Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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appears on the neck, it forms not only a ring around one side of the
neck, but appears likewise upon the trunk and the upper arm, corre-
sponding to the course of the cervical nerves and the brachial plexus.
In cases where it starts from the lower lumbar vertebras, it spreads
in a similar manner upon the thigh. Quite seldom is zoster found in
the face, and then it occupies one-half of the face in the shape of a
•belt. Zoster is almost always preceded by rheumatic pains in the
parts affected, by fever and debility. There is burning in the parts,
then follows redness, upon which gradually clusters of vesicles appear,
which often coalesce. In the course of four or six days they form
into crusts. This terminates the attack, unless new and fresh crops
of vesicles should break forth. The burning pain usually commences
to leave when the eruption is fully out, and disappears entirely with
the falling off of the crusts. Not unfrequently, however — and this is
quite a peculiar feature of zoster — there is developed, after all seems
well, an intercostal neuralgia, which is very painful and often quite
obstinate.

Therapeutic Hints,

Arsen., severe, burning pain, worse at night, and great restlessness.

Croton tigl., itching and painful burning and redness of the skin ;
formation of vesicles and pustules; desiccation of the pustules, and
desquamation and falling off of the pustules — a close picture of zoster.

Euphorbium.

Graphites, especially on the left side.

Merc, is said by some to be a specific for relieving the burning,
and preventing the appearance of new crops.

Mezer. is strongly recommended, and said to prevent and cure the
succeeding neuralgia intercostalis.

Puis., where there is gastric derangement ; evening aggravation, and
a mild, yielding, tearful disposition.

Rhus t., where there is fever, restlessness and itching-burning.

Silic.



612 DERMATITIS.

Herpes circinnatus {ring-worm) is characterized by its circular
form. The vesicles, usually much smaller than in other forms of
herpes, appear in a circle, the centre of which is perfectly healthy
skin. Sometimes, however, there is one larger vesicle, which not
unfrequently is filled with a bloody fluid, right in the centre of the
ring, and around the ring appears still another larger ring. This form
is called herpes iris. Many of these eruptions are said to be caused
by vegetable parasites. '

Hxerapeiitic Hints* — Compare Hydrastis, Natr. c, Natr. mur.,
Sepia.

3. Urticaria, Nettle-rash.

This affection is characterized by prominent and perfectly smooth
patches upon the skin, the color of which is either redder or whiter
than the surrounding skin. They are formed by a serous infiltration
of the 'paipillary layer of the cutis. The causes of these eruptions are
numerous. As such we may mention — 1, Various external irritations,
such as the contact with nettles, or with some kinds of caterpillars
and mollusks ; the sting of fleas, bed-bugs, mosquitoes, bees ; scratch-
ing with the finger-nails ; 2, Intestinal irritations from eating straw-
berries, crabs, clams, mushrooms; from taking copaiva-balsam ; 3,
Uterine irritations, during pregnancy ; menstruation ; different uterine
diseases, and after the introduction of pessaries.

Entirely unknown are the causes of urticaria febrilis, which
is chiefly attended by digestive disturbances, and has in its course
and progress great similarity with other exanthematic fevers. I have
often observed that symptoms which simulated croup, asthma or dif-
ferent other complaints, all at once disappeared as soon as the nettle-
rash made its appearance upon the skin. "We also find it associated
with chills and fever and other febrile complaints. In some cases it
assumes a chronic form^ which it is quite difficult to get rid of.

Therapeutic Hints,

Ant. cr., thick, white-coated tongue ; gastric derangement.
Apis, stinging, burning ; croupy cough ; uterine catarrh.
Arsen., burning ; chills and fever.
Bellad., during profuse menstruation.
Bryon., fever and rheumatic pains, worse from motion.
Calc. c, fat, plump children; teething period; chronic form.
Dulc, itching ; after scratching, burning ; after taking cold ; griping
pain in the bowels, with nausea and diarrhoea.



ECZEMA. 613

HepaP, clironic cases ; eruption on hands and fingers ; during inter-
mittent fever.

Ign., during the chilly stage of intermittent fevers.

Kali c, during menstruation.

Lycop., chronic cases.

Pulsat., during delayed and scanty menses.

Psorin., after suppressed itch, frequently-repeated attacks of urti-
caria, with fine vesicles on the top, which dry and peel oif in fine
scales ; regularly coming after any exertion.

Rhus t., itching, burning ; skin swollen and red ; after getting wet ;
worse in the cold air ; rheumatic pains, worse in rest ; fever.

Sepia, chronic ; breaks out during a walk in the cold air, and dis-
appears again in the warm room; especially on the face, arms, and
thorax.

