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OXFORD ENGLISH MONOGRAPHS
General Editors
PAULINA KEWES LAURA MARCUS PETER MCCULLOUGH
SEAMUS PERRY LLOYD PRATT FIONA STAFFORD
DANIEL WAKELIN
Divine Cartographies
God, History, and Poiesis in W. B. Yeats,
David Jones, and T. S. Eliot
W . D A V I D SO U D
1
3
Great Clarendon Street, Oxford, OX2 6DP,
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© W. David Soud 2016
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First Edition published in 2016
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for Rohini
Acknowledgements
A project such as a scholarly monograph is never simply the work of one

person. There are many people without whom this study, adapted from
my doctoral thesis at the University of Oxford, would never have taken
shape.
Above all, I would like to thank Rohini Ralby, not only my wife but
also a scholar and practitioner of the contemplative way. Her unstinting
love, support, and counsel first encouraged me to undertake this project
and then made it possible for me to complete it. I cannot thank her
enough. This book is dedicated to her.
My stepsons Ian and Aaron Ralby were always ready with their love,
advice, and affirmation from first to last.
Rebecca Beasley, my thesis supervisor at Oxford, was as gracious as she
was exacting through the whole doctoral process, and then offered equally
generous guidance as this book took shape.
Other scholars, at Oxford and elsewhere, also offered assistance in
various ways. Gavin Flood was unfailingly generous with his knowledge
of both Indic traditions and twentieth-century poetry; he, his colleagues,
and the students at the Oxford Centre for Hindu Studies formed a
marvellous scholarly community. Ron Bush, Meg Harper, Rowan
Williams, Richard Conrad OP, Paul Fiddes, Jon Stallworthy, David
Moody, Jason Harding, Richard Parish, John Kelly, Alexis Sanderson,
Doug Mao, Hanneke Wilson, Valentine Cunningham, and Michael
Whitworth all took time to share their thoughts on my work, as did
Stephen Ross, Ed Sugden, Alex Niven, Zohar Atkins, Olga Breininger,
Alys Moody, Charlotta Salmi, and Angus Brown. Charles Robinson at the
University of Delaware has remained a tireless and sagacious mentor for
many years. I also appreciate the assistance of other colleagues at Delaware,
especially George Miller, Chris Penna, Devon Miller-Duggan, and Bruce
Allen Heggen.
I have indeed been very lucky.
Contents
General Introduction 1
1. The Divine Self at Play: History and Liberation in the
Late Poems of W. B. Yeats 26
2. The Figure and the Map: The Anathemata of David Jones 98
3. The Silence and the Moment: The Dialectical
Poetics of Four Quartets 147
Afterword 217
Bibliography 221
Index 238
General Introduction
In his classic study The Disappearance of God, J. Hillis Miller foregrounds

the theological dimension of literature: ‘A work of literature is the act
whereby a mind takes possession of space, time, nature, or other minds.
Each of these is a dimension of literature. Literature may also express a
relation of the self to God.’ He goes on to observe that in some texts
‘theological experience is most important and determines everything
else’.1 While Miller’s comment refers primarily to Victorian writers, the
theological issues they confronted hardly diminished in importance or
immediacy in the first half of the twentieth century. And, though many
modernist writers followed the course Pericles Lewis describes as seeking ‘a
secular sacred, a form of transcendent or ultimate meaning to be discovered
in this world, without reference to the supernatural’, others—and one
might say poets especially—made explicit religious commitments.2 Even
well after the Great War, for W. B. Yeats, David Jones, and T. S. Eliot,
‘theological experience’ was often the overriding consideration, and it
determined a great deal about some of their most important works.
If we take ‘theology’ not simply as an academic discipline but in its
original sense of discourse about God, its importance to their poetry
becomes obvious. A theologically engaged poet’s conceptions of the nature
of the human self and its situation, of the ends and goals of life, and even
of the efficacy of language are likely to follow the trajectory of his religious
deliberations. Such an engagement becomes more pressing, and more
meaningful, in a time of theological controversy, historical trauma, and
widespread religious speculation. The relationship between theology and
text warrants sustained and careful attention.
