Special Pathology and therapeutic hints by C G Raue

Book review by Dr Jubin BHMS,MD(Hom)
Calicut. Kerala

Full name of the book :Special Pathology and Therapeutic Hints.
Author : C.G.Raue M.D
Second Edition : September 1884, Philadelphia.
Third Edition : August 1885, Philadelphia.
Fourth Edition : May 1^st 1896; Philadelphia, 121N 10^th Street.
Dedicated to : Raue’s students, Near and far, in whose behalf the first edition was elaborated and to the memory of our mutual  friends and teacher, Constantine Hering,this fourth edition is dedicated.
Published by : Jain Publishing and Company,   Rajguru Road,  Paharganj,  New Delhi – 110055.
Sole Selling Agents   : Harjeet and Company    New Delhi – 110055.
Tribute of appreciation : Dr.A.P.Verma for kindly making available the original   book for printing.
Price  : Rs. 50
Introduction to the Author : C.G. Raue M.D was formerly Professor of Special Pathology and Therapeutics in the Hahnemann Medical College of Philadelphia. 

Salient features of the book
1. It is a good book on Special Pathology and Diagnostics. Pathological terms are  given with meanings and explanations and then followed by Therapeutic hints in which all medicines concerning it are arranged in alphabetical order with indications  and references in some medicines.

2. Therapeutic hints are collected from all sorts of observations with low, middle  high and highest potencies. Dr. Raue preferred the highest potencies, as he says that the more accurately we individualise the more we may become inclined to  choose the highest.

3. No idea has been given regarding the dose, as it is still an open question and must be left entirely to the free judgment of the practitioners.

4. Old terminologies which were used in our old Homoeopathic text books by our pioneers are mentioned with meanings and explanations and it must be remembered that this book was written at a time when Pathology was not developed as the modern times.

5. It is an unavoidable book as old terminologies in earlier books are mentioned in this book. When referring now terms and meanings have changed and meanings are different and we will be misled if this work was not there.

1^st edition : It is a excellent work on Special Pathology and Diagnostics which has been borrowed by famous works and journals.

2^nd edition :

1. First edition has become old, it needs renovation. The pathological views had changed so grieviously since its appearance that a statement of the same through out the work became a reality.
2. No change was made regarding therapeutic hints. They were written years ago  and are true and reliable guides at the bedside to many physicians. They are select ed from the entire Homoeopathic literature.
3. 2^nd edition is re-written for the most part and is greatly enlarged and improved much.
4. Principal sources for the pathological part- Von Ziemssen’s Cyclopaedia, Frierich’s Disease of the liver, Walton’s work on the eye and von Troelsch’s  work on the Ear.
5. Arrangement is the same as that of first edition. 

3^rd edition :

1. Changes were made regarding disease germs. No change is given to the therapeutic hints.
2. Contributions to Therapeutics has been conceived and executed by Hering in his “Analytical  Therapeutics of typhoid fevers”and his first volume of Analytical Therapeutics . Bell has given a repertory on diarrhoea and dysentery, Cushingon leucorrhoea, Eggert on uterine and vaginal discharges, King on headaches,Wm.A.Allen on intermittent fevers, P.P.Wells on cholera all these are valuable contribution to our therapeutics.

4^th edition :

1. By the progress of medical science, there are found a number of changes.
2. A new chapter on Mental diseases has been added to bring to the attention of general practitioners and students in a concise manner the present state of this branch of medicine as developed in the last years by practical experience, experimental work in large hospitals and the progress of psychology itself.
3. Some changes have also been made in the classification of acute diseases treated of those of infectious origin being grouped into the chapter ‘Acute Infectious Diseases’. 

13. Content of the book :
The book contains pathological terms and therapeutic hints. Chapters include Mind, Head, Eyes, Ears, Nose, Face, Mouth, Neck, Thorax, Heart, Abdomen, Organs of Generation, Spine, Motor Apparatus, Nerves, Blood, Acute infectious diseases and Skin. Pathology with causes and therapeutic hints are given for each term listed below each heading.

