Two Cases of Aneurism of the Abdominal Aorta; One Cured by the Administration of Iodide of Potassium, the Other by Arterial Compression
Authors: G. H. Philipson
Journal: BMJ (1878)

DURING the year I876, two hundred and sixty-seven patients were admitted at the Newcastle-upon-Tyne Infirmary, under my care, of whom one hundred aiid eighty-three were in-patients and eighty-four were out-patients.Of the whole number, four were suffering from aneurism ; one of the arteria innominata, and three of the abdominal aorta.Of the three cases of abdominal aneurism, I propose giving the particulars of two ; the third patient was only eight days in the hospital.For comparison, therefore, this case is of little value, and, consequently, will not be recounted.CASE I.-Robert R., aged 26, labourer, married, living at Crook, in in the county of Durham, was admitted on June 8th, 1876.He stated that he had been unable to follow his employnIent for nine weeks, in consequence of pain in the back, which pain was severe and passed round the abdomen to the region of the umbilicus, where, at times, it was excruciating.Upon carefully examining the abdomen, a faint pulsatile prominence was seen near the umbilicus, at which situation, upon placing the hand flat, yet firmly, a pulsation was felt, more to the left of the umbilicus, which pulsation was expansile in character.At the spot where the pulsation existed, there was dulness upon per- cussion, and a blowing systolic murmur was heard.Upon auscultating the left vertebral groove, a distinct systolic murmur was heard.The respiration, over the whole of the chest, was of natural frequency and character.The lheart-sounds were normal.He was of sanguineous temperament, and in good nutrition.He had no knowi ledge of having sustained a fall, blow, or strain, and denied ever having suffered from syphilis.The case was regarded as one of aneurism from the follow- ing physical signs: the pulsation visible, perceptible, and expansile; the dulness upon percussion; and the murmur heard at the site of the pulsation in the abdomen and in the left vertebral groove.And further, it was inferred that the aneurism was of the abdominal aorta, from the situation of the pulsation, and of the variety, lateral, sac- culated, and not peripheric, dilating, from the pulsation and the dulness being to the left of the umbilicus.The patient was selected for the clinical medical examination for degrees in Medicine of the University of Durham.The diagnosis was confirmed by my colleague Dr. Arnison.The patient was ordered to maintain the horizontal position in bed, to take ten grains of the iodide of potassium in one ounce of water three times each day, and to have the ordinary meat diet.June 15th.Of his own accord, he mentioned that he was sensible of a beating in his abdomen, and that he had experienced a beating for fully six weeks previous to his admission.The iodide of potassium was increased to fifteen grains.June 24th.The pulsation was decidedly less forcible.The iodide was increased to twenty grains.July Ist.Ile still complained of pain in the back and round the abdomen.The pulsation was less expansile.No murmur was heard.The iodide was increased to twenty-five grains.July 8th.There were still paroxysms of pain, accompanied with difficulty in micturition.The iodide was increased to thirty grains.July 15th.The pain was less severe, more continuous.Upon care- ful palpation, scarcely any pulsation was felt.The iodide was in- creased to thirty-five grains.July 22nd.There was now very little pain.The iodide was increased to forty grains.July 29th.No pulsation was visible or perceptible; no murmur.August 12th.As no pulsation had returned, or murmur was to be heard, the patient was permitted to leave his bed for a portion of the day.The iodide of potassium was continued in doses of forty grains.The condition of immunity from pulsation and from murmur con- tinued, and he left the hospital on October 7th, 1876, to resume his occupation.He was instructed to preseilt himself after an interval of two months, which he did on December 20th, I876, when after very careful examination, no pulsation was detected, nor was any murmur heard.He expressed himself as feeling well, free from pain, and had been able to continue at work as a general labourer.CASE II.