomen is
bloated ; the stools are diarrhoeic, fetid ; the urine is rather scanty
and turbid , the feet are oedematous ; the skin is pale, often covered
with cold perspiration ; there is sleeplessness, especially the night
before a new paroxysm, and great sinking of general strength.

Bell., the heat predominates, with vertigo, hallucinations, delirium,
restlessness, anxiety; drowsiness, with inability to go to sleep, or
sopor; headache-, injected eyes, and sensitiveness to light; red
cheeks ; throbbing of the carotid arteries ; choking sensation in the
throat ; great thirst and dryness of the mouth and throat ; palpita-
tion of the heart , painful swelling of the spleen ; constipation ; great
irritability of temper, or else tearful mood.

Bryon., the chill predominates, only exceptionally the heat ; great
thirst during the chill, still greater during the heat; the sweat lasts
long. There is, as the most important leading symptoms : stitching
pain in the sides of the chest, with hard cough , stitching pains in the
hypochondriac regions and in the abdomen ; rheumatic pains in the
limbs ; all worse from motion.

Cactus gp., regular paroxysms at 11 o'clock A.M. or p.m.; first
chill, then burning heat, with headache, coma, stupefaction, insensi-
bility; thirst, shortness of breath, inability to remain lying. The
sweat is profuse, and attended with inextinguishable thirst. The
apyrexia is complete.

Calc. c, chronic cases; thirst during the chill. General indica-
tions : hardness of hearing ; pot-belliedness ; hard, bloated stomach ;
enlarged spleen; diarrhoea, white, undigested; monthly period too
early and too profuse ; glandular swellings about the neck ; altogether
scrofulous diathesis.

Caps., chill, mostly with thirst, and worse after drinking ; the chill
commences in the back and spreads all over ; after the chill sweat ;



INTEEMITTENT FEVER. 557

or heat, with sweat and tliirst at the same time. During the chill:
giddiness and excruciating tearing pains in the back and limbs, ex-
torting cries, and causing the patient to bend together like a hedge-
hog. During the heat : cutting pain in the bowels, and slimy, burn-
ing stools, with much pressing and bearing down ; headache.

Carbo veg., irregular paroxysms, sometimes commencing with
sweat, followed by chill. Before the attack toothache, headache and
pain in the limbs. During the chill great thirst. Heat and sweat
frequently mixed together, with evening hoarseness, dizziness, red
face, nausea, but no thirst. The sweat is sour and sometimes very
profuse. Afterwards long-continued headache ; heat and burning in
the eyes ; yellow complexion ; liver-spots in the face ; belching ; bad
smell from the mouth ; stomach bloated ; spleen swollen and painful ;
abuse of quinine.

Cham., heat and siveat predominate, and often together; red face,
or only one cheek red and the other pale ; sweat especially about the
head, and mostly hot. The tongue is red in the middle and white on
the sides, or white in the middle and red on the edges ; bitter taste ;
bitter vomiting ; great oppression about the heart ; diarrhoea. The
patient is very irritable, excited, complaining, with great restlessness
and anxiety.

China, the paroxysms come mostly at irregular hours, with thirst
before (not during) chill or heat and during the sweat ; they are
mostly preceded by palpitation of the heart with anxiety ; sneezing ;
nausea ; hunger ; pressure in the stomach ; pain in the bowels and
jerking, tearing headache ; pain in the limbs and great debility.
During the fever the veins appear greatly enlarged, and there is
great congestion to the head, with redness and heat of the face, even
with chilliness and coldness of other parts of the body. The sweat
is sometimes only partial and cold ; for example, on the forehead ; at
other times it is profuse, and almost always attended with thirst. In
general the patient sweats easily, especially at night during sleep ;
there is swelling of the liver and spleen, painful to motion and pres-
sure ; a characteristic weakness, exhaustion and cachectic appear-
ance, a sallow yellowishness of the skin, not only in the face but also
on the chest and region of the stomach, and different anaemic and
dropsical symptoms. The urine is scanty and turbid, with a thick
yellowish or brick-dust sediment, or a sediment of little crystals.
The presence of swamp-miasma is another indication.