14. Structure of the book :
Chapters are Mind, Head, Eyes, Ears, Nose, Face, Mouth, Neck, Thorax, Heart, Abdomen, Organs of Generation, Spine, Motor Apparatus, Nerves, Blood,Acute infectious diseases and Skin. Explanations of each terms and references for each term from text books on that subject available at that time.

15. Structure of Chapters :

1. Mind
Mental diseases – Introduction

1. The Sphere of Intellect includes paranoia, dimentia, checked evolution of psychical development and weak mindedness.

2. The Sphere of Conation and Activity includes exultatio furiosa,   frenzy and Tobsucht.

3. The Sphere of feelings or Emotions includes ,melancholia, delirium tremens, chronic alchoholism, dipsomania, opium poisoning and morphinismus.

2. Head
a. Diseases of the brain and its membranes includes anaemia, hyperaemia,vertigo, stupor, meningitis, hydrocephalus, encephalitis, sunstroke, apoplexy, embolism, thrombosis, hypertrophy, atrophy and tumors of the brain and its membranes.

b. Diseases of the cranium and its integuments includes abnormal largeness,smallness and diseases of the integuments includes eczema, impetigo, dandruff; seborrhea, favus, tinea, wens, naevus and hair.

3. Eyes

• General Observations
• Lids and Lachrymal Apparatus includes inflammation, stye, tumors,dacrocystitis and blenorrhoea of the lachrymal sac.
• Conjunctiva includes opthalmia, conjunctivitis and pterygium.
• Cornea includes keratitis, abscess of the cornea, onyx, hypopion and staphyloma.
• Sclerotica includes scleritis and sclerotitis.
• Iris includes iritis.
• Choroid includes choroiditis and glaucoma.
• Optic nerve and retina includes neuroretinitis, hemiopia, night blindness, astigmatism and asthenopia.
• Lens includes cataract.
• Sight includes refraction, accomodation, presbyopia, hypermetropia Myopia, short sightedness, astigmatism and asthenopia.
• Muscles and nerves includes mydriasis, myosis, ptosis, strabismus,nystagmus, fixed state of eyeball, morbid winking, twitching of eyeball,blepharospasm and neuralgia of the eye.
• Orbit includes orbital cellulitis, Basedow’s disease and exophalmic goitre.

 4. Ears

1. Analogy between eye and ear.
2. General Observations.
3. Auricle includes eczema.
4. Auditory canal and drumhead includes examination, earwax, furuncles and otitis externa.
5. The middle ear includes examination, otitis media, chronic forms; polypi, nervous deafness, Meniere’s disease, tinitus aurium and otalgia nervosa.

 5. Nose :

1. General Observations
2. Examination of the cavity of the nose.
3. Catarrah, coryza, cold in the head.
4. Chronic catarrah, ozaena.
5. Hay asthma, yearly cold.
6. Epistaxis.
7. Polypi
8. Inflammation of the nose.

 6. Face.

1. General Observations
2. Milk crust and eczema.
3. Comedo and acne.
4. Lupus.
5. Ulcus rodens and epithelioma.

7. Mouth.

1. General Observations
2. The gums include parulis, epulis and fistula of the teeth.
3. The teeth include odontalgia, toothache and swelled face.
4. The tongue includes noting its color, temperature, covering, form, size,     consistency, cracks, fissures, paralysis, inflammation and cancer.
5. Salivary glands and their ducts include saliva and ranula.
6. The tonsils include inflammation and amygdalitis.
7. The uvula and soft palate includes sore throat, angina faucia, catarrahalis     and follicularis, ulcers, retro-pharyngeal abscess and deep inflammation
8. The mucus membrane of the mouth in general includes stomatitis, thrush,     formation of ulcers, noma and gangrene of the mouth. 

8.Neck.

1. General Observations
2. Bronchocoele; struma or goiter.
3. Oesophagus includes oesophagitis, stenosis and narrowing.
4. Larynx and Trachea includes auscultation, larngoscopy, laryngitis;    oedema of glottis, phthsis, neoplasms, neurosis and spasms.

