In 142 cases of lead-poisoning, treated between 1852 and 1862 at the Jacob’s Hospital, Leipzig, forty-four patients (or about 31 per cent.) suffered from colic. Arthralgia—that is, pains in the joints—is also very common; it seldom occurs alone, but in combination with other symptoms. Thus, in seventy-five cases of lead-arthralgia treated at Jacob’s Hospital, in only seven were pain in the joints without other complications, fifty-six being accompanied by colic, five by paralysis, and seven by other affections of the nervous system. The total percentage of cases of lead-poisoning, in which arthralgia occurs, varies from 32 to 57 per cent.
Paralysis, in some form or other, Tanqueril[844] found in 5 to 8 per cent. of the cases, and noticed that it occurred as early as the third day after working in lead. The muscles affected are usually those of the upper extremity, then the legs, and still more rarely the muscles of the trunk. It is only exceptionally that the paralysis extends over an entire limb; it more usually affects a muscular group, or even a single muscle. Its common seat is the extensors of the hand and fingers; hence the expression “dropped-wrist,” for the hands droop, and occasionally the triceps and the deltoid are affected. The paralysis is usually symmetrical on both sides. Although the extensors are affected most, the flexors nearly always participate, and a careful investigation will show that they are weakened. If the paralysis continues, there is a wasting and degeneration of the muscle, but this is seen in paralysis from any cause. The muscular affection may cause deformities in the hands, shoulders, &c. Anæsthesia of portions of the skin is generally present in a greater or less degree. A complete analgesia affecting the whole body has been noticed to such an extent that there was absolute insensibility to burns or punctures; but it is usually confined to the right half of the body, and is especially intense in the right hand and wrist.
[844] Tanqueril des Planches, Traité des Maladies de Plomb, Paris, 1839. Tanqueril’s monograph is a classical work full of information.
§ 783. The older writers recognised the toxic effect of lead on the nervous system. Thus Dioscorides speaks of delirium produced by lead, Aretaeus of epilepsy, and Paul of Ægina refers to it as a factor of epilepsy and convulsions. But in 1830, Tanqueril first definitely described the production of a mental disease, which he called “lead encephalopathy.” This he divided into four forms—(1) a delirious form; (2) a comatose; (3) a convulsive; and (4) a combined form, comprising the delirious, convulsive, and comatose. Dr. Henry Rayner,[845] and a few other English alienists, have directed their attention to this question; and, according to Dr. Rayner’s researches, the number of male patients admitted into Hanwell Asylum, engaged in trades such as plumbing, painting, and the like, is larger in proportion to the number admitted from other trades than it should be, compared with the proportion of the various trades in the county of Middlesex, as ascertained from the census. Putting aside coarse lead-poisoning, which may occasionally produce acute mania, the insanity produced by prolonged minute lead intoxications possesses some peculiar features. It develops slowly, and in nearly all cases there are illusions of the senses, of hearing, taste, or smell, and especially of sight. Thus, in one of Dr. Rayner’s cases the patient saw round him “wind-bags blown out to look like men,” apparitions which made remarks to him, and generally worried him. Besides this form, there is also another which closely resembles general paralysis, and, in the absence of the history, might be mistaken for it.
[845] See an important paper, “Insanity from Lead-Poisoning,” by Drs. H. Rayner, Robertson, Savage, and Atkins, Journ. of Mental Science, vol. xxvi. p. 222; also a paper by Dr. Barton, Allgemeine Zeitschrift für Psychiatrie, Bd. xxxvij. H. 4, p. 9.