SILICA in the form of silicic acid is found in minute traces in animal tissues, having been ingested in vegetable foods and even more in eggs. Apart from possible metabolic value, its value in the animal economy is in the development and maintenance of hair, nails and feathers.
Neither the recognized textbooks of pharmacology not the records of toxicology afford any clue to the use of silica as a remedial agent. Its general distribution in the tissues, rather than concentration in any particular organ or tissue (except nails and hair), might suggest a systemic or constitutional effect therapeutically (if any) rather than a local one. Its clinical use has confirmed this suggestion.
PATHOGENESIS AND THERAPEUTICS.
WHAT we know of the provers of silica as a drug is derived partly on the healthy, and partly by its effects in disease. It was used by Paracelsus in cases of urinary calculi and some nervous conditions, and it is not without interest to note that in herbivorous animals considerable quantities of silica salts are found in the urine, and are said sometimes to cause stone in the bladder in sheep.
However,it was not until Hahnemann re-introduced it tested its value and defined its sphere, that it became an effective remedial agent, and then only on the homoeopathic basis. Its use in silicated mineral waters can scarcely be deemed an exception to this statement, though its prescribers may have been unconscious of its homoeopathicity.
To avoid repetition the pathogenesy and the therapeutics of silica will be considered together-its disease-producing and healing powers being practically identical, and no effort will be made to distinguish between the two. Its most conspicuous use is in a particular kind of malnutrition or marasmus, especially in children kind of malnutrition or marasmus, especially in children. Its choice is determined not by our being able to label the patient`s condition as due to congenital syphilis, rickets, or tuberculosis (though it may be helpful in all these conditions), but by the clinical ensemble or picture. A child requiring silica emaciates,or fails to increase in weight as a growing child should, or it may even lose weight and strength. Development is delayed or arrested and the child is backward in walking and talking. The surface and tissues of the body are sensitive to touch it cries or shows signs of distress when lifted or handled. In striking contrast with the emaciated limbs and wrinkled skin there is distension of the abdomen-an association often found in tuberculous children. The distension is mainly gaseous, but enlargement of the mesenteric glands may be present. These may be felt under anaesthesia, or if the abdomen is caught in a state of flaccidity, and have been demonstrated when for any reason, the abdomen has had to be opened. The want of tone implied by this distension permits of constipation, and a peculiar kind of constipation it is which characterizes the typical silica case. The stool itself is formed of hard, dry light-coloured lumps, of which the patient has hardly power to complete the expulsion, and, in children especially, the effort is abandoned and the partly expelled faeces slip back within the sphincter. The abandonment may be due to pain (from fissure or fistula), or to fatigue. Inactivity of the rectum may prevent the evacuation progressing so far, and be represented by occasional spasmodic ineffectual effort, or only ineffectual desire for relief. Other remedies have hard, dry stools (ex. gr., bryonia, lead opium, &c.) as features in their pathogeneses, but the recession is almost peculiar to silica. On the other hand, in some cases diarrhoea of offensive stools, with changing appearance, may be present, and its sudden arrest may cause aggravation of other symptoms.
Unsuitable feeding, teething, or unusually hot weather may be the exciting causes of such diarrhoea, or it may be more persistent, and be due to the irritation of long retained dry faeces.
Perspiration is another feature of silica cases. The “silica patient” is said to “sweat at both ends.” He has profuse head sweats, especially at night, or any time during sleep; it is often associated with soreness of the scalp. The feet are cold and sweat freely, the perspiration being offensive. This may be present in either rickety or tuberculous subjects. They are weakly, with lax muscles, pallor and fine skin, and have sunken eyes and pinched, old-looking face.
The student should here observe that the picture thus drawn does not portray accurately any one of the three constitutional diseases mentioned earlier in the article. It is the outline of a state of malnutrition which has features common to them all, yet not diagnostic (clinically) of any of them; if is a sketch of the features indicating silica as a remedy for this state. The sphere of this drug is wider than any of them, for there may be instances even of rickets (to which disease silica most closely corresponds) for which that drug is not suitable. It might be called and inorganic vitamin A. The sketch must now be filled in.
Suppurative and ulcerative conditions of a slow and chronic kind are benefited by silica if the patients present the features already described (or some of them) and those to be presently mentioned. Slow suppuration of all kinds, sometimes occurring as fistulae or sinuses, the result of acute or deep-seated suppuration; occurring in a variety of sites, ex, gr., round the nails ( paronychia), or in the lachrymal sac, peri-=anal fistulae (especially those blind internally)-all these call for the consideration of silica as a possible remedy. So do the following: skin wounds that are slow in healing: ulcers with bluish red and hard but sensitive edges, and with dirty, pale, exuberant granulation (“proud flesh”), pustules and boils (and recurrences of them). If a piece of necrosed bone is the source of the suppuration (after injury or periostitis), it should be removed; but if that is not possible and the sequestrum is small, its separation may be facilitated by silica, and healing will then follow. Some cases of caries require this drug.
