Plumbum

[lead.]

This metal is found native or in combination with other sub- stances, sulphur, oxygen, or acids. We use the metallic lead prop- erly purified, of which we make triturations. The acetate of lead, also known as sugar of lead, is likewise used by homoeopathic physicians.

The dynamic effects of tbe metal and of its salts, the acetate and carbonate of lead, seem to be so nearly alike that these various preparations are often used indiscriminately.

Our knowledge of the poisonous effects of lead and, largely, of its salts, is mainly derived from observation upon men whose occu- pation exposes them to daily contact with lead in some form or other; the use of leaden water-pipes, cosmetics, etc., furnishes many interesting cases of accidental, and even fatal, poisoning.

The following conditions characterize chronic lead poisoning: Lead colic (colica saturnina), which is located in tbe umbilical region, and is accompanied by obstinate constipation, violent thirst, much, and at times excessive, anxiety and restlessness and a hard, drum-like, retracted state of the abdomen. Keen, sharp pains in various parts of the body make their appearance, with a tendency to locate in the joints (arthralgia saturnina) ; these pains are excruti- ating, are worse at night, relieved by pressure, and are aggravated by motion.

Later, the muscles become affected, forming hard knots ; tremor, more or less general, becomes an annoying symptom, and tonic spasms set in ; frequently this condition is followed by paralysis in various parts of the body ; the most common form is that known as "drop-wrist," which consists in a paralysis of the extensor muscles of the forearm (paralysis saturnina). With this' paralytic state we may find associated loss of sensation in the affected parts (anaesthesia saturnina), and various other forms of severe disturbance in the nervous system ; even atrophy of the optic nerve, resulting in amaurosis, and deafness may occur.

At last the brain itself gives way to the influence of the poison, loss of memory shows itself; the kidneys become involved (albuminuria), and death occurs after a previous general depression of the functions of the brain or a development of convulsions, either of them terminating in coma.

640 PLUMBUM.

One symptom is usually found in all cases of chronic lead -poison- ing and is of great diagnostic value ; I refer to the formation of a blue line upon the gums where they join the teeth.

It is said that the liberal use of milk, as an article of diet, lessens the danger of poisoning to men who are obliged to handle lead con- stantly. Cases are on record of men who remained singularly free from poisonous symptoms while using large amounts of milk, but who commenced to suffer, at once and violently, from lead-colic and other severe symptoms, upon the discontinuance of the habit.

Acute cases of poisoning with lead are not very common ; when they occur they are usually due to the use of the acetate of lead. A poisonous dose of the sugar of lead causes vomiting of a milky- white substance, followed by a severe burning pain in the stomach and bowels, and great thirst. Constipation or diarrhoea set in, the stool being of a black color from the presence of the sulphuret of lead. If collapse takes place at this stage, we find the characteristic symptoms of such a state, as : very slow pulse ; coldness of the face and extremities ; pallor of the countenance with sunken eyes and vivid lips, etc.

Instead of these effects we may, however, find cramps, paralysis, anaesthesia, coma and convulsions. If the case proves fatal, the scene closes with coma and convulsions. The blue- line on the gums, to which reference has been made, is generally found in all cases, whether acute or chronic.

The mother of Mathew Muir, aged six years, and sick with whoop- ing-cough, procured from a quack schoolmaster a mixture, which was found to consist of a solution of ten grains of acetate of lead in six ounces of water ; of this the child took a teaspoonf ul, containing one-fifth of a grain of sugar of lead two or three times a day for nearly nine weeks, at the end of which time it got worse, and the medicine was discontinued. Two days after this, the child died, and the death became a subject of inquiry in the coroner's court. The parents stated that the boy was a fine healthy boy before his sickness, but that almost immediately after he commenced taking the schoolmaster's medicine, he began to fall away, and to complain of severe pains in its belly, for which he sought relief by lying on the belly, in which posture he also went to sleep; the belly also became hard and rather pinched in ; the bowels were very confined and the stools black and offensive, and there was an intolerable fetor of the breath ; latterly the child got very drowsy, and was unable to move about as usual. Upon the day of its death it became convulsed, and a few hours previously, it fell into a state of coma, from which it was never roused.

Six days after death the body was examined. It was extremely

PLUMBUM. 641

emaciated, the skin presenting a dingy-yellow appearance, the lips and inside of the mouth were bloodless, and of a pale lavender hue, while the gums had acquired a deadly blue color, the color deepen- ing as it reached the margin of the teeth. The brain was rather softer than natural, but this might have been due to decomposition ; the cortical substance, however, had a peculiar, bluish-gray color, and there were about two drachms of clear fluid in the right ven- tricle. The spinal cord was perfectly healthy and firm.

The lungs were slightly congested, especially upon the posterior aspect, and the trachea and bronchi were lined by a sanguineous secretion, and the bronchial glands were enlarged. The pleura contained a large quantity of bloody serum. The heart was somewhat larger than natural and flabby, and, in common with the large veins, contained a little black, uncoagulated blood. The stomach was not contracted, and contained about half an ounce of thick brownish fluid ; the intestines, both large and small, were contracted in some places, and dilated in others, and the small intestines presented several points of intussusception.

