Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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the opposite direction. This is impossible in one-sided tonic spasm.

The deviation from the natural axis of sight is either converging or
diverging, either iqnoarch or downwards, or even with one eye upwards
and with the other downwards. On account of its exceeding ugli-
ness, this latter has been styled strahismus horridus. In all these
different deviations from the natural axis of sight, one eye may be
afi'ected, or both may be involved. Each eye will assume imme-
diately the normal direction if the other be closed.

The causes are various.

We have found squinting to be a sign of some cerebral affections,
especially of hydrocephalus acutus, apoplexy, and others.

It may be a hereditary fault.

It may be acquired in early childhood by one-sided exercise of the
eyes, caused by inattention to the child, in keeping its head in an
improper and unfavorable position for seeing the things around the

It may be caused by weakness of one eye, in which case only the
stronger eye performs the function.

It may have its origin in spots on the cornea, or in cataract, or in
hypertrophy of the contracted eye-muscle, or in a wrong insertion of
one of the eye-muscles.

It may be caused by irritation in the intestinal canal by worms, or
by catarrhal affections.

Tlierapeutic Mints,

Belladonna, Gelseminum, Hyoscyamus, Sulphur, cerebral irritation
with corresponding symptoms.

54 EARS.

Cina, so-called " worm signs," picking nose ; restless sleep ; grating
of the teeth ; short hacking congh through the night, &g.

Cyclamen, left eye drawn towards the inner canthus after unsuccess-
fal operation.

Spigelia, intestinal irritation ; constant itching at the anus.

Sulphur, cerebral or intestinal irritation ; nightly itching of the
skin ; cutaneous eruptions ; disposition to costiveness.

Blepharo-plegla, Paralysis of the Eyelids.

This is either^ paralysis of the musculus levator palpehrarum^ in
consequence of which the upper eyelid falls down and cannot be
raised ; or it is a paralysis of the musculus orbicularis^ in consequence
of which the eye cannot be closed, even in sleep ; or it is a paralysis^
of both of these eye-muscles^ in consequence of which the eye is neither
closed nor fully open, but half open.

This affection is generally a sign of disorganization in the brain ;
it may, however, be brought on by rheumatic affections, or injuries
of these muscles.

Ophthalmo-plegia, Paralysis of the Eyehall.

This affects either one or several muscles, and causes the eyeball to
stand crooked in the orbit, or it is a paralysis of all the muscles of
the eyeball, and this causes a prolapsus bulbi. The sight is in such
cases much obstructed or entirely destroyed.

This kind of paralysis is generally accompanied by blepharo-plegia,
and is sometimes complicated with amaurosis.



At first sight, these organs seem so entirely unlike each other, that
it would seem scarcely possible to discover any analogy between them :
but on closer inspection, it appears to me so striking that I am aston-
ished at not finding it recognized and recorded in any of the works
on anatomy and pathology.


As T consider this similarity in the structure of the eye and ear of
great importance in clearing up the rather occult affections of the ear,
(the treatment of which is often very difficult,) I shall point out, with
some detail, the following quite remarkable features of similarity be-
tween the organ of sight and the organ of hearing.

The innna corresponds to the uj^j^er and the tragus to the lower eye-
lid. In animals the auricle is even movable, to collect or reject sounds,
as the eyelids are to take in or to keep out the light.

The eyelashes are represented by the hristly hairs at the mouth of the
meatus externus ; to keep out dust and insects.

The meatus externus is lined by a semimucous membrane, secreting
ear wax, corresponding to the conjunctiva of the eye, which secrets
eye-butter, both of which are subject to exactly similar inflammations
and mucous or purulent discharges.

Next comes the membrana tymjMni, corresponding not only in func-
tion, but also most strikingly in structure, with the cornea. It collects
sounds, while the cornea collects light ; and it is, at least, of a half-
transparent texture. The diseases to which it is liable correspond
with those of the cornea : inflammation, thickening, ulceration and

Immediately back of this membrane, in the middle ear or tym-
panum, lie the ossicula auris, those little bones, by which sound is
broken and communicated to the auditory nerve, in the labyrinth,
just as the light, by means of the crystalline leris, is to the optic nerve.
The middle ear or tympanum.^ with its ossicula, corresponds, therefore,
precisely to the anterior and posterior chamber of the eye with the lens.

