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Plumbum Metallicum - General symptoms - T.F. Allen

Lead, Plumbum, Plumb, Plb.

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HPUS indication of Plumbum Metallicum: Paleness
Common symptoms: Paleness, Loss of smell, Stiffness.

Below are the main rubriks (i.e strongest indications or symptoms) of Plumbum Metallicum in traditional homeopathic usage, not approved by the FDA.

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(Afternoon), Good-humored.

ennui. ill-humored. absorbed in work.

stitches in head. headache in forehead.

2 P.M., stitch in left eyeball.

coryza. 2 P.M., burning in tip of tongue.

tearing in left hypochondrium.

stitches in right hypochondrium.

stopped sensation in abdomen.

stitches in pectoral region.

sticking in upper part of sternum.

sticking in left mammae.

tearing in right wrist.

weakness of lower extremities of lower extremities.

jerking in left thigh.

flushes of heat and sweat.

toward evening, chilliness, warmth..

Appeared to be rapidly recovering, when he was suddenly seized, about 11 A.M., with furious delirium, attended at intervals, by general spasms. It was astonishing to see him, who, three hours before, could only pronounce with difficulty a limited number of words, whose voice was weak, and whose utterance was faint and drawling, now talking incessantly, and pouring forth shouts, screams, and abuse against all who approached him. His voice was loud and clear. His delirium turned chiefly upon the idea that his life was in danger from assassination or poisoning, and that every one about him was a murderer. His muscular strength was increased to such a degree, that, with one hand, he could lift all his mattresses at once with the greatest ease. He left his bed, and walked about briskly, knocking against every obstacle at random. His face was flushed.

his eyes sparkling and fierce. At last a strait-waistcoat was put on him, which heightened his fury. Pulse, 65.

heat of body rather increased. The delirium lasted about half an hour, when it was succeeded by coma, during which he lay stretched out and motionless, with closed eyes and somewhat pale face. Strong stimulation could only draw forth a few unmeaning grunts. An hour later, the delirium suddenly returned, to be followed again by coma, and thus, all that day and night, the opposing conditions alternated,.

Sudden attack of delirium, in the evening, accompanied by extreme restlessness.

he railed, threatened, and then fell into a deep sleep. This alternation of delirium and somnolency continued until morning.

next day, face flushed and covered with sweat. Eyes fixed and expressionless.

bloodshot. lids swollen.

pupils, especially the right one, extremely dilated, but moderately sensitive to light. Expression of face decidedly dull. Frequent movements, more or less forcible, of the head, limbs, and whole body.

so that he had to be put into a strait-waistcoat,.

Did not close his eyes for a minute all night.

sometimes was silent and quiet, sometimes hurried out of bed, wanted to dress himself, and went about looking for his clothes.

talked incoherently. abused the nurses and patients. In the morning, to prevent him from disturbing the ward, he was put into a strait-waistcoat. He resisted violently.

struggled, called for help, screamed, bawled, and even bit an assistant who had hold of him. After this, he became quiet and silent, and his limbs ceased trembling. When I entered the room, he called to me, and begged to be released. He had an astonished look.

something unusual seemed to have altered his expression of face,.

During the paroxysms, he lay flat on his belly, dug his fingers into his navel, tied himself tightly in his cravat, uttered dismal screams, declared that he had to go to stool.

sometimes got up and walked the room hurriedly, his hands pressed to his abdomen.

we have seen the poor fellow leaning on his belly against the iron railing of his bed,.

During the paroxysms, which occurred almost every ten minutes, the patient, suffering the greatest anxiety, his face all distorted, rolled about in bed uttering dismal groans.

he laid his pillow over his abdomen and begged the bystanders to press upon it with all their force.

this afforded temporary relief. He bits the sheets, his limbs writhed.

at times he might have been taken for a furious madman,.

Between the paroxysms, mind often much affected. Would leave home without knowing where he was going.

became enraged with persons he met.

and generally remembered nothing of what had occurred. When brought home, he would shut himself up until he got right again. One day, he left home to enter the Hospital Beaujon.

got lost, and was quite surprised to find himself at La Pitié,.

In the night, began to talk to himself quite incoherently, about all sorts of things.

then left his bed, and wanted to lie down in another bed in the room. The nurse easily got him back to his own quarters.

his gait was firm, and he had no tremor.

his eyes were wide open, somewhat projecting and fixed. His face had an expression of astonishment. During the rest of the night, he talked much to himself.

his delirium was mild and quiet. Next day, his expression was natural, and he had the use of all his faculties, but he seemed to take little interest in conversation, and his manner was remarkably listless. About 5 P.M., he began fairly to rave.

would keep chattering for several minutes, and then be silent for awhile. His face had a wild expression, which struck the house surgeon on duty. Pulse, 85.

no fever. Worse at night.

took part in all the conversation he heard, or fancied he heard,.

On the fifth day of the delirium, in the afternoon, he had a sudden attack of epilepsy, characterized by violent convulsive movements of the whole body, bloody froth at the mouth, biting the tongue, interrupted breathing, etc. After an attack, which lasts about half an hour, he becomes slightly comatose, but soon rouses, and enters again into delirium. On the sixth day of the delirium, the general aspect of the countenance was more unnatural than before. There was less of that harmony of expression which is indicative of a well-balanced mind. Sometimes the eyes were fixed and the features concentrated.

sometimes the former seemed to roll about, under the influence of serious thought, and the whole face to partake of this meditative look. He would still sometimes burst into laughter at the most unexpected moments. The limbs trembled, or rather, were shaken by slight spasms, which also ran over the face in different directions, coming and going at irregular intervals. The tongue was considerably swollen, from having been bitten during the epileptic seizures of the preceding day.

utterance also was impeded, being stammering, hurried, and abrupt.

an effect to which the slight spasms above spoken of also contributed. He was sometimes conscious of his condition, and said that he was insane. His talk became irrational more frequently, and continued so longer than on the day before. Yet even now, his intellectual aberration could only be discovered by very attentive observation. On the seventh day of the delirium, he talked much to himself, and tried to get into the neighboring beds.

he wandered more in his speech.

wanted to strike the nurse, without provocation.

when threatened with the strait-waistcoat, he quieted down somewhat. He often talked to himself at night.

what he said was incongruous, disconnected, and about all sorts of things. He got up three or four times, and tried to fold his bedstead together, under the impression that he was working some sort of machine.

then he laid down again. Twice he rose from bed, walked about with bare feet, and urinated in the middle of the floor.

next minute, he fancied one of the patients called to him, ran headlong to help him, and got into another bed at the opposite side of the room. His sight was unimpaired, his gait firm and confident. At times, he was silent and quiet, although he never closed his eyes. On the eighth day of delirium, he was quiet, but, in conversation, more decidedly irrational than on the day before. He spoke to others with a smiling face.

he was silent and looked very thoughtful. Now and then, he perceived that he had used a wrong word, as was shown, by his impatient gestures, and he tried to recall the proper one.

he talked to himself about all sorts of things. If he was spoken to so as to attract his attention strongly, and the questions were simple, and easily answered, his replies were rational. He talked no more sensibly about one thing than another. Even to-day, although not so apparent as yesterday, there was always, amid his delirious ravings, a certain semblance of good sense. The utterance is, as it were, spasmodic.

more abrupt and jerky than on the day before.

words are pronounced rapidly and incompletely,.

Out of his head, at times.

at night, quite delirious, talked almost constantly.

got out of bed. looked for his clothes, in order to dress himself.

ran all about the room, trying to get into the other patients' beds.

at last, after he had gone on in this way a good while, it was found necessary to put him in a strait-waistcoat, to which he submitted quietly. Next day, his eyes were wide open.

his expression was rather wild. When alone, he talked much to himself, sometimes calmly, sometimes violently.

generally about wine, which he would not take part in smuggling into the hospital. Sometimes he fancied himself at his foundry, at home, or in the street, etc. His conversation was a mixture of sense and extravagance. When his attention was strongly attracted to anything, what he said was at first rational, then he would suddenly drop the subject, and begin to talk about something quite different, mixing together in this way a great many ideas and incoherent words. But, on peremptorily recalling his thoughts to the topic gambolled from, he would again answer pertinently and sensibly for awhile,.

After trying in vain to find his clothes, he got up and walked the room, but with hesitating step, and feeling about with his hands, like one groping in the dark.

runs against the stove, the beds, etc.

sometimes uttered incoherent words, or called for his wife, or his friends.

wanted to talk about his business.

often said "My wife! my wife!" more frequently was silent. At last he became quiet, soon got into bed again, and seemed to fall into a deep sleep. After awhile, would rouse up and begin to act in the same way again. Once he was about to urinate upon the stand which held the patient's diet-drink. Sometimes he spoke rationally, but generally poured forth unintelligible words in a trembling and hurried voice. He talked to those about him, and made the most incongruous demands upon them. He was not violent, and threatened nobody. Now and then he put his hands to his forehead or abdomen, his face contracted, he groaned and exclaimed "My God! my God!" then began to cry like a child. Sometimes he was observed to lie down on his abdomen. Constant sleeplessness. Delirium and restlessness, worse at night. Recognized those about him, and maintained a long conversation tolerably well.

but, when a drunken patient happened to say to him, in an offensive tone, "They will put you in a strait-waistcoat, you old lunatic!" he became furious, stamped his feet, shook his fists, wept, etc.

poured forth a multitude of words. In a quarter of an hour, he became quiet again, and soon after slept a little. Being visited by his wife, he at first received her roughly, and loaded her with abuse.

then suddenly began to caress her, and seemed greatly pleased with the visit,.

His facial expression does not at all times correspond with the character of the conversation he is engaged in, nor with the other external influences which surround him. Thus, he will sometimes burst out laughing, while speaking of some very ordinary matter, or look serious and thoughful while answering the most simple question. Yet quite often his face wears its natural expression. At first he would not be taken for a victim of cerebral disease.

he is very quiet, and seems quite rational. But gradually as the conversation proceeds, he loses the thread of his ideas, and talks mere nonsense, or keeps contradicting himself most shockingly. When alone, he does not talk to himself. He eats, drinks, urinates, and goes to stool, as properly as anybody.

sometimes he gets up to visit other patients in the next ward.

the latter do not at first perceive that his intellect is at all affected, but when the hint is given them by the physicians, they soon declare that he talks wildly,.

Rose from bed in the night, and tied to get into his neighbor's bed.

took a cravat from me.

a pair of trousers from another.

walked as if groping in the dark, and bruised himself against the stove, washstand, etc.

talked to himself. at last the warden managed to get him into bed again. Quiet during the rest of the night.

but every now and then wanted his neighbors to give him "his drop." Next day, face wild.

eyes wide open. by turns fixed and wandering. Abdomen nowhere painful on pressure. Kept trying to get up in order to take his "drop," and called to the other patients, "Make haste and get up." His limbs were tremulous. His constant efforts to get out of bed made it necessary to put him in a strait-waistcoat.

he struggled hard against it, screamed, howled, uttered threats.

became red with passion, and tried in every way to break loose.

called out to the passers by and begged them to set him free. During the day, he was sometimes quiet and silent.

sometimes furious at the thought of being tied. He was never sleepy. Fancied, at times, that he heard delightful music, which soothed his sorrows,.

His utterance is drawling, difficult and frequently broken.

so that he talks like a child who has not learned to speak plainly.

instead of "oui," for example, he says "ui." Sometimes he cannot get hold of the right word.

then he frets and worries himself, and now and then becomes quite desperate. This difficulty seems to be met with chiefly in the case of substantives.

with adjectives, the intellect and organs of speech deal more easily,.

His colic was almost cured, when the nurses and his fellow-patients observed that his intellect was affected, and that he wandered in his speech, but to so slight an extent, that the aberration escaped the notice of the medical attendants. He lay quiet, with closed eyes, as if in a peaceful sleep.

when pinched as hard as possible he showed no sign of sensibility. When the fingers, hands, forearms, or arms were placed in any position, and left unsupported, they remained there for a few seconds, then oscillated a little, and fell back on the bed. This experiment was repeated several times, with the same result. The body was rigid, so that he could not be made to sit upright, and his attention could not be aroused for a moment. Suddenly he began to make a great variety of the most expressive gestures, at first with one arm only, but soon the other arm, the legs, trunk, head and face, all took part in these movements, which were performed in co-ordination, and seemed to express the same idea. Every moment he appeared to be possessed by the most dissimilar and grotesque conceptions, which he embodied in this way. At the same time he cried out, and tried to speak, but was prevented by the liquid in his mouth. If, at this time, he was gently pinched, he showed by an abrupt movement, that he felt acutely. The upper limbs no longer remained fixed in any position they were placed in.

they were too stiff to be moved at all. After the movements had lasted some minutes, they were succeeded by a state of absolute quietude, and he lay just as he done before they commenced.

then they began again, to be again followed by a period of repose, and so on, in alternation. Now, he indicated, by a significant gesture, that he desired to eat and drink.

now he suddenly spouted the ptisan, which he had been holding in his mouth, all over the surgeon in attendance. Then came an interval of quiet and unconsciousness, during which his limbs remained in any position they were made to assume. Next was witnessed a series of the most expressive gestures, although he kept his eyes shut, and uttered not a single word. Their significance is constantly varying.

sometimes they seem to indicate rage, sometimes despair, sometimes entreaty, sometimes the most profound meditation. At last he suddenly opened his eyes, called for drink.

then seemed to fall asleep again while swallowing his ptisan, but is easily aroused by being spoken to.

then he opened his eyes fully, began to talk about his mother, and while rambling volubly from one incoherent idea to another, still answered questions rationally. Left to himself, he talked incessantly, followed up an idea for a minute or two, and then left it for another. At one time he became much agitated, tried to get up, addressed the doctors, abused them, tried to strike and bite the nurses when restrained.

and at last, shouting and struggling, was put into a strait-waistcoat. On the second day of the delirium, he was lying quiet, with eyes half open. Soon he aroused completely, began to talk very fast, and at first answered questions rationally. But after conversing a few minutes, his thoughts became confused, and he began to ramble and talk to himself. By attracting his attention again, he could be brought back to the original topic, then got off the track again, and so forth.

so that his talk was a mixture of sense and nonsense. He was frequently influenced by the most grotesque delusions.

he fancied that a cavalry regiment was about to fall upon him.

or that he was in the presence of his employer, who was finding fault with him. His face looked rather wild.

at times he bursts out laughing. His head was full of notions. He recollected very well what happened a month or more ago.

but could not call to mind things that occurred only a few days before his delirium set in,.