One reason a literary critic might hesitate to venture into this territory is
that the linguistic terrain is so treacherous; it is filled with notoriously
1
J. Hillis Miller, The Disappearance of God: Five Nineteenth-Century Writers (New York:
Schocken, 1965), p. x.
2
Pericles Lewis, Religious Experience and the Modernist Novel (New York: Cambridge
University Press, 2010), 21.
2 Divine Cartographies
malleable signifiers. Such fundamental terms as ‘religion’, ‘spirituality’,
‘mysticism’, ‘sacred’, and ‘secular’, among others, resist the sort of crystal-
line definition that would prove most useful in a study like this. But use
them we must.
Adapting a phrase from Saussurean linguistics, Peter van der Veer
regards such signifiers as forming ‘syntagmatic chains’, in which the
different terms ‘are connected, belong to each other, but cannot replace
each other. They do not possess stable meanings independently from one
another and thus cannot be simply defined separately.’3 This is, I think, a
sound approach, though a more apt metaphor might be ‘constellations’ or
‘clusters’ rather than ‘chains’. One such cluster would include ‘religion’,
‘spirituality’, ‘ontology’, and ‘theology’. While I have broadly defined
‘theology’ above, it is sometimes used more narrowly elsewhere in this
book. ‘Ontology’, on the other hand, need not be linked with any of the
other terms, but occupies a space within the cluster when religious
deliberations involve, as they often do, questions about the nature of
being. In a given context, each of the terms may subsume one or more
of the others: George Santayana defines ‘spirituality’ as ‘the aspiring side of
religion’, yet it is often used to indicate a broader impulse than ‘religion’
suggests.4 Van der Veer, for instance, affirms that the very vagueness of
‘spirituality’, which ‘sever[s] ties with religious institutions’, makes it
‘productive as a concept that bridges many discursive traditions across the
globe’.5 The overall effect is that of an unstable Venn diagram, in which
the relative positions of, and overlaps among, these terms vary. At times,
near-synonymity gives way to sharp distinctions. The best one can do is
clarify the terms’ relative meanings as they cross different contexts.
Despite these and other difficulties, recent scholarship has begun to
explore more adventurously the intersection of modernism and various
forms of spirituality in the broad sense. Pericles Lewis’s Religious Experi-
ence and the Modernist Novel, as well as Matthew Mutter’s recent work on
the ambivalence towards both religion and secularism lurking in much
modernist literature’s ‘critique of asceticism and return to the world’, has
raised important questions.6 In particular, work on the links between
literary modernism and the occult and mystical enthusiasms of the late
nineteenth and early twentieth centuries has been expertly undertaken by
3
Peter van der Veer, The Modern Spirit of Asia: The Spiritual and the Secular in China
and India (Princeton: Princeton University Press, 2014), 9.
4
Cited in Van der Veer, Modern Spirit, 41.
5
Van der Veer, Modern Spirit, 7, 36. I will generally use the term ‘spirituality’ in the
broader sense that Van der Veer suggests.
6
Matthew Mutter, ‘Poetry against Religion, Poetry as Religion: Secularism and its
Discontents in Literary Modernism’ (Ph.D. dissertation, Yale University, 2009), 13.
such critics as Alex Owen in The Place of Enchantment, Timothy Materer
in Modernist Alchemy, Leon Surette in The Birth of Modernism, and
Sanford Schwartz in The Matrix of Modernism. In its discussion of the
late poetry of Yeats, this study touches on their work. But Eliot and
Jones—two major poets for whom, through much of their careers, reli-
gious belief was paramount and theology a compelling discipline—fall
largely outside the boundaries of such surveys. Fortunately, there is a fairly
rich corpus of criticism on religious aspects of Eliot’s and Jones’s work.
But the interpretative possibilities that arise from juxtaposing these three
poets have yet to be explored.
What I hope to contribute with this book is a kind of triangulation of
key texts: a selection of poems from Yeats’s final decade, during his most
intensive and fruitful engagement with Indic traditions; Jones’s The
Anathemata; and Eliot’s Four Quartets. While many Anglophone poets
addressed questions of religion and transcendence in the years surround-
ing the Second World War, Yeats, Jones, and Eliot stand out as bringing
strong theological stances to bear on the same poetic project: how to map
within a poem the relation between history and eternity, which for these
poets is inseparable from the relation between the individual self and God.
