Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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A thick^ swollen nose is either a sign of inflammation (if accompanied
by pain, heat, and redness) or of rhachitic and scrofulous diseases.
Lovers of intoxicating drinks are generally blessed with a suspicious -
looking nose of such shape.

The nose becomes pointed, pinched, during spasms ; during a chill,
and in collapse.

When in 'children the nose becomes suddenly pointed, it is a sign of
impending spasms ; an haUtually-^oinlQdL nose denotes derangement
in the mesenteric glands, and general atrophy.

If the nose becomes pointed suddenly during the act of parturition,
it is a sign of internal hemorrhage, or complete exhaustion or threat-
ening convulsions.

The pointed nose of a nursing mother indicates her complete unfit-



GENEEAL OBSEEVATIOlSrS. 65

ness for being -wet-niTrse. When it sets in suddenly in severe illness,
it is always a bad symptom; being a sign of extreme exhaustion
and collapse. A heavy motion of the nasal loings during respiration
is a sio-n of impeded respiration, either from asthma, pneumonia,
croup, dropsy in the chest, or incipient paralysis of the respiratory
muscles and utter prostration.

2. In regard to color.

A red nose may result from a variety of causes : extreme cold air,
congestions, crying, being overheated, cold in the head, worms, scrofula,
intemperate use of ardent spirits. In young girls it denotes the set-
ting in of menstruation.

Gircumscrihed redness of the point of the nose, of the cheeks, and of
the forehead, with paleness and coldness of the other parts of the face,
denote, in pneumonia, that suppuration has taken place.

A co2:>2oery shining redness at the root of the nose is a sign of existing
syphilitic ulcers within the nose.

The coppery nose of wine and liquor- drinkers is well known.

A pale nose is found in various morbid affections; during a chill,
during syncope, in spasms, from nausea, after great exertions, from
sexual excesses, profuse hemorrhages, and so on. In women it is a
sign of approaching menses or disturbed menstruation ; profuse leu-
corrhoea ; chlorosis. During pregnancy it is a sign that the foetus is
dead. In eruptive fevers it denotes a disturbance in the exanthematic
process and probable metastasis to internal organs.

A grayish, lead-colored nose is found in dropsy of the chest and the
pericardium, in induration of the lungs and some malignant typhoid
fevers.

Single lead-colored stripes have been observed in obstinate obstruc-
tion of the portal vein.

A bluish color of the nose is found in some cases of apoplexy; in
croup, in catarrhus suffbcativus, in diseases of the lungs, heart, and
larger blood-vessels ; in short, in all morbid conditions, which cause
a stagnation of blood, cyanosis.

Broionish, yellowish spots on and over the nose like a saddle indi-
cate mostly a diseased liver or chronic leucorrhoea.

A blackish fur at the nostrils is found in typhus, epidemic dysen-
tery, cholera, altogether in conditions of great prostration.

3. lit regard to temperature.

A hot nose we iind in violent coryza, inflammation, before bleeding,
during delirium, sopor, apoplexy.

Coldness of the nose we find during a chill, spasms, nausea ; from

5



6Q NOSE.

loss of blood, exTiaustion, and in consequence of inflammation of the
bowels.

An habitually cold nose is found in disordered states of tlie abdom-
inal viscera, in dropsical complaints, and in chlorosis.
To all this I have to add one more pathognomic sign :
The constant picking and horing at the nose, which is found fre-
quently in consequence of irritation in the intestinal canal from
v/orms, or in typhoid fevers, and cerebral affections. In these latter
cases there is always a want of natural secretion in the nose ; it is as
dry as a powder-horn ; its getting moist again is one of the most favor-
able signs in such cases.

A. Diseased Conditions of the External E'ose.

Comedones, Grubs, Worms.