The mesenteric .glands were enlarged, but the mucous glands of the intestines were healthy throughout their course. The bladder and ureters were full of urine, and appeared as if their muscular coats had been paralyzed. The other viscera were healthy.

The chemical analysis detected lead in the brain, the muscles, the liver, the intestines, the blood, and the fluid of the ventricle ; but it could not be discovered in the bile or in the urine. That part of the liver which surrounded the gall-bladder had acquired a deep, bluish- black color, from the action of the sulphur of the transuded bile upon the lead contained in the tissue of the liver ; but the bile itself which remained in the gall-bladder was of its natural yellow color.

Each dose in this case amounted to one-fifth of a grain, and the whole quantity taken to from twenty-six to thirty-three grains of acetate of lead. It is a circumstance worth noticing that lead was recognized in the contents of the stomach, although none of the medicine had been given for two days. (iV. A. Jour. Horn., May, 1852, from Pharm. Journal.)

In an English school some twenty girls used, for washing, water from lead-cistern ; they were also in the habit of drinking this water, contrary to orders, when no fresh well-water was at hand. Most of the girls lost the color of health from their faces ; they became pale, puffy and dark under the eyes ; their appetites failed, but few, if any, were thinner than before; many had offensive breath; some were frequently ailing, some had bloated abdomen, some occasional diarrhoea, some obstinate constipation; their faces were smooth and clav colored ; their urine was unusually plentiful and limpid. The whole school had evidently declined in health. When this state of affairs had existed for some time, one girl complained of headache and of pain in the bowels ; she was depressed and, at times, deliri-

VOL. II. — 40.

G42 PLUMBUM.

ous ; temples throbbing; pulse 130, feeble; skin hot and dry; no appetite or thirst ; respiration slow and sighing ; epigastrium ten- der ; tongue red at the edge, a brown fur down the centre ; bowels constipated ; urine copious and limpid. Aperients produced plenti- ful, dark, and very offensive dejections. In a few days she was con- valescent, but she remained long very debilitated, and had frequent fain tings. Her face was dusky, almost purple ; her lungs remained well.

This case was followed by several others, with some or all of these symptoms ; head and bellyache ; loss of appetite ; sickness ; rapid pulse ; hot, dry skin ; flushed, dusky countenance, confined bowels, feces pale ; urine copious and pale ; tongue flabby, tremu- lous, edges red and indented, a brownish fur down the centre, speckled with enlarged red papilla? ; gums generally pale and spongy. Several girls had fits, described as being hysterical; some had attacks of fainting ; the majority had a relapse, and some even three times.

All these troubles disappeared as soon as the cause was removed.

"His pulse is also very characteristic, showing atheromatous degeneracy of the arteries, the large vessels feel hard, inextensible, and seem to roll under pressure. The sphymograph shows this still more clearly, a short vertical ascension, a large plateau, and then a regular, slightly undulating descent. These three characters of atheroma explain how the artery becomes converted in an inex- tensible canal, which has lost its elasticity, and can only be distended by the blood to a certain degree, hence the short vertical ascension.

Once extended, it takes a long time to come back to its former state, it remains immobile for some time, and this immobility shows itself by a well accentuated line ; finally, contraction takes place, but slowly, and we see the well marked line of descent slightly undulat- ing. Our patient finally shows that dilatation of the heart which is so often observed in persons with atheromatous arteries, a conse- quence of the energy with which the heart must contract in order to overcome the fault of the arteries which have lost their contract- ility, and to force the blood into the capillaries. * * * This degeneracy of the arteries, common in persons suffering from satur- nine intoxication, is only found under four conditions : in aged people, in alcohol drinkers, in gouty patients and in lead poisoning.

The age of the patient, his well known sobriety, show that this is a plain case of lead poisoning." (Clinical lecture on lead poisoning by Prof. Hardy, Bulletin cle la Soc. Med. Horn, de France, December, 1879, Lilienthal's translation.)

Noack and Trinks have arranged the post-mortem symptoms of lead poisoning as follows :

Compact state of the bones of the skull. — Considerable flatness of the' convolutions of the brain. Cerebral substance pale, soft, deprived of blood, with a small quantity of liuid blood in the falciform pro-

PLUMBUM. 643

cess. Extravasaled blood on the surface of the brain. Brown, clear serum in the middle ventricle. Unusual softness of the cerebral substance. Partial induration of the cerebral substance. Hyper- trophy and induration of the hemispheres, with absence of blood, after epilepsia saturnina. Paleness of the plexus choroidei. The pineal gland was softened. Clear serum at the base of the skull. Partial and complete softening of the spinal marrow, which was transformed into a soft pap.

The thyroid body was pale and tenacious.