It is a question of theodicy, and of the role of the poet in public life,
especially in times of crisis—issues closely tied to what critics have called
late modernism, of which these three poets can be said to mark off certain
theological boundaries. But it is also a question of the nature of the
subject, and therefore of poetic agency, and ultimately of poetic strategy.
In these poems, theology translates into poetics.
Exploring the theological dimension of these texts requires a specific set
of contexts, some of which have only recently begun to adhere to mod-
ernist studies. The first is the problem of secularization, an issue that
caused a great deal of hand-wringing during the mid-twentieth century
and remains with us, albeit in a much more complex and ambiguous form
than earlier narratives allowed. Closely related to the question of secular-
ization are three spiritual currents that became points of contention in the
first half of the century: liberal Protestantism, the mystical revival, and
Theosophy. Liberal Protestantism served as a cultural antagonist for literary
modernism, especially during and after the Great War. The mystical revival,
which carried over from the nineteenth century, was one response to a
widely felt sense of desacralization partly precipitated by liberal Protes-
tantism. Theosophy—more precisely, the Theosophical Society and its
offshoots—emerged with the mystical revival as the most prominent and
influential early form of what now often goes by the name ‘alternative
spirituality’. Those contexts open up three further considerations: the
question of the nature of the subject, the critical conversation about ‘late
modernism’, and the taxonomy of difficulty proposed by George Steiner,
which serves as a useful hermeneutic device in this study.
SECULARIZATION AND THE SACRED
In his Massey Lectures of 1974, Steiner argued that ‘the political and
philosophic history of the West during the past 150 years can be understood
as a series of attempts—more or less conscious, more or less systematic, more
or less violent—to fill the central emptiness left by the erosion of theology’.
He identified movements ranging from Stalinism to Freudianism to struc-
tural anthropology as forms of ‘substitute theology’ engendered by a ‘nostalgia
for the absolute’.7 While he declined to advance a specific narrative on the
causes of secularization, his lectures conformed to what Charles Taylor has
called ‘the formerly dominant, unilinear secularization theory, which sees
the retreat of faith as a steady function of certain modernizing trends’.8
Like many of their contemporaries, Yeats, Jones, and Eliot subscribed
to variants of that narrative. We need only recall Yeats’s oft-quoted lines
from ‘The Second Coming’—‘The best lack all conviction, | While the
worst are full of passionate intensity’—to see the lineaments of Steiner’s
argument. Jones’s notions of ‘the Break’ and ‘the turn of a civilisation’
follow a similar trajectory, as does a great deal of Eliot’s poetry and prose,
especially after his conversion to Anglo-Catholicism.9 And all three poets
indulged in what Stephen Spender called ‘the nostalgic fallacy of vicarious
living’, which mythologized a lost organic community bound together at
least partly by a shared religion.10 Still, a more nuanced treatment of the
secularization thesis will prove helpful here.
The ‘unilinear’ narrative, grounded in Max Weber’s famous principle
of disenchantment, was already being challenged at the time of Steiner’s
lectures, and the controversy has continued through to the present day.
Much of the debate has hinged on defining secularization: is it about
public institutions, private belief and practice, epistemic frames, or all of
the above? Depending on the definition, it can be (and has been) cogently
7
George Steiner, Nostalgia for the Absolute (Toronto: House of Anansi Press, 2004), 2–5.
8
Charles Taylor, A Secular Age (Cambridge, MA: Belknap/Harvard, 2007), 461; emphasis
in original.
9
W. B. Yeats, The Variorum Edition of the Collected Poems of W. B. Yeats, ed. Peter Allt
and Russell K. Alspach (1957; repr. New York: Macmillan, 1987), 402 (hereafter referred
to as Allt and Alspach); David Jones, Preface to The Anathemata: Fragments of an Attempted
Writing (1952; repr. London: Faber and Faber, 2010), 15; David Jones, The Sleeping Lord
and Other Fragments, paperback edn (1974; repr. London: Faber and Faber, 1995), 9.
