Document nnN2LeXEB0YVDQGg2dYZove6

c SOME LANDMARKS IN THE HISTORY OF LEAD POISONING By RALPH H. MAJOR French, ii * l passage: KANSAS CITY, KANSAS N'ignores ie Dont la char; Fait autour c * AUL of Aegina is frequently sensation unimpaired, at other times Un grand vi Pheld up by the medical his with involvement of both motion and torian as an example of the sensation. So, whatever Paul's short low state into which the prac comings, he has left us the first titioner of medicine in the seavecncothunt of epidemic lead poisoning essayer Un homme t< Que lui est aj This ve: century had fallen, because hethfaret we possess today. This, to be be marret quently apologetically disclaimed any sure, may be only a description of John Harri originality and because he constantly what the Ancients also saw but their turned it : emphasized that the ancients knew accounts have either not been pre bethan En all of medicine that was worth know served or are not as yet unearthed. only a pas ing and that he was merely their Avicenna, the "Prince of Phy sees here humble scribe. However, Paul has sicians'* some three hundred years, poor man v his good points. Few physicians, an centuries later observed the same to be torn* cient or modern, have been so modest species of epidemic colic and wrote pain and t as to write seven books of medicine that "the paralysis is the crisis ofthe gas which without claiming any originality, and colic; and to many the sensation causes an i Paul, despite his self-effacing attitude, remains, and those who recover, re These p; did make some solid contributions cover by paralysis,! for nature expels our minds to medical science. In his Third this material and brings it to the been descr Book of "De re medica," he writes exterior." medical wri in a very interesting fashion about an Neither of these writers, however, that lead epidemic of colic which prevailed In expresses the belief that the disease paralysis. I his time. they described was the' result of lead. ocular disti I consider moreover a colicky affection, which still becomes violent from a kind of collection of humors, which took its origin from regions in Italy, moreover in many other places in Roman territory whence it spread like the contagion of a pestilential plague. Wherefore in many cases it passed into epilepsy, to some there came loss of motion with sensation unhurt, to many both, and of those who fell victims to the epilepsy, very many died. Of those indeed who were paralysed, not a few recovered, for the cause which attacked them ended by crisis. This description is generally ac cepted as the first description of lead Yet many physicians before Paul were familiar with the effects of lead. Indeed Nikander, who wrote his "Alexipharmaca" in the 2nd century b .c . describes both colic and paralysis as the result of the ingestion of lead. Nikander's verses on cerussa as trans lated by Euricius Cordus close with; Interdum obrepens oritur cum frigore somnus, Torpet iners motus, . Ianguentia membra fathiscunt. Sometimes a stealthy stupor comes with a chiU The feeble limbs dropp, motion becomes slow, then still. Falso modo videtur. False images > eyes. Indeed called the ] But this te to his phaj ents, for I about lead poisons. IN Cicero, imit was unkint works had them excep style was b colic, since our author describes at Nikander's verses on litharge were Many 01 tacks of colic followed by paralysis translated by Jacques Grevin de Ger- familiar wr of the extremities, sometimes with mont into quaint sixteenth century poisoning. ] 218 f ! N36912 m&ii m 3F other times motion and Paul's short,;s the first .d poisoning This, to he ascription of a.w but their t been prenearthed. :e of Phyldred years, I the same i and wrote crisis of the e sensation recover, reature expels s it to the rs, however, the disease suit of lead, before Paul ects of lead. wrote his 2nd century nd paralysis tion of lead, ssa as trans close with: xigore somnus, aitia membra comes With a becomes slow. tharge were :vin de Clerath century So me La n d ma r k s in t h e His t o r y o f Le a d Po is o n in g 219 French, in the following spirited considered