The anaemia of lead poisoning: a review.

Lead intoxication has been recognized as a clinical entity since ancient times. Hippocrates (370 B.C.) was probably the first person to associate lead with clinical symptoms, since when the harmful effects of lead on the body have been well documented. Early observations culminated in the brilliant monograph of Tanquerel des Planches (1839) in which the clinical aspects of the disease were completely outlined and most of the early signs of the disease were mentioned. So complete was this work that virtually nothing has been added to des Planches's observations since their publication. The earliest reference to lead anaemia was made in 1831 by Laennec, who described thinness of the blood and pallor of the tissues in cases of lead poisoning at necropsy. The first direct evidence of the effect of lead on red blood cells was presented by Andral and Gavarret (1840), who counted the number of red blood cells in cases of lead poisoning and found the count to be much lower than normal. Since these early reports a great deal of work has been undertaken to try to discover the means by which lead causes anaemia, but it is probably true to say that at the present time this mechanism is still not fully understood. This review is an attempt to draw together at least some of the theories which have been advanced in the past and to present them, it is hoped, in an easily accessible manner for future workers in this field.