10
Stephen Spender, The Struggle of the Modern (London: Methuen, 1965), 240.
argued that the secularization thesis is a fallacy. Even the concept of
disenchantment has been interrogated. In his 2007 study A Secular Age,
Taylor makes clear that we should not equate religion with enchantment:
‘Enchantment is essential to some forms of religion, but other forms . . .
have been built on its partial or total denial.’11 And Jean-Pierre Dupuy has
pointed out that, understood rightly, Weber presents disenchantment as
‘paradoxically itself both a belief and an act of faith’.12
Nevertheless, scholars such as Roy Wallis and Steve Bruce have found
little reason to doubt that ‘there has been a major change in the import-
ance and popularity of religion and that the term “secularization” is as
good a way of describing it as any’.13 The precise nature and origins of
this shift will doubtless continue to be debated. To cite a few relevant
examples, such otherwise divergent thinkers as Weber, Louis Dupré, and
René Girard have assigned responsibility to latent desacralizing impulses
within Christianity; Sanford Schwartz links the crisis of value with the rise
of scientific world views that ‘replaced [a] higher world with a mechanistic
cosmos utterly indifferent to traditional moral and spiritual sentiments’
and ‘left man stranded in a universe devoid of transcendent value’; Fredric
Jameson points to ‘the desacralization of the market system’; and Michael
Levenson links its British manifestation to ‘the self-celebrating independ-
ence of the middle-class’ in the nineteenth century.14
Perhaps no one has undertaken such a comprehensive survey of this
terrain as Taylor. Tracing the origins of secularization as far back as
the flowering of Franciscan spirituality, Taylor theorizes a ‘nova effect’
in which the rise of humanism as a viable alternative to belief in the trans-
cendent ‘spawn[ed] an ever-widening variety of moral/spiritual options’.15
For Taylor, the most decisive manifestation of secularization is neither the
withdrawal of religion from public spaces nor the falling-off of religious
practice, but rather what he terms ‘secularity 3’: a shift in the ‘conditions
of belief ’ that ‘takes us from a society in which it was virtually impossible
11
Taylor, A Secular Age, 553.
12
Jean-Pierre Dupuy, The Mark of the Sacred, trans. M. B. Debevoise (Stanford: Stanford
13
R. Wallis and Steve Bruce, ‘Secularization: The Orthodox Model’, in Steve Bruce
(ed.), Religion and Modernization: Sociologists and Historians Debate the Secularization Thesis
(Oxford: Clarendon Press, 1992), 8–30, at 25.
14
Sanford Schwartz, The Matrix of Modernism (Princeton: Princeton University Press,
1985), 39; Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act
(Ithaca, NY: Cornell University Press, 1981), 236–7; Michael Levenson, A Genealogy of
Modernism (New York: Cambridge University Press, 1984), 15.
15
Taylor, A Secular Age, 299. Louis Dupré advances a similar argument in Passage to
Modernity: An Essay in the Hermeneutics of Nature and Culture (New Haven: Yale University
Press, 1993). More so than Taylor, Dupré emphasizes the influence of late medieval
nominalist theology.
not to believe in God, to one in which faith, even for the staunchest
believer, is one human possibility among others’.16 This proliferation of
competing moral and spiritual sources, especially those that discount
transcendence of any kind, gives rise to the ‘malaise of immanence’, in
which ‘the sense that all these answers are fragile, or uncertain’ leads to a
general ‘fragility of meaning, analogous to the existential fragility we
always live with’.17 It also gives rise to alternative spiritualities. Taylor’s
narrative accounts not only for the spiritual bricolage of Yeats but also the
paths to conversion of Jones and Eliot.
Discussing secularization requires a working definition of the sacred. In
this respect, Taylor’s reading often relies on the work of Mircea Eliade, the
historian of religion whose theory of the sacred and profane, though not
unchallenged, has remained foundational in his field. Unlike René Girard,
for whom ‘violence is the heart and secret soul of the sacred’, which
‘consists of all those forces whose dominance over man increases or
seems to increase in proportion to man’s effort to master them’,18 Eliade
frames the dialectic of sacred and profane within that of Being and
Becoming. The sacred is associated, or even equated, with the former:
Whatever the historical context in which he is placed, homo religiosus always
believes that there is an absolute reality, the sacred, which transcends this
world but manifests itself in this world, thereby sanctifying it and making it
real. He further believes that life has a sacred origin and that human existence
realizes all of its potentialities in proportion as it is religious—that is,
participates in reality.19
For religious persons, then, ‘the sacred is equivalent to a power, and, in
the last analysis, to reality. The sacred is saturated with being.’ It follows
that any hierophany is the ‘revelation of an absolute reality’, such that ‘the
manifestation of the sacred ontologically founds the world’. The elimin-
ation of the sacred therefore ontologically uproots the world, and with it
the self.
