| Mania | 37 |
| Melancholia | 33 |
| Dementia | 19 |
| Dementia with epilepsy | 10 |
| Dementia with general paralysis | 24 |
| ? General paralysis | 7 |
| Alcoholic mania | 3 |
| 133 |
Savage[19] is of opinion that lead will produce any of the symptoms of general paralysis of the insane, and may even be a contributory cause of the disease, but no statistics are available of the Wassermann reaction in these cases. Goodall[20] refers to the fact that nerve poisons, such as syphilis, alcohol, and fevers, injury or sunstroke, which are intermediate in fixity between alcohol and lead, seem to have an intermediate influence in the production of general paralysis.
Jones states that the mental symptoms found in the cases are to be grouped amongst one or other of the following varieties:
1. Of a toxæmic nature, with sensory disturbances, which tend to get well rapidly.
2. Hallucinations of sight and hearing, more chronic in nature, which may be permanent. The delusions in this class are almost invariably those of being poisoned or followed about, and are in the main persecutory.
3. Those resembling general paralysis with tremors, increased knee-jerk, inco-ordination, accompanied with listlessness amounting to profound dementia, but which tend to get well.
Eye Changes.
—Two main forms of eye change are to be found amongst lead-workers. In the first place, temporary and sudden amaurosis makes its appearance, due no doubt to vascular change, either vaso-motor or hæmorrhagic. The trouble may occur in one or both eyes, may come on gradually, the patient merely being unable to distinguish letters or faces at a distance, or he may become suddenly totally blind. In the majority of cases the affection disappears under treatment, but in a small number of cases total blindness persists.
Occasionally nystagmus may be seen, but is not a common symptom; but dilatation of the pupils, quite apart from retinal changes, is not unusual. Inequality of the pupils may be observed, but partial dilatation of both pupils is more common, and is often associated with early anæmia. Conjunctival hæmorrhages are to be noted from time to time, without obvious cause, such as injury, etc., but in the majority of cases these have been associated with other symptoms.
The first feature noticed in the eye is loss of brightness, and a curious lack-lustre of the eyes of persons intoxicated by lead is one of the general features making up the saturnine cachexia. Loss of brightness of the eye is associated in many other diseases with anæmia, but is particularly prominent in lead poisoning, much more so than is to be accounted for alone by the degree of blood-destruction, and is a point of which the examining surgeon should always take notice.