Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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tightness across the chest, with a dry, tight cough; worse from even-
ing until midnight; unpainful diarrhoea.

Puis,, inflammation of the eyes and photophobia ; thick, yellow dis-
charge from the nose ; dryness of the mouth, without thirst ; nightly
diarrhoea, after previous rumbling in the bowels ; rattling, loose cough,
with expectoration of thick, yellow mucus ; increase of all the symp-
toms towards evening ; chronic, loose cough after measles.

Stram., sometimes before the outbreak of the eruption, if there be
frightful visions of rats, mice, &c., at which the patient is startled and
from which he tries to hide ; spasmodic affection of the oesophagus,
hindering swallowing.

Sulphur, either during the first stage, when the eruption makes a
tardy progress, or for after-complaints, such as chronic coughs,
originating in remnants of partial pneumonia ; chronic diarrhoea ;
hardness of hearing ; chronic discharge from the ears.

Veratr., pale, livid color, and tardy appdarance of the eruption;
hemorrhages without amelioration ; burning heat, with alternate cold
extremities ; very frequent, weak, intermitting pulse ; delirium ; rest-
lessness; drowsiness; apathy.



592 EXANTHEMATA.



Scarlatina, Scarlet Fever.

It is characterized by tlie following three features :

1. Erythematous inflammation of the shin^ which consists of a high
state of hjpersernia and an inflammatory oedema of the superficial
layers of the^ skin, in consequence of which the skin reddens and
swells. In many cases we observe a uniform redness all over —
scarlatina Isevigata ; in others the redness appears in more irregular
patches, or is darker in some places than in others — scarlatina
variegata; in still others, though more rarely, the inflammatory exu-
dation raises the skin to numerous little vesicles — scarlatina miliaris
seu vesicularis ; again, in others there appear large blisters filled
with watery or yellowish turbid fluid — scarlatina pemphigoidea s.
pustulosa ; in still others the inflamed cutis is elevated into small
papulae — scarlatina papulosa; and in very bad cases we sometimes
observe here and there ecchymosed spots as the effect of capillary
hemorrhages within the skin.

2. Inflammation of the m,ucous membranes of the fauces. This is
either a mere catarrhal inflammation, swelling, and reddening the
fauceS; tonsils, the velum palati, and uvula, which, at first dry, are
soon covered by an abundant secretion of mucus ; or in malignant
epidemics it is of a diphtheritic nature; then we observe grayish
deposits appearing upon the tonsils and fauces, which gradually be-
come discolored, loosen, and leave the surface of the mucous mem-
brane underneath irregularly broken and covered with ichor, which
emits a terrible smell. This same process extends up into the nasal
cavity and constitutes the virulent coryza of malignant scarlatina.
At the same time we observe a considerable swelling of the parotid
and lymphatic glands and of the subcutaneous cellular tissue of the
neck.

3. Inflammation of the kidneys, which consists of either a catarrhal
or a croupous inflammation of the uriniferous tubuli.

Scarlatina is a contagious disease, not only by contact and im-
mediate exhalation, but also by transmission through persons who
are not themselves affected. The nature of the poison we do not know.
To develop its effects upon the system requires a certain length of
time, which is called the stage of incubation, lasting from eight to
twelve days. The pred'isposition to take the disease seems to be not
nearly as universal as that for taking measles, quite a number of
persons escaping it altogether. Infants are mostly exempt from its



SCARLATINA. 593

attacks ; those of all other ages are liable to catcli it ; scarcely any
one gets it a second time. It generally appears as an epidemic, and
the different epidemics vary much in character, time of year, and
duration ; in Philadelphia endemic, every January and February par-
ticularly. Its normal progress has been divided into four stages :

1. The stadium prodromorum commences with repeated chills, fol-
lowed by heat, nausea, vomiting, violent headache, and feeling of
prostration. The pulse ranges from one hundred and twenty to one
hundred and thirty beats per minute, and the temperature of the body
ascends to 41° C. and over. This is quite characteristic, as no other
disease shows such a rapid increase of pulsation and temperature.
Besides these symptoms the patient commences to complain of sore
throat, dryness, and burning, and pain when swallowing. On inspec-
tion we find the throat red and swollen, and the tongue coated, but
"red on its edges. This state of things lasts in some cases only a few
hours ; in others it is entirely absent, the eruption appearing at once,
whilst in a majority of cases it lasts one or two days, and quite ex-
ceptionally still longer. So, also, varies the intensity of the attack
in different individuals ; from a mere indisposition, which is scarcely
minded, it may at once be associated with stupor and convulsions.