Sulphur, chronic cases; frequently indicated after Pulsatilla.

Urtica urens, without any concomitant symptoms.

4. Eczema, Vesicular Eruption.

Eczema consists in a diffuse, superficial dermatitis, which causes
numerous little vesicles upon an inflamed, irregular surface; some-
times these vesicles are intermingled with pustules ; at other times
the exudation may not be abundant enough to raise the epidermis
into vesicles, but only loosens it, so that it dies off and forms a scaly
surface ; or the epidermis is actually thrown off, leaving a raw, moist
surface behind, which, in some cases, becomes covered with a thin
scurf; in others, with a thick crust.

Its causes are — 1. Direct irritation of the skin by too high a tempera-
ture ; hot baths ; the application of wet bandages ; the rubbing in of
mercurial salve, or croton oil ; and by various other irritating sub-
stances. 2. /Stagnation of the venous blood within the capillaries. As
this takes place most frequently on the lower extremities, we find the
consecutive eczema there also, in the form of salt-rheum.

3. A dyscratic diathesis of scrofulous or rhachitic individuals.

4. In many cases we cannot trace it to any cause.

It chooses as favorite localities : the scalp, where it is called tinea
furfuracea, if it causes merely a separation of the epidermis in fine
scales ; or tinea amiantacea, if the dried exudate and the loosened epi-
dermis form a kind of asbest-like layer upon the inflamed surface.
Such peeling-ofif processes are known under the name of dandruff.

The face. Here it occurs in all forms, and has received many differ-



614 DEKMATITIS.

ent names: eczema impetiginosum and ruhrum ; porrigo larvalis^ tinea
faciei, crusta lactea, crusta serjnginosa, &g.

The genital organs, in males the penis and scrotum, and in females
tlie labia m,ajora. It is either acute or chronic ; the latter especially
when on the scrotum. By its terrible itching it drives one almost to
madness. It may appear also upon the perinseum, and around the anus.

The inner side of the thigh, just where the scrotum touches it. This
is called eczema marginatum, and has been observed especially in
shoemakers and cavalry-men. It commences on the inner side of the
thighs, just where the scrotum touches it, but soon appears also on
the corresponding place of the other thigh.

The legs. Here it forms a large, red, raw, constantly-secreting
surface ; sometimes covered with thick crusts. This is called salt-
rheum.

The bends of the extremities. The scanty exudate generally dries
with the loosened epidermis, and forms a brittle covering ; which, on
motion of the limbs, cracks in different directions. Sometimes the
secretion is more profuse, and keeps the affected parts constantly moist.

Hands and feet. It is a peculiar fact, that, hands and feet are attacked
almost always simultaneously. When it appears on the dorsal side,
it generally assumes the form of simple eczema or vesicles, and may
be confounded with itch. On the palms of the hands or soles of the
feet it scarcely ever occasions vesicles, but causes the epidermis to
peel off in the form of white scales ; for which reason it has been
called psoriasis or pityriasis palmaris or plantaris. The progress of
the disease is seldom acute ; all forms are characterized by great itch-
ing ; and scratching is apt to spread the affection further.

Therapeutic Hints, — In selecting the remedy for such affec-
tions, the constitutional symptoms must never be lost sight of I can
give hints only to local symptoms, as the other would lead too far,
and still could not meet all the possible complications.

Eczema on the scalp, compare :

Arsen., generally dry, scaly eruption, sometimes fetid, purulent se-
cretion, with nightly burning or terrible itching ; better from external
warmth.

Baryta c, moist crusts, with falling off of the hair ; glandular
swellings on the neck and under the lower jaw.

Calc. c, thick crust, moist or dry, with scrofulous diathesis.

Clematis, the eruption looks inflamed during the increasing, and
dry during the decreasing moon.



IMPETIGO.



615



Graphites, impetiginous eruption; soreness after scratching; worse
on left side and in the evening ; sticky secretion.

Hepar, purulent secretion, itching and sore, worse in the morning
and on the right side.

Lycop., thick crusts, with fetid secretion underneath ; bleeds easily-
after scratching.

Merc, yellow crusts, stinging, burning ; the surroundings inflame
easily after scratching.

Natr. m., raw, inflamed surface, discharging continually a corroding
fluid, which eats away the hair ; boundaries of the hair.

Rhus t., thick, moist crusts ; tingling, stinging, burning, especially
at night.

Staphis., yellow, acrid moisture oozes from under the crusts ; upon
the denuded surface form at once new vesicles which again burst.
By scratching one place the itching ceases but appears at another
place.

Sulphur, crusts and pimples itching spontaneously, especially at
night ; easily bleeding.

