Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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protrude beyond the closed eyelids. There is considerable discharge
of purulent matter — opthalm.o-'hlennorrhcea. Should the lids stick
together — which is often the case — the matter collects behind the lids,
and runs, when the lids are opened, in a full stream down the cheeks.
' Catarrhal conjunctivitis is always heiter in the m^orning and ivorse
fro'm early evening until about midnight, when all the symptoms again
become less violent. When conjunctivitis assumes a chronic form,
its symptoms are the same, but less violent.

Therapeutic Mints,

Aeon., from cold winds, or when foreign bodies, like cinders, pieces
of steel, &c., fly into the eye,

Arsen., burning pain, lids spasmodically closed.

Bell., right eye, throbbing pain, hot tears, or dryness of the eyes ;
light is painful ; nose sore from coryza.

Digitalis, chronic; a yellowish redness of the conjunctiva palpe-
brarum.

Euphorbium, purulent discharge ; feeling of great dryness in the
eyes, with profuse discharge ; excoriations in the eye-corners.

Euphrasia, chemosis; acrid tears; coryza with burning; discharge
from the nose and pain in the frontal sinuses.



42



EYES,



IVferc. sol., cold in tlie Lead ; running of the nose.

Nux v., the inner canthi are more inflamed than the remaining por-
tions, or bloody ecchymosed spots on the conjunctiva, smarting like
salt, worse in the morninsf.

Puis., pressing pain ; smarting tears, worse in the evening.

Rhus i, great swelling of the conjunctiva; little discharge ; very
painful.

Of the same nature as the above is



This is a conjunctivitis, which often befalls new-born children;
hence its name. It is characterized by the same symptoms as ordi-
nary conjunctivitis. "When badly managed, suppuration may destroy
the cornea, thus rendering the child blind for life.

Therapeutic Hints,

Aeon., at the beginning; redness of the eye; no discharge; restless-
ness ; dry, hot skin.

Arsen., Natp. mur., after external application of nitrate of silver.

Cham., colic; green discharges; restlessness.

Lycop., copious discharge of pus^ the lids are puffed out by pus
beneath ; the conjunctiva looking like a piece of raw flesh.

iVlepo. sol., thin mucous secretion from the eyes; green diarrhoeic
stools; soreness of the anus , jaundice; syphilitic infection.

Rhus t., the swollen conjunctiva protrudes from between the lids
like a pad, when they are opened.

Sulph., thick pus in large quantities.

Ophthalmia Scmfulosa.

Scrofulous inflammation generally attacks both eyes, going from one
to the other. The patients shun the light more than the amount of
inflammation would lead us to expect. They keep their eyes con-
stantly covered, and bury their faces into the bed- pillows. For this
reason they always feel better when night comes, and get worse again as
soon' as the sun rises; a symptom which distinguishes this form of
inflammation from ophthalmia catarrhalis, in which it is just the re-
verse. Frequently we find such patients pressing their hands upon
their eyeballs^ which gives them relief, and which is a pathognomic
symptom of this complaint. There is a periodical flow of hot and
acrid tears, corroding the adjacent parts. The Meibomian glands
secrete more slime than usual, which sticks to the tarsal edges of the



INFLAMMATION OF THE EYES.



43



lids and to tlie ej'-elaslies, forming hard, brownish crusts, under which
the skin becomes irritated, and the eyelashes are apt to grow in a
wrong direction, (false hairs,) or they fall out altogether, when the
tarsal edge becomes hardened and full of little furuncles.

The conjunctiva bulbi is at first inflamed only in patches of a palish
redness, the blood-vessels run in lines from the canthi towards the
cornea, leaving white stripes of conjunctiva between them. On the
edge of the cornea they form a network, and out of it some of these
enlarged capillary vessels extend over the cornea, where some little
blisters are seen to be forming, containing a purulent fluid. The
cornea then becomes sufi'used, grayish, opaque, and in severe cases
the inflammation extends even to the iris.