2. The stadium eru-ptionis is almost always accompanied by an ex-
acerbation of the fever. The eruption shows first on the neck, not as
in measles on the face, which remains unchanged, presenting only
feverish, reddened cheeks. From the neck it spreads further over
the body, so that usually in twenty-four or thirty-six hours the
whole body is covered. The deepest redness appears on the neck,
around the joints, and on hands and feet. Pressure with a finger
upon the skin causes, for a moment, a white spot, which speedily
grows red again from the periphery to the centre^ unlike that in
measles, which spreads from the centre to the periphery. As the
eruption grows and spreads, so, also, grows the angina faucium ; and
the thick, white fur which had coated the tongue is now peeling off,
leaving it red all over with highly-inflamed papillee, constituting the
so-called strawberry tongue. The skin itches intensely. All these
symptoms are not, however, in all cases alike. In some the redness
may spread almost simultaneously all over the body and be very
intense ; it may be either scarcely noticeable or of different aspects,
as described above ; the angina also may amount to scarcely any
thing, or be very intense ; it may be of a diphtheritic nature, or be
combined with catarrh of the larynx or bronchial tubes.

3. The stadium JiorescentiBe, the time, during which the eruption

38



594 EXANTHEMATA.

remains upon t"he skin, lasts usually from four to five days ; about tlie
second day of this stage it stands in its fullest bloom, at the same time
the fever and throat symptoms reach their height. The urine con-
tains considerable quantities of cast-off epithelial cells, and frequently
traces of albumen ; in general the patient is sickest at this stage. It is
the climax of the disease. Erom this time all the symptoms grow
milder ; the eruption declines, the fever lessens, the angina gradually
leaves, and the patient feels better altogether. Yet this is not imi-
formly the case. The fever may rise anew, because nev/ complica-
tions set in ; the eruption and angina may disappear too q^uickly or
too tardily, &c.

4. The stadium desquamationis sets in usually on the fifth day after
the eruption first appeared, and lasts from eight to fourteen days. At
first we observe fine white scales peeling oft' on the neck, the desqua-
mation extending gradually over the whole body. On the hands and
feet great flakes of skin are often loosened by the patient himself, as
a wholesome pastime after so severe an illness ; fever and angina lessen
constantly, until finally, in about three or four weeks from the com-
mencement of the disease, perfect recovery takes place. This is the
normal course of a simple scarlatina case.

There are other forms, however, yet to be considered. The scarla-
tina sine exanthemate, or scarlet fever without eruption, differs from a
simple angina by the greater intensity of fever, the deeper invasion
of the whole system, its occurrence during an epidemy of scarlet fever,
and its premonitory signs.

The scarlatina sine angina, or scarlet fever without sore throat, is
characterized fully by the eruption, the fever, and the prevalence of
the disease.

The scarlatina maligna, typJiosa, is characterized in the following
way : In the premonitory stage even, the patient is greatly prostrated,
apathic ; only half conscious or comatose ; the pupils are mostly
dilated ; there are either simply slight twitchings and jerkings of the
limbs, or general convulsions : the tongue is dry ; the pulse very small,
and scarcely countable ; the body is burning hot, with cold extremities.
The eruption is either intense, breaking forth suddenly all over, and
peeling off very soon in large flakes, as though the skin had been
scalded. Such patients die ; and, it seems to me, for this physiological
reason, that life cannot be sustained if a certain amount of the surface
of the skin becomes destroyed. In other cases the eruption does not
come out regularly, looks purple, livid, and is mixed with ecchymosed
spots ; diarrhoea and meteorisms associate, and the tongue and gums



SCARLATINA. 595

"become covered with a black coating. Also sucli patients die mostly
in the second stage, or sink during the stage of desquamation.

Another bad form is that of angina maligna^ which is generally of
a diphtheritic character, and generally complicated with infiltration of
the parotid^ submaxillary^ and lymphatic glands. This diphtheritic
process extends up into the nose (compare Diphtheritis) and causes a
virulent coryza, that much-dreaded symptom of scarlet fever, with
fetid discharge from the nostrils, and a terrible smell from the mouth.
At the same time the whole convolute of the cervical glands swell
into lumps ; the patient lies in a stupid or comatose state, with his
head bent backwards ; the pulse ranges from one hundred and forty
to one hundred and sixty per minute, and the temperature of the
-body from forty- one to forty-two degrees C Should this morbid
process also extend into the larynx, there are small chances left for
recovery. In some cases the inflammation spreads along the Eusta-
chian tubes into the tympanum, causing an otitis interna, which may
lead to perforation of the membraua tympani, and caries of the
petrous portion of the temporal bone.

