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.
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.
The comatose and convulsive forms of encephalopathy may end in dementia.
Urine.-Chronic lead poisoning affects the kidneys and causes a typical red granular nephritis. The urine is very copious, of low specific gravity and contains small quantities of albumin and casts.
Circulation.-Lead poisoning may lead to arteriosclerosis and high blood-pressure. The number of the red corpuscles of the blood is greatly reduced. The drug checks the separation of urates from the blood and their excretion by the kidneys, hence gout is very common in those poisoned with lead.
Sexual.-It causes pregnant women to abort, and for this reason has often been used as an abortifacient. Young girls who work in lead, long before they get colic, suffer from retarded or suppressed menses and become markedly anaemic. An abnormal number of the children whose parents work in lead are idiots or epileptics.
Respiration.-Epistaxis, haemoptysis and consolidation of the apex of the lung occurred in two cases of poisoning (in one case the right and in the other the left).
Sleep is restless, the patient assumes strange postures in sleep and has a constant desire to stretch. With the exception of nephritis and neuritis, there is no organic change that can with certainty be attributed to the action of lead.
The above account of chronic lead poisoning is mainly an abbreviation from “Tanquerel des Planches,” quoted in C.D.P.
Nervous System.-As would be expected from the action of plumbum as sketched above, the metal has its principal therapeutic application in the treatment of nervous affections, especially of paralyses, neuralgias and convulsions. An enumeration of the nervous diseases in which it has been found useful will include infantile paralysis, locomotor ataxy, paralyses of local groups of muscles, such as writer’s or piano- palsy, paralyses of pharynx, tongue, eyes and facial muscles, post-diphtherial paralyses, chronic forms of epilepsy, epileptiform convulsions, lock-jaw, neuralgic pains, especially of the sciatic nerves, and those accompanying cerebral or spinal diseases, such as the lightning pains of locomotor ataxy, and crampy pains in various parts which, when occurring in the various parts which, when occurring in the chest, may simulate angina pectoris.
Plumbum will often follow opium in cases of cerebral haemorrhage. Paralyses requiring plumbum are usually preceded by an altered mental condition, the patient becomes slow of perception, his memory is impaired, he cannot find the right word, is anxious and restless, sad and dejected, there may be causeless fright and paroxysms of screaming if the patient is a child, or, if an older person, sudden fainting on passing from one room to another, or on entering a room full of company. Melancholia may be followed by delirium. Certain physical symptoms also commonly precede paralyses, viz., trembling, spasms, shooting pains in the course of the large nerves, violent headaches and dimness of sight.
With paralysis of any part there is wasting, not only of the affected muscles, but of the skin, which becomes shiny and cold, and of subcutaneous tissues from which the fat disappears, so that a paralysed limb is much emaciated and looks like only skin and bone.
Neuralgic pains indicating plumbum are sharp and constant, acute by paroxysms, sometimes lightning-like and wander from part; they are relieved by hard pressure and are worse from motion. Cramps, which are common, may be mistaken for rheumatism. Excessive hyperaesthesia of the skin is an indication for plumbum in post-diphtheritic paralysis, as it may be also in other complaints. Vaginismus, for which the drug is useful, is the result, of combined hyperaesthesia and spasm.
In epilepsy plumbum is indicated in the chronic forms: before the attack the limbs are heavy and numb and the tongue swollen, after the attack there is long-lasting confusion in the head; there is no aura.
Neuralgic pains may alternate with colic, which is the same thing as saying that pain in the nerves of the limbs may give place to pain in the nerves of the intestinal walls, and is an instance of their wandering character.
