Lead poisoning and lead absorption

by Sir Thomas Morison Legge; Kenneth Weldon Goadby

In chronic nephritis treatment should be along the ordinary lines and the same remark applies to enlargement of the liver.

Heart.

—Symptoms due directly to disease of the heart are rarely caused by lead alone. The heart muscle may suffer in the same way as the other muscles of the body, and in lead poisoning in animals distinct hæmorrhages are found between the muscular fibres in the heart muscle, and it is therefore probable that a form of myocarditis may exist in lead poisoning. This, together with the increased arterial tension, may cause dilatation, but the symptoms are those related more to the general condition of arterio-sclerosis than to any direct heart lesion, and as a rule these symptoms do not call for any special treatment.

Treatment of Nervous Manifestations in Lead Poisoning.

—With one or two exceptions, the diseases of the nervous system associated with lead intoxication only appear when actual lead poisoning is established. Certain evidences of affection of the nervous system are occasionally seen in the prodromal stage, or stage of lead absorption. These may be merely temporary and disappear often under treatment, by change of employment and reduction in the quantity of lead absorbed. Thus, dilatation of the pupils—the reaction to light being extremely sluggish or absent—is often a feature of the later stages of the condition of lead absorption. Tremor may also be a symptom, the outstretched hands exhibiting a fine undulatory movement, often increased on attempting to perform some act such as touching the nose, or touching the two fingers together, and when these symptoms occur they must always be regarded as of somewhat grave import. But it must be remembered that tremor may occur as a common complication of alcoholic cases, and further, follows excessively hard manual work, though there is usually little difficulty in distinguishing between the various forms.

The symptomology of nervous diseases associated with lead poisoning has already been carefully set out in [Chapter IX.], and the pathological changes underlying these symptoms in [Chapter V.]

Of the general treatment, little needs to be added to what has already been stated for the treatment of lead anæmia and general lead intoxication. Iron and arsenic (not strychnine, especially in presence of colic), and other similar drugs, should be employed together with iodides either as potassium iodide or as an injection in the form of an organic compound, of which there are several varieties on the market.

The injection of normal serum has been advised, as well as saline injections, and in some instances venesection has been practised, but it is doubtful whether anything is to be gained by this form of treatment.

Further, it has been stated that some lead is excreted through the skin, and for this reason sulphur baths, bathing in sulphuretted hydrogen water, etc., have been recommended to neutralize any lead that has gained access to the skin. Serafini[10] has claimed that by means of electrolytic baths a certain amount of lead can be found present in the water after continuous passing of a current, and it has been supposed by these observers that the lead has been actually driven out of the body under the action of the electric current. It is, of course, possible that such lead as is discoverable in the water was merely that which had already become incorporated with the patient’s skin through mechanical contact.

Whatever form of treatment be adopted of a general type, the patient must certainly be removed from the chance of any further lead absorption; a person who is suffering from wrist-drop or other form of paresis should not be employed in any portion of a lead works where he may come into contact with any form of lead or its compounds for at least a year after the paresis has disappeared, and even then it is inadvisable for such a person to return to any form of dangerous lead work.