They appear like little black spots upon the nose, and consist in a
retention of the sebaceous secretion, which becomes inspissated, caus-
ing a distention of the related hair-follicles. Eeaching the mouth of
the latter, the secretion hardens and becomes deeper in color, and at
the same time, from being exposed to the dust and dirt of the atmos-
phere, the extremity is rendered dingy and dark-colored." If a fold
of skin, including one of these spots, be pressed between the fingers,
the concreted secretion is squeezed out in the form of a little white
cylinder about a line in length and blackened at its extremity. It
is this lengthened form of this cylinder, with its dark extremity, that
has gained for it the name of grub or worm. Dr. Simon has dis-
cerned in the sebaceous matter certain microscopic animalcules, sup-
posed to be of the genus acarus.

Acne Punctata

are those red piviples upon the nose and face of young men and
women, which are simply inflamed sebiparous glands and related
hair follicles, excited by the overload of inspissated secretion.

JJierapeutic SintSo — Compare Bell., Carbo v., Hepar s., Lach-
nanthes. Sulphur.

After sexual excesses, Calc. c, Phos. ac, Sulph.



is the same thing as to its nature, but attended with much more
bright-red looking inflammation around the pimples. It is mostly of
a chronic nature, and disfigures the face indeed considerably.



DISEASES OF THE NOSE. 67

Tlierapeutic Mints, — Ars., Euta, Ehus t.

Old Warts upon the Nose

Are indicative of Causticum in quite different complaints.

Lupus, Wolf^

Has its name from its exceedingly destructive character ; its seat is
most commonly the nose, although it is not unfrequently found on
other parts of the face, lips, cheeks, eyelids, and on the neck.

"It commences as a tubercle of a dull-red color. After a variable
period of time, during which the tubercle remains indolent, a thin
brown and adherent scab forms upon its summit. If scratched off,
another is produced in its place by the desiccation of an ichorous
fluid, which escapes from the abra^led tubercle. On the removal of
this latter scab the skin beneath is iound more or less deeply ulcer-
ated, and the ulcer soon becomes concealed by another and larger
scab,

" The ulcer, like the original tubercle, offers much difference in re-
spect of rapidity of progress, being one while very slow, and again very
speedy in its devastating course. When the latter tendency exists,
the entire nose has been destroyed in less than a month. It is then
characteristically termed lupus vorax.

" Its surface is uneven, sometimes studded with unhealthy granula-
tions, but more frequently covered with white patches of lymph. Its
edges are thickened and red, and it frequently pours forth a consider-
able quantity of fetid, ichorous and semipurulent fluid.

"When the ulcer heals, the cicatrix is remarkable for the white and
corrugated bands and the unhealthy-looking skin, and the recurrence
of the morbid action on these cicatrized spots is far from being uncom-
mon." Wilson.

The deformity which results from this disease is sometimes quite
distressing, drawing the wings of the nose, the lips and eyelids out of
all proper position.

It is clear that such a violent local destruction must grow out of
a deep constitutional disorder.

Therapeutic Mints, — Ars., Caust., Cicuta, Staphys.
Besides these, compare Bell., Calc. c, Hepar, Sepia, Siiic, Sulph.



68, NOSE.

B. Diseases of the Nasal Cavity.

Catarrh, Coryza, Cold in the Head.

This is an inflammatory affection of tlie mucous lining of the nasal
cavities, commencing generally with a dryness, which is followed by
a watery or mucous discharge. It frequently spreads over the entire
continuation of this membrane, upwards into the frontal sinuses, side-
ways into the Highmorian cavities, or backwards and downwards into
the posterior nares, the fauces, down the larynx, trachea and bron-
chial tubes. It generally commences with sneezing, owing to the
irritated state of the mucous membrane ; causes, in some instances,
hardness of hearing, owing to the inflamed and swollen state of the
Eustachian tube ; and is accompanied by a cough, which is dry at first,
and afterwards loose, on account of the mucous membrane of the
larynx, trachea and bronchial tubes becoming involved in the same
process. Sometimes such a cold or catarrh spreads even upon the
mucous lining of the intestines and causes diarrhoea. It is obvious
that, the greater its extension, the more the whole organism must
become involved ; hence we find it frequently accompanied by chilli-
ness and feverishness.

