Picric Acid

Picric acid at first causes congestions. These are soon followed by weariness and mental inactivity, showing how intensely the remedy attacks the vital forces. This weariness progresses from a slight feel- ing of fatigue on motion to complete paralysis. It is accompanied by indifference, want of will-power, and desire to lie down and rest.

Animals, poisoned with this acid, were affected with paralysis of the hind legs, with slow breathing and great muscular weakness. At the autopsies made on them, the cortex cerebri, the cerebellum, medulla oblongata and spinal cord were found reduced to a soft, pulpy mass. The blood was dark brown in color, and loaded with little shining, greasy particles. The urine was rich in phosphates and uric acid, and poor in sulphates and urates.

Albumen and sugar were also found in the urine. The liver was full of fat granules and its borders dark with stagnant blood.

These symptoms and pathological observations bespeak the use of Picric acid in diseases of the brain and spinal cord. To give it, we

picric acid. 539

need not wait until paralysis has set in. We may find it useful in typhoid conditions and also in conditions of brain fag when the mind has been over- worked. In the latter affection, Picric acid is one of our best remedies.

It is also useful in neurasthenia. You will find dull headache with aggravation from the slightest attempt at using the mind. This may be in the forehead or in a still worse place, in the occiput, and may then extend down the spine. The patient complains of feeling constantly tired and heavy.

Any attempt to study brings on anew these symptoms of the brain, and also develops burning along the spine and very great weakness of the legs and back, with soreness of the muscles and joints. Sometimes sleep is restless and disturbed by priapismic erections. With these, of course, there will be frequent seminal emissions. Sometimes you will find severe pains in the neck and occiput going up to the supraorbital notch or foramen, then extending down into the eyes.

There are hot feeling in the lower dorsal region, and aching and drag- ging in the lumbar region, which is worse from motion. On awaking from a sleep the patient has a tired aching in the lumbar region. The legs are heavy and, at the same time, weak. With this heaviness of the feet he sometimes complains of dull frontal headache.

Sometimes he complains of numbness and crawling in the legs, with trembling and with pricking, as if from needles. He has tingling of the lips, formication about the head, and crawling as of ants over the surface. The least exertion causes prostration. He also has vertigo, worse when he stoops, walks or goes up-stairs.

He has headaches, with dull, throb- bing, heavy, sharp pains, worse from study or movement of the eyes, and better from rest, the open air, or binding the head tightly. The pupils are dilated. Sparks appear before the eyes, which may even smart and burn. Thick matter forms in the canthi.

The eye symp- toms are worse from artificial light. Accompanying the congestion of the head is nose-bleed. The nose is full of mucus. The patient can breathe only when the mouth is open.

The saliva is either frothy or stringy. The taste in the mouth is like that of the acid itself, sour and bitter. The throat feels rough and scraped; better from eating and worse from empty swallowing, and worse after sleep. There is thick, white mucus on the tonsils.

On swallowing, the throat feels so sore that it almost seems as if it would split. Sour eructations may accompany the frontal headache. Now, these gastric symptoms may accompany the brain fag. Nausea, which is worse about five o'clock

54-0 A CLINICAL MATERIA MKDICA.

in the morning and worse when attempting to rise. He also complains of pressure and weight about the stomach. He wants to belch, but does not seem to have the power to do it. The irritating effect of the drug is further shown by diarrhoea with stools which are thin, yellow and sometimes oily, with a great deal of burning and smarting at the anus, with prostration and unsuccessful urging to stool.

The kidneys are congested. The urine has an abnormally high specific gravity, and contains sugar. It is also albuminous. The conjunctivae are yellow, just as you find in jaundice.

Papules appear on the face and turn into small boils. The feet are apt to be cold. These, then, are the main symptoms of Picric acid. Now, let us study those of a few of its related remedies.

Phosphorus, like Picric acid, causes fatty changes in the blood, kid- neys, brain and spinal cord. Both remedies meet in sexual excesses and priapism, and both may be indicated in brain fag; both have con- gestive vertigo and crawling and tingling sensations here and there over the body. The distinction lies principally here: Phosphorus causes more irritability with the weakness, as displayed by over-sensi- tiveness to all external impressions. Hence, the senses are too acute, or, if failing, there are present photopsies; loud noises in the ears; sen- sitiveness to odors, to electric changes in the atmosphere; head weak; cannot think, with aggravation from loud noises.

