Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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and the whole body cool; bluish-red all over; pulse thread-like,
scarcely to be counted.


Roseola Febrilis, Rubeola.


TMs hibrid affection is defined by Canstatt as a red-spotted exan-
thema, wMch, if we compare its general symptoms witli those of the
mucous membranes, leaves it doubtful whether to call it scarlet fever,
measles, urticaria, or erythema, because it may agree in some points
with the one or the other and differ entirely in others. Kubeola, as
occurring in epidemics, is either a modified scarlatina or measles.
The first, rubeola scarlatinosa, corresponds in all its symptoms of the
throat and the consequent dropsical affections to scarlet fever, with
the exception of the eruption, which is entirely similar to measles.
The other, rubeola morbillosa, shows all the catarrhal symptoms of
measles, whilst its eruption is entirely similar to that of scarlet fever.

Therapeutic Mints, — Compare both Measles and Scarlet

Variola, Small-Fox; Variolols, Varioloid.

The nature of the variola-virus we do not know, except by its efiect
upon the organism. It is regenerated again whilst it develops its
effects, and thus propagated from organism to organism. The infec-
tious matter is contained in the variola-pustules as well as in the ex-
halation from the small-pox patient. Infection takes place, therefore,
not only by inoculation or immediate contact with the patient, but
also by more remote means. The poison can be carried by other
persons in their clothes, or by things which have been in the atmos-
phere of the patient. It is very persistent in its nature, and may re-
tain its property for years if excluded from the atmosphere, and not
exposed to great heat. There is no difference between the virus of
small-pox and that of varioloid ; either may cause the one or the
other disease. This seems to depend entirely upon the susceptibility
of the organism, and its adaptation for a greater or less development
of its effects. Small-pox and varioloid difi'er, therefore, only in the
intensity of their symptoms. The individual predisposition for tak-
ing the disease is wide-spread ; no sex, no age, not even the foetus is
exempt : some persons, however, are never affected by it. Those who
once lived through an attack are, almost without exception, safe from
any further infection. Vaccination seems likewise to destroy the pre-
disposition to the disease ; if not in toto, at least partially. For, ever
since vaccination has become generally introduced, the epidemics


have grown decidedly milder, the majority of cases being varioloids;
whilst previous to the discovery of vaccination, the reverse was the
rule. Nevertheless, there are epidemics which are still characterized
by great malignity, whilst others again are exceedingly mild. It has
not been possible to trace out any cause for this difference.

Its course and symjjtoms. After there are nine days of incubation,
the first stage, or the stadium proch'ornorum seu invasmiis, begins with
a shaking chill, or repeated chilly sensations, which are followed by
a permanent heat. The temperature rises in some cases to 41 or even
42° 0. This high fever is accompanied with a number of painful
symptoms of the head, throat, stomach, and general body ; in some
cases, with delirium and convulsions. No other, however, is so
characteristic of the disease as the dreadful backache, with which it is
almost invariably associated. The fever rises continually during the
first three days, showing only in the morning slight remissions. On
the evening of the third day it reaches its height. Only in rare cases
is this premonitory stage absent.

The second stage, the stadium eruptionis, commences on the evening
of the third day. There appear little red spots or papulae first on the
face. If very numerous, they coalesce like measle-spots, with which
they might be confounded if it were not for the granulated feel which
they present to the sense of touch. On the second day the eruption
appears on the neck, chest and back ; and on the third day it spreads
over the extremities. There are always more papulse comparatively
on the face than on any other part of the body, and when they are so
numerous as to coalesce, they coalesce in the face ; rarely, if ever,
on the rest of the body. Variola conjiuentes can therefore be seen
only on the face, whilst everywhere else the papulae remain isolated —
variolse discretse ; or at most only touch each other — variolae coherentes.
On the second day the papulse change into little vesicles or blisters,
with a characteristic depression, like a navel, at their centre. As they
grow, they fill with a milky, purulent fluid, and thus become con-
verted into pustules. It requires for their full growth about six
days ; or counting from the time of invasion, nine or ten days. Si-
multaneously with this eruption on the skin, an eruption of the same
character is appearing upon the different mucous membranes. On
the conjunctiva, it causes flow of tears, photophobia, and in severe
cases total closure of the eyes for many days ; in the mouth it causes
salivation ; in the pharynx, difficulty of swallowing ; in the larynx,
hoarseness and cough ; and in the genitals, itching and burning pain.