It is a severe and often very stubborn complaint. Badly managed,
it may terminate in long-lasting, sight-hindering spots on the cornea ;
in prolapsus iridis, or staphyloma, in case these little ulcers perforate
the cornea ; in an effusion of pus into the eye-chambers, {hypopyon^)
in case the cornea and iris are involved in the inflammation. Com-
paring scrofulous with catarrhal inflammation, we establish the follow-
ing diagnosis;



Scrofulous Inflammation,

The conjunctiva is red in streaks,
the blood-vessels run in bundles
from the canthi towards the cornea,
leaving between them white stripes
of conjunctiva.

Secretion is hot, acrid, corrod-
ing.

Photophobia is stronger than the
objective inflammation seems to
indicate.,

Exacerbation from morning till
night; amelioration evening and
night.



Catarrhal Inflammation.
The conjunctiva is red all over,
the blood-vessels run parallel
towards the cornea.



Secretion is mild, puriform.

Photophobia corresponding with
the degree of inflammation.

Exacerbation towards evening;
better in the morning.



Therapeutic Sinfs.

Apis, eyelids swollen, inflamed, turned inside out, granulated ; eye-
lashes fallen out; conjunctiva injected; chemosis; cornea grayish,
smoky, opaque; pain, hurning- stinging.

Arsenicum, lids spasmodically closed ; conjunctiva inflamed; look-
ing like a piece of raw beef ; cornea degenerated ; hurning p)ain ; on



4:4: EYES.

tTie face a fine eruption, and under the eyes places excoriated by the
acrid discharge, which are sometimes covered with crusts.

Aurum, nightly agglutination of the lids ; a pannus-like extension
of enlarged blood-vessels over the cornea to the pupil ; great photo-
phobia ; hot, burning tears when attempting to open the eyes ; cutting
pain through the eyes ; excoriations on the cheeks and swollen glands
on the neck ; after the abuse of Mercury.

Belladonna, slight redness ; scalding, acrid tears ; great photophobia.

Calcarea c, spasmodic closure of the lids and photophobia; ulcers
on the cornea ; stinging pain, worse from candle-light ; difhcult hear-
ing ; sweat on forehead ,• thick, red nose with acrid discharge, or nose
stopped up ; swollen upper lip ; swollen glands on the neck ; large
abdomen ; great desire for eggs.

Causticum, pressing pain relieved by external pressure ; yellowish-
ness of face ; warts on eyebrows and nose.

Conium, chronic ; great photophobia without much inflammation.

Hepar s., especially after the abuse of mercury ; ulcers on the cornea.

Mercurius sol., worse from slightest cold ; lying on the face through
the day ; peevish, troublesome ; nose full of mucus.

Mercurius sub!., lids swollen and spasmodically closed, — the upper
reaching over the lower, like a pad ; ulcers and chalk- white excres-
cences upon the cornea ; pus in the anterior chamber of the eye ;
cheeks around the eyes covered with pustules ; glands of neck hard
and swollen ; eruption on occiput.

Natrum mur., thin, watery, excoriating discharge from the eyes ;
after the abuse of nitrate of silver.

Rhus tox., pimples and vesicles on the cornea; eruptions on the head
and face ; swelling of glands behind the ears ; disposed to weep.

Sulphur, chronic ; edges of lids thickened and ulcerated ; outer
canthi red; cornea surrounded by a pale-red ring; spots and ulcers
upon the cornea ; stitches through the eye into the brain ; double
sight; eruptions over the body; swollen glands; diarrhoeic stool,
worse in the morning.

Besides these there are recommended : Baptisia tinct. and Podoph. ;
the latter especially, if worse in the morning.

Ophthalmia Syphilitica

Is an inflammation found, as its name implies, in persons afiQicted
with syphilis. There are two distinct forms of this malady, —

Ophthalmia gonorrhoica, and

Ophthalmia syphilitica stride sic dicta.



