Ord. I. Mineral Astringents.
(Sulphuric, Nitric, and Hydrochloric acids. Acetate and Diacetate of Lead; Sulphate and Sesquichloride of Iron; Alum; Sulphate of Zinc; Sulphate of Copper; Bichloride of Mercury; Nitrate of Silver.)
These medicines have already been noticed among Restorative and Catalytic Hæmatics. Their Astringent action on muscle is of much less moment than their important operations in the blood. Neither is it theoretically a matter of so much difficulty; for it appears, as we have seen, to admit of a simple explanation.
By their chemical action on albumen, these substances coagulate blood, and thus act in a simple way as styptics when applied to bleeding parts externally. They form peculiar insoluble compounds both with albumen and fibrine, and it is probably by virtue of their action on the latter that they are able to cause the contraction of muscular fibre, which is a fibrinous tissue. The constriction, set up chemically, is apparently continued and propagated by the vital force of the muscle.
The most important only of the mineral Astringents are mentioned above. It must not be supposed, when their chemical actions are mentioned, that such actions are always allowed free play in the living and circulating blood. They are no doubt constrained by various forces from operating there, or else the consequences of such a disturbance of the condition of the elements of the blood would be dangerous in the extreme. (Vide page 104.) They act, before entry into the blood, on mucous membranes and external parts; and on coming out of the blood, on the terminal capillary vessels, on the ducts of glands, and on mucous membranes again.
Astringents act very much alike on external parts; only that some are more soluble than others, and some excel the rest in chemical activity. But they differ considerably in their applicability for internal use. They must be given in such quantity that, after absorption and dilution by the whole mass of the blood, they may still be capable of exerting a perceptible action on distant parts. A small portion of one of them will not suffice to repress hæmorrhage, or to diminish a super-abundant secretion.
From this it follows that the mineral acids, Alum, and the salts of Iron, are the only astringents of this order which can in all cases be given internally with advantage. For being comparatively innocuous, they can be safely prescribed in the quantity required; whereas the other mineral Astringents are poisonous substances, which cannot be given in large doses without considerable danger.
Of the mineral acids, Sulphuric acid is the best Astringent. Phosphoric acid is seldom or never used as an Astringent. We might indeed have supposed it to be inapplicable, from the fact that it forms soluble compounds with albumen and fibrine,—instead of coagulating these substances, like the other mineral acids.
Sulphuric acid is a Restorative Hæmatic; and, when given in small doses, may remain in the blood, and not pass out through the glands. It acts first upon the mucous surface of the stomach. When there is a relaxation of this mucous membrane, as in many cases of atonic dyspepsia, with a large formation of flatus, and an over-secretion of the gastric fluid, this acid may be very serviceable. It tends to correct these evils by a topical action. In cases of Pyrosis, where there is an alkaline reaction in the vomited fluid, as sometimes occurs, Sulphuric acid is still more peculiarly applicable, because it further acts chemically in neutralizing this alkali. When given in large doses, the acid cannot remain in the system, but must be excreted from it by the glands. In passing through them it tends to act as an Astringent by corrugating and diminishing in caliber their minute ducts, and thus decreases the amount of the secretion. But it does not act on all glands alike. Dr. Bence Jones has found that it seldom passes out into the urine. It therefore does not sensibly diminish the secretion of urine. It is probably excreted partly by the skin, and partly by the bowels; for it diminishes the amount of the sweat in profuse perspiration, and of the fæces in diarrhœa. Sulphuric acid is free before entrance into the blood, and after expulsion from it into the secretions. Thus at these periods it acts as an Astringent. But while in the blood it combines with the alkali contained in that fluid, and forms a salt which is not astringent. So that when it diminishes any secretion, this is nearly tantamount to a proof that it is actually excreted by the gland which forms that secretion. It acts on mucous membranes generally, being probably excreted in small quantities by those which are remote from the stomach. It is not of use in cases of hæmorrhage, except when the bleeding takes place from some mucous membrane. It is thus given with more or less advantage in Hæmatemesis, Hæmoptysis, Melæna, and chronic Dysentery—i.e. in hæmorrhage from the mucous surfaces of the lungs, stomach, and bowels.
Alum is a universal Astringent, acting more or less on all parts of the body, and diminishing all secretions. It is a very useful remedy in all cases where Astringents are required. It does not seem to be impaired in power while in the blood, as is the case with Sulphuric acid; and is therefore applicable in all hæmorrhagic cases. It has been highly recommended in the case of lead colic, and seems to operate in this instance by stimulating to contraction the muscular fibre of a paralyzed portion of the intestine.