On all fours with these suppurations is chronic catarrh of various mucous surfaces, to which reference will be made in their various localities.
The discharge from all these sources is offensive, and (except at the onset) thin and irritating; the skin around itches and may be sensitive to touch; warm applications give marked relief. The absorption of old inflammatory deposits is markedly favoured by silica, in which power it rivals sulphur.
Nervous System.-The symptoms indicating silica in the nervo- mental sphere are notable. The patient is desponding, tired of life, and inclined to weep. His resistance is lowered-all impressions induce too marked a reaction; he is startled and anxious from sudden noises; an unexpected touch will elicit an exaggerated response (ex. gr., a “knee-jerk”) being unexpectedly addressed or stumbling against a stone causes tremor, a sudden flush of heat all over or even slight sweat, he is fearful that he will not be able to carry out his usual duties. If he is a lawyer, he is confident he cannot face the court; if he is a surgeon he fears he cannot perform the operation planned, or if he is a clergyman he feels quite unable to preach his sermon-in all the cases it is anticipation which is so greatly felt. When the event is actually entered upon, self-consciousness disappears, and the duty is performed properly, but it is at the price of exhaustion. A frequent repetition of this dread and effort means reduced vitality and a threatened breakdown. The patient becomes restless, irritable and fidgety; his mind is confused and he cannot fix his attention; thinking is an effort and memory is poor for recent events; he is over-fatigued by a small physical or mental effort; and is relieved by lying down, and “lying fallow,” and by wrapping up warmly. This may be described as neurasthenia, or psychasthenia, and it may be due to prolonged worry and mental strain; to over-study (as after working for an examination), or it may have a sexual origin. Or sexual symptoms may have a neurasthenic origin-coition may be followed by exhaustion, palpitation or fainting (chiefly in men), and further, depression be induced thereby. Kent in an apt sentence, illustrates the value of silica, when he writes, “What silica is to the stalk of grain in the field, it is to the human mind.” Many of the chronic effects of fright or shock are curable by it.
A condition called “spinal irritation,” with pains up the spinal column and along the nerves radiating from the cord, tenderness in one or more spots in the back, with pain from the nape up to the head, and the general lowered resistance, already described, has been treated successfully by silica.
Some of the mental symptoms suggest dementia praecox, and in such cases silica should be studied; also in failure obsessions or inferiority complexes. Melancholia may develop.
Generalities other than those named. The silica patient is often very sensitive to the influence of alcohol, he has a tendency to local muscular weaknesses, with a feeling as if partly paralysed, general surface tenderness; soreness of the whole side lain upon; tendency to twitchings or even epileptiform spasms; general aggravation after waking in the morning and difficulty in getting warm even during exercise.
Head.-Headaches suggesting silica are mostly from the nape of the neck up on to vertex and extending forward to one eye-it is the modalities as much as the site however constitute the indications; they are: aggravation from mental effort, noise, movement, especially jarring (compare baryta carb., and berberis), light, stooping and cold air. Amelioration results from the opposite conditions, especially local and general warmth. The scalp is sore with these headaches, and giddiness with tendency to fall forwards may be present. Frontal pains may be renewed by sudden turning, stooping and talking, and may be relieved by binding up the head tightly. An itching rash-eczema or other is noticeable on the scalp, with itching and soreness after scratching.
Eyes.-There is a sensation of roughness as of sand in the eyes and sticking pains, causing lachrymation. Vision is (temporarily) interfered with-dimness of sight, black spots before the eyes (worse after headache), letters run together when reading. Ulceration of the cornea and opacities have been cured (? recent cases) by this drug, and also blepharitis.
Ears.-Swelling of the external ear, otorrhoea ((thin and offensive), otalgia, especially when swallowing, with itching in the meatus, hardness of hearing, especially the human voice, or general hypersensitiveness to sounds- any of these may be present in silica cases.
Nose.-Similar symptoms, mutatis mutandis, plus epistaxis, are found here.
Face.-The pale, anxious suffering expression has been mentioned. Soreness in the corners of the mouth (as found under graphites, lycopod, rhus and antimony ) may be noticed- as also pimples or blisters, with burning pain. The face is not fat (like calcarea cases), and the head is likely to be big. The mouth (inside) is liable to sores or gumboils, and the teeth are sensitive to cold water in the mouth. The sensation of having a hair on the front of the tongue (contrast nat. mur. and kali bich). should attract attention as an indication for silica (provided always that no hair be present!)
Digestive System.-Besides sore throat, as if raw, worse on the left side, with pain on swallowing, and tenderness to touch, the velum palati (soft palate) seems to be paralysed, and food returns through the nose. The drug thus may be thought of in post diphtherial paralysis, and ( with less prospect of benefit) in bulbar paralysis.