In other cases the infiltrated cervical glands suppurate, accompanied
by a new increase of fever, causing various typhoid symptoms. At
this stage not very imfrequently the synovial membranes inflame
also, or pleuritis or pericarditis may suddenly set in, followed by an
abundant purulent exudation.

, During the period of desquamation most generally the third locali-
zation of the scarlatinal virus takes place, that into the kidneys,
causing a croupous nephritis, with its subsequent scarlatinal dropsy.
There are epidemics where almost all patients show symptoms of it —
albumen in the urine and dropsical swellings ; whilst in others they
are only exceptionally observed.

Still another sequoias of scarlet fever is to be mentioned: dropsy
without albuminuria, which generally creeps on slowly and may attain
. to a great height ; it is generally not so dangerous as that caused by
nephritis.

On the whole, I must say that the different scarlatinal epidemics
differ essentially from each other, and so do individual cases in one
and the same epidemic.

TJierapeutic Mints,— As a preventative I would still recom-
mend Belladonna high, one dose every night until symptoms appear.
If it cannot prevent the attack, it has seemed at least to mitigate its
violence. The clumsy imitation by the old school — drop-doses of



696 EXANTHEMATA.

the tincture or extract — I would surely not recommend, nor do I
wonder that they have not seen any beneficial effects from them.

The terrible burning and itching of the skin is best relieved by
rubbing the body all over with bacon (fat part of smoked ham) once
or twice a day, always if the skin is dry, glands swollen, scrofulous
diathesis.

When the temperature of the body rises to forty-one degrees and
over, it has been found beneficial to envelop the whole body in a cold
wet sheet.

Where there are many children in a family, those not affected should
be kept away from the sick-room.

Aeon., rarely, and only in the very beginning of the attack, if
characterized by the following symptoms : great dry heat and con-
gestion of the skin ; thirst ; rapid and hard pulse ; great restlessness ;
headache ; peevishness, which revolts against all interference ; or at
a later period: sudden excruciating pain in the stomach, gagging,
retching, vomiting of blood, and stoppage of breath ; distressed face,
anguish ; cold sweat on forehead ; gasping.

Ailanthus, "violent vomiting; severe headache; intolerance of
light ; dizziness ; hot red face ; inability to sit up ; rapid small pulse ;
drowsy, at the same time very restless; great anxiety; two hours
after the first invasion the drowsiness had increased to insensibility,
with constant muttering delirium ; did not recognize the members of
the family ; she was now covered, in patches, with an eruption of
miliary rash, with efflorescence between the points of the rash of a
dark, almost livid color ; the patches between the points of the erup-
tion were of a dingy, dull, opaque appearance ; the eruption was more
profuse on the forehead and face than elsewhere, and especially on
the forehead ; the pulse was now small, and so rapid as hardly to be
counted ; the surface had become cold and dry ; the livid color of the
skin, when pressed out by the finger, returned very slowly ; the whole
was a most complete picture of torpor." These toxical symptoms,
caused by Ailanthus, and observed by Dr. Wells of Brooklyn, simu-
late so strikingly some forms of scarlatina that it must be a curative
agent in such cases.

Ammon. c, hard swelling of the right parotid and lymphatic glands
of the neck ; putrid sore throat.

Apis is, according to Wolf, indicated in usual as well as in those
grave cases where the blood is thoroughly poisoned by the virus, and
the whole nervous system under its paralyzing influence ; the fever
assumes a typhoid character ; the tongue is of a deep-red color, and



SCARLATINA. 597

covered with blisters, "wliicli become converted into sores and ulcers,
with stinging pains ; the nose discharges a thick, white, bloody, fetid
mucus ; the tonsils are swollen and hard, and the swallowing difficult ;
the whole abdomen is sore to the touch ; the discharges from the
bowels are diarrhoeic, slimy and bloody; the urine is scanty, and of a
dirty red color ; micturition sometimes painful ; the breathing is ac-
celerated and labored; there is loss of consciousness, delirium, sopor,
convulsions, trembling of the limbs ; the skin is either burning hot
all over, or gradually growing cool, or hot in some and cool in other
places ; the fever rises constantly, and the pulse changes frequently
in character ; dropsical symptoms during desquamation.

Arsen., when the eruption delays or grows suddenly pale, livid, or
is intermixed with petechia3 ; malignant sore throat ; different dropsi-
cal affections ; dyspnoea ; extreme restlessness and anxiety ; prostra-
tion ; typhoid symptoms ; cold hands ; burning heat internally, with a
cold external surface ; cold perspiration ; quick, small pulse.