9. Thorax :

1. General Observations
2. Local Abnormalities.
3. Palpation includes temperature, form, resistance, fremitus, friction and     pulsation of heart.
4. Percussion includes general observations; tympanitic and non-tympanitic sounds, hyper resonance and cracked pot sound.
5. Auscultation includes normal and abnormal sounds; auscultation of voice and cough and special diseases of the respiratory tract.
6. Affections of the bronchial tubes include bronchitis, catarrah and asthma.
7. Affections of pulmonary parenchyma include pneumonia, tuberculosis,emphysema, oedema of lungs and haemoptysis.
8. Affections of pleura includes pleuritis, pleurisy, pneumothorax, dropsy of chest and haemothorax.

 10. The Heart

1. Auscultation
2. Diseases of pericardium include pericarditis, inflammation and dropsy of pericardium.
3. Diseases of the endocardium include endocarditis, insufficiency of valves, constriction or stenosis of openings of heart and heart clots.
4. Diseases of heart muscle includes myocarditis, hypertrophy, dilatation;fatty degeneration of heart.
5. Nervous affections of the heart includes nervous palpitation; angina pectoris and stenocardia.
6. Diseases of aorta includes aneurism of thoracic aorta.
7. Diaphragm includes diaphragmitis, hiccough, neuralgia, rupture and perforation of diaphragm.

 11. Abdomen :

1. General Observations
2. Stomach includes dyspepsia, indigestion, vomiting, catarrah acute and chronic, gastritis, gastralgia, ulcus ventriculi,carcinoma, haemorrhage from the stomach, haematemesis and gastromalacia.
3. Intestinal canal includes catarrahal affections, typhilitis, proctitis, periproctitis, dysentery, cholera morbus, summer complaints, hydrocephaloid, constipation, hernia, torsion or twisting of bowels, intussception,ileus,intestinal haemorrhage, malaena, haemorrhoids, flatulency, enteralgia, tuberculosis, cancer of the intestines; polypus, fissura ani, fistula recti, prolapsus recti, proctalgia and intestinal worms.
4. Peritoneum includes peritonitis, ascites, dropsy and tympanites.
5. Liver includes physical examination, pigment liver; melanaemic liver resulting from malaria fevers, hyperaemia, perihepatitis, hepatitis, cirrhosis, syphilitic inflammation; yellow atrophy, fatty liver, colloid liver, carcinoma, hydatids, catarrahal inflammation, cholilithiasis, gall stones, thrombosis, embolism; purulent inflammation of the portal vein, icterus and jaundice.
6. Spleen includes physical examination, anatomical peculiarities, haemorrhagic infarction, splenitis,tumor of spleen acute and chronic, cancer; echinococcus and rupture of spleen.
7. Pancreas includes general observations, pancreatitis, inflammation; fatty diseases and cancer of pancreas.
8. Kidneys include examination of urine, diabetes mellitus; glycosuria, diabetes insipidus, haematuria, uremia, albuminuria, Bright’s disease, nephritis, intestinal inflammation or induration, amyloid degeneration, renal abscess, nephrolithiasis, pyelitis, perinephritis and inflammation.
9. Bladder includes cystitis, calculi, spasms, atony, paresis, nocturnal enuresis, retention of urine and ischuria. 

12. Organs of generation

Male genitals :

1. Venereal diseases includes gonorrhoea and complication sequelae,
2. epididymitis, orchitis, prostatitis, buboes, general contamination of the system in consequence of gonorrhoea, chancre, syphilis, sycosis, figwarts, syphilitic affections of various organs.
3. Testes includes hydrocoele, orchitis, carcinoma testis, varicocoele, spermatocoele.
4. Prostate includes  prostatitis, enlargement and tumors of prostate.
5. Vesiculae seminalis includes spermatorrhoea, impotency and sterility. 

Female genitals :

1. Examination of the parts.
2. Ovaries includes hydrops ovaries and formation of cysts in the ovaries.
3. Uterus includes endometritis, catarrah of uterus, leucorrhoea, parenchymatous  metritis, hydromeria, haemometria, displacement, anteflexion, anteversion, retroflexion, retroversion, prolapse, inversion, morbid growths, cancer, hysteralgia, metrorrhagia and haemorhage from the womb.
4. Menstrual anomalies includes menorrhagia, amenorrhoea and dysmeorrhoea.
5. Vagina includes catarrah, vaginismus and pruritus vulvae.
6. Mammae includes mastitis, inflammation, scirrhus and cancer.

