lower extremities, and lead colic. The gums were softened and ulcerated, but the blue border of the gums was well defined. He was ordered pil. strych., gr., ter in die. Six days after, he noticed abdominal twitching, evidently produced by the strychnine. The bowels were then freely moved, and were open regularly without cathartics during the remainder of the time he was in the hospital. His urine was submitted to an imperfect examination. There were no evidences of lead. On the 13th, he commenced the iodide of pot., grs. XV. in die, gradually increased to 3i. On the 25th, the pains in the soles of the feet, which had been unusually severe, had entirely left him. The limbs had decidedly improved, while the upper extremities remained the same. Takes pot. iod., 3 i. in die. May 13th. Is able to walk about with little effort, and is gradually regaining the use of his hands. The blue line has nearly disappeared. July 6th, was able to assist in the work of the ward. There was no lead in the urine. Two weeks after, it appeared in the urine, and iodide of potassium was found in the saliva. Sept. 18th. The evidences of lead had disappeared. He was discharged cured on the 14th of October. CASE 3. Dennis D, brother of the last-named patient, aged 22, a harness-maker by occupation, was admitted April 9th, 1853, with entire loss of the use of the arms, imperfect control of the lower limbs, and lead colic. In his case, the thumbs and index fingers were paralyzed and dropping, while the other fingers were unaffected. The same treatment precisely was pursued. May 15th. He was able to walk without assistance, and was gradually gaining the use of his arms. July 13th. Lead was found in the urine and saliva. Patient was profusely salivated, and the treatment suspended two weeks. There is no reason to suppose that this salivation was owing to the "liberation of mercury" by the solvent power of the iodide of potassium. Sept. 18th. There were no evidences of lead in the urine. Nov. 1st. He entirely recovered the strength of his hands, though slight paralysis of the fingers remained. Was discharged decidedly relieved, Nov. 19th. Since he left the hospital, he has been able to gain a livelihood, and is gradually acquiring the use of his hands. In both these cases, the reason the lead did not appear earlier in the urine, is probably owing to the imperfect manner in which the examinations were made. The first specimen submitted to the analysis of Prof. Outram 1 contained lead, though several days had elapsed since the last examination. CASE 4. A laborer, aged 30, was admitted April 6th, 1853, with lead colic, pains in limbs and soles of feet, constipation, &c. The attack was referred to drinking water which was brought a long distance in leaden pipes. His bowels were never moved without medicine. Ordered pil. strych. gr., ter in die. On the 10th, he noticed abdominal twitchings, and his bowels were freely opened, and they remained so while he continued under treatment. On the 20th, he began to convalesce from an attack of typhus fever, contracted in the house, and then became affected with general paralysis. He was much prostrated by the attack of fever, and convalescence was very slow. May 14th. He was ordered pot. iodid. grs. xv in die, increased to 3i. At the time he commenced taking the iodide of potassium, he was so much prostrated as to require porter and generous diet. He had no power whatever in his arms, and his gait was so insecure that he could not walk without assistance. He, however, began to improve rapidly, and in one month was able to feed himself and walk unassisted. July 6th. The urine was carefully examined, but no lead was detected. On the 13th, it was ascertained, by chemical analysis, to exist in the urine and saliva. He was completely cured, Oct. 11th. CASE 5. Peter Conway, 50, Ire., porter, was admitted June 20th, 1853. He had complained for several weeks of constipation and vague neuralgic pains in various parts of the body, especially in the abdomen and lower extremities. There was no blue line on the gums, and we did not suspect the presence of lead. The pains were regarded as syphilitic in their character, and he was put upon treatment for constitutional syphilis. He had had the primary disease several years before. After taking the iodide of potassium a short time, a well-marked blue line appeared along the margin of the gums. The urine, on examination, was found to contain lead. CASE 6. A vocalist, aged 33, was admitted May 21st, 1853, much prostrated from an obstinate attack of diarrhoea, which had troubled him for two months. His health had also been much impaired by his previous intemperate habits. His constitution was entirely broken. down. It was feared that he was suffering from incipient cirrhosis. There was tenderness over the right hypochondrium. The liver was enlarged; the urine high-colored and scanty; the countenance sallow, and the conjunctiva tinged yellow. He also complained of neuralgic pains in the limbs, excruciating pains in the soles of the feet, and a partial loss of power in the limbs. The treatment was first directed to the diarrhoea, and measures adopted to restore the general health. On the 26th, he noticed slight paralysis of the extensors of the hand, which increased so rapidly that on the 1st of June there was dropping of both wrists, and he had scarcely any power over them. The