Phosphorus also has backache, with feeling as if the back would break on any motion, and with burning spots in the back, better on rubbing. Sexual excitement is very strong, but the erections are not so intense as under Picric acid, although the lasciviousness is more marked. Even when, in extreme cases, all irritability has ceased, the history shows that it once charac- terized the case.

Nux vomica resembles Picric acid, somewhat, in the brain fag and in the gastric symptoms, in the sour eructations, in the aggravation to- wards morning, and in the inability to study. Nux is distinguished by the prominence of its gastric symptoms.

Oxalic acid, more than Phosphorus, resembles Picric acid in the ex- treme picture of spinal softening. There are weakness about the loins and hips, extending down the legs, and numbness in the back. Picric acid has more heaviness and Oxalic acid more numbness. The legs are apt to be bluish and cold. The patient complains of paroxysms of dyspnoea. Another symptom, and one indicative of spinal meningitis, is intense inflammatory pain all through the back. A general

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symptom of Oxalic acid is pains coming in small spots, and greatly aggravated on thinking of them.

Another remedy closely related to Picric acid is Sulphur. This causes congestion of the lumbar spine, so intense congestion that paraplegia, with numbness and tingling, results. Heat in the spine. Retention of urine.

Phosphoric acid suits cerebro-spinal exhaustion from over-work. The least attempt to study causes heaviness, not only in the head but in the limbs; numbness; vertigo; confusion of thought; tingling, for- mication, especially in small of back; back and legs weak, yet no pain, except a subjective sense of burning; emissions even during stool; genitals relaxed,

Argentum nitricum has backache, worse when first rising from a seat and better from moving about, with trembling weakness of the limbs; vertigo, with fear of projecting corners, etc.; bones at sacrum give out; limbs tremble; impotency; organs shrivelled.

Alumina is indicated in cases somewhat like those calling for Picric acid, but is distinguished by the pains in the spine as though a hot iron had been thrust into the part. The patient staggers when walking in the dark. He also has painful feeling about the soles of the feet.

Silicea is quite similar to Picric acid. It is useful in nervous ex- haustion, where the patient dreads any exertion either of body or mind. When he is warmed up to his work, he can get along pretty well. He also has numbness in the toes, fingers and back, and the constipation peculiar to Silicea.

Zinc causes nervous exhaustion. Its backache is worse at the last dorsal vertebra, and is worse while sitting; burning along the spine; formication in the calves; weak limbs; weak back and limbs, with goneness when hungry, especially at 11 A. m. All the nervous symp- toms are worse from wine.

Of the remedies which cause violent erections you may compare the following: Cantharis, Phosphorus, Capsicum, Agariais, Pulsatilla, Platinum, Opium, Ambra grisea, Zincum, Physostigma, Pet7'oselinum and Mygale.

LECTURE LII.

SILICEA.

( Asaf. , Phosphorus, Conium, Graphites. Silicea. < Sulphur, Calcarea ostr., Lycopodium.

( Gettysburg water. <Mercurius.

Silicea in its crude state is inert. It is insoluble, and hence has very little effect on the system. When potentized according to the formula of Hahnemann it becomes one of the most valuable drugs in our materia medica. It is a grand illustration of the efficacy of potenti- zation.

The great and important effect of Silicea lies in the nutritive changes which are made by it. As nutritive changes are more evident in the growing child than in the adult, you will find Silicea symptoms ap- pearing mostly in children from infancy up, not that it is contraindi- cated in the adult, but its use is shown more evidently in the young. The child, then, is imperfectly nourished, not from defective quality of the food it takes, but from defective assimilation. The head is dis- proportionately large; the fontanelles, especially the anterior, are open; the body is small and emaciated, with the exception of the ab- domen, which is round and plump, as is often the case in scrofulous children.

The head, including the scalp, neck and face, is covered with an offensive sweat. The face is pale, waxen, earthy or yellowish. The bones are poorly developed, as#are also the muscles, consequently the child is slow in learning to walk. Silicea is especially adapted to rachitic children.

The fibrous parts of the joints are inflamed, swollen or ulcerated. This gives the joints, especially the knees, a knob-like appearance.