 13. Spine includes anaemia, hyperaemia, apoplexy, spinal irritation, spina bifida, leptomeningitis, myelitis, myelomalacia, multiple sclerosis, tabes dorsalis, spasmodic spinal paralysis, polymyelitis and cocodynia.

 14. Motory apparatus includes rheumatism, rheumatic fever, gout, arthritis, rachitis, rickets, osteomalacia, progressive muscular atrophy, necrosis, caries, hip disease, gonoarchrocaece, bursitis, abscess of the ankle joint, angular curvature of the spine, panaritium, felon, whitlow, bunion and ingrowing nails.

15. Nerves.

1. Anatomical diseases of the peripheral nerves includes neuritis, atrophy, hypertrophy and neoplastic formation of the nerves.
2. Functional diseases include hyperaesthesia, anaesthesia, neuralgia, cephalagia, hemicrania, migraine, prosopalgia, cervico-occipital,cervico-brachial, intercostal lumbo-abdominal neuralgia, mastodynia, sciatica, spasm, convulsion, cramp, mogigraphia, chorea, hysteria, neurasthenia, catalepsy, epilepsy, eclampsia, tremor and paralysis agitans.

16. The Blood includes cyanosis, dissolution of the red blood corpuscles,leukaemia, hydraemia, plethora, symptomatic anaemia, oligaemia, pernicious anaemia, chlorosis, scurvy, purpura haemorrhagica, haemophilia and haemorrhophilia.

17. Acute Infectious Diseases includes fever, clinical thermometry, crisis and critical days, intermittent, remittent, congestive, pernicious, yellow, break-bone fever, typhus, exanthematicus, typhoid fever, enteric fever, relapsing fever, influenza, parotitis, mumps, diphtheria, pertrusis, whooping cough, cerebrospinal meningitis, acute military tuberculosis, anthrax, hydrophobia, tetanus, cholera, erysipelas and plague. Exanthemata includes measles, scarletina, rubella, variola and chicken-pox.

18. Skin

1. Hypertrophy of the skin includes ichthyosis and fish-skin.
2. Atrophy of the skin includes rupia and isolated blisters.
3. Hyperaemia and anaemia of the skin.
4. Dermatitis and inflammation of the skin includes erythema, herpes, urticaria, eczema, ulcus varicosum, impetigo, ecthyma, pemphigus, isolated large pustule, pompholyx, furuncle, carbuncle, psoriasis, lichen, prurigo, scabies, itch, prurigo contagiosa, burns, scalds, chilblains and frost-bite.
5. Anomalies in the secretions of the skin includes sudamina, foot sweats,anidrosis, comedo, milium and molluscum.

16. Glossary index : It is given in alphabetical order with alphabet written in the top as capitals so as we can easily find the word from the alphabet written at the top.

17. De-merits :

• It is a useful book but no upgradation only reprints appear. So as pathology advanced much and meanings got changed no change in the book appears.
• Repertorial part is pathology based, so common medicines are included, also it is very concise.

18. Similar works :

1. Chitkara. H.L – Definitive Dictionary of Terminologies of Mind in Homoeopathy.
2. Encyclopaedia of Repertory by Pravin. B. Jain.
3. A Handbook of useful thoughts on Homoeo Practice and Disease Terminology by Chatterjee. T.P.
4. Descriptive Medicines with Clinical Methods of Homoeopathic Therapeutics by Kichlu and Bose.

 WORDS — USED :

 1.Anchylops : Inflammation of eyelids is simple as a consequence of cold. It commences on edge and spreads over whole lid to margo orbitalis where it abruptly ceases. Differential diagnosis- erysipelas and apt to diffuse itself further and further. Lid hard; swollen, red covered with little blisters. 