Still further back we come into the labyrinth of the ear, which is
filled, in its membranous portion, with a limpid fiuid^ first well
described by Scarpa ; and which corresponds perfectly to the vitreous
humor of the eye : whilst the numerous filaments of the two branches
of the auditory nerve, the vestibular and cochlear nerves, spread out
into a nervous membrane^ resembling closely that of the retina, so that
the labyrinth of the ear corresponds entirely to the -posterior part of
the eye with its vitreous humor and its retina.

There is one appendix to the ear — the Eustachian tube — which starts
at the tympanum, and opens into the lateral wall of the throat, and
there is also one appendix to the eye — the lachrymal duct — which starts
at the inner canthus of the eye and opens into the nose ; th© former
carrying away secretions from the tympanum, .and the latter from the
eye, each corresponding closely to the other ; and lastly both organs
are situated in close proximity to porous bones: the ear on the mas-

56 EARS.

toid portion of tlie temporal bone, and the eyes below the frontal
sinuses of the frontal bone.

This striking similarity in the structures of the ear and eye at once
brings the diseases of the ear (by comparing them with those of the
eye) nearer to our comprehension ; and may even influence the choice
of a remedy in a given case.

In detailing the special diseases of the ear, I shall make therefore
a similar classification as that which was observed in those of the eye.

General Observations on the Ear.

The auricles grow pale from fright, chills, spasms, loss of vital fluids,
exhaustion and frost. A marked paleness of the left auricle denotes
inflammation of the spleen.

Redness of the auricles is found in congestive and inflammatory
conditions of the head and ears.

Flushes are caused by mental emotions ; or occur before bleeding
of the nose, delirium, apoplexy.

An hahitual or frequently-occurring redness of the auricles denotes
disturbed actions in the abdominal organs ; or else menstrual and
hemorrhoidal affections.

A striking redness of the auricles in new-horn children is a sign of
premature birth.

Small, inflammatory, purplish, suppurating spots on the auricles are
a sign of chronic syphilis.

Swollen auricles, if inflammatory, are caused by erysipelas, injuries,
eruptions ; if habitual, not inflammatory, it is a sign of scrofulous con-
ditions ; if oedematous, a consequence of abscesses or Bright's disease.
The auricles are —

Hot in inflammatory and congestive conditions of the head and ears,
also in consequence of great exertion of the voice, and in diseases of
the larynx.

Cold, in chills, spasms, and from exhaustion. Auricles habitually
coll are found in weak and chlorotic individuals. In hysteric persons,
cold auricles are the forerunners of a hysterical spasm; whilst in
delirium and mania they denote a cessation of the paroxysm.

Discharges from the ears may originate either in the meatus audi-
torius externus, in the middle ear, (the tympanum,) or even in the
cavity of the skull. They are of various characters.

If, after a fall or external injury of the head, there be a discharge
of blood, it denotes a fracture of the skull. The ears bleed also in


scorbutic affections ; from too great a pressure, or frora insufficient
pressure of the atmospheric air, (cannon-shot; on high mountains;)
from too great exertions in screaming, coughing, vomiting, straining,
blowing musical instruments.

Pus or ichorous matter is the product of a previous inflammation
either in the meatus auditorius or in the middle ear. In rare cases
the pus comes from an abscess in the brain, which has broken through
the petrous portion of the temporal bone.

Thin ear wax is, in most cases, the consequence of a chronic inflam-
matory state of the meatus auditorius externus.

I. Inflammation.

It may take place on any part of this organ, and therefore we have
an inflammation of the auricle ; of the meatus auditorius externus ; of
the membrana tympani ; and of the labyrinth. Wherever it be, it is
chojdiQXQvizQdi hy local irritation ; continuous congestion ; and (as a re-
sult) hy a gradual change in structure.

When confined to the external ear, it lies open for inspection ; not
so if it attack the parts of the internal ear. The fact that the passage
is somewhat curved makes it impossible in many cases, particularly
in adults, to examine with the eye, the parieties of the meatus and the
membrana tympani at its further extremity. It will be in place,
therefore, to speak here of the best means and modes of exploring and
examining these parts.

. The light should be strong, and sunlight is far the best. This,
however, can seldom be made to fall upon the membrane without
straightening the channel, by means of a tube, termed a speculum,
auris. The short bristly hairs at the mouth of the meatus present
also an obstacle to ocular inspection. True, we may, by directing
the auricle towards the sun, pulling it upwards and outwards,
drawing the tragus outwards, and incJining the head of the patient
strongly in the opposite direction, see the membrane, in many cases,
where there is little or no disease ; but generally a speculum auris is
necessary ; by it we are enabled to have a full view of the meatus
and the membrana tympani ; further, however, we cannot see. How,
then, can we diagnosticate an inflammation of the middle ear or tym-
panum f

I must remark here, that this inflammation is never confined to
the lining membrane of the tympanum, but that it generally involves
the Eustachian tube and the mastoid process, whose numerous cells are
lined by a continuation of the same mucous membrane.