He seems to recognize familiar acquaintances.

sometimes he talks unintelligibly to himself.

more frequently is silent. When his attention is strongly attracted, he at first answers rationally.

then suddenly utters some words without meaning or connection.

afterwards takes up again the thread of logical thought. He usually waits some time before answering a question.

it seems as if it required great mental exertion for him to understand what is said,.

During the evening of the seventh day, suddenly great restlessness.

he hears everywhere threatening voices, officers come to arrest him, to seize his furniture, and to expel him from his lodgings.

the voices come from the pillow, the mattress.

they enter by the window, where he sees people, and they consult about him with closed doors.

he gets up, looks for his clothing, wants to run away, to his lodge, etc. The next morning he sits at the edge of his bed, the eyes fixed steadily to the window, or looking about in a restless manner.

he recognizes all persons around him, replies correctly to all questions, but cannot recollect what he ate yesterday, whether his bowels moved or not, and looks to his wife in an interrogating manner.

insists, though as if afraid to acknowledge it, on the reality of his hallucinations,.

Has a cachectic look. cheeks hollow and pale.

yellow complexion. no signs of lead poisoning, aside from the cerebral symptoms. Yet this case is not one of encephalopathy in any form. It is a chronic affection of the mind, which we must try to describe in order to characterize it. He is absorbed in himself.

pays no attention to what goes on about him. He does not converse with his neighbors.

when questioned he answers rationally, indeed, but briefly. When his wife and children come to see him, he pays no attention to them, and goes on with what he is about, as if they were not present.

yet he says he is fond of them, and seems to think a good deal of their visits. He has never shown any irritability. When in bed he keeps moving his hands.

folds and unfolds the coverings. Sometimes he gets up and wanders about the room, now singing, now gradually quickening his steps, as if impelled by an irresistible force, now stopping and turning about abruptly.

his gait is uncertain. His behavior is nearly the same day and night,.

The patient imagined that he was constantly followed, and that he heard voices coming from the chimney (temperature 36.5°, pulse 64, regular and small, good appetite, clean tongue, very slight colic, no paralysis, with a blue line on the gum, with constipation).

this man after a few days wished to leave the hospital and go home, because he was convinced that there were fiends in the building that pursued him and sought his life,.

The cerebral functions were strangely disturbed. Various hallucinations showed themselves. Erroneous ideas were formed as to the identity of herself and those around her, and the situation in which she was placed. A mild, but easily controlled form of delirium arose. For some days this alternated with a different state.

if she attempted to speak to those around her, she seemed to have difficulty in finding language, and before she could succeed in conveying her meaning, the idea fled, and a jumble of unconnected words was all that escaped her. And now the condition of the nervous system became one of apathy. Impressions were made upon the senses with difficulty, and speedily vanished.

her attention was no sooner gained than it was lost, and she remained for hours at once in a state of semi-consciousness. At this stage, phenomena were occasionally present approximating to those described as characteristic of catalepsy and ecstasy. On placing the arms, for example, extended in any particular position, they remained fixed in it for some minutes, and then slowly relaxed and sunk down.

The colic was not severe, and was getting better under treatment by Croton Tiglium Croton tig., when the face was observed to have a singular expression. There was an astonished look, as if something extraordinary had happened.

and he had a thoughtful appearance, which was not borne out by his answers to our questions. In the evening delirium set in, and lasted all night. Next day he talked incessantly about everything. At 9 A.M. he had an attack of epilepsy, followed by deep coma, which lasted almost all day, and during which he only uttered a few cries,.

Talks to himself a good deal, mostly about his business, his associates, or his relatives. When his attention is forcibly attracted, and he is asked where he feels pain, he places one hand on the middle of his forehead, and the other on his stomach, and utters a few words which indicate unmistakably the seat of suffering.

but if he is not talked with, so as to keep his thoughts fixed, his mind begins to wander, or he falls asleep,.

The patients were in a state of nervous irritability, difficult to describe. In their beds they were restless and unable to find an easy position, and after many useless efforts they fell back exhausted and worn out, with pain.

the respiration became hurried.

the heart's action was painful and violent.

groans and sighs were uttered with vehemence, whilst abundant tears ran from their cheeks.

symptoms greatly resembling those of hysteria. These tears, sighs, and groans were not occasioned by the violence of the pains, and often coincided with the abatement of the suffering,.

Is generally silent. when he speaks his words are disconnected, but his articulation is good, although the voice is somewhat broken. When he becomes interested in anything talked about, he sometimes answers rationally, sometimes sits facing his questioner in silence, without looking at him. At times he answers a simple question quite wide of the mark,.

Lies motionless and crouched together.

eyes shut or half shut. Often snores as if in the deepest sleep. Now and then he utters some dull grunts.

makes some automatic movements.

half opens his eyes and shuts them directly. Cannot be roused by the sharpest questioning.

has to be pinched hard.

then he opens his eyes, at first partially, then widely.

and finally, without answering, falls back into lethargy. Sometimes, when annoyed by these experiments, he turns in bed, and makes a dull grunting, indicative of his displeasure,.

Suddenly fell back unconscious, without convulsions or foam at the mouth. Two minutes after he raised himself up and said, "It is nothing." Next moment he was trying to reach the bed of one of his fellow-patients, when, for the second time he suddenly fell unconscious, without the slightest spasm, either then or afterwards.

he was carried to bed in this condition, and remained in a state of profound coma, from which he could not be roused for two or three hours. At the end of this time he opened his eyes, now and then, and talked about all sorts of things, imagined he was spoken to, answered his neighbors, and then relapsed into somnolency. This alternation of coma and loquacity lasted a great part of the night. Next morning he was found apparently fast asleep.

at the end of an hour he appeared to rouse up suddenly, half opened his eyes, uttered a great many disconnected words, tossed about in bed, rose and urinated on his pillows, put his head down and lifted his buttocks in the air, then relapsed into coma. If he was pinched or very sharply spoken to, during his lethargy, he at first would open his eyes and then shut them directly.

at last, by continuing the use of stimulants, he was made to open his eyes completely.

they were fixed and wild-looking. If now he was questioned earnestly, he would look hard at the questioner, without being able to utter a single word, or else he would stammer out some disconnected words, and then fall back into coma,.

Lies on his back, crouched together, quiet and sleepy, eyes shut or half shut. At times snores as if sound asleep. Rouses from this state of sopor only to utter a few inarticulate words in a weak voice, half open his eyes and immediately close them again. When stimulated, as by pinching, he at first gives evidence of no sensation whatever, but if the stimulation is kept up for some time, he slowly draws away the part operated on, and then opens his eyes, which look quite wild.

rolls them about stupidly, and returns no answer when questioned.

falling back finally into lethargy. His features are motionless and inexpressive.

at times, some automatic movements of the head and arms take place,.

Seems to be always asleep.

it is hard to rouse him from this state of coma, and he only wakes enough to half open his eyes, and answer everything with yes or no, indistinctly uttered in a loud voice, then turns over in bed and falls asleep again. If, after being well shaken, he is asked where he feels pain, he points slowly towards the umbilicus.

he says and does everything very slowly,.

Ophthalmoscopic examination between the paroxysms showed that the disk was prominent, its outline hazy, its color an opaque bluish-white, the sclerotic ring not visible, and the vessels diminished in calibre. Beyond anaemia of the brain-substance, and a marked increase of cerebro-spinal fluid, there were no marked eye changes found in the brain.

the sheaths of the optic nerves were distended.

microscopic examination showed numerous capillary vessels throughout the swollen disk, and a moderate development of the nuclei of the connective tissue.

there were none of the spindle-shaped swellings of the nerve-fibres found in the former case,.

In the left eye acuteness of vision was normal.

by the right fingers were counted at only 1 1/2 meter (instead of 70, normal).

ophthalmoscopic examination showed very greatly dilated veins in the fundus of the left eye, no neuritis optici, visual acuteness of the right eye 5/20, perception of color very feeble.

field of vision very greatly limited, 20 degrees from the point of fixation,.

Dimness of vision, coming on in the following manner He feels a weakness in all the limbs.

at the same time there is a roaring in the ears, and an appearance before the eyes like falling snow or showers of fire.

he almost loses consciousness, and has to lean against something to prevent falling. This occurs from twice to six times daily (generally two or three times in twenty-four hours),.

Sudden loss of vision, with headache, with sensitive pupils.

after a few minutes the patient was able to count the fingers.

this was associated with wide open staring eyes.

the upper lids seemed drawn far above the upper corneal margin.

on attempting to use the ophthalmoscope the patient became very restless and anxious, rolled the eyeballs, spoke unintelligibly, and tried to get out of bed.

this was followed by an epileptiform spasm, with complete unconsciousness,.

The patient suddenly lost the power of distinguishing objects about him, and for a short time could not see the light.

this sudden loss of vision was followed by a sudden paralytic spasm, with loss of consciousness.

on the next day the sight partly returned, so that the patient was able to see as through a fog, and for five days the sight gradually improved.

on the sixth day there was again sudden loss of vision, this time without headache and without subsequent convulsions,.

Tearing in the right side of the lower jaw near the chin.

after rubbing, it extends into the right lower ribs, where it disappears of itself.

it then returns in the former place and in the corresponding teeth.

afterwards deep breathing causes a sticking below the right scapula, and when this ceases, a stitch in the upper part of the right scapula (after two hours),.

Usually, in cases of saturnine discoloration of the gums, the teeth are dark brown at their bases or necks, while their edges are of a lighter brown, with a shade of yellow or green. This appearance should not be mistaken for the ordinary deposit of tartar. The incisors and canines are most liable to this discoloration, but it may occur on all the teeth, though they are seldom affected in an equal degree. When the process of gingival absorption has resulted in a loss of substance, the discoloration of the teeth becomes more decided. The teeth thus affected finally deteriorate.

they become brittle, break off, decay, and fall out long before the usual time. The coloring matter adheres firmly to the osseous substance of the teeth, with which it appears to combine, so as to be detached with difficulty, as is the case also with that of the gums,.

The discolored portion of the gums quite often becomes considerably thinner, sometimes as thin as a sheet of note-paper.

or else, as more frequently occurs, it dwindles in superficial extent. In the latter case the interdental partitions gradually disappear, and the concavity of the gums is increased, in consequence of molecular absorption, which takes place within the substance of their tissue, without visible solution of continuity. When this process of absorption is complete, the teeth are stripped of a portion of their gums, and are laid bare. The gums thus form, quite frequently, only a more or less projecting pad, sometimes marked by vertical incisions. This change in the nutrition of the gums always follows upon their discoloration. The latter, however, often disappears, in proportion to the shrinking of the gums from interstitial absorption, so that what is left of them is only slightly tinged with blue. Usually the discoloration and loss of substance do not take place in both alveolar borders to the same extent. The twofold change is generally most marked in their anterior portion. The lower gums are apt to show rather more of it than the upper.

and it sometimes happens that the gums of only two or three teeth are thus affected,.

Cannot eat or drink anything on account of three ulcers in the mouth, two on the under side of the tongue, and one on the inside of the cheek.

cold drinks almost set him crazy.

he swallows hot drinks best.

the ulcers were of a perforating character, and had eaten into the tongue to the depth of four or five lines.

rapidly healed by direct application of Alumina Alum,.

The lungs were well distended during the respiratory period.

On examining his chest I found evidence of consolidation in the left apex, and appearance of its commencing in the other.

there was no râles, moist or dry, and very little cough.

while the poisoned water was being used there was scarcely any rising of the upper left chest on inspiration (the respiration being very harsh, almost bronchial; soon after pure water was used, the chest began again to expand, and the respiration became puerile),.

Violent dull pressure as from a block of wood pressing against the anterior and lower portion of the left side of the chest, superficial, as if in the surface of the lung, very much aggravated on inspiration, especially on deep inspiration and also on laughing.

lasting from morning after rising until after dinner.

while lying upon the sofa after dinner he could not endure the pain, and could find relief in no position.

this was accompanied by drawing sticking in the left upper arm, and at times sticking between the scapulae, that lasted a few minutes, and then suddenly disappeared, together with a pain in the chest (ninth day),.

