(Ag NO3). Nitrate of silver. Triturations and solutions in distilled water to 3c and alcohol afterwards.
INTRODUCTION
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.
PATHOGENESIS.
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.
PROVINGS.-
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.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,