The full development of the eruption is generally attended with


great relief to the patient ; all tlie pains lessen and tlie fever decreases
considerably. In cases of variola confluentes only, the relief is not
marked. This is, however, not the end of the trouble.

On the ninth or tenth day the fever commences to rise again ; it is
the beginning of the stadium suppwatiorns s. maturationis. At this
time the pustules enlarge still more, the surrounding skin commences
to inflame and to swell, and there forms a red areola around each pus-
tule. Eedness and swelling coalesce from all sides, and constitute a
diffused, erysipelatous appearance of the whole face, greatly disfigur-
ing the patient. This process gradually spreads over the whole body,
in the same order in which the eruption commenced to appear. The
patient complains of great tension and burning of the skin, and the
affections of the eyes, mouth, throat, larynx, and genitals increase in
corresponding order. The heat of the body rises again, as above
stated, and is frequently mingled with chilly sensations ; it rises ac-
cording to the intensity of the inflammation of the skin ; and does
not abate until the dermatitis reaches its acme. This renewal of heat
is called the secondary or suppurative fever. It may attain to such
a height as to induce symptoms of adynamia and general paralysis,
asthenic, typilioid small-pox. In other cases it combines with a hemor-
rhagic diathesis, when the content of the pustules becomes bloody,
and bloody extravasation within the skin or hemorrhages from differ-
ent mucous membranes take place, hemorrhagic or seiotic small-pox ;
or, though only in rare cases, portions of the inflammation mortify
and discharge a badly-looking ichor, gangrsenous small-pox. Besides
all this, as the variola-poison is apt to localize during this stage in
serous membranes and parenchymatous organs, we meet with a num-
ber of different complications, such as, dyspnoea; stitching-pains in
the chest ; cough ; bloody expectoration ; pneumonia ; pleuritis ;
pericarditis; meningitis; suppurative inflammation of the joints ; peri-
ostitis ; subcutaneous and inter-muscular abscesses ; inflammation and,
suppuration of lymphatic glands ; suppuration of the eyes with hy-
popyon, and croupous exudations in the larynx and trachea.

The last stage, or the stadium exsiccationis, usually commences about
the eleventh or twelfth day. The pustules burst and discharge their
contents, which dries and forms hard, brownish crusts. There is still
some fever at first ; it lessens, however, continually, and with it gradu-
ally disappear all the painful symptoms which arise from the eruption
on the different mucous membranes. The crusts now gradually drop
off; at first those which cover the most superficial pustules; they
leave dark-red, somewhat elevated spots, which, however, after some


time, entirely disappear. Not so tlaose whicli form upon deep-seated
ulceration. They adhere a long time, and leave, after dropping off',
an uneven scar, which looks at first red, but by degrees grows con-
spicuously white, to remain so for life. In confluent small-pox the
destructive process is of a still greater extent, in circumference as
well as in depth, and the scars form frequently hideous distortions of
the face, similar to the scars of deep burns. This is the course and
progress of variola.

Varioloid runs a similar but much milder course ; all its stages are
milder and shorter ; its secondary fever is much less intense, or want-
ing altogether ; and its suppurative process does not destroy the cutis,
so as to leave scars.

Therapeutic Mints,

Apis, where there is an erysipelatous redness and swelling, with
stinging, burning pains ; stinging, burning pain in the throat.

Arsen., in asthenic cases, with great sinking of strength, burning
heat, frequent small pulse, great thirst, great restlessness, and when
the pustules sink in, and their areolae grow livid.

Bellad., during the first stage ; high fever ; congestion to the head :
sore throat ; sleeplessness, with desire to sleep ; convulsions.

Bryon., at the commencement, and also when the chest symptoms
indicate it.

Camphor., in those dangerous cases where the swelling suddenly
sinks in and the pustules suddenly dry up, showing a complete giving
out of the life-forces.

Hepap, croupy cough ; suppuration.

Hydrastis can. has been given successfully when there was great
swelling, redness, and itching; and great soreness of the throat. Is
said to prevent the pitting to a considerable degree.

Merc, especially during the suppurative stage ; great flow of saliva ;
dysenteric discharges from the bowels.

Phos., hemorrhagic diathesis ; bloody contents of the pustule's ;
hard, dry cough ; bronchitis ; hemorrhage from the lungs.