Besides, compare Anacardium, Ant. cr.. Borax, Cicut., Cyclam.,
Dulc, Kali bichr., Nitr. ac, Oleander, Phos., Sepia, Silic, Thuyai

Eczema on the face, compare Arsen., Bell., Borax, Calc. c, Clemat.,
Cicuta, Croton tigl., Cyclam., Graph., Hepar, Lye, Merc, ISTatr. m,,
Ehus t., Sepia, Staph., Sulphur.

Eczema on the genital organs, compare Argent, nitr., Arsen., Calad.,
Croton tigl.. Graph., Hepar, Lye, ISTatr. m., Nitr. ac, Petrol., Ehus t.,
Sep., Sulphur, Thuya.

Eczema marginatum^ compare Natr. m.. Sepia, Sulphur.

Eczema on the legs, salt-rheum. As this affection is the result of
stagnation in the venous circulation, it will be a great service to
bandage the limbs tightly. Amongst the remedies compare Arsen.,
Calc c, Carbo veg.. Graph., Lach., Lycop., Merc, Natr. m., Ehus t.,
Sarsapar., Sepia, Silic, Sulphur.

Eczema in the hends of the extremities, compare Ammon. c, Bry.,
Calc. c. Graph., Ledum, Merc, Sepia, Sulphur.

Psoriasis, or pityriasis "palmarmn, or plantaris point to Magn. c,
Eanunc. bulb., Ehus t.. Sepia, Sulphur.

5. Impetigo, Pustular Eruption,

It differs from eczema only by its pyogenic tendency. As, how-
ever, the contents of the eczema- vesicles frequently become milky



616 DERMATITIS.

and purulent, no distinct line of demarcation can be drawn between
these two skin-affections. In fact, many of the eruptions cited under
eczema of the scalp and face may, with equal propriety, be classed
under impetigo. Its causes are the same as those of eczema. In
addition, we find this form especially in scrofulous subjects, in whom
there is a great vulnerability of the skin, so that any little irritation
or wound of the skin at once begins to fester. We also find it
sometimes after vaccination sprouting forth over the body.

The eruption of the impetigo is sometimes attended with fever ; a
part of the skin reddens, burns, and itches, and now little pustules
appear, which after a while burst and form yellowish, brownish, or
greenish crusts; they gradually dry and fall off; in about ten or
fourteen days all signs of it have disappeared. In other cases this
process goes on for a long time, as constantly new pustules arise and
the first-affected parts of the skin still go on to secrete a watery
fluid — chronic impetigo. The scratching with the nails is especially
apt to spread the affection, and it may, in this manner, be even
transmitted to other persons. When the pustules appear singly it is
called impetigo sparsa ; when in groups, impetigo figurata ; and when
upon a highly-inflamed surface, impetigo erysipelatodes.

Therapeutic Hints. — All that has been said under eczema is
applicable here. All the constitutional diseases must be considered.
If Hebra and his echoes assert that it be pure imagination of an
erroneous idea of the natural processes in the human body to sup-
pose that eczema, if cured by external means, {id est, by being sup-
pressed by green soap, Kali causticum. Tar, &c.,) could ever do
any harm; we leave them to grow wiser by closer observation, and
stick to old Hahnemann and our own experience. There is no dis-
tinct line of demarcation between eczema and impetigo. The latter
is admitted by Hebra himself to be in connection with scrofalous
diathesis ; why not the eczema ? If the one be the expression of a
general contamination of the system, why not the other ? But it is
so much easier to cut off the fruits of a tree than to root out the tree
itself.

6. Ecthyma, Isolated, Large Pustules.

Upon a red and swollen surface appear single pustules of the size
of a pea, which contain a yellow, purulent, or dark-colored fluid if there
be blood mixed with it. They are surrounded by a red areola, and



PEMPHIGUS. 617

appear most frequently upon the extremities, on the seat, on the chest,
and on the neck ; less often on the face. Ecthyma is almost always
attended with stinging pains, and in irritable persons with slight
fever. In the course of a few days the contents of the pustules dries
and forms a round, brownish crust which soon drops offj without leav-
ing a scar behind. Sometimes, however, the crust adheres longer, and
there forms beneath it an ulceration which even eats into the cutis.
In chronic cases the eruption of such pustules goes on repeatedly for
a long time.

The causes of ecthyma are like those of eczema and impetigo : ex-
ternal irritation, especially antimonial salves, fresh lime upon the hands
of bricklayers, red-hot-iron sparks upon the hands of blacksmiths,
&c. We meet it, likewise, during the course of febrile diseases, like
hydroa, during itch, and in consequence of protracted diseases, poor
living, cachectic, scorbutic and syphilitic conditions.

