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Homeopathic Materia Medica by Dunham
(sil)SYNONYMS : KIESELERDE, TERRA-SILICEA, ACIDUM SILICIUM.
The proving of Silicea upon the healthy subject was published by Hahnemann in vol. iii. of the "Chronic Diseases," 1828. Additional symptoms are found in the " Materia Medica" of Hartlaub and Trinks, vol. iii., and a fragment by Wahle, in the "Archiv fur Homeopathische Heilkunst," xv., 2, 87. These are all incorporated in Hahnemann's essay in the second edition of "Chronic Diseases." A proving by Ruoff was published in " Hygea," viii. (1838), and one by Hencke in "Allg. Horn. Zeitung," 55, 17 (1857). A proving of Aqua Silicata, by Becker, was published in " Hygea," xxii. (1847), and a paper by Dr. Colby in "New England Medical Gazette" (1871).
In our study of Silicea we shall follow Hahnemann's essay in the second edition of " Chronic Diseases."
1. HEAD, (A.) SENSORIUM. Confusion in the head; mental exertion is very difficult; confusion in speaking; it is difficult to seize the right expression; a brief conversation causes confusion of the head and general lassitude ; memory is enfeebled; dullness in the head without pain, as if it were too full of blood.
Vertigo is a very prominent symptom. It occurs when the prover rises from the recumbent position or from stooping, or when sitting or walking. Also when looking upward. It seems to come from the dorsal region up through the nape of the neck into the head (as does the headache of Silicea). The vertigo makes the prover incline to fall forward or to the left, and is so severe that he fears he shall fall. It is aggravated by motion, and by looking upward, and is accompanied by nausea.
(B.) HEADACHE. The headache of Silicea is characteristic. Its location is for the most part in the forehead, extending often to the temples and involving the eyes, especially the right eye and temple. There is also a characteristic aching and pain, extending as if from the back up the nape of the neck through the occiput to the vertex. Many of the pains, especially the pressing, aching pain, are described as affecting the whole head.
The pains are chiefly aching, pressing; also tearing and boring; and heaviness and fullness, as though there were too much blood in the head.
The headache occurs after mental exertion or annoyance. It is decidedly aggravated by mental or bodily exertion, by quick movements of the head or body, which convert the dull aching pain into acute stabs ; by noise and by light. It is relieved by quiet, darkness, lying down, and, which is characteristic of Silicea, by wrapping the head up warmly. This condition, relieved by warmth, we shall meet in other Silicea symptoms. It is to be remarked that the relief is not afforded by simple pressure, as with Menyanthes, but by warmth, E. G., by warm-water compresses. Indeed, the pressure of the hat increases the occipital headache.
The concomitants are pain in the eyes when the globes are revolved laterally in the orbits, chilliness and nausea and vomiting.
The similarity of this headache to that of Spigelia, Paris quadrifolia, Cocculus and Gelsemium, should be noted.
The Silicea headache is mostly on the right side. The scalp is sensitive to touch; the hair falls out when combed; upon the scalp are itching pustules.
2. EYES. In the orbits, pressure and soreness; the eyes pain in the morning, as if they were full of sand and too dry; the lids quiver; they are agglutinated; they are spasmodically constricted, and can hardly be opened; there are symptoms of conjunctivitis, with moderate lachrymation and mucopurulent discharge.
Itching in the eyes; aching of the globe, with redness of the sclerotica.
Considerable photophobia in paroxysms; muscae volitantes; objects confused before the eyes; throbbing in the ears; shakes the eyes so that objects move up and down.
From the paroxysmal character of some of these symptoms, it would seem probable that most of the eye affections of Silicea are sympathetic.
3. EARS. Itching, aching, drawing, pinching pains in the external meatus. These pains some times occur, and often are aggravated, when blowing the nose or swallowing. The external ear is swollen, with discharge of fluid from the meatus, with hissing noise and deafness; deafness; noises of various kinds in the ears; hard and painful swelling of the parotid gland.
It would appear from these symptoms (as well as from clinical results) that Silicea corresponds to a catarrhal affection of the ear, both external and middle, and of the Eustachian tube, producing deafness. There is also exalted sense of hearing, probably sympathetic, with headache.
4. NOSE. Tenderness of the septum narium and of the end of the nose. Pressure and aching at root of nose. Drawing pain in root of nose, and zygoma. Throbbing in nostrils, extending into the brain, with throbbing headache in the forehead. Fluent coryza, acrid watery discharge. Discharge of bloody mucus. Epistaxis. Dryness in the choanse. Morsels of food lodge in the choanae on swallowing. The sense of smell is unnaturally keen.
5. FACE. The cheeks, lips and chin are affected. The complexion is pale, as after a long sickness. From time to time white spots appear upon the cheek. In the malar bones and behind the ears and in the temporo-maxillary articulation, pains of a drawing, tearing character, aggravated by motion and by touch. Painful constricting spasms in temporo-maxillary articulation, and then in the temple. Itching and papular eruption on the forehead and nose, cheeks and lips, painful when touched.
