LEAD. 
§ 816.] 
admitted from other trades than it should be, compared with the propor¬ 
tion of the various trades in the county of Middlesex, as ascertained 
from the census. Putting aside coarse lead-poisoning, which may occa¬ 
sionally produce acute mania, the insanity produced by prolonged minute 
lead intoxications possesses some peculiar features. It develops slowly, 
and in nearly all cases there are illusions of the senses, of hearing, taste, 
or smell, and especially of sight. Thus, in one of Dr Rayner’s cases 
the patient saw round him “ wind-bags blown out to look like men,” 
apparitions which made remarks to him and generally worried him. 
Besides this form, there is also another which closely resembles general 
paralysis, and, in the absence of the history, might be mistaken for it. 
§ 816. The degenerative influence on the organ of sight is shown in 
six of Dr Robertson’s patients, whose insanity was ascribed to lead— 
four of the six were either totally or partially blind. 
The amaurosis has been known to come on suddenly, and after a 
very brief exposure to lead— e.g. a man, 34 years of age, after 
working for three days in a white-lead factory, was seized with intense 
ciliary neuralgia, had pains in his limbs and symptoms of lead-poisoning, 
and the right eye became amaurotic. 1 This form of impairment or loss 
of vision is different from the Retinitis albuminurica, 2 which may also be 
produced as a secondary effect of the poison, the kidneys in such cases 
being profoundly affected. The kind of diseased kidney produced by 
lead is the granular contracted kidney. 
Eulenberg speaks of the sexual functions being weakened, leading 
to more or less impotence. 
Lewy, 3 in 1186 patients suffering from lead-poisoning, has found 
caries or necrosis in twenty-two cases, or about 1-8 per cent. ; fifteen 
were carious affections of the upper jaw, four of the fore-arm, two of the 
thigh, and one of the rib and sternum. Epilepsy and epileptiform con¬ 
vulsions occur in a few cases ; it is very possible that the epilepsy may 
be a result of the uraemic poisoning induced by diseased kidneys. 
Five cases of fatal poisoning occurred between 1884 and 1886 among 
the employees of a certain white-lead factory in the east of London. 
The cases presented the following common characters. They were all 
adult women, aged from 18 to 33, and they had worked at the factory 
for short periods, from three to twelve months. They all exhibited 
mild symptoms of plumbism, such as a blue line round the gums, and 
more or less ill-defined indisposition ; paralyses were absent. They were 
all in their usual state of health within a few hours or days preceding 
death. Death was unexpected, mostly sudden. In four cases it was 
1 Samelsohn, Monalsbl. /. Augenheilk., xi. 246, 1873. See also a case of lead 
amaurosis described by Mr W. Holder, Pharm. Journ., Oct. 14, 1876. 
2 Ran, Arch. f. Ophthal., i. (2), 205, 1858; and Schmidt’s Jahrbuch, cxxxiii. 116; 
cxliii. 67. 
3 Die Berufskrank d. Bleiarbeiter, Wien, 1873, p. 16. 
41 
