c. Lead may paralyse either the motility or the sensibility of parts – paralysis vel anaesthesia saturnine.
We have observed 102 cases of paralysis. It is ordinarily heralded some time in advance by certain disturbance of the system – lassitude, sense of weight or coldness, torpor accompanied with weakness or a shattered feeling, an unwonted heaviness, a certain inaptitude to movement in the parts about to be invaded by the paralysis. Sometimes tremors, more or less intense, with the heaviness and dulness, severe as prodromata. These feelings will often go off as the patient is warmed by work. The paralysis, when it sets in, sudden and complete. It is usually limited to one or several muscles, or to the muscular apparatus of one limb. It most frequently attacks the upper extremities (especially their terminal portions), then the lower, rarely the trunk, less rarely the vocal apparatus. It is the extensors of the limbs which are affected. The initial tremor consists rather of a slight agitation of the muscles than of their alternate contraction and expansion. It is a “tremblottment,” never reaching to the degree of the mercurial trembling. When the paralysis has lasted a long time, months or years, there is noticed a flaccidity, a wasting, an extraordinary emaciation of the parts deprived of movement; the skin is whitish, pale, of livid, often earthy – yellowish look, rough to touch, dry, harsh, as if scorched; it seems to have its natural thickness. The epidermis often desquamates. The subcutaneous cellular and adipose tissue entirely disappears; the skin is then lax and flaccid, and seems too wide for the parts it covers. The flesh is soft, the volume of the muscles is diminished; they no more stand out in relief. When this atrophy has reached its height the skin seems glued to the bones, whose prominences can be readily felt; and if a whole limb be attacked, it drags down by its own weight, and may even become dislocated. If the case be prolonged the whole body becomes the subject of this atrophy, and resembles a veritable skeleton in a transparent envelope; there then follow infiltrations, eschars, gangrenous patches. In general emaciation the urine often becomes colorless; in 3 cases we found it alkaline. We have not observed any involvement of the bladder in the paralysis. The palsied parts are often bathed in the m. in copious viscid. Lachrymation is sometimes unusually active, without other ocular disorder. All the lead paralyses are slow, gradual, and progressive in their course. They are always amenable to persistent treatment (sulphurous baths and strychnia) if the muscles are not altogether atrophied. In the few cases in which death has occurred, p. m. examination has revealed no constant or characteristic morbid changes, unless it be an excess of serosity in the cranium and the vertebral canal.
Saturnine anaesthesia may be limited to the skin, or may extend to the subjacent parts; it may be common sensibility that is affected, or special – as that of vision. We have seen 23 cases of it; in 4 the deeper parts were affected, in 7 the skin only; 12 consisted of amaurosis. Of the first 11, 3 had paralysis of movement coinciding with that of sensation, in 4 the two affections occupied different seats, in 4 others the loss of sensibility stood alone. Like the paralysis, the anaesthesia affects limited tracts, as a finger or two, the palm, &c.; it may be more extensive, but is never general. It usually comes on suddenly; may be complete or partial; is very mobile, shifting seat and extent quickly; and rarely lasts more than a week or two. It may co – exist with arthralgia, even at the same spot, but is then superficial only. In two patients dying while anaesthetic, no alterations were found in the nervous system which would account for the phenomena.
Of the amaurosis we have seen 12 cases, in 2 of which no other cerebral symptoms co – existed. It seldom, however, exists apart from other manifestations of poisoning. It usually appears suddenly (14 times double, and complete or partial, the pupil behaving accordingly. It seldom lasts long (6 – 8 d.), and usually goes off as rapidly as it has supervened. Three autopsies, performed in such cases, showed no alteration in retina, optic nerves, or brain.