The trachea contained a quantity of fluid with mucous flocks, the mucous membrane of the trachea was pale. The pulmonary cells were generally adhering to each other, the free spaces containing several pounds of a brownish serum. The substance of- the lungs was pale, tenacious, without blood, filled with a quantity of frothy serum; the pericardium contained two pounds of a dark-brown serum mixed with hard flocks.

The serous coat of the heart, particularly the pericardium, is lined with a layer of a reddish-gray, fine-vitreous, meshy, firm, exuded lymph. The heart is more than double its natural size. The wall of the left ventricle is more than an inch thick, of a pale-brown color, containing firm, pale, bloody lymph, with black-red coagulated, and other, blood ; the wall of the left auricle was firm.

The liver was brown-red, relaxed, the gall-bladder contained a light yellow, fluid bile ; the small lobe of the liver was inflamed.

The spleen was distended. Pancreas relaxed.

Stomach contracted into the shape of a barrel, containing a small quantity of a brown turbid fluid ; the mucous membrane of the stomach was considerably involuted, thick and tenacious. The stomach exhibited gangrenous spots here and there, the mucous membrane was corroded in some places. The bowels were consid- erably contracted, containing gray, yellowish feces, which were ad- hering to the walls. The bowels show partial contractions and dilatations, arising from paralysis of some portion of the muscular membrane.

The mesenteric glands are in a flaccid condition. The duodenum and jejunum seem involuted and inflamed, the whole colon is filled with scybala, the blood-vessels of the intestines are blue.

Both kidneys have dwindled to one-half their size ; the surface of the cortical substance shows large degenerations or granulations of the size of a millet-seed and slightly raised above the surface, of a dingy, yellowish-white, very firm, tenacious ; a deposit of a blackish- blue pigmentum was deposited here and there through the degener- ated portion of the kidneys, with a few scattered cysts of the size of a pea, containing a brownish serum. The bladder was contracted, contained a few drops of turbid urine ; in the abdominal cavity six pounds of gray serum were discovered (in the case of an engraver, thirty years old, who had handled preparations of lead since his childhood, and had had ten attacks of the lead colic, the last attack ten years ago).

64:4 PLUMBUM.

As consequences of a chronic poisoning by lead were discovered : shrinking and considerable contraction of the inner cavities, particu- larly of the stomach and bowels, hardness of the parenchymatous organs, which had become much smaller in consequence of a mor- bid contraction ; great thinness and almost inorganic hardness of the muscles ; complete shrivelling of the mucous and adipose tissues. A special examination of the neurilemma and the nervous substance is entirely wanting.

A re-examination of the facts given, shows that leal affects the healthy body in the following order : Its primary action is exerted upon the intestines, then upon the muscular fibre. The latter becomes not only atrophied, but undergoes disorganization, or such severe structural changes that no striated fibre can be fouud. It then attacks the spine and its nerves, both motory and sensory, lessening the size of the nerve-trunk, destroying its integrity of structure, and reducing the nerve to a fibrous cord. At last it throws itself upon the brain and its nerves, showing an especial effect upon the nerves of the eye and ear.

CEREBROSPINAL GROUP.

Tanquerel des Planches describes the effects of lead upon the brain under the comprehensive appellation of encephalopathta satur- nina, characterized by a delirium which may either be bland or furious.

In the bland delirium, the expression of the eyes is at times mild, at others dissatisfied and stupid ; some patients laugh (risus sardoni- cus), others cry and look sad ; there seems to be no relation between the expression of the face and the ideas ; sometimes these seem first rational, then incoherent, then again rational; sometimes the patients seem thinking before they answer, they look at the persons, have to be asked several times ; when alone, they are silent or mutter, call absent persons ; the voice is natural ; they agitate their arms, urinate anywhere indiscriminately ; are troubled with frightful hal- lucinations or hear music.

In the frightful delirium, the eyes look wild, the features are con- tracted ; the patients shriek, curse, tear their clothes and fetters, seek to injure persons ; the eyes are distorted, the jaws creaking ; there is subsultus tendinum, trembling of the limbs as in chorea ; the tongue is dry, parched, covered with yellow or blackish crusts ; these are likewise seen on the teeth ; occasionally there is amaurosis ; sometimes the delirium is bland in the day time, furious at night ;

PLUMBUM. 645

between the paroxysms sopor sets in in some cases ; the face is straw-colored, the pulse full and regular, seventy to eighty.

Headache, violent pains in the scalp, from the occiput to the fore- head.

Arthralgia saturnina, lead rheumatism ; the flexor surface is more affected than the extensor ; the lower limbs first, then the upper, lumbar region, wall of the chest, back, neck ; the affection does not follow the track of nerves ; long before, even months, the parts are numb and weary; the pains are prickling, with rigidity or numb- ness ; che parts feel weak as if broken, with constriction or withering of the parts, or formication with shuddering ; the pain is often as if from a bite, or as if burnt by red-hot coal, or as if a hot fluid were coursing through the blood vessels, or as if touched by an icy-cold body; most frequently the pains are tearing, crushing, mingled with a few single, violent, sudden darts, recurring from time to time, and resembling electric shocks ; there are remissions ; the pain is dimin- ished by pressure, increased by motion ; sometimes the muscles are attacked with trembling and spasms ; the parts are neither hot, red nor swollen ; the pulse is soft and regular ; in fifty-five cases it was hard, slow and vibrating, in seventeen irregular ; the affection may last for weeks and months ; it may co-exist or alternate with other lead diseases.

