ArticlePDF AvailableLiterature Review

Abstract and Figures

Silver has been used extensively throughout recorded history for a variety of medical purposes. A review of the literature in English was undertaken, primarily using PUBMED, to identify the medical uses of silver before the clinical introduction of antibiotics in the 1940s. Silver has been used for at least six millennia to prevent microbial infections. It has been effective against almost all organisms tested and has been used to treat numerous infections and noninfectious conditions, sometimes with striking success. Silver also has played an important role in the development of radiology and in improving wound healing. Silver was the most important antimicrobial agent available before the introduction of antibiotics.
Content may be subject to copyright.
History of the Medical Use of Silver*
J. Wesley Alexander
Background: Silver has been used extensively throughout recorded history for a variety of medical purposes.
Methods: A review of the literature in English was undertaken, primarily using PUBMED, to identify the
medical uses of silver before the clinical introduction of antibiotics in the 1940s.
Results: Silver has been used for at least six millennia to prevent microbial infections. It has been effective
against almost all organisms tested and has been used to treat numerous infections and noninfectious conditions,
sometimes with striking success. Silver also has played an important role in the development of radiology and in
improving wound healing.
Conclusion: Silver was the most important antimicrobial agent available before the introduction of antibiotics.
Metallic silver was known to the Caldeans as early as
4,000 B.C.E., and it was the third metal known to be
used by the Ancients, after gold and copper [1]. Over these
millennia, silver has been used for numerous medical condi-
tions, mostly empirically before the realization that microbes
were the agents of infection. The metal was used in many
configurations, including vessels or containers for liquid,
coins, shavings, foils, sutures, solutions (e.g., nitrate, oxide,
bromide, chloride, and iodide), colloids providing fine parti-
cles, and electric colloids (introduced in 1924, which provide
even smaller particles of 0.1 mcm to 0.001 mcm in diameter).
Electric colloids of silver became the mainstay of antimicrobial
therapy in the first part of the 20
Century until the intro-
duction of antibiotics in the early 1940s. Complexes of silver
and protein known as mild silver proteins also were em-
ployed. These formulations were delivered topically (by so-
lution, ointment, or direct application of colloids or foils),
orally, and by injection. By 1940, at least 50 silver products
were marketed in the United States.
Medical Uses of Silver B.C.E.
Herodotus, the Father of History, accounts that no Persian
king, including Cirrus, would drink water that was not
transported in silver containers, which kept the water fresh for
years. This was particularly important in military conflicts,
where fresh water from natural sources was not readily avail-
able [2]. The ancient Phoenicians, Greeks, Romans, Egyptians,
and others also were recorded to have used silver in one form
or another to preserve food and water, and this was practiced
through World War II.
The application of silver plates to achieve better wound
healing was used by the Macedonians, perhaps the first at-
tempt to prevent or treat surgical infections. Hippocrates used
silver preparations for the treatment of ulcers and to promote
wound healing. It is likely that silver nitrate also was used
medically because it was mentioned in a pharmacopeia pub-
lished in Rome in 69 B.C.E. [1].
Medical Uses C.E. to 1800
The first clear record of silver nitrate being used as a
medical agent was reported by Gabor in 702–705, and Avi-
cenna used silver filings as a blood purifier in 980 A.D. and
also to prevent palpitations of the heart and to treat offensive
breath. Somewhat later (1520), Paracelsus used silver inter-
nally and also applied silver nitrate as a caustic for the treat-
ment of wounds, a practice that continues today. In 1614,
Angelo Sala gave silver nitrate internally as a counterirritant,
as a purgative, and for the treatment of brain infections.
During this same time, the Alchemists, who connected the
seven planets to the seven days of the week as well as to parts
of the body, connected silver to the moon and the brain,
giving birth to terms such as ‘‘the silver moon’’ and ‘‘lunatic.’
Silver later came into vogue for the treatment of epilepsy
when an epileptic stopped having seizures after he swal-
lowed a large silver coin used to prevent him from biting his
tongue [1].
*Presented in part at the 25
Annual Meeting of the Surgical Infection Society, Miami Beach, Florida, May 5–7, 2005.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Volume 10, Number 3, 2009
ªMary Ann Liebert, Inc.
DOI 10.1089=sur.2008.9941
During the early pioneer days on the North American
continent, when there was no refrigeration and water needed
to be transported long distances, it was common practice to
drop silver coins into the transport vessel to preserve water.