58 EARS.

But that does not improve our facilities of diagnosis; for these
tissues are just as little accessible to ocular inspection. And at the
beginning of an inflammation of these parts it might, indeed, be
difi&cult to say, with positiveness, this is an inflammation of the mid-
dle ear. For, although there are numerous, and, indeed, very painful
subjective symptoms, yet they are variable, and might indicate this
or another condition. However, this uncertain state of thino-s does
not last long, before some objective signs, of which we can avail our-
selves, set in. Grenerally, after some lapse of time, the memhrana
tympani gets involved, likewise, in the inflammatory process. If we
apply the speculum auris now, we find this membrane, although still
transparent, show a pale-reddish hue ; by the further process it grows
purple and loses its transparency. Besides this we find the in-
flammation spreading to the velum palati, and to the tonsils, and
uvula. At the same time the hearing is much impaired, and this is
especially owing to an obstruction in the Eustachian tube, either by
a swelling or mucous secretion filling it and the tympanum.

"The simplest means of examining the permeability of the tube
and drum is to direct the patient to close his mouth tightly and press
his nostrils together with his fingers ; then attempt to blow or exhale
forcibly. A sensation of fulness and of crackling will be experienced
in one or both ears if the passage be pervious. This is secured by
the distention of the membrana tympani by the pressure of the air."
(Bryan.) And if the physician lays at the same time his ear to the
ear of the patient, or puts the stethoscope upon the mastoid process,
he will hear plainly the rushing in of the air into the tympanum and
air-cells of the mastoid process if the tube be pervious. If tube and
tympanum be filled with mucus he will hear a decided mucous
rattle, and if the tube be impervious he will hear nothing at all.

Eichter recommends to fold the auricle over, so that it closes the
external meatus ; then to apply the stethoscope upon it. If the tube
be pervious, we hear plainly all noises which an ins23iration, or an
expiration, or the voice, may produce ; but we do not hear them if
the tube is in any way obstructed.

The labyrinth is altogether inaccessible to inspection and ausculta-
tion. And although pathological anatomy has shown and distin-
guished a number of organic changes, which no doubt were in con-
nection with impaired hearing, yet all these things are of no practical
avail, because we have no means by which we could be enabled to
diagnosticate them, during the life of the patient ; we are here entirely


left to subjective symptoms. So mucli in regard to inflammation of
tlie ear in general, and its diagnosis. Now to the special forms.

Erysipelas of the Auricle

Is mostly in connection with erysipelas of tlie scalp or face, and needs,
therefore, no further explanation.

Intertrigo Auriculae, Soreness behind tlie Ears,

Is a complaint mostly of little children. Appearing at first as an
erythema, there soon commences an oozing of fetid matter, which
hardens into crusts. Gradually the whole lobe becomes excoriated
and even parts of the adjacent scalp. A sudden suppression of this
eruption by external means has been found frequently to be followed
by various affections of the brain and its membranes.

Therapeutic Shits, — Compare Graph., Petrol., Sulphur.


Develop themselves out of inflamed sebaceous glands. They thus
correspond with styes on the eyelids. They are found singly, and
generally at the mouth of the external meatus, closing it until they
break and discharge ; or they form clusters, when they develop them-
selves in the meatus externus.

Therapeutic Mints, — Puis., Sulph.

Otitis interna, Inflammation of the Middle Ear,

It commences usually at the membrana tympani, spreads rapidly
all over the tympanum, the Eustachian tube and the cells of the
mastoid process, attacks the labyrinth, and majr even penetrate through
the petrous portion of the temporal bone, and affect the brain and its
membranes. It is a most violently painful affection. Its objective
symptoms are at first little marked, and stand in no proportion to the
violence of the attack. The membrana tympani appears reddened,
the mastoid process becomes hot, swollen, and finally red and inflamed.
Little children bring their hands constantly to the afi'ected ear, scream
out loudly, throw their head from side to side, bore it into the pillows,
and become still more uneasy when rocked in the cradle. If nursing
at the breast, they let the nipple suddenly go and do not drink, because

60 EARS.

the motion of sucking increases tlie pain ; but tliej will take the milk
out of a spoon.