Excessive prostration of strength.

Anaisihesia saturnina: (a.) Deep-seated, of the limbs and trunk ; the skin, cellular tissue and muscles are insensible to external stim- uli ; at times the parts are movable, at other times immovable ; (b.) Superficial, only the skin is insensible.

Paralysis saturnina; the extensor muscles are principally affected ; precursory symptoms : debility, sensation in the limb as if broken, feeling of coldness and rigidity, trembling, awkward movements, weariness, dragging of the lower limbs, the patient drops everything; general or partial paralysis, single muscles or bundles of fibres may be paralyzed ; the upper limbs are more frequently paralyzed ; the extensor muscles are first affected ; in the morning the parts are bathed in viscid sweat ; general emaciation ; pale, watery urine ; the skin is pale, livid, yellowish, clay-colored, rough, dry, scales off, looks thinner and more relaxed ; the cellular and adipose tissues disappear, the muscles are thin and soft ; in the highest grade of atrophy the patient is only skin and bones ; the limbs are infiltrated, with gangrenous spots. Tanquerel has observed : Paralysis of the upper

646 PLUMBUM.

limbs, with aphonia. Paralysis of the shoulder and deltoid muscles. Paralysis of one arm. Paralysis of the wrist and fingers, or wrist alone, and finger alone. Paralysis of the lower limbs as above. Paralysis of the trunk. Paralysis of the muscles and organs of speech. Paralysis of all these parts together.

Convulsions of the upper limbs, which are extended outward during the attack.

Convulsions, general, like shocks through the limbs, also with contractions of the parts.

Convulsions, epileptic, alternating with flexion and extension of the limbs ; there is foam at the mouth, but not generally, also with delirum and coma ; after such an attack the patients do not become entirely conscious ; they remain stupid, their limbs tremble, and they stagger ; the breathing is short, frequently stertorous ; the mouth shaped as when smoking.

Convulsions, cataleptic, the patients seem asleep, not sensible ; -in half an hour, the face, head, trunk and limbs perform strange movements; the patients sometimes cry out, stutter; these condi- tions alternate for hours.

Cachexia: Impoverished nutrition, emaciation, with dryness and pale color of the skin, exhaustion, oedema, even anasarca and de- pression of spirits are generally the result of chronic lead poisoning.

These various effects of the lead poison suggest its employment in the following diseases :

HEADACHE with heaviness in the cerebellum, violent pains in the integumeut of the skull, extending from the occiput to the forehead ; feeling, as if a ball were rising from the throat into the brain. Vertigo on stooping and on looking upward; especially use- ful in chronic cases, and in persons who have symptoms of maras- mus, accompanied by great mental depression, constipation, colic, and symptoms of threatening paralysis.

EPILEPSY which seems to proceed from the splanchnic nervous system, attacks then the nerves of sensation and of motion, then the sjjine, then the brain. It is especially applicable to cases in which there exists a tendency to paralytic numbness of the extremi- ties before or after the epileptic spasms, and a tendency to a delirium which may be violent, and again so low, that it is often difficult to recognize it. Consciousness returns very slowly.

PAKALYSIS, especially after apoplexy, with rapid emaciation, with atrophy of the affected limb, loss of sensation ; dryness and

PLUMBUM. G47

pallor of the affected limb ; constipation ; paralysis of the arm ; paralysis of the tongue.

MARASMUS with utter prostration of the reproductive func- tions ; emaciation ; loss of appetite ; constipation ; paleness, dryness, coldness and flabbiness of the muscular tissue.

CEREBROSPINAL MENINGITIS— Plumbum has also been recommended in cerebro-spinal meningitis with well-marked symp- toms of paralysis, as described ; colic, with hardness and retraction of the abdomen ; great emaciation ; constipation ; pressive occipital headache.

ORBITAL AND AURICULAE GROUPS.

Lead causes complete loss of sight.

A young painter had been attacked with lead-colic of which he was cured. Some years after this occurrence, he had another attack. When almost recovered, the spasms set in again with intense fierceness quite suddenly; at the same time he became unable to distinguish the surrounding objects, and gradually he became completely amaurotic. Toward evening, he was suddenly attacked with epilepsy, loss of consciousness, convulsions ; he tossed about, with froth at the mouth.

In a few days he had recovered sufficiently to leave the hospital ; but he returned again in two months with an attack of lead-colic, although he had not worked at his trade since his last sickness. This time the colic was accom- panied by all the signs of gastro-enteritis. His epilepsy again made its appearance in the course of his sickness, accompanied with vio- lent delirium, cries, etc. He finally recovered.