6. LIPS. Vesicular eruption on the margin of the lips, smarting when touched, and very painful. The corners of the mouth are ulcerated. The submaxillary glands are swollen and painful to touch and on swallowing.
7. GUMS AND TEETH. Gums swollen, sensitive and ulcerated. Vesicles on the gums. Dental ulcers, painful from contact of cold water. Toothache, shooting and soreness, chiefly in carious teecn, worse at night, aggravated always by cold air and water, sometimes also by very hot food, as well as by cold, accompanied by sore gums, heat in head and burning cheeks.
8. MOUTH. The mouth and lips are dry (primary, 30 hours) ; much saliva (secondary, 8 days).
9. TASTE. Bitter, foul, bloody, sour.
10. TONGUE. Sensation as if a hair lay on the tongue. Tongue sore at the tip, coated and numb. The right half is swollen.
11. THROAT. In the hard palate and in the velum, itching and stitches. Uvula swollen and elongated.
Itching at orifice of Eustachian tube, with hoarseness and dry throat. Sticking pain in the throat, only when swallowing, the throat being painful when touched; sore throat as though a lump were on the left side of the throat.
12. OESOPHAGUS. Difficult deglutition; the food passes slowly into the stomach.
13. STOMACH. Sensations of weight and pressure in the stomach. Pinching and griping pains. Gnawing sensation, relieved by lying with the limbs drawn up. Most of these sensations and many other symptoms come on or are worse after eating, are increased by walking, and are accompanied by flatulence.
(A.) APPETITE. Unnatural hunger, especially toward evening, but no real appetite ; the food will not go down; after eating a small quantity, nausea; also a sensation of weakness in the stomach. After eating, eructations, tasteless, also acid; feeling as of a stone in the stomach ; also vertigo without nausea ; also deafness, chilliness, palpitation, sweat of the face, sleepiness, heartburn, hiccough. Aversion to meat.
(B.) THIRST. Increased.
14. HYPOCHONDRIA. Across the stomach and hypochondria griping and pinching pain in parox ysms for weeks. Drawing and pinching pain extending to hip-joints. Drawing and pinching pain extending from the hypochondria to the spinal column.
(A.) RIGHT HYPOCHONDRIUM. Continued pressure, stitches, pain posteriorly (near the renal region). (B.) LEFT HYPOCHONDRIUM. Pain as if something would tear away.
15. ABDOMEN. Abdomen distended and hard; not much flatulence. Tearing, griping and cutting pains, affecting chiefly the umbilical region, occurring or worse when walking, relieved by applying warm cloths. Pain in the inguinal region, as though a hernia would protrude. The inguinal glands are swollen and painful. Much offensive flatus.
16. STOOL. Constipation, with desire for stool. Sensation as though faeces remained in the rectum, which has not power to expel them. When, after much violent effort of the abdominal muscles, faeces have been nearly expelled, they suddenly recede into the rectum. This symptom has often been verified in practice. Silicea produces likewise diarrhoea. Stools are pappy with mucus, like particles of membrane ; or are fluid, scanty and putrid-smelling, and are attended by a biting, burning sensation in the anus ; or they consist only of bloody mucus, with burning and biting at the anus. Frequent desire for stool, with chilliness and nausea.
After stool, burning in anus; pressure in head; constriction of chest; relief of colic, and great exhaustion; he falls into a slumber from which colic wakes him.
17. ANUS AND RECTUM. Stitching, cutting and burning in rectum and anus. Stitches toward the genital organs. Moisture of the anus. Haemorrhoidal tumors protrude with stool, return with difficulty, and discharge bloody mucus. They are very painful (sticking) and tender. Spasmodic, boring pain from anus up into the rectum and to the testes.
18. URINARY ORGANS, (A.) BLADDER. Pressure upon the bladder while urinating; burning after it.
(B.) URETHRA. Smarting and burning while urinating. Fine stitches continually in anterior part.
(C.) URINE. Scanty, with yellow or red sandy deposit.
(D.) MICTURITION. Frequent desire; constant desire, with discharge by drops and burning in the urethra; need to urinate frequently, every quarter of an hour; must get up almost every night to urinate.
Accompanied by burning and smarting in urethra ; accompanied by itching in the pudenda.
19. GENITAL ORGANS. MALE. (A.) PENIS. Pressure from the prostate forward; prepuce swollen, with itching and moist eruption externally; redness near the corona, as if abraded, with itching.
(B.) TESTES. Pain in the right, as if indurated; pain at night, but only when lying.
Hydrocele (reported by Wahle). Sweat and itching of scrotum; itching and moist eruption on scrotum; aching in spermatic cord, the testes hanging lax.
