Lead poisoning and lead absorption

by Sir Thomas Morison Legge; Kenneth Weldon Goadby

The electrical treatment of the injured nerves and muscles should be undertaken energetically; both the galvanic or faradic currents may be used. Probably the best form is the galvanic. A small medicinal battery may be utilized, the method of application being as follows: One pole of the battery should be placed over the affected muscle, and the other pole placed in a basin of water into which the patient’s hand is dipped. The current should then be passed. It is better not to use a current of too great intensity, particularly at the start, although it is found in practice that a much greater current can be borne in the early stages of the treatment than when the muscles and nerves commence to recover. As a rule the patient experiences no inconvenience whatever from a considerable current during the first week of his affection, but at the end of a fortnight or three weeks less than one-third of the initial current can be borne. The current should not be passed continuously, but should be used for a short time and then shut off, being again switched on for five or six minutes, and then again shut off. The applications may also be modified by placing one hand in the vessel of water and stroking the affected muscle and nerve with the free electrode. The application of the current should be for not more than half an hour at a time, and may be applied twice in the twenty-four hours. It is quite easy to instruct the patient to perform the electrical treatment for himself in this manner when the paresis is affecting either the upper or lower extremity.

With the faradic current the circuit should be closed while the current is at a minimum, and then the quantity of current raised to some 15 to 20 milliampères.

For affections of the lower extremity the application may be made by means of one of the usual baths in which the foot is immersed, the other electrode being placed on the back or other suitable position. If both the lower extremities are involved, then both feet should be placed in a bath into each of which the source of electricity is connected.

Ionization by means of the faradic current may also be made use of. For this purpose one of the halogens, preferably iodine or chlorine, should be used, it being remembered that chlorine and iodine ions enter from the negative pole, so that in such a case the bath in which the affected limb is placed must be connected with the negative pole of the battery.

Subsequently, with either form of electrical treatment, the part should be well rubbed, and passive movements as well as massage are an advantage in promoting the return of normal function. As the muscles gradually return towards their normal state, graduated muscular exercises should be used.

When treated in the first week or two of the onset, lead paresis frequently recovers, and in a person suffering from lead palsy for the first time, confined only to the hands or to a group of muscles in the shoulder, prognosis is good. The prognosis of palsy of the lower limbs is not so good.

Paralysis of the facial nerve is occasionally seen in lead poisoning, and where this occurs it should be treated as previously recommended, by means of iodides in association with localized electrical treatment. One pole of the battery should be placed below the external auditory meatus, and the other one passed over the face on the affected side.

In long-standing cases where no attempt has been made at treatment in the early stages of the disease, and where considerable muscle degeneration has already taken place, the prognosis as a rule is very bad. Efforts should always be made in an early case by passive movements and massage of the affected muscles to improve their nutrition as far as possible. The diet should be light, and alcohol should not be given at any time.

Affections of the Central Nervous System.

—The typical form of affection of the central cerebral nervous system caused by lead, is lead encephalopathy. The disease may be insidious in its onset, and may be preceded by a long stage of chronic headache with slight or total remissions. Headaches may last for several months before the actual acute stage of the disease is reached. In the examination of several brains of persons who have died from lead encephalitis, microscopic sections of the brain have shown signs of hæmorrhages which must have taken place some considerable time prior to death, and were no doubt associated with the headache that had been complained of for some time previously, before the onset of the fatal illness. (See [Plate III.]) Persistent headache occurring in a lead-worker should always be regarded with grave suspicion, and such a case should be treated on the assumption that it is an early case of lead encephalitis. Bromides and iodides should be given, and the patient placed in quiet surroundings, and fed on light, nutritious diet, and every attempt made to produce elimination of the poison.