This practice also was used to preserve milk and prevent
spoilage, without knowledge that it was the prevention of
bacterial growth that caused the effect. During the late 1700s,
Anton van Leeuwenhoek invented the microscope, leading to
the examination of almost all substances and tissues. Ani-
malcules, small viable particles most now known to be bac-
teria, were discovered, but their presence in the mouth and
tissues of healthy individuals convinced some that animal-
cules were not associated with disease. Others soon began to
recognize that they might be agents of infection.
Privileged families used silver eating utensils and often de-
veloped a bluish-gray discoloration of the skin, thus becoming
known as ‘‘blue bloods.’ Privileged people also often avoided
sunlight sothat the presence of the bluish discoloration, argyria,
might become even more prominent. The prevalence of argyria
prior to 1800 has not been documented, but it was reported to
be associated with a reduced mortality rate during epidemics of
plague and other infectious diseases.
Medical Uses 1800–1900
By 1800, there was wide acceptance that wine, water, milk,
and vinegar stayed pure for longer periods of time when
stored in silver vessels. Silver nitrate also was used success-
fully to treat skin ulcers, compound fractures, and suppurat-
ing wounds, well before the time of Lister.
One of the seminal contributions to the medical uses of
silver was by Doctor J. Marion Sims in 1852 [3] (Fig. 1). Sims
became engrossed with the problem of vesico-vaginal fistu-
las, which were created at the time of delivery, especially
in slave woman, who often had rickets and deformed pel-
vises. These young, otherwise healthy women became social
FIG. 1. J. Marion Sims. Reproduced from Sims JM. The Story of My Life. New York. D. Appleton & Co. 1888.
outcasts because of their continued incontinence, unclean-
ness, and stench. This was only shortly after Semmelweis was
able to decrease puerperal sepsis by improved hygiene
through hand washing, but before Pasteur showed that bac-
teria caused disease and well before Lister’s successful use of
antiseptics to prevent surgical site infections in 1867. Sims
went so far as to keep these slave women in a small hospital
near his home so he could be more attentive to their care. He
tried many times to repair the fistulas surgically using stan-
dard sutures, such as silk, but these attempts all failed. Con-
vinced that silver had healing properties, he had his
silversmith produce fine silver wires that he then used as
sutures to close the fistulas. This was highly successful, the
first success being in a slave woman named Anarcha, who
had undergone 12 previous operations using silk for closure.
Sims became widely recognized as the first American surgeon
to achieve international renown, traveling throughout Europe
to demonstrate his successful techniques. He also used silver
catheters for urinary diversion until the repairs had healed. At
one time, Sims declared boldly that the use of silver sutures
was one of the major contributions to surgery in the 1800s.
Other sutures were introduced that were coated with silver,
but the success of these was not well documented.
Another seminal contribution was made in the 1880s by
Doctor Carl Siegmund Franz Crede, a German obstetrician,
who pioneered the use of silver nitrate eye drops to prevent
ophthalmia neonatorium (gonorrheal ophthalmia) in new-
born infants [4]. He first used a 2% solution, but this was
reduced subsequently to a 1% solution because of the irrita-
tion the higher concentration caused. This was a highly effective
therapy, reducing the incidence of ophthalmia neonatorium
from 7.8% to 0.13% in 13 years. Because of the success of this
method, the employment of silver nitrate eye drops in newborn
infants was widely accepted throughout the world, and in nu-
merous countries, this therapy was mandated by law and
persisted until after the introduction of effective antibiotics.
B.C. Crede, a surgeon, is credited with being the first to
employ colloidal silver for wound antisepsis in 1891, after
observing Halsted applying silver foil to wounds to treat in-
fections [1,2]. Topical application of silver salts became a
common therapy. Crusius used silver nitrate for the treatment
of burn injuries in the 1890s, well before its recent rediscovery.