Therapeutic Hints. — Compare Ant. cr., Arsen., Calc. c, Lach.,
Lye. Nitr. ac, Silic, Sulph., Tart. em.

The general constitutional indications must never be lost sight of.

7. Pemphigus, Pompholyx, Isolated large Bulloe or Blisters.

Upon a red, inflamed, but not infiltrated surface, appear pretty large
blisters, which are filled with clear serum and much resemble those
occasioned by burns or fly-blisters. About their causes nothing is
known, except that if they occur in new-born children they are of a
syphilitic origin, and in grown persons they are symptoms of some
general dyscrasia or cachexia.

The acute form of this affection is extremely rare. It is always
attended with pretty high fever, and general indisposition, and lasts
about fourteen days. Eenewed outbreaks may prolong it much longer.
The chronic form of pemphigus, which may grow out of an acute
attack, lasts months and even years. One crop after another appears
upon the skin, showing the bullae in all the phases of their develop,
ment : the youngest are transparent, the older have a milky appear-
ance ; then they burst and leave an excoriated surface. This raw
surface still continues to secrete serum, and is finally covered with a
thin crust. The worst form is pemphigus poliaceus. It begins with
a single blister, which is continually increasing, until the whole sur-
face of the body is literally skinned and then covered by a brownish
crust. It is said to have a fatal termination.

Tlierapeutic Hints. — Compare Arsen., Canth., Caust., China,
Dulc, Kreas., Lach., Merc, Ranunc. bulb., Rhus t., Sulph.



618 DEEMATITIS.

8. Rupia or Rhypia, Isolated Blisters^ wliich form thick

crusts.

The bullae contain a purulent reddish matter, which gradually dries
and forms a thick, dark crust. Underneath this crust matter continues
to form, which again dries and consequently raises the centre of the
crust, whilst on the periphery it becomes encircled by a vesicated
border, which again dries up into a crust. And as this latter is much
thinner than the first which has been successively heaped up, the
whole assumes a great similarity to an oyster-shell. On removing the
crust we find a deep, foul, excoriating ulcer. Eupia is said (by
Hebra) to be always of syphilitic origin.

Therapeutic Mints, — Compare Syphilis.
9. Furunculus, Boil.

A furuncle consists in an inflammation of one or several closely-
grouped cutaneous glands, the follicles of which at first become infil-
trated. By-and-by the inflammation spreads to the surrounding cellu-
lar tissue, extends through the covering skin, and, accompanied by
acute pains, and even fever, finally perforates the skin and discharges
a bloody matter ; the core, however, (which is the infiltrated follicle
enveloped in cellular tissue,) is not discharged until all of it has been
loosened from its surroundings. Large boils generally occur singly ; of
small ones, so-called blind-boils, which discharge very little, or nothing
at all, there frequently appear several at a time, or in rapid succes-
sion, and may torture the patient for a considerable length of time.
Their exact cause is unknown. We sometimes find them prevailing
almost epidemically, and they frequently appear during the reconval-
escence from severe illness.

Therapeutic Mints. — Never use the lancet or have it allowed
to be used, because it never does any good, but always harm, as it
increases the inflammation and protracts the healing process.

For large boils, compare Apis, Crotal., Hepar, Lach., Lye, Merc,
Nitr. ac, Silic, Stram.

For small ones, Arn., Bell., ISTux v., Sulph.

For a disposition to boils, Arsen., Calc. c, Lye, ISTux v., Phos. ac,
Silic, and Sulph.



CARBUISrCULUS. 619

10. Carbunculus, Carbuncle.

The carbuncle commences with severe pains in the part affected,
which are mostly of a burning character, and continue to be so
through the whole course. The painful spot now commences to dis-
color ; it generally assumes a purplish hue ; and it gets hard and
swollen. After five or six days we observe numerous little holes
forming in the raised and discolored place, out of which project yel-
lowish spots of a mattery substance. By this time the swelling,
hardness, and discoloration may still increase, as well as the extent in
circumference. Only a little pus is discharged from the small holes.
They, however, gradually widen and coalesce, until by degrees a con-
siderable portion of the cutis is entirely destroyed. Now we observe
the decaying cellular tissue underneath; the pus discharges more
copiously, and with it large pieces of decayed cellular tissue (sloughs)
are thrown off. The loss of substance sometimes amounts to several
square-inches. This process is always attended with considerable
fever, and is quite apt to assume an adynamic character. When
complicated with cerebral symptoms, which are the consequence of
the absorption of the pus into the blood, such cases may terminate
fatally. In more favorable cases there appear at the bottom of the
wound new granulations, and by a slow healing process the whole
lost substance is finally restored.

