In both these instances the disorder excited partook very much of the character of the spasmodic colic which is caused by the gradual introduction of lead into the body; and in the last the whole course of the man’s illness was very like that of the worst or most acute form of colica pictonum. But in another example which came under my own notice, the symptoms were more nearly those of ordinary irritation,—namely, vomiting, burning, and pricking pain in the throat, gullet, and stomach, with trifling colic subsequently; but the patient recovered in two or three days. The quantity taken was supposed to exceed a quarter of an ounce. So, too, in a case which occurred to M. Villeneuve of Paris, the symptoms were chiefly vomiting and purging, with faintness and some convulsions. His patient swallowed intentionally above an ounce of acetate of lead in solution. Sulphate of soda and sulphate of magnesia were given promptly as antidotes; in an hour the symptoms had abated materially; and next day she was well.[[1318]] This was the case in which Orfila found lead in the urine. Of the same nature, also, are two cases briefly alluded to by Mr. Taylor, as having been caused in London in 1840 by Goulard’s extract. The subjects, who were children, were seized with vomiting, purging, and other symptoms like those of Asiatic cholera; and both died within thirty-six hours.[[1319]]
In another instance, related by Mr. Iliff of London, where an ounce of the acetate was accidentally swallowed in solution, the symptoms were at first colic pains and vomiting, in the course of a few hours vomiting and tenderness, and, after these symptoms receded, a peculiar state of rigidity and numbness, which was not entirely removed for several days. In this case no remedies were used for three hours; and even two hours later, when the stomach-pump was resorted to on account of the slightness of the vomiting, lead was found in the first fluid withdrawn,—a new proof of the feeble action of acetate of lead, compared with some other metallic poisons.[[1320]]
So much for the operation of the acetate of lead in large doses. Physicians, however, are much better acquainted with the effects of lead when introduced in the body continuously and insidiously in minute quantities. For all tradesmen who work much with its preparations are apt to suffer in this way, and many other persons have been brought under its action in consequence of articles of food and drink being impregnated with it. The disease which is thus induced may be divided into two distinct stages.
The first stage is an affection of the alimentary canal, the leading feature of which is violent and obstinate colic. This symptom at times begins abruptly during a state of sound health; but much more commonly it is ushered in by a deranged state of the stomach, not unlike common dyspepsia, seldom so severe as to excite alarm, and commonly imputed at first to a wrong cause. There is general uneasiness and depression, a dingy yellowish complexion, weakness and numbness in the limbs, a sweetish styptic taste and fetid breath, a slaty tint of the teeth and gums, with a blue line along the margin of the gums where they touch the teeth, a slow hard pulse, great emaciation, loss of appetite and tendency to indigestion. This state, which was first well characterized by Mr. Wilson[[1321]] of Leadhills, and has lately been more fully described by M. Tanquerel,[[1322]] is of great moment as apprizing the workman of the necessity of taking active measures for preventing the more formidable effects, which otherwise are sure to follow. Of the warning symptoms none is so invariable or so characteristic as the blue line along the edge of the gums, an appearance which was first noticed by Dr. Burton of St. George’s, London,[[1323]] and has been since observed in every case of lead colic, whether impending or present.—If alarm be not taken in time, the obscure complaints hitherto mentioned become attended by and by with uneasy sensations in the stomach, stretching ere long throughout the whole belly. At the same time the stomach becomes irritable, and the food is rejected by vomiting. Cramps in the pit of the stomach then arise, and extend to the rest of the belly, till at length the complete colic paroxysm is formed. The pain is sometimes pretty constant; sometimes it ceases at intervals altogether; but much more commonly there are remissions rather than intermissions; and it is remarked that both the remissions and exacerbations are much longer than those of common colic. The pain is very generally, yet not invariably, relieved by pressure; even strong pressure seldom causes any uneasiness, provided it be not made on the epigastrium; nay, some patients have been known to bear, with relief to the paroxysms, the weight of two or three people standing on the belly.[[1324]] The belly is almost always hard, the abdominal muscles being contracted: sometimes it is rather full, more commonly the reverse, and the navel is often drawn in so as almost to touch the spine. The bowels all the while are obstinately costive. Either there is no discharge from them at all; or scanty, knotty fæces are passed with much straining and pain. This state, long supposed to depend on spasm, is now known to arise on the contrary from paralysis, of the intestinal muscular coat. In a few instances diarrhœa takes the place of the opposite affection. The urine is commonly diminished. The saliva has been described as greater than natural in quantity and bluish in colour; but Dr. Burton says he did not observe a single instance of this in forty cases which he carefully examined. From the beginning, or more generally after a few hours or days, the limbs are racked with diffuse cutting pains; which, according to Tanquerel, affect chiefly the limbs, especially near the joints, are worst at night, are often attended with cramps, and are relieved by pressure. The aspect of the countenance is dull, anxious, and gloomy: in advanced cases the expression of gloomy anxiety exceeds that of almost all other diseases. It appears from the latest works on this disease published in France, and particularly from the able treatise of Mérat, that the pulse is rarely accelerated, but on the contrary often retarded.[[1325]] This does not accord with the experience of some earlier writers;[[1326]] and in the few cases I have seen in this city the pulse has been always frequent. It cannot be questioned, however, that, as Mérat states, fever is not essential. The skin has a dull, dirty, cadaverous appearance, is often, though not always hot, and in either case is bedewed with irregular, clammy, cold perspiration.