the father of materia, passage: medica, wrote that cerussa "causes * t N 'ignores ie te pri', la Litharge mortelle hiccough, cough and dryness of the Dont la charge se sied dans Ie ventre, & cruelle i Fait autour du nombril enfler & tournoyer ,r Un grand vent tout bruyant, tel que peut cssayer Un homme tourmentfe par la douleur cachee P A V Lid* Que Iui est apportant I'incurable trenchee: ^GI'NET OP VS DE RE ME* This verse is too picturesque to be marred by a translation. Sir John Harrington could probably have turned it into equally quaint Eliza flfxd atwrprimm Mefirm, Latmitaa tedonmmperlO A N N EM GVI N TE RIVM Aademacm,do* form me bethan English. But the reader with diem, only a passing knowledge of French sees here a striking picture of the poor man who has taken litharge only to be tormented by an intense inward ad t ec t is in ev n d em d o m mtiffmtgtdn* Miotiihnrib eodem Andere tuekaibr<aitf pain and the stirring up of a mass of gas which blows out his navel and CVM INDICE C0PI05ZSSIM0 causes an incurable colic. These passages leave no doubt in our minds that Nikander who has been described as the most ancient medical writer after Hippocrates, knew that lead produced both colic and Ynetift tyiJ Andrtm Arrwtbeniim* i % k paralysis. He also was familiar with the M D X X x in. ocular disturbances of lead poisoning: Fig . 1. Tit l e -p a g e o f Pa u l o f Ae g in a s "d e b e Me d ic a ." 1^42. Falso modo ante oculos rerum simulachra videtur. tongue, the extremities become lan False images of things only are seen before the eyes. guid, the mind gives way, the limbs are paralysed," and Galen very ex Indeed Nikander might well be plicitly warned against drinking water called the poet laureate of lead colic. that ran through lead pipes, which But this term would fail to do justice caused those who drank it to be sub to his pharmacological or poetic tal ject to intestinal disorders. Vitruvius ents, for he wrote verses not only remarked that "water is much health about lead but about many other ier from clay pipes than from lead poisons. Nikander was praised by pipes: since it seems to be poisoned Cicero, imitated by Ovid, but Plutarch by the lead, for white lead is formed was unkind enough to say that his from it: this moreover is said to be works had nothing poetical about harmful to the human body." them except the meter and that his Paracelsus, in his works Das Neudte style was bombastic and obscure. Buck in der Artzney ("de Contrac- Many other authorities were also turis "), das istvon krummen und lahmen familiar with certain features of lead Gliedem (the ninth book of thera poisoning. Dioscorides, who is usually peutics, "de Contracturis," that is i i s s s h s SSF? DUP050312464 220 Annals of Medical History concerning crooked and lame mem bers) speaks of Von Ursprung der Contractur die auss der Colica ent- NICANDRI POET AE BT MEDICI A ti$tiipimi Thfritca cr Alcxiph&rmrd kt m[mrci<i8A*$tr Bvaicwa Cordm>l'itdiem> IDEM IK EADEH* Cont?A$uoscfcfmmorfni iftusfymidtUt Hicandrhutptcro carmtneMuftdccct, Praterqudm dir* HuentiiuulncrttUugpa, lUudtsiliapotefimcerecttumlm&Tg>quhbdncJxbitapciorcmdi<cre]>ejlcm C2<Wf<jtf tosushibct cutt&dutita&l&ar* remedies the people sometimes rose up against him and made things so unpleasant that he was forced to seek another location. Another physician in those distant times who has left us a good account of a case of lead poisoning was Jean Fernel of Amiens. We remember him as a patriotic Frenchman who, smart ing with resentment because syphilis was so Universally called the morbus gaUicus of'^French disease, insisted that it be ' called the Disease of Venus or the venereal disease, as Jacques de Bethencourt hadsuggested. In his treatise "de Iuis venereae" he records the following history: I f > j ( SHAKc o e o e d ia e Apuichrfc ftmm s$cnolgbmt Fig . 2. Tit l e -p a g e o f Nik a n d e r s "Th e r ia c a & Al e x ip h a r ma c a ." 