Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

. (page 59 of 65)
Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 59 of 65)
Font size
QR-code for this ebook


seem to him dangerous ; perceptions entirely lost ; he is unconscious ;
eyes hollow, staring, and sunken; pupils much dilated and little



582 FEVERS.

sensitive to light, immovable, and but slightly dilated; nostrils dry
and black ; face sunken and hippocratic ; risus sardonicus ; lips,
teeth, and tongue covered with a thick, brown coating ; lips cracked ;
face covered with perspiration ; grinding of teeth ; tongue protruded
with difficulty ; tongue bright red ; tongae heavy, stiff", and numb ;
loss of speech ; inextinguishable thirst ; epigastrium and stomach,
extremely sensitive to pressure ; abdomen distended, tense, and hard ;
surface of the abdomen hotter than the rest of the body ; tympanites
with pain in the back ; watery diarrhoea ; the stools are passed in-
sensibty ; stools fluid, offensive, with white flakes ; involuntary
stools ; numerous, liquid, dark, offensive stools, with severe pain ;
secretion of urine suppressed; urine copious ; involuntary urination;
respiration irregular and intermittent.

Cuprum, according to Baehr, in typhus without high fever, but with
excessive weakness, which increases under the signs of dissolution of
blood (nose-bleed and petechise) rapidly, until under general par-
alytic symptoms death ensues.

Fluop. ac, recommended by Hering when there is decubitus.

Ginseng, loud gurgling noise in the ileo-csecal tract, dry tongue,
heat, delirium on going to sleep. Liedbeck.

Hydrocyan. ac, when the drink which is swallowed rolls audibly
down the throat, as though it were poured into an empty barrel.
Heynel.

Hyosc, entire loss of consciousness, and of the functions of the
organs of the senses ; does not recognize relatives or friends; illusions
of the imagination and senses. Delirium which is continued while
awake, and which sees persons who are not and have not been
present. Indistinct and muttering loquacity; muttering with picking
of the bed-clothes; inability to think, the thoughts cannot be directed
or controlled ; constant staring at surrounding objects, with apparent
entire self-forgetfulness ; or else great agitation; restlessness; jump-
ing out of bed; attempts to run away, &g. Eyes red and sparkling,
staring, rolling about in their orbits; squinting; deafness; distorted
face, stupid expression; tongue red or brown, dry and cracked;
paralyzed; loss of speech, or indistinct speech; cadaverous smell
from the mouth; involuntary or unnoticed stools in bed; suppressed
secretion or retention of urine ; involuntary discharge of urine.
Paralysis of sphincter ani and vesicae. Convulsive motions; grating
of teeth; jer kings; subsultus tendinum; trembling; sleeplessness, or
constant sleep with muttering; coma vigil. Koseola spots on chest
and abdomen.



TYPHUS.



583



Ignat., great impatience and despair about pains and bad feelings,
wbich he cannot describe; gets easily frightened, and feels as though
he were swung toand-fro in a cradle or in a swing. Attacks of
yawning, stretching, followed by pain in the front of the head, which
does not allow opening the eyes; choking sensation from the stomach
up into the throat, with oppression in the chest, better from belch-
ing ; palpitation of the heart ; sinking, weak feeling in the pit of the
stomach ; convulsive motions of the limbs ; jerking of the tendons.
Sleeplessness on account of various visions as soon as he falls in a
doze ; troublesome dreams.

Lachesis, fever worse in the afternoon ; sweat without alleviation ;
sleep with following aggravation of all the symptoms; loss of con-
sciousness ; muttering ; stupor ; sunken countenance ; dropping of
.lower jaw; dry, red or black tongue, cracked on the tip and bleed-
ing ; in the attempt of protruding it, it trembles ; or the tip remains
under the lower teeth, and does not come out; dry lips, cracked
and bleeding ; stools very offensive, whether formed or loose ; sore
throat, with deafness ; nasal, indistinct speech ; dyspnoea ; cough, with
slimy, bloody expectoration.