Vonnaegele realized that the antibacterial effects of silver were
attributable primarily to the silver ion, and did systematic
studies that led to the finding that silver was an effective anti-
microbial agent for almost all unicellular organisms (at least 650
species), but frequently not against mold or parasites [5]. Silver
also had another use in medicine during the 19
Century, in
that Konrad Ro
¨ntgen discovered in 1895 that X-rays activated
silver halide crystals, making it possible to record radiographic
Medical Uses 1900–1940
Halsted was one of the first American surgeons to advocate
the use of silver foil for wound dressings, and silver sutures
often were used in surgical incisions to prevent infections. The
use of silver for ophthalmologic treatment was extended con-
siderably. Roe [6] used a colloidal form of silver in the successful
treatment of infected corneal ulcers, interstitial keratitis, ble-
pharitis, and dacrocystitis. Colloidal silver also was reported to
be effective treatment for puerperal sepsis, staphylococcal sep-
sis, tonsillitis, acute epididymitis, and other infectious diseases
Between 1900 and 1940, tens of thousands of patients con-
sumed colloidal silver, and several million doses of silver were
given intravenously. Whereas such therapy generally is safe, it
was shown that high doses of silver, when given parenterally,
could cause convulsions or even death, and that oral adminis-
tration of huge doses could cause gastrointestinal disturbances.
Argyria, the deposition of silver in normal skin and other
tissues, came to be a known complication of silver therapy.
Because of this and the increasing use of silver for medical
therapy, the American Silver Producers Association recruited
W.R. Hill and D.M. Pillsbury to examine the incidence and
consequences of argyria [1]. They searched the world litera-
ture and were able to find 357 cases that had occurred by
1939. The earliest cases were recorded in the 1700s. It became
apparent that silver compounds administered by any route
except the unbroken skin could produce argyria when used
for a sufficiently long period of time. However, chronic argyria
appeared to cause no pathologic alterations of the affected or-
gans and to have no important physiologic consequences. In
clinical practice, the gastrointestinal tract probably was the
most important site to absorb silver. Once in the body, silver
can be deposited in the majority of tissues, nerve tissue and
skeletal muscle excepted. Two hundred thirty-nine of the 357
cases of argyria occurred as the result of silver given for
medical indications. The remainder was related primarily to
industrial uses such as mining and refining. In only 16 of the
239 cases where silver was given for medical indications had it
been used for less than one year, and most of the patients with
argyria had taken silver for a much longer time, as long as 20
years. Silver nitrate was responsible for 49% of these cases. The
total dose of silver needed to cause argyria with silver ars-
phenamine was approximately 6 g, or 0.9 g of metallic silver. In
one interesting case, the only contact with silver was when
silver structures were used to repair a hernia.
Recommended Uses of Silver by the 20
Over time, the well-established indications for the effective
use of silver were for water purification, wound dressings for
the promotion of healing, the prevention and treatment of
infection, dental hygiene (the prevention and correction of
pyorrhea, gingivitis, and bad breath), eye conditions (pri-
marily the prevention of ophthalmia neonatorium), and other
infectious complications.
Less clear evidence of effectiveness (possibly effective) exists
for use for epilepsy and central nervous system disorders, a
variety of digestive disorders, as a tonic in old age or disability,
and for the treatment of arthritis, hemorrhoids, dandruff, and
warts. Silver also was recommended for a wide variety of other
diseases where effectiveness was questionable. These included
diabetes mellitus, obesity, colds, psoriasis, allergies, and many
Historically, silver has been a major therapeutic agent in
medicine, especially in infectious disease, including surgical
infections. Its risk:benefit ratio is advantageous.
Author Disclosure Statement
No conflicting financial interests exist.
1. Hill WR, Pillsbury DM. Argyria–The Pharmacology of Silver.
Baltimore. Williams & Wilkins, 1939.
2. Grier N. Silver and its compounds. In: Block SS, ed. Disinfec-
tion, Sterilization and Preservation. Philadelphia. Lea & Febi-
ger, 1968:375–398.
3. Sims MJ. The Story of My Life. Marion-Sims H, ed. New York.
D. Appleton & Co., 1884.
4. Schneider G. Silver nitrate prophylaxis. Can Med Assoc J
5. Searle AB. Colloids as germicides and disinfectants. In: The
Use of Colloids in Health and Disease. London. Constable &
Co., 1920:67–111.
6. Roe AL. Collosol argentum and its ophthalmic uses. Br Med J
7. Duhamel BG. Electric metallic colloids and their therapeutic
applications. Lancet 1912;1:89–90.
8. Sanderson-Wells TH. A case of puerperal septicaemia suc-
cessfully treated with intravenous injections of collosol ar-
gentum. Lancet 1916;1:258–259.
9. Van Amber Brown G. Colloidal silver in sepsis. Am J Obstet
Dis Women Childr 1916;20:136–143.