We have also : Contraction of the eye and eyelids. (Edema of the eyelids. Profuse discharge of acrid tears and diminution of sight. Staring, wild look.

Contraction of the pupil. Itching in the canthus of the left eye, with pain when rubbing it. Tearing in the eyelids, with drowsiness early in the morning. Frequent dis- charge of corrosive tears.

Heaviness in the eyes on moving them, and painful drawing in the inner muscle from before backward. Aching pain above the eyes when moving them. Sensation as if something had lodged under the eyelids, and as if the eyeball were too large, with exquisitely painful pressure. Varicose distension of the vessels of the cornea, resembling a thick net and obscuring the sight.

In spite of the above array of symptoms we have no clinical ex- perience with plumbum in diseases of the eye. Its possible use in amaurosis would depend upon the primary, constitutional oause of

648 PLUMBUM.

the local disorder. If it is based upon marasmus of the optic nerve, which appears as a part of a grand group to which lead stands in homoeopathic rapport, then we might use this remedy with great assurance of success if the time for relief has not passed.

It is well known that the regular school use the acetate of lead as an external application in diseases of the eye. The strength of the solution is from half a grain to two grains of the salt to the ounce of water. Without again defining the limits within which homoe- opathy justifies the use of topical applications, we would urge extreme caution against the local application of drugs to the eye in the hands of the general practitioner. It cannot be denied that infinite mischief has resulted from such practice.

As far as the use of sugar of lead is concerned, it has been discovered that a deposit of the albuminate of lead is formed when a solution of the acetate of lead is applied to the abraded eye ; such abrasions of the surface are of frequent occurrence in inflammation of the conjunctiva and sclerotica.

The effect of lead upon the ear if not very marked. We have a few symptoms, such as : Buzzing in the ears ; diminution of hear- ing and sight ; tearing in the ear ; fine stitch in the right lobule ; fleeting pains in left meatus auditorius ; boring pain in the right ear after dinner, etc. While we may find cases of

DEAFNESS, which presents these symptoms, the group is too unimportant to yield us reliable indications, unless interpreted by our general knowledge of the curative powers of this drug.

FACIAL GKOUP.

Lead may cause haemorrhage from the nose which it is often difficult to arrest. It causes a clay-colored, cadaverous, sunken appearance of the countenance expressing anguish.

IDENTAL GKOUP.

Lead has a very marked effect upon the gums. It causes spongi- ness of the gums ; a bluish, ash-colored border is seen along the alveolar margin of the gums ; they dwindle away, become thinner, shrink ; the teeth decay.

CHTLO-POIETIC GROUP.

Lead causes a disorganization of the lining membrane of the mouth, which has all the characteristic signs of

STOMATITIS. It causes salivation of a bluish color ; ulcers

PLUMBUM. 649

under the tongue ; ulcers, as from mercury, with a whitish, thin coating on the tongue.

Other effects of lead ai'e : Loss of appetite, intense thirst, a sweetish taste in the mouth, followed by an intensely bitter taste ; vomiting of a greenish-gray substance ; vomiting of a foul bile ; the vomiting is accompanied with a burning distress in the epigastric region ; anguish, which is sometimes unceasing. In accordance with these symptoms we have prescribed lead with good effect in

CHRONIC SPASMODIC VOMITING of mucus, blood and bile, which seem to depend upon, or to be attended with, symptoms of atrophy of the stomach.

CARDIALGIA coming on in paroxysm, with burning, shooting pains in the pit of the stomach, relieved by bending forward or backward and by pressure ; thirst ; emaciation ; excessive constipation.

Mrs. E., aged forty years, suffered for a year from severe gastralgia. She com- plained from pressure in the stomach, as from a heavy weight, increasing to a strangling sensation during the severe colicky paroxysms, and followed by sour and bilious vomiting. External pressure does not incommode her ; loss of appetite ; excessive thirst; pains in the back, sometimes alleviated by bending forward, at other times by bending backward ; constipation ; once a week a hard, knobby stool ; the paroxysms increase in severity and duration, and the patient is already atrophic and anncmic.

Nux and bismuth did nothing. A new examination revealed taste always sweetish ; abdomen compressed and hard like a board ; constriction of the throat; paralytic weakness of ihe extremities, especially on the right side, hands and feet cold ; total and striking want of perspiration. Plumbum aceticum30, then *, then 8 cured in a few weeks. (Dr.

S. Lilienthal in A?n. Jour. Bom.

Mat. Med., vol. iii., P- 43-)

Among the effects of lead upon the pharynx and oesophagus, we notice the gradual supervention of a stricture of this organ, prevent- ing deglutition ; the patients complain of a sensation as if a ball were rising from the epigastrium to the chest and pharynx. Hence we may recommend lead for certain forms of

DYSPHAGIA, of a spasmodic character, very gradual, leading to an inability to swallow any but the thinnest kind of food.