One might mistake this group of symptoms for acute hydrocephalus,
if it were not for the absence of vomiting, the sighing respiration, the
obstinate obstruction of the boivels, with flat, hollow abdomen, and the slow,
intermitting pulse. And also the screaming of the child is different
from that in hydrocephalus ; this, however, one must know from expe-
rience ; it cannot be described.

It is seldom that, under judicious Homoeopathic treatment, this com-
plaint ends in a destruction of the membrana tympani or the ossicula

Therapeutic Mints. — Aeon., Bell., Calc. c, Cham., Merc, Puis.,
Nux v., Rhus t., Sulph.

II. Products resulting from Inflammation.

Is a discharge from one or both ears, sometimes purulent. The
disease is very common, particularly during infancy and childhood.
From being at first a discharge from the lining membrane of the
meatus auditorius externus, in consequence of previous inflammation,
it gradually becomes chronic, and gives sometimes great trouble to
the patient and the doctor. In teething, ophthalmia and other inflam-
mations, nature sometimes establishes this discharge and relieves in
this way the other complaints. " For this reason, which is a matter
of common observation both among the profession and the people,
together with the aphorism, which says, 'Suppression of discharges
from the ears induces diseases of the brain,' it is an every-day affair
to see otorrhoeas entirely disregarded, and no means whatever taken
to remedy them." (Bryan.) This neglect, or rather this fear, to touch
this complaint, has no doubt its good reasons also in numerous sad
experiences, which the old school has made, if its advocates succeeded
in suppressing this discharge.

Therapeutic Mints.

Arsenicum, profuse, ichorous, cadaverously-smelling discharges ;
sinking and prostration.

Asa foet., purulent discharge; diminished hearing; after abuse of

Aurum, fetid discharge ; caries of the mastoid process and ossicula ;
after abuse of Mercury.


Calc. c, puruleut discharge ; difficult hearing, with noise in the ears ;
mostly right ear ; swollen glands on neck ; large abdomen ; little warts
on hands and fingers.

Carbo veg., offensive discharge; difficult hearing ; membrana tym-
pani and external meatus inflamed, sensitive to touch ; pain from right
ear down the neck when turning the head ; after itch-like eruptions.

Caustic, offensive discharge; paralysis of face ; hardness of hearing.

Elaps, discharge coloring the linen greenish; hard hearing; stitches
in forehead ; lachrymation.

Hepar, scrofulous individuals; affection of the mastoid process ; after
abuse of Mercury.

Lycop., puruleut, ichorous discharge ; difficult hearing ; scrofulous
affections ; after scarlet fever.

Merc, sol., offensive discharge ; itching in the ears ; vesicular erup-
tion in the face and pustules on the lower limbs ; syphilitic origin.

Nitp. ac, buzzing; throbbing in the ears; difficult hearing; ob-
structed Eustachian tube ; swollen tonsils ; after scarlet fever.

Puis., tearing, stitch-like pain; redness and swelling of the meatus;
catarrhalic affection of the Eustachian tube.

Silic, boring pain ; feeling of obstruction, sometimes going off with
a report ; swelling and redness of the mastoid process.

Sulphur, purulent offensive discharge, mostly left ear; intertrigo be-
hind the ear ; itching and bleeding after scratching ; eruption on face
and body.

Ulcerationj Thickening, and Destruction of the Mem-

It is an easy matter to diagnosticate these morbid changes of the
membrana tympani, as they lie open to ocular inspection, by apply-
ing the ear-specuium. They may arise from inflammation of the
meatus externus and its subsequent ulceration — otorrhoea ; or from
an inflammation of the membrane itself; or from otitis interna, and
its subsequent forming of pus, by which the membrane is perforated.
Thus it is not a primary affection, but always, like corneitis, the con-
sequence of inflammatory processes in the neighboring parts.

Therapeutic Mints. — Hepar, Merc.
. Besides, compare therapeutic hints to otitis and otorrhoea.

62 EARS.

Destruction and Discharge of the Ossicula Audltus.

The ossicula can, of course, be discliarged only when the mem-
brana tympani has been previously destroyed. An examination by
the speculum auris will then show the full extent of the destruction.

Therapeutic Mints, — Anrum, Asa, Hepar, Nitr. ac, Silic, as
nearest related to caries in bony structures. Besides, compare Otitis
and Otorrhoea.