Address correspondence to:
Dr. J. Wesley Alexander
Department of Surgery
University of Cincinnati College of Medicine
231 Albert Sabin
Cincinnati, OH 45267-0558
... Silver is being used for medical purpose since long. The father of the history, Herodotus, mentioned that Persian kings used to drink water only in silver containers or the water to be transported or kept in a container that is made of silver so that the water remains fresh for years (Alexander, 2009). This was mostly used during the military conflicts, where fresh and clean water from natural source was not available (Grier, 1968). ...
... The first clear record of using silver nitrate for medical purpose was found in 702-705 CE by Gabor. Silver also used by Avicenna in 980 CE for fillings as blood purifier, prevent palpitations and for the treatment of offensive breath (Alexander, 2009). In 1800 century, silver nitrates were successfully used for the treatment of skin ulcer, fractures and suppurating wounds and later silver was being used treat epilepsy (Hill and Pillsbury, 1939). ...
Silver nanoparticles is now a fastest growing sector because of its various applications. Commercially synthesized silver nanoparticles are more toxic than biosynthesized or green synthesized one. Thereby, a good number of research have been conducted on green synthesized or plant mediated AgNPs fabrication. Various pant based synthesized methods are also being developed. Size of the silver nanoparticle is a vital factor to determine physiochemical properties, antibacterial and cytotoxicity of the silver nanoparticles. On the other hand, temperature, pH, agglomeration, time for reaction and reducing agent is the key factor for determination of particle size. Temperature also influences the reaction time for the formation of nanoparticles. After fabrication of AgNPs, it is to be characterized that can be done by UV-vis, XRD, EDX, TEM, SEM, FTIR and Dynamic light scattering (DLS) system. For its better application antimicrobial activity and cytotoxicity needed to be studied. The increasing applications of AgNPs also influencing the environment like a Trojan horse. Thus, this review mainly focused on the plant based green synthesis method. Future research could benefit from investigating the connection between temperature, pH, antibacterial activity, cytotoxicity, and environmental applications of nanoparticles.
... Generally, metallic nanoparticles have a good bacteriostatic effect resulting from their large surface/volume ratio, allowing them to contact the bacterial cell in a desirable manner [14][15][16][17][18]. Recently, metallic ions, metal nanoparticles, and metal oxides based on silver [19][20][21], gold [22], copper [23], cerium [24,25], iron [26], cobalt [27], copper oxide [28,29], ...
Full-text available
This review provides information on the latest advances in inorganic materials with antimicrobial properties based on a metallic species immobilized on the clay mineral montmorillonite realized between the years 2015 and 2023. This class has shown many promising results compared to certain organic agents. Montmorillonite in natural and/or modified forms is a good platform for the storage and release of metallic species, and several researchers have worked on this mineral owing to its cation exchange capacity, low cost, biocompatibility, and local availability. The preparation methods and the properties such as the antibacterial, antifungal, and toxicological activities of this mineral are discussed. The main characteristics of this antibacterial class for the elimination of pathogenic bacteria were examined and the known weak points of its antimicrobial application are discussed, leading to suggestions for further research.
... Since ancient times, silver ions or salts have been known to have antimicrobial properties. 16 Silver is currently used to inhibit bacterial growth in a wide range of applications, including dental work, catheters, and burn wound dressings. 17 In light of the rise in antibiotic-resistant bacterial strains, certain metals, especially in nanoparticle form, have garnered heightened interest. ...
Full-text available
: Compared to other fixed orthodontic appliances, orthodontic brackets have a substantial impact on enamel demineralization. This demineralization is a result of organic acid production by various microorganisms, primarily from Streptococcus mutans and Lactobacillus acidophilus. Preventing white spot lesions and caries during orthodontic treatment presents a considerable challenge for clinicians. Silver exhibits broad-spectrum antimicrobial activity against various microorganisms, including Gram-positive and Gram-negative bacteria, certain viruses, fungi, protozoa, and antibiotic-resistant strains. As such, the purpose of this research is to investigate the antibacterial properties of orthodontic brackets coated with silver nanoparticles against Streptococcus mutans and Lactobacillus acidophilus. The study involved 80 stainless steel orthodontic brackets, which were divided into four groups, each containing 20 brackets. In each group, there were uncoated brackets serving as the control group, and the experimental group consisted of brackets coated with silver dioxide. Coating was done by physical vapor deposition with the help of RF Magnetron sputtering unit. Surface morphology and material composition was analyzed by SEM and EDS unit. Afterward, the brackets underwent microbiological tests to evaluate their antibacterial efficacy against Streptococcus mutans and Lactobacillus acidophilus. The study found that silver nanoparticle-coated stainless-steel brackets exhibited effective antibacterial properties against both Streptococcus mutans and Lactobacillus acidophilus when compared to the uncoated brackets. Silver nano particle coated SS brackets showed increased anti-bacterial effect towards S. mutans than L acidophilus. Using silver nanoparticles to coat orthodontic brackets represents an innovative and effective approach to prevent the formation of white spot lesions in patients receiving fixed orthodontic treatment. The antimicrobial properties of silver nanoparticles can combat bacteria like Streptococcus mutans and Lactobacillus acidophilus, responsible for enamel demineralization and the occurrence of white spot lesions. This advancement in bracket technology has the potential to significantly reduce the risk of enamel damage and improve overall oral health outcomes for orthodontic patients.