INFLAMMATION OF THE EYES. 45

Ophthalmia gonorrhoica is a conjunctivitis, wliicli is brought on
either by a suppression of gonorrhoea or by accidental poisoning of
the eye with gonorrhoeal discharge. The inflammation attacks first
the conjunctiva, which swells rapidly, to such a degree that it not
only surrounds the cornea like a wall, but overlaps and covers it,
making the eyeball appear like a piece of raw meat. The cornea
and iris likewise become involved in the inflammatory process, and
the whole is of such an acute nature that the coats of the eye may
become perforated, discharging their entire contents in the course of
twelve or twenty -four hours.

Ophthahnia syphilitica^ strictly so called, is a symptom of chronic
syphilis. It attacks primarily the iris, which changes its natural
color into brown, reddish spots. These spots swell to uneven pro-
tuberances, and appear like condylomatous excrescences. The pupil
of the eye contracts and becomes distorted, especially towards the
inner corner of the eye. All around the cornea there is a deep-
seated, reddish, inflamed ring, and the cornea itself becomes opaque.
The conjunctiva bulbi grows pale-reddish; at the same time there
are other symptoms of lues venerea, so that this affection is easily
diagnosticated.

Tlieraj^eutic IJints.

Argentum nitp., lids swollen ; thick, puriform discharge ; granulated
degeneration of the conjunctiva.

Cinnabaris, condylomatous excrescences on the iris, edge of the
pupil, or the edge of the lids.

Kali bichrom., pustules on the cornea, surrounded by indolent in-
flammation ; pale reddish ring around the cornea ; eyelids granular ;
ulceration in the fauces.

Nitric ac, lids swollen, hard, livid; copious yellow discharge run-
ning down the cheeks ; region around the eye painful and sore to
the touch.

Phytolacca dec, reddish-blue swelling of lids ; left eye worse ;
worse also in the morning, and when closing the eye ; granulations ;
circumorbital pain.

Pulsatilla, or Tartar em., after suppressed gonorrhoeal discharge.
These discharges are often brought back by these remedies.



46 EYES.

II. Products Resulting from Inflammation.

Chalazion, Hardened Stye^

Is, in its nature, notliing but a once-inflamed sebaceous gland, or
common stye, which, however, did not discharge, but became indu-
rated, and continues to be in this state, — a hard, round, colorless
little swelling on the edge of the eyelid.

Therapeutic Mints. — Graphites, Puis., Sepia, Staphis., Thuya.

Tylosis, Callosity of the Edges of the Eyelids^

Is an induration of the Meibomian glands, making the edge of the
lid hard, roundish, and uneven. The sound eyelashes have fallen
out, and instead of them there are a few thin hairs growing in an in-
ward direction, thus irritating the eyeball. This deformity is the
consequence of a preceding blepharitis.

Therapeutic Shits. — Borax, Ehus t., Spigel.
Onyx, or Abscess of the Cornea,

This appears like a little, circumscribed, yellowish spot in the tis-
sue of the cornea, which contains pus. It is a result of inflammation,
and may form on any part of the cornea.

Therapeutic Mints. — Calc. c, Hepar, Merc, Silicea, and others.

Hypopyon

Is a collection of pus in one or both of the eye-chambers ; and is
caused by either an abscess of the cornea, which breaks towards the
interior, or an inflammation and consequent purulent deposit in the
iris.

Hypopyon differs from onyx in the following particulars :



Hypopyon.

The pus lies always behind the
lower segment of the perfectly
transparent cornea.

As the pus collects behind the
cornea, in the anterior chamber,
it forms, as high as it reaches, a



Onyx.

The pus may form at any point
of the cornea, which is at that
point opaque.

The pus is encased between the
lamellse of the cornea in various
shapes ; and the different positions



PEODUCTS FKOM INFLAMMATION.



47



Hypopyon.
level surface, which changes, ac-
cording to the position of the
head, like any flaid in an ordinary
vessel.

Looking sideways npon the eye,
the cornea appears perfectly clear.



Onyx.
of the head can have no influence
upon their position or shape.