Therapeutic Hints,

Allium Cepa., profuse discharge of bland water from the eyes, and
hurning, excoriating vjater from the nose ; terrible laryngeal cough,
which compels the patient to grasp the larynx with his hands, for it
seems to him that the cough would tear it.

Aconit., in the commencement, dry state ; from dry, cold west winds.

Apsen., burning, excoriating, watery discharge, with a feeling of
being stopped up.

Bell., headache worse from motion ; dull pain in frontal sinuses.

Berberis, chronic form; left side; extending into the Highmorian
cavity ; purulent yellow or greenish discharge.

Bryon,, extending into the frontal sinuses, or into the chest; stitch
pain.

Calc. c, in children of scrofulous tendencies ; great liability to
catarrhs ; stoppage of nose, or fluent coryza succeeded by colic.

Cham., chilly ; feverish ; thirsty ; one cheek red, the other pale ;
rattling cough on the chest.

Cyclamen, frequent sneezing; profuse discharge ; loss of smell and
taste ; pain in head and ears.



DISEASES OF THE NOSE. 69

Eupatop. perfo!., hoarseness; rougliness of voice; cougli worse in the
evening ; aching in all the bones.

Euphrasia, profuse discharge of white mild mucus; eyes inflamed,
and full of acrid tears ; cough only through the day.

Gelsemlnum, disposed to catch cold in the head from any change in
the weather; sore throat in the upper part of the pharynx; pain on
swallowing, shooting up into the ear ; deafness.

Hepap s., exposure to cold west winds, croupy cough, disposition to
taking colds after abuse of Mercury.

lodium, chronic, fetid discharge ; nose swollen and painful; scrofu-
lous habit.

Kali bichp., a sense of tight pressure at the root of the nose.

Lachesis, profuse discharge of a thin, watery slime ; soreness of nos-
trils and lips ; useful after suppression of a cold in the head,

Mepc, dropping of water from the nostrils, nose swollen, red, sore ;
after sweating in the night, the cold is no better in the morning ; feels
bad in a warm room, and the cold he cannot bear either ; epidemic
form.

Nux v., at the commencement, nose dry ; or fluent only through the
day, and in the evening stopped up again ; dry cough ; constipated
bowels.

Phytolacca, flow of mucus from one nostril while the other is stopped;
total obstruction of the nose when riding.

Pulsatilla, thick, yellow, greenish discharge ; loss of smell and appe-
tite ; no thirst ; feels better in the fresh air, worse in the warm room ;
nose-bleed ; affection of frontal sinuses.

Rhus t., thick, yellowish mucus; fever-blisters and crusts under the
nose ; after getting wet ; aching in all the bones, worse in rest.

Sanguinapia, fluid coryza alternating with stoppage of the nose;
eyes painful when touched ; soreness in throat ; cough, and finally
diarrhoea.

SpigelTa, copious discharge, badly tasting and smelling ; flows during
the night down into the posterior nares, and causes choking.

Sulphup, chronic form ; stoj^page ; or thick, yellowish, greenish dis-
charge ; sore nose ; deafness.

A particular form of coryza. is the so-called

Yearly Cold, or Rose Cold,

Which attacks some persons at the same date every year, mostly in
summer, sometimes in fall. The symptoms do not vary much from



70



NOSE.



an ordinary cold in the liead, except tliat it is very stubborn, lasting
uninterruptedly for four or six weeks.

Therapeutic Mints — Ailanthus, Ars., Natr. c, Nux v., Silic.

The' Snuffles, or Stuffed Nose of Infants,

is quite of the same nature. It hinders children in nursing, and
sometimes in sleeping.

Therapeutic Mints. — Hux v., Sambucus.

Amm. c, when the child in the act of going to sleep starts up
again on account of not getting breath.

