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December 17, 1898


JAMA. 1898;XXXI(25):1486. doi:10.1001/jama.1898.02450250044008

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It has been well said by one of the great teachers in medicine that when a patient comes before the physician with obscure symptoms in connection with the nervous system, indicating organic disease, two conditions should always be thought of as the possible exciting cause: syphilis, and chronic metallic poisoning in some one of its forms, usually in the form of lead. This dictum arose from the fact that syphilis is competent to produce almost any lesion in the body, and that lead often manifests its presence by conditions which are so unusual that its presence as an exciting cause is not suspected. It frequently gains access to the body in a manner which does not raise suspicion, as for example, in the well-known epidemics of plumbism that have arisen from the use of previously pure water delivered through lead pipes, the attacks of "dry cholera" so-called which have followed

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