Nitrate of Silver in Epidemic Dysentery. By Lew. Slusser,
M. D., of Canal Fulton, Ohio.
That diseases of an epidemic character are more difficult to
manage—more intractable in their nature and treatment, than the
same in a spasmodic form, is a principle in the practice of medi-
cine that will not, I presume, be denied.
During the summer of 1849, dysentery prevailed in this section
with unwonted virulence. In some neighborhoods the mortality
attending its prevalence was so alarming, that with some practition-
ers it was regarded as but another form of Asiatic cholera.
In very many cases, the ordinary remedies, such as we had been
accustomed to prescribe in former years, and with satisfactory
results, utterly failed. Neither mercurials, opiates, nor astringents,
separately, or in varied combination, exercised any control over the
symptoms, not even palliating them. The same may be said of
ipecac., Hope’s mixture and counter-irritation. Nor had injections
of starch and laudanum, ice water, or suppositories of solid opium
any effect in mitigating the tormina and tenesmus. Dr. Young’s
buttermilk treatment, (vide Amer. Jour, of Med. Sci., 1842,)
proved advantageous in a few cases; in others, it undoubtedly
aggravated the symptoms. Antiphlogistics were contra-indicated.
Some cases, despite the most energetic treatment, would terminate
fatally in less than forty-eight hours ; others, prostrated from the
excessive evacuations,’fell into a typhoid condition, lingered a
fortnight or more, and then died. In this latter condition it was,
after having failed with those remedies hitherto regarded as ortho-
dox, that I had recourse to nitrate of silver, a remedy first suggested
I believe, in this disease, by M. Trousseau. In determining upon
this article, I was mainly influenced by the knowledge of its fre-
quent exhibition in other enteric affections, both acute and chronic;
and particularly by the ocular proof of its beneficial effects in typhoid
fever, which prevailed among us the previous spring. Regarding
the pathological conditions of the two affections, as in many, respects
analogous, I felt justified in giving the remedy a trial. The results
were very satisfactory ; and I may add, that subsequent experience
confirms the favorable opinion previously entertained.
I have not had any experience of its effects in the first stage of
dysentery. In what some authors, very properly, as I conceive,
designate the second stage—where the discharges give evidence of
an ulcerated condition of the bowels, accompanied with typhoid
symptoms—I regard nitrate of silver as the remedy to be preferred to
any I have yet seen recommended. I will give particulars of a
few cases from notes taken at the time.
The first case in which I exhibited it, was that of Mrs, T---,
set. about 35; the mother of four children. I had treated her in
the spring for “sore mouth peculiar to nursing women.” In June
she had an attack of cholera morbus, which yielded upon the exhi-
bition of our ordinary remedies. About the first of August, dysen-
tery made its appearance in her family.’ First her husband was
attacked; he convalesced in a few days upon the calomel and opium
treatment. Next herself.
Resorting to the previously tried remedies already mentioned,
without any mitigation of symptoms, her condition soon became
such, that I was satisfied unless some other course of treatment was
speedily adopted, the result could not be otherwise than fatal. At
this stage decided typhoid symptoms had supervened ; countenance,
hippocratic ; skin, bedewed with a cold clammy sweat; eyes, sunken
and lustreless; pulse, weak and frequent; tongue, dry, red and
glazed; thirst, ardent; bowels, tympanitic ; tormina and tenesmus
almost incessant; fifteen and twenty discharges in as many hours,
of a purulent, bloody, and lymphous character.
I determined upon the following prescription :
JL	Argent. Nitrat. Crys.	gr. vj.
Pulv. Opii.	9j.
Mucil. Gum Acac.	q. s.
M. ft. pil. No, xij.	One every two hours.
Her prostrated condition was such as to demand the free exhibi-
tion of stimulants, in order to sustain the faltering energies of life.
Brandy and arom. spts. ammon. were given pro re ncita. At the
same time I ordered an injection every three hours, of gr. ij. nitrate
of silver dissolved in §j. warm water, mixed with a gill of tepid
milk. At the expiration of twenty-four hours from the adoption of
this treatment, I found an evident amelioration of the distressing
symptoms. The evacuations were less frequent, and there was a
decided mitigation of the tormina and tenesmus. I was encouraged
to repeat the prescription, but prolonged the time of giving the pills
to three hours, and omitted the injections. The discharges soon
after exhibited the characteristic dark appearance, the effects of the
remedy, and contained less mucus. The symptoms gradually
abated, the secretions became natural, and in a few days the patient
was entirely out of danger.
The next case was that of a daughter of Mrs. T. aet. 10 years.
She had been confined about a week ; condition much the same as
that of her mother. Ordered the same prescription, observing a
differential proportion. The improvement, for the first twenty-four
hours was not so marked as that of her mother; and observing a
want of action about the surface, I concluded upon the following:
JL Nitrate Argent. Crys.	gr.	iiss.
Salph. Morph.	gr.	i.
Vin. Ipecac.	si.
Aquae Camph.	§i.
M. A teaspoonful every two hours. At the same time ordered a
warm bath. This had the desired effect. Free perspiration follow-
ed ; the alimentary secretions improved ; and in a short time she
also recovered.
Few days after, saw Mr. M---------, aet. about 45, in consultation
with Dr. Donahu. He had been laboring under dysentery some
twelve days, and was much prostrated. Pulse 130; abdomen tym-
panitic, though not tender upon pressure; had discharged on the
day previous a large quantity of fatty matter, having the consistence
of healthy pus, but inodorous; tongue dry, and covered with a
thick white coat; the papillae prominent; sordes upon the teeth and
gums; his whole surface covered with a foetid clammy perspiration.
He had had the full benefit of the calomel and opium treatment.
Typhoid symptoms were present, and it was evident there was a
decided downward tendency.
The treatment adopted in case first was decided upon, and the
results were equally fortunate.
1 deem it unnecessary to extend this article, by a detailed history
of other cases, with like symptoms, treated by the same curative
agent, and resulting alike satisfactorily. Sufficient, I think, has already
been adduced to recommend the agent as one at least worthy of
trial. I might mention that I suggested the remedy to several
neighboring practitioners, and so far as I have heard, its administra-
tion, in the conditions before specified, was attended with uniform
success.
In obstinate diarrhoea of infants, it has proven in my hands an ex-
cellent remedy. In advanced stages, where the prostration and
emaciation is extreme, dejections frequent and watery, I have ex-
hibited the following mixture with admirable results.
Argent. Nitrat. Crys.
Sulph. Morph, aa.	gr. ij.
Gum Arab.	3i-
Sacch. Alb.
Aquse.	f. giij.
Ft. mix. Teaspoonful everv three hours to a child three years
old.