1532. Tr a n s l a t e d b y Eu r ic iu s Co r d u s . spring! an Handen und Fiissen ausgetheilt (concerning the contracture that comes from the colic distributed to the hands and feet). Paracelsus, who as one of his critics remarks "in the midst of the most incomprehensible jargon, sometimes writes intelligibly" evidently in the course of his wander ings saw and studied lead colic. It has also been pointed out that Para celsus who was very fond ofprescribing lead as a remedy, may have himself caused many of the cases he saw. Indeed this may explain in part the circumstance that when he located in a town and began dispensing his A painter of Anjou, thirty years of age, of a good and sound constitution, noticed for the first time in 1557, that his fingers were heavier than usual, that they were numb and difficult to move; after several days he felt them contract and move convulsively, finally the affec-. tion was progressively aggravated, until the fingers remained flexed and could not be extended. Moreover, the affection reached the hands and arms, and so by the chillipg of the nerves and tendons, filled with a thick humor, they became heavy, trembling and numb. Soon after he experienced the same trouble in his feet, and walking became impossible. However, he had very little pain in his feet, nor in his arms and hands. The poor fellow, as if he had not had already enough ills, saw a symptom appear much more serious and much more painful; for an acute and unbearable pain now attacked his stomach and hypochondrium and extended throughout his abdomen. This pain did not let up during the day or night, it was attempted but in vain to ease it with clysters, hot applications, baths and other remedies. Fernel attributed the attack to cinnabar, a mercurial pigment which the painter constantly wiped off his > \ 1 | | j j | | I 1, brushe howevt descrip ers' lea pointei would tion be in Feri than p Anjou failing his brt a matt coincid same ] the ca: on the lead fc terrible and si This c the int Felb first cl descrit "Prax< colic w by tor Tormil MEN (g Noist one pla places . . . T. may m which cients. Now tl and aff now ci certain has bee Platl excelle: happy tion of Whi DUP050312465 jmetimes rose ade things so 'as forced to those distant good account ling was Jean emember him n who, smart:cause syphilis ;d the morbus :ease, insisted e Disease of il disease, as had suggested, venereae" he story: ;hirty years of d constitution, : in 1557, that han usual, that ficult to move; them contract nally the affec;gravated, until i and could not the affection ons, and so by s and tendons, r, they became nib. Soon after trouble in his me impossible, ttle pain in his lands. The poor it had already tn appear much ore painful; for ble pain now Eiypochondrium ; his abdomen, during the day ed but in "vain ot applications. he attack to >igment which wiped off his So me La n d ma r k s in t h e His t o r y o f Le a d Po is o n in g 221 brushes with his fingers. Later authors, however, have seen in this account the description of a typical case of paint ers' lead colic with paralysis and have pointed out that salivation, which would have occurred had the intoxica tion been due to mercury, was absent in Fernel's case. So that it was more than probable that the painter from Anjou became ill because he had the failing of wiping off lead paint from his brushes with his fingers. It is also a matter of interest that by a curious coincidence, Fernel describes on the same page of his "de Iuis venereae" the case of a friend of his who took, on the advice of an Empiric, powdered lead for his gout. This friend, after a terrible dysentery, became constipated and suffered from atrocious colics. This case he cites .as a warning against the internal use of lead. Felix Platter, who published the first'classification of diseases in 1602, describes colic with paralysis. In his "Praxeos Medicae" he speaks of the colic with " atrocious pains & attacked by torments whence they. call them Tormina, the Germans call them k r ime n (gripes). Noises in the belly & creases, now in one place now running about in several places . . . Constipation attacks many . . . Terrible convulsions & weakness may moreover follow these.pains now: which was unknown to most of the an cients, but is frequent in our generation. Now these complications may be general and affect the greater part of the body: now circumscribed they damage only certain parts. Thus impairment of motion has been frequently described. Platter's description of lead colic is excellent but his explanation is less happy for he blamed it upon a reten tion of bile. While there are many other scat tered references by physicians to lead colic, it was Francois Citois who first established its right, as it were, to be Ni c i i i e Quodgcnusmuitxmotds.Letlialcvencnum Contincaut infcbcftia,Sc kcibxjdocea. PloptcrcaViftorNicandrinomcnadcptus PcipcEubaxtabit: virusatomncftigit. D3 Fig . 