When catarrhs become chronic, they lead to an ulcerated state of
the membrane, forming constantly a fetid, putrid and puriform dis-
charge of the most offensive and penetrating smell. This state , of
chronic ulceration of the mucous membrane within the nasal cavities
and frontal sinuses is called

Ozaena.

Therapeutic Mints, — Compare Alumina, Asa foet., Aurum,
Cal. c, Kali bichr., Kali hydroj., Lachesis, Merc, Phos. ac, Silicea,
Sulph., Baptisia tinct., Hydrastis, Phytolacca, Sanguin.



Therapeutic Mints. — Compare Calc.c, ISTatr. mur., Phos., Sang.,
Teucrium, Thuya.

Epistaxis, Nosebleeds

This affection is a mere symptom of the most different conditions
of the organism. "We observe it in consequence of congestive as
well as in consequence of anaamic and chlorotic conditions. It may
sometimes bring relief to headache and congestive states ; and it may
be an unfavorable sign in adynamic and contagious diseases, as small-
pox and measles, when they assume a typhoid character. In dis-
eases of the heart, lungs, and spleen, it is never a good sign. In old
age it is a sign of threatening apoplexy.

Its most frequent exciting causes are, mechanical injuries; a fall
or blow upon the nose ; straining when coughing ; and suppression



DISEASES OF THE NOSE. 71

or irregularity in menstrual discharges, or a suppression of an habit-
ual hemorrhoidal flow.

The blood itself varies greatly in character. It may be hricjht-red,
or darh^ — almost black ; it may easily coagulate, and it may be quite
thin, and never coagulate.

Generally, one nostril only bleeds ; seldom both. The blood dis-
charges either through the nostrils in front, or backwards, through
the posterior nares, into the fauces, thence into the stomach or the
larynx. This last phenomenon requires a little attention, so as not
to confound it with vomiting oi blood, or bloody expectoration from
the lungs.

Therapeutic Hints. — In general, hrigJit hhod, Aeon., Arn.,
BelL, Bry., Dulc, Hyosc, Millefol., Ehus t., Sabad.

Dark blood, Crocus, ISTux v.

Clotted blood, Cham., Merc, Ehus t.. Plat.

Aeon., in arterial congestive bleeding,

Agaricus, in old people with relaxed state of the circulatory system.

Am. c, in the morning, when washmg.

Arnica, after external injury.

Apsen., after a fit of passion or vomiting; great heat and restless-
ness.

Bellad., congestion to the head; worse from motion, noises, and
bright light ; sparks before the eyes ; noise in the ears ; fainting.

Bryonia, in the morning after rising; vicarious menstruation.

Carbo veg., profuse and long-continuing; paleness of face; small,
intermitting pulse.

China, anaemic state; singing, ringing in the ears; great paleness
of face, and fainting.

Crocus, black, viscid blood, with cold sweat on forehead.

Erigeron, congestion of the head ; febrile action ; red face.

Hamamelis, in combination with haamoptysis.

IVJerc. sol., blood coagulates in the nose, and hangs down like icicles.

Moschus, with all the signs of depletion ; spasmodic jerking of the
muscles.

Nux v., congestion to the head; pain in forehead; constipation;
suppressed hemorrhoidal flow.

Puis., vicarious menstruation.

Rhus t., at night ; during stool ; from bending forward, and any
bodily exertion.



72 FACE.

Secale, anemic state, eitlier from exhaustive diseases or artificial
depletion,

Thiaspi bursa pastoris is recommended by Bonningliausen as one
of the most efficient remedies, but without special indications.

Trillium pendulum, passive hemorrhage.

Veratrum alb., deadly paleness of face; coldness of body; slow,
intermitting pulse.



FACE.

The face of a patient tells a long story, and it will be well for the
student to observe closely its features, expression, color and tempera-
ture. The experienced physician reads out of it not only the degree
of severity of an attack, but often also its whole general nature. But
that must be learned by practice. There are shades so fine that they
could not be well described, but which nevertheless stamp upon the
whole a peculiar character.

