This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
According to Monneret, "pain arising during digestion, from whatever cause," may be relieved by mixing the subnitrate freely with the food, but more definite indications may be given. Gastric pains dependent on indigestible food, marked constipation or hepatic congestion, require emesis or purgation, while in vomiting connected with fermentation of food, dilatation of stomach, etc., antiseptic remedies and perhaps washing out of the viscus may be necessary.
Bismuth is specially indicated in cases of difficult digestion with tendency to diarrhoea, in subacute or chronic gastritis, and gastralgia with marked irritability of mucous membrane: for such cases, Odier first introduced it (in Geneva, 1786); he describes severe gastric pain as frequent among the servants there who lift and carry on their heads large vessels of water - the pain was either spasmodic, sudden, intense, and relieved by pressure, or more persistent and accompanied with sensations of gnawing, sinking, and pulsation; eructation, nausea, and vomiting occurred in greater or less degree, and the general health and mental state became much depressed. Such cases were much relieved by bismuth in moderate doses; and Marcet, Bardsley, and other English physicians have published similar experiences.
Nothnagel finds it especially useful when pain occurs after food in badly nourished overworked persons; but when there is marked anaemia or a general neuralgic condition it is not so serviceable alone, nor is it very permanent in its good effects. Prussic acid, or opium, alkalies, and later iron and bitters, may be conjoined with it. Caizergues especially praises a combination of 4 gr. with 1/3 gr. of extract of belladonna in the gastralgia of chlorosis (London Journal of Medical Science, 1851).
When acid pyrosis is a marked symptom, bismuth is particularly indicated either alone, or, if acidity be marked and constipation usual, then combined with magnesia. According to Trousseau, if the rejected fluid be insipid, glairy, or sour ropy phlegm, bismuth alone is contra-indicated, but in most cases it deserves trial, requiring only that constipation be remedied. The nausea and vomiting of gastric irritation is commonly amenable to bismuth, reflex vomiting, such as that of pregnancy, not so
(Husemann); this is an argument in favor of the local protective effect of the drug.
In infantile vomiting, which is frequently dependent on acidity or ill-digested food, and accompanied by diarrhoea and pain, bismuth is exceedingly useful, being, as it is, practically harmless and tasteless - 1 to 2 gr. may be placed on the infant's tongue with a moistened finger. A minute dose of creosote, 1/10 of a drop, may often be usefully combined (British Medical Journal, ii., 1875).
In Ulceration of the Stomach, when pain is very severe and exhausting, and when vomiting is frequent, much relief may be given by full doses; and I have noticed that distressing thirst has been rather relieved than increased by the remedy. Dr. Brinton attached great value to it; it is often given with opium in such cases.
In Malignant Disease even, I have found bismuth palliate for a time the most severe symptoms; and in both these conditions it acts mainly by forming a smooth layer over exposed and hypersensitive nerves, and so preventing the contact of food and unhealthy secretions: to obtain such a result it is evident that more than ordinary doses are required.