Devergie states that acute poisoning with nitrate of silver, administered in the shape of pills, is more frequent than one would suppose. Yet Dr. Powell[1] states that it should always be given in pills, as the system bears a dose three times as large as when given in solution. The usual dose is from one-quarter of a grain to one grain three times a day when administered as a medicine. In cases of epilepsy Dr. Powell recommends one grain at first, to be gradually increased to six. Clocquet[2] has given as much as fifteen grains in a day, and Ricord has given sixteen grains of argentum chloratum ammoniacale. [Footnote 1: U.S. Dispensatory, 18th ed., p. 1049. Wood & Bache.] [Footnote 2: Handbuch der Giftlehre, von A. W. M. Von Hasselt. 1862, p. 316.] Cases of poisoning have resulted from sticks of lunar caustic getting into the stomach in the process of touching the throat (Boerhave)[1]; in one case, according to Albers, a stick of lunar caustic got into the trachea. [Footnote 1: Virchow's Archiv, Bd. xvii., s. 135. 1859.] Von Hasselt therefore urges the utmost caution in using lunar caustic; the sticks and holder should always be carefully examined before use. An apprentice[1] to an apothecary attempted to commit suicide by taking nearly one ounce of a solution of nitrate of silver without fatal result. It must be remarked, however, that the strength of the solution was not stated. [Footnote 1: Handbuch der Giftlehre, von A. W. M. Von Hasselt. Zweiter Theil, 1862. p. 316.] In 1861, a woman, fifty-one years old, died in three days from the effects of taking a six-ounce mixture containing fifty grains of nitrate of silver given in divided doses.[1] She vomited a brownish yellow fluid before death. The stomach and intestines were found inflamed. It is stated that silver was found in the substance of the stomach and liver. [Footnote 1: Treatise on Poison. Taylor, 1875, p. 475.] It is evident that the poisonous dose, when taken internally, is not so very small, but still it would not be safe to administer much over the amounts prescribed by Ricord, for in the case of the dog mentioned one third of a grain injected into the jugular vein produced death in four and one-half hours. The circumstance that more can be taken internally is explained by the rapid decomposition to which this silver salt is liable in the body by the proteine substance and chlorine combinations in the stomach, the hydrochloric acid in the gastric juice, and salt from food. The first reaction produced by taking nitrate of silver internally is a combination of this salt with the proteinaceous tissues with which it comes in contact, as also a precipitation of chloride of silver. According to Mitscherlich, the combination with the proteine or albuminous substance is not a permanent one, but suffers a decomposition by various acids, as dilute acetic and lactic acid.