Chinin. sulph., regular paroxysms at the same hour, and clear inter-
missions; real thirst, mostly only during the sweat. During the



558 FEVERS.

paroxysm pain in the dorsal vertehrse on pressure; pain in tlie region
of the liver and spleen on bending, taking a deep breath, coughing ;
the urine gives a voluminous, brick-dust-like or fatty sediment, or
contains crystals of urates ; ringing in the ears, with dizziness and
enlarged feeling of the head.

Cimex, before the chill thirst and heaviness in the legs. The chill
commences with clenching of the hands and violent raging; it is
attended with pains in all the joints ; sensation as if the tendons were
too short; the knee-joints are usually contracted, so that the legs
cannot be stretched ; the chest feels oppressed, obliging one to take
a long breath frequently ; irresistible sleepiness ; it ends with a tired
feeling in the legs, obliging one to change position constantly ; with
thirst ; drinking, however, causes violent headache ; continuous dry
cough; oppression of breathing; heaviness in the middle of the
chest; anxiety. Abstaining from drinking ameliorates all this. The
heat is attended with gagging ; the oesophagus feels constricted, and
the water drank goes down only at intervals ; no thirst. The sweat
is mostly on the head and chest, accompanied by hunger.

Cina, thirst only during the chill, or only during the heat. Nausea,
vomiting, diarrhoea, pain in the stomach and abdomen may set in at
any time, and soon be followed by a clean tongue and ravenous ap-
petite. The face is puffed and pale even during the heat ; the pupils
are much enlarged, and the child often picks at the nose.

Diadema, paroxysms every day or every other day at precisely the
same hour ; chill predominating ; constant chilly feeling ; always
worse in rainy, cold days; menses too early and too profuse; enlarge-
ment of the spleen,

Eupatorium perf., long before the chill great thirst, which continues
through chill and heat; after drinking vomiting; the paroxysms
usually occur in the morning, about seven or nine o'clock; they arc
attended with intense aching in the back and limbs, as if the bones
were broken, and with a number of gastric or so-called bilious symp-
toms ; the sweat is generally not very prominent, or even wanting,
but sometimes drenching, and the intermission is sometimes marked
by a loose cough.

Eupatorium purp., the paroxysm comes at different times in the day,
every other day ; chill commences in the ho,ck and then spreads over the
body ; violent shaking, with comparatively little coldness ; thirst
during chill and heat ; violent bone-pains during chill and heat.

Ferpum, similar to Arsen. and China, it will be frequently of ser-
vice in protracted and badly- treated cases by quinine, which arc



INTEEMITTENT FEVEE. 559

characterized by anosmia and total prostration of tbe reproductive
sphere of the system. We observe great paleness of the face, which,
however, may flush up from any excitement to a fiery redness of
short duration ; pale, almost white ; paleness, whiteness of the inner
surface of the mouth ; vomiting of every thing that is eaten without
being digested ; swelling and hardness in the hypochondriac regions
great weakness and emaciation ; dropsical swelling of the feet
frequent congestion of the lungs; continued shortness of breath
nun's murmur in the veins.

Gelsem., from all that is published about this valuable agent I can-
not make out a definite sphere of its action. It seems to be
especially suitable in evening paroxysms, when the chill begins in the
extremities ; where the heat is attended with nervous restlessness ;
delirium ; mental anxiety or agitation ; vertigo ; a curious sensa-
• tion oi falling ; sensitiveness to light and sound ; partial blindness or
deafness ; or where there is a want of distinctiveness in its several
stages, the whole presenting an adynamic condition of the system,

Hepar, bitter taste in the mouth; bilious vomiting; diarrhoea;
itching, stinging nettlerash before and during the chill ; fever-blisters
around the mouth ; tettery eruptions in the chest ; previous abuse of
mercury.

Ignat., thirst only during the chilly or in short spells, independent of
any stage. The chilliness is relieved by the external application of
warm things ; external heat, or heat in some, and coldness of other
parts of the body ; sometimes with pain in the bowels ; afterwards
sleep and sweat. The paroxysms are sometimes accompanied with
spasmodic symptoms ; heaviness of the head ; aching pain in the
occiput ; vomiting and pressive pain in the pit of the stomach. The
paroxysms are apt to postpone or antepone.