This, the first stage of colica pictonum, may end in three ways. In the first place, the patient may recover at once from it as from an ordinary colic; and it is consolatory to know, that a first attack, taken under timely management, is for the most part easily made to terminate in that favourable manner. In such circumstances it rarely endures beyond eight days. But it is exceedingly apt to recur, if, for example, the patient expose himself to what in ordinary circumstances would cause merely a common colic or diarrhœa; and if he returns to a trade which exposes him again to the poison of lead, the disease is sure to recur sooner or later, and repeatedly, unless he observes the greatest precautions. In one or other of these returns, sometimes even in the first attack, the colic is not succeeded by complete recovery, but gives place to another more obstinate and more alarming disease. This secondary affection is of two sorts. One, which occurs chiefly in fatal cases, is a species of apoplexy. The other, which does not of itself prove fatal, is partial palsy.
In violent and neglected cases of colica pictonum, the colic becomes attended in a few days with giddiness, great debility, torpor, and sometimes delirium; as the torpor advances the pains in the belly and limbs abate; at length the patient becomes convulsed and comatose, from which state very few recover. Tanquerel, who is unnecessarily minute in subdividing the various affections produced by the poison of lead, distinguishes four kinds of affections of the head, coma, epilepsy, delirium, and a combination of all these.[[1327]] A very rare termination allied to that now described is sudden death during the colic stage, without any symptom which would lead one to suspect its approach. A case of this kind has been related by M. Louis. His patient, five minutes after talking to the attendant of his ward, was found at his bedside in the agony of death; and no cause for so sudden a death could be found on dissection.[[1328]] Somewhat similar was a case which occurred in 1838 at the hospital of La Charité at Paris. A man labouring for three days severely under the colic stage of the disease, began to breathe stertorously soon after straining at stool, and died in three hours.[[1329]] In a case which occurred to Dr. Elliotson death was owing to concomitant perforation of the stomach, a concurrence which was probably accidental, but which was also once observed by Dr. Copland.[[1330]]
In cases, on the other hand, which have not been neglected, and particularly when the attack is not the first, the departure of the colic often leaves the patient in a state of extreme debility, which by and by is found to be a true partial palsy, more or less complete. This affection is sometimes present before the colic departs, but is apt to escape notice till the pain abates. Occasionally it supervenes on a sudden, but more generally it is preceded by a sense of weariness, numbness and tremor of the parts. The palsy is of a peculiar kind. It affects chiefly the upper extremities, and is attended with excessive muscular emaciation. The loss of power and substance is most remarkable in the muscles which supply the thumb and fingers; and in every case which I have seen the extensors suffered more than the flexors. The paralysis is hardly ever complete, except perhaps in the extensors of the fingers. When it is considerable, the position of the hands is almost characteristic of the disease. The hands are constantly bent, except when the arms hang straight down by the side; they dangle loosely when the patient moves; he cannot extend them, and raises one arm with the aid of the other. The palsy is attended, according to Tanquerel, with diminished heat in the parts, and feeble pulsation in the arteries which supply them. There is seldom any loss of sensation in the affected parts. But the paralysis sometimes affects the nerves of the other senses. Thus two cases of paralysis of the nerves of vision have been related by Dr. Alderson of Hull;[[1331]] and Tanquerel says this affection is not uncommon in Paris, and is attended with dilated and immovable pupils. The latter author also once met with deafness in the same circumstances.—Patients affected with lead palsy usually complain of racking pains in the limbs and arms, digestion is feeble, and trivial causes renew the colic. From this deplorable condition it is still possible to restore the sufferer to health, chiefly by rigorous attention to regimen. But he too often dies in consequence of a fresh attack of colic as soon as he returns to his fatal trade.
The lead palsy, however, does not always come on in this regular manner. Sometimes the primary stage of colic is wanting, so that the wasting of the muscles and loss of power are the first symptoms. I have seen a characteristic example of the kind in a sailor who had been employed for a month in painting a vessel. He had great weakness and wasting of the arms and hands, particularly of the ball of the thumb; but except a tendency to indigestion, costiveness, and transient slight pain of the belly, he had suffered no previous disorder of the intestines. I have seen the paralytic affection confined to the extensors of one hand in a compositor, and Dr. Chowne met with a similar affection of both hands in a gas-fitter.[[1332]] Dr. Bright observed palsy without colic in the case of a painter three times in the course of seven years.[[1333]]—In like manner, according to Tanquerel, the neuralgic affection may occur severely without any precursory colic; and the same author has witnessed both coma and convulsions in the same circumstances.
Colica pictonum, with the collateral disorders specified above, is the only disease which has been distinctly traced to the operation of lead insidiously introduced into the body. But many other disorders have been ascribed to its agency. Boerhaave seems to have imagined that consumption might be so induced; and Dr. Lambe thought that to this cause may be traced the increased prevalence of “scrofula, phthisis, dropsy, chronic rheumatism, stomach complaints, hypochondriasis, and the host of nervous complaints which infest modern life.”[[1334]] These conjectures are wholly destitute of foundation in fact.
In whatever form lead is habitually applied to the body, it is apt to bring on the train of symptoms mentioned above;—the inhalation of its fumes, the habitual contact of any of its compounds with the skin, the prolonged use of them internally as medicines, or externally as unguents and lotions, and the accidental introduction of them for a length of time with the food, may sooner or later equally induce colica pictonum.