limbs were also completely paralysed. There was no blueness of the gums. He had never suffered from colic. He had previously stated that he was not aware of having been exposed to the influence of lead. He now remembered to have spent several nights in a newly-painted saloon, and that he had drank freely of champagne, the inferior qualities of which are known to contain some preparations of lead. The paralysis, from these circumstances, was regarded as depending on saturnine poison. His urine was examined, but no appearance of lead was ob served. June 5th, he commenced taking the iodide of potassium in small doses, gradually increasing, so that he took 3j of iodide. On the 13th there were slight traces of lead in the urine, and in five days the quantity had sensibly increased, and on the 20th, the evidences of lead were very decided, both in the urine and saliva. He had then been under full treatment for a month. The improvement in his case was truly remarkable. His flush had reäppeared; he had entire use of his hands, and was able to move his limbs at pleasure, though he had not sufficient strength to walk. Sept. 18th. Lead had disappeared from the urine. Oct. 1st. The treatment was discontinued, and he was ordered strych. acet., grs. ter in die. He is now gradually regaining the power of his limbs, and is able to walk without assistance. The cases of lead colic were not so satisfactory to us, as the patients were unwilling to remain under treatment after the more acute symptoms had disappeared, when, as they believed, they were cured. The blue line, however, disappeared more rapidly in those who were treated by the iodide of potassium, and the chemical proof of the lead in the urine leaves but little room for doubt that the system might be entirely relieved of the saturnine poison, and that the cure would be both radical and complete. The value of this remedy in metallic poison is fully established by the observations of M. Melsens himself. In a single case of salivation, 1 where this treatment was adopted, I have seen the mercury eliminated Whether the pathology of these diseases, as sustained by M. Mel- The treatment of constipation attending lead colic by strychnine, has been introduced into the hospital within the last two years. In some cases it had a most happy effect. Supposing the constipation due to a paralysis of the muscular coat of the intestines, it is rational to suppose that when this is fully overcome, the bowels would act of themselves, and thus this symptom would not only be relieved, but cured. In most instances, cathartics are merely palliative, and patients are constantly obliged to resort to them. Why not treat this paralysis like the paralysis of the hand or limbs? Cases 2, 3, and 4 were treated by the strychnine. In 3-6 days the patients noticed slight abdominal intestinal (?) twitchings. This was soon followed by copious and free discharges from the bowels, and they remained soluble the remainder of the time they were under treatment, though for several weeks before they were obliged to resort to laxatives. In some cases where the symptoms resulting from constipation were urgent, its action was hastened by an enema, or even by cathartics. In two instances a diarrhoea supervened, and continued until the strychnine was suspended. In other forms of paralysis, strychnine is known to have the opposite effect. In two cases of paralysis not depending on lead, the bowels became confined while under its use. Its efficacy in chronic diarrhoea is now generally admitted. The injurious effects produced by the emanations of lead are much more frequent than is generally supposed. By referring to the records, I find that forty-seven cases of the different forms of lead disease have been treated in the New York Hospital within the last two years. Many of them had been treated for "neuralgia," " colic," "enteritis," &c. before their admission to the hospital. The true nature of their disease was not suspected, not because they could not have been easily recog nized, but simply because too little attention has been directed to this par ticular class of diseases. Case No. 5 may be cited as an illustration of this truth. There was no cause in that case to suspect the existence of lead poisoning. The patient was not aware of having been exposed to its influence, and the prominent symptom-the blue line along the gums-was entirely absent. This symptom was present in forty-five of the forty-seven cases attended to. The paralysis in Case 6 might have easily been mistaken for an entirely different disease. The iodide of potassium established the diagnosis in the one, and confirmed it in the other. Recent experiments have established the fact, that one frequent cause of lead diseases is the emanation of lead from newly-painted apartments. This cannot be too forcibly dwelt upon, as many have doubtless sacrificed their health through ignorance of the fact. By the following table, eight patients could refer their attack to sleeping in a room freshly-painted. I have seen a whole family affected with lead colic from this cause alone. In Cases 2 and 3, it may perhaps be questionable whether the attack could be referred to this cause, as so long a time had elapsed between the exposure and the development of this disease. The following cases have been received into the New York Hospital since September 14th, 1851. |