Ipecac, predominance of gastric symptoms during the paroxysm as
well as during the apyrexia. It begins chiefly with yawning, stretch-
ing, and a collection of saliva in the mouth ; then follows the chill,
with nausea, vomiting, diarrhoea, and great oppression of the chest,
with heaving. The three stages may be very strongly marked or
very light ; the thirst is generally quite inconsiderable in all of them.
The apyrexia has the same gastric symptoms, especially a marked
sensation of relaxation of the stomach, as though it were hanging
down ; entire loss of appetite. The spleen is little if any swollen.
Miasma ; after the abuse of quinine and arsenicum ; after faults in
diet.

Laches., one of the most important remedies after the abuse of



560 FEVERS.

quinine. The paroxysms are mostly in tlie afternoon, witli pain in
tlie small of tlie back and limbs; restlessness; oppression of tbe
chest; jerking; headache; red face; talkativeness.

Lycop., where there are other chronic symptoms — cough, with
thick, yellow, salty expectoration ; oppression of the chest ; pain in
the left side ; palpitation of the heart ; pale face, often with circum-
scribed redness of the cheeks ; sour vomiting ; bloatedness of the
stomach ; rumbling in the bowels ; great debility ; the sweat is often
sour and profuse, following sometimes immediately upon the chill,
and at other times not until some time after the heat ; after the sweat,
thirst,

IVSangan., incomplete intermittent, consisting of only heat and
sweat, with moderate thirst.'

IVlezer., incomplete intermittent, consisting of chill with thirst, and
sweat with sleep.

IMatr. m., one of the most important of all in recent as well as in in-
veterate and badly -treated cases. Hard chill very often at 11 o'clock
A. M., with great thirst which continues through all stages. The heat
is characterized by the most violent headache. There soon appears
an eruption of hydroa or fever-blisters, which cover like pearls the
upper and lower lip. During the apyrexia sallow complexion, dry,
white-coated tongue ; bitter taste ; water tastes bad ; loss of appetite ;
after eating, sour belching and vomiting; pressure in the stomach;
swollen stomach; pain in the region of the kidneys; cutting pain in
the urethra after micturition.

Nux V. is characterized by great prostration and paralytic weak-
ness from the beginning. Hard chill with bluish face and blue nails ;
stitching pain in the abdomen ; spasmodic drawing and stiffness of
the lower extremities ; great thirst ; the heat is great, and notwith-
standing this the patient covers himself all over, because uncovering
or the slightest motion makes him feel chilly ; headache ; great thirst,
especially for beer. Both chill and heat are accompanied with gastric
and bilious symptoms. During the sweat the painful symptoms
gradually subside. During the apyrexia, headache ; yellowish com-
plexion ; belching; loss of appetite; nausea; vomiting; constipa-
tion ; liver and spleen swollen ; cough ; debility ; soreness of the
spine.

Opium, sleep during chill and heat ; during sweat he feels still
burning hot ; children and old people.

Pulsat., the several stages are in general not very violent, and mostly
unattended by thirst ; or thirst only during the heat ; or the several



INTERMITTENT FEVER.



561



Stages are mixed up. The paroxysms set in frequently (fhougli not
always) in the evening, and last through the night. Characteristic
features : tearful and peevish ; headache during the intermission ; face
pale or yellow-greenish ; tongue moist, coated, with bad taste ; loss of
appetite and thirst ; nausea ; vomiting of slime and bile ; spleen en-
larged ; stools diarrhoeic, slimy, watery, at night ; profuse, watery
urine ; suppressed or scanty menses ; pain in the chest and cough,
with pain in the bead and pit of the stomach ; frequent palpitation of
the heart; murmur in the jugular veins; constant chilliness and
drowsiness ; chlorotic state of the system.

Rhus t., before the chill ; stretching of the limbs ; yawning, with a
feeling in the maxillary joint as if sprained; thirst; cough, with
sweetish, foul expectoration. Chill in some parts, and in others heat ;
or hard chill, with aching in the small of the back, drawing in the
limbs, and formication in the fingers ; with restlessness and constant
change of position. The heat is sometimes before and sometimes
after the chill, and often attended with nettle-rash ; pain in the bowels
and diarrhoea. The following sweat is often profuse and sour. The
paroxysms set in most frequently in the evening and last through the
night ; they generally return every day, but seem altered every other
day.

