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.
In those cases of thoracic and abdominal aneurism, in which surgical treatment is impossible or highly dangerous, the clinical results obtained by iodide of potassium should not be ignored. Nelaton recorded marked relief to the signs and symptoms of an innominate aneurism under the use of this remedy, which he gave empirically at the request of the patient; and Bouillaud, following up this clue, obtained good results in aneurisms of the carotid and thoracic vessels (Medical Times, i., 1859).
Chuckerbutty, in Calcutta, published three cases relieved, in one of which the aneurism was already projecting through the sternum when the drug was commenced, and Dr. W. Roberts and Mr. Windsor recorded some equally striking results about the same time (British Medical Journal, ii., 1862; i., 1863).
It is, however, to Dr. Balfour that we are most indebted for drawing professional attention to this subject (Edinburgh Medical Journal, 1868-1869). He summarizes 15 cases, all of which, save one, were relieved, and in 12 the external tumor was actually lessened and the sac partly consolidated. In one of his earliest patients the bulging, which was evident between the second and third ribs, disappeared after a few weeks' treatment with 30-gr. doses thrice daily, and this dose was continued for nine months "without any unpleasant symptoms," but with complete subsidence of aneurismal suffering. The same man had not improved under previous doses of 20 gr., and Dr. Balfour points out the importance of pressing the drug to saturation before considering it inert. It is very quickly eliminated - large doses within two or three days - and many of his patients took 20 to 30 gr. several times daily. In a few, coryza and headache were quickly induced, and 5 gr. only were tolerated, but, as a rule, no worse symptoms were caused by large than by small doses. Additional evidence in favor of this treatment has been furnished by Dr. W. Roberts, Dr. Shapter, and others (Medical Times, 1874; British Medical Journal, 1873-74), and recently Dr. Philipson has reported a cure of an abdominal aneurism (British Medical Journal, i., 1878).
It seems to me no argument against such cases to say, with Dr. Bristowe, that any remedy which coagulates the blood in an aneurismal sac must tend to coagulate it elsewhere, and is therefore inadmissible; or to note with Mr. Holmes that aneurism may sometimes develop in patients already under the influence of iodide (Medical Times, i., 1872). This is only saying that the remedy is not infallible, and that its mode of action, whether on the composition or vital condition of the blood (Chuckerbutty, Roberts), on the nervous system (Balfour), or on the walls of the sac, is not yet clear. I have myself seen remarkable advantage from its use, and suggest, in addition to the above explanations, a possible anti-syphilitic effect - for the occasional connection of syphilis and aneurism is sufficiently proved by modern research.
Since the observations of Dupuytren, who reported three cases of aortic aneurism relieved by lead acetate (together with small bleedings and rest), this remedy has been tried by many physicians. Dr. Owen Rees reported a case of acute popliteal aneurism (Lancet, i., 1865), with thin walls, and no coagula in the sac, which did not improve under pressure, and was thought incurable without operation; on October 29th, 3 gr. of acetate with opium were ordered thrice daily, the diet was not restricted, nor rest enforced: on November 1st, there was a slight blue line on the gums: on November 5th, the dose was increased to 5 gr., and this was continued for twenty-six days, when the remedy was stopped on account of colic: aneurismal pulsation had ceased. On December 31st the man was at work, and on January 17th reported cured. This rather striking instance I have not found supported by the results of others, though Dr. A. Clark reports a case of thoracic aneurism in which 2 gr. of acetate with opium were given thrice daily for two months, and the patient got better; he was kept constantly at rest (Medical Times, ii., 1867, p. 566). Stille remarks that the sacculated form of aneurism can only be cured by coagulation of blood in the sac, and in so far as acetate of lead promotes this, it assists a cure, but in the fusiform aneurism, with symmetrical distension, no mere astringent can exert a salutary power. Bellingham objects to the use of lead in any case, and Mr. T. Holmes, who has known aneurism develop during the course of a lead colic, asserts that the acetate is of no real value in the treatment of the malady (Lancet, i., 1872). Dr. Bristowe points out that it may help to quiet the circulation, but cannot really coagulate blood within the vessels, otherwise its administration would lead to danger from thrombosis or embo-lism. From a general review of the evidence at present before us, I should conclude that although individual cases of apparent benefit may be cited, as a rule very little can be expected in aneurism from the use of lead.