Carbuncle differs entirely from furuncle. It is of a much more
destructive character, appears principally on the nape of the neck
or along the spine, and attacks chiefly aged persons ; whilst furuncle
is never associated with gangrenous destruction of substance, appears
here and there and everywhere, and attacks all ages alike.

TJierapetitic Mints, — No knife. But compare:
Anthracinum, when the burning pain is violent and not relieved by
Arsenicum ; cerebral symptoms ; absorption of pus into the blood ;
gangrenous destruction. A carbuncle on the back of a man, some
sixty years of age, had attained a size of nine inches in length, and
five inches in its greatest width. There was sloughing ; abundant
discharge of ichorous, terribly smelling pus; and poisoning of the
blood by absorption of pus. Arsen. had no beneficial effect ; Anthra-
cin. relieved at once. Ever since then I have given Anthracin. in
several cases, where there were symptoms of the same destructive
character, with the same beneficial result.



620 DERMATITIS.

Apis, when the erysipelatous inflammation extends further and
further.

Arsen., great burning; great restlessness; great thirst, with drink-
ing but little at a time ; great debility ; all the symptoms are worse
in the night, and better from external warm applications.

Bell., bright redness; throbbing pain; drowsiness, with inability
to go to sleep.

Carbo veg., dark, blackish appearance ; fetid odor.

Kreosot.

Lach., bluish, purplish appearance ; inability to bear any bandage
around the neck ; cerebral symptoms.

Nitr. ac.

Rhus t., great restlessness ; feels somewhat relieved of the violent
pain as long as he is in motion.

Secale.

Silic, during the process of ulceration ; it seems to clear the wound
of its decayed masses, and to promote healthy granulation.

II. Panaritium, Paronychia, Whitlow, Run-Around, Felon.

It is an inflammation on the thumb or on one of the fingers, which
terminates in suppuration. There are two distinct varieties of this
inflammation, a superficial and a deep-seated one.

The superficial form, whitlow, run-around, is generally seated
immediately around and beneath the nail, commencing either at the
side of the finger upon its dorsal surface, or at its extremity. With-
out much, if any swelling, the part is of a dusky reddish aspect, ten-
der on pressure, and exquisitely painful, throbbing violently and in-
cessantly, and causing more or less constitutional disorder. Two or
three days after these phenomena present themselves, matter is ob-
served in the finger, lying just beneath the epidermis, which is ele-
vated into a yellowish vesicle at the side and root of the nail. In
many cases pus is also situated below the nail, especially at its pos-
terior extremity ; and sometimes, again, it is found chiefly, if not ex-
clusively, in the cellular substance immediately beneath the true
skin. The inflammation generally extends some distance up the
finger, and occasionally even over a considerable portion of the han.

Special Hints.

Arsen., inveterate cases ; eruption in the bends of the knees ; pus-
tulous eruption ; burning and itching ; better from external warmth.

Carbo veg., eruption dry and fine; almost over the whole body;
worst on the extremities ; itching worst after undressing ; dyspeptic
symptoms ; belching of wind and passing flatus ; after the abuse of
mercurial salves.

Caust., after the abuse of sulphur and mercury ; yellowish color of
the face; warts in the face; involuntary discharge of urine when
coughing, sneezing or walking ; sensitiveness to the cold air.

Hepar, fat, pustulous and crusty itch ; also after previous abuse of
mercury.

Mercury, fat itch, especially in the bends of the elbows.

Psorinum, inveterate cases; with symptoms of tuberculosis; also
in recent cases ; eruption in the bends of the elbows and around the
wrists ; repeated outbreaks of single pustules, after the main eruption
seems all gone.

Sepia, after previous abuse of sulphur ; itching worse in the even-
ing ; especially in females.

Sulphur, main remedy ; voluptuous tingling-itching, with burning
and soreness after scratching.

Sulph. ac, when itchiness of the skin and single pustules appear
every spring, after a not perfectly-cured itch.



628 ANOMALIES IN THE SECRETIONS OP THE SKIN.

v. Anomalies in the Secretions of the Skin.

The secretion of gaseous substances is either augmented, for example,
in fevers, when the temperature of the body is considerably raised,
and in a hot atmosphere ; or it is diminished^ when the air is damp and
its temperature low. In disease, a diminution of gaseous secretion has
been ascertained by actual measurement only in diabetes mellitus.

.The secretion of watery substances^ which is called perspiration or
sweat, may be promoted in any healthy person by drinking large quan-



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 62 of 65)