Arum triphyllum, great soreness of the mouth ; redness of the tongue,
with elevated papilla ; cracked corners of the mouth and lips ; stop-
page of the nose without, or with profuse yellow discharge, filling the
whole nasal cavity and throat; putrid sore throat; submaxillary
glands swollen ; urine abundant and pale ; eruption all over the
body, with much itching and restlessness ; during desquamation.

Asclepias syriaca is recommended for dropsy in consequence of
nephritis.

Baryta c, swelling of the parotids, tonsils and submaxillary glands,
with much saliva, or else dryness in the throat, with pressing, sting-
ing pain on swallowing.

Bell., congestion to the brain, with delirium ; on closing the eyes
he sees horrible things; wants to sleep and cannot sleep; anxious
dreams ; starts in sleep ; springs suddenly up in bed, or attempts to ;
throbbing of the carotid arteries ; involuntary moving of the hands
to the head; bending the head backwards; head hotter than the
remaining body; eyes injected; face fiery red, or pale and puffed, or
sunken ; tongue white, with red edges, or else red all over, with
raised papillse ; fauces inflamed, swollen ; cannot swallow, or only with
greatest difficulty ; external swelling of the neck ; vomiting.

Bryonia, when the eruption delays or suddenly disappears; begin-
ning dropsical symptoms ; pleuritis or meningitis,

Calc. c, after Belladonna, about the third day ; great, hard swell-
ing of all the glands about the neck ; greatly inflamed throat, with
aphthaa on the tonsils and roof of the mouth ; the pale, bloated face



598 e2:anthemata.

sTiows no signs of eruption ; great anxiety and oppression, tlireaten-
ing paralysis of the lungs ; scrofulous individuals ; longing for boiled
eggs.

Camphora, in desperate cases, commencing rattling in the throat ;
breath hot, forehead hot, with hot perspiration ; limbs cold and purple.

Carbo veg., in last stage; rattling in the throat; complete sinking
of vitality ; cool breath ; cool extremities ; sticky, cold perspiration.

Coffea, as an intermediate remedy for excessive nervous excitement,
sleeplessness and palpitation of the heart.

Colchicum, nephritis; bloody urine, looking almost like ink, and
containing albumen ; dropsy.

Cuprum, when the eruption quickly disappears, with subsequent
convulsions, rolling of the eyes, distortions of the face, mouth and
all the flexor muscles; great restlessness, throwing about; sopor;
delirium.

Gelseminum has been given in large doses to "control the pulse,
calm the nervous erethism, determine the eruption toward the surface,
relieve pain and lessen the cerebral congestion." I believe its proper
homceopathic' sphere of action will be found rather in those asthenic
forms of scarlet fever, which from the commencement show marked
signs of a general toxication of the blood by the scarlatinal virus, viz. :
profound and intense prostration of the whole muscular power ; cere-
bral intoxication ; pulse frequent, soft, weak and so feeble as to be
sometimes imperceptible; impaired vision; spasms and paralysis.
Dr. Morgan gives the following hints : Chilliness, or at least cold
hands and feet ; heat with languor and drowsiness ; when sleeping, the
patient talks in delirious muttering, or half wakes at times ; crimson
flush of the whole face in all positions ; suffusion of eyes, heavy look-
ing ; throat feels as if swelled ot: filled up, is diffusely red ; tonsils red
and slightly swelled; when the eruption recedes, all the viscera are
threatened.

Helleb., dropsical symptoms, in consequence of nephritis.

Hepar, after previous abuse of mercury.

Hydrocyanic, ac. has been suggested by Dr. Wells, when the erup-
tion in its early appearance is dark-colored and soon becomes livid,
only slowly regaining its color when this is expelled by the pressure
of the end of the finger ; rapid, feeble pulse.

Hyosc, stupid drowsiness, or else great nervous excitability and
sleeplessness ; utter stupidity, or else illusions of the imagination and
senses ; vacant staring at things, or else sparkling, red, prominent
eyes; embarrassed, indistinct speech; answers no questions, or else



SCARLATINA. 599

indistinct muttering loquacity ; mouth and throat dry and red ; ina-
bility to swallow ; abdomen distended, tympanitic ; watery, involun-
tary and unnoticed stools in bed.

Iodine, after mercury ; ulcers in the throat ; glands swollen, suppu-
rating ; every thing appears bright blue to him in the distance ; worse
from warmth and from warm things of all kinds.