Sabad., intermittens incompleta, consisting of chills only; or inter-
mittents with predominating chill, and thirst between chill and heat ;
the paroxysms occur precisely at the same hour ; sometimes they are
accompanied with morbid hunger in alternation with loathing of food ;
during the apyrexia there is a constant chilliness ; sometimes cough
with heavy breathing and pain in the chest.

Sambucus, profuse, debilitating sweat, lasts through the apyrexia ;
commences in the face, is worse whilst the patient is awake, disap-
pears and changes to a dry heat when he is falling asleep.

Sepia, chronic cases, with one or the other of the following symp-
toms : frequent flushes of heat; paralytic sinking down of one of the
upper eyelids ; yellowishness of the white of the eyes ; brownish-
yellow saddle across the bridge of the nose ; yellowishness around tlie
mouth; loathing of meat and milk; diarrhoea after drinking milk ;
pain in the liver on moving; bearing down towards the genitals; pal-
pitation of the heart ; tettery eruptions ; the coldness begins in the
feet and rises upwards.

Silicea, in scrofulous subjects.

Sulphur, like Sepia, in chronic cases ; especially when rooting in the
soil of suppressed itch or other cutaneous eruptions, with one or the

36



562 FEVERS.

Other of the following symptoms : heat on the top of the head, with
cold extremities ; red lips ; red tip of the tongue ; worse always after
eating ; sudden attacks of faintness, with hunger in the forenoon ;
costiveness, or else looseness of the bowels early in the morning,
driving out of bed ; hemorrhoidal complaints ; leucorrhoea : cough
when lying down in the evening ; feverishness through the night ;
complete sleeplessness; itchiness of the skin.

Tart, em., thirstlessness during chill and fever ; shuddering with
sleepiness; heat with sopor ; sweat with sleepiness; fainting; anxiety;
and pain in the lower extremities.

Thuya, according to Wolf, if Apis is not suf&cient, and the com-
plaint originates in a chronic gonorrhoeal contamination of the system ;
only the uncovered portions of the body perspire ; those which are
covered are dry and hot.

Veratr., chill and coldness predominate ; with sticky, cold perspira-
tion ; heat not so marked ; the sweat profuse, often cold and long-
continuing. Attending symptoms: great exhaustion; sinking of
strength ; nausea ; vomiting ; diarrhoea, or obstinate constipation ;
cramps in the limbs. It is indicated, therefore, in the most pernicious
kinds of intermittent fevers, and those which occur during the preva-
lence of cholera.

Pernicious Intermittent; Remittent and Continuous Ma-
larial Fevers ; Congestive Fevers.

These fevers are frequently met with in the south and southwest of
the United States, and in the tropical countries. They are all of a
malarial origin ; which is proved by the fact, that they occur exclusively
in regions ivhere ague prevails ; in regions, therefore, which, by their
conformation of soil and climate, constitute the necessary conditions
for the development of the miasma; and it is further proved by the
fact, that remittent fevers, when improving^ gradually change into the in-
termittent type. Hence remittent fevers are only graver forms of the
effects of the same unknown virus, called miasma, that causes the
ague ; and this corresponds again with the fact that we find remittent
fevers oftener in such regions in which the common intermittent cases
are likeiuise much more severe than in other regions.

The pernicious intermittent is characterized either by a higher viru-
lence, intensity, and longer duration of all its stages, so that the end
of an attack reaches into the beginning of a new paroxysm ; fehris
intermittens subinirans ; or the heat alone increases to such an in-



CONGESTIVE FEVER. 563

tensity as to induce delirium, stupefaction, and coma ; simulating all
the appearances of typhus or malignant infectious diseases: fehris in-
termittens comaiosa; or the chilly stage predominates to such an extent
that the pulse becomes smaller and smaller, the impulse of the heart
weaker and weaker, the stagnation of the blood in the veins greater
and greater, causing cyanosis, and the temperature of the body lower
and lower, to perfect collapse, simulating thus closely the appearance
of cholera, which may indeed prevail simultaneously at the same
place: fehris intermittens algida.

Remittent fever has no apyrexia, but in place of it there is merely



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 56 of 65)