Charles D. F. (Charles Douglas Fergusson) Phillips.

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served for chronic patches with much infiltration. Nitrous ether proves
the best vehicle, because it dissolves sebaceous or fat.ty secretions, and
allows the remedy to act better on the distended capillaries 30 to 40 gr.
in the ounce may be used. Eczema in the neighborhood of ulceration
yields to lotions of moderate strength. For eczematous or aphthous con-
ditions affecting the genital organs, or the nipple, and commonly accom-
panied with severe itching and irritation, a solution containing 4 or 5 gr.
in the ounce should be first used in cases that are somewhat acute; but,
if relief be not given, a paint containing 30 to 40 gn in the ounce should
be carefully and lightly brushed over the part. Quite the best treatment
for fissured nipples is to touch them thoroughly but lightly with a fine
point of nitrate: all secretion should be cleansed from the part before
such applications, and warm fomentations should be ready for use after-
ward, as the pain may be severe. In abrasions or aphthous conditions
about the mouth, the solid nitrate is one of the best remedies, although
a painful one.

Hums and Scalds. In superficial burns the strong solution has been
applied, and to deeper injuries, when the true skin is affected, the solid
stick has been used with the object both of forming a covering from air,
and of lessening the degree of cicatrization (Fricke). This method has
not met with general support, but a modified plan was recommended by
Mr. Skey, who used a lotion containing about 6 gr. in 1 oz. for infants,
and twice that strength for adults, covering the part immediately after-
ward with cotton wool (Lancet, ii., 1861). A mixture with linseed oil
has been commended (Wernher), and the solid stick is always useful in
later stages when ulcerations are slow to heal. Hebra applies it once or
twice daily, especially where there is liability to adhesions.

3. Counter-irritant. The action of the remedy when applied locally
in superficial inflammations, has earned for it the title of " caustique
antiphlogistique," but we cannot recognize in it any distinctly caustic
action, any more than we can verify the production of a " substitutive in-
flammation," which replaces for a time the original malady, and then it-
self subsides (v. p. 11). The main factor in the result is an astringent
effect on the vessels and nutritive processes, but there are cases in which,
when the nitrate is applied to some other than the affected part, it will
relieve by an action which may properly be called counter-irritant or de-
rivative, the "medication irritante transpositive " of Trousseau. Thus,
Liston and Elliotson treated erysipelas by its application to the neigh-
boring sound skin, and Lubanski, Egan, and others treated amenorrhcea
by pencilling the os uteri (Dublin Journal, 1848).

Orchitis Synovitis. In these deeper-seated inflammations benefit



SILVER. 17

may be obtained from strong nitrate of silver applied on this principle of
counter-irritation. The best position for the application has been much
discussed, some placing it as near the part as possible, others insisting
that it shall be between the heart and the inflamed tissue, and others that
it shall affect vessels which receive their supply from a different source
than the affected part. The simple rule adopted by Mr. F. Jordan, with
much success, is to apply the nitrate over the adjacent vascular territory ;
thus, in orchitis he acts upon the great vessels in the groin and front of
the thigh (Practitioner, vol. ii.). In synovitis it is used round the affected
joint, though iodine is usually preferred in this disorder.

In irritation of the prostate gland or seminal ducts, it may be applied
to the perineum, rather than to the urethral membrane itself.

4. As a Direct-irritant (the " medication excitative " of Trousseau),
the nitrate finds some applications.

Hydrocele. The solid stick may be applied, for instance, to the inte-
rior of a hydrocel'e-sac after evacuating the contents, but an injection
through a trocar is more under control: the object is to excite sufficient
inflammation to induce adhesion (this is now better effected by iodine).

Tumors. Small cystic or fatty tumors may be cured by inducing
moderate suppuration, and one of the best means for this purpose is
the injection into their substance of a few drops of solution containing
1 part of silver nitrate in 6 or 8 of water; this mode of treatment was
specially introduced by Luton, who termed it " parenchymatous substi-
tution."

Neuralgia Sciatica. Luton applied the deep injection of this salt
also to the treatment of these maladies.

In sciatica of chronic and obstinate character, 10 to 20 drops of the so-
lution injected deeply near the seat of pain will lead to a localized sup-
puration which sometimes quite cures the original malady: it is best used
in the nates at the point of emergence of the sciatic nerve.

