(Ag NO3). Nitrate of silver. Triturations and solutions in distilled water to 3c and alcohol afterwards.
SOME of the phenomena recorded here have been obtained from salts other than the nitrate and are probably due to the silver ion. This account should be read in conjunction with argent. met.
LABORATORY EXPERIMENTS are chiefly the result of experiments with the oxide and albuminate, sometimes injected intravenously or subcutaneously. When so introduced into the body the medullary centres are first stimulated; the blood pressure is increased the pulse slowed and the breathing quickened and deepened. Later the blood-pressure falls and respiration becomes low and laboured through stimulation of the vagus. The heart continues to beat after the breathing has ceased.
In less acute poisoning there is time for bronchial catarrh to develop, leading to oedema of the lungs – but not of cardiac origin. The kidneys are irritated, and the quantity of urine is increased and albumin is present.
Congestion ecchymosis, and even ulceration, occur in the stomach and intestines, although the drug has not been taken by the mouth being carried to those parts by the blood-vessels.
In chronic poisoning silver is deposited in the skin the mucous and serous membranes, the renal glomeruli, the connective tissue of the liver, spleen, choroid plexuses, tunica intima of aorta and the mesenteric glands in the form of minute granules. Discoloration is caused, varying from light brown to dark grey and it is permanent. This is known as argyria, which may occur in workers in silver and from prolonged local or internal use (as formerly for epilepsy). It is not now very common. In the skin the pigment is deposited in the corium, (not in the epidermis); it is not excreted by the kidneys but is eliminated through the mucous membrane of the alimentary canal. The gums swell and a dark red or violent line along the edges develops. Besides the cardiac and respiratory effects nervous system symptoms are quickly produced when large quantities are in circulation. Convulsions may come on in a few hours, ending in death with imperceptible pulse, pinched face and cold clammy skin. The convulsions may be excited by the slightest peripheral irritation and may persist after voluntary movement is abolished.
Loss of consciousness in spells, peripheral anaesthesia, twitchings of face and arms, jaws clenched, eyes turned up with dilated and irresponsive pupils may be present. At this stage, even during intervals of consciousness, the patient may be unable to answer questions through inability to articulate.
Faintness, depression of spirits, a stuporous condition and dyspnoea, with cramps here and there, or even paresis form a less severe syndrome due to silver poisoning.
Yet another class of cases from prolonged use of the nitrate may be noticed, in which the nerve symptoms are absent or nearly so. They appear to have an anaemic condition as their basis. There are basis. There are shortness of breath, palpitation, great weakness (frequent in “provers,”q.v.) with oedema of lower extremities and some ascites. In these cases destruction of the red corpuscles occurs (haemolysis) leading to ecchymosis and effusions; chlorosis, catarrhs of mucous membranes, granular degeneration of renal and hepatic cells and of the muscular fibres of the heart, are other effects of the drug. The legs emaciate, though on account of the oedema there may be hardness and tension of the skin, which cannot be raised into folds. Flexion of the legs may occur.
Mental symptoms ensue in chronic cases; confusion of thought, depression amounting to melancholia, slowness of mental activity, loss of memory, vertigo, headache, noises in the ears and defective sight.
Nitrate of silver has been well proved both in substantial doses and in dilution. The records are striking, for the nerve symptoms noted in poisonings are conspicuous by their absence, with the exception, perhaps, of well-marked weakness, induced early and lasting long. It is shown by fatigue on slight exertion, tiredness in the lower limbs (and calves), as after a long walk or an illness.
The stress of the action of argent nit. in provings falls nose, urethra and intestines, and on skin and fibrous tissues.
Eyes.- Redness of the conjunctivae (lids and globe), smarting heat, soreness (especially of the corners), catarrh- causing the lids to stick together during sleep – slight dread of light, mucus obscuring sight. Moving and touching the eye aggravate the pains, which may be felt more in the morning on described as burning dryness, sticking, itching or boring Both eyes are affected but perhaps the right one most severely especially the inner corner, This is an exception to the left- sided general action of the drug. “The inflammation of the eye is better in the cool spots and sinous shapes float before the eyes.