3. Po r t r a it o f Nik a n d e r . (Co u r t e s y Su r g e o n Ge n e r a l 's Lib r a r y .) of considered a distinct disease, in his diatriba de novo et populari apud Pictones dolore colico biliaco which appeared in 1617. In this work, dedi cated to his patron. Cardinal Riche lieu, Citois described an epidemic of spasmodic colic occurring in the prov ince of Poitou in 1572, and following this publication, we see the disease "colic of Poitou" or colica pictonum described with increasing frequency in the rpedical texts of the time. Citois described in great detail the disease which he says appeared in the province of Poitou in 1572 and grad ually became milder. He notes -also that it had been previously observed in Paris and Picardy and moreover in Silesia, Moravia and throughout southern Germany. Citois begins his dissertation with the remark that his century had seen several other new diseases which were the instruments of DUP050312466 222 Annals of Medical History- God's wrath upon a sinful and unre pentant world, particularly lues vene rea, sudor anglicus, plica polonica and Following the description of Citois in 1617, the "colic of Poitou" or "bilious colic," as already noted, takes its place in medical literature as a definite syndrome. Sydenham in his "Processus Integri" has a brief chapter, "Dc colica Pictonum" and writes, "This is a sort of colic, which is wont to degenerate into palsy, depriving the patient of the use both of his hands and feet [a fact noted by Riverius in his chapter on Palsy], and which is extremely common in the West Indies, where it destroys many persons." Thomas Willis wrote of colics with atrocious paroxysms and griping in the belly which were often followed by weakness and paralysis. Sydenham did not speculate as to the causation of the colic. Willis is more bold and explains it with the aid of his favorite theory, a spiritum animalium dejectu. Daniel Sennert, who saw and de scribed many things clearly, even though he believed in witchcraft and pacts with the Devil, wrote: the scurvy. And now colica pictonum was added to the list. Citois describes the characteristic colic which seized the patients and gives a particularly graphic account of the palsies. In describing the patients he writes: . . . they are seen moving about through the hamlets like ghosts or statues, pale, filthy, thin, with their hands crooked and hanging down from their own weight, they can be moved only with great effort to the mouth or upper parts of the body and not down to the feet but only to the muscles of the thighs. Their gait is ridiculous rather than provoking pity, the voice noisy and rattling. . . . many widely different places, such as Moravia, Austria, Franconia & many other places have a colic for where strong, sulphuric & tartaric wines are in use it is common & frequently leads to paralysis, arthritis and epilepsy . . . Such a.< colic .-Is; j indeed was widespread in Silesia; arid, in the Duchy of Tuscany in the year (1621. Wepfer was very familiar with,this colic which he ascribed to "wine either excessively sour or fumigated- with sulphur and bismuth and mixed'.with other ingredients and adulterants." Bernardino Ramazzini in his "Dc Morbis Artificium Diatriba,"ithe(first treatise on occupational diseases,! pub lished in 1700, noted that potters\vho work with lead often show its noxious effects. " For in them," he says, ' "at first tremors appear in the hands; soon rii!i they are "that rare in whom cadaverou; Sydcnhf is extren Indies" s malady u went to I turned to the diseas book, "CM of