Phos. ac, typhoid conditions ; subsultus tendinum ; great restless-
ness ; great fear of death ; the pustules don't fill with matter ; some
degenerate into large blisters, which burst and discharge a watery
fluid, leaving the surface excoriated ; watery diarrhoea.

Rhus t., typhoid symptoms, dry, cracked tongue; sordes on the
lips and teeth ; great debility and restlessness ; the eruption shrinks
and looks livid.


Sarracenia bas been used empirically, and is said by some to sborten
and to ameliorate the progress of the disease ; others deny it. The
short of it is, we do not know any characteristic indications of the
remedy as yet.

Sulphur is indicated where there is any tendency of metastasis to
the brain during the suppuration ; is indispensable occasionally as an
intercurrent remedy when others seem to fail ; and Goullon advises
its uniform use in the stadium exsiccationis.

Tart. em. has been found by some to ameliorate the progress of
the disease.

Thuya, recommended by v. Boenninghausen as preventative as well
as curative agent. He states that it shortened in an epidemy of 1849,
in his neighborhood, all cases, and prevented all scars.

Vaccininum has been used undoubtedly with great benefit in small-
pox; its use has shortened and ameliorated all stages quite considera-
bly. Sulphur was given afterwards.

Variolinum makes the progress of the disease much milder ; removes
quickly all dangerous symptoms; changes imperfect pustules into
regular ones, which soon afterwards dry up; promotes suppuration
on the third day, and exsiccation on the fifth, sixth, ninth day, and
prevents all scars. This is the unanimous testimony of ten physi-
cians who have used it in different epidemics.

Varicella, Ghicken-Pox.

Some pathologists consider chicken-pox as the lightest form of
variola. It may be so. Still, if we consider what experience teaches,
that varicella does not extinguish the liability to either cow-pox or
small-pox, and that an infection with varicella causes the identical
varicella and not variola or varioloid, we obtain rather a strong argu-
ment against the identity of the two.

Yaricellse often prevail epidemically, and we also find sporadic
cases. They frequently precede, accompany or succeed epidemics of
small-pox, measles and scarlet-fever.

They consist, at first, in little red spots, like flea-bites, which in the
course of a few hours develop themselves into little blisters, filled with
a transparent, straw-colored fluid. The form of these blisters varies,
and according to the different forms which they occasionally assume,
they have been divided into varicellse glohulosse, ovales, leniiculares,
coniformes, cuminatse. Some of them often fill with pus and become
varicellse intsiulosse, leaving, after desiccation, a scar. Their appear-

606 SKIN.

ance, in most cases, is the first symptom of the disease, without any-
previous ailment. They spread irregularly over the body, and con-
tinue to appear in crops for several days ; so that, when the first crop
is already in a state of desiccation, a new crop shoots up. In this way
the whole process may last fourteen days, and even longer. A simi-
lar eruption occasionally takes place upon the mucous membranes,
and forms little ulcers in the fauces ; but that is not often the case.
The general feeling of the patient is not often materially disturbed ;
though some cases are attended with fever, headache, want of appe-
tite and general indisposition.

Therapeiitic Hints. — It seldom needs any treatment. The
occasionally attending symptoms may be met by Aeon., Ant. cr.,
Bell., Merc, Puis., Ehus t., Tart. em. Compare Variola.


The skin, as the exterior investment of the body, serves to protect
it ; at the same time it is the medium by which a continued exchange
goes on between the interior organs and the outer world. It is the
connecting link between them ; the last and lowest of the human
frame. Its affections are almost always tokens of some internal de-
rangements, hence their suppression is almost always followed by an
aggravation of internal troubles. On the other hand, internal com-
plaints get better in the same degree that the morbid process passes
outwardly to the skin. This, we might state in brief, as the essence
of Hahnemann's psora-theory, which has been thrown aside by the
would-be wise, who never understood it. According to Nunez, the
suppression of cutaneous eruptions on the anus is followed by liver
complaints ; on the legs, by digestive derangements ; on the scrotum
and penis, by impotence and seminal emissions ; behind the ears, by
cough and affections of the eyes ; on the scalp, by pulmonary phthisis ;
on the arms and hands, by laryngeal phthisis ; in the palms of the
hands, by nervous asthma ; on the nose and nostrils, by discharges
from the ears ; on the face, (acne rosacea,) by heart diseases. The
skin being easily accessible to ocular inspection and microscopical
investigation, its affections have been thoroughly searched and
minutely arranged and described, especially by Hebra. It would
alone fill a large volume were I to give a minute investigation of this


subject. For sucli there is no room in a work of this kind. I shall
confine myself to a cursory exposition. Besides, several of these
affections have been treated of in previous chapters.