Throat and mouth are certainly specifically influenced for the symptoms are induced by infinitesimal doses as well as small crude doses. The throat is dark red- fauces, velum palati, and uvula; or whitish patches appear (like a smear of caustic); soreness burning, rawness feeling of a splinter, or a hair felt on swallowing, breathing or moving the head (as with hep., ac. nit., sil.); tenacious mucus causes hawking. The mouth is irritated; the tongue is dry and sore and the papillae prominent and painful; or a red streak is noticeable down the centre. The gums may swell, salivation occurs, offensive breath is sometimes noticed. Toothache if present is made worse by cold water or food, sour things and mastication.
The nose is also irritated shown by coryza, sneezing itching, headache over eyes. The left nasal bone in one prover felt as if bruised and on the septum a pimple developed which bled easily.
Urinary Symptoms.- The urine is usually profuse pale and frequent, though sometimes as a reaction it becomes scanty and dark. Micturition is difficult, painful (burning) during and after the act; straining may be necessary or urination may be involuntary. The urethra itself is painful especially near the scrotum and at the orifice. The urethral symptoms are very frequently described by provers and seem to be due to definite urethritis for a mucous discharge has occurred. A sore painful spot about an inch inside the rectum on the anterior wall has been interpreted (probably correctly) as due to an extension of irritation to the prostate.
Sexual Organs.- Priapism may occur and sore spots. on the foreskin. In men and women dyspareunia may be present- in the former due to urethritis. In women menstruation may be prematurely induced, though scanty. It is liable to be accompanied by pain in the loins and sacrum. The latter is constant and characteristic symptoms in both sexes, and is sometimes relieved by walking or standing, but it is not necessarily connected with the genital sphere.
Digestive Sphere.-Greenish foetid, mucous stools are frequently recorded, induced by drinking. They occur most commonly at night, with colic and flatus,or with a little blood and masses of mucus, usually, however, painless.
Some abdominal distention is present; the prover cannot bear tight clothing round the waist; nausea and morning vomiting of stringy mucus, nausea removed by a good meal; and violent eructations-these, especially if accompanied by a headache as if the head were enlarged but relieved by a tight bandage, are conspicuous digestive symptoms. A craving for sugar is sometimes present. Occasionally acute symptoms are indeed-sharp pain in the gastric area (especially to the left) with much tenderness, worse on breathing and from pressure.
Respiratory Sphere.-Burning and heaviness in the chest; stitches in one side or the other; soreness in the larynx; warty growths on the vocal cords, cough caused by talking loudly or much; suffocative cough, worse noon or evening-these constitute the chief evidences of argent. nit. pathogenesy in this sphere, when due to the local irritations of the drug. The grave symptoms from central damage have been mentioned. No pneumonia or definite bronchitis is induced.
Heart.-Palpitation or irregular action is induced with digestive symptoms; worse in afternoon; full feeling in chest, better in motion in the open air; these may be brought on by excitement or exertion.
Joints and Muscles.-A very large number and variety of pains, sharp and transitory in and around many joints, especially the small ones, are reported by provers. Weariness, weakness, stiffness and trembling on exertion, as after a fatiguing walk, are prominent. The sacral pain already mentioned appears to be due to fibrositis, and with the associated weakness of legs and generally, is a prominent argent nit feature.
Generalities.-Twitching, cramps and tremors are conspicuous in poisonings and are occasionally mildly reproduced or suggested in provers. A later stage of this is represented by paresis, and by paralysis, motor and sensory, in final stages. Weakness, general and local,is aggravated by any physical and mental exertion.
Skin.-The discoloration is a mechanical process, but the irritation of the skin of the neck and in the margin of the hair is specific. Dermatitis in this region with redness, burning pustulation and itching, worse in the evenings, amounts almost to an eczema.
Head.-Pains in one side of the head and one eye; boring in forehead, worse on left side; headache relieved by binding it up tightly,and worse from violent movement such as dancing and from mental exertion-all are argent nit features.
Sleep.-Heavy sleep, or restless sleep, or wakefulness from strange or pleasing fancies in the early part of the night are common. Or sleep may be disturbed by colic, calls to stool, or by dreams-“monstrous,” amorous, or of snake, &c.