Eliade therefore takes a bleak view of secularization. Suggesting that ‘the
completely profane world, the wholly desacralized cosmos, is a recent
discovery in the history of the human spirit’, he insists that, in the
aftermath of that development, ‘modern nonreligious man assumes a
tragic existence’.20 A desacralized cosmos is, in effect, stripped of its
16 17
Taylor, A Secular Age, 3. Taylor, A Secular Age, 308.
18
René Girard, Violence and the Sacred, trans. Patrick Gregory (Baltimore: Johns Hopkins
19
Mircea Eliade, The Sacred and the Profane: The Nature of Religion, trans. Willard
R. Trask (1957; repr. Orlando, FL: Harcourt, 1987), 202.
20
Eliade, The Sacred and the Profane, 11, 21, 203.
connection to Being. Eliade’s notion of the ‘tragic’ effects of secularization
meshes neatly with Taylor’s ‘malaise of immanence’.
Yeats, Jones, and Eliot adopted similar stances, subscribing quite openly
at times to the narrative that secularization is a pernicious, even dehu-
manizing development. And all three regarded liberal Protestantism as one
of its prime agents.
LIBERAL PROTESTANTISM
Taylor’s admonition not to confuse disenchantment with secularization is

exemplified by liberal Protestantism. A broad religious orientation rather
than a systematic theology, it pervaded the educated classes of Britain and
America in the late nineteenth and early twentieth centuries. Though
often traced back to Friedrich Schleiermacher’s Romantic immanentism,
liberal Protestantism came into its own with a late nineteenth- and early
twentieth-century collection of theologians who based their approaches on
Kantian critique. The foremost among these were Albrecht Ritschl and
Adolf von Harnack. Following Kant, these theologians affirmed the inner
moral imperative as the surest sign of a Supreme Being, and of a divine
order of which humanity is part and to which it is accountable. ‘Ritschl-
ianism’, according to the theologian Paul Tillich, ‘was a withdrawal from
the ontological to the ethical’, and regarded the purpose of Christianity as
‘to make morality possible’. Such a theology effectively denuded religion
of mystery. As a result, it ‘aroused the wrath of all those for whom the
mystical element in religion is decisive’.21
Around the turn of the century, the lightning rod for that reaction was
liberal Protestantism’s most famous exponent, Harnack. He was primarily a
church historian rather than a systematic theologian; his hugely popular
book What Is Christianity?, translated into English within a year of its
German publication in 1900, set about answering its titular question
using ‘the methods of historical science, and the experience of life gained
by studying the actual course of history’.22 Harnack’s historically deter-
mined vision of the faith, in which Jesus is presented as a ‘spiritual person-
ality’ for whom, ‘rightly understood, the name of Son means nothing but
the knowledge of God’, grounded Ritschlian ethical Christianity in a
21
Paul Tillich, A History of Christian Thought: From its Judaic and Hellenistic Origins to
Existentialism, ed. Carl E. Braaten (New York: Simon and Schuster, 1968), 512–14.
22
Adolf Harnack, What Is Christianity?, trans. T. Bailey Saunders (2nd rev. edn, New
York: G. P. Putnam’s Sons, 1903), 7.
foundation of textual and historical scholarship.23 For Harnack, the true
gospel preached by Jesus bore little resemblance to the superstructure of
Hellenized dogma that developed around it over succeeding centuries. True
Christianity ‘is a practical affair, and is concerned with the power to live a
blessed and holy life’; it is essentially an ethical doctrine, taught by someone
whom Harnack seems to regard as a great religious teacher but not as the
Word made flesh. As Harnack frames it, Christianity ‘teaches us to live our
lives aright’ and is therefore primarily a path of moral self-realization:
But if with a steady will we affirm the forces and the standards which on the
summits of our inner life shine out as our highest good, nay, as our real self; if
we are earnest and courageous enough to accept them as the great Reality and
direct our lives by them, and if then we look at the course of mankind’s
history, follow its upward development, and search, in strenuous and patient
service, for the communion of minds in it . . . we shall become certain of
God, of the God whom Jesus Christ called his Father, and who is also our
Father.24
The key elements here—the surety of an innate and reliable moral sense,
the vision of history as an ‘upward development’, the subtle resistance to
traditional doctrines of the Incarnation—unmistakably position liberal
Protestantism as a mode of religion steeped in Enlightenment rationalism.