The many involuntary provers of lead testify, without dissent, to its power of producing a most violent type of colic. To the brief description of this malady, already given, we will add that the pain itself is spasmodic and most severe; there will be present nausea and vomiting, eructations of gas ; great thirst ; slow, hard pulse, difficult and painful urination, and much restlessness and anxiety. The hand frequently feels the intestines knotted up into hard, firm balls. The contracted and hard abdomen, the persistent constipa- tion and the blue line on the gum, are always present.

The following symptoms also belong to plumbum : Scanty, hard,

650 PLUMBUM.

black-brown feces resembling sheep's dung. Yellow, black, scanty- stool, floating on the urine. Flatulence. Slow, urging to stool, with slow discharge of tenacious feces.

Ineffectual urging to stool. Yellowish stool, afterward soft and watery. Lead-colored stool with vomiting of feces. Diarrhoea with rumbling, without pain.

Fre- quent, bloody stools, with horrible cutting, violent eructations and fever. Pressing pain at the rectum, from within outward. Dart- ing and burning pains in the rectum, perineum, neck of the bladder. Constriction and drawing up of the anus ; prolapsus ani.

The anus is drawn in, and as if internally constricted, with sensation as if a string were drawn across.

There is probably no drug which produces upon the healthy so persistent a constipation as is caused by lead. In the great factories, which furnish us by far the largest amount of information on this topic, a workman who is not made thoroughly miserable by this affliction, is indeed a rare exception. This constipation is probably due to an insufficiency of intestinal mucus and to a paralytic condi- tion, and even structural change, of the intestinal muscular fibre, caused by the poisonous action of the lead upon the organism.

CONSTIPATION.— Plumbum is a most valuable remedy for constipation, which presents these two prominent features, viz., dry- ness of the excretion and muscular atony. When these conditions are met, and we find, in addition, those constitutional indications which point to the drug, and among which we may mention : colic, with hardness of the abdomen, contraction of the anus, emaciation, loss of appetite, sweet taste in the mouth, etc., then we may expect prompt relief from its exhibition.

A woman has suffered for a long time with abdominal colic and the most stubborn constipation. The stools are as hard as stone and are expelled only with the greatest effort. Her bowels have not moved now for fourteen days. She received plumbum acet.12 Within eight hours she had a copious, and very hard, but not difficult evacu- ation.

Within the next twenty-four hours her bowels moved three times more; the last passages were natural ; her bowels remained regular. (Hartlaub in Annal. d. Horn. Klinik, vol. iv., p. 327.)

Mrs. B. has been troubled for years with constipation. The stools consist of hard balls; there is little or no pain present. I gave five powders of plumbum, to be taken one each night £nd morning. It is three or four months since the prescription was given, and there has been no return of the constipation. (Dr. Godden, Am. Homaiopathist, August, 1878.)

HAEMORRHOIDS. — Plumbum may be used the in treatment of haemorrhoids, and of

FISSURE IN ANO.— A study of symptoms . produced by plumbum, and a clear understanding of the relation of the remedy

I'Ll'MUU-M. 651

to the constipation which generally exists in such cases, makes the enumeration of special indications unnecessary.

DYSENTERY with violent colic, and hardness and retraction of the abdomen ; very severe tenesmus. Dysentery brought on by the use of cathartics in cases of previous, obstinate constipation in which Dlumbum seemed indicated.

TYPHILITIS with great sensitiveness to touch of the abdomen,, especially in the ileo-ccecal region ; the abdomen is hard and con- tracted ; violent colic; stubborn constipation, with tenesmus and expulsion of hard, dry balls of dark color ; nausea, vomiting ; great, thirst ; anxious countenance ; the tongue is dry, red on the edges and brown in the center ; low delirium ; paralytic lameness of the extremities ; dysuria.

VOLVULUS or intussusception, with dryness in the mouth, thirst, bad, foul taste in mouth. Belching of foul gas, vomiting after taking drink or food; fecal vomiting. Burning, colicky, pressing pains in the bowels; knotting up of the intestines, great tenderness to pressure ; constipation with agonizing tenesmus. Great anxiety ; utter prostration ; livid countenance ; coldness and para- lytic lameness of the limbs ; pulse small, weak, rapid ; hiccough.

Mrs. T., aged thirty years, heretofore in good health, was taken with colic, for which aconite and arsenic were prescribed without affording her relief. Two days later she vomited up dead worms ; the colic continued. Prescribed cina and nux ; no relief.

On the lollowing day : constant hiccough, with belching of fetid gas ; nausea and retching, with immediate vomiting after drinking. Coated tongue, foul taste in the mouth, dryness in the mouth without thirst. Loss of appetite ; no fever. Pressing, burning, tearing pains in the lower abdomen ; tympanitic condition of the lower abdomen, with a tumor of the size of a fist in the umbilical region, which is sensitive to pressure ; the paroxysms of pain seem to. start from this tumor.

The in- testines are full of gas and can be felt singly as the gas moves about ; constant rumbling from flatulence. The bowels have not moved for four days, although there has been frequent desire. The patient has never had hernia, nor can any traces of hernia be detected now. Nux, belladonna, cold compresses upon the bowels and injections gave no relief.

