Plumbum metallicum. Lead, the element. (Pb), atomic weight 206.39. Plumbum aceticum. aceticum of lead. Sugar of lead. [Pb (C2H3O2)2 3H2)]. Plumbum carbonicum. Carbonate of lead. Pure white lead. (PbCO3). Triturations of any of the above.
PATHOGENESIS.
WHEN a solution of acetate of lead is applied to the mucous membranes or exposed tissue, it precipitates protein and forms a protective covering. Solutions applied to the unbroken skin have3 no such effect. The mental contained in the precipitate is not destructive of the cells, and is astringent rather than corrosive. When very large quantities are swallowed the symptoms of irritant poisoning occur, such as nausea, vomiting, abdominal pain, violent purging or sometime s constipation, blood in the vomited matter and stools, great thirst, weakness and collapse. In a few instances death has occurred, but recovery is the rule, and afterwards the patient may in some cases suffer from the same effects as result from chronic lead poisoning.
Chronic lead poisoning is due to absorption of lead into the system, either through the mouth, through the lungs from exposure to the dust of powered lead, from the rectum or vagina when lead is used in douches, from the surface of ulcers when it is used as a sedative lotion. and from the skin as when a solution is used as a hair dye. Lead is taken by the mouth in various ways, the most common being in water which has become impregnated from lying in contact with lead water-pipes; other sources are wine and cider to which lead has been added to reduce their acidity; cooking utensils lined with lead glaze, the use of lead in solder to close tins of meat or fruit, &c.
It is absorbed more rapidly than than the majority of the metals; it remains in the tissue a long time, and in cases of poisoning is found in most of the organs, especially in the liver and kidneys. It is excreted in the urine, bile, intestinal secretions, saliva, milk and perspiration. It is a very insidious form of poisoning, and there is great variability in susceptibility in susceptibility to it. Women and children are more liable to it than men; anaemia, alcoholism. Relapses are common and may appear years after the first symptoms. The symptoms very greatly in different cases, but show themselves under four principal forms-viz., colic, arthralgia, paralysis and encephalopathy. One or more of these may be present in the same individual. They are preceded by a preliminary intoxication of which the symptom are discoloration of the gums, the well- known “lead line.” a peculiar metallic taste and smell, putrid odour of the breath, icterus, emaciation and slowness and feebleness of the circulation. The icterus is a dirty or earthy yellow tint of the skin, and arises from liberation of large quantities of hemoglobin from the breaking up of red cells; it is not a real jaundice, but a yellow-tinted anaemia. Emaciation is marked, but mostly on the face where it gives rise to wrinkles. The pulse is small, narrow, soft, compressible and reduced in frequency.
Colic-Pain begins in a grumbling manner and then suddenly sets in with great severity. It is a neuralgia of the digestive and urinary organs, characterized by intense abdominal pains which are continuous but become more acute in paroxysms, are diminished by pressure and are accompanied by hardness and retraction of the abdomen, obstinate constipation, nausea and vomiting. The pain is most frequently at the umbilicus, is described as twisting, m tearing, burning, boring or constricting and is extremely severe. Constipation follows the pain and is accompanied by frequent desire for and attempts at stool. Retraction of the abdomen coincides with paroxysms with a sensation as if the umbilicus is drawn back to the spine, the abdominal walls are in a state of cramp and there is a tightening of the sphincter ani, with contraction of the rectal walls, so that the finger can with difficulty be introduced into the bowel. Nausea precedes and is more frequent than vomiting, which is molar apt to occur when the colic is seated in the epigastrium; there is much reaching and straining and the vomited matters are bitter, viscid, and of dirty green colour. Flatus is eructated but not often occurs. When the colic is situated principally in the hypogastric or renal regions there is usually functional disturbance of the urinary organs. There is then painful contraction of the neck of the bladder, and during the paroxysms of pain urine can be passed only in drops. notwithstanding an urgent desire. The pains may involve the testicles, which are retracted. They may be severely felt in the uterus and vagina, which maybe in a state of spasm. A sensation of constriction is felt over the praecordia and cramping pains sometimes occur in the thoracic muscles and the diaphragm. In one case pain spread from the epigastrium to the chest and extended down the arms, and was accompanied by a stifling sensation and palpitation. The pains are increased by cold and relieved by warmth.
