Therapeutic Application

Besides the uses of the nitrate as an ternal remedy, which will be noticed elsewhere, it is employed for two distinct purposes; the one, for its direct influence on the alimentary mucous membrane, the other, for its effects upon the system at large through the circulation.

1. For its influence on the stomach and bowels, it might be employed, in minute doses, as a tonic, in debilitated states of their functions; but other remedies answer the indications so much more conveniently and effectively, that it is very seldom used for this special purpose. Still, as it has been supposed to exercise a peculiar influence over the nervous tissue, it has been recommended in certain painful affections sometimes dependent on dyspepsia, as gastrodynia and pyrosis; and it has been found useful in morbid sensitiveness of the stomach. But it is vastly more beneficial, given rather freely, through its alterative action upon the mucous membrane in a state of chronic inflammation or ulceration; and has been strenuously recommended even in active irritation or acute inflammation of the same tissue.

In chronic gastrilis of the worst kind, I know of no remedy so effectual as nitrate of silver. Recommended originally, so far as I am aware, by Dr. Hudson, of Dublin, in this affection, it has been employed by me habitually since the first published notice, and with the happiest effects in most obstinate cases. I have not been in the habit of using it in mild cases, which yield readily to a regulated diet, with other suitable hygienic measures, and with little aid from medicine; but, in those severe and obstinate forms of the affection, which have set all ordinary means at defiance. I have found it a most valuable resource. The cases in which it has appeared to me to do most good are those attended with incessant vomiting of food, and often with a smooth dryish tongue, apparently destitute of the papillary structure. I have used it, too, whenever I suspected the existence of ulcers in the stomach. One case of yeasty vomiting, of a most obstinate character, and probably dependent on an ulcer near the pylorus, yielded in the course of two or three months to this remedy. One most striking instance, in which I have little doubt that it was the means of saving life, was that of a female patient in the Pennsylvania Hospital, who had been reduced to the last degree of emaciation and debility, and whose death I was looking for from hour to hour. The stomach had long refused to retain food, and the slightest nutriment induced vomiting. I directed that nothing whatever should be taken into the stomach, except a little cold water, and pills of nitrate of silver with opium, repeated three or four times a day; life being sustained by the injection of rich soups with laudanum into the bowels. The vomiting ceased under this treatment; in a few days a disposition for food returned, which was very cautiously indulged; and the patient went on gradually improving, until her health was perfectly re-established after many months of illness. I believe the remedy acts, in these cases, very much as it does upon the visible mucous surfaces when inflamed. Combining with the outer layer of the epithelium, or of the ulcerated surface, it forms a thin coating, which protects the diseased tissue beneath from irritating matters in the stomach, whether derived from its own secretion or from without, and at the same time, by its astringent and tonic properties, imparts a healthy contraction and tone to the expanded vessels. To produce this effect, it must be in the state of the nitrate. The oxide or the chloride will not at all answer as a substitute. Hence the importance of giving the medicine upon an empty stomach, when it will be less likely to encounter decomposing substances, and will thus be enabled to exert its full influence on the diseased membrane. In these cases, I have never administered large doses of the salt Beginning with one-quarter or one-third of a grain, combined with from an eighth to half of a grain of opium, repeated three or four times a day, I have very gradually increased, if the symptoms otherwise refused to yield, up to one grain at each dose; but have never exceeded that quantity.

In chronic enteritis, also, great benefit is said to have accrued from the nitrate of silver; though, in the trials I have made with it, the results have been much less favourable than in the gastric cases. It probably seldom enters the small intestines, or at least penetrates far into them, without being decomposed, and thus rendered unable to act on the surface of the bowel in the method above referred to. In ulcerative affections and chronic inflammation of the small intestines, it has appeared to me less effective than sulphate of copper. Nevertheless, much testimony might be adduced in its favour, not only in chronic, but even in acute inflammation of the alimentary mucous membrane.

Trousseau strongly commends its use in acute dysentery, giving half a grain of the nitrate of silver, and the same quantity of nitre, made into a pill with starch, repeated every half hour till it begins to purge; at the same time administering, twice a day, an enema composed of a pint of distilled water holding from three to ten grains of the salt of silver in solution. (Trousseau et Pidoux, Traite de Therap., 4e ed., i. 354.) The latter part of the treatment, that, namely, by injection into the rectum, has been imitated with great asserted success in some severe cases of the disease; though the measure has failed in many others. Of the use of nitrate of silver by the mouth, in this complaint, I have had no experience.