In America, liberal Protestantism found its fullest expression in Uni-
tarianism, the denomination in which T. S. Eliot was raised. Charles
William Eliot, distant relation of the poet and president of Harvard
University, epitomized Unitarian liberalism when he proposed ‘a new
ideal of God’ encompassing ‘the Jewish Jehovah, the Christian Universal
father, the modern physicist’s omnipresent and exhaustless Energy, and
the biological conception of a Vital Force’.25 Such a theology not only
seemed to incorporate scientific and philosophical trends; it also ‘had the
considerable advantage of being able, tacitly, to appeal to the common
feeling that real progress was being made on all sides by human society’.26
Such liberal Protestantism was partly a reaction against the more
strident aspects of Calvinist theology, especially the seemingly fatalistic
and inhuman doctrines of total depravity and double predestination. But
it did not lack for critics, most of whom regarded its confidence in human
23
Harnack, What Is Christianity?, 14, 138.
24
Harnack, What Is Christianity?, 157, 322.
25
Barry Spurr, ‘Anglo-Catholic in Religion’: T. S. Eliot and Christianity (Cambridge:
Lutterworth Press, 2010), 5.
26
S. W. Sykes, ‘Theology’, in C. B. Cox and A. E. Dyson (eds), The Twentieth-Century
Mind: History, Ideas, and Literature in Britain, vol. ii: 1918–1945 (London: Oxford
progress and perfectibility as delusory, and its immanentist sense of God
as an attempted domestication of the divine. Both Baudelaire’s and
T. E. Hulme’s assertions of Original Sin militated against not only
Romanticism but also the liberal mindset. The most effective critics of
liberal Protestantism, however, were Søren Kierkegaard, who anticipated
it but whose works were translated into German only in the 1910s and
English only in the 1930s, and Karl Barth, who shook the foundations of
the liberal edifice with the 1922 edition of his The Epistle to the Romans, a
prophetic rebuke disguised as biblical exegesis. As we shall see, Barth
exerted considerable influence over Eliot’s thought just before and during
the Second World War.
Perhaps no literary figure better personifies the predicament of liberal
Protestantism than Matthew Arnold. As Charles Altieri has observed,
Arnold was arguably ‘the age’s greatest humanist’,27 but his most quoted
poems, among them ‘Dover Beach’ and ‘Stanzas from the Grand Char-
treuse’, are saturated with nostalgia for a sense of the sacred. Nonetheless,
in Literature and Dogma, Arnold bleaches Christianity of its mystery
to reconcile it with empiricism. His famous (or infamous) formulation
of religion as ‘morality touched with emotion’, a sensibility and a practice
grounded in ‘the sweet reasonableness of Jesus’, made him a prime target
for a range of opponents, eventually including Eliot. While those attacks
were often reductive, some of Arnold’s more glaring accommodations to
purely secular thought, such as his utilitarian defence of Christianity as
contributing mightily to ‘the sum of universal happiness’, exemplify the
fragilization of belief explained by Charles Taylor.28 It is not surprising
that Arnold would argue that poetry must become the refuge of the
sacred—nor that many late-nineteenth- and early-twentieth-century
believers would seek to recover a sense of the sacred in those regions of
spirituality most resistant to secularist influence.
THE MYSTICAL REVIVAL
In his 1911 essay ‘Whither the New Art?’, Wassily Kandinsky declared
that ‘a general interest in abstraction is being reborn both in the superficial
form of the movement towards the spiritual and in the forms of occultism,
27
Charles Altieri, ‘Objective Image and Act of Mind in Modern Poetry’, PMLA, 91/1
( January 1976), 102.