the / Epidemics Barbadoes 1759. "T1 "is most gripes, an most pain those whe of spiritui as are fi most sub He descr: the Bow much dis: "Faeces, afterward Lumps li also the " ling alonj soon afte to the Ni and the' Weaknes: Parts be< Loss of I Sensatior The d occasions but neitl any clej centuries Sennert c the caus< and pan of Iitharj DU P050312467 WKSy: ion of Citois Poitou" or sady noted, al literature sydenham in has a brief tonum" and colic, which into palsy, the use both act noted by 1 Palsy], and mon in the stroys many is wrote of -oxysms and h were often id paralysis, ate as to the fillis is more h the aid of itum animal- ;uw and delearly, even tchcraft and >tc: it places, such onia & many where strong, re in use it is to paralysis, Such a colic Silesia and in fie year 1621. iar with this "wine either igated with mixed with Iterants." in his "Dc >a," the first iseases, pubpotters who / its noxious le says, "at hands, soon So me La n d ma r k s in t h e His t o r y o f Le a d Po is o n in g 223 they arc paralyzed" and he adds "that rarely anybody sees a potter, in whom the countenance is not cadaverous and leaden." of Wiirtemberg in 1696 was so im pressed with these facts that he issued a decree making it a capital crime to Sydenham's remark that this colic "is extremely common in the West Indies" shows how widespread the malady was. William Hillary, who went to Barbadoes in 1752 and re turned to London in 1758, described the disease in that very interesting book, "Observations on the Changes of the Air and the Concomitant Epidemical Diseases in the Island of Barbadoes," which first appeared in 1759. "This Colic," Hillary observes, "is most commonly called the Dry- gripes, and dry Belly-ache, and is a most painful Disease." He noted that those who "are immoderate Drinkers of spirituous Liquors, especially such as arc fiery and new . . . arc the most subject to this cruel Disease." lie described the "griping Pains to * the Bowels, which are soon after much distended with Wind" and the F ,iq 5. Po r t r ait or Sir Geo r g e Bak er . (Co u r t es y |f "Faeces, when they are discharged o p Su r g e o n Ge n e r a l s turna r y .) I afterwards, are in little hard dry add litharge to wine. However, these Lumps like Bullets." He mentions scattered facts about the colic of also the "unusual Sensation and Ting Poitiers were either unheeded warnings ling along the spinal Marrow; which or lacking conviction. The mystery soon after extends itself from thence was finally cleared up by the well- to the Nerves of the Arms and Legs, known investigations of Baker on and they become weak, and that Devonshire colic. Weakness increases till those extreme Devonshire colic had probably been i Parts become paralytic, with a total endemic for centuries. William MusLoss of Motion, though a benumbed grave in 1703 wrote: Sensation often remains." The dry belly-ache, Hillary saw . . . indeed there is another colic, in % i occasionally while practicing in Bath but neither he nor his colleagues had Devonshire, caused by the excessive use of cider crude and acid; it indeed comes from this, it infests only those, who are any clear idea of its cause. For in the habit of drinking it, and moreover centuries it had tormented its victims. For this reason are affected: since during Sennert came very close to discovering those seasons when the cider is abundant the cause and Vicarius described colic it spreads among the people; on the 1 and paralysis following the addition contrary when the apples are not abun of litharge to wine. Indeed the Duke dant it is rarely seen. [He mentions a i f $ DUP050312468 224 Arrnafs of Medical History I \ gentleman who had what they call the colica pictonum ending in paralysis] the joints then were weak, thin, without motion. Dr. Huxham who is perhaps best known for his "Essay on Fevers" gave a very accurate account of the Devonshire colic as he saw it. In the beginning of the autumn 1724, a season particularly remarkable for an abundance of apples, it spread itself all over the county of Devon, among the populace especially, and those who were not very elegant and careful in their