(C.) SPECIAL FUNCTION. Frequent erections; sexual desire enfeebled; frequent nocturnal emissions ; great prostration after coitus.
Discharge of prostatic fluid, with a difficult stool, or at every stool. .
20. GENITAL ORGANS. FEMALE. (A.) VULVA. Itch ing, with watery leucorrhoea.
(B.) VAGINA. Sensation like labor pains; leucorrhea copious, watery, with violent itching of the vulva, or following a pinching pain around umbilicus on micturition; bloody mucus immediately after menstruation.
(C.) Menses first anticipate, then are increased in quantity. The secretion has a strong odor, preceded by a strong pressure and a compressed feeling over the eyes as of a weight, and by constipation.
At the commencement of menstruation, paroxysms of icy coldness of the whole body. During the menses cold feet, melancholy, anguish in epigastrium ; drawing between scapulae, only at night, relieved by bending backward; strong burning and soreness of the pudenda, with eruptions on the inside of the thighs.
After the menses, immediately a discharge of bloody mucus from the vagina.
21. RESPIRATORY ORGANS. (A.) NASAL MUCOUS MEMBRANE. Frequent sneezing, which causes burst ing pain in chest; nose obstructed, cannot speak or breathe through it; fluent coryza; coryza some times dry, sometimes fluent, but persistent. This and the cough are accompanied by swelling of the sub-maxillary gland, sore throat on swallowing, great chilliness, compelling to lie down ; then, after an hour in bed, great burning heat.
(B.) LARYNX AND TRACHEA. Hoarseness; roughness and dryness in the throat, with irritation, inducing cough after lunch.
Sore feeling in top of larynx.
Tickling itching in the region of the supra-sternal fossa, which threatens suffocation, until a deep shattering cough comes on, which lasts several hours, and produces pain in abdomen and throat.
(C.) COUGH. Deep, exhausting; at first dry, then loose, with abundant purulent expectoration, provoked by tickling in the throat and supra-sternal fossa; by a sensation as if a hair lay from tip of tongue to the trachea and produced a tickling, compelling to cough, hack and scrape; by tickling in larynx at night; excited by cold drinks (Rhus), by every act of speaking; by lying down at night; occurring chiefly at evening, and at night when lying.
Accompanied by pain in thorax and sternum; rawness of chest and throat; vomiting of mucus; pain in epigastrium.
(D.) SPUTA. Abundant transparent mucus; matter which sinks in water; yellowish green, offensive masses; thick masses of pus; bloody mucus or pure blood.
(E.) THORAX. Pressing pain, stitches; general sensation of weakness in chest; weakness when speaking; has to use the whole chest to utter his words.
Induration in left mamma.
(F.) RESPIRATION. Deep sighing; dyspnoea; better after eating.
22. HEART. Palpitation when sitting quietly.
23. BACK. Coccyx pains, as after long riding in a wagon; sacral pain on standing up; aching and tension and violent stitch.
Stiffness and pain in the dorsal region; tearing or aching with chill, finally passing into a dull headache; rending pain between scapulae; drawing pain in scapulae in paroxysms. Then it goes into nape of neck and head, where it becomes a vertigo, so that he feels as if he should fall.
Pain and burning in scapulae.
In nape of neck, stiffness, causing headache; stiffness of one side of neck, preventing turning the head; swelling of cervical glands; eruption, like nettle-rash, in the nape of the neck.
Swelling of thyroid body.
24. EXTREMITIES. UPPER. Pressing pain in the shoulder, extending to the hand, with the feeling as if one could not lift a heavy weight; also at night in the shoulder, extending to the elbow, aggravated by uncovering, relieved by warm wrappings; drawing soreness in the axillary glands, in the hands and fingers; jerking pains in shoulders and arms; sticking in the fingers, as if from splinters of wood; the arms and hands are heavy, and feel paralyzed ; tonic spasm of the hand when writing.
25. LOWER. Similar sensations to those described in the upper extremities. Pains and stitches under the great toe-nails, very severe; sweat of the feet, especially of the soles and between the toes, which become abraded and sore from walking; very offensive smell of the feet, without sweat; the limbs and feet feel very tired, and as if paralyzed ; painful tonic spasm in the feet and toes during a long walk.
26. SLEEP. The prover is wakeful in the evening, by reason of thronging thoughts; the sleep is either frequently interrupted by frightened waking, or disturbed by dreams and fantasies; at night the circulation is excited, with throbbing in all the vessels and a jerking of the whole body; burning in the stomach, with nausea and vomiting of food, and flatulence; anguish and restlessness; sleepwalking ; nightmare.
27. Fever in a definite form is not produced by Silicea. Some chilliness, especially after lying down at night, and heat during the night, with thirst; copious sweat at night, especially toward morning.