By looking sideways upon the
eye, we clearly see the place where
the pus lies imbedded within the
cornea.



Tlierapeiitic Mints, — Ars., Hepar, Merc, sub.. Plumb., Sulphur.



When, in consequence of inflammation, the cornea and iris grow
together, and the cornea becomes changed in its texture, and when,
at the same time, the aqueous humor in the posterior eye-chamber
increases, then the cornea commences to bulge out, either partially
or wholly ; and this partial or total protrusion of the cornea is called
staphyloma. In this condition of things the structure of the cornea
is always changed. It becomes opaque, and is softened. The most
protuberant portion of the cornea becomes thinner, while the re-
mainder of it gains a greater consistency and opacity. The protru-
sion may assume a spherical or conical shape. Such degeneration of
the cornea of course destroys the sight.

Ilierfipeutic Hints, — Apis, Sulphur, Silicea.

Cataracta Lentis et Capsute, Lental and Capsular

Cataract.

"We understand by this expression a dimness or opacity of the lens
and its capsule, by which the sight becomes either partially or totally
destroyed.

In examining the eye, we observe immediately behind the pupil a
grayish, opaque, and convex body — the lens, which has lost its trans-
parency. The change towards opacity may be either slow or quick ;
there are cases on record in which a cataract had been formed in a
single night ; but it usually occupies several months, and even years.
In proportion as the opacity increases, the sight becomes dimmer.
There is this peculiarity about this disease : the patient sees better



48 EYES.

towards evening and in cloudy days than in bright sunshine, "because
then the pupil is more dilated, and the light can pass around the
cataract into the eye.

"When the cataract is perfect, we observe behind the pupil a dark
ring encircling the grayish body, which is nothing else but the shade
falling from the iris upon the opaque lens.

TJierapeittic Mints,

Ammonium carb., especially the right eye.

Belladonna, after an acute inflammation of the eye.

Calcarea c, in scrofulous individuals.

Causticum, constant inclination to touch and rub the eye, which
seems to relieve a pressure in it.

Lycopodium, after typhus; suppressed menses.

Magnesia c, from left to right; previous disposition to headache
and furuncles.

Silicea, after inflammation of the eye ; preceding ringworms ; sup-
pressed sweat of feet.

Sulphur, from right to left ; after cutaneous eruptions, especially
itch.



Is a morbidly-altered state of the choroidea or choroid tunic, causing
a sea-green opacity deep in the fundus of the eye, which appears con-
cave. In some cases the vitreous humor of the eye has been found
of a greenish color. During the progress of the disease the pupils
become enlarged and distorted, the iris discolored, the cornea dim,
the sclerotica staphylomatous widened. The loss of sight is much
more rapid than the greenish opacity would at first seem to warrant.
The patient sees better by strong than by dim light. Its progress is
slow. Both eyes may be affected at the same time, but are seldom
attacked simultaneously.

Therapeutic Mints. — Phosphorus.

Amaurosis.

Although this affection in many cases may be primarily a dynamic
affection of the optic nerve and the retina, nevertheless it is also in
many cases the result of inflammation and apoplexy. This may justify
me in speaking of it in this connection.



PRODUCTS FROM INFLAMMATION.



49



There are few objective signs, which characterize the complaint.
The pupil, although in the beginning movable, gradually enlarges,
becomes rigid, and does not quite keep its circular shape. Deep in
the fundus of the eye we observe sometimes a dirty, smoky, concave
opacity, but not always.

The iris moves slowly, does not react against the light as before, its
color changes, becoming either lighter or darker.

The loss of sight is much more rapid than these objective signs
would indicate. But as long as there is some eyesight, the patient
sees better in the morning, after a refreshing sleep, than at any other
time.

Cataract, glaucoma, and amaurosis are to be distinguished in the
following way :



Cataract.
Convex, grayish opa-
city immediately be-
hind the pupil.

The pupil is mov-
able, generally circu-
lar, not dilated.

The loss of sight is
proportionate to the
opacity.

