We can not flatter ourselves with the belief that the errors of this kind are things of the past only, for it is a fact that can not be questioned, that despite the floods of light that have been thrown upon the real nature of many diseases, and the therapeutic action of most medicines during the last few decades by the aid of pathology, chemistry and the microscope, many physicians, at the present time, daily administer drugs with full faith and confidence in their medical action, whose claim to a place among the medical agents applicable to the condition observed, is unreal and unsubstantial.

Reflections of this kind lately passed through my mind while witnessing an alarming attack of pulmonary hemorrhage, and seeking to decide upon the best measures, medical and otherwise, to be instituted for the well being of my patient. Within the last few days, a serious case of uterine hemorrhage, of which I have had charge, has served to recall them; therefore, I propose to briefly present some of the conclusions arrived at in relation to the value in these cases of a certain class of medicines that have been, from almost "time immemorial," much relied on in the treatment of these same hemorrhages-pulmonary and uterine I refer to astringents. I can hardly deem it necessary to refer to authorities, to sustain the statement that astringents are much relied on by the majority of the profession in the treatment of hemorrhage from the lungs and uterus, when scarcely an author is known to me, who, when detailing the treatment to be practiced in these cases, does not recommend their use upon the ground that their property of astringency will exert, if not a curative influence, at least a restraining one on the bleeding.

In presuming to question the truth of the opinions so generally held, in relation to the value of astringents when administered internally in the hemorrhages referred to, I do not for a moment deny that a certain remedial value may, and perhaps often does attach to them under such circumstances, only that this value comes from and is dependent on their astringent qualities.

To show what I mean, Prof. Harrison* among others, hold, in reference to the well known astringent, acetate of lead, that "its capability of arresting uterine hemorrhage has been most thoroughly tested by an enlarged experience of the entire body of the profession," and that "in hemoptysis its astringent property has been amply displayed." Now, while it is admitted that this "enlarged experience" may show that the medicine, acetate of lead, does sometimes exert some curative

*Elements of Materia Medica and Therapeutics, volume ii, page 410.

action in these cases, it entirely fails to show that it does so in consequence of any astringent quality it possesses, and that its good effects are not entirely owing to its action as a sedative. Yet this medicine, as well as alum, and the vegetable astringents, tannin, kino, catechu, rhatany, galls, &c., are administered daily in cases of hemorrhage, under the belief that they will do good in consequence of their exerting a constringing influence upon the capillary blood vessels, and the power they possess of coagulating or precipitating albumen-effects they are known to produce when externally applied to bleeding surfaces-that their action is the same, whether used as external or internal medicines.

In an effort to show that the assumption that astringents, when administered internally, control pulmonary and uterine hemorrhage by virtue of their astringency, is an entirely gratuitous one, it becomes necessary to examine the theories proposed, accounting for this supposed power, and see if they are truthful or fallacious in character.

According to Dr. Stille,* the manner in which astringents aet in controlling hemorrhage, "is not regarded in the same light by all who have examined the subject." Some suppose that it is in consequence of their power to coagulate the albumen of the blood, while Dr. Headland holds that they "act directly and especially on museular fibre; they cause this to contract, whether it be striped and voluntary, or of the involuntary and unstriped kind." According to this view, "they are taken into the blood in a state of solution," they "pass through the walls of the capillaries to the muscular tissue," and "stimulate to contraction the unstriped muscular fibres existing in the middle coat of the arteries, in the walls of the capillary vessels, in the lining of the ducts of glands generally, in the substance of the heart, and in the coats of the stomach and intestines." How this contraction of the muscular fibre is brought about, is not very well explained. Dr. Headland, however, says that "it seems to depend somehow on the chemical power just mentioned, for astringents appear to constringe fibrinous as well as albuminous tissues by a chemical action." The "chemical power referred to," is that by which astringents coagulate and pricipitate an albuminous or fibrinous solution.

The slightest examination of the first theory, that astringents when internally administered, control hemorrhage because of their power to coagulate the albumen of the Mood, will show it to be unworthy of consideration. If it is claimed that when so administered, they have *Therapeutics and Materia Medica, vol. i, page 178.

†The Action of Medicines-Astringents.

the power of coagulating the blood within the vessels, how is it that this effect is not general? That it is not so, we know, because were it so, death would be the immediate and inevitable result. And what is the wonderful intelligence that holds in abeyance the chemical affinity, which in general, causes the coagulation and precipitation of albumen, where this substance and astringents are brought into contact, while it is being passed into the blood from the stomach, conveyed in this fluid to the heart, and from thence, in the one case, to the capillary vessels of the lungs, and in the other, to the vessels of the uterus, until the very vessels themselves are reached, which are the seat of the hemorrhage? Certainly no one who exercises his reason can conclude that in this way astringents may arrest a hemorrhage of the kind we are considering. The ground that these medicines increase the coagulability of the blood, is equally untenable. Indeed, there are no facts that give plausibility to the assumption, while all the knowledge that we have in relation to their direct action upon the blood, is inconsistent with this supposition. *Mitscherlich, having partially immersed frogs in a solution of tannic acid, so that their blood became impregnated with it, found that the circulating fluid grew darker in color, coagulated more slowly than usual, and formed an imperfect and pasty clot." This experiment, which has been performed by others with a like result, positively contradicts the theory that astringents exercise any influence in the way of increasing the coagulability of the living blood.