In other chronic obstinate neuralgia, and, according to Le Dentu, in
any deep-seated neuralgic pain of any part, similar treatment has proved
of service: of a solution containing 1 part of nitrate in 5 of water he in
jects deep into the cellular tissue 2 or 3 drops: this causes acute pain for
the moment, and sometimes a small abscess afterward, but never serious
trouble (Medical Record, 1877). Bureau, in a recent thesis (Paris, 1877),
sums up very favorably the experience recorded up to the present time
of this method of treatment; it is said to be both certain and rapid in its,
effects, and not to cause much irritation of the deep tissues. Luton him-
self used a 10 per cent., also a 5 per cent, solution, and others one of 25
per cent., injecting 5 min. all with successful results.

In Chronic Joint- Disease, Synovitis, etc., equally good results have
been recorded from the method of Luton i.e., deep injections into the
joint-cavity (Medical Record, November, December, 1877). The process
VOL. II. 2



18 MATERIA MEDIC A AND THERAPEUTICS.

may be compared with that of Thiersch for cancer, in which weak solu-
tions only are used, and suppuration is not intended (v. p. 9).

THERAPEUTICAL ACTION (INTERNAL). The value of silver compounds
is acknowledged in certain disorders of the gastro-intestinal mucous mem-
brane, and of the central nervous system. In the former their action is
a local one, doubtless of the same character as that exerted upon the ex-
ternal surface; in the latter they are given for a " constitutional" effect
of tonic or indirectly sedative character, which may perhaps be resolved
into a regulating or astringent effect upon the capillaries (Hudson, Lane).
In support of this view has been quoted the power also possessed by these
salts of moderating uterine and other discharges, but this is perhaps only
contingent on the improved state of the stomach-functions; in the present
state of our knowledge, however, the record of clinical facts is of more
importance to us than the theories formed to explain them.

Dyspepsia Chronic Gastritis Chronic Gastric Catarrh. The ni-
trate and the oxide are both valuable in many of these cases, and in judging
of their suitability in a given instance, it is not easy, nor is it essential, to
draw a definite line between functional and organic disorder. Gastric pain,
especially when severe, and coming on some time after food, with ten-
derness, distension, pyrosis, and vomiting, are sufficient indications. Dr. J.
Johnson, one of the earliest observers of this use of the nitrate, found that
mental depression, or motor disturbance of convulsive character, furnished
additional indications for it (" On Indigestion," 1826). Dr. Symonds
recommended it "in nervous irritability with passive or chronic conges-
tion of the stomach." In Dr. Hudson's cases, pain of very acute charac-
ter and long duration, with distension, thirst, constipation, and vomiting
of sour fluid, were relieved within one or two weeks, but he gave the
remedy (^-gr. doses) with opium (^ gr.), and hop (Dublin Journal, May,
1840). Dr. Osborne, a distinguished Dublin physician, found it valuable
in gastralgia with "sour vomiting" (1831), and more recently we find
Dr. Spender praising it as the "best remedy in pyrosis" (Practitioner,
October, 1868), and Dr. H. Wood, "in vomiting of much yeasty fluid."
I should attribute importance to its disinfecting properties in such cases.
Dr. Wilson Fox also adds his testimony to the " well-established reputa-
tion of the silver salts in chronic gastric catarrh," and places them next
to bismuth: he would generally prescribe them, however, with opium,
while Frerichs, also a high authority, gave them with belladonna. The
absence or the presence of constipation will be a useful guide to the choice
of these adjuvants. In gastritis, Dr. A. Fleming obtained very good re-
sults from the nitrate, and his mode of using it would seem to obviate, if
that be necessary, the objection urged by Brinton,and to some extent by
Husemann, viz., that the smallness of the dose, and the dilution and chemi-
cal change of the drug, must make it almost inert. Dr. Fleming was ac-
customed to order oz. only of distilled water containing from 1 to 4 gr.



SILVER. 19

of the salt, to be taken fasting 1 , and in the recumbent position, the pa-
tient then to turn himself from side to side, so as to insure contact of the
remedy with different parts of the stomach-wall. In some cases he even
injected the dose directly into the viscus, with a syring-e and perforated
tube (Medical Times, i., 1859). Dr. Hartshorn valued the nitrate in
chronic gastritis; he gave it in pill (American Journal, July, 1849). My
own use of the remedy has been generally in doses of -$ to gr. every
four or six hours in distilled water, and I have certainly observed from it
much relief of discomfort and pain, flatulence, heartburn, and pyrosis,
yet there is some uncertainty in its action (v\ p. 24). Women suffering
from the above symptoms, together with severe retching and vomiting of
tenacious fluid, and a too frequent and profuse menstruation, are almost
always relieved by it, but the maladies in question assume so many phases,
and are more or less amenable to so many forms of treatment, that we
cannot be surprised at difference of opinion as to the true value of this
one.