Silicea is complementary to Thuja, especially in nervous affections and for the bad effects of vaccination. Whatever we may say in favor of the necessity of vaccination, we do know but that this operation may be followed by unhappy symptoms, and that, too, when the purest of virus has been used. Hence, at times, you have to counter- act the bad effects that may follow the operation. We know that in Paris some 30,000 or 40,000 children were vaccinated after each was

silicea. 543

given a dose of Sulphur, and this is supposed to prevent the outbreak of any other disease than the vaccinia itself. If such bad effects as erysipelas, convulsions or diarrhoea should follow, then you will give Silicea, which will cure the case. Thuja, itself, is complementary here, and comes in very well for diarrhoea following vaccination, and also when the vaccination fever is high. Pustules, like those of small- pox, together with a rash, appear all over the body.

Melandrinum is also useful for ill-effects of vaccine, but as yet it has been only im- perfectly proven.

You notice that to the right on the board I have placed Mercurius, prefixed by a "crescendo" mark. That means that Mercurius does not follow well after Silicea. Their symptomatologies are apparently similar, and yet they do not seem to agree, although Silicea will anti- dote some of the effects of crude mercury, but, as potentized medicines, they do not follow each other well, hence you must be careful in de- ciding between the two drugs.

Fluoric acid antidotes the over- use of Silicea in bone affections.

Hepar also antidotes some of the effects of Silicea.

We are now ready to take up the effects of the drug. First, on cellular tissue. Silicea has long been known as a valuable drug, be- cause of its affinity for cellular tissue. It produces inflammation of this extensive tissue of the body, going on to suppuration, and suppuration, too, which is rather indolent or sluggish in type, not necessarily malignant, but tending to perpetuate itself and become chronic.

The termination of the Silicea cellulitis, then, is in suppuration, which is persistent, in ulceration which is persistent, or in induration. I have already illustrated this in the application of Silicea to the tonsils when these glands suppurate and refuse to heal, Silicea is more than ever the remedy when this occurs in rachitic chil- dren. You will see it also in the treatment of boils or furuncles, fur- uncles which occur in crops and which do not heal readily, but con- tinue to discharge a rather thin, watery and even ichorous pus, usually having a foul odor, or less commonly a thick pus.

Silicea may fre- quently be suggested as a remedy to prevent boils, on account of its tendency to produce inflammation of the connective tissue.

So, too, it would be suggested in that dread disease, carbuncle, par- ticularly when it is situated between the shoulder and nape of the neck, a common site for carbuncle.

Silicea may also be used for induration. For instance, following

544 A CLINICAL MATERIA MKDICA.

the treatment of boils and abscesses, or other inflammations of this kind involving the parenchyma of an organ, you may have plastic exudation, which results in induration. This induration Silicea will cause to be absorbed, thus placing Silicea alongside of Graphites, a drug which you will remember tends to absorb indurated surfaces, even going so far as to effect the obliteration of cicatrices.

The same has been said of Phytolacca, but I think that this lacks confirmation. It certainly lacks the confirmation that Graphites has had.

Sometimes you will find that Silicea is unsuccessful in these indu- rations. Then a dose of Sulphur, interpolated, makes Silicea act better.

Silicea may be given with good result in all forms of ulcers, both benign and malignant. Its distinctive features are ulcers from bone diseases, as caries or necrosis, scrofulous ulcers which appear about joints, ulcers which appear in the back from vertebral caries, and ulcers which appear about the hip in hip-disease, particularly if con- necting with fistulse. The pus is thin and offensive, and often mixed with blood and sometimes with little particles looking like cheese. There is very little tendency to heal spontaneously.

These ulcers are relieved by warm and aggravated by cold applications.

Silicea acts upon the bones. We find it indicated in scrofulous children where the bones are curved, as for instance in spinal curva- ture. Not only is it indicated in lateral curvature, but where there is caries of the vertebral column itself.

It may also be indicated in diseases of the hip, or knee-joint, when the discharges are thin and offensive, and when there are fistulous tracks opening into the joint. The patient is of a scrofulous diathesis, and presents the constitutional characteristics that I have already mentioned as belonging to the Silicea patient. In addition to the symptoms there enumerated, the Silicea patient may have an offensive foot sweat, and this tends to make the toes sore and even raw. Some- times there is an offensive axillary sweat.