Lye, sopor ; delirium ; uses wrong words for correct ideas, which
he intends to express ; fear to be left alone ; restless sleep, with out-
cries and loud laughing ; when awaking, exceedingly cross, irritable,
scolding, screaming, behaving disagreeably ; violent jerkings of the
limbs, shaking the whole body, awake or asleep ; subsultus tendinum ;
catching at flocks ; sunken face, yellowish, or with circumscribed red-
ness in the afternoon ; tongue red and dry ; sometimes it is spasmodi-
cally thrust to-and-fro between the teeth ; lower jaw sunken ; bowels
much distended, with rumbling and constipation; urine leaves, if voided
in bed, a red, sandy stain ; cold hands and cold feet ; one foot hot and
the other cold.

Merc, may be indicated at the beginning of the disease, when there
is : swollen and bleeding gums ; fetor from the mouth ; pain in the
liver ; green-yellow stools ; dark urine ; bronchitis ; icteroid color of
the skin.

Moschus, in cases of impending pamlysis of the lungs, where the
cough ceases and the collected mucus cannot be expectorated ; where
respiration and pulsation of the heart grow weaker and weaker ;
where in swallowing, the fluid rolls audibly down the throat, and stool
and urine pass off involuntarily.

Mup. ac, febris stupida; constant sliding down in bed, with groan-
ing and moaning in sleep, and muttering and unconsciousness whilst



58i FEVEES.

awake ; excessive dryness of moutb and tongue ; tlie tongue is Tieavy,
paralyzed ; the patient cannot mo>e it at will, even if conscious ; the
pulse intermits every third beat ; profuse discharge of watery urine ;
watery diarrhoea ; stools and urine involuntary.

Nitr. ac, in case of typhoid hemorrhages ; great sensitiveness of the
abdomen ; green, slimy, acrid diarrhoea ; tenesmus ; white, coated
tongue, with sore spots ; inflammatory affection of the lungs with rat-
tling cough and breathing ; brownish, bloody expectoration and irreg-
ular pulse ; after calomel.

Nux v., "in the early stage, if there be chilliness on slightest move-
ment ; dryness of the front of the mouth and tip of the tongue ; intol-
erance of impressions on the external senses, all of which seem much
exaggerated ; great sensitiveness to the open air ; thirst, with aversion
to water ; strong want to lie down, and considerable relief on doing
so." Wells.

Opium, febris nervosa stupida ; the stupor is complete ; he cannot
be roused or only with great dif&culty ; lies speechless, with open eyes
and stiff" limbs ; delirium, mild or furibund, with loud talking, laugh-
ing or singing ; attempts to escape ; congestion to the head ; face dark-
red and bloated ; respiration slow, deep-drawn and sighing, stertorous,
rattling; constipation or offensive watery diarrhoea; involuntary
stools ; retention of urine.

Phos., pneumo-typhus ; violent bronchitis and even hepatization ;
hard, dry cough with tightness in the chest ; or loose, rattling cough,
with tough, transparent, or thick, yellowish, or reddish expectora-
tion ; cough worse from evening until midnight ; vomiting of watery,
bilious, and slimy masses with great pain ; frequent, unpainful diar-
rhoea with meteorism and loud rumbling ; the discharges are watery,
greenish, grayish, or black from decomposed blood ; great weakness
after each discharge ; numerous roseola-spots, ecchymosis, and miliary
eruption on the trunk ; great heat of the trunk with cold perspiration
on head and extremities.

Phos. ac, complete apathy and indifference; don't want to talk;
answers slowly and reluctantly, or short, incorrect ; stupor ; stupid
expression of the face ; bleeding from the nose ; meteoristic distention
of the abdomen, with a great deal of rumbling and gurgling, and
unpainful, watery, grayish diarrhoea ; also involuntary stools ; great
debility; relaxed, pale skin; ecchymosis; bluish-red spots on the
parts where the patient lies upon ; decubitus ; temperature of the
body not high ; constant, sticky, or profuse sweat ; pulse weak, and
small, frequent, and intermitting.