... Silver has long been known for its antimicrobial activity. 23 Recent development in nanotechnology has further augmented its antimicrobial and anti-inflammatory properties when used in nanoform with several applications in dentistry, such as resins, implants, and other biomaterials. 8,24 This proprietary colloidal nanosilver tooth gel used in the present study is composed of SilverSol®, a patented colloidal nanosilver, xylitol, and peppermint Overall oral health assessment in the three treatment groups Fig. 6: Tooth sensitivity assessment in the three treatment groups oil as active ingredients. ...
Silver and its compounds have been used for thousands of years as antibacterial and medicinal agents. Silver nanoparticles (AgNPs) subsequently received much attention due to their unusual physical, chemical, and biological properties, which are mainly caused by AgNP size, structure, composition, luster, and structure compared to their bulk species. When free radicals interact with bacteria, they can cause damage to the cell membrane, enabling it to penetrate and eventually lead to cell death. Compared to other salts, silver nanoparticles have excellent antibacterial activity due to their large surface area, allowing for high interaction with bacteria. There are many techniques for producing silver nanoparticles, including physical, chemical, and biological processes.Physical and chemical processes for making silver nanoparticles are expensive and complicated, whereas biological approaches are easier and safer to implement. In the biological and environmental areas, metal nanoparticles with controlled particle size and surface chemistry have a broad spectrum of applications. Nanomaterials must becharacterized in addition to the manufacturing procedures to explore differences in activity based on morphological distinctions. AgNPs are widely used as antibacterial agents in the field of health, food storage, textiles, and various environmental applications.So, in this systematic review, we examined silver nanoparticle preparation methods, characterization, applications, and fundamental concepts of silver nanoparticles (AgNPs).
Full-text available
The intricate environment of biofilms provides a heaven for bacteria to escape antibiotic eradication, leading to persistent chronic infections. Therefore, it is urgently needed to develop effective therapies to combat biofilm‐associated infections. To address this problem, a series of antimicrobial agents are designed and synthesized utilizing triphenylamine imidazole silver complexes (TPIMS). Due to the photoactivated release of Ag⁺ coupled with aggregation‐induced emission (AIE) properties and efficient ¹O2 generation, TPIMS exhibits excellent visual diagnostic capabilities and potent broad‐spectrum antimicrobial activity, showing antimicrobial efficacy against both Gram (+) and Gram (−) bacteria. Additionally, TPIMS shows extraordinary antibacterial performance and biofilm resistance against methicillin‐resistant Staphylococcus aureus (MRSA), with reduced potential for resistance thanks to the synergistic effect of phototoxicity and dark toxicity. Notably, among the TPIMS variants tested, TPIMS‐8 has demonstrated exceptional curative ability against resistant bacterial biofilm infections in vivo with minimal side effects. Furthermore, it is applied to clinical samples from infected patients and the results indicated that TPIMS‐8 is able to achieve excellent bacterial‐specific detection and superior killing of drug‐resistant bacteria even in complex systems, demonstrating its great potential for clinical applications. This study presents a promising foundation for the development of advanced antimicrobial therapeutics targeting multidrug‐resistant bacteria and biofilm‐associated infections.
Full-text available
In modern medicine the resistance to conventional antibiotics is becoming a serious concern due to high instances of mortality. Several metallic nanoparticles are suggested as promising anti-microbial agents against multidrug-resistant bacteria and some viruses. Among the nanoparticles mentioned, we review the recent finding which demonstrate the impact of silver nanoparticles on antimicrobial activities and recommend them as a potential candidate for restraining infections.