Ravenous hunger (see cina and ferrum), and excessive thirst; also bitter taste and acid risings and burning in the throat after eating, desires food to be cold; also nausea, these are silica indications, though not striking ones. Pain and weight in the epigastrium and hard distension of the abdomen may be found in some of the tuberculous conditions mentioned, or in functional dyspepsia; pain in the region of the liver and rumbling, with offensive flatus, may be found under silica. Reference to the constipation and diarrhoea of silica patients has already been made; they may suffer from piles cutting and stinging in rectum and with burning during stool. Fissures and excoriations around the anus may cause pain and oozing of moisture; silica will help even old cases (see graphites), acid nit, and aloes recent ones.
The urinary system supplies no indications of importance, but sometimes urging to micturate at night is present, and it has been used for nocturnal incontinence in children (rickets).
Sexual Organs.-Increased sex consciousness, increased desire and persistently recurring thought, are found under silica in both sexes. In men this irritation is associated with nocturnal emissions and loss of prostatic fluid during defecation. Sweat and itching of the scrotum are found.
In women, similarly, pruritus of vulva, acrid leucorrhoea, and bearing down in the vagina occur. Menstruation is not characteristic, but spells of icy coldness during the catamenia should bring silica to mind. The breasts may be hard, and the drug has proved of great value in chronic mastitis and in small innocent lacteal duct cysts. Soreness of nipple (especially the left), like other orificial soreness, may call for silica.
Respiratory and Circulatory Systems.-Mild irritation of the former tract is found, hoarseness, of chest, cough worse in the evening and when lying down at night, and after waking (lachesis), shortness of breath and pressive pain under the sternum and expectoration of thick, foetid, lumpy phlegm or tenacious offensive mucus. These symptoms have led to the use of silica in chronic bronchitis, asthma, bronchiectasis and fibroid phthisis, with favourable if not curative, results. Palpitation and quick pulse are common in these cases, and throbbing may be felt in the whole body.
Neck and Back.-In the neck, glandular enlargements after such illnesses as diphtheria, scarlet fever and measles, or due to tuberculosis are not uncommon. They may cause a feeling of stiffness, chokiness and heat of the head with aggravation in a warm room and from warm applications. This is a noteworthy exception to the usual amelioration from heat in silica, like other exceptions it “tests the rule,” but is not a contra indication against the remedy. The thickening of such glands may be materially reduced by it (compare sulphur).
From neck down to coccyx pains of various kinds, shooting burning, and bruised as from long lying on a part, are found under silica. They have a feature found more strongly in rhus cases, namely, stiffness and aggravation of pain on rising from a seat or getting up in the morning, with relief after moving about. Silica is more adapted for chronic cases where damp is not so prominent an indication as with rhus (cf. also rhodo. and ruta).
Skin.-The cutaneous affections in various parts have been sufficiently dwelt upon. The itching of silica cases is worse at night; skin lesions are sensitive to touch and to cold, and are comforted by warm applications.
Nails on fingers and toes are crippled and the hair falls out.
Sleepiness.-Great drowsiness in the day after eating is a silica symptom (resembling lycopodium) or drowsiness with yawning. The patient starts and talks in his sleep. He dreams of past events, of his youth of dead people or of corpses; or so sexual subjects.
Temperature.-Chilliness followed by heat may come on in the afternoon, with considerable rise of temperature, and as a part of mild chest or abdominal affections, rickety conditions, or with headaches, thirst at night, and flushes of heat in the face and head, may be features found in a patient requiring silica. Profuse perspirations at night, sometimes offensive, are notable, without accompanying fever. The head, feet and axillae are the most usual sites. The foot sweat is particularly offensive, and many ailments have been attributed to its suppression by local applications. . . . . These are the striking features of a most valuable remedy unknown to orthodox medicine. A study of the Hahnemannian schema will suggest many uses for it.
(1) Malnutrition, with features resembling rickets, tuberculosis or inherited syphilis.
(2) Perspirations of head, feet and axillae, all offensive especially that of the feet. Ailments from suppression of sweat; sweat on slight exertion.
(3) General and local sensitiveness to cold, especially damp cold, relieved by local and general warmth.
(4) Sensitiveness of general surface to touch; also of areas round ulcers, suppurations, &c.
(5) Despondency, tiredness of life, fearing unable to accomplish ordinary duties, exhaustion after carrying them out, neurasthenia.
(6) Chronic and slow inflammatory and suppurative lesions, ulcerations, &c, with hard edges, offensive discharges; fissures, fistulae.
(7) Glandular enlargements, abdomen, neck, &c.
(8) Constipation, hard, dry faeces, deficient expulsive power and recession of partly expelled stool (especially children).
(9) Hypersensitiveness of special senses-hearing, sight; easily startled, with excessive reactions.
(10) Mastitis and innocent cysts.
(11) It promotes the expulsion of foreign bodies from the tissues, such as needles, splinters of bone, &c.
From cold, especially damp cold-a general modality-including uncovering part, ex. gr., head; motion (especially jarring), lying on painful side, but weariness necessitates lying down, loss of body fluids (china):
From general warmth, ex. gr., warm room; local warmth, applications to or wrapping up parts, ex. gr., head, suppuration developing in a painful area.