Sight better in dim
light.



Glaucoma.
Concave sea-green
opacity deep at the fun-
dus of the eye.

The pnpil is im-
movable, distorted, di-
lated.

The loss of sight is

greater than the opacity

would seem to indicate.

Sight better in strong

light.



Amaurosis.
Concave, dirty, smoky
opacity deep at the fun-
dus of the eye; some-
times absent.

The pupil is immov-
able, not quite round,
and dilated.

Great loss of sight,
with little or no opa-
city.

Sight best in the
morning after refresh-
ing sleep.



Tlierapeutic Hints*

Aupum mur., sudden attack after scarlet fever and during childbed,
with cold perspiration, small pulse, quick, irregular breathing.

Belladonna, after suppressed scarlet eruption, with cerebral symp-
toms.

Gelseminum, with thirst for light ; after apoplexy, congestion to the
head.

Nux v., in consequence of habitual use of intoxicating drinks.

Phosphorus, previously illusions of sight, and after sexual excesses.

Seoale cor., with photophobia ; suppressed secretion of tears ; stitch-
ing pain in the eyes ; dilated pupils ; blue and fiery dots flying before
the eyes.

Sulphur, after suppressed itch.



50 EYES.

Veratrum virlde, immense circles of green color around the candle,
which, on closing the eyes, turn red ; vertigo ; after loss of vital fluids.

Zincum, suddenly coming and going, with headache; contracted
pupils.

III. Pseudo-formations.

Tumores Cystici, Encysted Tumors.

These are degenerated sebaceous glands, which are situated in the
cellular tissue of the lids. They consist of a sac or cyst, the contents
of which are of various characters; sometimes hard; serai-fluid, like
wax ; mixed with hairs. On pressure they are movable under the
skin, and are of variable size.

Therapeutic Mints, — Calcarea c. Thuya.
Pterygium, Wingskin.

This is a triangular or wing-shaped morbid growth on the conjunc-
tiva. Starting with its broad base at the corner of the eye, it reaches
with its apex the edge (seldom the middle, and still more seldom
crossing the middle) of the cornea. It is loosely connected with the
conjunctiva. It generally makes its appearance at the inner — rarely
at the outer — corner of the eye. Very rarely it appears on the upper
or lower part of the eyeball. These growths are of dif^'erent consist-
ency and color : some look red, inflamed, and are full of blood-vessels ;
some are quite thin, almost transparent ; and still others are thick and
of a whitish or yellowish hue.

Therapeutic Hints.
Arsenicum, Spigelia,

Argentum nit., pinkish redness of the conjunctiva.
Zincum, severe pressure at the root of the nose and across the supra-
orbital region, lachrymation which is worse in the evening.

Pannus, Vascular Sldn over the Eyeball.

This seems to be, primarily, an inflammation of the conjunctiva
bulbi. Small blood-vessels run from the white of the eye towards
the cornea, and over it. By-and-by they enlarge in size, and increase
in number from all sides, thus forming a dense net- work of blood-
vessels over the whole eyeball, to such a degree that neither cornea



PSEUDO-FORMATIONS. 51

nor pupil can be seen throngh it; and the wliole eyeball appears like
a piece of raw meat.

The pathognomonic distinction between this affection and conjunc-
tivitis is, that in the latter the net- work of blood-vessels seldom
extends over the cornea, but around it, exhibiting there considerable
swelling of the conjunctiva, with effusion. The sight is, of course,
impaired, or totally destroyed.

Therapeutic Mints, — Ars. ? Aur. ? Merc. subl. ?
Fungus Ocoli, Fungus of the Eye.

This is a malignant pseudo-formation, characterized by an abun-
dant vascularity and a soft texture, which is easily lacerated, and
bleeds from the slightest wound. This is fungus liBematodes. Fungus
medullaris consists of a mass similar to marrow.

