SILVER. 
§ 862.] 
—This is very rare. Orfila relates an attempt at suicide ; but most 
of the cases have been accidental, and of these, in recent times, about 
five are recorded, mostly children. The accident is usually due to the 
application of the solid nitrate to the throat, as an escharotic, the 
stick breaking or becoming detached, and being immediately swallowed ; 
such an accident is related by Scattergood. 1 A piece of silver nitrate 
f inch long slipped down the throat of a child, aged 15 months: 
vomiting immediately occurred, followed by convulsions and diarrhoea ; 
chloride of sodium was administered, but the child died in six hours. In 
other cases paralysis and an unconscious state have been observed. 
2. Chronic Poisoning. —Salts of silver taken for a long period cause 
a peculiar and indelible colour of the skin. The body becomes of a 
greyish-blue to black colour ; it begins first around the nails and fingers, 
then patches of a similar hue appear in different parts of the body, and 
gradually coalesce, being most marked in those parts exposed to the light. 
The colour is not confined to the outer skin, but is also seen in the 
mucous membranes. There is also a slight inflammation of the gums, 
and a violet line around their edge. Ginpon observed this line after two 
months’ treatment of a patient by silver nitrate, the whole quantity 
taken being 3*9 grms. (about 60 grains). The peculiar colour of the 
skin is only seen after large doses ; after 8 grms. taken in divided doses 
Chaillon could not observe any change, but after 15 grms. had been taken 
it was evident. So also Riemer has recorded a case in which, after a year’s 
use of silver nitrate (total quantity 17-4 grms.), a greyish-black colour of 
the face was produced, and, when nearly double the quantity had been 
taken, the colour had invaded the whole body. 
§ 862. Post-mortem Appearances. —In the acute case recorded by 
Scattergood, the mucous membranes of the gullet, of the great curva¬ 
ture of the stomach, and parts of the duodenum and jejunum were 
eroded, and particles of curd-like silver chloride adhered to the mucous 
membrane. 
In the case recorded by Riemer of the long-continued use of silver 
nitrate, the serous and mucous membranes were coloured dark ; the 
choroid plexus was of a blue-black ; the endocardium, the valves of the 
heart, and the aorta pale to dark grey, as well as the rest of the vessels ; 
the colouring was confined to the intima. The liver and kidney also 
showed similar pigmentation. The pigment (probably metallic silver) 
was in the form of very fine grains, and, as regards the skin, was situate 
under the rete Malpighia in the upper layer of the corium, and also in 
the deeper connective tissue and in the sweat glands. Liouville has 
also found the kidneys of a woman similarly pigmented, who took 
silver nitrate daily for 270 days, in all about 7 grms., five years 
before her death. 
1 Brit. Med. Journ., May 1871. 