Kali c, swelling of the right parotid gland ; fever and restlessness ;
always worse about three o'clock in the morning; smell from the
mouth like that of old cheese ; great dryness of the skin ; oedematous
swelling, like little bags, between the eyebrows and upper eyelids.

Lach., diphtheritic inflammation of the throat ; ulcers on the tongue ;
suppuration of the glands of the neck ; pleuritic, pericarditic and
general dropsy in delayed desquamation, with great oppression ; urine
almost black ; stool badly smelling ; fever worse in the afternoon.

Lye, diphtheritic sore throat; stoppage of the nose; rattling in the
throat ; comatose state ; deafness and purulent discharge from the
ears ; great peevishness and crossness on getting awake ; worse from
being covered too much ; scanty, dark-red and albuminous urine, with
strangury ; oedema of the face, hands and feet ; ascites ; secondary
eruption of dark-red blotches on hands, thighs, back or face ; colic
during desquamation, with costiveness.

Merc, consecutive anasarca and ascites ; soreness and inflamma-
tion of the genital organs.

Merc, jod., after Lachesis ; loss of voice, hoarseness, can only lisp ;
fauces bluish-red, ulcerated.

Muriat. ac, intense redness rapidly breaking out all over the body
in the first hours of the attack with coma ; or scanty eruption, which
is interspersed by petechise ; dark redness of the face ; purplish color
of the skin ; burning heat of the body ; great anxiety and restless-
ness, constantly compelling the patient to uncover himself; aggrava-
tion in the evening ; pulse intermitting in regular intervals ; severe
angina ; dark, bluish-red fauces, aphthae ; foul breath ; discharge of
thin, acrid pus from the nose, excoriating nose and lips; sighing,
groaning respiration ; sliding down in the bed.

Nitr. ac, diphtheritic sore throat extending up into the nose, from
which discharges profusely a thin, purulent matter ; tonsils swollen ;
tongue dry, fissured ; diflacult deglutition ; indistinct speech ; some-
times deafness; intermitting hreathing ; eruption of a fine, miliary
nature ; skin burning hot.

Opium, convulsions, delirium, and a soporous condition, with snor-
ing, which were not relieved by Belladonna.



#



600 EXANTHEMATA.

Phos., after Mur. ac, althougli, on the whole, the patient be im-
proving, a suspicious rattle in the throat commences ; also by pre-
vailing chest-symptoms ; likewise in case of over-sensitiveness of all
the senses, and yet there appears an apathetic quietness and don't-
care disposition ; burning in different parts of the body, which com-
pels change of position.

Rhus t., when, after Belladonna, about the third day the fever be
still rising ; when the eruption looks dark ; when the eyes appear
swimming, as if intoxicated ; when the tongue grows red and smooth,
and a drowsy state, with delirium, sets in ; great restlessness ; bleed-
ing from the nose at night; rheumatism of the joints, worse in rest;
oedema of the scrotum and penis ; the swollen, parotid glands break
open, discharge ichor copiously ; impure, deep cavity, as if one could
see into the throat ; first the left, then the right.

Secale, watery discharge from the nose and yet a stoppage of the
nose ; bloody and albuminous urine ; cannot bear the heat of the
stove.

Senega, oppression ; rattling in the chest ; loose but feeble cough,
with little expectoration ; hydrothorax.

Silic, fever worse at night; sleep disturbed by pain in the ears;
child wakes up throwing the arms about and screams ; puts the
hands behind the ears ; otitis interna ; if sickly after vaccination, or
soon after, follows scarlet fever ; like to be covered, wrapped up.

Sulphur, rapidly growing red all over, and intensely so with follow-
ing sopor soon after the first vomiting ; burning heat of the skin ;
eruption at first bright, soon growing purple, attended with diarrhoea,
worse in the morning.

Veratr. alb., in hot summers ; burning heat changing with coldness
of the extremities ; small, frequent pulse.

Veratr. vir., according to western physicians, in large doses, rather
antipathically, to subdue arterial excitement. The homoeopathic
indications are yet to be found out.

Zincum, especially in threatening paralysis of the brain ; complete
unconsciousness; the child lies perfectly motionless; jerking of the
whole body, or twitchings of single limbs ; grating of the teeth ; shrill,
frightful screams, with altered voice ; cannot speak any more ; occi-
put very hot ; forehead cold, covered with cold perspiration ; white,
pale, distorted face ; breathing short and quick, but no rattling ; dis-
charge from the bowels and bladder involuntarily; limbs icy cold,



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 60 of 65)