A careful study of these cases establishes the fact that in a considerable proportion of them the morbid condition is myalgic. Whether it be due to simple muscular malnutrition or to some specific action of lead upon the muscle-substance is not determined. The analogy between these muscular pains and lead colic renders it probable that in a large majority of the cases the latter view is correct. These pains are frequently associated with the attack of lead colic; sometimes, however, they precede the colic, while at other times they follow it. After a series of remissions and exacerbations the pain often ceases as suddenly as it began. As in other lead affections, relapses are frequent. The prognosis is favorable.
The English physicians, and especially Garrod,6 Todd,7 and Bence Jones,8 have insisted upon the frequency of gout in chronic lead-poisoning. Murchison,9 Wilks,10 and others regard this association as causative. This view has not found general acceptance in France. Lancereaux11 in particular, after a comparative study of the lesions of the kidney and of the joints in saturnine cachexia and the corresponding lesion of gout, concludes that the gouty kidney and the kidney of lead-poisoning have the same appearance, and are simply varieties of interstitial nephritis, and that the articular and arterial lesions in both affections are identical. So-called saturnine gout differs in no respect, either in its clinical or anatomical characters, from ordinary gout. It would therefore appear superfluous to describe saturnine gout. At the same time, it must be insisted upon that chronic lead-poisoning exercises an important influence in the production of gout—a causal relation due to the fact that lead diminishes the excretion of uric acid.
6 Medico-Chirurg. Transactions, 1854, vol. lvi.
7 Clinical Lectures, London, 1856.
8 Transactions of the Pathological Society, London, 1856.
9 Lancet, 1868.
10 British Medical Journal, 1875.
11 “Nephritis et Arthrites saturnines: coincidence de ces Affections paralleles avec la Nephrite et l'Arthrite goutteuse,” Arch. gén. de méd., Decembre, 1881.
4. Lead Palsy; Lead Paralysis; Paralysie Saturnine; Bleilähmung.—This condition is fourth among the affections due to chronic lead-poisoning, both in frequency and in the order of succession. Nevertheless, like each of the others, it may be the first in the order of appearance after disturbances of nutrition which are in some rare cases of very slight degree. As a rule, however, the paralysis has been preceded by colic or by joint affection, or by both. Tanquerel12 found that in 88 cases of lead palsy 25 had been preceded by an attack of colic, 15 by two attacks, 3 by ten attacks, 1 by fifteen attacks, and that in single cases as many as twenty, and even thirty, attacks of lead colic had occurred before the appearance of paralysis.
12 Loc. cit.