28
Matthew Arnold, Dissent and Dogma, vol. vi of The Complete Prose Works of Matthew
Arnold, ed. R. H. Super (Ann Arbor: University of Michigan Press, 1968), 176, 396, 398;
emphasis in original.
spiritualism, monism, the “new” Christianity, Theosophy and religion in
its broadest sense’.29 That essay came at the end of a decade in which
mysticism, variously conceived, had featured in a series of influential
publications. In 1901, the Jesuit Augustin Poulain had published Des
Graces d’oraison Traité de théologie mystique, a treatise on contemplative
prayer and mysticism that would go through nine editions in five lan-
guages by the start of the Great War. The following year came William
James’s The Varieties of Religious Experience. In 1908, after years of
painstaking work, Friedrich von Hügel published The Mystical Element
in Religion. Evelyn Underhill, for whom von Hügel served as a spiritual
director, produced her seminal Mysticism in the same year as Kandinsky’s
essay. The internationalism of these texts, and their enormous popularity,
speak to the breadth and depth of interest in mysticism at the time.
The ‘revival of mysticism’, as Holbrook Jackson termed it in 1913,
more commonly known as the mystical revival, described ‘a range of
spiritual alternatives to religious orthodoxy that sprang up in the 1880s
and 1890s and gained momentum and prominence as the old century
gave way to the new’. The trend had emerged over the entire course of the
previous century. Wayne Proudfoot contends that it began in the wake of
Schleiermacher’s 1799 On Religion: Speeches to its Culture Despisers as a
‘protective strategy’ designed to ‘seal off a guarded domain for religious
experience amid modernity’.30 While that position disregards, for
instance, the strain of mysticism running through English culture from
such early figures as Julian of Norwich through many Elizabethan and
Jacobean poets and divines, the Cambridge Platonists, William Law, and
various Protestant sects, it does go some way towards explaining mysti-
cism’s move from the margin towards the centre in the nineteenth
century. In seeking to preserve an inviolable space for experience of the
sacred, many adherents of mysticism, however they conceived it, sought
to fend off the perceived hegemony of a secularist world view. Embedded
in Bernard McGinn’s definition of mysticism as ‘the inner and hidden
realization of spirituality through a transforming consciousness of God’s
immediate presence’ is the sense of mysticism as both interior and
reserved.31
29
John Golding, Paths to the Absolute: Mondrian, Malevich, Pollock, Newman, Rothko
and Still (London: Thames & Hudson, 2002), 86–7.
30
Alex Owen, The Place of Enchantment: British Occultism and the Culture of the Modern
(Chicago: University of Chicago Press, 2004), 20; Eric Leigh Schmidt, ‘The Making of
Modern Mysticism’, Journal of the American Academy of Religion, 71/2 ( June 2003), 274.
31
Bernard McGinn, ‘Mystical Consciousness: A Modest Proposal’, Spiritus 8/1 (Spring
2008), 44.
Transcendentalism, that American amalgam of German Idealism, Indic
spirituality, and European mysticism, certainly played a pivotal role in
the revival. Eric Leigh Schmidt marks the date of 20 May 1838, when
Bronson Alcott first convened a meeting of the Transcendental Club to
discuss mysticism, as a watershed. By 1902, William James would refer to
an ‘everlasting and triumphant mystical tradition’.32
A crucial ingredient in both Transcendentalism and the mystical revival
as a whole was the pervasive influence on Western thought and literature
of translations from India that began to appear in the late eighteenth
century, perhaps most influentially Max Müller’s 1870s series, Sacred
Books of the East. In the early twentieth century, Sir John Woodroffe’s
Tantrik Texts series would exercise a similar, if lesser, fascination. One
need only consider Schopenhauer’s fondness for the Upanishads, or the
quotations and allusions to Indic texts in Emerson, Thoreau, and Whit-
man, or even Nietzsche’s sharp dismissals of Buddhism, to see the extent
to which Indic traditions had become part of the discourse of Western
religion and philosophy. To be sure, many such understandings were
orientalist distortions of traditions that pose serious problems of commen-
surability for Western thinkers. But the salient fact is that many nine-
teenth- and twentieth-century enthusiasts or adherents of both Western
and non-Western mysticism sought to make it an arena in which direct
encounter with the sacred would restore a sense of ontological and
teleological security.
