This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
This medicine is much used for the general purposes of the astringents. In consequence of its combination of sedative with astringent properties, it will frequently act very efficiently in the relief of inflammation, when brought directly into contact with the surface affected; and it is to this agency that much of its therapeutic value is to be ascribed I shall first treat of its internal, and subsequently of its external or local use.
1. Internal Use. The hemorrhages are among the complaints in which it is most useful. Its sedative property gives it a great advantage in these affections, especially when of the active kind, over other astringents, which, being somewhat, however slightly, stimulant, cannot always be employed with propriety in the early stage. Acetate of lead may always be given when the indication exists to suppress the discharge. But, from the facility with which lead is absorbed, the medicine is peculiarly adapted to those cases in which the affected part can be reached only by the medium of absorption and circulation. When the seat of the hemorrhage is such that the astringent can be directly applied to it, alum is probably more efficient as a mere hemostatic. Such are the cases of hemorrhage from different parts of the alimentary canal. Hut in hemorrhage from the lungs, acetate of lead is preferable to all other astringents, and is very much used. In hemorrhage from the kidneys, and from the uterus, it is also one of the best remedies. In the former, I have seen it promptly effectual, and would strongly recommend it. In all these cases, but especially in haemoptysis, it should generally be combined with a little opium to prevent irritation of stomach, and with ipecacuanha if there is febrile excitement, without nausea or a tendency to it. The opiate is peculiarly indicated in the pulmonary affection, from its effect in quieting the cough. About one-sixth of a grain of opium, and an equal or double quantity of ipecacuanha, may be combined with each dose of the acetate. Though, as above stated, alum is probably more effectual in haematemesis and intestinal hemorrhage, yet the salt of lead is frequently employed in these affections, and not without advantage. It should in these also be combined with opium.
In certain conditions of diarrhoea, this medicine is very useful. I do not think it adapted to the acute form of the disease, attended with inflammatory excitement; but rather to chronic cases with copious and exhausting discharges, with or without ulceration of the small intestines; and I have also found it extremely useful in certain cases, whether recent or of long standing, in which, without evidences of inflammation, the evacuations are very copious, and of a whitish gruellike appearance from the absence of bile. In these latter cases, it should be given in combination with small doses of calomel and opium, and frequently repeated.*
In epidemic cholera, with exhausting rice-water discharges, the above-mentioned combination is, I think, the most efficacious which can be employed; but the urgency of the danger in this case demands larger doses than simple diarrhoea; as it is of the utmost importance to produce a prompt impression.
The advanced stages of cholera infantum may sometimes be treated advantageously with this astringent. It may be tried in all obstinate cases of the disease, in connection with opiates, and with a little calomel or blue mass when bile is wanting in the passages. Occasionally it has been found efficient, not only in arresting the diarrhoea, but also in correcting the irritable stomach of this disorder, probably by an antiphlogistic influence on the gastric mucous membrane.
It is the same antiphlogistic action which has recommended it in dysentery, in the treatment of which it is highly esteemed by some. Its use in acute dysentery originated with the late Dr. Richard Harlan, of Philadelphia; and has found many advocates. I confess, however, that my experience with it, in the ordinary forms of this affection, does not accord with theirs. It no doubt appears to act favourably in some cases; but I have often met with others, in which, after an employment of several days, it has increased the griping and uneasiness of the patient, without any beneficial influence over the disease, and in which the symptoms have speedily subsided, under proper treatment, after its omission. But in chronic cases, with rather copious discharges, it is often useful. I shall have occasion directly to refer to a condition of dysentery, in which it may be employed as an injection with the greatest advantage. As in other bowel affections, it should in this also be associated with opium.
*The following formula may be used.
Plumbi acetat., gr. vj ; Hydrarg chlorid. mit., Opii pulv., āā gr. j; Acaciae pulv., Syrup, āā q. s. Mix, so as to form a mass, to be divided into six pills, of which one may be taken every half hour, hour, or two hours, according to the urgency of the case.
In reference to its antiphlogistic effects, acetate of lead has been used with great supposed advantage in pneumonia, especially in the old, and in other cases in which bleeding has been sufficiently employed, or may be contraindicated. (L'Union Medicate, No. 82.) But pneumonia so often ends in recovery under any treatment, that reports of the efficacy of one or another remedy must be received with great hesitation.