Two days later the suffering was less violent. Forty- eight hours later, vomiting of fecal matter, hiccough with fecal odor, more pain. Prescribed plumbum met.6, one dose every two hours. Improvement.

Stool of hard, small feces, which look as if they were covered with membrane. Return of appetite and recovery. (Theuerkauf in Allg. Horn.

Zeitg., vol. lvi.)

A widow, sixty years old, presented the following symptoms: The countenance looked worn; pulse small and frequent; the extremities cold and like the forehead, covered with sticky perspiration; belching of foul odor and at times fecal vomiting; tearing, burning pains in the lower abdomen, which concentrate around the umbili- cus and are greatly increased by touch, motion and, above all, by the vomiting which is excited by drinking the smallest amount of water. The lower abdomen is tym- panitic, the intestines are puffed-up with flatulence, and can be traced singly.

To the left of the umbilicus a tumor of the size of a fist, which is exceedingly sensitive. Her bowels have not moved since yesterday; great thirst. Early in the morning she received plumbum met.16, to be taken every three hours; cold compresses upon the bowels and cold injections. By 9 p.

M. the pains were easier ; after midnight, evacuation from the bowels, cessation of vomiting and only slight pains. Convales- cent on the next day. {Ibid.)

652 PLUMBUM.

JAUNDICE with excessive constipation, and constitutional symp- toms which indicate plumbum.

September 19, 1869 A lady, thirty-six years old. She has always been very bilious; and has been relieved of her "bilious attacks" by heroic treatment, but thinks she cannot endure its severity any longer. She now feels weak and exhausted.

Her skin and the whites of her eyes are very yellow ; the urine is also very yellow, and stools very light in color ; she complains of much nausea, particularly in the evening, or at night, when she vomits her food ; she is restless, and her sleep is broken at night. She is not able to leave the bed. At 1 1 A. M.

I gave her a dose of plumbum200, on her tongue. On that afternoon and in the evening she had greater nausea than before and felt very badly, but did not vomit. The next day she was a little better; on the next the stool was of a more natural appearance, and the urine of a higher color, and on the 26th, just eight days after the first and only dose of medicine had been given, I discharged her cured. (Dr.

H. N. Guernsey, Hahn. Monthly, January, 1870.)

URINARY GEOUP.

Lead diminishes the secretion of urine ; it causes a perfect reten- tion of urine ; tenesmus at the neck of the bladder, with burning in the urethra; the urine looks saturated, brown, is mixed with blood.

This group of symptoms does not occur isolatedly in cases of lead-poisoning; it is generally associated with the effects of lead upon the intestinal canal. Nevertheless, it may constitute the most prominent group in the series, a sort of

ISCHUKIA, for which lead may be an indispensable remedy. This condition might likewise be described as a case of

ELEMATTJRIA, requiring the exhibition of lead ; the name is not material ; the essential condition, the pathological process as it is, is the great object of cure.

DIABETES MELLITUS — Plumbum promises to become a most important remedy in the treatment of diabetes mellitus and especially in

BRIGHT' S DISEASE of the kidneys. It does not come within the limits of this work to enter into a full consideration of the im- portance of physiological data and of their bearing upon the proba- ble curative power of certain drugs. But it is well to state, that the hope of finding in plumbum an efficient remedy for these intractable diseases, was originally, and is now mainly, based upon a knowledge of the physiological effect of lead upon the kidneys and of its power to produce, in the kidneys, structural changes, which are sufficiently like those found in Bright's disease, to arrest the attention of the thoughtful student.

We find, however, among the symptoms of plumbum many indications, which still further indicate the homoe- opathicity of lead to these two diseases. The following pathogenetic

symptoms of lead furnish the key to its use in diabetes. Great emaciation ; unhealthy, cachectic look of the countenance : dryness of the skin ; dryness of the mouth, tongue and lips with a thirst which it is difficult to satisfy; great prostration of mental and physical powers, with profound melancholy; impotence. Severe constipation ; boring, pressive headache from the occiput to the frontal bone, with vertigo and dimness of sight ; constriction of the throat, making deglutition difficult and even painful ; wasting away of the muscles of the body with paralytic weakness in the extremi- ties. (Sugar has been found in the urine of persons who were subjects of chronic lead-poisoning).

The symptomatic indications for plumbum in morbus Briglitii are much like those given under diabetes. The impression upon the nervous system and spine is perhaps even more profound than we have noted ; and we may find cutaueous anaesthesia, chlorosis, dyspnoea, atrophy of the optic nerve and subsequent amaurosis; epilepsy ; paralysis.

Dr. S. A. Jones reports an interesting cure of Bright's disease in the American Ob- server, November, 1875. The length of the report forbids its insertion here. The following table of nine urinary analyses shows the effects of plumbum in the case of his patient, a gentleman, fifty-two years old.

Urine in

Sp. Gr.

Albumen.

Urea in

Ratio in

Relative

Phospho'ic

c. c.

i-iooths of aC.C.