diet; and that, though it may not rage with the same degree of violence, and may affect a vastly less number of people, yet it infests that county more or less every autumn. Huxham describes the colicky pains and paralysis in a vivid way. He also notes that apples were so abundant they were thrown to the hogs. "But the swine-hogs, as well as the swinemen, suffered from the gluttonous abuse of the apples; and all of them wasted greatly in their' flesh, and many died." Huxham expressed his conviction that the Devonshire colic was due to the tartar, extracted from the apples in the process of making cider. Huxham's explanation however failed to satisfy one doctor at least and a little over twenty-five years later Baker began his remarkable studies. George Baker was the son of the Vicar of Modbury, Devon, where he was born in 1722. He was educated at Eton and Kings College, Cambridge, taking his m.d . degree in 1756. He first began practice at Stam ford in Lincolnshire but removed to London in 1761. He rapidly ac quired a large practice, became phy sician to Her Majesty's household, and was created a baronet in 1776. He was nine times president of the j College of Physicians. On June 29, f 1767, he read his famous paper, "An Inquiry concerning the cause of the Endcmial Colic of Devonshire," before the College of Physicians. ? J l I Baker is mentioned in "The Gold- \ Headed Cane" as a friend of its fourth owner, William Pitcairn, and l described as "that profound and t elegant scholar." \ To him the whole medical world looked up with respect, and in the treatment of any disease in the least degree unusual, if it was desired to know all that had ever been said or written on the subject, from the most remote antiquity, down to the case in question, a consultation was proposed with Sir George Baker. From his erudition everything was expected. | \ * Baker's erudition and his familiarity with the medical literature of the past, probably suggested to him the similarity between colica Pictonum, Devonshire colic and Nikander's de scription of the effects of lead. Baker was doubtless more or less familiar from his childhood with Devonshire colic. Although only two years old at the time of the great epidemic which Huxham described, yet he doubtless saw succeeding epi- demies, and in later life, after becoming a physician, he developed an especial interest in this disease. Baker's keen mind saw an anology between lead colic and Devonshire colic and he studied Huxham's account closely. "For although" he said "I always pay that`deference, which is due, to the authority of this celebrated phy sician, I have for some time" epneeived doubts concerning the solidity of his doctrine" (that Devonshire colic was due to the tartar of cider). Baker first assembled some inter- 1 * { | I 1 f 1. 1 I * 1 I } csting d; county c who tho boiled it vessel, c drank of shire col the paris as soon large Ie drank tl most cru shire co He was fact tha shire pi Hcrefon effects. Baker clusiveh cider oi while tl He shov it was 3 cidcr-pr Bakei great st " faithle found ii assertec used to had ao The col his opp' of the 1 did not but thi pouring would i and th cider. Still oppone to the particu him tc whethe DUP050312469 jsident of the On June 29, is paper, "An cause of the ishire," before 1 "The Goldfriend of its Pitcairn, and rofound and d world looked e treatment of ;ree unusual, if that had ever . the subject, itiquity, down a consultation George Baker, erything was is familiarity iture of the I to him the a Pictonum, ikander's de' lead. more or less dhood with gh only two of the great n described, seeding epiafter becom:ve!oped an ease. Baker's igy between re colic and Dunt closely. ! "I always h is due, to brated phyter conceived lidity of his re colic was some inter- So me La n d ma r k s in t h e His t o r y o f Le a d Po is o n in g 225 esting data. He found that in the many years sold sugar of lead to the l: county of Kent a certain gentleman farmers for the purpose of correcting \ i$ who thought his cider was too sour sour cider." And Baker closes by say boiled it with honey in a brewing- ing that it seems most probable that vessel, capped with lead. All who lead is the cause of the disease. "In drank of it were seized with Devon this opinion, however, 1 may have shire colic. He also learned that in erred; but I shall be happy even in the parish of Bury Pomeroy the cider my error, if it shall excite some more as soon as made was stored in a successful inquirer to investigate, and large leaden cistern. Those "who to discover a truth of so much real drank the cider, thus prepared, were importance to human society." 