They are found on different parts of the eye, and have been named
according to their location: ■

Fungus carunculse lachrymalis, which is a malignant degeneration
of the eye-caruncle;

Fungus conjunctivse^ which grows upon the conjunctiva, and may
be a fungus hsematodes or medullaris ; and

Fungus medullaris hulhi, which develops itself upon the retina,
appearing first as a grayish, or yellowish, or greenish opacity, deep in
the fundus of the eye. It soon grows to an uneven mass, extending
towards the front, pressing the vitreous humor and lens out of their
positions, which, in consequence, degenerate. Then the bulbus grows
larger, becomes harder, and its surface uneven and knotty. It pro-
trudes out of its socket, until, finally, the fungus bursts forth through
the cornea, and appears like a purple or yellowish, soft, spongy mass,
which bleeds easily, and constantly secretes a fetid, thin, ichorous
matter. The glands of the adjacent parts swell at the same time,
and the patient dies from exhaustion.

Therapeutic Hints.— Ars., Cannab., Carb. an., Phos., Sepia,
Thuya.

Sclrrhus and Cancer

Are merely two ^diff'erent stages of the same malignant disease, which
seems to manifest a preference for glands.

Scirrhus commences as a small swelling, with a nucleus as its
centre, from which white stripes run towards the periphery. These



52



EYES.



radii are separated by a whitish, fatty substance. There are often
several such swellings near together, which gradually unite, and
form one hard, knotty swelling. In its further progress, growing
larger and larger, it inflames and ulcerates loithin. Thus far, this
complaint is called scirrhus. By the continued suppurating process
within, the tumor bursts, and discharges its fetid, thin, ichorous mat-
ter exteriorly, when it is called o;pen cancer. It spreads rapidly, and
destroys life in a short time.

Scirrhus and cancer of the eyes is found starting at the lachrymal
caruncle, at the tear gland, at the eyelid, and sometimes within the
eyeball itself, after a long, chronic inflammation and staphylomatous
degeneration.

Therapeutic Hints,— Ars., Bell., Calc. c, Garb, an., Hydrastis,
Lachesis, Phos., Sepia, Silicea, Thuya.

The individual case may, however, suggest still other remedies.

IV. Affections of the Motory Nerves of the Eye.

The muscles of the eye, lid, and iris are under the control of the
third, fourth, fifth, and sixth pairs of cerebral nerves. The aba-
lienation in the motion of the eye consists either in an increased ac-
tion — spasmus — or in an impaired or total loss of action — paralysis.
We have therefore to distinguish two kinds of morbid afi:ections in
the motory system of the eye, — spasms and paralysis.

Blepharo-spasmus, or Spasms of the Eyelids.

This is either a ionic spasm, in which the eyelids suddenly, by a
spasmodic contraction of the musculus orbicularis, become tightly
closed to such a degree that neither the patient nor anybody else can,
by external force, open them. In such cases Viola adorata and
Symphitum have been found useful, the latter after a blow ; or

A clonic spasm, in which the eyelids constantly, in quick succes-
sion, open and shut, which is technically called nictitatio morbosa.
Here Agaricus is frequently indicated.

Ophthaimo-spasmus, or Spasms of tlie Eyelall.

This also is either tonic or clonic.

If tonic, then the eye is set, motionless, and drawn either to that
side where the muscles are spasmodically contracted ; or the eyeball



AFFECTIONS OF THE MOTOEY NERVES. 53

stands motionless in the middle, but is drawn back into tbe orbit.
This is the case when all the muscles are contracted at the same
time. In the first case, the pupil is drawn sideways, whilst in the
latter it is dilated.

If the spasms he clonic, then the bulbus is in a constant swinging
motion, from side to side, and in very c[uick succession, so that the
patient is incapable of holding the eye still for a moment. This
complaint is sometimes congenital, and seems not to interfere at all
with the sight of the patient.

Strabismus, Squinting.

This differs from both of these spasmodic affections. It is an in-

s voluntary turning of the eyeball out of the natural axis of sight,

whereby, however, the patient retains the ability of turning the eye in



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 6 of 65)