TYPHUS. 5S5

Pulsat,, at the early stage wliere external heat is intolerable, caus-
ing a sense of heat with distress ; uncovering, however, is followed
immediately by a chill ; or there is heat only of one side, or heat of
one side with coldness of the other ; or sweat of one side ; there may
be great drowsiness ; delirium ; frightful visions ; dry tongue, as if
burnt, and yet no thirst ; rumbling in the bowels and diarrhoea, with
pinching pain, worse at night ; pulsating in the epigastrium.

Rhus t., mental operations are slow anfl. difficult ; he answers cor-
rectly but slow, sometimes hasty ; delirium ; talks much to himself,
or talks incoherently, without any seeming connection of ideas ;
headache ; worse from opening and moving the eyes ; bleeding from
the nose, especially after midnight; the lips are dry and covered
with brown crusts ; the tongue is red at the tip, in the shape of a
triangle ; the bowels are loose, worse at night ; involuntary alvine
discharges during sleep. There is often severe cough, with tough,
bloody expectorations ; bronchitis ; pneumonic infiltration at the
lower lobes of the lungs ; severe rheumatic pains in the limbs, worse
in rest ; somewhat ameliorated by moving and changing position ;
constant restlessness; tossing about; restless sleep, with frightful
dreams, and frequent waking, and never that state of quiet, profound
coma ; dry heat or sweat, during which the patient desires to be
covered ; roseola-spots ; miliary eruption ; great exhaustion.

Silic, sometimes in the very worst cases, with excessive debility,
profuse perspiration, and a strong desire to be magnetized ; magnetiz-
ing relieves the great weakness, and Silicea promotes the forming of
abscesses, boils, &c., thus throwing the poison to the surface, and
securing a gradual though slow recovery.

Stpam., loss of consciousness ; imbecility ; stupefaction of the
senses ; delirium ; singing ; laughing ; whistling ; constant, involun-
tary, odd motions of the limbs and body ; spasmodic distentions of
the face ; loss of sight, hearing, and speech ; all objects appear
oblique to him ; red rash upon the chest; blackish diarrhoea every
hour ; stools smell like carrion ; suppressed secretion of urine ;
retention of urine ; copious, involuntary discharge of urine.

Sulphur, when in psoric individuals the well-selected remedy has
no or only a superficial effect ; besides, if there be sleepless nights ;
slow comprehension when being asked; heat and fulness in the head;
chronic, sore, and inflamed eyelids ; great dryness of the ears ; pale,
sickly aspect ; bright, red lips ; undefined redness of the tip of the
tongue ; bleeding from the nose, teeth and gums ; offensive smell
from the mouth ; diarrhoea, worse early in the morning ; unpainful



686 FEVEES.

or witli tenesmus; great prostration after stool; offensive urine;
catarrh and inflammation of the lungs, especially during the com-
mencement of infiltration, recognizable by the crepitation sound.

Taraxacum, during rest intolerable, tearing pains only in the lower
extremities, (Rhus t. has such pains in all the limbs;) constant mutter-
ing to himself, similar to that of Hyoscyamus ; violent, tearing pain in
the occiput ; great chilliness after taking any thing to eat or drink.
(v. Bo 67171171 ghaus en.) Map-tongue.

Tart, em., in pneumo-typhus, with great rattling in the chest,
dyspnoea, &c. ; symptoms of oedema pulmonis.

Veratr., during cholera-epidemics; great prostration; cold sweat-
ing ; coma ; vomiting and watery diarrhoea ; bluish face ; pointed
nose ; wrinkled skin.

Zincum, staring eyes; delirium with attempts to get out of bed ;
complete unconsciousness ; lying on the back and sliding down in
bed; grasping at flocks; subsultus tendinum ; constant trembling of
the hands and coIdTiess of the extremities ; relaxation of the muscles of
the face ; hippocratic face ; pale, waxy complexion of the face ;
decubitus on the sacrum and trochanter ; frequent, involuntary dis-
charges from the bowels ; frequent, small, intermitting, scarcely per-
ceptible pulse ; impending paralysis of the brain.