Stoppage or Stricture of the Eustachian Tube

Corresponds exactly to the stoppage of the lachrymal duct of the
eye. It can be verified by the above-stated manipulation of driving
the air into the tube.

Theraxtetitic Hints. — Compare Calc. c, Con.,. Gelsem., Graph.,
Jodium, Laches., Nitr. ac, Puis., Silic, Sulph.

III. Pseudo-formations.

This morbid growth is found most frequently situated deep in the
meatus externus ; rarer near its mouth ; and still rarer at the mem-
brana tympani. There are two kinds of polypi : soft and hard ones.
The first kind consists of a jelly-like substance, of a grayish or pale-
reddish color. Such are called mucous polypi. The latter have
more consistency, and grow upon a pedicle, which is fibrous, and
contains a number of blood-vessels, by which the morbid growth
obtains its nourishment. They look red, often dark-red, or bluish,
and are either smooth or uneven on their surface. These are
called fibrous polypi.

The diagnosis of polypi is difficult only as long as they are very
small. When larger, they can be easily distinguished from any
other affection of the ear by ocular inspection ; and they attain some-
times a fearful size, so that they not only protrude from the meatus
externus, but even overlap t\m auricle.

Therai^eutic Hints, — Calc. c, Merc, Thuya.


IV. Impaired Hearing— Deafness.

The causes of deafaess are quite numerous ; and if tliej are
enumerated in the order in which the tissues succeed each other
from without inwards, they will appear as follows :

1st. Any thing that obstructs the free passage of the meatus auditor i us,
as foreign bodies, earwax, polypi, inflammation, collection of pus,
and so on ;

2d. Morbid processes luhich involve the onembrana tyvipcmi, as in-
flammation, and consequent ulceration, thickening, degeneration, and
destruction of this membrane ;

3d. Morbid processes lohich involve the tympanum and the ossicula
auditus, as inflammation of the middle ear and consequent collection
of pus, loosening and destruction of the ossicula ;

4th. Morbid processes lohich involve the Eustg,chian tube, as inflamma-
tion and consequent mucous engorgement or stricture in that tube ;

5th. Morbid processes in the labyrinth and the auditory nerves, about
which we know very little, and the nature of which can rarely, if
ever, be diagnosticated during the life of the patient.

In considering these different causes, it is obvious that some cases
of impaired hearing, and even deafness, are certainly curable^those
which are caused merely from obstruction or inflammation; whilst other
cases must be considered out of the reach of any medicine, as those
which are caused by partial or total destruction of certain vital parts
of the ear. For example, deafness, in consequence of an obliteration
of the auditory nerve, is surely as hopeless a case as amaurosis after
established decay of the optic nerve.

Therapeutic Mints.

Conium, accumulation of earwax, looking like decayed paper mixed
with pus or mucus, or blood-red ; hardness of hearing ceasing when
the wax is removed and returning with the wax.

Lachesis, want of wax ; ears very dry.

Muriatic ac, accumulation of wax, which is dry and hard, and of a
brown-red color.

Petroleum, a large quantity of thick or thin wax ; sensation of
rushiilg of water in the ear.

When in consequence of inflammation, compare Otitis and Otor-

Calc. c, Con., Gelsem., Graph., Jod., in consequence of catarrh of
the Eustachian tube.

64: NOSE.

Nitric ac, IVlerc, in consequence of swollen tonsils.

Ann,, Phos., in consequence of typhoid fever.

Lye, Nitric ac, after scarlet fever.

Merc, Puis., after measles.

Petrol., Rhod., with disposition to rheumatism and gout.

Ca!c, Jod., Lye, in scrofulous subjects.

Graph., in young persons with habitual herpetic eruptions in the

Petrol., in old people.

Cham., Puis., IVierc, Bell., in children with otalgia.

Asarum, IViagnesium, Spigel., accompanied mostly by otalgia.

Nux v.. Bell., Cham., lancinating pain.

Magnesium, lancinating pain on walking or talking.

Puis., burning pain with purulent discharge of blood.

Bgn., tugging pains.

Anac, dragging pain in external ear.

Argent., violent, insupportable itching in the external ear.

Chelid., Puis., China, noise in the ear.

Led. pal., tinnitus aurium.

Conium, tumors and boils behind the ear.

Spongia, pimples and pustules in the external ears and pulsation in
ear j ceasing on lying on the affected side.



1. Concerning the indications from its form and shape.

Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 7 of 65)