Page:The American Cyclopædia (1879) Volume X.djvu/253

 LEAD 247 refers to the centre of the abdomen. The bowels are obstinately constipated; there is constant pain in the belly, aggravated in par- oxysms, and relieved or not increased by pres- sure. The walls of the abdomen are hard and sometimes retracted ; there is often nausea and vomiting; dysury is sometimes present, and the patient is exceedingly restless, sleepless, and anxious. Notwithstanding the gravity of the symptoms, the tongue is clean or but slightly coated, the skin cool, the pulse regular, and perhaps a little slower than natural. Left to itself, the disease is of uncertain duration, but under proper treatment it is ordinarily sub- dued in a few days ; the patient, however, is subject to relapses, and when he remains ex- posed to the original cause of the complaint, the colic gradually becomes complicated with palsy, or perhaps it is terminated by a fatal affection of the brain. Where death has taken place, post-mortem examination shows no spe- cial lesion ; but in this as in other varieties of lead poisoning, chemical reagents detect the presence of the metal in the blood and the tis- sues of the body. The following treatment adopted at Guy's hospital, London, where nu- merous cases of the disease are received, was contributed to Percy's " Metallurgy of Lead " by Dr. Owen Rees: "In the majority of cases an ounce of castor oil mixed with 10 drops of laudanum is given twice daily, and large hot poultices of linseed meal are applied to the belly. At night a draught, consisting of 40 drops of Battley's sedative solution (liquor opii sedativus) in camphor mixture, is pre- scribed, if the bowels have been acted upon by the oil taken during the day. In severer cases, accompanied with tenderness of the belly and retching, bleeding from the arm to the amount of 16 or 20 fluid ounces may be prac- tised with advantage when the patient is young and strong. Pain and spasm are thereby very quickly allayed ; and the stomach often loses its irritability and immediately afterward re- tains food and medicine. Where the patient is less robust, the application of 15 or 20 leeches to the belly followed by a warm poultice has been found to produce much relief. Castor oil with Battley's sedative solution is also given as in other cases. Clysters of this oil may be re- sorted to when the stomach is too irritable to retain medicine ; and in all cases a pint of warm gruel injected into the rectum greatly soothes the patient." Mr. Williams states that accord- ing to his experience "no relief is obtained unless the patient is kept under the influence of opium for a few hours before giving purga- tives and clysters ; that while the spasm lasts the use of purgatives is futile, even clysters of castor oil being expelled without being soiled by faacal matter or tainted by faecal odor ; that he begins his treatment by administering a dose of three or four grains of opium, and that in severe cases he has not seen any soothing effect from the injection of warm gruel into the rectum." In lead arthralgia, besides the gen- eral symptoms of chronic poisoning, the pa- tient suffers from paroxysms of sharp, dart- ing pains, commonly in the limbs, but some- times in the trunk ; these pains do not follow the course of the nervous cords, and they are increased by motion and diminished by pres- sure. In the intervals of the paroxysms the patient suffers from a sense of fatigue and constriction in the affected parts. Sulphur baths given daily for seven or eight days form the most efficient method of treatment. It would seem, according to the experiments of M. Mel sens, that iodide of potassium adminis- tered internally has the power of eliminating lead from the system in cases in which it exists ; and Yalleix has found this remedy particularly efficacious in lead arthralgia. It may be given in doses of from 6 to 10 grains three times a day. Lead paralysis is very rarely general; commonly it is confined to either the upper or lower extremities, and in these to one system of muscles. In five cases out of six the upper ex- tremities alone are affected, and the paralysis is limited to the extensor muscles of the hand and wrist, the hand remaining permanently flexed, giving rise to the "dropped wrist." The muscles have lost their contractility, be- come wasted, and in bad cases after death look pale and as if converted into fibrous tissues. Often the paralyzed parts have more or less lost their sensibility; sometimes this loss of sensibility (lead anaesthesia) occurs independent of paralysis of movement. Lead palsy is rare- ly a primary affection, lead colic or arthralgia commonly preceding it. Its progress is slow, and in well marked cases the results of treat- ment are somewhat uncertain. The internal use of iodide of potassium for the purpose of eliminating the poison, the employment of small doses of strychnia, of electricity, and of friction to stimulate the injured muscles, are the means most to be relied upon. In all cases the disease is chronic, and the treatment requires to be persevered in for a long time. Lead en- cephalopathy, brain affection produced by lead, is happily the rarest of the forms of lead poi- soning. In a few cases the patient is attacked suddenly and without warning; but in the majority of instances, after the symptoms char- acteristic of the effect of lead upon the system are already well marked, and often after colic has supervened, the patient is attacked with headache, vertigo, sleeplessness or somnolence, frequency of pulse, and stiffness or pains in the limbs. The disease may now assume one of three forms. He may be suddenly attacked by a delirium, which in some cases is mild and tranquil, in others serious, the patient being dangerous to himself and others. In other cases he is seized with epileptiform or epilep- tic convulsions, in the intervals between which he only partially recovers the use of his intel- lect, remaining stupid and confused. Both these forms are apt to terminate in coma. In a third the patient is comatose or deeply som- nolent from the commencement, neither delir-