Chills, followed by heat and sweat, are caused by this drug. The chills spread from nape to coccyx-relieved by warmth, not affected by movement or open air; chills recur at midday.
If above abstract were taken alone as a series of indications for the use of argentum nit. in the treatment of patients exhibiting similar symptoms, the result would show the drug to be a remedy of no small value. It was with such records, or less complete ones, that the pioneers of homoeopathy begin. Clinical experience with it has afforded other indications which enable the therapeutist to prescribe with great precision.
Argentum nit. is a deeply acting remedy but produces some of its result with rapidity. The wealth of material in the “Cyclopaedia of Drug Pathogenesy” shows that it quickly induces malnutrition, weakness and emaciation, consequently it should be considered in a thin, withered-looking subject, looking prematurely old. Whether this be a child suffering from congenital syphilis or other with malnutrition causing this dried-up appearance, whether the cause be identifiable or not, the remedy must receive careful consideration.
Digestive Sphere.-Argentum nit. is useful in gastralgia and dyspepsia, especially when there is great accumulation of wind in the stomach, which is eructated in bursts of explosive violence giving great relief; it is also very valuable for gastric and duodenal ulcers.
Diarrhoea in children (or adults) with some urgency, where the stool contains greenish, flaky mucus or specks of blood and is passed with a good deal of flatus-a noisy, spluttering evacuation-may be the cause of such emaciation as has diarrhoea and its results, especially where forcible eructations of gas and marked abdominal distension are present. If the patient is old enough to give evidences of desires, a craving for sugar, if very marked, would be a strong confirmation of the choice. Eating sugar, however, is said to cause or aggravate the diarrhoea in such patients. The Diarrhoea may be painless or colicky and an action is often induced by drinking.
Other agents cause emaciation, of which iodoform and calcarea phos. are noteworthy instances. Both these may require consideration before making a choice. Cravings for savouries and salt, and love of heat would turn the scale in favour of the phosphate.
The mention of heat to a reference to one of the chief general modalities of nitrate of silver, namely, aggravation of the patient`s general condition in a warm and close room and corresponding amelioration in the open air. This modality extends to many of the local symptoms also-such as headache and ocular symptoms. It is very important clinically.
The headaches calling for arg. nit are often unilateral, either left-sided or not distinctively one side more than the other, though they may be usually the same side in any one patient. The sensation of fulness, bursting, swelling of being enlarged or expanded, may be experienced by the patient-the description probably being an interpretation of hyperaemia or congestion. The left side of the forehead is a favourite spot, the pain is brought on or aggravated by sharp physical exertion,. such as tennis, running or dancing, and by mental strain or effort; it is ameliorated by pressure or firm bandaging.
Vertigo may be an accompaniment of the headache, with buzzing in the ears; also giddiness on looking down from a height or even on looking up to a height, or on walking over water on a bridge or plank.
Mind.-When at a height and crossing water an impulse may seize the patient to throw himself down or to jump into the water, and this is with difficulty restrained.
The arg. nit patients finds it difficult to force himself to do things because he fears he will fail (comp. silica in more chronic cases); he is nervous in facing a trifling ordeal, such as meeting strangers or at the idea of having to be punctual, e.g., in keeping an appointment, catching a train, &c.
This nervous tension may induce diarrhoea; or in children fear of punishment on being found out in a fault may cause incontinence of urine, or an urgent desire to pass water. This, if discovered, would be suggestive of argent. nit. which, in this feature, recalls anacardium. In the adult this is matched by a patient breaking out in a sweat on facing some unexpected responsibility.
The fear of failure causes a constant feeling of being in a hurry, and compels the patient to walk fast or hurry in his work. He gets so much into his day that time seems very long. The feeling of being in a hurry is met also by ac. sulph. and lilium tig., but in the latter drug it is more likely to be associated with disease of the female pelvic organs.