A graver form is phlegmonous inflammation or abscess of lid. It commences as a little firm nodule, extends over the eyebrows, cheeks and lids and may attain the size of a pigeon’s egg. If not checked in onset, it terminates in formation of abscess which breaks either outside or rarely perforates the conjunctiva. If abscess forms at the inner angle of eye near lachrymal sac is anchylops. Causes includes injuries (wounds, blows upon eye).

2. Chiragra – Gout affecting the finger joints.

• Gonagra – Gout affecting the knee joints.
• Omagra – Gout affecting the shoulder joints. 

3. Apoplexia serosa : Hydrocephalus in second childhood or old age. Brain shrinks which cause empty space within the skull. As no vacumm exists, empty space is filled with serum. Space vacated is at once taken up by an exudation of fluid called hydrocephalus ex vacuo. It sometimes happens that exudation of serum takes place so suddenly and so profusely as to cause all the symptoms of apoplectic stroke called apoplexia serosa.

4. Mogigrapia, Graphospasmus, writer’s cramp, pianist’s cramp : mere tired feeling of hand after long continued writing. This feeling increases and writer has to pause to rest the hand lastly impossible to hold pen and write.

A spasm of extensors draws fingers asunder.

Spasm of flexors of first 3 fingers or only one of them makes it impossible to hold pen. Spasms may be clonic or tonic. Sometimes thumb and fingers are only slightly drawn together and writing impossible. If writing attempted, with other hand, same spasms attack it also. Also in shoemaking, milking, playing musical instruments, setting type, sewing. Causes include overexertion, or disturbances in co-ordinating apparatus. Increased by anxiety and constant thinking of it. Light and large penholders ought to be used.

5. Frog or Ranula : Swelling on floor of mouth under tongue either in middle or on one side of fraenum linguae caused by widening of Wharton’s duct in  consequence of obstruction by minute foreign bodies which have become lodged or incrust rated. 

Inspection : Soft, elastic, fluctuating, transparent type of blister or bag sheath like membrane and contents- gluey; transparent; pale yellowish; brownish fluid, alkaline reaction and no microscopic elements. Varies in size and form. When small it is globular as it increases it is modified by surrounding tissues.

6. Gravedo : Catarrahal inflammation of mucus membrane lining the nasal cavity characterized by redness and swelling of membrane; discharge at first  watery and lastly mucopurulent. Catarrah flow down preceded by feeling of lassitude and chilliness and sensation of weight and pressure in the head which latter give rise to the name of Gravedo or coryza while cold in head is  the principal cause.

7. Haematozoa of Laveran : Plasmodium malaria as the probable microorganism causing malaria. Protozoan found in blood during a paroxysm attached mostly to  red blood corpuscles which it destroys and exhibits amoeboid movements.

8. Haemoptoe : Haemorrhage of respiratiory organs.

9. Haemorrhophilia or Haemophilia : Congenital haemorrhagic diathesis. even slightest wounds bleed profusely. It exists in families and are propagated to 3- 4 females. Females are affected and propagate to male children.

10. Miserere or Ileus : Stercoraceous vomiting in consequence of any kind of occlusion of intestines.

11 Hydroa : Labial herpes.

12. Urinae profluxio : Diabetes insipidus.

13. Mollites ossium or malacosteon : Osteomalacia or softening of  bones.

14. Pestilentia or Plague : acute infectious disease characterized by suppurative inflammation of lymphatic glands ad development of typhoid symptoms.

15. Agenesia : Deficiency in the proper development of the brain, the causes of Which  we causes of which we don’t know.

16. Luscitas or fixed state of eyeball is limited or lost power of movement of eye ball which remains in a fixed position either with or without deviation from the orbital axis. Symptom either of paralysis of third nerve when eyeball is turned outward by abductor or of paralysis of abductor when eyeball is turned inside, all of brain disease, chronic hydrocephalus. But external causes – injuries to muscles of the orbit or their nerves, tumors, staphylomatous enlargement of sclerotica may also fix eyeball in any direction.