28. SKIN. In many places itching or burning itching. Itching eruption, papular or vesicular, upon the chest, thighs and back. The skin is sensitive and irritable, and the whole body is painful as if beaten. Abrasions readily take on the suppurative process.
In ulcers already existing, there are boring or aching, stitching pains, with abundant formation of pus.
29. MIND. The faculties are depressed, and memory weakened.
30. DISPOSITION. Anxiety and restlessness, such as follow fright; peevishness and angry irritation; ill humor and contrariety, with disgust of life.
1. VITAL POWER. Silicea manifests but little distinct action upon the vital powers. The sensorium is somewhat depressed in its activity. The special senses of sight, hearing and smell are exalted in connection with the headache hereafter to be described, but no perversions of sense are recorded. The peculiar pains affecting the head, nape of neck and the eyes, show a definite field of action. The muscular system exhibits only a moderate degree of depression. The sphincters are not affected.
2. ORGANIC SUBSTANCE. On the other hand, the organic substance of the body is profoundly and variously affected. The mucous membrane of the large intestine and of the nares, pharynx and respiratory tract generally is affected, secretions being increased, and so modified in respect of, at least, the respiratory tract, as to resemble pus. Pustular eruptions appear on the skin, abrasions readily take on suppurative action, and ulcers already existing increase in size and activity, and become the seat of stitching, boring pains. Clinical experience abundantly confirms these deductions.
3. SPHERE OF ACTION. The head, orbit, eyes, and at least the upper part of the spinal cord; the nasal and pharyngeal mucous membrane, including the Eustachian tube and the middle ear; the large intestine, 'the bronchial mucous membrane and the genital organs, the skin and the lymphatic glands. appear to comprise the sphere of action of this remedy.
4. The sensations which it produces are in the head and eyes, pressing, shooting and tearing; in the limbs, a paralytic weakness; in the skin, itching and burning itching; and in ulcers, a sticking and burning pain.
5. PERIODICITY. Not marked.
6. PECULIARITIES. It at once appears on reading the pathogenesis of Silicea that the symptoms, with hardly an exception, are aggravated by cold and decidedly ameliorated by warmth. This is noticed of the headache, which is relieved by wrapping the head up warmly, not by the pressure of envelopes, as is the case with Menyanthes, Veratrum and some other drugs, but by the warmth. It is true, also, of the abdominal pains, which are relieved by warmth ; of the cough, which (like that of Rhus) is provoked by cold drinks and relieved by warm ones ; and of the shoulder pains, which come on at night when the shoulders are uncovered, and are relieved by covering (in contradistinction to Ledum, the pains of which, at night, compel the throwing off of the bed covering). The only apparent exception to this statement is found in the aversion to warm food; the prover can tolerate only cold food.
7. CHARACTERISTICS. The characteristics of Silicea are summed up as follows by Bïenninghausen :
"Profuse sweat of the head, the body being dry, or nearly so. (Rhus toxicodendron has sweat of . the body, except the head.) Desponding disposition, sensibility OF the pericranium; headache, relieved by warmth ; pale, earthy complexion ; disgust for meat and for warm food; abdominal pains, relieved by warmth; much sneezing, with acrid coryza; going to sleep of that part of the body on which one lies; unhealthy state of skin; many ulcers form; sleeplessness, on account of orgasm of blood; quickened pulse; chilliness, even by every movement."
From the very year that its proving was published, Silicea has taken high rank as a remedy for cases involving profuse suppuration, causing abscesses to come speedily to maturity and moderating the secretion of pus. In this' regard, and as a remedy for "simple ulcer," it has a brilliant clinical record. It seems to be equally applicable whether the suppurative process be set up in the cellular or muscular tissue, in a gland or in a joint. In fistula lachrymalis, Silicea has not infrequently been beneficial, sometimes completely curing. It compares with Natrum muriaticum and Petroleum in this respect. It has gained a high reputation for the arrest and cure of whitlow, as well as for the affection of the matrix of the nail, popularly called "ingrowing toe-nail," and to cure which the toe-nail is so often unnecessarily torn out. When Silicea fails in these cases, Graphites often succeeds.
Silicea is a most valuable and efficient remedy in caries and in periostitis. It is related in these respects to Asafcetida, Graphites and Conium maculatum, and to Platinic chloride, which I have used successfully in two cases of caries of the tarsus, and for a knowledge of which I am indebted to Dr. Wm. S. Searle, of Brooklyn, N. Y. Its value in affections of the bones would naturally suggest its use in rachitis in children, in which the symptoms of "sweating in the head only," and tenderness of the surface of the body, indicate its homeopathicity. (Hughes.) It has been recommended from experience as a valuable remedy in TABES DORSALIS, though not so well indicated, I should think, as Alumina or Ruta. Where a remedy is so decidedly indicated, and has proved so successful in certain defined morbid processes of a chronic nature, such as suppuration and rachitic dyscrasia, there is danger of our overlooking its applicability to more acute and transitory functional diseases; we are likely to have a too limited estimate of its powers to help the sick.