Itching and sticking pains in both breasts.

the left breast suppurated about the nipple and discharged for six days a somewhat serous water, after which it remained well.

in the right breast there developed an induration extraordinarily large, occupying the whole substance of the breast, firmly adherent towards the outer portion, of a livid color, extending upward and outward over the whole periphery of this swelling, with here and there red streaks, together with violent pains in the swelling, that extended to the arm and affected its use.

after being opened it discharged a large quantity of thin and corrosive matter, and after several days the swelling entirely disappeared,.

Heart measures 15 by 20 centimeters.

the beats can be noticed over the whole surface of the heart and in the epigastric region.

violent pulsation in the jugular veins, which are enormously distended, pulse very small and rapid, associated with oppression and oedema of the limbs.

the heart-sounds are very difficult to distinguish, consisting of indefinite double friction-murmurs,.

The heart was evidently enormously large. It was impossible to lay the patient on his left side on account of it, as any pressure on that side could not be borne for a moment. His greatest suffering was a sense of pressure upon the heart, feeling as it were imprisoned by the thoracic wall.

but it maintained its rhythm through the whole period of respiratory intermission, becoming at the beginning of the period slower, and falling to 100 or 105 beats per minute, holding that for a time, and then rapidly increasing in number until he breathed, when every available muscle was brought into violent exercise to give him air,.

Affection of the heart in chronic lead poisoning is often difficult to diagnosticate, because it is dependent upon change in the muscular structure of the heart without coincident disease of the valves, and with or without atheromatous degeneration of the vessels.

usually there is hypertrophy and dilatation of the left ventricle.

ten cases out of twenty-five were associated with parenchymatous nephritis in the stage of atrophy,.

Frequent palpitation, with dyspnoea, at times so great that it threatened suffocation.

he seemed to feel the heart beating along the neck and as far as the vertex, with full, hard, regular pulse.

the beating of the heart was visible and perceptible in the praecordial region over a space of about two and three-quarter inches vertically, and about three inches transversely.

the sounds of the heart were audile over nearly the whole anterior portion of the chest, but were normal (for this palpitation the patient received 3-grain pills of the Acetate of lead; this treatment relieved the palpitation and violent action of the heart, so that the pulse became weak and full, about 50; but the Sugar of lead brought on the most violent colic, with nausea and vomiting, with pains in the lower extremities, on which account the remedy was suspended),.

Plumbum Metallicum author has shown the most remarkable effect of Pilocarpin, administered subcutaneously in lead colic.

the effect of which on the pulse is shown by the tracing annexed.

corresponding to the control of the pulse by the Pilocarpin, was the relief of pain.

this relief lasted only as long as the action of the drug was exhibited by the change in the pulse,.

Stoll asserts that he noticed a tense, full, hard, and vibrating pulse in workers in lead, who were otherwise healthy. We have observed nothing of the sort. On the contrary, we have remarked in workmen obliged to inhale or swallow large amounts of lead, a small, slender, soft, and easily compressible pulse. In rare cases, along with these changes in the arterial circulation, a marked diminution of the pulse is observed.

it goes down to 40, 45, 50 or 55, having been 60 or 70 previous to exposure. This slowness of pulse occurs, with equal frequency, after the internal use of lead preparations,.

For three or four months she noticed that with each return of the catamenia her voice became noticeably weaker, until it became merely a faint whisper, in which state it remained a period of six years and a half. Even a short conversation caused great fatigue of the muscles of the chest. This was at once explained by the laryngoscopic examination, which showed that there was not the slightest approximation of the vocal cords on attempting to speak, and the glottis remaining widely open.

a large volume of air was required to be forced through it in order to produce the faint whisper above mentioned. This demanded an effort of the expiratory muscles, which was very fatiguing,.

Sometimes both upper or both lower limbs are palsied in the same degree, or the same muscles are affected in both. In other cases the complaint attacks one limb only.

or the corresponding extremities may be affected by different degrees of paralysis, and the loss of power fall upon different muscles, or varying numbers of muscles in the two limbs,.

Since in paralysis of the limbs only some of the muscles are affected, while their congeners and antagonists act naturally, it follows that the equilibrium between the two classes is destroyed so that their movements become irregular, and partially influenced as if by normal contraction, occasioning more or less of deformity.

which is gradually increased as the muscles become habituated to their unnatural position,.

Three months ago he first felt great weakness in the hands and forearms.

this gradually increased, and about three weeks subsequently he was suddenly affected, whilst walking, with intense pain in the thighs. The use of both pectoral and pelvic extremities was lost. At present he has very little power from the shoulder to the wrist.

he can hold any light body in the hand, but cannot clasp with firmness. The arms hang loosely by his side.

he has a little motion with the forearm, but cannot raise the limb from the shoulder,.

Sudden attack of slight bruised pain in the lower extremities, together with pricking and formication on the soles of the feet.

walking aggravated the latter sensation to such a degree that it was both difficult and painful. This heightening of sensibility was more troublesome at night.

in the daytime it soon disappeared after he got heated at work. Next the superior extremities began to lose strength, the wrists and fingers became somewhat flexed, and could not be fully extended, and at last the upper limbs became totally immovable, and were affected by very severe pains. The arms hung straight down, and seemed as if fastened to the sides.

when raised and let go, they fell like dead weights. After immense exertion he succeeded, through the action of the pectoral and large dorsal muscles, in turning his hands back to back, and carrying them behind him. No amount of effort produced the slightest movement in a single muscle of the shoulders, arms, forearms, or hands. The trapezius remained some lifting power at the shoulder.

the latter seemed depressed.

the elbow, wrist, and fingers were slightly flexed. The forearm and hand were held edgewise, i. e., in a position half way between pronation and supination. The limbs were freely movable in any direction by external force. The parts deprived of locomotion were very painful, feeling as if bruised.

this pain was worse on the slightest movement, constant, aggravated at night, and affected only the parts around the shoulder, the subclavicular space, the axilla, and the whole of the upper extremity. When the arm was squeezed, he cried out that the marrow of his bones was being bitten. No the slightest pain was felt in any part of the spine. The sense of touch was unimpaired,.

Even in cases where normal sensibility was preserved, a sense of fatigue and weight was always experienced in the paralyzed parts, and especially in the joints lying in the track of the affected muscles.

in every case there was a feeling as if a heavy weight was suspended to the joints, and as if the chief obstacle to moving the parts was the specific gravity of the limbs which had to be lifted,.

Very severe pains in the joints.

worse in those of the lumbar vertebrae and of the shoulders, but all the other joints are affected, though in a less degree. The finger and toe-joints and the articulations of the jaws are almost entirely painless. The pains are not much felt when the joint is at rest. They are aggravated by the least movement.

pressure on the parts about the joint is less painful than movement.

on pressing the bones together which belong to a joint (as for example the humerus against the glenoid cavity, or the tibia against the condyles of the femur) the pains are still more severe than during movement. There are no severe spontaneous pains.

if he keeps still he is comfortable. The muscles themselves are entirely painless,.

Pains very severe at the epigastrium.

less so at the umbilicus and hypogastrium.

none elsewhere. they where of a tearing nature.

constant but much aggravated at times, when, with shrunken, wild-looking countenance, she would throw herself into the strangest attitudes, uttering sharp cries, and begging and praying those about her to press their hands upon her abdomen with all their strength.

this would give some relief.

she also tied her handkerchief tight around her,.

Boring pain, quite severe at the epigastrium, slight at the hypogastrium, scarcely felt at the umbilicus.

acute in the right testicle.

worse by paroxysms. Pressure gradually applied with the flat hand relieved it, but it was aggravated by suddenly and forcibly bearing down on the abdomen.

and pressure did not good unless the limbs were previously flexed upon the pelvis. Pressure on the abdomen uniformly caused the pain to shift its place.

when it was applied from the umbilicus to the hypogastrium, the pain went up to the epigastrium,.

Extremely violent pains in the umbilical region, that shoot to other portions of the abdomen, somewhat relieved by pressure.

at times they became so violent that the patient was almost wild, tossed about the bed, pressed both fists into the abdomen, and declared that he must go to stool immediately.

the abdominal walls were greatly retracted, associated with vomiting of greenish bile, with offensive exhalations from the mouth,.

Severe pain, constant, but worse by paroxysms, at the umbilicus, and felt in a circle all around the abdomen and corresponding portion of the trunk.

ameliorated by hard pressure, but aggravated by gentle pressure. During the paroxysms he draws himself together, clings to the bed-rail, and keeps up a hard rocking movement.

sometimes he digs his fists deep into the navel, doubles himself up, lies flat on his belly, etc.,.

Very severe pains in the whole umbilical region, as if the bowels were twisted, especially immediately around the navel.

the pain is less severe in the hypogastric region. These colic pains remit and return about every five minutes.

their approach is shown by the agonized and anxious expression of the features.

they are accompanied by restlessness, all sorts of attitudes being taken in order to obtain.

relief. to this end, the hands are instinctively rubbed lightly on the abdomen, and at last he cries aloud for help,.

Severe pain at the umbilicus and hypogastrium, becoming excruciating by paroxysms, during which he utters dismal screams, lies on his abdomen, rolls himself up, etc. Face shrunken and expressive of great anguish.

abdomen retracted and hard, especially about the umbilicus. The pain during the attacks is of a twisting nature.

between them, it is a mere feeling of constriction. Colic pains somewhat aggravated by pressure. No nausea or vomiting, but frequent eructations,.

Pains in all the bowels, but much worse at the navel.

they consisted of an excruciating tearing. The paroxysms, which returned at intervals of less than six minutes, caused the greatest agitation.

with flushed face and wild eyes he uttered cries of rage and despair, which disturbed the patients in the adjoining wards. One of his companions thrust his fists into his abdomen in order to relieve him.

he himself pressed it with all his force against a chair.

at times he leapt out of bed, holding up his belly with his hands, and begging to have its pains relieved,.

Late in the afternoon of the third day he began to feel general uneasiness, and a dull pain in the umbilical region, which radiated over the whole abdomen, especially in the direction of the recti muscles.

this pain gradually increased during the night, becoming lacerating in its character, and causing great restlessness and moaning.

it was accompanied by attacks of vomiting of a bitter, bilious, slightly green matter, metallic taste, anorexia, lack of thirst, chilliness, cramps in the lower extremities, sleeplessness, and anxiety,.

Exceedingly acute twisting pain at the umbilicus and epigastrium, often much worse by paroxysms, and only slightly relieved by slow and gradual pressure. During the paroxysms the abdomen is depressed and very much contracted.

there is nausea or vomiting, he screams out, rolls about in bed, keeps changing his position, tries to provoke vomiting with his fingers.

when questioned he answers quite rationally, but does not want to be spoken to,.

Abdomen retracted and hard (during the paroxysms).

relaxed and little depressed (between the paroxysms). Swellings, as large as the fist, frequently appear in various parts of the abdomen.

they are very movable.

the appearance and disappearance are almost instantaneous.

percussion, palpation, and the gurgling they cause, show them to result chiefly from gaseous accumulations in the intestines,.

During the paroxysms all the bowels seem in commotion, agitated by abrupt, spasmodic, irregular contractions. This is especially the case when hiccoughing comes on.

at such times he becomes quite desperate, complaining of a most severe tearing sensation throughout the bowels. He generally lies flat on his belly, finding most relief in this position.

sometimes the body and limbs are jerked about, and there is an audible lively chattering of the teeth,.

The colic was worse in paroxysms, which were extremely frequent.

there was then great restlessness, loud screaming.

sometimes he lay flat on his belly, sometimes got out of bed to lie on the brick floor, or strongly pressed a chair against his abdomen.

sometimes struck himself with his hands, or tied his cravat around him.

in short, tried in all sorts of queer ways to relieve the terrible pains, but any ease thus obtained was of short duration,.

During the paroxysm the pain often ascends from the epigastrium into the chest, extending thence along the external surface of the upper extremities.

it then occasions the utmost uneasiness and anxiety.

he sits up in bed, laboring under violent palpitation, and a feeling of suffocation almost amounting to syncope. Respiration 35-40. As soon as the colicky attack subsides, all the symptoms of the chest and arms disappear.

he is prostrated by fatigue.

he expands his chest slowly to its full capacity,.

Colic, consisting of intermittent boring pains in the abdomen, usually commencing in the umbilical region, sometimes so violent that the patient became perfectly wild and knocked his head against the wall, or even stood upon his head, with most frightful cries.

tried to press with all his force upon his abdomen.

the pain often extended to other regions, to the chest, threatening suffocation, to the small of the back, kidney, bladder, lower extremities, always accompanied by obstinate constipation, and usually by retraction of the abdomen.

abnormally slow pulse,.

A fit of colic coming on during micturition, the flow of urine suddenly stops, and at the same time the penis, which is very painful, becomes retracted, much shrunken, and concealed under the scrotum. When the fit is over the urine flows quite freely again.

during micturition, and for some time afterwards, a slight smarting is felt all along the urethra,.

Attacks of violent abdominal pain, coming on sometimes two or three times daily, with dull pain in the intervals. There is a feeling as of a bar lying across under the navel, succeeded by a pain rising towards the stomach. The pain sometimes extends into the back and loins, somewhat relieved by pressure on the abdomen. There does not seem to be any connection between the stools and the colicky paroxysms.

the latter are more frequent in the night.

the stools occur at intervals of several days.

there may be two or three in the same day. The paroxysms are generally accompanied by a yellow tinge of the sclerotica,.