(I believe that the best remedy for axillary sweat is Petroleum. ) The child also has tendency to swelling of the glands, which suppurate. Now with these symp- toms there is a peculiar susceptibility to touch. I would here compare it with Lachesis, which as you will remember has extreme hyperesthe- sia of inflamed parts. I dwell on this symptom for two reasons; first because it will help you to differentiate from the closely allied lime

silicea. 545

salts, and secondly because it illustrates a property of Silicea which you will see when we come to speak of its action on the nerves.

Let us now stop to compare Silicea with its related remedies. Asa- foetida has offensive discharges from the bones. It is distinguished, however, by the intolerable soreness around the ulcer. For instance, in caries of the tibia, with an external outlet and discharging pus, the parts around the ulcer are so sore and tender to the touch that the patient cannot bear the softest dressing.

Phosphorus is very similar to Silicea in bone disease. It resembles it in abscess, particularly in mammary abscess, with fistulous openings. It is similar, too, in the caries of bone, particularly in necrosis. Phos- phorus, like Silicea, has over- excitability of the nervous system.

Platinum mur. is also a valuable drug in caries of the bones.

Another is Angustura, which is particularly useful in caries of the long bones, as the humerus, tibia, femur, etc.

Strontiana carbonica is especially useful in caries of the femur with coexisting watery diarrhoea.

Gettysburg salt is rich in carbonate of lithium, and is very useful for symptoms precisely like those of Silicea, namely, carious ulcers, or ulcers about joints, such as occur in hip-disease or in caries of the vertebrae. The discharge is acrid and excoriating.

Sulphur, Calcarea, and Lycopodium are similar to Silicea in the scrof- ulous diseases of children. The distinction between Calcarea and Silicea is as follows : the Calcarea head sweat is confined to the scalp, and is sour rather than offensive. The feet also are damp from sweat, but the sweat does not, as in Silicea, make the feet sore or raw. Cal- carea lacks the sensitiveness to touch of Silicea.

In this sweating of the head, the body being dry, Silicea is exactly opposite to Rhus tox., which has sweating of the body, the head being dry.

The mucous membranes do not escape the action of Silicea. We have otorrhcea, the discharge from the ear being offensive, watery, and curdy. Often you find the membrana tympana perforated, the puru- lent discharge thence containing little pieces of bone, the result of in- volvement of the mastoid process or the ossicles of the middle ear by the disease.

There is keratitis, especially with tendency to the formation of sloughing ulcers, which tend to perforate the cornea like those of Nitric acid. In the Silicea child they are not vascular, so there is not

546 A CIvINICAI, MATERIA MEDICA.

much infiltration of the surrounding tissues. Hypopyon is present. The lids are swollen and covered with suppurating styes.

The nose is also affected. Silicea is especially useful in nasal catarrh -when ulcers exist on the mucous membranes, and these discharge a thin, bloody excoriating matter; or they may be dry, and then there is annoying dryness of the nose. It is also useful when the catarrhal process extends backwards and involves the outlets of the Eustachian tubes, producing an intolerable itching and tingling in this locality.

We also find Silicea indicated in some forms of hay- asthma, espe- cially that which begins with itching and tingling in the nose and vio- lent sneezing and excoriating discharge from the nose.

Silicea has also an action on the lungs. It produces hoarseness and roughness and dryness, with a tickling cough wThich seems to come from the supra-sternal fossa very much like Rumex crispus. There is also a feeling as if a hair were lying in the throat, larynx or trachea. The cough is excited by cold drinks, as under Rhus tox. and Scilla, by the very act of speaking, as in Phosphorus, Rumex, Ambra grisea, etc., and worse at night when lying down, just like Rumex, Phosphorus and Lycopodium.

Sometimes it ends in the vomiting of mucus.

Silicea is useful in the suppurative stage of tuberculosis, when the cough, at first dry, becomes loose, with the expectoration of offensive muco-pus. You will find it of great service in the phthisis mucosa of old people. After great exertion the patient expectorates nasty pus, which is horribly offensive. But Silicea will seldom cure these cases. It can only palliate.

Phellandrium aquaticum is an excellent remedy in the last stages of phthisis when the expectoration is terribly offensive.

I would advise you to remember Capsicum for bronchial catarrh when the breath is not offensive except during the cough. You know that the Capsicum patient is of lax fibre and cannot get up the expec- toration; so some of it lies there and undergoes decomposition. The air of ordinary expiration is not offensive, but as soon as the patient brings that from the very depths of the lungs, the offensive odor be- comes quite marked.