Arthralgia.-This name is given to sharp pains of a neuralgic character, felt mostly in the neighborhood of the joints and on the flexor aspects of the limbs, but they may be also present on the trunk. They are generally preceded by a feeling of numbness and lassitude in the parts they are about to attack and they set in usually in the night. They are rending, contusive, or like a burning liquid coursing through the veins, or as if an ice-cold body touched the part. They have paroxysmal exacerbations lasting only a few minutes, when the muscles of the affected part become rigid and painful. There may be trembling or shudderings. The pains are increased by the heat of the bed or undue cold.
Paralysis.-Paralysis may be either of motor or sensory nerves and is usually preceded by certain prodromata, such as lassitude, weakness, coldness and an inaptitude for movement in the part about to be invaded by the paralysis. Tremors may be present with the heaviness of the parts. Paralysis when it sets in is sudden and complete. It is almost invariably limited to the extensors and to one or several muscles forming a group, most frequently the extensors of the wrist, the well-known painter’s palsy or “wrist-drop.” This is as a rule bilateral, but not necessarily so. It begins in the middle and ring fingers, which cannot be extended, then spreads to the index and little finger, afterwards to the thumb and wrist. The supinator longus remains unaffected. The paralysed muscles atrophy rapidly and the other tissues of the part emaciate; the adipose tissue disappears and the skin becomes thin and wrinkled. The cause of lead palsy is peripheral neuritis and degeneration of the nerves, which sometimes involve secondarily the cells of the anterior cornua of the spinal cord.
Extreme dyspnoea may arise from paresis or paralysis of the intercostal nerves and may come on in short attacks with painful, convulsive cough. Anaesthesia and analgesia may accompany the paralysis, or may accompany the paralysis, or may come alone. They affect limited tracts and are never general, come suddenly and shift their area quickly, and usually last only one or two weeks, after which sensation returns. In some cases of poisoning there was extreme hyperaesthesia of every part of the skin. anaesthesia may occur in the retina, with or without other cerebral symptoms, and there is then blindness, complete or partial; it comes on suddenly and seldom lasts long, but in a few cases atrophy ensued. When there is nephritis caused by lead, albuminuric retinitis may be present.
Encephalopathy.-Encephalopathy is characterized by delirium, coma, or convulsions, singly or combined, and accompanied or not by loss of one or more of the senses. Its manifestations are very mobile and changeable. It may be preceded by headache, usually occipital or unilateral, vertigo, sleeplessness or disorders of sight and hearing, or the patient’s disposition alters and he becomes sad, indifferent, morose, lachrymose, fretful or restless. Stupor, embarrassment, and slowness of thought and movement may precede the onset, or a physical symptom like dysphagia from constriction or paralysis of the throat. Delirium is quiet, simple, mental aberration, with hallucinations of sight and hearing, or it is furious and maniacal, with reddened, distorted or convulsed face. There is much talking. Either form of delirium is paroxysmal with intervals of somnolence. Coma ensues with or without delirium, is sudden in its onset, and is rarely profound.
Convulsions are the most frequent cerebral phenomena. They may be irregular, resembling no recognized form of convulsion, or they may consist of epileptic, epileptiform, tetanic or cataleptiform attacks. The intellect is nearly always affected at the same time. Irregular convulsions are usually partial and consist of tonic or clonic spasms of the face or of a single limb or part of a limb. They come suddenly and are of short duration. General convulsions begin with trembling and clashing of the teeth, then spasmodic shocks go through the whole body and are followed by general stiffness, fixed eyes, a wild look and loud cry; consciousness is not altogether lost and after a few minutes the face regains its expression, the limbs relax and sleep succeeds. In the saturnine epilepsy there is no aura and the sopor that follows is a coma, lasts for days and may be broken by fresh attacks or replaced by delirium.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,