—Tanquerel[10] called attention to the aphonia of horses in lead works, necessitating tracheotomy, and Sajous[11] described adductor paralysis of the glottis in a house-painter. Morell Mackenzie[12] also described unilateral paralysis of the adductors in persons suffering from lead poisoning, whilst Seifert[13] particularly describes a curious case in which paralysis of the transverse and oblique arytenoid muscles prevented contraction of the cord in its posterior quarter, and in a second case of paralysis, affecting the posterior crico-arytenoid muscles on both sides, the adductors remained unaffected. What is still more interesting in Seifert’s case is the fact that at the post-mortem old hæmorrhages were found in the mucosa of the arytenoids and aryepiglottidean folds. Occasionally sensory paralysis may be found in the special sense organs—such, for instance, as loss of taste, loss of smell, and, in addition, diminished power of hearing—but these defects rarely if ever occur unless accompanied by distinct mental changes and generalized paralysis.
6. Eye.
—Poisoning affects the eye in two ways:
- (a) Defects of the visual mechanism.
- (b) Defects of the muscular mechanism of the eye.
Lockhart Gibson[14] describes a large number of cases of paralysis of the muscles of the eye met with amongst children in Queensland. The cause was traced to the painted railings near which the children had been playing. The white lead paint had somewhat disintegrated under the action of the sun’s rays, forming an efflorescence; the children admitted to have rubbed the paint and then sucked their fingers.
Between July, 1905, and 1908, sixty-two cases of plumbism in children were admitted to the children’s hospital, and of these sixty-two cases thirteen had well-marked ocular symptoms. The paralysis of the muscles of the eye was almost invariably one of the external rectus, but other muscles were at the same time affected; occasionally paralysis of the whole of the oculo-motor muscles was seen with the exception of the superior oblique. It is worthy of note that amongst these children a very large number suffered, in addition to their eye paralysis, with foot-drop and wrist-drop, and, on the whole, suffered from foot-drop to a much larger extent than from paralysis of the hands.
Galezowski[15] describes paralysis of accommodation of the eye, and in cases described by Folker[16] some amount of orbital paralysis was also present.
7. Generalized Paralysis.
—These types do not differ in form from the previously described types, except, perhaps, as regards their rapidity of onset. Where the onset is slow (chronic) the subject is usually one who has been previously affected with paralysis of the extensors of the hand, followed by development of the paralysis in the shoulders, hand, leg, thorax. In the acute form, paralysis may affect all the muscles in a given limb or group, and reduce them in a few days to a complete condition of paralysis. In extreme cases the patient lies on the back and is incapable of rising, and sometimes even unable to eat. The intercostals, diaphragm, and larynx, are also affected, while there is generally dyspnœa and aphonia. The muscles of the head and neck appear to escape. In these acute cases, pyrexia may be a common symptom.