Full-text available
Silver is commonly used both in ionic form and in nanoparticulate form as a bactericidal agent. This is generally ascribed to a higher toxicity towards prokaryotic cells than towards mammalian cells. Comparative studies with both silver ions (such as silver acetate) and polyvinylpyrrolidone (PVP)-stabilized silver nanoparticles (70 nm) showed that the toxic effect of silver occurs in a similar concentration range for Escherichia coli, Staphylococcus aureus, human mesenchymal stem cells (hMSCs), and peripheral blood mononuclear cells (PBMCs), i.e. 0.5 to 5 ppm for silver ions and 12.5 to 50 ppm for silver nanoparticles. For a better comparison, bacteria were cultivated both in Lysogeny broth medium (LB) and in Roswell Park Memorial Institute medium (RPMI)/10% fetal calf serum (FCS) medium, as the state of silver ions and silver nanoparticles may be different due to the presence of salts, and biomolecules like proteins. The effective toxic concentration of silver towards bacteria and human cells is almost the same.
Die antibakterielle Wirkung von Silber wird in zahlreichen Haushalts‐ und Medizinprodukten genutzt. Dabei kommen außer Beschichtungen aus metallischem Silber auch Silbersalze und zunehmend auch Silber‐Nanopartikel zum Einsatz. Der Stand der Forschung zur Wirkung von Silber auf Bakterien, Zellen und höhere Organismen wird zusammengefasst. Es zeigt sich, dass das therapeutische Fenster für Silber kleiner ist, als oft angenommen wird. Gleichwohl sind die Risiken durch die Verwendung von Silber für Menschen und Umwelt als begrenzt einzuschätzen.
In this work, an in situ reduction method was used to prepare nanosilver-modified polyethersulfone (PES-Ag) ultrafiltration membranes by mixing up the reducing agent ethylene glycol and the protective agent polyvinylpyrrolidone to reduce AgNO3 in the casting solution. The effects of coagulation bath temperature (CBT) on the separation performances, antifouling property, tensile strength, and stability of the nanosilver particles were researched. The results indicated that when the PES-Ag membranes were prepared in 40°C coagulation bath, the loss rate of nanosilver particles during preparation was minimum, only 18.5%. With the CBT increasing from 20 to 60°C, the water flux of the PES and PES-Ag membranes increased, whereas the rejection rate decreased. The largest flux reached 471 L·m−2·h−1 for PES-Ag membranes prepared at 60°C and the rejection was over 90%. The results of contact angle and flux recovery ratio showed that PES-Ag membranes had better hydrophilicity and antifouling property. Furthermore, the PES-Ag membranes could inhibit Escherichia coli from growing. POLYM. ENG. SCI., 2013. © 2012 Society of Plastics Engineers
Metals have been used as antimicrobial agents since antiquity, but throughout most of history their modes of action have remained unclear. Recent studies indicate that different metals cause discrete and distinct types of injuries to microbial cells as a result of oxidative stress, protein dysfunction or membrane damage. Here, we describe the chemical and toxicological principles that underlie the antimicrobial activity of metals and discuss the preferences of metal atoms for specific microbial targets. Interdisciplinary research is advancing not only our understanding of metal toxicity but also the design of metal-based compounds for use as antimicrobial agents and alternatives to antibiotics.
Studies on the effects of nanomaterial exposure in mammals are limited, and new methods for rapid risk assessment of nanomaterials are urgently required. The utility of Caenorhabditis elegans cultured in axenic liquid media was evaluated as an alternative in vivo model for the purpose of screening nanomaterials for toxic effects. Spherical silver nanoparticles of 10 nm diameter (10nmAg) were used as a test material, and ionic silver from silver acetate as a positive control. Silver uptake and localization, larval growth, morphology and DNA damage were utilized as endpoints for toxicity evaluation. Confocal reflection analysis indicated that 10nmAg localized to the lumen and tissues of the digestive tract of C. elegans. 10nmAg at 10 µg ml(-1) reduced the growth of C. elegans larvae, and induced oxidative damage to DNA as measured by 8-OH guanine levels. Consistent with previously published studies using mammalian models, ionic silver suppressed growth in C. elegans larvae to a greater extent than 10nmAg. Our data suggest that medium-throughput growth screening and DNA damage analysis along with morphology assessments in C. elegans could together provide powerful tools for rapid toxicity screening of nanomaterials. Published 2013. This article is a US Government work and is in the public domain in the USA.