Pain in the whole abdomen, more severe at the epigastrium than at the umbilicus or hypogastrium.

twisting during the paroxysms and compressive between them. During the attacks he inflated or puffed out his abdomen, which gave some relief, as also did pressure.

he kept changing his position, screamed out, rose from bed, struck his abdomen with his clenched fists, etc.

his face was much shrunken, his eyes hollow and dim. Between the paroxysms the abdomen sank down.

it felt hard and contracted,.

Dull fugitive pains in the abdomen, which increased slightly after eating, and were relieved by pressure.

pains were paroxysmal, more severe at night, and seemed to radiate from the epigastrium to all parts of the abdomen.

after continuing for two or three weeks they grew more persistent and severe. The pain at this time was wringing, griping, twisting, and radiating to various parts of the abdomen. Afterwards he complained of a feeling of weight in the bowels, tenesmus, and a throbbing in the epigastrium. At night it was impossible to sleep, except from the effects of an anodyne. He was constantly restless, every moment changing his position for the purpose of allaying the violence of the pain, and with the hope of finding some relief from a new position.

sometimes he would lie crosswise the bed, rise up suddenly to walk, making firm pressure upon the bowels with his hands, but the violence of the pain would soon compel him to discontinue his walk.

he would also resort to various means to make firm pressure upon the abdomen, which seemed to afford temporary relief.

sometimes uttered rending cries,.

Constipation, at first conquered by injections, now became more obstinate. The injections formerly retained in the bowel only in part were now retained entirely.

the gases and liquids accumulated in the intestines produced under the pressure of the hand, a loud gargouillement, which could be heard at some distance.

a sensation of fulness, and a pressing desire of going to stool, induced efforts without result.

the sphincter ani remained contracted, and gave exit to neither gases or liquids, thus offering an invincible resistance to the strong contraction of the abdominal muscles,.

Three years previously, the patient had been in the hospital with albuminuria and casts in the urine, but when discharged these symptoms had disappeared.

at that time he had no brain symptoms except headache.

on this occasion, the urine, which was retained in the bladder and had to be drawn with a catheter, contained albumen and a large number of casts.

two days subsequently there was anuria, trismus, opisthotonos, convulsions followed by loss of mind.

during the attack the tongue was badly bitten, the pupils contracted and indolent.

on the following days the amount of urine, in spite of treatment (an infusion of squills), 600 and 700 c.cm.

the urine for twenty-four hours contained 17 grams of urea.

the patient did not have another spasm, though he suffered from most violent pains in the upper and lower extremities.

after this the amount of urine increased, the urea rose to 39 and 41 grams, the albumen diminished, the pus disappeared and the mind became free, but after about two weeks he was seized with erysipelas, from which he died, , though the process was not equally diffused.

while frequently the whole field was occupied by small cells of connective tissue with scarcely a trace of uriniferous tubes, other sections exhibited the tubercles of normal size and configuration, but separated by abnormally broad septa of connective tissue.

the glomeruli presented varying characters, some normal, others atrophied to fibrillar knots of connective tissue, and others in all possible stages of degeneration. The substance of the pyramids was less affected than the cortical.

the growth of connective tissue was here much less pronounced, and in many places was not noticed at all.

the tubes were for the most part denuded of epithelium. The small arteries of the kidney showed no remarkable change.

in the transverse section was seen a very broad zone of connective tissue.

hyperplasia thickening of the walls and contraction of the calibre of the vessels were not noticed. The intertubular capillaries in both the cortical and tubular portions of the kidney were excessively filled.

in the latter there were numerous spots of haemorrhages into the urinary canals, and here and there the cativies of the urinary canals were found stopped by old plugs, and by some calcareous concretions. The liver showed analogous changes of hyperplasia of connective tissue, in some places even tubercular nodes of connective tissue growth. The heart showed inflammatory connective tissue growth, with chronic myocarditis.

in some places very broad septa of small-celled connective tissue was formed between single muscular fibrillae. (Microscopic examination of other parts of the body cannot be detailed here. -T. F. A.).

In one of the cases, the sphincter vesicae did not permit the urine to pass for more than thirty-six hours, so much so, that the bladder extended up to the umbilicus.

in the same patient the whole of the genito-urinary apparatus was especially affected. At times the testes were retracted into the inguinal canal, occasioning most excruciating pains in the back, loins, scrotum, and perineum,.

The patient had not passed water for thirty-six hours, and the bladder felt bloated. I examined the region of the bladder externally, but on account of the excessive tenderness, could not positively ascertain whether it was full or not.

on passing the catheter I found it entirely empty, with the exception of a few drops of bloody mucus.

there was in this case complete suppression of urine,.

Quite frequent vesical tenesmus.

ineffectual urging to urinate.

sometimes after much effort, which increases the pains, urine passes guttatim. He urinated twice in twenty-four hours, during remissions, to the amount altogether of about a glassful. Bladder not distended. Catheter passed with difficulty.

the operation caused great uneasiness, and almost threw him into convulsions,.

A large quantity of urine, of sp. gr. 1008, half of which became solid on boiling and adding Nitric Acid nitric acid.

blood-discs were abundantly seen under the microscope, but no casts.

when he began to recover the albumen gradually diminished in quantity (as I discovered less lead in the urine), and at last totally disappeared, but has occasionally a little, perhaps one-fiftieth part, albumen.

later, albumen rapidly increased, and there was not an atom of urea in it, its sp. gr. being 1002,.

Secretion of a large quantity of watery urine, on the surface of which a pellicle had been observed after standing (the same had been noticed about a year previous and occasionally since then).

the pellicle was of pearly whiteness (it looked exactly like spermaceti), with a distinct metallic lustre.

it left a greasy mark on the paper in which it had been wrapped.

i. e., fatty matter mixed with lead in some form.

the color was natural.

reaction acid, but not strongly so.

sp. gr. 1022. no albumen.

on standing for an hour, deposits a light flaky sediment (one fourth), showing under the microscope only a few granules (mucous), and a solitary cell of renal epithelium, containing several fatty globules,.

Urine scanty, yellowish-brown, turbid, sp. gr. 1019, albuminous, sediment consisting of a large number of tubular crystals of uric acid, perfectly hyaline cylinders, to some of which adhered cells similar to white blood-corpuscles, to others fat-drops.

this was associated with epileptiform spasms, with complete loss of consciousness, during which the temperature was 40°, pulse 140,.

In the first stage, when the poisoning is of recent date, and there are colics and vomiting, there is generally a very notable diminution of the urinary secretion.

it falls sometimes to as little as 1/4 or 1/5 of the normal quantity.

the density is augmented, but not proportionally to the diminution in quantity, as is the case in simple oliguria.

there is, therefore, a diminution of the extractive matters contained in the urine.

the urea is from six to seven times less in quantity.

the Acid Phos phosphoric acid, uric acid, and chlorides are less, but the coloring matters are ten to twenty times more abundant than normal. In the second period, the vomiting and colic have disappeared, and the lead is introduced into the various organs, and acts upon their functions.

the quantity of urine still remains a little below the normal point.

the extractive matters are still less in quantity, the urea being only half the normal quantity.

the same may be said of phosphoric and uric acids.

the quantity of coloring matter is still very great. In the third stage there is anaemia, and the intoxication is confirmed.

there is a permanent alteration of the urine, characterized by a less quantity and density, and notable diminution of the urea and phosphoric and uric acids.

whether this diminution is dependent upon some disturbance of assimilation, or is connected with a certain degree of impermeability, is still a doubtful point.

nevertheless, as we find double the quantity of normal excrementitious matter present in the blood, we may rather ascribe their diminution in the urine to impermeability. Lastly, to anaemia, is coupled albuminuria.

the quantity of urine secreted is very variable, sometimes approaching the normal.

but the density is very low.

the extractive matters are considerably diminished.

and whether albuminuria exists or not, we do not observe any increase of the quantity of uric acid in the blood.

nor is uric acid found in the serum of a blister,.

Cerebral affections and amaurosis, with albuminuria.

the amaurosis is supposed to depend upon the chronic nephritis, which is produced by lead.

this view is supported by the circumstance, that in several cases, the amaurosis and the cerebral (usually epileptic) symptoms appeared and ceased coincidentally with the appearance and cessation of the albuminuria, .

Both arms, but especially the right, began to feel numb and weak after his third attack of colic. The weakness gradually increased, and in about three weeks a trembling began, at first slightly, but which is now very great. The oscillations, especially of the arm, are uniform in extend, and rapidly performed. He says that the trembling diminishes and increases alternately. It is greatly aggravated after fatiguing work. The legs are not affected in any way. All the movements of the arm are performed naturally.

the fingers and forearm can be extended with the greatest ease. Electro-muscular contractility is normal. The force of compression in the right hand, according to the dynamometer, equals 30 kilograms.

in the left hand, 45 kilograms. The pulling strength is 70 kilograms. Muscular strength, in this case, is but slightly impaired,.

Trembling of the hands, followed by weakness of the third and fourth fingers, so that they could not be fully extended.

afterwards the second and fifth fingers became affected, afterwards the wrist, and finally even the shoulders.

the arms hung down relaxed.

the shoulders and arms were emaciated, especially the deltoid muscles.

the balls of the thumbs emaciated.

on passive motion of the hands and fingers there were trembling motions of the muscles, also at other times there was exquisite fibrillar twitching.

if he attempted to raise the arm, the trapezius and sterno-cleido-mastoid muscles contracted and raised the shoulder as much as three inches, then the pectoral muscles contracted and drew the arm slightly forward.

he was, however, able to flex and extend the elbow by means of the biceps and long supinators on the one hand, and the biceps on the other.

contraction of all the muscles was very weak.

pronation and supination of the hand was possible, with trembling, etc.,.

The whole right arm trembles a good deal. The oscillations are rapid and uniform, with a regular to and fro motion. The tremor persists even after the patient has been told to fix his attention on it, in order to prevent it. There is no decided movement of the fingers per se.

it is rather a movement of the whole arm. The left arm also trembles, but in a much less degree,.

About three weeks ago his arms became affected. They are "shaky," he says.

are agitated by clonic convulsions when he attempts to use them. He cannot write, and can with difficulty feet himself.

at one time he was unable. His right arm at one time was fixed, by the contraction of its muscles, to his side up to 10 or 11 A.M. every day. After walking for some time, his arms get quite steady for three or four hours. His grasping power is lessened,.

Paralysis of the upper extremities.

the extensor muscles became completely paralyzed.

both arms hung by the side, could not be raised.

the patient could not use the hands in eating, drinking, or dressing himself.

the flexor muscles were somewhat weakened, and use was associated with trembling.

this was followed by atrophy of the muscles,.

Inability to lift the right arm, which is applied to the chest.

its other movements are performed naturally. Pains in right side of neck, right shoulder, inner portion of right arm, bend of right elbow, palmar surface of right forearm and wrist.

increased by movement.

unaffected by pressure.

worse by paroxysms, during which they burn like fire, and between which they are contusive. Skin of these parts insensible, but their contractility unimpaired,.

Paralysis of the extensors of the forearms.

pronation impossible. the lower portion of the forearm, especially of the right much emaciated.

the hypothenar decidedly diminished in volume.

the action of the long supinators preserved.

muscles of the right upper arm atrophied, as also those of the left, but in a less degree.

deltoids also atrophied.

analgesia and anaesthesia of both arms, especially of the right.

the same symptoms were noticed in the lower extremities, only the extensors of the feet very little paralyzed.

there was no ataxia of motion,.

The first indication of paralysis of the arm was noticed after writing, and manifested itself by weariness and trembling of the hands, and inability to completely extend the fingers.

weakness affected at first the third and fourth, then the fifth and second fingers, then the thumb, at last the extensor carpi ulnaris, associated with transient weakness of the extensor muscles, not at all of the supinators (the patient was left-handed, and the paralysis was worse on the left side),.

Raising the arm became difficult and almost impossible.

after awhile the arm became entirely paralyzed, especially the deltoid muscle.

the elbow, wrist, and finger-joints were somewhat flexed.

the hand retained its position midway between pronation and supination.

the paralysis that began in the extensors gradually extended to flexors, and the arm became completely paralyzed.

tearing pains in the arm, aggravated by pressure, worse at night, at times so violent that the patient became wild with pain.

the sensation of touch was absolutely unaffected.

sensation of heaviness in the wrists and fingers.

finally, a feeling of icy coldness in the extremities,.

Upper extremities emaciated.

the extensor muscles completely atrophied.

the space between the radius and ulna sunken.

skin dry, gray, rough.

both hands flexed at the wrists.

both osseous spaces hollowed.

the basal phalanges stand at right angles with the metacarpus.

the middle and terminal phalanges flexed into the palm of the hand, so that the nail pressed into the skin, the terminal phalanx of the thumb stands at right angles with the basal phalanx.

abduction and adduction almost entirely lost.

separation of the fingers impossible.

all extensor motion is impossible.

pronation and supination almost entirely lost.

scarcely any power to flex or extend the forearm at the elbow.

motion at the shoulder in free,.

There was a marked loss of substance over the right shoulder, all the scapular muscles being atrophied and shrunken.

the head of the humerus could be distinctly felt, and even the irregularities on the surface of the shaft. Lower down, all the muscles of the arm and forearm were much wasted. The fingers were flexed. At times a distinct muscular tremor was seen in the affected muscles, but this was just after attempting to use them. He had no power to raise the arms, which hung useless by his sides. He complained of a good deal of tenderness when his arms were moved about,.