The headache produced by Silicea is so characteristic and well defined, and, withal, corresponds, to a form so frequently met with, that it is one of the remedies most frequently employed by me for headache. The pain involves the occiput, nape of the neck, vertex and the eyes, or generally the right eye. It is a sticking or a tearing pressing pain, generally beginning in the neck and shoulders and going upward to the occiput and vertex, and extending through the head to the right eye.
Its conditions are characteristic, for it is much aggravated by motion, noise or light, the senses of sight and hearing being unnaturally acute. The patient prefers to lie down in a dark, quiet room. It is relieved by warm applications to the head. When most violent, it is accompanied by nausea and vomiting, and it passes away during sleep. The face is pale. In its conditions of aggravation this headache resembles that of Spigelia, but the latter affects the left eye and temple rather than the right, and is not relieved by warmth; but it is mitigated by pressure, and the pain does not come from the neck and shoulders.
The headache of Paris quadrifolia (a valuable remedy in headache) has some resemblance to that of Silicea. The sensation is, however, a kind of tightness, as if the cerebral membranes were on the stretch, with pressure on the temples and a very painful feeling, as though a cord were stretched tightly from the back of the eyeballs to the center of the brain. This headache is aggravated by thinking and relieved by pressure. The eyeballs feel too large for the orbits.
The headache of Menyanthes is a pressure from above downward; or, in the forehead, from without inward; or, in the temples, a lateral inward pressure, with pressure in the eyeballs. It is relieved by compression of the head, but neither this nor the other remedies except Silicea has mitigation by warmth. I mention these remedies (Paris quadrifolia and Menyanthes) because, like Silicea, I believe they are not so frequently used in treating headache as they might be with advantage.
In chronic bronchial affections also, Silicea is of value. The cough and sputa furnish characteristic indications, prominent among which is, that the cough is "provoked by cold drinks." I may add, from observation, that the pains, soreness and weakness of the chest, are relieved by inhaling moist warm air.
In uterine or vaginal catarrh, Silicea has proved a valuable remedy, the occurrence and character of the leucorrhoea furnishing an indication.
GENERAL VIEW OF ITS ACTION
In the pathogenesis of Silicea the action of this substance is shown to be marked, first, upon the nutrition, the vegetative sphere ; emaciation, loss of appetite, retarded digestion, constipation, sweat confined to the head, but profuse on that part of the body; offensive sweat of the feet, swelling and suppuration of the lymphatic may be cited in evidence. The sweat confined to the head is a pathognomonic symptom of rachitis, and the inference from it that Silicea might be of service in this disease is confirmed by clinical experience. Experience has likewise confirmed Hahnemann's declaration that Silicea has a wonderful control over the suppurative process, whether in the soft tissues, the periosteum, or the bone itself.
SECOND. Upon the nervous system Silicea exerts a peculiar action. With evidence of exhaustion, furnished by sensation of weakness, paralysis, etc., there is an exalted condition of susceptibility to nervous stimuli ; the special senses are morbidly keen, the brain cannot bear even moderate concussion, nor the spine concussion or pressure, and the whole surface is unnaturally tender and sensitive, cold aggravates and warmth relieves. There is, then, an erethism conjoined with exhaustion.
Nor is this all. This erethism, which is not evanescent, but endures for some time, is of such a nature that, while it lasts, spasm is easily induced— indeed, spasm often occurs without any evident provocation, or with only the provocation of muscular exertion and fatigue. Thus, for example, the sensation of weakness and the cramp in the feet at night and when walking, the sensation of weakness and the spasm of the thumb and hand when writing, the sensation of paralysis in the rectum and the spasm of the sphincter ani when making an effort to pass faeces, a spasm which characterizes the peculiar form of constipation observed under Silicea, and so often cured by it.
Clinical experience has taught us that general spasms occur on slight provocation in case of this Silicea erethism.
As an instance of this condition of the nervous system, we may cite the headache of Silicea. It comes on after much exertion, which has exhausted or worried the patient. Its seat is the supra-orbital region, generally the right, or the eye itself, and the pain extends along the base of the brain to the occiput, and down the nape. Noise, motion, light and concussion are intolerable. Repose, quiet, darkness and external warmth give relief.
In subjects whose nutrition is at fault, aching and sharp pains in the nape of the neck frequently occur on the occasion of any nervous strain or exhaustion, and when they exist are aggravated by exertion or excitement. Silicea presents an analogous symptom, with similar conditions.
For patients, on the other hand, in whom fatigue and impaired nutrition produce sluggishness and inaction of the nervous system, Silicea is not at all indicated. It is, for example, very different from Lycopodium in this regard.