General Jlints,

In predominant cerehral symptoms, compare: Apis, Bell., Bryon.,
Cupr., Hyosc, Lach,, Opium, Stram., Zinc.

In predominant abdomi7ial affections : Apis, Arson., Bryon., Carbo
veg., China, Colch., Ginseng, Merc, Nux v., Phos. ac, Ehus t., Secale,
Sulphur, Ver.

In 'p7ieumo-typhus : Apis, Bell., Bryon., Merc, Phos., Puis., Rhus t.,
Sulphur, Tart. em.

In febris nervosa stupida: Arn., Ars., Carbo veg., Cocc, Hyosc,
Lach., Mur. ac, Phos. ac, Rhus t, Secale.
■ During reconvalescence, when there is too great hunger: Puis.

Diarrhoea, with cutting in the bowels after sour things : Ipec.

Over-exertion of the body : Rhus t.

Fright: Ign.

Chagrin : Nux v.

Loss of memory : Anac

Complaints, which go from above downwards : Selen.

When commencing below and spreading upwards : Gaaco.

Protracted reconvalescence : Psorinum.



MEASLES. « «^87



EXANTHEMATA.



Measles are contagious, and more so during tlie stadium prodromo-
rum et eruptionis than at a later period. The nature of that poison
is entirely unknown. Only this much is certain, that it regenerates
itself in the infected person, that it impregnates the surrounding at-
mosphere, and that it may be carried from there to other quarters.
Measles prevail therefore mostly as epidemics, in preference, it seems,
during those months which favor catarrhal affections. As a general
rule, they attack a person only once in life, and more children than
grown persons, although there are many exceptions. The time of
incubation varies from eleven to fourteen days.

The eruption of measles consists in numerous, roundish, lentil-sized
red spots, which are a little raised above the level of the surrounding
skin, and contain generally in their centre a little papula. The closer
they appear the more do they coalesce, and in this way they form ir-
regular, half-moon-shaped plaques, whilst on places where they are
scarce, they stand isolated. Between these spots the skin appears of
a normal color ; on the face, however, it is usually somewhat oedema-
tously swollen. Even in cases where they appear so abundantly as
to coalesce, {moriilli confluentes^ they do not present an evenly diffused
redness, but always a spotted appearance. There are cases in which
the hyperasmia of the skin results into an extravasation of blood,
causing the eruption to assume a dark, blood-red appearance, and
petechial spots to appear between the eruption ; this form is called
morbilU 2:)etechiales or ruheolse nigrse. The measly redness disap-
pears under the pressure of the finger, and reappears again after re-
moving the finger, from the middle toioards the periphery, contrary to
scarlet-fever redness, which reappears from the periphery to the
centre. Measles are always more or less accompanied by catarrhal
affections of the eyes, nose, larynx and bronchial tubes, even by pneu-
monic symptoms. The blood is, like in other infectious diseases,
destitute of fibrin, and of a dark color.

The course and progress of measles is the following :

The first stage, or the stadium prodromorum, consists in a seem-
ingly simple cold in the head and chest. There is chilliness and



588 EXANTHEMATA.

feverisTiness ; "headaclie ; sensitiveness to light ; watery eyes ; watery
discharge from the nose ; sneezing ; nose-bleed ; hoarseness and
cough, which latter assumes sometimes a croupy nature. Only in
exceptional cases these symptoms amount to any considerable severity,
and may then be associated with vomiting, delirium and sopor ; in
the majority of cases, however, the little patients do not mind them,
but run about. On inspection of the fauces we observe that about
the third day of this premonitory stage the identical eruption of
measles has made already its appearance in the form of single, lentil-
sized red spots upon the roof of the mouth and fauces, some twenty-
four or twelve hours before there is any sign of an eruption on the
external skin. This accounts at once for all the catarrhal symptoms,
and for the fact that measles are already transmitted at this early
stage from child to child by the mere breath.