It has naturally been thought that risk of caustic and irritant effects
might be obviated, and equally good curative effects obtained by the use
of the oxide of silver instead of the nitrate, and this was brought promi-
nently before the profession by Mr. Lane ( Medico- Chirurgical Review,
July, 184041), and afterward, in a special treatise, by Sir James Eyre.
The former records a number of cases with severe but intermittent gas-
trodynia, general uneasiness, nausea, and watery eructation, almost all
relieved quickly by ^ or -gr. doses of the oxide: nothing is said about
diet or other adjuvant treatment. Mr. Lane states further, that if or-
ganic mischief have resulted if the tongue be tumid and cracked, and
the pain constant, or the ejected fluid " glairy" (as in Todd's "follicular
gastric dyspepsia"), then the remedy is of no service; but it is not neces-
sary to adopt these limitations if other indications for the remedy exist.

Uterine Disorders. Dr. Hudson and others remarked the great im-
provement in certain uterine symptoms during the exhibition of silver,
and recorded cure of many cases of menorrhagia, of uterine leucorrhosa,
and of painful menstruation, though not with the scientific precision now
expected. Many cases occurred at the menopause, some during preg-
nancy, and in several a previous long sterility was followed by fecunda-
tion: simple vaginal leucorrhcea was not benefited.

Guided partly by this marked sympathy between the gastric and the
uterine conditions, I have prescribed the oxide for nervous highly-sensi-
tive women suffering from gastrodynia and pyrosis, with coincident uter-
ine flux, and have often seen marked and immediate improvement in
both symptoms, and without any drawback. The use of the medicine
need not, however, be restricted to such cases; its action is somewhat
similar to that of bismuth, and it may be used if that should fail to re-
lieve. It has the advantage of being effective in a much smaller dose:



20 MATKRIA MKDICA AND TIIETiAPEUTICS.

-Jj to j gr. is usually quite sufficient, and in the form of a minute pill
this is readily taken. I have not seen the irritation from it which has
sometimes been described, nor the salivation which might be produced
by its too prolonged use, nor any symptoms of argyria. It should not,
however, be continued for many weeks consecutively. It is useful for
cases in which arsenic also relieves, and an interesting fact is that this
remedy and bismuth have often an equally good influence over uterine
loss when connected or coincident with gastric disorder.

In the cardialgia and vomiting of pregnancy I have found it useful
when many other remedies fail to give the slightest relief.

Gastric Ulcer. In so serious an organic disease, which must, of ne-
cessity, often end fatally, it is not surprising if the powers of the silver
compounds have been called in question. Cases of marked relief, if not
cure, by these remedies have, however, been recorded (Stille), and it
seems reasonable to allow that if they can relieve ordinary gastritis, they
may relieve the same condition when dependent on a local lesion; they
lessen local congestion and local nerve-irritation, and in some cases, at
least, they form a protective layer of albuminate, and probably thus re-
lieve the pain of gastric ulcer.

Jaundice. Dr. Peebles (U.S.) has recorded several cases of jaundice
in which rapid improvement followed the use of nitrate of silver given in
f-gr. doses twice daily for two to ten days: he attributes its good effects
to its modifying the state of the mucous membrane, and relieving a chronic
gastro-enteritis, and lessening the obstruction of gall-ducts by diminish-
ing glairy mucus (American Quarterly Journal, July, 1849).

In catarrhal jaundice, with pain and functional stomach-disorder,
Dr. Bartholow reports good results from similar treatment, which he
compares to that by mercury or arsenic.

Chronic Diarrhoea Dysentery. I have obtained great benefit from
nitrate and oxide of silver in many forms of these disorders in serous
diarrhoea, in chronic and periodic forms, in diarrhoea after fever, and in
that of dysenteric character.