The following clinical case illustrates the action of Silicea, as above described:
August 19th, 1869, I was consulted in regard to A. G. W., resident in Boston; a well-grown, bright-looking lad, twelve years old, of dark complexion and hair. His health had been good until the injury soon to be described. There was no inheritance of spasmodic disease. When he was brought to me he was suffering from epileptiform spasms, of which he had for three months had one or more every day. The history of his injury and its results may best be given from his mother's manuscript as follows (dated March 4th, 1870):
"On the 5th February, 1869, Albert fell upon the ice, making a very severe bruise directly over the right eye. He said, when he got up from the fall, he was a little dizzy, but it did not hurt him any. That night he complained of being very chilly; the next morning on rising, seemed as bright and well as usual, but late in the afternoon complained of feeling tired, and wanted to retire that night earlier than usual. The following morning he rose with the same tired feeling, accompanied by chilliness, was very quiet, and said he did not feel well enough to go to school. During the week commencing February 7th he was very quiet and not well, the chilliness continuing, and he complained a great deal of his eyes, which were weak; and he could not look at print or anything that required close observation; and at times said everything looked dark as if it was night. He also complained of dizziness, and felt as if his limbs would give out and he should fall down while walking.
"After that week I do not think he complained of objects appearing dark, but all the other symptoms continued, with pain and swelling of his bowels. This last symptom he did not complain of so much the first two or three weeks, but it increased very much, the bowels being swollen, full and hard a great part of the time, particularly late in the afternoon and at night.
"I think I may safely say it was in the early part of March he began to be very restless and uneasy, seldom getting to sleep before ten o'clock or eleven, or even later. The only way he could be induced to be quiet or lie still, was by reading to him. As time advanced, that would quiet him but a very short time ; he would start up suddenly, running through the rooms, up and down stairs, as fast as he could, and finally throwing himself on the lounge, would sink into unconsciousness. These turns gradually became more severe. I could hardly detect any change from day to day; only by looking back a week or a fortnight could I tell that he grew worse. The attacks grew more frequent and more severe until he was rigid (every limb and every part of his body), his eyes became set, and sometimes one side of him would be convulsed, jerking and twitching. These spasms would vary, lasting from five to twenty minutes usually; but the most severe ones were thirty minutes. From these he would gradually relax, his eyes would close gently and he seemed to sink into an unconscious sleep. At first he would sleep a short time, rouse up suddenly, and always ask where he had been and what time it was.
"After a time, he would not wake from these unconscious turns, but would seem to pass into a natural sleep for the night. These spasms he had every night with but few exceptions after May 1st. Commencing about six, p. M., or shortly after, and having from four to six spasms, and sometimes more, until near ten o'clock, and, during the intervals between the spasms, he would listen to reading, or be crawling over the bed, pulling the pillows round his neck, tossing them up, and doing such unnatural things, apparently not conscious. The latter part of July, and after, he would at times have these attacks in the day; then they seemed to be brought on by over-excitement, extreme fatigue, or disappointment. On one or two occasions, while walking in the fields with his father, he fell down, lying a few moments, then recovering.
"His appetite was very changeable all through his trouble ; sometimes he wanted to eat too much, then for a long time would have but little appetite.
"He was very nervous, and could hardly be induced to sit down to take his meals; was constantly in motion, wanting some amusement all the time. When going into his room to prepare for the night (during July and after), he would, before removing any of his clothing, GO into these spasms. His mind always seemed active, bright, and quick, except when in these spasms, and I have not had occasion for a moment to think it was at all disturbed ; in fact, he seemed more keen and quick than before his injury. His disposition was very much changed. Being naturally pleasant, cheerful and happy, and quite persevering and firm, he became peevish and irritable, very persistent in his own way and wishes; always unhappy if opposed, and seemed in this respect altogether unlike himself.
"He continued as I have described him, apparently growing worse, until he consulted you in August. In about one month from that time, we began to hope (through fears) that he was a very little better; the attacks seemed lighter, more severe ones once in a few days, then less severe again, the severe turns growing less frequent, with longer intervals between. In this way he showed improvement for a time, then would pass a night or two without a spasm ; then three or four nights, more or less ; the spasms diminishing in this way, until the last spasm he had was October 23, 1869. Since that time, he has been extremely nervous at times, and showed strong symptoms of spasms; but these passed off without further trouble. Twice since you discharged him he has been very nervous and excitable, and on these occasions, following your advice, I resorted to the powders for nervousness (Silicea 2°°), which seemed to have the desired effect. At times, when tired, he seems more nervous and irritable than is natural; but this wears off by degrees. It might be well for me to mention that a bath does not always affect him pleasantly, and quite recently he complained of feeling badly after getting into it, and appeared stupid and inactive; not because he remained in the bath too long; it seemed more the result of the shock when he first got into the water. Twice within the last two months it has affected him in this way. Aside from this and the nervousness, I am happy to say he seems quite well. In regard to medical treatment, there was no medicine advised by any physician consulted, before yourself, but the bromide of potassium, with great care to be taken respecting his diet, and the quantity, quality and regularity of his meals. Our family physician felt that unless an operation were performed, his trouble would result in loss of intellect, and that was the only treatment that could save him from such an affliction. We consulted one of the first surgeons in Boston regarding it; his opinion was, that it would not be a safe operation, and he did not think favorably of it. With the bromides and plenty of exercise in the open air on a farm, he might ultimately be better."