17. Glossanthrax : Fatal glossitis caused by poison of anthrax or carbuncle of Tongue.

18. Angina granulose or follicularis : Chronic sore throat.

19. Angina faucium or catarrhalis : Sore throat.

20. Lienitis : Inflammation of spleen.

21. Hydrorrhaehis congenital or spina bifida.

22. Malum potti or kyphosis or angular curvature of spine or sponyloarthrocace.

23. Tussia convulsive or pertusis or whooping cough : Fits of coughing with the Characteristic whoop which consists in a long crowing inspiration on account of Spasmodic closure of glottis followed by several short expirations in quick  Succession ending in vomiting of ingesta. 3 stages – catarrahal, convulsive, critical   Popular belief with regard to whooping cough : “ It is six weeks coming, six Weeks standing and six weeks going”. Physical signs like that of bronchitis.

24. Milium : collection of hardened sebum with the extended follicle, being Covered by epidermis it shows no dark, dirty point.

25. Peliosis rheumatica or purpura rheumatica : Purpura often begins suddenly; without prodromal warnings, with petechiae upon the skin or epistaxis or at other times its outbreak is preceded for several days by langour, headaches, loss of appetite and even moderate fevers. In still other causes it commences with rheumatic pains in lower extremities especially of knees and ankles called as Purpura rheumatica.

26. Polypan arthritis or Arthroxerosus : Rheumatic or nodular gout.

27. Doppelte Gleider or Zweiwuchs : Rachitis or rickets.
Prominence of contagious epiphyses of upper and lower arms is marked that joint Between them forms a depression which gives the appearance of 2 elbows- Articuli duplicate or Zweiwuchs (double growth.

28. Lentigenes – Liver spots. Abudant formation of pigment in rete Malphigi Causes more or less dark color to skin, when accumilation in confined spots without rising above level of skin constitutes lentigenes.

29. Ephelides—freckles. Abudant formation of pigment in rete Malphigi Causes more or less dark color to skin, when accumulation in confined spots without rising above level of skin constitutes ephelides.

30. Bunion : What bursitis is to the knee, bunion is to metatarsal joint of Great toe, inflammation of bursae situated in this joint, in consequence of undue pressure of shoes or boots. Arnica releieves acute symptoms.  Calcarea carb frequently cures chronic cases.

31. Dolor faciei Fothergilli or neuralgia facialis or neuralgia of trigeminus Or fifth nerve or prosopalgia.

32. Crural neuralgia or ischias antica – Seat is the crural nerve, pain is felt from the inner and lower portion of thigh, down to the inner portion of the Foot and big and second toe.

32. Rupia or Rhypia : Late, malignant manifestation of syphilis.

33. Psammona or sand tumor is a tumor of brain and its membranes and Is an inflammatory proliferation of cellular tissue in which calcareous Deposit takes place, usually grows from duramater commonly at the Base of skull, is a hard hemispherical tumor, white and smooth and size Of a cherry stone.

34.  Hemeralopia or night blindness : Patient sees well enough as long as there is enough stimulus of bright light, but he cannot discern objects any More; as soon as the amount of light required by him is withdrawn whether Day or candle light. It is common in seafaring men. The glare from the sea Seems to be the exciting cause added to some constitutional weakness. Also In harvesters and soldiers- fatigue and exposure to glowing sunlight seems to be elements in its production.

35. Craniotabes or soft occiput : Normally posterior fontanelle closes earlier than anterior fontanelle. Posterior fontanelle by a morbid process of absorption of already formed substances may re-open or several holes may form nearby the bony structure withering away gradually leaving onlythe integuments called as craniotabes or soft occiput.

36. Syphilides : Various affections of skin in consequence of syphilis go under the name “ syphilides”. They have peculiar red color- coppery red. More in dark complexioned people. Polymorphism, annular form and absence of itching or any other sensation.

38. Hydraemia consists of a decrease in albumen and increase of water in serum sanguinis. As a result, serum is much more prone to exudation than its normal state and so frequently associated with dropsical effusion.

Causes :

1. Long continued pathological secretion of clear albumen or albuminous Substances (mucus, milk) in consequence of albuminuria, severe diarrhoea, pus formation, exudation, loss of blood, mucus discharges, too copious flow of milk and too long continued nursing.