1. The aspect of the face.

a. A delicate appearance, with long-fringed eyelashes, often serves
to point out the tubercular diathesis.

b. The thickened alse of the nose and upper lip of scrofula are
most marked in childhood.

c. The pallor of aneemia is very important ; it is waxy in chlorosis
and pasty in diseases of the kidneys.

d. A puffy appearance about the eyelids along with ansemia is very
generally an indication of albuminuria.

e. A bloated, blotchy face generally indicates irregular habits of living.
/. The features undergo remarkable changes in erysipelas, paroti-

titis, facial paralysis, &c.

g. A sunken face indicates exhaustion, either from too great exer-
tion, or loss of sleep, want of nourishment, or profuse diarrhoea, or
disturbed digestion. If it sets in suddenly during pregnancy, it is
a premonitory sign of abortus. If you find it in the incipiency
of a disease, without previous weakening causes, it denotes a severe
illness. If it sets in suddenly, during a disease, without chill or
spasm, by which it might be caused, it is a sign of extreme exhaus-
tion or metastasis, mortification, or apoplexia nervosa.



GENERAL OBSERVATIONS. ' 73

h. The hippocratic face is characterized in the following way:

The skin upon the forehead is tense, dry, or covered with cold
perspiration; the temporal regions are sunken in; the eyelids are
pale, and hang down ; eyes are dull, without lustre, turned upwards,
and sunken ; the alge nasi are pinched together, and the nose is very
pointed ; the molar bones stick out, and the cheeks are sunken in
and wrinkled ; the ears appear to be drawn in, and are cold ; the
lips are pale, livid ; the lower jaw sinks down, and the mouth is open.
It is always a sign of extreme prostration of vital power, and is
found in cholera, in mortification, and during death-struggle.

i. A wrinkled face is natural to old age, but in children it is a sign
of imperfect nutrition, and is found in consequence of exhausting
diarrhoea and atrophy. In boys and half-grown lads a wrinkled face,
without loss of appetite or sleep, is a sign of onanism,, or other bad
habits. Such a young, old, and wrinkled face is a pitiful sight.

The linea ophthalmia zygomatica is a line or fold, commencing at the
inner canthus of the eye^ running towards the zygoma where it ends. It
shows momentarily, when children cry, but becomes more permanent
in children with affections of the brain. Its appearance in simple
catarrh is said to indicate the setting in of hooping-cough.

The linea nasalis is a line or fold, which commences at the upper
part of the alse of the nose, and runs toioards the orbicularis oris^ (the
sphyncter of the mouth,) forming a more or less perfect half-circle.

This line, if found in children, denotes abdominal diseases, espe-
cially inflammation of the bowels, also rhachitis, scrofula and atrophy.
In grown persons it is said to have been observed as a concomitant
symptom of albuminuria, ulcer and cancer of the stomach, and degen-
eration of the liver.

The linea lahialis is a line or fold, which commences at the corner
of the mouth and runs down towards the side of the chin, where it ends,
and whereby the chin appears to be elongated. This line is said to
be a characteristic sign in children of inflammatory diseases of the
larynx and lungs. Yery marked it has been found in grown persons
who suffered with ulceration of the larynx and bronchial affections,
attended with difficulty in breathing and much mucous discharge.

k. The risus sccrdonicus, a spasmodic distortion of the face, which
resembles a kind of laughing, is found in irritation and inflammation
of the brain, in inflammation of the pericardium and diaphragm, in
irritation of the intestinal canal, in abnormal conditions of the menses,
even after mental excitement; fright and depression of spirits.



74 FACE.

2. The expression of the face is, in health, the reflex of the mind ; and
in disease it has a distinct reference to the nervous system.