The above account was written by the patient's mother, March 4th, 1870, and I have quoted it IN EXTENSO, because of its clear description and history of the origin, progress and decline of the disease. I purpose now to supplement it from my clinical record, made while the case was under treatment, and which does not, in every particular, agree with the mother's narrative, made from recollection, four months after the last spasm occurred. I saw the patient at my office, for the first and only time (the treatment was conducted by correspondence), August 19, 1869. He appeared very bright and intelligent, responding promptly and clearly when questioned. His mother described the case as already detailed, stating, however, that on the steamer, the preceding evening, he had had a worse attack than ever, in consequence, probably, of the excitement produced by traveling. She described the attack as follows, saying it was like those he had had for a fortnight previous, though more severe and lasting longer:
"When in the bedroom, and about to prepare for bed, he would fall or throw himself upon the bed, then he would plunge head foremost on hands and knees and thrust his head. against the bolster or the wall, seemingly unconscious of what he was doing. His friends were obliged to be ready to put cushions between his head and the wall or object against which he seemed about to plunge, in order to guard him from injury. If touched, checked, or resisted while in this condition, he would bite or violently resist. After a time, from five to twenty minutes, he would sink upon the bed, become convulsed, and then generally sink into a deep sleep. The bowels were regular. Urine appeared normal. Appetite capricious. The seat of the injury appeared swollen and irregular to the touch, as though there had been a fracture of the outer table of the cranium and some displacement of the fragments. He said that stooping for any length of time produced a sharp pain in the right side of the forehead and heaviness over the eyes, so that he could not keep them open. I noticed a symptom which had never before been observed, viz.: That pressure upon the spine, in the lower part of the dorsal region, as from the fifth to the ninth dorsal vertebra, produced sharp pain in the right forehead, in the seat of the injury."
His mother's attention being quietly called to this fact, she reported from time to time that it was a constant symptom so long as the spasms continued, and that it gradually disappeared, PARI PASSU, with the nervousness, which remained for . some months after the last spasm. Pathologically this symptom is one of great interest. The lad was much excited during my examination of his case and was quite loquacious, and on this account, and because of the peculiar combative disposition evinced in the attack of the previous night, I gave Hyoscyamus 200, ordering that all other medication should be discontinued.
August 26. His mother reports that his condition is as before. She notices, however, that the spine is sensitive at the nape and throughout the cervical and upper dorsal regions, even more than below. Pressure upon the spine produces pain in the head. She had not noticed these symptoms before, but cannot say that they have not existed. Her attention was never directed to them. Appetite sometimes ravenous, sometimes very poor. Tenderness in the epigastrium is a constant symptom. The abdomen always large and protuberant. Calcarea carbonica 200.
Sept. 10th. His mother reports that on the 8th he fell and struck his head in the same place, producing swelling and pain. He was unconscious for some time after the fall. Prior to this his spasms had seemed to be lighter, and his appetite had been more regular, but his excitement and irritability greater. Belladonna 200.
Sept. 22d. He has occasionally passed a day without any spasm, but every few days has had a severe one. He is less irritable, and seems more like himself than since his injury. When excited he moves his eyeballs continually, and snaps his eyelids together spasmodically for a short time. Belladonna 200 again.
Sept. 28th. He took three doses of Belladonna. Had severe headache with spasms in the evening, and unconsciousness. His mother thought the medicine did not agree with him,—aggravated his nervousness and inclined him to spasms. She discontinued it. Calcarea carbonica 200.
Oct. 9th. He improved for a few days. Then had more headache, and at night nervousness and spasms. He says it is pain in his head which makes him nervous, and he cannot keep still. The pain is sometimes in the forehead and sometimes in the side of the head. When the pain becomes very acute he passes into unconsciousness. This pain is in and around the seat of injury, and extends thence to the occiput. It is aggravated by motion and noise and relieved by warmth. Silicea 200, to be dissolved in water, a tea-spoonful every six hours until some effect appears.
Oct. 19th. He has been freer from headache since the last report, and has not complained of the pain at all.
Oct. 28th. Was quite well and free from spasms till the 23d, on which day, having struck his foot while at play, and suffered a good deal of pain and some excitement there from, he had a hard spasm, passing off in unconsciousness. His eyes have been much better. Silicea 200, as before.
