SYNONYMS.—Plumbism, Saturnism, Morbus plumbeus, Molybdosis, Molybdonosus, Intoxication saturnine, Bleivergiftung.
CLASSIFICATION.—Chronic lead-poisoning manifests itself in serious disorders of nutrition which are widespread and implicate all the tissues of the body; but for the reason that its more striking and characteristic symptoms relate to the nervous system, it has been classed among disorders of that system as a toxic neurosis.
Acute poisoning by lead is an entirely different affection. It depends upon the power of the salts of lead to coagulate albumen. Its symptoms are those of acute corrosive gastritis; derangements of the nervous system are secondary. It does not fall within the scope of the present article.
HISTORY.—Chronic lead-poisoning must have existed from the infancy of the arts in which the metal is employed. It does not, however, appear to have been recognized until after the time of Hippocrates. Celsus was aware of the danger attending the administration of lead. Nicander, Dioscorides, Aretæus, and Paul of Ægina recognized lead colic and the paralysis resulting from its long-continued introduction into the stomach. Among Arabian physicians, Rhazes and Avicenna accurately describe the effects of the preparations of lead. No considerable addition to the knowledge of the subject was made until the seventeenth century. In 1616 was printed at Poitou the famous work of Citois, De novo et populari apud Pictones dolore Colico bilioso Diatriba. The epidemic colic described by this author was caused, although he little suspected it, by the common use of wine which had been treated by lead to remove its acidity. This practice, which is of very ancient date, and is described in the writings of Cato, Pliny, and Columella, was at one period very general in Europe, and had been forbidden by imperial ordinances as early as 1437.1 It remained for Stockhausen, in a treatise published at Goslar in 1656, and entitled De Lythargyrii Fumo, noxio, morbifico ejusque metallico frequentiori morbo vulgo dicto Hutten-Katze, to demonstrate that Poitou colic was produced by lead in particles in emanations, and for Wepfer in 1671 to first clearly point out the fact that the epidemic colic so often described was usually caused by lead in wine. During the eighteenth century the epidemic colic attracted much attention among medical men, and its etiology was made clear. Henkel called the affection founder's colic, and showed how it was produced in those engaged in casting lead; Huxham, in his work on Fevers (1745), described the disease as it prevailed in Devonshire, and several English observers conclusively proved that the epidemics of colic frequently appearing in certain districts were caused by the presence of lead in cider, and that it was due to the action of the apple-juice upon lead used in the construction of the presses and implements employed in the manufacture of that popular beverage.
1 Vide Tanquerel des Planches, Lead Diseases, translation by S. L. Dana, M.D., LL.D., Lowell, 1848.
During the current century the closer study of the etiological relations of disease has revealed many unsuspected sources of lead-poisoning in the arts, and of lead contamination, both accidental and intentional, in articles of food, drink, and luxury. Hence the literature of the subject has assumed very extensive proportions. The French physicians have devoted much attention to this subject. The great work of Tanquerel des Planches, to which reference has already been made, remains to this day the most complete and comprehensive authority. Quite recently valuable additions to existing knowledge have appeared in some of the Paris theses.2
2 Vide Capelle, De l'Intoxication saturnine, Paris, 1883; Séguin, Ch., De l'Albuminurie transitoire des Saturnins, Paris, 1883; Goudot, Étude sur la Goutte saturnine, Paris, 1883; Verdugo, Contribution à l'Étude de la Goutte saturnine, Paris, 1883; and Coutard, La Colique du Poitou considérée comme Intoxication saturnine, Paris, 1884.
ETIOLOGY.—A. Predisposing Influences.—Individuals exposed to lead and its compounds are not all equally prone to its effects. The degree of liability is to some extent dependent upon individual susceptibility, and to a much greater extent upon circumstances which are determined by the season, climate, age, sex, diet, and mode of life of different persons. It will be convenient to consider the predispositions which arise from occupation under the head of the Exciting Cause.
Variations in the degree of susceptibility to chronic lead-poisoning appear to be explicable in a majority of the cases solely upon the theory of idiosyncrasy. While a large proportion of the cases are in well-developed, strong, and previously healthy adults, individuals of feeble constitutions do not escape. Those occupations which involve the greatest exposure to the danger of contracting this affection at the same time demand the powers of a robust frame. Habitual recognition of these dangers, such as begets the habitual exercise of reasonable precautions against them, diminishes to some degree the liability of a few workmen.
Season.—Due allowance being made for the difference in the number of workmen employed in manufactures which involve exposure to lead, and especially in the making of white lead, at different seasons of the year, it has been found that attacks of lead colic and of lead palsy are more common in warm than in cold weather. Heat predisposes to the attack, either by favoring the dissemination of the lead compounds or by facilitating their absorption by various channels, especially by the skin, which is more freely exposed in summer, and at the same time more or less bathed in sweat in which the dust of lead salts may be dissolved.