Lead poisoning and lead absorption : $b The symptoms, pathology and prevention, with special reference to their industrial origin, and an account of the principal processes involving riskLegge, Thomas Morison, Sir
Science
Lead poisoning and lead absorption : $b The symptoms, pathology and prevention, with special reference to their industrial origin, and an account of the principal processes involving risk
Legge, Thomas Morison, Sir
Lead poisoning
This case is a typical one of the anterior brachial type, showing
partial recovery of function. The man is able to grasp, although the
wrist becomes strongly flexed in so doing.
CASE 2.--We are indebted to Dr. Gossage for this case, which was
presented at the Out-patients of the Westminster Hospital; and to
Dr. Worrell, who made the electrical investigations. We are further
indebted to Dr. Worrell for the reports which are given in tabular form
of the electrical reactions of these three cases.
This is a case of brachial type, with weakness of both deltoids, and
the patient was unable to raise his right arm at the shoulder. It
will be seen that there is here also evidence that the electrical
contractility diminishes before the entire loss. It will be also
noticed that the supinators are unaffected.
CASE 3.--These are the electrical reactions of a case which had
recovered. This man showed the ordinary anterior brachial type, which
came on suddenly, although he had shown distinct weakness of wrists
when forcible flexion was performed for nine months previously, but
there had been no obvious increase in the weakness. He was immediately
removed from his work, and within seven days paralysis, which at first
only affected the extensor communis digitorum, had spread to the minimi
digiti and the extensor indicis, the opponens pollicis being also
involved on the right side. He was treated from the start with faradic
current, and was instructed to use the battery himself, which he did
twice a day for a year. At the end of two months he was sufficiently
recovered to be given light work, and at the time of taking the
reactions his wrists have so far recovered their power that we were
unable to flex them forcibly.
The progressive weakness noted in the three cases has already been
referred to, and may be a prodrome of paralysis, but there may be
recovery without paralysis supervening.
=Tremor.=--Tremor may be observed in a large number of cases of lead
poisoning, and is invariably associated with paralysis, although the
symptom of tremor by no means always progresses to definite palsy. Two
types of tremor are described--fine and coarse--and Gübler further
describes a type of tremor which is both rhythmic and intermittent. The
tremor is usually distinctly increased on attempting to grasp or point
the hand (intention tremor), but it is difficult to separate tremor
from alcoholic tremor, and, further, it must not be forgotten that
persons engaged in arduous work may show a certain amount of tremor due
to muscular fatigue. Persistent tremor, however, is a symptom that is
always to be noted and carefully watched.
Of the types of paralysis, the antibrachial is the most common, and,
secondly, probably the brachial. The least common is the peroneal. The
table on p. 54 shows the distribution of cases of paralysis, so far as
they can be made out from reports received since 1904.
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