In the Silicea diarrhoea the stools are offensive and usually painless and lienteric. The child vomits its food. These symptoms are asso- ciated with the characteristic skin lesions and constitutional peculiari- ties which go to make up the Silicea child.

The constipation of Silicea is quite characteristic. The stool

siucea. 547

partially escapes from the rectum and then seems to slip back again. I think that this symptom is easily explained. There is defective ex- pulsive power on the part of the rectum. With a great deal of strain- ing the stool is partly pushed down. When the bearing ceases then it slips back.

Next you have to remember the action of Silicea on the nervous system. It has here a very peculiar effect, which was pointed out first by Dr. Dunham. It causes a tendency to paralysis and paralytic weakness.

Here, too, the trouble seems to be due to defective nutri- tion of the nerves themselves, both in the brain and spinal cord. Then you will have to remember it as a remedy in paralytic weakness ac- companying disease of the spinal column. Often, with this condition, there is the peculiar constipation I have just described. With all these paralytic troubles there is an over-susceptibility to nervous stim- uli.

The senses are morbidly keen. The brain and spine cannot bear even an ordinary concussion or vibration. The surface of the body is tender and sensitive to the touch. Cold aggravates the symptoms and heat relieves.

Silicea may be given in convulsions of an epileptic character, with well-marked aura, when it starts from the solar plexus, as in Bufo and Nux vomica. The attacks are also said to come in certain phases of the moon. The patients are worse from any over-strain of the mind or emotions.

The headache of Silicea is of a nervous character, and provoked by any excessive mental exertion. It is generally worse over the right eye. It is aggravated by any noise, motion or concussion, and better from wrapping the head up warmly. It is not the pressure, but the warmth, that relieves. Sharp, tearing pains rise from the spine into the head. At the height of the paroxysm there is apt to be nausea and vomiting from sympathetic involvement of the stomach.

You should here compare Menyanthes, Paris quadrifolia and Stron- tiana carb. Menyanthes was first confirmed by Dr. Dunham. It has a peculiar headache coming from the nape of the neck, over the head. There is a bursting pain, as if the membranes of the brain were tense, and were pushing the skull open. This is relived by pressure rather than by warmth.

Paris quadrifolia has headache of spinal origin, which arises from the nape of the neck and produces a feeling as though the head were immensely large.

548 A CLINICAL MATERIA MEDIC A.

Strontiana carb. produces headache coming up from the nape of the neck and spreading thence over the head. It is just exactly like the headache of Silicea. You will have to distinguish by the collateral symptoms.

There are other nervous symptoms produced by Silicea. The patient has vertigo, which, like the pains, seems to rise from the spine into the head. It also causes difficulty in balancing. He has a fear that he will fall, and always to the left.

Speech is somewhat confused. He finds it difficult to grasp the exact expression he wishes, and this even in ordinary conversation, and yet, when warmed up to his subject, he sometimes speaks quite fluently. Sluggishness is a contraindication of Silicea in nervous conditions. You cannot use it in torpid, flabby, nerveless persons.

Remember that exactly the opposite is the case with disease of the lower tissues.

Silicea acts just as powerfully on the spine as it does on the brain, causing general motor weakness. Here, too, it is attended with the same irritability. The neck is stiff, causing headache. This stiffness of the neck is not from cold, not from rheumatism of the various muscles, but from spinal irritation.

The small of the back aches as if beaten or pounded. The patient complains of pains about the coccyx, and cramps such as one experiences after sitting a long time or after, riding a long time over a rough road. The legs tremble. They easily grow weary, particularly in the morning.

I^oss of animal fluids causes marked aggravation of the symptoms. For instance, seminal emission or coitus causes, or is followed by, bruised aching all over the body. There may also be symptoms of the spine which indicate locomotor ataxia. The fingers feel stiff, with loss of power in them.

The part of the body on which he lies goes to sleep.

Silicea is useful in chronic rheumatism. It is one of the remedies on which to depend in treating hereditary rheumatism. The pains are predominantly in the shoulders and in the joints, and are worse at night and worse when uncovering.

A related remedy here is Ledum, which has exactly the opposite ag- gravation to that of Silicea. The patient is worse from covering up. The symptoms usually extend from the feet upwards.

LECTURE LIII.

ARSENICUM ALBUM.