Quantity in C. C.

grammes.

Acid in grammes.

May 16, . . . .

1 160

IOlS.

O.IO

Il6.

"■773

May 23,

. .

IO24.3O

O.IO

70.

9-997

May 30,

. .

IOI4.7O

O.06

73.80

17-544

June 6,

. .

I2IO

IOI6.9O

0.02

24.20

19-542

Tune 13,

. .

1021.13

O.06

61.92

27-43I

I.702

Juue 20,

IO16.9O

O.08

IO4.40

28.415

2.088

June 27,

.

,

IO2O.32

O.06

53-40

21-343

2.I36

July 4,

. .

IOII.58

O.06

95-64

26.336

2.39I

July II,

• •

1 1 60

IOI3.IO

0.02

23.20

21.952

I.798

N. B. — All the reactions were strongly acid.

" By a coincidence the urinary quantity is the same in the first analysis before taking lead, and in the last after eight weeks' use of it ; hence the following contrast is ' in order ' :

Albumen.

Urea.

May 16, . . . July 11, . . .

1 160 c. c. 1 1 60 c. c.

O.IO

0.02

11.773 grammes. 21.952 grammes.

—0.08

—92.80 c. c.

-(- 10.179 grammes.

" The albumen determinations are by bulk. The quantitative determinations with the ferrocyanide of potassium give uncertain results, and the process by precipitation

654 PLUMBUM.

SEXUAL GEOUP.

s

IMPOTENCE. — Hence we infer that in impotence, more especi- ally when attended with a painful swelling and excessive heaviness of the testicles, lead may prove useful ; or, if you please, in swelling and weight of the testicles, with impotence ; this condition might gradually lead to complete atrophy of the sexual organs.

STERILITY — We know that lead causes sterility ; hence in a condition of the female organism indicating general symptoms of marasmus, where sterility constitutes a prominent symptom, we may recommend lead for sterility, more particularly if this seems to have resulted from, or if it was preceded by frequent miscarriages, and a cachectic state of the system has been the result of these frequent losses. It is well known that women who live in silver-ore smelting huts, become disposed to miscarriages.

UTERINE HAEMORRHAGE Plumbum may be employed in

PLUMBUM. 655

CHLOROSIS with obstinate constipation, dyspnoea, swelling of the feet, paralytic lameness of the limbs, scanty urination, mental depression.

RESPIRATORY GROUP.

Lead causes a species of aphonia; it has also caused a bloody cough, terminating in fatal suppuration of the lungs.

May lead be homoeopathically employed in diseases of the respira- tory organs which may lead to consumption? Lead causes a dryness of the lining membrane of the respiratory organs, a prostrated con- dition of its functional activity which may terminate in suppuration and ultimately phthisis. Old-school physicians have used the acetate of lead quite frequently in irritations of the bronchial and pulmo- nary lining membrane, from a simple pulmonary catarrh to suppu- rative phthisis.

Mitchell informs us that "Professor Ebbling, of Hamburgh, reported a case of what he calls pulmonary catarrh, in a woman aged sixty, cured by doses of a quarter of a grain of sugar of lead mixed with a scruple of sugar, and given every third hour. Six powders arrested the disease, which, at the end of nine months reap- peared, and was again cured by three powders." " This statement," writes the sagacious Professor, "which was republished in the New York Medical Repository for 1813, seems to be deceptive. We can- not perceive on what principle such minute doses of the acetate could have so promptly met such a case. A much more rational

650 PLUMBUM.

practice is given by Dr. Fauquier for the arrest of night-sweats of phthisis pulmonalis, twelve grains of the acetate of lead adminis- tered at bed-time having had the desired effect."

It is evident from this reasoning, that the sagacious Professor judges of the worth of a thing by its size ; so does the American savage judge of the power of a man by the number of feet he measures and by the development of his muscles.

MUCOUS PHTHISIS— In mucous phthisis, the acetate of lead has undoubtedly effected cures. As a proof of this I extract the following case, which is only one among a number, from Kopp's Memorabilia.

Dysuria and constipation, vertigo and pains in the head maybe regarded as confirmatory indications for the exhibition of lead in this disease, although diarrhoea would not counter-indicate lead if the essential character of the disease should preponderate in favor of this agent.

HAEMOPTYSIS. — A case of heemoptysis is likewise related by Kopp :

A man of seventy, of a slender make, was attacked with a violent cough, discharge of a quantity of bright-red frothy blood, coldness of the extremities, chilliness fol- lowed by heat, irritated, hard, accelerated pulse, constipation, thirst, palpitation of the heart, and undulating feeling of malaise and warmth in the chest, embarrassed feeling about the head. The patient was promptly cured with a few doses of the acetate of lead.

TUBERCULOUS PHTHISIS — But plumbum has also been used in the advanced stages of tuberculous phthisis. It resembles ferrum in these cases.

PLUMBUM. C57

that in certain forms of asthma, rheumatic or purely spasmodic,

lead may afford much help.