1 most cruelly tormented by the Devon But the proof was complete. Lead shire colic: and that many died." was removed from the cider presses in |I He was also much impressed by the Devon and Devonshire colic became fact that while the cider of Devon a matter of history. Confirmations of shire produced colic, the cider of Baker's views came from various parts f Herefordshire produced no such of the world. It was found that in the i effects. West Indies, rum was distilled through Baker finally proved his thesis con pewter worms and the pewter con clusively by demonstrating that the tained a considerable quantity of lead. cider of Devonshire contained lead So the dry belly-ache that Hillary while that of Herefordshire did not. saw was caused by lead in the rum. 1 He showed further that in Devonshire Two other very important obser it was a common practice to line the vations in lead poisoning were made i cider-presses with lead. later. In 1834 Henry Burton examin Baker's investigations created a ing patients in St. Thomas Hospital, great storm. He was denounced as a London, noted an important diag "faithless son of Devon"; the lead he nostic sign of lead poisoning. found in his experiments, came, it was asserted, from some shot which were used to cleanse the bottles and which had accidentally been left in them. The colic, it was loudly proclaimed by his opponents, was due to the humors of the body. This second objection he did not deem worthy of an answer, but the first one he demolished by pouring the cider through a cloth that would not allow shot to pass through and then demonstrating lead in the In a total number of fifty patients, [he wrote], who were examined whilst under the influence of lead, a peculiar discolora tion was observed on their gums, which I could not discern on the gums of several hundred patients, who were not under the influence of lead . . . The edges of the gums attached to the necks of two or more teeth of either jaw, were dis tinctly bordered by a narrow leaden-blue line, about one twentieth of an inch in width, whilst the substance of the gum cider. apparently retained its ordinary colour Still the storm raged. To one of his and condition. opponents, he wrote, "I here appeal to the conscience of one person, in Nothing further of importance was particular, whose zeal has induced added to existing knowledge of lead him to' oppose, my opinion in print, poisoning for over sixty years. Then whether it be not true, that he has for in 1900, Hamel, working in Grawitz' f j. > wwMiiwiuynwmwi i DUP050312470 226 Annals of Medical History clinic, studied 25 cases of lead poison ing and found in all but 2, basophilic granules in the red blood cells, the same granules that Grawitz had de scribed the previous year, in severe anemias. This observation was soon confirmed by numerous investigators and its great importance in the diag nosis of lead poisoning established. Epidemics of lead colic, once so frequent, are now practically un known. Their disappearance has been due to Baker's demonstration that "Devonshire colic" and colica pictonum were nothing other than lead poisoning. The world has long since forgotten that Baker was physician to Queen Charlotte or nine times president of the College of Physicians. His elegant and learned writings on epidemic catarrh and epidemic dysen tery are known only to the medical antiquarian but his . "Inquiry con cerning the cause of the Endemial Colic of Devonshire" remains a medi cal classic, a model of clear accurate thinking, careful experimentation and lucid presentation. Sporadic cases of lead poisoning still occur, but they are usually