Very numerous dilatations of the cutaneous veins of the forearm and under surface of the lower third of the upper arm.

the dilatations much larger than peas.

especially noticed at the point of union of veins, but also at other points, especially after muscular exertion and on compression of the venae profundae brachii.

these dilatations had the appearance of strings of pearls,.

Very numerous moniliform dilatations of the veins on the forearm, upper arm, and back of the hand, chiefly corresponding to the points of union of veins, always much more prominent after muscular exertion.

there were no varices in other parts of the body, except a few slightly dilated veins on the calves.

this was associated, as in other cases, with colic, arthritic pains, paralysis of the extensors of the forearm.

relieved by a galvanic current,.

Complete insensibility of either arm from the junction of its upper with its middle third down to the finger tips. Tactile sensibility of these parts entirely abolished.

the hardest pinching, the deepest pricking with pins and needles, was unfelt.

his hands being tied behind him, a glowing coal was placed in one of them without eliciting any sign of feeling. Tactile sensibility was unimpaired in the shoulders and upper arms,.

Lacerating pains, with occasional cramps, of the entire upper limb from the shoulder to the wrist. These are neither increased nor diminished by pressure or movement.

they are sharp one moment and dull the next. No redness or swelling. The pains seems deeply seated. Cutaneous sensibility is unimpaired. The affected limbs tremble slightly all the time,.

Dull, boring pain, especially at the bend of the elbow, and extending up to the shoulder.

the hand is kept flexed, and cannot be straightened or lifted.

the arm cannot be raised.

uses both hands in carrying a glass to his lips.

on trying to straighten the bent arm, while the patient opposes the effort, the supinator longus is perceived to resist quite forcibly,.

Bluntness of sensibility in the extensor surface of the forearm and fingers.

the patient, however, is able to localize sensation.

sensation benumbed. the test of electro-muscular contractility with the induced current shows in both arms moderate reaction in the extensors of the thumb, scarcely noticed in the extensors of the fingers.

there is, however, good reaction along the course of the median and ulnar nerves.

there is no reaction in the extensors digitorum communes.

it is noticeable, however, that while the patient is able to extend both hands, there is no trace of action in the extensors of the wrist,.

No sensation when pricked burned in the hands or forearms.

only a partial sensation in the lower half of the arms. Burning does not cause even a feeling of warmth, and no pain was experienced, even when the anterior surface of the forearm was burned so as to raise a blister.

yet there are severe pains in this region. Neither tickling nor changes of temperature are felt in the hands or forearms,.

Boring pains all over the palmar surface of the forearm, in the bend of the elbow, and in the axilla.

the upper arm is not painful.

ameliorated by gentle pressure, but somewhat aggravated by firm pressure.

constant, but returning in very hard paroxysms, during which he squeezed his forearms with his hands.

entreats to be tied round with ropes, his handkerchief, etc.,.

Seized suddenly, in the daytime, with pains in both forearms.

these pains took a course which seems to have corresponded with that of the radial nerve. They were so severe as to prevent sleep. At the same time, she felt a great deal of pain when stretching out the hand, though able to perform the movement. Only the ring finger of the left, and the ring and little fingers of the right hand, could not be extended. In both elbow-joints there was a sort of uneasiness, like a feeling of fatigue. This was also felt in the leg behind the ankle-joint,.

The right wrist and fingers are semiflexed, and can be bent still farther.

when flexed as much as possible, the finger-ends fall upon the middle portion of the thenar and hypothenar regions. The semiflexed parts cannot be extended. When he shuts his hand, and then tries to open it, he merely stops contracting the flexors.

the extensors do not act at all,.

Between the paroxysms, the right wrist and the semi-flexed fingers could neither be separated nor completely extended. When the hand was closed, the tips of the fingers reached only to the thenar and hypothenar regions. All other movements of the upper limb were easily performed. No paralysis on the left side. The paralyzed parts have retained their normal sensibility.

no cramps or tremor. Sleep is good.

the senses are perfect.

digestion well performed.

a stool every day,.

In the upper limbs, the trembling is almost wholly confined to the hands, which move to and fro in almost uniform oscillations. Only when he is vexed or fatigued, does it spread all over the upper limbs. The tremor is always worse in evening than in the morning. He can still squeeze quite forcibly with either hand.

but as he is very powerfully built, it is evident that the strength of his limbs is not in proportion to his general muscular vigor. Measured by Duchenne's dynamometer, the compressive force exerted by the right hand is equal to 12 kilog., that of the left hand to 10 kilog., the pulling force is 62 kilog., which is certainly below what his appearance would indicate. The sensibility is entirely unimpaired. The muscles of the forearm contract as normally as those of other parts under the action of electricity. Tremor worse when he is intoxicated,.

Having soon satisfied myself that these fingers were completely insensible when pinched, I made him stretch out his right hand as far as possible, when, despite all his efforts, the little and ring fingers hung down semiflexed on the palm, while the other fingers were fully extended. He could bend the two paralyzed fingers somewhat further, but no completely. Impressed by this peculiar attitude of the hand, which at once brought to my mind that rare affection, local lead poisoning, I mentioned my suspicions to my colleagues and the students in attendance. I questioned the patient concerning his occupation. He said he was employed in the manufacturing of certain chemical compounds, where he rinsed bottles, etc., but distinctly denied that any preparation of lead was among the ingredients used, and insisted that the same was the case as to Merc Viv mercury. He had never had colic, and his gums showed not the slightest trace of a lead line.

but this was not inconsistent with my view of the case, under the supposition that the paralysis was due to the local and direct action of Titanium Metallicum the metal. I asked him if he was right-handed. He answered in the affirmative. I then asked him to compress my hand in his right hand. He tried to comply.

but that hand had no grasping power, being especially weak at its inner border.

a trial with his left hand, however, gave me severe pain. The right little and ring fingers, also the inner border of the right hand and the inner half of the palm and back of the same, were completely insensible to touch, pricking, pinching, cold, and tickling.

the other fingers, and the rest of the right hand, retained their natural sensibility. In spite of the patient's denial that he had been in the habit of touching lead, or of using a leaden tool, I assured him that he had been poisoned by that metal, which he had frequently handled with the last two fingers of his right hand. In order to convince him, I told him to take a Sulphur sulphur bath, which, if it should have the effect of blackening the paralyzed hand only, especially its affected parts, would show, beyond doubt, the presence of lead in his system, and the propriety of his following my advice. If otherwise, then I would confess myself mistaken. I prescribed for him 1 gram of Iodium Iod. Potass. daily.

and Iodide ointment to be rubbed with the right hand. Just as he was leaving the dispensary, he turned around and remarked, that "perhaps it was capping the vials which had done the mischief." Now, if I had not stuck to my theory, this case would certainly have slipped through my fingers. Seizing the cue thus presented, we got him to explain to us the mode in which he fitted on the leaden capsules. He applied the sheet-lead smoothly over the neck of the vial, by clasping the latter between the inner half of the palm and the last two fingers of his right hand.

after working in this way for awhile, these parts became covered with a grayish-black discoloration derived from contact with Titanium Metallicum the metal. On re-examining the palm of the hand, we found two callosities on the inside of the knuckle-joints of the two paralyzed fingers, and none elsewhere. These sufficed to show that the patient told the truth, since these were the precise points most subject to friction during the process he had described to us,.

The compressive force exerted by the right hand is not great.

it is registered at 5 kilograms by Duchenne's dynamometer.

the left hand is stronger, marking 5 1/2 kilograms. The right hand is used with much difficulty.

he cannot button his clothes with it, but can still employ it in conveying food and drink to his mouth. Movements are performed quite easily with the left hand. There is not the least paralysis of the extensor muscles.

their muscular contractility is practically unimpaired,.

The two left middle fingers are firmly flexed upon the metacarpus.

the other fingers are similarly bent, but to a much less degree, and can be extended almost completely, which is not the case with the former. When the hand is shut, the two middle fingers reach only to the upper portion of the thenar and hypothenar regions.

the other fingers touch the palm, but fall short of the lower metacarpus. The left middle fingers can only be separated when flexing them. The left thumb can be abducted, adducted, and brought into opposition. The left wrist, when at rest, is less bent than the right, and can be straightened out without previously shutting the hand,.

The right fingers are bent almost to a right angle with the metacarpus.

when the hand is shut, their tips only reach the upper portion of the thenar and hypothenar regions. When the hand is opened, and the flexors cease their contraction, the fingers return to their semiflexed condition by a purely mechanical movement, in which the extensors take no part. The right fingers can only be separated partially, and when flexing them. The right thumb cannot be abducted or brought into opposition, but is still capable of adduction. The right wrist is kept somewhat flexed.

it can be straightened out only when the hand has been previously shut.

it is then capable of adduction and abduction,.

The left middle and ring fingers are bent at a right angle with the metacarpus, and cannot be in the least extended.

the thumb, index, and little fingers can be extended pretty well, but not completely.

the dorsal surfaces of the latter describe a slight curve, and the superior extremities of the index and little finger form a considerable angle with those of the middle and ring fingers. During extension of the wrist and fingers, and when the forearm is brought into supination, the forcible contractions of the supinator and radial muscles, and of the extensor carpi ulnaris are plainly visible.

and between the two lumps which they form is seen a very small portion of muscle which remains without motion.

this is the extensor communis.

on the back of the wrist, the tendons of the extensores proprii digitorum are seen contracting with their wonted energy.

abduction and adduction, impossible by the middle and ring fingers, can be performed by the index and little fingers, though in an obscure and uncertain manner.

the thumb is freely abducted, adducted, and brought into opposition, which last movement is easily effected by the little finger also.

the phalanges can be bent on one another, so that the tips of the ring and middle fingers shall fall between thenar and hypothenar regions, while the remaining fingers touch the palm. The fingers of the right hand are similarly affected, but to a much less degree,.

The fingers are bent upon the metacarpus, at an obtuse angle, which is almost a right angle.

they can be extended and separated a very little.

the last phalanges are but slightly flexed upon the second phalanges.

the hand cannot be firmly closed, and when this is attempted, the finger-ends come in contact with the middle portion of the thenar and hypothenar regions.

the thumb and little finger cannot be placed in opposition.

all other movements of the upper limb are easily performed, but they are rather slow and feeble,.

The fingers are firmly flexed upon the metacarpus.

on shutting the hand, their tips come into contact with the lower portion of the thenar and hypothenar regions. The fingers can be but partially separated, and that only when flexing them.

on ceasing to contract they are drawn closer together, and they are quite incapable of extension,.

On the right hand, the ring finger alone is flexed at an obtuse angle, and it cannot be in the least extended.

yet it does not seem so much bent down as the left middle fingers, because the other fasciculi of the extensor communis digitorum kept it somewhat extended. When the fingers are closed, the ring finger does not get as far down as the others, neither can its abduction and adduction be fully effected,.

Right fingers flexed at an obtuse angle with the forearm.

can be extended 3/4, and separated to a like distance. On shutting the hand, the right finger-tips fall beneath the thenar and hypothenar regions. The right thumb can be adducted and placed in opposition.

it is incapable of abduction or extension. Right little finger easily brought into opposition,.

No contraction could be obtained by magneto-electricity, nor by inductive currents of electricity, in the extensor comm. Digitalis Purpurea digit.

by the continuous current (forty or fifty elements), a few faint contractions were produced in these muscles, on closing the current. They were scarcely visible in the extensor of the left hand, and it is doubtful if they occurred at all in that of the right,.

Dorsal and palmar surfaces of little and ring fingers entirely insensible to all stimuli.

the anaesthesia extends also from the fourth and fifth metacarpal bones to the styloid process of the ulna. The skin of the inner surface of the middle finger, and of the third metacarpal bone is equally insensible. Pain is felt on thrusting a pin deep into the affected portion of the metacarpal region.

and also on wringing or jerking violently the fingers whose skin is insensible. The fingers move without difficulty, but less nimbly than usual, and as if benumbed.

but not one of their muscles is paralyzed,.

One foot began to drag, and soon he could only creep about "on all fours." The hand of that side was also soon affected.

he could not button his clothes or cut his food, and was carried up and down stairs. Soon he regained power of his limbs. Again the paralysis returned, and the necessity of creeping, but I think the hand this time was only slightly affected. A subsequent amelioration took place,.

During the paroxysms, which occur oftener than every five minutes, he tries to obtain relief by moving about in bed, also by extending his limbs, which is impossible, on account of the strong spasmodic contraction of their muscles. Soon, however, the period of relaxation arrives.

quietude returns. and the cramps and acute pains cease. The paroxysms occur more frequently in the night than in daytime,.

The tremor of the lower limbs does not affect the gait, but when he is sitting or lying, or when he is required to lift his legs, they tremble very perceptibly.

the right limb much more than the left. The power of resistance to forced flexion and extension, though lessened, is still considerable. Sensibility unimpaired in both upper and lower limbs,.

The numbness, before spoken of, affected the right limb a day or two after, and soon extended over the whole of both limbs, from the buttocks to the toes.

and, for a long time, I so lost the sense of feeling in them, that I had no consciousness of where the feet were, unless I saw them.

for many weeks I did not know whether one foot touched the other in bed,.

Contemporaneously with the loss of animal contractility in the upper limbs, the exaltation of sensibility in the abdomen began to involve the inferior extremities. Severe bruised pains were felt in the forepart of the thighs, in the knees, calves, and soles of the feet.

pains were also experienced in the lumbar region. They all disappeared entirely along with the colic.

the paralysis alone remained,.