The second stage, the stadium erwptionis, is marked by an exacerba-
tion of the fever ; the temperature of the body rises and ranges during
the height of the disease between 39, 4° and 40, 4°, and may, in severe
cases, reach even 41°. During this time it happens occasionally that
convulsions set in. The eruption appears first in the face and spreads
gradually downwards over the whole body. There is now a peculiar
measle-smell, scenting the whole atmosphere of the patient. In
anomalous cases the eruption appears at first on the arms ; in others
it stays confined to single portions of the body, and in still others
there is no eruption at all, {morhilli sine exanthemate,) although all
the other symptoms and the previous exposure to the infection leaves
no doubt as to the nature of the disease. The stadium eruptionis
generally is completed in twenty-four to thirty-six hours, although in
some cases it lasts three, even four days, in which cases the first spots
already disappear when the last come out.

During this stage the catarrhal affection generally reaches its height,
and in malignant epidemics it occurs that already at this early stage
death ensues in consequence of general paralysis and adynamia. In
such cases the pulse grows weaker and weaker ; the cutaneous capil-
laries burst and cause hemorrhages within the cutis ; the prostration
of strength is excessive, and the patient sinks into a typhoid condition.

The third stage, the stadium florescentise, is blended with the erup-
tive stage. In usual cases, already twenty-four hours after its full
development, the redness commences to grow paler, and with it all the
other symptoms, heat and catarrh, gradually grow milder. Such
normal cases are termed morhilli vulgares, simplices or erethici.

In other cases the measle-spots grow darker, assume a purple color,



MEASLES. 589

and remain visible upon tlie skin for five or six days. The dark color-
ing of the eruption is owing to the rupture of the cutaneous capilla-
ries, and for this reason the redness does not disappear under the
pressure of the finger. The whole morbid process is of a much
severer nature, and approaches that of other inflammatory processes.
The heat rises above 40° ; there is throbbing of the carotid arteries,
palpitation of the heart, and a full, strong pulse ; the catarrhal cough
not unfrequently changes into a croupy cough, and there may even
exist a complication with lobular pneumonia ; or the catarrhal affec-
tion extends upon the alimentary canal and causes vomiting and diar-
rhoea. This state of things may augment to complete prostration and
collapse ; then the eruption disappears from the skin, and such a condi-
tion is not without danger. This form of measles has been termed
morbiUi inflammaiorii, or synocliales.

A still other form is that which has already been alluded to in the
second stage. It is characterized by general adynamia and torpor.
The eruption remains visible only a short time, is either pale-reddish
or purple, and frequently interspersed by petechiee. It is often com-
bined with profuse bleeding from the nose ; the pulse is very frequent
and scarcely perceptible ; and the patient sinks into sopor and col-
lapse. This form is called morhilli asthenici^ nervosi^ torpidi, or septici.

The fourth stage, the stadium desquamationis, commences in simple
cases usually about the eighth or ninth day of the disease. The
measle-spots have at this time entirely disappeared, and in their places
we observe a gradual loosening of the epidermis, which is thrown off
in the form of fine scales. This process can best be observed on the
face and hands, whilst on the parts covered, the loosened skin is rubbed
off before it is noticed. This stage is rarely interrupted by dangerous
complications ; still it may become complicated by croupous laryngitis
or pneumonia. Noma or mortification of the labia pudenda is of
very rare occurrence.

As sequelse of measles are mentioned as quite prominent, chronic,
catarrhal cough, and chronic pneumonia, which may end in con-
sumption. Besides these, a number of scrofulous affections, such as
chronic inflammations of the eyes; otorrhoea; glandular swellings;
and chronic inflammations of the periosteum and of the joints. It is
but just to remark that under homoeopathic treatment sequelas are of
very rare occurrence.