Graves preferred the nitrate (which he gave in grain doses) to any
other astringent or to opium, but (as remarked by Stille) he avoided it
in cases of ulceration, when really its advantages may best be proved.
Dr. J. MacGregor reports several cases of exhausting diarrhoea during
advanced phthisis, in which the relief was marked and immediate; he
gave the remedy also in 1-gr. doses with gr. of opium, and in enema
(British and Foreign Review, September, 1841). I have myself often
found it of the greatest advantage in such cases, restraining the profuse
discharge, and aiding to strengthen the patient; I have given from ^ to
1 gr. In the form of enema, containing 3 to 4 gr. in 2 oz. of distilled
water, it is a valuable remedy for chronic dysentery and ulcerative con-
ditions of the rectum; the enema may be repeated every six to twelve



SILVER. 21

hours for three or four times, if necessary. If ulceration or congestion
be situated higher up in the intestine, the nitrate is best given by the
mouth in pill, since it is thus most likely to reach the affected part un-
altered, and to exert the local action which is desired. The chloride of
silver has also been used with advantage in chronic dysentery.

Diarrhoea of Children. The nitrate has been recommended by Trous-
seau, Mauthner, etc. I do not think it advisable for acute cases, for it
is uncertain in action, but, in prolonged and obstinate cases, a few doses
often act well; they may be given by the mouth or rectum.

Typhoid Fever. Dr. Pepper has recorded fifty cases of typhoid fever
in which, after the second week, the medicinal treatment was nitrate of
silver (^ gr.), with small quantities of belladonna and opium; only one
case was fatal, and he considers that these remedies act favorably by
limiting follicular catarrh and modifying its secondary effects (Boston
Journal, October, 1877).

Diseases of the Nervous System. It is curious that silver was early
appropriated to the treatment of cerebral disorders by the theories of
astrology, which associated both the metal and the malady with the influ-
ence of the moon: by the time of Linnseus its medicinal virtues were so
far distrusted that he describes only its " power as political, its use, com-
mercial." It retained, however, some reputation in epilepsy, and of late
years there has been further evidence of a neuro-tonic power exerted by
it rather upon the spinal than the cerebral nervous system, as illustrated
in some forms of paralysis.

Epilepsy. Unless we are wholly to reject past records and the opin-
ion of distinguished physicians, the nitrate has given good results in a
large number of epileptic cases. Heiin considered it the best of reme-
dies, and Trousseau, who used also the chloride, places the silver salts
second only to belladonna (" Traite," Ed., 1868). We need not, how-
ever, quote many authorities to the same effect: we recognize that it has
relieved, sometimes even seemed to cure, cases of this disease, and may,
therefore, under certain conditions, relieve others. We should not, with
Krahmer, consider it most suited for the robust, with symptoms of head
congestion, but rather for the delicate with morbidly irritable and suscep-
tible nerve-system, and a languid state of the organic functions (Stille);
it is in the pallid and anaemic that strychnia acts well sometimes (Tyrrell),
and it is in similar cases that I should be hopeful of good results from
silver. Curci considers that it does good in epilepsy connected with
spinal disease, but when dependent on local lesion as hemorrhage, soft-
ening, or tumor the malady is not influenced by it. More definite indi-
cations we cannot at present lay down, and must acknowledge that, of
any given number of cases, the majority at least will not yield to this
remedy, and others, if they receive temporary benefit in the prolonging of
the interval or lessened severity of the attacks, will ultimately relapse.



22 MATERIA MEDICA AND THERAPEUTICS.

The greatest objection to nitrate of silver, and one which has led to its
comparative disuse, is the possibility of its discoloring the patient, and
this even without curing his malady 1 have seen epileptics discolored
by the medicine, and yet suffering as severely as ever from their convul-
sions. Unfortunately the nature of the disease requires a long continu-
ance of treatment, and therefore a medicine must be preferred which
shall, at least, not inflict so visible an injury, and we need seldom pre-
scribe the silver salt until a fair trial has been made of bromides, of bel-
ladonna, etc. If, however, it be decided upon, then a purgative should
be given at the commencement of, and occasionally during treatment;
the remedy should be omitted for a few days at intervals, and the gums
should be carefully watched for signs of systemic saturation. The use
of nitrate for epilepsy in children has been objected to by Loobenstein,
but I have seen it of service in chronic cases. Brenner recommends the
chloride in infantile convulsions, and also in the brain-affections of
typhus. Niemann found advantage from the ammonio-chloride in epi-
lepsy and melancholia.