Very acute pains, passing from the knees to the soles of the feet, where they are much more severe than anywhere else. The backs of the feet, the toes, calves, and popliteal spaces are painful in degrees varying according to the order in which the parts are named. The pain is tearing, worse by paroxysms, increased by walking and movement and diminished by rest, but never affected by pressure.

it is accompanied by a feeling of burning heat, without redness or swelling, which keeps him trying to place the parts in contact with cooling things.

the warmth of the bed increases the pain. Now and then the cramps are felt in the calves and in the soles of the feet, which parts are also sometimes troubled with pricking and formication. Sometimes jerks and shocks, as of electricity, pass all through the body, and especially affect the lower extremities. The arthralgia is worse at night. At last, he is completely prostrated by the violence and duration of the pains,.

Lancinating pains in the knees, popliteal spaces, calves, soles of feet, bends of elbows, metacarpi, and temples.

constant, but worse by paroxysms, diminished by pressure.

unaffected by motion. The excessive sensibility, which is unaccompanied either by redness or swelling of the parts, is most acute in the popliteal spaces and calves,.

The right leg was semiflexed upon the thigh when the patient stood up.

he could flex it further, but not completely. Extension was impossible.

the knee could not be straightened. The right thigh was somewhat flexed upon the abdomen. All the other movements of the limb were performed naturally. He could not stand on the affected limb alone. While walking, which was only possible for a few minutes, and with the help of a cane, he dragged the right foot along, on tiptoe,.

Leg semiflexed upon the thigh.

it can be flexed still further, but not completely.

long standing is impossible.

walking is painful and staggering.

he drags his feet after him, so that he stumbles over every obstacle.

he can hardly get downstairs, but goes upstairs more easily.

when fatigued, his knees feel particularly tired.

all other movements of the lower limbs are easy,.

A spasmodic working of the feet from side to side troubled me, and they would often draw back out of the shoes. I was unable to draw on a boot. While sitting still, the legs would insensibly draw back on the thighs, till the feet got entangled under the chair.

this involuntary drawing back of the leg made it very difficult to go upstairs, a man held the foot on the first stair, while a person behind assisted me to rise so as to lace the other foot on the next stair.

and then the man would hold that foot in place, or it would certainly have drawn back so as to have thrown me down. While going downstairs, I straightened the whole limb before planting the foot upon the next stair, and, with the help of a man and the banister, could get down safely,.

The right toes are strongly bent upon the metatarsus.

they can be further extended, but cannot be flexed upon the foot or separated in this way. The right foot is strongly bent upon the leg.

it is incapable of flexion.

its abduction and adduction can only be effected by extending it, and causing the leg to move the whole foot at once,.

The toes are strongly flexed on the sole of the foot, and cannot be extended.

that is, their extensor muscles are paralyzed, and their flexors, therefore, permanently contracted. Abduction and adduction of the toes are prevented by want of power in the interosseous muscles. All other movements of the lower limbs are easily performed,.

Chilliness, always worse towards evening, even by a warm stove.

head dull, dizzy, with thirst, redness of the face, and soft rapid pulse, over 100.

while in bed, external heat with internal chilliness.

at last the heat increased, the skin became hot and dry, pulse frequent, without thirst.

after midnight, the skin became gradually moist until sweat broke out on the chest, abdomen, and head.

after 2 o'clock, sleep with confused dreams.

on the next morning, tongue coated, head dull, face pale, and always on rising there is a stitch extending through the head from below upward.

this attack was repeated after ten weeks,.

Unnatural coldness of the lower limbs, uncomfortable to myself, and perceptible to the touch of others. I wore my warmest winter clothing all summer, and always had a blanket shawl over my lower extremities, even the hottest days, when taking my drive.

in the house I used an India rubber water cushion to sit upon, and had it filled with arm water every day,.

He was wonderfully emaciated. If placed in an erect position, he fell over in any direction if not supported, and he had not the slightest command over the flexors or extensors of upper or lower extremities, especially the upper, which seemed to have ceased to act at all. The deltoids seemed entirely gone.

the head of the humerus could be traced in the glenoid cavity quite plainly.

his ribs were covered only by skin.

in fact, he looked more like a dried skeleton than a living person,.

Gout is much more frequent in persons suffering from lead-poisoning than in others.

this arthralgia of lead-poisoning is distinguished by the absence of redness and tumefaction.

a tumor that appears on the dorsal surface of the wrist, in some cases coincident with the paralysis of the extensors, extends along the tendons, is not changed in color, consistence, or mobility.

it is caused by hypertrophy of the tendinous expansions, never commences in the articulations,.

The number of blood-corpuscles is very largely diminished, in some cases to the number of 2,200,000 in a cubic millimeter of the blood.

but while the number is so much diminished, their size becomes greatly increased, being relatively to the size of healthy blood-corpuscles, as 9 to 7, true macrocythemia.

this increase in the size of the red corpuscles is found not only in cases of acute but also of chronic poisoning,.

First taken with vomiting, colic, and all the symptoms of lead-poisoning.

since then has never been quite well.

has an aversion to food.

occasional slight colic and constipation. About four months after resuming work had a bad relapse.

besides colicky symptoms there was a general debility, tremor in the legs and arms, and some oedema about the ankles.

in a few days the hands were paralyzed,.

(Colic in 1850; second attack 1869; 1871, third attack. Paralysis began; lead rheumatism set in at the same time with the debility. Since the latter period, sleep has been troubled with nightmare. Since 1871, seven other attacks of colic, each successive one more severe, and accompanied by pain along the limbs, severe headache, and arthralgia; no delirium; no paralysis. In November, 1874, he left off working in lead; nevertheless, January 6th, without apparent cause, he was attacked by very severe colic),.

(First attacked when at Montevideo; very severe colic, lasting fifteen days, accompanied by violent cerebral symptoms, so that he lay as if dead for some hours. Two months later another attack of colic, lasting three or four days only, but which he had scarcely got over when gradual paralysis set in, which so disabled him that he had to be fed by hand. Two months later the symptoms returned, only there was less paralysis than the first time),.

All the symptoms were aggravated at night, and particularly by lying in bed.

they produced such a continual agitation and anxiety as to compel him frequently to rise and walk about the house.

in this mode he passed the nights, until the light of a new day saw him lie down on his couch worn out by fatigue and exhausted by suffering.

these nightly walks always needed the aid of another person, and he retained when walking the same bent position as in repose,.

Had his first attack of lead colic (quite a violent one) about twenty-two years ago. Had no further trouble of the sort until his second seizure in 1865. For some time previous to the latter date there had been a weakness of his upper extremities, to which, at the time of the second attack, there was added a trembling in them, that became in a few days very great. In a month, however, he left the hospital completely cured. Since then the tremor returned at varying intervals of time, but not very severely. It was worse in the morning, and he informs us that if he drank two or three glasses of brandy it would cease during the rest of the day. The affection had never been much as to prevent him from working. He had other symptoms of alcoholism, such as raising of phlegm in the morning, illusions of sense, etc. In the course of the last two months he had to spend several day in sandpapering some old wainscots painted in white lead, the process raising a fine dust, which he inhaled largely. On July 25th he had another and very severe attack of colic, and the trembling returned at the same time with great violence. According to his custom he took some brandy to relieve this latter symptom, but did not succeed in removing it. Being now disabled from work, he entered "La Charité" August 3d. The tremor affects the whole body. The upper limbs are agitated by rapid and well-defined oscillations. He has some difficulty in grasping objects, but electro-muscular contractility appears to be almost unimpaired. The lower extremities are similarly affected when he is standing up. The gait is uncertain.

he staggers in his walk. The head also trembles perceptibly, the tongue quivers, yet there is no hesitation of speech. The dynamometer indicates a marked diminution of strength.

the compressive force of the right hand equals seven kilograms, that of the left four and a half kilograms, the pulling strength twenty-two kilograms,.

The first symptoms which I can recall (I now speak of my first attack) are a peculiar uneasiness or moderate pain in the bowels, with a sort of feeling that there was or would be required some action of them, but no effect of the kind ordinarily followed, or could be induced by natural effort.

Yet there was at that time no excessive constipation.

Plumbum Metallicum uneasiness, or these sensations, were not constant, but grew in frequency, the pain gradually creeping round to the lumbar region, when it became fixed and constant; by degrees, however, diffusing itself over the system, particularly the lower limbs.

I do not recollect any pains in my head.

But by the middle or latter part of the summer of 1838 I became greatly debilitated, yet was without fever, the pulse not elevated.

An uneasiness or pain in the lumbar region now caused me continual suffering.

I had a feeling of great misery; could walk but a few steps without wanting to sit down; and if I did so it was a great effort to rise again.

I had a sense of constant lassitude or weariness, and an indisposition to motion.

I was perplexed by the symptoms.

The least fatigue, and all motion fatigued me, aggravated the suffering.

I have now a very vivid recollection of going with two or three friends to pass a day at Nantasket Beach.

We went out in a boat, and I well remember my sufferings as I lay listless in one end of it, trying by various changes to put myself in a posture of some ease, which I could not succeed in doing.

I remember distinctly the question asked me by one of my companions "Are you in pain?" I was scarcely able to get home.

We rode in a carryall, and I remember the difficulty I had in supporting myself, holding as I could by different parts of the carriage.

The bowels had now become wholly inactive, and it was, I think, two days, at least, before they could be moved, and then very imperfectly.

During this time I was in a most restless state, day and night.

There was no sharp pain, but a constant dull, gnawing pain, more particularly in the lumbar region and bowels, and a tired feeling in all the limbs.

I was every moment changing my position, seeking ease, but not for a moment finding it.

I would get out of bed every little time and sit in a chair, or attempt to walk the room, but it was all the same.

There was no relief to be had.

After the bowels had been effectually stirred, I found myself in a degree relieved.

I went through the next year very well, keeping up my system of outdoor exercise so far as my duties allowed.

In the latter part of winter, or in early spring, I had an attack, mainly, in the left side, apparently in the intercostal muscles.

From this I recovered in no long time, and went on till late in the spring of 1840.

Then and in the early part of the summer I had a return of the old symptoms described as occurring in 1838; only with this difference, that the development of the disease was much more rapid.

I went through the same process of active medicines, injections, etc., before the bowels could be stirred.

I became more debilitated than before, the countenance assuming in a more marked degree the peculiar earthy yellow described by M. Tanquerel.

Then came on the pure arthralgic pains.

They seemed to be deep, as if in the very bone, and were seated more particularly in the flexor muscles, as the inside of the elbow-joints and the joints of the knees.

Soon after, that is in July, there commenced a trembling of the fingers, which soon passed into decided paralysis, the paralysis increasing for about three weeks.

Plumbum Metallicum paralysis was in the extensor muscles of the fingers, wrist, forearm, and arm of both the upper limbs; the lower limbs, with a slight exception, not being affected.

My arms when left to themselves hung loose and dangling at my sides, as if turning on a pivot.

Using only one at a time, I could elevate them only in a slight degree.

I could not get my hand to my chin or mouth.

But what puzzled me at that time was that there were certain motions which I could perform, for example, placing the palm of one hand against the back of the other, I could get them to my face; the flexor muscles of the hand, which were not paralyzed, being thus brought into action.

So, too, I could draw on my boots almost as well as now, the same muscles acting.

If my arms were elevated to a right angle with the body, the palm of the hand being turned downward, the whole hand fell at the wrist, hanging loose as a piece of cloth, and the will had no more power over it.

I could not, without help, raise the hand in the least, not so much as one of my fingers, in the slightest degree.

When I took a tumbler to drink, I clasped it with both hands fully spread, and could so get it to my lips.

When I ate I rested my right arm, below the elbow, on the edge of the table, and grasping the wrist with the left hand, and then bringing my mouth down to within three or four inches of the table, I could get the food to it.

The backs of the hands became prominently arched; the fingers, when left to themselves, became bent and half shut, the natural consequence I suppose of loss of power in the extensor muscles.

The rotary motion of the arms was entirely lost, a fact to which my attention was directed, when they attempted to assist me to put on my coat.

I tried all I could to exercise the poor lame muscles, but all fatigue, that is all use of them, seemed to be attended with injury.

They had totally lost their contractile power.

The abdominal muscles were similarly affected, though not in the same degree.

If I had any it was only a slight power over them, which gave me great trouble when an action of the bowels was needed, though they could at this time be readily moved by medicine.

All the time there was more or less of arthralgic pain, more particularly at this period in the inside of the knee-joints.

The pain seemed to have no connection with the paralysis, and was greater in the parts not paralyzed than in those which were.

The intercostal muscles on the left side were now affected; for months I could not sneeze; the moment the process began it was arrested by these muscles.

The sensation was a very unpleasant one.

I had no constant thirst, though I felt thirst at times, especially in the afternoon, or when unusually fatigued.

I had little or no fever, though at one time a highly nervous pulse.

I have spoken of the loss of the power of motion in certain muscles, or their loss of contractility.

The sensibility of the muscles or nerves, with a slight exception, was not impaired, but the reverse.

There was a soreness or peculiar tenderness in all my flesh.

Sitting in a common wooden chair and leaning back, the parts of the chair seemed to penetrate to the very bones.

The exception referred to was a small muscle in the inner part of the left thigh.