Therapeutic Ilints. — The bed-room ought not to be kept too
warm, but of an equal temperature of about 05 or 06° F. It ought



690 EXANTHEMATA,

to be aired frequently with care. The light in the room ought to be
modified according to the patient's own desire. If he wants to drink,
let him have cold water ; he may eat fruit provided his bowels are
not disordered. After fever and catarrhal irritation have passed
away, give him a warm bath, and on the following day a cool wash
all over, taking care that it be done quickly, and that the patient be
well rubbed and dried by flannel afterwards. After that time he
may be allowed to go into the fresh air, provided the weather allows it.

Aeon, is the very remedy at the beginning, because it corresponds
to all the symptoms of usual cases — full, quick pulse, dry, hot, burn-
ing skin ; fever ; restlessness ; catarrhal irritation from the eyes down
into the bronchial tubes ; nose-bleed ; dry, hacking, or even croupy
cough ; stitch pains in the chest; restless sleep, with jerking and start-
ing ; grating of the teeth, moaning and groaning, or sleeplessness with
great agitation and anxiety ; pain in the stomach and bowels, with
vomiting and diarrhoea.

Ant. cr., pain in the ears; white, ""coated tongue; gastric derange-
ments.

Apis, confluent eruption and oedematous swelling of the skin ; greatly
inflamed eyes ; croupy cough ; violent cough, similar to hooping-
cough ; catarrh of the bowels, with diarrhoea ; prostration, muttering
and delirium.

Arsen., in adynamic cases. Persistent burning heat of the skin;
frequent, quick and small pulse ; great anxiety ; restlessness ; palpita-
tion of the heart ; too early or sudden disappearance of the rash ; pale,
earthy color of the face ; bloatedness of the face ; thrush in the mouth
and fauces ; constant craving for cold water, with but little drinking
at a time; vomiting and diarrhoea; great sinking of strength; all
worse about midnight.

Bell, may be indicated as often as Aeon, in the commencement, if
there be heat with moisture of the skin, quick, but soft pulse ; con-
stant drowsy sleep, or drowsiness with inability to go to sleep ; con-
gestion to the head; injected eyes; thick, white-coated tongue ; sore
throat, even diphtheritic; hollow, barking, croupy cough; jerkings
of the limbs ; convulsions.

Bryonia, by slowly-forthcoming eruptions and inflammatory affec-
tions of the chest ; dry, painful cough, constipation, &c.

Camphora, in those dangerous cases where the face grows pale and
the skin cold, assuming a bluish, purple color, with utter prostration
and spasmodic stiffness of the body. Also in different after-com-
plaints, especially painful and difficult micturition.



MEASLES. 591

Carbo veg., persistent hoarseness after measles.

Cham., painful, watery diarrhoea, in consequence of taking cold.

Coffea, nervous, restless agitation, preventing all sleep- short, dry,
hackino; couo-h.

Dposera, cough, with drawing together of the epigastrium, similar
to hooping-cough.

Euphrasia, streaming of hot, burning tears from the ejiies, with great
photophobia ; profuse running from the nose, without burning ; cough
only during the day.

Hepap, croupy cough, with rattling in the chest, but without expec-
toration ; worse in the morning.

Ipec, tardily forthcoming eruption, with oppression of the chest ;
tickling cough and vomiting.

Kali bichr., flowing of water from the eyes, with burning when open-
• ing them ; pustules on the cornea ; stitches in the left ear extending
into neck and head, with swelling of the glands ; watery discharges
from the nose with great sensitiveness and ulceration of the nostrils ;
thirst, with dryness of mouth and tongue ; watery diarrhoea, followed
by tenesmus ; loud, rattling cough, with stringy expectoration.

Merc, diarrhoea, with pain in the bowels and tenesmus.

Nux v., after previous use of drugs; nose stopped up ; cough dry
in the evening and loose in the morning.

Phos., in complication with bronchitis and pneumonic symptoms ;



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 59 of 65)