I. Hypertrophy of the Skin.

A. hypertrophy of the entire structure of the skin we find often in
single, confined places, constituting so-called moles, or another's marks,
and soft ivarts. They appear raised above the level of the skin, and,
from large deposits of pigment within the rete Malpighii, they are of
a dark-brown color and covered by a luxuriant growth of hair.

A hypertrophy of the epidermis, hard and horny, constitutes
callosities, which form on such places as are exposed to external
pressure, especially on the hands and feet. Corns or clavi are callo-
sities, which grow on small, circumscribed places of the feet, in con-
sequence of the pressure of tight shoes. Horns, or cornua cutanea,
consist either in an excessive, circumscribed hypertrophy of the
epidermis or in enlarged hair-follicles.

An abundant formation of pigment in the rete Malpighii causes a
more or less dark color of the skin ; when accumulating in confined
spots it constitutes, without rising above the level of the skin, naevi
spin, (mother's marks ;) lentigines, (liver-spots ;) ephelides, (freckles ;)
chlosmata uterina, that is, brownish spots on the forehead and upper
lip during pregnancy, or in consequence of uterine disorders ; and
the peculiar darkening around the nipples and the darkening of the
linea alba during pregnancy.

A hypertrophy of the papillary layer of the cutis constitutes

Ichthyosis, or Fish-Skin,

Is, according to Hebra, always of a congenital or hereditary nature.
The skin appears dry and rough and covered with thickened and
exfoliating cuticle, like scales, all over ; with the exception of the
face, the inner side of the joints and the scrotum. In light cases the
skin presents merely a rough appearance, being covered with fine,
white scales, loithout any sign of congestion or inflammation under-
neath. These light cases are called by some authors pityriasis;
whilst other writers reckon to pityriasis also those cases where such
small^ whitish patches of unhealthy cuticle form upon a red, inflamed
surface, calling it pityriasis rubra. It seems that the latter is a


superficial dermatitis, and has nothing to do with a diffused hyper-
trophy of the papillary layer of the cutis.

TJierapeutic Hints — Compare Calc. c, Clem., Graph., Hepar,
Lye, Petr., Plumb., Sepia, Silic, Sulphur, Thuya. Eubbing with
oil, and afterwards taking a warm bath, is best suited to remove the
hard scales.

Hypertrophy of single papillse causes loarts^ (verrucas vulgares,) and
figwarts^ (condylomata.)

A circumscribed hypertrophy of the cutis constitutes so-called
polypi of the skin, and the mulluscum simplex, a hard, sometimes
pediculated tumor.

A hypertrophy of the cutaneous capillaries causes telangiectasias.
Some of them remain stationary through life, whilst others enlarge
continually and may give rise to profuse hemorrhages.

II. Atrophy of tlie Skin.

Atrophy of the entire shin takes place in consequence of general
marasmus, either senilis or prasmaturus, induced by exhausting

A want of pigment throughout the whole skin is congenital to
albinos or kakerlakes. A disappearance of pigment in single places
of the skin, vitiligo or achroma^ gives, especially to dark persons, a
white-spotted appearance.

An atrophy of the hair-follicles causes baldness, calviiies, or, as it
happens mostly to aged persons, alopecia senilis. The falling out of
the hair after severe illness depends merely upon a nutritive dis-
turbance of the hair-follicles, not upon a wasting away of the same.
Therefore the hair grows again as soon as these nutritive disturbances

A want of pigment in the hair makes it gray and white.

. Hypersemia and Anaemia of the Skin.

A stagnation of blood in the cutaneous capillaries, in consequence
of heart disease, causes cyanosis.

Hypersemia, or congestion of the skin, characterized by redness of
the skin, is caused by exposure to heat, by the application of different
irritating substances, such as mustard, cantharides, mezereura, &c. ;
by a blow or fall ; by the different exanthematic diseases and fevers
of different descriptions.


Ansemia of tile skin, characterized by great paleness of the skin,
is always associated with a general anasmic state of the system;
moreover, it is induced by exposure to cold, and is quite a character-
istic sign of chills.