To suppose that when taken into the blood in a state of solution, they pass through the walls of the capillaries to the muscular tissues, and stimulate the muscular fibres to contraction, is to believe with Mr. Headland, that as they form peculiar insoluble compounds, both with albumen and fibrin, 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," and that "the contraction thus set up chemically, is continued and propagated by the vital force of the muscle." While this view may serve well as a theory to explain the supposed action of astringent medicines, it is merely an assumption, it not even being proved that they constringe capillary vessels, or contract muscular fibres, except when they can be brought into direct contact with them. This view requires, First-That we assume the capillary vessels to be contracted by the action of astringents. Sec

*Stille, op. cit.

ond-That this is owing to the contraction of muscular fibres. Third— That while these substances are passing through the blood on their way to these muscular fibres, their natural chemical tendencies are suspended, "being constrained by various forces;" and, Fourth-That "on the exit by secretion from the blood, they resume their original activity." Can we yield our assent to a doctrine based on such evidence? Certainly not. Although it is true that when astringents are applied to the web of a frog's foot, under the microscope, the capillary vessels are seen to become constringed, and the muscular fibres contracted, it does not follow that they ever act in a similar manner after having been received into the blood. Indeed, if we correctly understand their modus operandi when locally applied, it seems impossible to conclude that they ever can do so, for it seems to be pretty well established that the phenomena they are seen to produce when thus used, are the result of the strong affinity of the astringent substance for water, which it therefore abstracts from the tissues with which it is brought into contact, the constringent effect seen being actually the result of a partial desiccation of the part. It seems legitimate to conelude, that when an astringent substance is taken into the stomach in a case of pulmonary or uterine hemorrhage, this affinity will be gratified long before the medicine reaches the pulmonary or uterine capillaries.

If an appeal is made to clinical experience to substantiate the assumption, that astringents do, despite these theoretical objections, control these hemorrhages by virtue of their astringency, no positive and unequivocal testimony is obtained. If it is maintained that there are many medicines-quinine for instance-whose precise mode of action is unknown, yet whose curative influence is positively established, the truth of the claim will be unquestioned; but to my mind, the same kind of evidence has never been presented in favor of this reputed curative action of astringents as has been in the case of quinine and some other medicines, and I am so fully convinced that careful observation and dispassionate judgment will lead to the conviction that a negative result will follow, when they are administered internally in cases of pulmonary and uterine hemorrhage, in so far as such effect must depend upon their astringency, I am willing to submit the case without further argument, simply stating that I never administer them, in the kind of cases I have been considering, in the hope of obtaining curative results from this power.

CASE OF APHASIA.

BY G. W. H. KEMPER, M. D., MUNCIE, IND.

On January 3d, 1869, I was called to see, in consultation with Drs. Jump and Kerr, Mr. Thomas Stanford, residing near New Burlington, in this county.

Mr. S., at the time of his death, was seventy-four years old. His life had been characterized by extreme vigor of body and mind. For several years he was a member of our State legislature, and at various times has held minor county offices.

During the latter part of last December, he noticed that he had some trouble about taking the proper length of steps in walking. Sometimes he would, contrary to his will, step too far, and at other times not far enough. He noticed this irregularity and spoke of it to his family, but nothing serious was anticipated, until Tuesday, December 29th, when he sat down to breakfast and commenced saying grace, but kept repeating the same word for some little time. Finally, his wife spoke to him and asked what was the matter. He replied, nothing, and exclaimed "how singular," and then proceeded to eat. During all this day, his memory of words would fail him, and he found much difficulty in making known his wants. Desiring a younger son to start to school, he said, "Go to-to-to-," and seemed puzzled that he could not finish the sentence. Some one said, "To school, father?" and he replied yes. On Wednesday morning, having some business to transact with a neighbor, he attempted to write a note, but kept writing the same word. He tried for half an hour, but was compelled to give it up, although an excellent penman.

At this period, Dr. Jump was called to see him, and found his condition as follows: No pain in any locality, pulse one hundred, full and regular, tongue furred, pupils unchanged, temperature normal, appetite good as usual, no paralysis nor even numbness. Dr. Jump prescribed a mercurial cathartic, to be followed with oil or a saline cathartic in four hours, if the bowels were not moved, a warm pediluvium with mustard, restricted diet, and potass. iod. in five grain doses three times a day. Dr. Kerr, a son-in-law, who lived some distance, came on Friday and remained with him until his death.

We saw him, in consultation, at twelve M., on Sunday, January 3d. His condition was similar to what it had been since Wednesday. He