588 IMPORTANT POISONS AND THEIR TREATMENT 



hands occurs, the hands are moved with difficulty, or, finally, can no longer 

 be extended : The unfortunate condition of bilateral radial paralysis develops 

 (wrist-drop). Sometimes the havoc ceases there; no other symptoms appear; 

 but radial paralysis renders the patient incapable of working for a long time, 

 and frequently for life. 



The condition becomes more serious if there is evidence of grave cere- 

 bral disease; symptoms of encephalitis, epilepsy, mania, briefly, mental dis- 

 turbances of all kinds, indicate how seriously this poison influences the brain. 

 Because of these disturbances the prognosis is very serious; and unless dis- 

 ease of another organ, consequent upon this toxicosis, particularly the lead 

 kidney, terminates the life of the unfortunate patient, the insane asylum is 

 likely to be his final resort. 



The terrible nature of lead poison is thus apparent, and yet I have men- 

 tioned but a few signs of this toxicosis. It must be added that metabolism is 

 most unfavorably influenced by lead, in that it leads to an increased forma- 

 tion and excretion of uric acid, and thus produces symptoms which are also 

 observed in arthritis urica (gout). 



What remedial agents does therapy furnish with which to combat these 

 conditions, and what treatment must be adopted if the phenomena described 

 have already appeared? Eegarding the first point, only a careful prophylaxis 

 is in order. Workmen in lead who have once recovered from lead colic must 

 always change their occupation; the dangers to which they are subjected 

 must be fully explained to them, and they should be induced to seek other 

 means of support which do not bring them into contact with combinations 

 of lead. If, however, the unfortunate symptoms are present, i. e., radial 

 paralysis, we may attempt to improve the condition by the employment of 

 electricity, massage, particularly vibratory massage, also by the administra- 

 tion of preparations of iodin, such as sodium iodid, iodipin (10 per cent, 

 solution), and furthermore, by the use of baths. In the main we must admit 

 that in radial paralysis, encephalitis, epilepsy, etc., due to lead toxicosis, we are 

 almost powerless. 



A word regarding the diagnosis. In the characteristic " lead line," the 

 peculiar bluish discloration of the mucous membrane of the mouth in those 

 areas in which the teeth are implanted in the Jaws, we have a cardinal symp- 

 tom of lead toxicosis. It is true this symptom may be explained in many 

 ways, since various factors, for example, tooth powder which contains wood 

 charcoal, chronic mercury poisoning in workmen in iron and iron salts, may 

 produce a symptom which sometimes very closely resembles this. Hence a 

 diagnosis should never be made from the lead line alone. If, however, other 

 symptoms, particularly colic, favor the view that we are dealing with lead 

 toxicosis, the presence of the lead line may be considered to confirm this diag- 

 nosis, the more so as the chemical proof of lead in the secretions, for example, 

 m the urine, is frequently negative, particularly in the late stages of the 

 disease. 



_ In practical importance mercurial poisoning may be placed side by side 

 with saturnine poisoning. Since the soluble combinations of mercury have 

 been utilized as antiseptics in therapy, the number of cases of acute as well as 