In general, I may say :

a. A rigid, staring, stupid, trouhled, hut sometimes also a smiling
countenance, is found in affections of the brain, and in typhoid condi-
tions ;

1). An anxious, sad, and restless expression is found in lung and heart
diseases ; and

c. A inorose, long-faced, apathetic expression is found in abdominal -
disorders.

3, The color of the face.

a. Redness, if hahitual, denotes a tendency to gout and hemorrhoids ;
and is a sign of indulgence in good-living and alcoholic liquors.

Flying, often- changing redness is seen in children during dentition,
in women before menstruation, or after conception, and is also found
in inflammation of the lungs.

Bright, vivid redness is found in nervous diseases, hysteria and ten-
dency to hemorrhages.

Dark, purplish redness is found in congestive, apoplectic and suffo-
cative conditions.

Redness, cooning and going in spots, I have often found in brain dis-
eases of little children.

One-sided redness, with paleness and coldness of the other side, in
encephalitis, is, according to Schonlein, a sign of the formation of
pus in that half of the brain which corresponds to the red side of
the face. It is found also in diseases of the lungs, heart and abdo-
men.

The circumscribed hectic flush is characteristic of phthisis.

Redness of the cheeks, with a ivhite ring around the alse of the nose and
the mouth, are frequently met with in different fevers, and is a sign of
pretty severe illness.
. h. Paleness.

Sudden paleness, especially around the mouth, is found in children
with colicky spasms in the abdomen.

Great paleness, alternating toith flushes of redness, is found in inflam-
mation of the lungs and brain ; also during dentition.

A pale, peculiar white and wrinlded face is found in children with
chronic hydrocephalus.

A sudden paleness, after an inconsiderahle limping, in children, com-
bined with great lassitude, is a sign of a lingering hip-disease.



GENERAL OBSERVATIONS. 75

In women, paleness is a sign of profuse or suppressed menstruation
or chlorosis.

Sudden paleness during pregnancy ^vogno^txcoXQ^ tTireatening metror-
rhagia, or abortion, or the dying of the foetus.

Sudden paleness about the nose is in scarlet fever a bad sign ; it
denotes a metastasis to the brain; during the pealing-off period it is
a forerunner to dropsy.

Sudden paleness after a fall indicates concussion of the brain.

Pale lip)S are characteristic of chlorosis.

c. Blue color of the face

Is found in organic diseases of the heart, especially in dilatation of
the ventricles and disorganizations of the valves, whereby the oxy-
genation of the blood is intei-fered with. In the highest degree it
exists in cyanosis, a state in which, consequent upon structural faults in
the heart, the venous and arterial blood becomes mixed. In new-born
children, therefore, if it is lasting, it is a sign of such malformation ;
if it, however, soon passes off, it may have been caused by hard
labor-pains, face-presentation, or by the navel string being wound
around the neck of the child.

We meet it likewise in consequence of strangulation or suffocation.

d. Livid, grayish, lead-colored face denotes deep-seated organic dis-
eases, scirrhus, gangrene.

e. Yelloioish color of the face is found mostly in diseases of the liver.
The yellowness of jaundice varies from a pale orange to a deep-
green yellow.

There is a certain yellowness of a malignant aspect, which is dis-
tinguished from jaundice by the pearly lustre of the eyes.

/. Brown spots in women are mostly signs of pregnancy, or irreg-
ularity in menstruation ; they are also said to be found in liver com-
plaints.

Irregular brownish spots, a little raised above the skin and covered
with small pustules, which sometimes discharge a bloody fluid, are in
children a sign of congenital syphilis.

Fat, short, and broad persons, with dark-brown or black hair, dark
eyes, yelloAv-brownish, dark color of the skin, are mostly affected on
the right side with liver complaints and so on.

g. Telangiectasia on the face, especially on the upper parts of the
cheeks and on the lower eyelids, are almost always connected with
some obstruction or stasis ; often in the chest, but more frequently
in the abdomen, and a diminution of chlorides in the urine.

Telangiectasia if ever so small, on the right side of the face.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 8 of 65)