There was a spot there or four inches in length, and two or three in breadth, which had lost its sensibility.

There was at times a sensation of a peculiar and unpleasant kind at the bottom of my feet, a sort of burning, which I used to relieve, when in bed, by drawing up the covering and pressing the soles of my feet firmly against the foot board, which produced a cool and agreeable sensation.

I had also at times a violent pain in the back between the shoulders, rather nearer the right than the left shoulder, which I would relieve by getting on my bed and lying flat on my back, bringing as much pressure to bear on the part affected as I could.

Plumbum Metallicum method mitigated the pain before a long time In a multitude of ways I was a great sufferer; but the brain I did not think was affected, and I do not now think it was,.

On the 7th of January he was suddenly attacked with epileptic fits. He had a succession of fits, which lasted for thirty-six hours. He stated that he had no recollection of anything that had happened from the time of his admission into the hospital until the 12th of January.

that he woke up with severe headache, occupying the entire head, with vertigo, and found that he had lost the power of moving the left leg and the right arm. There was a decided diminution of sensation in the affected limbs, and the right hand was in a permanent semiflexed condition, with very little power of opening or closing the fingers,.

A sudden violent shock in the extremities, so that he fell to the ground, with spasmodic flexion of the legs.

so great he heels touched the nates.

on attempting to extend the legs he suffered the most violent painful cramps in the thighs and calves, at the same time the abdomen was retracted and so sensitive that the touch of even his shirt caused the most violent pains, with obstinate constipation.

this was followed after a week by a similar sudden shock in the arms, with spasmodic pain.

the hands were violently flexed and the fingers spread apart.

the pains lasted several weeks, and gradually disappeared.

during this period he was able to sleep only while lying on the back, with the right arm clamped between the legs.

after the spasm left the arm he noticed that he could not use the right arm as easily as before, and that the fingers hung down.

the next year the left hand became affected in a similar manner.

all these attacks had been attributed to colds.

the skin of the arms became rough, dry, cracked,.

Attack of lead epilepsy, while in bed. One quick loud cry.

tetanic rigidity of the neck and limbs.

face pale. entire loss of consciousness.

respiration ceases in a moment.

face blue. congested spots on the forehead and face.

spasms of the facial muscles.

slight clonic convulsions (movements concentric).

bloody whitish froth at the mouth.

this condition lasted three minutes. Paralysis of the limbs.

coma, with stertorous breathing, lasting a quarter of an hour.

aroused to half consciousness, but continued drowsy. Two other fits in the course of the day.

not so strong,.

Very violent epileptic attack at about 10 A.M.

immediately became unconscious.

convulsions of the limbs.

tetanic stiffness of head and body.

face livid and horribly distorted.

stertor. foam at the mouth.

spasm of the eyeballs.

this attack was succeeded by deep coma, during which he lay motionless in bed, with half-closed eyes and open mouth. Sensibility and motor power are retained, though in a diminished degree.

some dull grunts at long intervals, and occasional automatic movements of the limbs are the sole evidences of animation,.

Epileptic convulsion. the muscular contraction began in the abdomen, and extended upwards to the throat.

the jaws were so violently brought into contact that a tooth was dislodged.

the eyes rolled upwards.

and lastly, the muscles of the limbs were affected. For an hour after the convulsion the patient lay perfectly motionless, and then became very restless and talked incoherently. In about nine or ten hours he had a second convulsion, and after nearly an equal interval a third, and again a fourth. Each fit lasted for one minute.

they were all preceded by vomiting a dark-colored matter, and followed by symptoms similar to those which succeeded the first fit,.

Attack of fully developed epilepsy with biting of the tongue.

it lasted a quarter of an hour, and was immediately succeeded by coma, which continued twenty minutes. On regaining consciousness he wanted to get up and walk about, work, take a drink, etc., then relapsed into coma, and so on alternately.

the delirium lasting three times longer than the coma.

the delirium more generally occurs after than before the epileptic attack. Pupils so much dilated that the Irisis hardly visible,.

He was hardly in bed at the hospital before he told us he was about to have an attack, by the sensations of formication and pricking, which extended from the index and thumb of the right hand to the shoulder.

at the same time the fingers became flexed into the palms, the thumbs being covered by them. The forearm was strongly flexed upon the arm, and held in forced pronation.

the wrist also was strongly flexed, and the whole limb agitated by clonic spasms. The right hand and forearm were red from stagnation of blood.

with his left hand he supported his right forearm, which tended in its movements to approach the trunk. The head also shook, and was inclined to the left. There were slight spasms of the eyes. There was a slight circular movement of the lower jaw, but no frothing at the mouth, nor was the intellect in the slightest degree affected, although he was unable to utter a word.

and he fully understood everything that was said within his hearing. The attack lasted about half a minute. After it was over he complained only of a little numbness of the right hand,.

Peculiar paralytic sensation extending from the back towards the hands and down to the feet, especially involving the left side of the body, which felt asleep.

she was unable to move a limb.

this paralytic condition seemed to disappear with a shock, and was followed by a sudden spasmodic stretching of the left extremities, which seemed as if dead.

wherewith the fingers of the left hand were spasmodically closed, with pronation of the wrist and gradual extension of the arm at the elbow, and extension of the left lower extremity from the knee to the ankle, lasting several minutes.

this cramp returned at short intervals.

the patient cried aloud from pain, and, although consciousness was partly lost, yet she was able to make short, indistinct answers.

after about twelve hours these spasms affected other muscles.

whenever a spasm occurred the head suddenly and with a jerk was drawn to the left side, and at the same time bent forward, so that the chin rested upon the left clavicle.

during the next day the spasms occurred every quarter or half an hour, and the excessive paleness of the face of the first day changed to a bright redness.

on the third day the spasms began to affect the right side in a similar manner, and were associated with opisthotonos, so that the body was balanced upon the neck and heels.

at the close of the paroxysms, rattling in the trachea and oozing of tenacious, frothy mucus from the mouth.

at this time there began to be noticed, during the intervals between the spasms, a jerking of the facial muscles.

pupils contracted, the sclerotic dirty yellow, lips bluish, gums retracted from the teeth, exhibiting a lead line, middle of the tongue covered with a yellowish-white coating,.

Suddenly seized with convulsions.

the upper and lower extremities were violently thrown into alternate flexion and extension.

the body is forcibly and involuntarily shaken.

the head bends backward. All sensation is lost, but there is neither frothing at the mouth nor stertor.

the face is injected. The convulsions lasted about five minutes. When they cease, he lies quiet and motionless in profound coma, and cannot be stimulated into attention. After this has continued for a quarter of an hour, convulsions again set in, but do not last as long as at first. Thirty-four convulsive seizures were counted within twenty-four hours.

between them he was always comatose,.

The latter part of September his brother reported that at school he had fallen, and according to his description was convulsed. It subsequently appeared that some days previous he had a similar attack while amongst his playthings in an attic room, when his brother noticed him lying on the floor and acting strangely, and asked, "What he did so for?" he replied, "He did not know." The evening of the day of the attack at school, the nurse called his parents, after he had been asleep, saying that he was breathing strangely. Nothing abnormal appeared when we arrived, but in the course of an hour I heard the heavy and laborious breathing, and found him in a convulsion, which continued not over a minute. The eyeballs were distorted, and the body and arms flexed spasmodically. These attacks numbered seven or eight daily, and in the course of two or three days amounted to fifteen daily, which number daily continued until the middle or latter part of the following February, having, however, once numbered twenty-two to twenty-three in twenty-four hours.

but this was when the attacks were not the most protracted nor the most brief. The duration of each attack varied at different periods, from (I should judge from memory, not by the watch) one-third of a minute to one and a quarter or one and a half minutes. They did not vary much in duration and severity usually during a period of twenty-four hours, but did in a period of weeks. The heavy, laborious, almost stertorous breathing was our first admonition during the early attacks (when he was asleep).

soon this ceased, and during the last month or two this symptom occurred only at the close of the convulsion, and was our first notice of its subsidence. Indeed, I remember failing to discover any sign of respiration during the greater part of an attack in some of the later weeks. Some other symptoms varied in a like manner, as to order, during the whole period. A small quantity of saliva ejected from the mouth terminated many of the attacks, perhaps one-fourth of them. The turning in of the thumb upon the palm was sometimes noticed, but was not always or uniformly the case, while I think strong flexion of the fingers was a usual accompaniment. The strong contraction of the muscles of the back and neck, at the termination of the convulsions, was noticed during the severe attacks, but did not accompany the lighter attacks. The attacks in the daytime were without premonition.

sometimes he thought he had a slight dizziness a moment before, but was unable to notify us. To us the attacks seemed instantaneous.

as when as cheerful as usual (talking the moment before) he would fall to the floor from his seat.

once, when standing by the dinner-table chatting with his brother, he fell backwards, turning one-quarter around, the arms and neck contracting, otherwise at full length, striking his head against a sheet-iron stove,.

Having never had nervous complaints of colic (except an attack of the so-called "Madrid colic"), was suddenly taken, while eating, with convulsions movements of the limbs, soon followed by a general stiffness. No frothing at the mouth or stertor. He fell to the ground, but without loss of consciousness.

could not answer questions, but understood all that was said about him. This state lasted five minutes.

after which he could talk as sensibly as usual.

only complaining of great weakness. Next day another convulsive attack like the above,.

Suddenly his head inclines forcibly to the right, his limbs stretch out, become stiff, and are strongly convulsed, as also is his face, which turns blue.

his eyes are wide open and rolled upwards.

pupils exceedingly dilated.

violent shocks pass over the whole body.

bloody froth issues from the mouth.

the beats of heart and pulse are tumultuous and quite strong. Then the spasms of body and limbs subside, the oppression increases considerably, and he is threatened with suffocation.

inspirations are deep-drawn and difficult. The previously dark-red face becomes pale as a corpse.

only the whites of the half-opened eyes are visible.

the body becomes cold.

the frothing at the mouth ceases.

he remains motionless an sleeps a little while.

pulse 140, and very small. He awakes in a few minutes, his eyes fixed and staring, and his whole countenance looking very dull.

is ill-humored, and will hardly answer questions.

finally, turns over to his left side and falls asleep,.

After working seven weeks, an attack of colic.

five days later saturnine encephalopathy set in.

he fell down unconscious when in the act of washing his hands.

then he had spasms.

this attack lasted two hours. Four or five hours after, another attack like the first.

it only lasted an hour.

until this time his lead symptoms were confined to these to attacks, and a certain degree of muscular weakness in the upper extremity only. A few days afterwards he found that he could hardly use his upper limbs in eating.

when he tried to carry a glass, for instance, to his lips, his arm shook so much that he could not drink.

the muscles were also very weak. Next day there was slight formication in the lower limbs.

walking was still almost natural. At the end of four days he walked with difficulty, and was obliged to lean against something so as not to fall down.

at the same time he had severe headache, with dimness of vision and hard hearing, especially on the left side. In proportion as the difficulty in walking increased, the involuntary movements of the upper limbs became less decided,.

When seized by a paroxysm, he lies down on the floor, rolls about in every direction, places himself in all sorts of attitudes, squeezes his feet, calves and knees with his hands.

groans aloud, calls for help, while his distorted face expresses the keenest agony.

entirely engrossed by his pain, he can scarcely answer when addressed. In from three to five minutes, he gets more quiet, but is so completely exhausted he can hardly stand on his feet,.

Hypochondrium seemed distended and tympanitic.

on moderate pressure gurgling sounds in various parts of the abdomen.

pressure in the umbilical region seemed to cause pain.

retention of stool and suppression of urine.

even on the next day the left side was more affected by paroxysms than the right.

sometimes they assumed a tonic, at other times a clonic character.

on the sixth day, the muscles of the left side of the face only were affected.

there was not only opisthotonos, but also sometimes emprosthotonos and pleurothotonos.

the tonic spasms always occurred suddenly, as with a shock, affected especially the muscles of the face, neck, trunk, and extremities at the same time.

the head became drawn towards the left side and fixed as above described, the muscles of the shoulder and nape of the neck drew up the shoulder.

the left arm and left foot were so violently stretched out that the joints creaked.

the muscles of the left half of the face were drawn down so that the lips were closed, and the left corner of the mouth drawn downward, and the left cartilage of the nose drawn to the left side.

the attack generally lasted about two minutes and suddenly ceased.

the clonic spasms affected all the muscles of the face.

they usually occurred after the close of the atonic spasms, sometimes, however, preceded it, were characterized by trembling and twitching affecting the orbicularis palpebrarum and corrugator superciliorum, and also the levator labii, and sup. alae nasi, the depressor alae nasi and levator of the upper lip, zygomata, and risorius muscles.

trismus I did not observe.

closure of the mouth was effected by the orbicularis oris.

at times also twitching of platysma myoides,.

Every day or two he has an attack of spasmodic contraction of the flexor and adductor muscles.

his legs are forcibly flexed on the thighs, and the thighs on the abdomen, and sometimes one leg is drawn over the other.

his arms are drawn so forcibly against his chest that it is impossible to raise them, and the forearms and wrists are forcibly flexed.

the muscles of the neck, particularly the sterno-cleido-mastoid, draw the head clear down upon the thorax, and greatly to one side, and occasionally the head is jerked from side to side.

during these attacks he is perfectly conscious, but if he attempts to talk, he stutters and makes peculiar indistinct sounds, but cannot articulate.

he also makes a groaning sound, which he says is involuntary.

during the attacks of spasm, he suffers intolerable pain, and is left completely prostrated when they are over.

during his worst attacks, the pulse does not exceed 80 beats per minute, and generally it is about 65, full and steady. The rectus abdominis, upon each side, contracts so as to be prominent and hard almost as bone, and all the muscles attached to the ribs contract so forcibly as to draw them in, and produce such pressure upon them as to cause him to frequently cry out that they are breaking,.