2. Insufficient supply of nutrient or disturbed nutrition so that the received nutrition is not converted to albumen and assimilated. So it is found in connection with the  most different morbid processes. They are associated with diseases of heart and  lungs especially tuberculosis, chronic indigestion, protracted intermitting fevers, Bright’s disease etc.

39. La Grippe : Acute infectious disease and epidemic characterized by catarrahal manifestation affecting respiratory and digestive tract with prostration, pain in bones and limbs, severe nervous symptoms and fever. Exciting cause is a microorganism, bacillus described by Pfeiffer. 3 forms – catarrahal, gastric and nervous depending on the organs which receive the brunt of the attack.

Complications : Pneumonia, pleurisy, phthisis, bronchitis, gastritis, neuralgia, meningitis,melancholia and acute mania.

40. Leptomeningitis spinalis : Inflammation of soft membranes the spinal piamater and arachnoid ; inflammation of duramater is rarely met with as a primary disease.

Causes : Inflammatory process of neighboring organs, either of the spinal marrow or of the vertebrae, external injuries, exposure to cold etc. It is quite attendant upon tubercular meningitis.

Symptoms : A combination with cerebral affections of course tinctures the whole picture at once with brain symptoms may even disguise the spinal affection together. If the inflammation is confined to the spinal piamater we find

1. A pain in the back at the place of the inflammation which even extends over the whole spine.
2. Pains in limbs aggravated by motion and touch.
3. Painful stiffness of muscles which is like opisthotonus especially if cervical muscles are affected. Even masseter muscles are affected and resemble  tetanus. Respiration is difficult and the higher the inflammation extends the  greater is the dyspnoea which ends in suffocation. These tonic spasms are  excited by least motion of the spine.
4. Acute stage may pass over to chronic form with exudation and consequent paraplegia. Tuberculization of the exudates is followed by oedema of the lungs, catarrah of the bladder and  decubitus. Its prognosis is rather a doubtful one. 

41. Haemorrhagia intestinalis, intestinal haemorrhage, malaena : Takes place in consequence of either

1. Obstructed circulation of blood through the vena porta as in the case ofcir rhosis of the liver, diseases of the heart and lungs, compressions of the blood vessels by large abdominal tumors.
2. Erosions or degenerations of the blood vessels from  intestinal ulcers during typhus, yellow fever,scurvy etc
3. Lesions caused by corroding or cutting substances, wounds etc or
4. Suppressed normal, or habitual, bloody discharges as menstrual or haemorrhoidal.

A copious, internal haemorrhage is characterized by sudden paleness, coldness  of the body, collapsed features, weak pulse, fainting, fits of chilliness and discharges of blood from the bowels.The discharged blood when it comes from the upper part of the intestines is generally dark and mixed with intestinal contents like tar. It is generally red and fluid when it comes from the lower Portions. A black, tar- like appeararance of stool is not a sign that it contains blood, as it may be colored by bile. Throwing the passage into water, it colors the water red when it contains blood,and when it contains bile the water is colored green or yellowish.

42. Podarthrocace or Abscess of the Ankle joint : This commences with pain,       swelling just in front of each malleolus filling up the hollow which naturally       exists there. So also gradually disappear the grooves at the side of the tendo- achilles and the whole joint swells considerably. By and by suppuration takes    place, the pus may escape at different places, forming like in the knee joint     disease, fistulous openings and may lead to considerable destruction of the  affected bones.

43. Hysteralgia or irritable womb or neuralgia uteri : This consists of severe,       often times excruciating pains in the region of the uterus and it may not be       able to prove the existence of corresponding changes in the uterus by our        present investigations. So this excludes all those cases where the pain    can be traced to morbid alterations objectively demonstrable. They remit        or aggravate and are greatly influenced by atmospheric changes, mental or        emotional excitements, indigestion and are found inwomen of a nervous temperament.

44.Nystagmus or trembling of the eyeballs : It is an involuntary, rhythmical  motion of the eyeball, mostly from side to side; sometimes in an oblique      direction, without impairment of the muscular movements. These oscillatory      motions are nearly always permanent during waking hours, but do not       interfere with the simultaneous action of the two eyes, sometimes with squint.