IV. Dermatitis, Inflammation of the Skin.

I. Erythema.

Erythema is characterized by a diffused redness of the skin, which,
under the pressure of the finger, disappears, and leaves not a white,
but a yellowish spot, which at once grows red again. It gradually
disappears and is followed by desquamation ; it is always attended
with more or less burning pain. Erythema is caused by exposure to
"heat, the rays of the sun ; by different irritating substances. When
it occurs in small children between the folds of the skin around the
neck, behind the ears, between the thighs, &;c., or in fat women under
the dependent breasts and becomes raw, it is called intertrigo. The
erythma between the buttocks, in consequence of friction from walk-
ing in hot weather, is vulgarly called " TFoZ/"." "When erythema is
the consequence of pressure from lying long in one position, as in
severe illness upon the os sacrum, trochanters, or other prominent
parts of the body, it is called decubitus. So, also, do we observe
erythema, in consequence of acrid discharges from the eyes, nose,
bowels, and genitals upon the adjacent parts.

Besides all this there is an erythema, which, without any apparent
cause, appears spontaneously upon the back of the hands and feet ; in
rare cases it spreads over the face and trunk, but never without, at
the same time, showing itself upon the back of the hands and feet.
It appears in these localities as an evenly-diffused redness and swell-
ing, which, after a short time, becomes covered with smaller, and
larger, dark-red, or even purplish-colored papulse, erythema papu-
LATUM seu tuberculosum. It is always attended with an annoying,
burning pain, and in some cases with feverishness. After a few days
the redness, swelling, and papulae disappear, and the whole morbid
process winds up with desquamation of the cuticle in the course of
eight or fourteen days. In some cases it lasts longer, when repeated
crops of papular eruptions follow each other in succession and on
different localities.

The ERYTHEMA NODOSUM appears almost exclusively on the lower
extremities of young persons. Upon the reddened skin appear



lumps of the size of hazelnuts or walnuts, whicli are painful to the
touch and which have the greatest similarity to bruises, changing
their color from red to purple, then to blue, and lastly to green and
yellow. This form is always attended with feverishness and ends
with desquamation after eight or fourteen days ; only in rare cases
new crops follow.

Therapeutic Sints. — Intertrigo of infants between the thighs,
when attended with acrid diarrhoea, compare Borax, Cham., Merc,
Rhus t., Sulphur,

When behind the ears, G-raph., Petrol., Sulphur.

In general, Lye.

Erythema from exposure to the rays of the sun. Aeon,, Camphor,

Decubitus, Arn,, Carbo veg., China, Fluor, ac, Sulph, ac, &c., com-
pare the corresponding chapters.

Erythema from acrid discharges, compare the corresponding chap-

Patulous erythema, compare Aeon., Bell., Lach,, Merc, Ehus t.,

Erythema nodosum, compare Am., Mezer., Lach,, Ledum, Lye,
Sulph. ac. Sulphur.

2. Herpes.

The different forms of herpes are characterized by their exudate
under the epidermis in the form of globular vesicles, arranged in
clusters upon an inflamed patch of the skin, which terminate fre-
quently in the formation of a thin incrustation.

The HERPES FACIALIS appears on the face ; when on the cheeks and
upon the eyelids it is called herpes phlyct^nodes ; when upon the
lips, herpes labialis, or HYDRO A YE^BiiA^, fever-Uisters. This latter
form is a frequent attendant upon croupous pneumonia, intermittent
fevers, and other febrile diseases. It scarcely ever occurs in typhus.

A special treatment is not required, but its presence may suggest
Bry., Grraph., Hepar, Natrum m,, (especially in intermittent fevers,)
Rhus t,, Sulphur.

The HERPES PR^PUTiALis appears in preference on the prepuce,
but also on the scrotum, penis, and on the outer parts of the female
organs. Its appearance in clusters of globular vesicles, which are
soon covered with a thin crust, distinguishes it at once from chancre.


Hepar or Merc, are almost always sufficient for its removal ; and in
case of violent itching and burning in females, Caladium seguinum.

The HERPES ZOSTER or ZONA is characterized bj its peculiar way
of spreading along the course of certain nerves. When it appears on
the thorax, the clusters of vesicles occupy the space in which one of
the spinal nerves takes its course, commencing near one of the verte-
bra and running around on one side of the trunk towards the sternum,
thus forming a kind of belt around one-half of the thorax. When it

Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 61 of 65)