The right side became more and more feeble.

mobility of the upper extremities very much diminished, associated with some atrophy of the muscles of the posterior portion of the upper arm, with very limited extension of the hand.

sensibility of the arm to touch and temperature also diminished.

of the lower extremities the right limb was very feeble, so that walking was very difficult.

the right lower extremity was affected with anaesthesia, like that of the right side of the trunk, right arm, and right side of the face, corresponding exactly to the median line of the body.

there was diminished sensibility of the right side of the tongue.

the reflex movements in the throat were almost entirely abolished.

the voice was nasal and speech very indistinct,.

Eventually all muscular power seemed to leave her, and she tumbled from the chair in which she was sitting to the floor. I noticed that there seemed to be not so much a loss of muscular power as proper co-ordination.

and, although if shaken and spoken to loudly, she would answer questions intelligently, immediately afterwards she lapsed back into stupor,.

First attack of lead colic, six years ago, severe. Eight or ten days thereafter, paralysis of the hands.

could not lift them. This had been preceded by slight cramps in the fingers, which came on before the colic and lasted about fifteen days. Wandering pain throughout the body generally, now here, now there. Second attack four years ago.

suddenly taken with colic and cramps.

paralysis of the extensors remained. Third attack three years ago.

increased paralysis, which remained. Fourth attack, one year ago.

paralysis unchanged. Fifth attack, fifteen days ago.

very severe colic. increase of paralysis,.

He began painting at the age of sixteen years, and left it off to enter the army at the age of twenty-one, without having felt the slightest symptom of lead-poisoning. While still in the latter service, at the age of twenty-three or twenty-four, he suddenly felt, during a violent fit of sneezing, a cracking in the right side of the head.

and immediately after was taken with formication and numbness in the whole right side of the body, together with weakness of these parts. All these complaints gradually got better, and when his term of service was ended, they had entirely disappeared,.

Lead palsy begins with a simple numbness or slight tremor, and ends with a complete loss of the power of movement. The degree of this loss bears no proportion to the extent of the paralysis. Saturnine tremor is rather a slight agitation, than a visible contraction and expansion of the muscles. It is never accompanied by that perceptible and almost spasmodic action which characterizes mercurial tremor. This affection really constitutes the first stage of lead palsy.

it is connected with a marked weakness of muscular contraction. When the parts affected by tremor are put in motion, their muscles seem to hesitate or oscillate in their contractions, which are short-lasting, and doubtfully performed. Moreover there is always complaint of weakness in the parts affected by tremor, even when there is no fully developed paralysis. Upon saturnine tremor, when it has lasted some time, there almost always supervenes a complete paralysis of one or more muscles of the affected-parts. The tremor is almost always restricted to a part or the whole of one limb, rarely affecting two at once.

but it may involve both the upper and lower extremities, the lips, tongue, or vocal apparatus,.

Great prostration at twilight.

he lies down, feels the beating of the pulse, becomes hot in the face, that burns in several spots, without sweat and thirst.

with trembling of the hands and vertigo, as if the couch moved, renewed by thinking of it, with sensitiveness to noise.

he at last falls asleep and wakes after three hours with a weary prostration, that disappears after moving about.

there, however, remains dulness in the head and a bruised feeling in the small of the back,.

Excessive hyperaesthesia of the cutaneous nerves, at times so great that it was impossible to lightly touch the surface of the body without the most violent pain, accompanied by crying and weeping, but deep pressure relieved the pain.

the sensitiveness was not constant nor general, but affected sometimes one part, sometimes another, and sometimes disappeared entirely and returned without apparent cause.

it seemed especially violent over the bony processes, as for example, on the spinous processes of the dorsal vertebrae,.

The surface of the body was affected with an excessive hyperaesthesia, so much so that it was often impossible to touch even slightly the skin of the chest, abdomen, back, face, and superior or inferior extremities, without forcing tears or cries from the sufferers. This hyperaesthesia was only superficial, and was much more excited by a slight touch than by hard pressure.

thus, if instead of touching the abdomen with the end of my little finger, I applied firmly my open hands, far from increasing the pain, it lessened it. This increased sensibility of the cutaneous system was neither constant nor general.

it was excited sometimes in one part of the body, sometimes in another.

at times it would become less, and now and then entirely disappeared, to reappear soon after without any ascertainable cause,.

Entire loss of cutaneous sensibility in the hypogastrium and iliac regions.

also in the penis, scrotum, and upper two-thirds of the thighs. Pressure on the hypogastric region causes pain, which is not the case with the other insensible parts. The skin of the affected parts is insensible to pricking pinching, etc., but pain is felt when a pin a thrust deeply in, or the muscles are pinched,.

Complete analgesia over the entire surface. Sensitiveness when tickled, which is normally very acute, is considerably diminished, but not abolished. It is diminished in the palms of the hands, especially of the left. In the soles of the feet he scarcely feels any amount of tickling.

although, before working in white lead, he was so sensitive to it, that it would make him jump immediately,.

Out of one hundred and two cases of motor-paralysis, anaesthesia of the affected parts was observed in five cases, and arthralgia in eight. In three cases out of the five, the paralytic anaesthesia seemed to involve the deepest tissues of the limbs.

the muscles, as well as the skin, appearing insensible to all stimuli. In the two remaining cases, the loss of sensibility was confined to the skin, the patients complaining of violent pain deep within the limbs. Thus, paralysis may be accompanied at the same time by both anaesthesia and hyperaesthesia. When only hyperaesthesia coexists with motor paralysis, the pain is referred to the skin, the muscles, or even the bones,.

Insensibility to pricking, of the right upper limb (excepting the shoulder), and of the right foot, right leg, and lower third of right thigh. Diminished sensibility to pricking, of the right side of the face, right shoulder, and upper two-thirds of the right thigh.

also of the left upper limb. The transition from entire to partial insensibility takes place abruptly, and along the line of junction of the lower third with the upper two-thirds of the right thigh, corresponding exactly with the lower border of the patient's shirt,.

Diminished sensibility of the hands, especially their dorsal surfaces, and of the left hand. In the forearms, the insensibility is greater on the palmar surface, and especially in the left forearm. Above the elbow the tactile sensibility is much less affected. On the left fingers and forearm, the pressure of the upper point only of the aesthesiometer is perceived. Anterior surface of left arm, 100 mm. Tactile sensibility of lower limbs unimpaired. Insensibility to pricking of the right thumb, the palm or surface of the right fingers, and the right palm of the palmar surface of the left fingers, and of the palm and back of the left hand. Diminished sensitiveness to pricking on the dorsal surface of the fingers of both hands, especially the left, also on both forearms.

from thence it gradually diminishes towards the shoulders. Slightly diminished sensitiveness to pricking over the rest of the body. Immediate analgesia (or an algesia, properly so called), when burned, together with consecutive analgesia, or anodynia of the hands. Burning is only felt as a warmth, and causes no pain afterwards, though it has raised a blister. Diminished sensitiveness to burning on the forearms. General absence of sensibility when tickled. The upper limbs are insensible to changes of temperature,.

Very considerable loss of sensibility in right hand and right forearm, as far as two fingers' breadth below the bend of the elbow (as far as he plunged his arm into the liquid white lead). Less want of sensibility in the remainder of the right upper arm and in the right half of the face. He did not feel both points of the aesthesiometer until they were applied to the upper arm. Not much loss of sensibility in the right upper arm.

and it became less and less along the forearm towards the bend of the elbow,.

Diminished sensibility to pricking and burning, amounting almost to analgesia, on the right hand and forearm.

less on the palmar surface of the right wrist and forearm, and the right arm. Slightly diminished sensibility to the same, on the left hand, and dorsal surface of the left wrist and forearm. Diminished sensibility to painful impressions on the right side of the trunk and on the front of the chest, corresponding to the part of the shirt worn during work,.

Walking, or even standing still, brings on the cramps, which are characterized by a forcible and permanent contraction of all the affected parts, perceptible to both sight and touch.

these cramps are exceedingly painful.

they are somewhat diminished by pressure, and increased by motion of the limb, which motion they restrict.

so that when they come on he has to go to bed, or lean against something. When lying down, he can move his limbs freely, excepting when the cramp comes on. The lancinations and cramps are more acute behind the knee-joint than anywhere else. Cold water compresses afford temporary relief. Not a wink of sleep, either by day or night,.

Exceedingly acute lacerating pains all through the limbs, loins, back, and walls of the chest.

they are worse at intervals, both during and between the paroxysms of colic, and give rise to extreme agitation.

they are slightly diminished by pressure, and sensibly increased by movement, so that he tries to keep as quiet as possible.

but during the paroxysms, not knowing what to do to ease himself, he assumes all sorts of positions. These pains, which are unaccompanied by swelling or redness, are worse in the lower limbs, and especially the knees, in the forepart of the thigh, and in the soles of the feet. They are felt all through the limbs. There are no cramps, and motion is unimpaired,.

Four women had fifteen pregnancies, distributed as follows, viz., ten abortions, occurring between third and sixth month.

two premature births, the children dying soon after birth.

one child still-born. one delivery occurring at the full period, but the child died the same day.

out of these fifteen cases only one child was born alive that did not show any symptom of lead diathesis. Five women had given birth to nine children before they were subject to the influence of lead poisoning.

the children were healthy and alive.

neither did the mother suffer from any menstrual irregularity.

but after going into the type-cleaning works, they had together thirty-six pregnancies, distributed as follows twenty-six abortions, from the second to the sixth month of pregnancy.

one premature birth, the child dying soon after.

two children still-born.

seven at full term, of whom four died in their first year, and one in his second, and only two still alive, one of whom is very delicate and anaemic. A woman after having five abortions, left the type-polishing works, and after recovering from the effects of lead poisoning, gave birth to a healthy child, still living. A woman left the works for a time and then went back.

during the time she was under the influence of lead poisoning, she frequently aborted, but during the interval she was absent from the works she gave birth to a healthy child,.

Previous to her present employment, she had been delivered of three healthy children at full term, still alive.

but since her employment as a type polisher, she had suffered much from ill-health, an attack of painter's colic three months after beginning this work, and again four years later.

shortly after second attack she became pregnant, and was delivered of a dead child.

three years elapsed and she had a miscarriage at the fifth month of her pregnancy.

she had become pregnant eight other times, and each time after a short suppression of the menses, and the delay of two or three months, she miscarried, characterized by an abundant menorrhagia, and accompanied by colicky pains at the time,.

Miscarriage in the second month of pregnancy, and in the third month of the next pregnancy.

in the following pregnancy she suffered from alternating constipation and diarrhoea, did not miscarry, but the child was emaciated, and was a pitiful object, and lived only one month.

she passed through the next pregnancy, but the child was very slight, weighed only 2600 grams.

having now left her occupation of painting (she had a bad habit of holding the brush between her lips), she passed through her subsequent pregnancy with a more robust child than before, weighing 3200 grams, without haemorrhage.

this infant lived,.

About the third week in October, began to experience a "tired," heavy feeling of pain in the lower limbs, particularly her knees.

the same pain was soon felt about the navel and in the groin, giving the sensation of a cord pulling down, and extending to the very lower part of the bowels.

soon a similar pain was felt in the shoulders, back, arm, hands, fingers, feet, and toes, particularly over the tops of the feet and hands. She suffered the characteristic nausea of pregnancy for the first two months, none afterwards, until December 31st, when she was seized with vomiting, with an increase of all the symptoms just named, until it closed with abortion, January 9th,.


Skin of the whole right lower extremity insensible; the strongest stimuli produce not the slightest impression. Pain is caused in the subcutaneous tissues by strong pressure, twitching the muscles, or electro-puncture,

Sensitiveness of the skin to the air (first and second days),

General sensitiveness of the skin,

Every part of the skin, especially the arms and lids, became exceedingly sensitive to touch,

Burning like fire in ulcers,

Skin burning,


Formication on the extremities (first night),

Severe formication in the forearms and fingers,

Formication on the soles of the feet and insteps, especially on the right side, when standing up,

Sensation of formication in the soles of the feet; it seems to him as though he were walking on nutshells,

Formication on the feet,

Formication on the soles of the feet, ,

Violent sticking itching between the left middle and ring fingers (first day),

Sticking and painful formication in the soles of the feet,

Sticking in the skin (first day),

Some pricking on the soles of the feet,

Fine stitches here and there in the skin of the face (sixth and seventh days),

Itching of the whole body,

Itching in the evening, H. and T.

Itching of the tetter, that was usually without sensation,

Itching of the skin,

Intense itching of the skin,

Frequent itching on the face (first day),

Itching on the skin between the right thumb and index finger (after one day),

Itching between the left thumb and index finger, not at all relieved by scratching (after five hours),

Itching with burning, especially after scratching, on a spot on the inner side of the right wrist; after scratching a long time a numb sensation, lasting several hours (first day),

Itching, especially on the thigh,

Itching of a dry tetter on the right tibia, that usually had no sensation,