The disease nearly always arises in infancy and is seen frequently seen in       connection with congenital cataract, or other states of the eye which impair       sight. It is common in the Albinos, when there is absence of the pigmentum       nigrum.Although ascribed to a morbid condition of innervation, its true nature is       unknown.

45. Blepharospasm : The eyelids are violently and persistently closed. It is nearly       always associated with intolerance of light and discharge of tears. Its sources       are various. They may arise in the eye itself, or in other organs, and transmit       their influence to the brain at the origin of the portio dura, through the  fifth       nerve, the optic, the vagus, the sympathetic, or directly from cerebral      disturbance. It is produced by trichiasis; strumous conjunctivitis, corneitis,        retinitis, carious teeth, supraorbital neuralgia, a blow on the head or other        injury, hysterical irritation. It may affect one or both eyes, it may last a     long time uninterruptedly or in spells, it may be associated with spasm of  the facial muscles.

46. Dandruff : It is an eczema with but scanty exudation, not sufficient to raise        the epidermis into vesicles, it merely loosens it, when it dries and peels off        in scales. The scalp underneath remains congested,and thus new scales are        constantly reproduced. It may extend over the whole scalp even down to the   eyebrows and the beard, or be confined to patches only of irregular form and      variable dimensions.

47. Uraemia : It arises in consequence of imperfect depuration of the blood in renal       disease, the results of the retention of the blood in renal disease, the results       of the retention in the blood of the dross of the capillary interchanges,       namely nitrogenous substances and specific urine contents.

Acute uraemia : In acute and chronic kidney diseases, it manifests itself in       the form of epileptic convulsions, which are succeeded by coma, or in       some instances by a condition of maniacal excitement. Frequently a series      of epileptic attacks terminate in death. At times these uraemic fits       are preceded by dropsy, dyspepsia, obstinate vomiting and even amaurosis       which latter however may subside as suddenly as it comes.

In the chronic form of uraemia, the epileptiform fits are usually absent or       amount only to twitchings of certain groups of muscles, or they close the       scene after long continued coma. The principal symptoms are increasing     somnolence, apathy or stupefaction, advancing at last to complete coma      Frequently preceded by stubborn and incessant vomiting of masses which       contain carbonate of ammonia. Also itching of the skin even in the state of      unconsciousness. Lastly there have been observed in chronic renal affections;     along while before the fatal termination, paroxysms of asthma; most frequent    at night, with intervals of complete freedom.

48. Flatulency or meteorism of abdomen : Abnormal collection of gas in the   intestinal canal.

49. Menstruatio difficilis or dysmenorrhoea : This means painful menstruation with regard to the quantity of blood discharged although at times it may be        scanty. The different complaints may set in either before or at the time when        the menstrual discharge begins, and generally last for a day or two or extend      throughout the whole menstrual period.

According to its causes there are 3 types of dysmenorrhoea.

1. From structural changes or flexions of the uterus termed as mechanical dysmenorrhoea.
2. From congestion in the uterus termed as congestive dysmenorrhoea with congestion to the pelvic organs and continue for days with a profuse discharge.

Common in plethoric as well as anaemic, weak individuals. In some cases it may be caused by thickened state of the peritoneal covering of the ovaries and difficult perforation of the Graafian follicle. Very violent congestion causes an exudates between the mucus lining and the parenchyma of the uterus throwing portion of the basement membrane out and is called as membraneous dysmenorrhoea.

3. From a morbid sensibility of the nervous system in general and the uterine nerves especially called as neuralgic dysmenorrhoea. This results from     disturbance in the healthy equilibrium of the mind’s action and a dejection of spirits even before the menses with distending pains in the uterine region,     in the back and lower extremities or with neuralgic pains in more distant    organs or with cramps, spasms etc. In some cases it results from spasmodic    closure of the os uteri.

50. Porrigo devalcans or Alopecia circumscripta : Caused by a parasite, microsporon audonini which attacks the hair in isolated patches and the denuded patches are left clean and polished and of a marble whiteness and is not contagious.