Excessive sweating, exhausting diuresis, copious mucous or purulent discharges from the respiratory and urinary passages, and abundant suppuration, from whatever source, have been considered as offering indications for the astringent influence of acetate of lead. In phthisis it has been recommended for the night-sweats, the muco-purulent expectoration, which is sometimes exhaustingly copious, and the diarrhoea, either severally or conjointly. As to the night-sweats, I think they are, in general, more effectually and more safely controlled by other means, less calculated than acetate of lead to disturb the digestive process, which it is all-important to sustain. The same remark is applicable to the expectoration. In these affections, therefore, separately, I would not advise the remedy; but, when they exist in combination with obstinate diarrhoea, and a chronic sub-inflammatory condition of the gastric mucous membrane, the indication for its use, in reference to the latter conditions, is perhaps strengthened by the possible benefit which may be hoped for from it, in reference to the former.
Obstinate mercurial salivation is said to have yielded to the internal use of this remedy; but its local application is preferable.
In yellow fever, acetate of lead was strongly recommended by the late Dr. Irvine, of Charleston, S. C. It is only in the second stage, after the subsidence of the first long febrile paroxysm, that the remedy should be employed. At this period, with greatly reduced powers of system, and probable depravation of the blood, there is usually phlogosia of the gastric mucous membrane, with a tendency to prostrating hemorrhage, in the form either of unaltered blood or black vomit. Should the blood be fatally depraved, no medicine could save the patient; but in doubtful cases, where a slight impression might turn the scale in the favourable direction, it seems reasonable to expect benefit from a medicine, calculated, by contracting the vessels, and exercising a sedative influence on the nerves, at once to correct the inflammation and obviate the hemorrhage. I have, myself, used the acetate of lead under these circumstances, in a few instances, and in all with favourable results. In one case, there was an appearance, in the evacuations from the stomach, of commencing black vomit. Two grains should be given, with a little opium, every two hours, and continued until thirty-six or forty-eight grains have been taken, or until the dangerous period is past, unless some unpleasant effect of the medicine should be previously experienced. I would repeat, that the acetate is not to be used until the first febrile symptoms have begun to subside, which is usually on the second or third day.
In enteric or typhoid fever, acetate of lead would seem to be indicated as an alterative and antiphlogistic remedy for the diseased state of the mucous membrane of the ileum. Hence, it has been recommended in this affection by the German practitioners. In this country, it has been employed very successfully by Dr. John L. Atlee, of Lancaster, Pa., who gives it in doses of from one to three grains every two, three, or four hours, commencing, after having first evacuated the bowels by a mild cathartic, and persevering so long as the enteric symptoms continue. I cannot speak of the remedy from experience, having never used it in this complaint.
In the irritable stomach of bilious fever, and in other cases of obstinate vomiting, the medicine has been employed with supposed advantage; though it might be difficult to say, in many instances of this kind, how much was due to the acetate, and how much to the opium usually given along with it.
Aneurisms of the aorta and of other large internal vessels have been treated with some advantage by acetate of lead. Introduced into use originally in Germany, the practice was imitated by Dupuytren and others in France; and I have myself tested its efficacy in some degree in this country. The astringent and sedative influence of the preparations of lead would seem to be indicated in this affection; and several instances are on record in which the tumour has very much diminished in size under the use of the acetate. (Arch. Gen., 3e ser., v. 443.) In one of several cases in which I employed it in the Pennsylvania Hospital, an aneurismal tumour, which showed itself projecting from the thorax near the left sterno-clavicular junction, underwent a marked diminution, and became at length scarcely perceptible; but the patient left the house before any definitive result was obtained. I am not aware that any satisfactory case of a complete cure by this remedy has been reported. Indeed, considering the condition of the coats of the vessels in internal aneurism, altered as they generally are by atheromatous deposit, cartilaginous or bony degeneration, or other organic affection, a cure by this measure would be in most cases impossible; and, even when no insurmountable difficulty of this kind might be in the way, few constitutions would probably be found to tolerate, and few patients to submit to the long-continued and persevering use of the medicine which would be necessary to success. The plan is to give six or eight grains of the acetate daily, in doses of one or two grains, at equal intervals, and to continue until nausea or griping pains in the bowels, or other symptoms of lead-poisoning are exhibited; then to suspend the remedy until these symptoms have subsided; after which it is to be resumed; and thus alternately, until the end aimed at is effected, or found to be unattainable.
Simple enlargement of the heart, independent of disease of the valves, would seem to offer quite as good a chance of success, under this treatment, as internal aneurism. I have employed it in cases of this kind; and, in one of great cardiac dilatation in a boy, found the dimensions of the heart, as indicated by percussion, to diminish considerably. What finally became of the case I do not know; as the patient passed from under my care in the midst of the treatment.
Acetate of lead has been used in various nervous diseases, as epilepsy, hysteria, hooping-cough, and even tetanus; but few would at present expect from it any very material benefit in these affections. I remember to have seen somewhere an account of a case of hydrophobia which had ended favourably under its use; but there can be little doubt that the disease was mistaken.