More pronounced mental symptoms are irrational actions, illusions, hallucinations, loss of memory, fear of death, with prediction of the date (aconite), degenerating into melancholia. Such cases must be compared with the aurum pathogenesy, and with that of metallic silver. Obsessional states, especially fears; dementia praecox; impulsive suicidal tendency, and some cases of general paralysis with tremor may require the consideration of the nitrate. The mental condition may be associated with (if not due to ) nervous excitement, trembling, palpitation, pulsation all over the body, with feeble, irregular action of the heart. Palpitation brought on by lying on the right side is an unusual indication for argent nit. Subjective symptoms of the nervous system are various pains in joints and soft parts of the limbs and back-“boring, crawling, pressure, stitches, tearing and weariness.” Pains and tenderness along course of nerves. Objectively there may be cramps, twitchings, drawing up of legs towards abdomen by spasm, or tenderness of tendons (or teno- synovitis), staggering from weakness, amounting to paresis.
The sacral pain and stiffness extending down the thighs are important symptoms of argent. nit. The pain necessitates moving about and the patient must straighten his back to get ease. THe pains have various modalities. Amelioration from standing or walking (back), but movement if continued is painful (scapula and shoulder, &c). Walking or motion in the open air relieves some of the chest pains, rapid walking relieves others (ankles). Distant muscular effort aggravates many muscular pains, e.g., blowing the nose, sneezing, deep breathing (chest, loins, head, &c).
In time past nitrate of silver was used in substantial doses for epilepsy, but this is now abandoned. The convulsions induced by the drug might be held to indicate it homoeopathically, and Nash states that the dilated pupils for hours or days before the attack is a characteristic indication in epilepsy. For convulsions a preceding restlessness is indicative. The convulsive movement induced by slight draughts or slight stimuli remind one of tetanic spasms. In any of these cases a number of other symptoms common to drug and disease would be required to justify the use of argent. nit. The same may be said of locomotor ataxy, where shooting pains in limbs, stiff gait, inability to stand with the eyes closed, and girdle pains have caused the drug to be used.
Respiratory diseases requiring Argentum nit. are mainly laryngeal, in which there is hoarseness with phlegm rattling in the throat till expelled in small lumps by coughing. It is useful in the chronic laryngitis of singers and is indicated when raising the voice causes coughing.
Eyes.-The ocular lesions of our drug have caused it to be prescribed with success in acute conjunctivitis with swelling of the lids, chemosis, sticking together of lids. Even in purulent ophthalmia and in keratitis it has been successful in low and high dilutions, but it is said to require to be supplemented by local use in gonorrhoeal require to be supplemented by local use in Gonorrhoeal ophthalmia. It was strikingly useful in one case where the conjunctivitis was part of a widespread infection, dermatitis being present above and below the eyes, and on the nape and on adjoining hairy scalp as recorded in provings. Argentum nit. is useful in eye strain (from over-use) and defective accommodation.
Genito-urinary Sphere.- Urethritis due to Bacillus coli should be amenable to argent. nit., and it should be considered in gonorrhoea. Other symptoms are indicated in the previous sections. Involuntary or unconscious urination may require its exhibition.
(1) Fear of crowd, of passing corners, high buildings; apprehension about keeping appointments, catching trains, &c., may cause diarrhoea.
(2) Feeling of hurry, inducing rapid walking, but walking is unsteady.
(3) Pains are liable to be periodic and come and go slowly; as a corollary time seems long.
(4) Mental and physical effects of over-study, mental strain or anxiety.
(5) Palpitation from lying on the right side, forcing patient to change position.
(6) Acts chiefly on left side-except eye.
(7) Headaches, unilateral, relieved by cold bathing and tight bandaging.
(8) Anaemia with ecchymoses.
(9) Gastrodynia and gastric and duodenal ulceration.
(10)Inflammation of mucous membranes, especially eyes and urethra.
(11) Sacral pain extending down thigh.
(12) Diarrhoea with greenish mucus.
(13) Inflamed fauces and larynx.
(14) Acts well in thin, dried up, prematurely old people.
Generally: from heat and close rooms (like apis and puls., &c.), from cold food and ices; mental exertion; eating sugar; drinking (diarrhoea).
From open air, bathing with cold water (except toothache), from movement (back), tightly binding (head).