CONTENTS.

Section I. Bureau of Materia Medica.

II. Bureau of Clinical Medicine.

III. Bureau of Obstetrics.

IV. Bureau of Surgery.

V. Bureau of Statistics.

PART II. SECTION I.

REPORT OF BUREAU OF MATERIA MEDICA.

S. LILIENTHAL, M. D., 230 West Twenty-fifth street, New York.

CONTENTS.

IX. Observations on Silicea. Carroll Dunham, M. D.

X. The Importance and Manner of Studying the Materia Medica. Alfred K.

XII. Medicinal Interference. George F. Hand, M. D.

XIII. Differential Diagnosis of Phosphorus and Arsenicum. S. Lilienthal, M. D. XIV. Proving of Lilium Tigrinum. E. M. Hale, M. D.

XV. Proving of Lilium Tigrinum. Wm. E. Payne, M. D.

XVI. Verified Symptoms of Lilium Tigrinum. T. F. Allen, M. D.

XVII. Toxicological Effects of Arsenic. C. Judson Hill, M. D.

XVIII. Toxicological Effects of Morphine and Laudanum. Stillman Spooner, M. D.

XIX. Iodoform. B. F. Underwood, M. D.

IX.

Observations on Silicea.

BY CARROLL DUNHAM, M. D.

General view of its action.-In the pathogenesis of silicea, the action of this substance is shown to be marked:

1. 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 affection is confirmed by clinical experience.

Experience has likewise confirmed Hahnemann's declaration, that silicia has a wonderful control over the suppurative process, whether in the soft tissues, the periosteum or the bone itself.

2. Upon the nervous system, silicea exerts a peculiar action. With evidence of exhaustion furnished by the 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, either 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 cramp in the calves at night and on walking; the spasm of the thumb and wrist when writing; the spasm of the sphincter ani when making an effort to pass fæces; 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 cases of this silicea erethism.

As instances 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 of the neck. 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 it 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 19, 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, 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 of 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. 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 continued, and he complained a great deal of his eyes which were weak; and he could not look at a print or anything that required close observation; and at times said everything looked dark as if it was night. He complained of dizziness and felt as if his limbs would give out, and he should fall down while walking.