Newman's Notions | June 2016 | FREE
Most ACP Hospitalist content is available exclusively to ACP Members. This article is free to the public.

Colica Pictonum

Ancient Rome and Flint, Mich., share a connection.

It is hard to imagine 2 more dissimilar places than ancient Rome and Flint, Mich. Nonetheless, there is a strong bond between that early civilization and the present one.

Lead was the first smelted metal, with evidence of its use millennia before the common era. It was used for everything from flavoring wine to making healing amulets. Lead was an easy-to-obtain and malleable substance well suited to plumbing (a word that stems from the Latin for lead, plumbum) and many other uses.

Illustration by David Rosenman
Illustration by David Rosenman

However, we know now that lead can be absorbed through the skin, as well as inhaled or ingested. It is a potent neurotoxin associated with delayed mental development in children who are chronically exposed and can cause a wide variety of medical symptoms, from abdominal pain to infertility. The symptoms of lead toxicity, including abdominal pain and paralysis, were recognized in ancient times, but the association with lead was not known. The Greek physician Nicander described the condition poetically in the second century B.C.

A feeble cough tries, it in vain to expel.

He belches so much, and his belly does swell.

His sluggish eyes sway, then he totters to bed.

Complains that so dizzy and heavy his head.

Lead poisoning was likely common in ancient Rome. The wealthiest citizens stored their water and food in vessels decorated with lead-based glaze. Lead was added to wine to prevent it from spoiling and to improve the taste, and water was transported in lead pipes. There has been an ongoing debate over whether chronic lead exposure contributed to the fall of the Roman Empire.

In the early 17th century, French physician François Citois described lead poisoning in detail, naming it Poitiers' colic (or colica Pictonum) after his hometown. However, he attributed it to astrological influences. He noted that monks did not get the disease, which we now know was probably because they did not drink lead-laced wine.

One hundred years later, British physician John Huxham described a disease he called the Devonshire colic, with similar symptoms of abdominal pain and neurologic problems. He noted a connection between cider, the traditional beverage of the residents of Devon County, and the excruciating pain of colic and rheumatism. Several years later, Sir George Baker, also of Devonshire, recognized that lead in the cider presses was causing the symptoms. Using a scientific method of observation and experimentation, he found that by removing the lead from these devices, he was able to eliminate the dread disease.

Back in France, another physician was making a very astute set of observations and drawing conclusions on the etiology of this disease. Théodore Tronchin was a Swiss physician who studied in Cambridge and in Leyden (famous for its factor) under the great physician Boerhaave and practiced in Paris. He was the doctor for several famous patients, most notably Voltaire. (No HIPAA regulations apply to this era.) Ten years before Baker published his findings, Tronchin made the connection between lead and illness. He reviewed the literature and gave concise case descriptions. He noted that potters who used lead glaze inhaled and drank lead and developed symptoms.

His most interesting discovery related to an epidemic of lead poisoning in Amsterdam. It had become fashionable to use lead gutters to collect rainwater for drinking. In homes where leaves had fallen in the gutters, decomposing and acidifying, the residents became ill, but this did not happen in leafless homes. He realized that the decomposing leaves caused the lead to leach from the gutters.

Lead poisoning did not spare the residents of North America. Benjamin Franklin noted the deleterious effects of lead in the printing process, which had been used since the time of Gutenberg's first press. A colonial law prohibited the use of lead in rum distillation.

Despite millennia of observations of harm, lead remained pervasive in products from paint to gasoline. With regulatory changes and massive effort, the levels of lead have diminished markedly in the U.S. over the past 4 decades. However, we are not “out of the water” yet.

The CDC estimated that in 2014, 1 in 20 children under 5 years old had significant elevation in their lead levels. In April 2014, the residents of Flint, Mich., got a rude awakening when they turned on their taps and saw discolored water. The local government had made a cost-cutting decision and changed water sources from Lake Huron to the less-than-pristine Flint River. The discoloration was due to the river water corroding iron from the water mains into the drinking supply. Federal regulations required the water to be treated with anticorrosive agents, but these were not followed. More than a year later, residents learned that lead from aging pipes was also leaching into their water. As a result, Flint residents had significant lead exposure, most potentially damaging to children.

And Flint is not the only place in America at risk. Despite centuries of observation, description, research, and prevention, the same element, atomic number 82, continues to plague the human race.