Digestion.-Plumbum is an important remedy for affections of the alimentary tract when colic and constipation are present. It is useful for gastralgia when pains are very sudden and severe, are relieved by hard pressure and associated with vomiting of food; there may be a sensation in the epigastrium as if a ball rose into the throat and caused suffocation,preventing speaking and swallowing (ignat., rumex., lach.). When the vomited matters are faecal or a brownish blood-stained fluid, and there are abdominal cramps some obstruction of the fluid and there are abdominal cramps,some obstruction of the bowels is indicated. Plumbum is the remedy if with the colic the abdominal muscles are hard and knotty and there is a sensation of retraction of the umbilicus, the patient bends double and presses hard against the abdomen. The symptoms retraction with the colic is very characteristic of this remedy, it may be a sensation only or there is an actual retraction of the umbilicus towards the spine which causes the contour of the abdomen to be concave. The colic is so severe that the pain as it were overflows and radiates to the back loins anus, lower extremities, chest and upper arms. Colic of this description are cured by plumbum, more especially when associated with constipation. A similar colic with diarrhoea requires colocynth. In the plumbum constipation the patient strives in vain to pass a motion being hindered by spasm of the sphincter ani. Faces when passed are hard, dry, black balls or small balls agglomerated, like sheep dung. Plumbum is a remedy for chronic constipation though there is no colic; retraction of the abdomen and the character of the stools are the indications. such a constipation may be due to impaction of faeces from paresis of the bowel, or may be an obstinate habitual constipation caused by long neglect or by the bowel being exhausted by the abuse of purgatives. Plumbum will be useful in cases of incarcerated hernia and in any form of obstruction that is not the to a mechanical cause; in these cases there may be tympanites instead of retraction. It acts by restoring harmonious peristalsis and, probably, by invigorating paralysed sections of the intestines as well as by quieting those in spasm.
Neuralgia of the rectum associated with spasm is relieved by plumbum. It is useful in hepatitis with jaundice, vomiting and constipation when the characteristic colic is present,
Urine.- It is a remedy for retention of urging or the urine is passed drop by drop with great effort, which increases the pain; also for haematuria with severe pain which increases the pain also for haematuria with severe pain down the course of the urinary disease for which plumbum is most valuable is nephritis, especially chronic interstitial nephritis, with abundant urine of low specific gravity and little albumin or anasarca, with hypertrophy of the heart, mental depression and a dry, yellowish skin.
Sexual.- Plumbum is indicated in spasmodic dysmenorrhoea when the characteristic colic and retraction of the navel are prominent symptoms. It is a remedy for abortion when this results from failure of the uterus to develop normally during pregnancy, and for anaemia of an inveterate kind associated with constipation and a tendency to neuralgia; the mucous membranes are very pale and there are great lassitude and prostration.
Respiration.- It has been used in Phthisis in the stage of suppuration, with short dry cough and purulent sputa. It is sometimes of service in haemoptysis when this is due to arteriosclerosis secondary to granular kidney.
Treatment of lead poisoning:-
Acute poisoning: Emetics or washing our the stomach; sodium or magnesium sulphate to form an insoluble sulphate and to open the bowels; morphine or opium to allay the acute pain of lead colic.
Chronic poisoning: Mainly preventive by removing sources of poisoning; sulphuric acid lemonade. Physiological antidotes; alumina aethusa, nux, opium, colocynth (colic).
(1) Paralyses: of single muscles or groups of muscles, especially of extensors of the wrist.
(2) Colic, with retraction of the navel; with constipation.
(3) Constipation; faeces of dry, hard balls; spasmodic contraction of rectum and sphincter ani.
(4) Neuralgias and cramps, better from hard pressure and worse from motion.
(6) Coldness; emaciation; earthy or yellowish wrinkled skin.
(7) Slowness of mind and functions.
(8) Hyperaesthesia in acute affections; transient and wandering anaesthesia in chronic affections.
(9) Blue line along margins of the gums.
(10) Atrophy of affected parts.
(11) Chronic interstitial nephritis.
(12) Epileptiform states; spasms.
From touch, motion, at night in room full of company, mental exertion,lying on left side (palpitation)
From hard pressure, at rest lying down, bending double (colic), stretching limbs.