d. The saturnine “encephalopathy” is characterised by delirium, coma, and convulsions, singly or combined, and accompanied or not by loss of one or more of the senses. It is without fever, and has a physiognomy so mobile that the manifestations may change from one day to the other, or between m. and n. Their brusque, instantaneous appearance and disappearance constitute its most remarkable feature. We have been 72 cases among workmen. Of these, 6 were attacked primarily; the rest had already, or had previously had, other plumbic affections. It may surprise the workman without warning in the midst of his occupation, or may announce its advent by several functional cerebral or other derangements. Thus in some cases severe headache is felt, with vertigo or tipsy feeling; in some there is insomnia, or restless sleep troubled with baleful dreams. We have observed disorders of slight and hearing, – as dazzling, tinnitus, diplopia, strabismus, dilation or contraction of pupils; or an unnatural look – astonished, stupid, or pensive. One patient complained of fulness and weight, with atrocious pain in orbits. The disposition may become sad, unquiet, indifferent, morose, lachrymose; sudden fears may assail the mind, and lead to restless changing of place with the view to banish or escape them. Lastly, stupor, an indescribable malaise, embarrassment and slowness of thought and movement may proceed the advent of this malady. Out of the 72 cases observed 19 had prodromata of this sort. Sometimes they appear elsewhere than in the cerebral sphere, as in the form of dysphagia, or a sense of constriction in the pharynx.
The delirium may be quiet or furious. The former presents every variety of simple mental aberration, passing rapidly from one to another, sometimes accompanied by hallucinations of slight or hearing. In the furious form there is a kind of mania. The face is slightly reddened, sometimes distorted or convulsed. There is much talking. The tongue sometimes becomes dry and brown; and yellowish or even blackish crusts from on teeth and gums. Either is paroxysmal, with intervals of somnolence.
The coma may be with or without some degree of delirium. In either case it is sudden in its onset. It is rarely profound.
Convulsions are the most frequent cerebral phenomenon we encounter, though rarely (5 cases only) occurring alone. They may be irregular, whether partial or general,-i. evening resembling no recognised malady of the kind; or, more frequently, they consist of epileptic, epileptiform, tetaniform, or cataleptiform attacks. In nearly every case the intellect is constantaneously affected, whether before, during, or after the convulsions. Irregular, partial convulsions may consist of clonic or tonic spasms of the face or of single limb: they come on suddenly, at short intervals, and are accompanied by delirium or somnolence, or by intense headache and hallucinations of sense. General convulsions of this kind are most apt to seize those exhausted by the colic. They are taken at first with agitation, characterised by general trembling with clashing of the teeth, as in the cold stage of ague. Then come spasmodic shocks through the whole body, and these are followed by general stiffness. Consciousness has not been altogether lost; but they look wild, with fixed eyes; and if questioned, stare awhile and utter only a cry. After a few m. the pale face regains its expression, and the limbs relax. Sopor, more or less deep, usually succeeds the attack; more rarely delirium. In the saturnine epilepsy, mental distraction, giddiness, restlessness, frontal headache, amaurosis, may precede the attack; or it may set in unannounced. No aura has been felt. One patient uttered a cry at the onset, one a groan. The attack differs in no respect from that of idiopathic epilepsy; but the sopor that follows it is a coma, which may last for days, and may be broken by fresh attacks – one patient had 34 in 24 h. Sometimes delirium replace it. A part only of the full cortege of epileptic phenomena may occur, when the convulsions may be styled “epileptiform”. They are cataleptiform when, consciousness and sensibility being lost, the limbs retain for a time any position in which they are placed. We have seen but 2 cases of this kind. Recovery set in with various movements of head, face, and body, as if to express feelings, the eyes still being closed; then cries were uttered; finally lethargy again supervened. After several of such alternations consciousness returned, but was of a delirious character.
The encephalopathy may co – exist with the other saturnine maladies, in various combinations. There are no other derangements of health characteristic of it, save such as might be expected from the violence of the attacks; but there is rapid loss of flesh. The course of the disease is very irregular, abounding in surprises. The delirious form affords the best prognosis; the comatose and convulsive forms may end in dementia, or in death. We have never seen meningitis or encephalitis supervene. Of our 72 cases, 16 died. Combining their autopsies with those on record, we find 32 cases in which no noteworthy cerebral lesion was found after death, while in 21 there was a subsidence or flattening of the convolutions, with augmentation or diminution of the consistence and size of the cerebral mass. We are inclined, from the facts, to think the latter change a secondary one.(TANQUEREL DES PLANCHES, Maladies de Plomb. 1839) [ The above is a resume of all the pathogenetic facts contained in the work above cited. EDS.]
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.