Nov. 9th. No spasms nor unconscious turns since Oct. 23d. No complaint of pain or headache. There is no longer any tenderness of the spine, nor pain produced in the head by pressure on the spine. The nervous movement of the eyes is slight. He continued to improve steadily, except for a few days toward the end of November, when disordered digestion seemed to produce an increase of irritability, which, with the indigestion, was speedily relieved by a dose of Nux vomica 200, until Dec. 5th, when he complained, while taking a bath, that when the water touched his shoulders it caused pain in the forehead, in the seat of the injury. This aggravation was ascribed to the effect of a blow on the head from a falling door the preceding day. No other bad effect resulted. After Dec. 4th he had only Saccharum lactis.
Jan. 7th, 1870. Continues quite free from spasms, and grows steadily less irritable. No headache, pain or tenderness of the spine. Appetite regular and normal. Digestion and sleep good. Likes to read, and can take a lesson of an hour in length without fatigue.
Discharged, with instructions to take a dose of Silicea 200 in case of any unusual amount of excitement or return of pain. The lad continued to improve without interruption, and in October, 1870, appeared perfectly well and resumed attendance at school. No symptoms of illness of any kind had appeared up to Jan. 15th, 1871, nor to December, 1871.
On a review of this case, it appears that disturbance of the circulation was apparent, in a slight degree, within a week after the blow upon the head; that the disturbance gradually increased, and was then replaced by nervous irritability, conjoined with a sense of physical prostration and with disturbances of nutrition, until, nearly two months after the injury, the first paroxysm occurred. The spasms increased in frequency and severity until he had been a month under homeopathic treatment. At what period the tenderness of the spine first existed we have no means of ascertaining. It continued until some time after the spasms ceased, declining in intensity as they became less severe. It is noteworthy that with all this disturbance, the intellect and the special senses were not blunted, but came into a condition of erethism or exalted activity. And, moreover, that excitement from unusual stimulus, or from opposition, or from physical injury, caused an increase of nervous excitement, of tenderness of the spine, of headache, and of disposition to spasm. These features of the case are in marked correspondence with the pathogenetic action of Silicea.
Reviewing the result of treatment, it appears that the bromides, though steadily given under skillful direction, had no effect to diminish irritability or control spasm. The effect of exercise in the open air on a farm, as recommended, was faithfully tried from May 1st to August 19th; but the lad grew steadily worse, and the more he exercised, even in moderation, the worse he was. Of the homeopathic remedies, Hyoscyamus probably did no good, and was not a wise prescription, being based on too partial a view of the case. Belladonna appeared to allay the violence of the spasms to some extent, and to moderate the nervous irritability. Under Calcarea carbonica the digestion and assimilation, which had been much impaired and perverted, were nearly restored to the normal state. It must be noted, however, that although in these respects improvement followed the use of these remedies, nevertheless, while they were being taken, the headache and tenderness of head and spine steadily increased, the spasmodic action of the eyes and lids set in and increased, and the spasms, though less frequent, increased in severity. The irritation of the nervous centers was evidently not controlled, and the case assumed more and more the aspect of a well-established centric epilepsy. While, therefore, the remedies produced beneficial results and undeniably contributed to the cure, they did not cover the entire case, and it is a question whether the ultimate favorable result would not have been more speedily attained had the Silicea been administered at an earlier date. This remedy I regard as the chief instrument in the cure. For, so soon as the patient came under its influence there was evident that mitigation of all the symptoms and their disappearance, one by one, which the homeopathist is wont to recognize as evidence that he has found in his remedy a similimum to the case. The amelioration began at once in the symptoms immediately referable to lesions of the nervous centers. The headache ceased; the spine became less tender; pressure upon it no longer caused pain in the seat of the injury. The susceptibility which had, under other remedies, persisted coincidently with improvement in other respects, rapidly decreased. In a word, from the time Silicea was given, universal improvement began; and it was scarcely interrupted until the child appeared perfectly well again.
Happily for the patient and his parents, no opportunity was afforded for obtaining by inspection a certain knowledge of the organic lesions existing in this case. Whether, as was supposed by the attending physician, a depression of the inner table of the cranium or a spicula of bone protruding therefrom, produced pressure upon the brain, and consequent irritation, or whether a low grade of inflammation resulted in tissue degeneration in some part of the encephalon, must be matter of conjecture; other hypotheses may be formed. If the former, the recovery could hardly have been expected, and can hardly be explained. If the latter, then under the action of remedies a retrograde metamorphosis must have occurred, and the normal tissues must have gradually replaced again the degenerate substitutes. In any view, this was not a case in which we could reasonably anticipate a spontaneous complete restoration to health. The recovery, therefore, under the administration of homeopathic remedies is an interesting phenomenon; nor is the interest of the case the less that these remedies were all given singly and in the 200th potency.