Paralysis Ataxia. We cannot speak with any confidence of the
power of silver compounds to relieve serious or chronic cases of this kind,
though there are not wanting records of improvement, more or less marked,
obtained under their use. Wunderlich reported seven cases of ataxy
arrested in progress under 5-gr. doses, two or three times daily; while
Charcot and Vulpian related five cases that had lasted respectively two,
four, five, and two of them fifteen years. A pill containing ^ to f gr.
of nitrate was given daily for from thirty-five to sixty days, and in every
case, in the course of a week, improvement commenced as to sensibility,
power of placing the limbs, as to sight, and especially as to lessening of
pain (" Memoire sur le Nitrate," Bulletin de Therapeutique, 1862). The
report of such cases caused much sensation, but Topinard, who criticises
them closely, asserts that in some the diagnosis was imperfect, and that
admitting it in the others to be correct, there were unsuccessful cases to
be compared with them, and many others unrecorded (" De 1'Ataxie Loco-
motrice," Paris, 1864). He has collected altogether twenty-eight cases,
more or less favorable to the efficacy of the nitrate, and nine unfavorable;
to these, he has added seventeen cases carefully noted under his own
observation: commencing with -fa gr. daily, he continued it for ninety
days, interrupting the course every eight days for a week; then gr.
was given for four months. In the first case reported, no good result
was obtained, though erections recurred; at the end of the treatment
the patient was worse, and the same has to be said of eleven other cases:
in the remaining five there was some amelioration of symptoms. Alt-
haus, on the other hand, has had, on the whole, a favorable experience
with this remedy, and I believe that I have seen benefit from it in re-
lieving the " lightning pains," and in arresting, for some time at least,



SILVER. 23

disorder that was progressing, but it is no specific against locomotor
ataxy.

Diphtheritic and Mercurial Palsy. A case of the former kind, cured
under the use of nitrate, is recorded (American Journal Medical /Sci-
ence, April, 1865, p. 485), but I am not aware of others. Fairly rapid
recovery in six instances of mercurial palsy is reported by Sernentini
with doses of from to 3 gr. daily (quoted by Dr. Waring).

Nerve- Debility Headache. In some few cases of nerve-debility and
depression connected with overwork, anxiety, or excess, and exhibiting
hypochondriacal symptoms morbid fear, impaired mental capacity, and
frequent rather deep-seated fixed headache I have seen improvement
under the use of nitrate, and have felt justified in connecting it with this
drug, because iron, and bromides, and other remedies had been used
without advantage, and the patient's mode of life and circumstances were
not altered when the silver was commenced.

In hysterical or nervous headache it was valued by Dr. Graves, and
others have found it useful in neuralgia, for which Paterson recommends
especially the iodide. If the headache be accompanied with constipation
or gastric disorder, an occasional laxative is required.

Various Diseases. Other disorders, which may either be called " ner-
vous " in character, or are connected at least with reflex nerve-disorder,
and which the salts of silver have been found sometimes to relieve, are
such as chorea, angina pectoris (Copland, Diet.), spasmodic asthma
(Waring, Ourci), palpitation (Kopp), vertigo (Rademacher), pertussis
(Berger): for this last iodide is especially recommended. They have been
given also in more general diseases, as intermittents (Sokolow), diabetes,
and phthisis (Brady, Moore), the object desired in these latter cases be-
ing mainly to lessen the excessive discharges from the kidneys, the skin,
and the bowels; in some instances they have certainly succeeded, though
we could not expect them to alter the ultimate termination of such mala-
dies. In dropsy the nitrate was given by Boerhaave as a purgative in 2-
gr. doses, and has been more lately commended by Dreyer (Husemann).
In syphilis the chloride and oxide were given by Serres and others, but
their value has been disproved by Ricord. The ammonio-chloride has
been used as a cathartic and a vermifuge.

PREPARATIONS AND DOSE. Argenti nitras : dose, % to ^ gr. (B.P.);
it may vary from -fa to \ gr., and more has been sometimes prescribed.
Argenti oxidum : dose, ^ to 2 gr. in the form of pill.

The dose of the chloride is about the same as that of the oxide,
though upward of 30 gr. have been given without gastric pain (Trous-
seau): the dose of iodide and other salts is also about the same as the
oxide.

As a caustic the solid nitrate may be used alone, or " mitigated "
e.g., with nitrate of potash (Crayons de Barral, de Desmarres), or with



24 MATERIA MEDIC A AND THERAPEUTICS.

sulphate also (Guyot). In default of a metal, or caoutchouc, or quill
holder, melted sealing-wax forms a convenient coating, and a file, or fric-
tion with wet lint, sharpens the point better than a knife : for small fis-



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 3 of 40)