recog nized easily by the demonstration of a lead line on the gums and of baso philic granulations in the red blood cells. I ndeed, the presence of a lead line and basophilic granulations have saved many a patient with the tentative diagnosis of intestinal obstruction from an unnecessary surgical opera tion. The observations of Burton and of Hamel were thus also of tremendous importance and they may be rightly considered as ranking with the other landmarks in the history of lead poisoning. The words written in italics: i.e. colica pictonum, appear in the original in italics; words written with small capitals below: as, k r ime n and d a s n e u d t e b u c k in d e r a r t z n ey , are written in the original in Gothic type. i * P Re f e r e n c e s 1. Pa u l i Ae g in e t a e . Opus de Re Medica nunc primum intergrum Latinitate donatum per Ioannem Guinterium. Venetijs apud Andream Arrivaneum, MDXXXXII. 2. Av ic e n n a . Quoted by Baker. 3. Nic a n d r i. Poetae et Medici antiquissimi: Theriaca & Alexipharmaca in Latinos versus redacta, per Euricium Cordum, Medicum. Francofordiae Apud Christianum Egenolphum, Anno md x x x ii. 4. Les oeuvres de Nicandre traduictes en vers francais par Jacques Grevin de Clermont en Beauvaisis. Anvers. C. Plantin, 1567. $. Nic a n d e r . Alexipharmaca. Jo. Gorreaeo. interprete. Parisiis apud Vascosanum, 1349. 6. Dio s c o r id is . Libri Octo graece et Latine. Parisii Apud Petrum Haultinum 1549. 7. Der Buecher und Schrifften des Edlen Hochgelehrten und Bewehrten Philosophi unnd Medici Philippi Theo- phrasti Bombast von Hohenheim Paracelsi genannt. Erster Theil. Frahckfort am Meyn. Joh. Wechels Erben,;Anno MDCIII. 8. Io a n n is Fe r n e l ii Amb ia n i. Therapeutices Universalis. Francfurti'VApud Andream Wechclum, md l x x x i. ,.. 9. Fe l ic is Pl a t e r i, quondam Archiatri ct Profess. Basil. Ord: PraxeoslMedicae. Basilae, Impensis Emanuelis I Ktfnig, MDCLVI. 10. Cit o is . Quoted by Baker. 11. Th o ma e Sy d e n h a m, Medic doct.f Opera Omnia Medica. Patavii, Typis Semi- narii, md c c x x v . - , 12. Th o ma e Wil l is . Opera Omnia (Caloniac md c x c iv . De Anima Brutorum! Patho- logici, Gaput XV, DePassionefjCdlica. 13. Da n ie l is Se n n e r t i, Vratislaviensis,: D. & Medicinae in Acadamiai '.Witte- bergensi Profess. P. Medicinae jPrac- ticae. P. 594. Venetiis MDCL. /Apud Iuntas & Hertz. -- ' . 14. We t s 15. Ra ( 16. Iin ( t c 17. Ml C 18. Hv l 19. Ba i DUP050312471 tear accurate entation and id poisoning isually recoglstration of a md of basole red blood : of a lead line is have saved he tentative obstruction rgical operaT Burton and f tremendous ly be rightly ith the other ory of lead lies: i.e. colica ;inal in italics; apitals below: 1 bu c h in d er he original in So me La n d ma r k s in t h e His t o r y o f Le a d Po is o n in g 227 14. We p f e r , Jo h . Ja c o b i. Historiae apoplecticorum. Amstelaedami apud Janssonio-VVaebcrgias, md c c x x iv . 1$. Ra ma z z in i, Be r n a r d in i. Opera Omnia. Genevac, Cramer & Peraehon, 1716. j 6. Hil l a r y , W. Observations on the Changes of the Air and the Concomi tant Epidemical Diseases in the Island of Barbadoes. London, 1766. 17. Mu s g r a v e , G. De arthritide symptomica. Oxoniae, 1703. 18. Hu x h am. J. Opusculum de Morbo Colico Damnoniensi. Londini, J. Hinton, 1752. 19. Ba k e r , G. An inquiry concerning the Cause of the Endemial Colic or Devonshire. Med. Trans. London, 1: 175, 1772. 20. Bu r t o n , H. On a remarkable eflfect upon the human gums produced by the absorption of lead. Med. Cbir. Traits., London, 23: 63, 1840. 21. Ha me l . Ueber die Beziehungen der kSrnigen Degenerationen der rothen Blutkorperchen zu den sonstigen morphologischen Veranderungen des Biutes mit besonderer Beriicksichtigung der Bleiintoxication. Deutscb. Arch. J. klin. Med., 67: 357, 1900. I i t * I I ahenheim Paraleil. Franckfort s Erben, Anno a n i. Therapeuanefurti Apud >l x x x i. m Archiatri et axeos Medicae. anuelis Konig, fic doct. Opera i, Typis Semi- )mnia Caloniae utorum Pathoissione Colica. tislaviensis, D. damia. Witteledicinae Pracs md c l . Apud % | \ 1 i 1 i } r L l tjmrpF? DU P050312472