Yet the inwardness of mysticism could not shield it from the criticisms of
sceptical psychologists. The mystical revival unfolded in what has also been
called ‘the golden age of hysteria’, and many researchers were inclined to
dismiss claims of mystical consciousness out of hand. In France, where the
Catholic Church in particular frowned upon popular expressions of mysti-
cism, such researchers as Jean-Martin Charcot, Albert Houtin, and Pierre
Janet categorized mystical experience as the pathological expression of a
dissociative consciousness.33 In his introductory lectures on psychoanalysis,
Freud refused to dignify mysticism with a definition, folding it in with such
occult phenomena as séances, which he regarded as having the ‘secret
motive’ of supporting religion against ‘the advance of scientific thought’.34
His break with Jung was driven partly by the latter’s interest in mysticism
and Hermetism.
32
Schmidt, ‘The Making of Modern Mysticism’, 282–7.
33
C. J. T. Talar (ed.), Modernists and Mystics (Washington: Catholic University Press,
2009), 10–11.
34
Sigmund Freud, New Introductory Lectures on Psycho-analysis (1933; repr. New York:
W. W. Norton, 1989), 42.
Yeats, Jones, and Eliot all took seriously the possibility of mystical
experience and practice, but to different degrees and in very different
ways. Though Eliot pursued a deep interest in mysticism throughout his
life, he regarded mystical consciousness as ‘a gift of grace’, asserting that
‘you will never become a mystic unless you have the gift’. He therefore
remained dismissive of what he called ‘the warm fog which passes for
mysticism nowadays’, in which people of ‘vague thinking and mild feeling’
seek out ‘a swooning ecstasy of pantheistic confusion’.35 For much of his
life, Yeats folded his mystical inclinations in with his occult pursuits, but
in his final decade he mostly abandoned his earlier fascination with magic
and spiritualism in favour of the study and translation of largely mystical
Indic texts and traditions. Jones, the most exoterically inclined of the
three, saw mystical consciousness as reserved for very few extraordinary
souls—though some critics regard him as having suffered from the strain
of attempting and failing to achieve his own mystical vision.
THEOSOPHY
The mystical revival, universalist aspirations, fascination with Indic tradi-

tions, and occult enthusiasms converged in Theosophy, a term probably
coined early in the nineteenth century by the erstwhile occultist–
universalist Fabre d’Olivet, but famously appropriated by Helena Pavlova
Blavatsky, co-founder and head of the Theosophical Society from 1875
until her death in 1891.36 Despite some excellent studies, the remarkable
influence of the Theosophical Society on early-twentieth-century art has
only recently begun to be widely appreciated. Associated with it, as mem-
bers of either the Society or one of its offshoots, or as occasional lecturers
or visitors, are Yeats, Pound, Hulme, Kandinsky, Mondrian, Malevich, and
Scriabin, among others.
Blavatsky, the product of a Russian family that claimed aristocratic
ancestry, so embroidered her life story that it is difficult to ascertain much
before her arrival in the West in the 1870s. After immersing herself in the
spiritualism that had taken hold in the United States after the Civil War,
she founded the Theosophical Society with Henry Steel Olcott in New
York in 1875. Though Blavatsky was clearly a charlatan, she had a
35
T. S. Eliot, ‘Thinking in Verse: A Survey of Early Seventeenth-Century Poetry’,
Listener, 3/61 (12 March 1930), 443; T. S. Eliot, ‘The Mystic and Politician as Poet:
Vaughan, Traherne, Marvell, Milton’, Listener, 3/64 (2 April 1930), 590; T. S. Eliot, ‘The
Silurist’, Dial, 83/3 (September 1927), 263.
36
Leon Surette, The Birth of Modernism: Ezra Pound, T. S. Eliot, W. B. Yeats and the
Occult (Montreal: McGill-Queen’s University Press, 1993), 21.
remarkable power of synthesis, and her major contribution was the
construction of a mystical–universalist system that did much to infuse a
reverence for Indic traditions into Western popular culture. Her major
books, Isis Unveiled (1877), The Secret Doctrine (1888), and The Key to
Theosophy (1889), became source material for countless aspiring occultists
and mystics. Isis Unveiled, ‘an unruly amalgam of Western occultism,
Buddhist and Hindu teachings, and more than a dash of anti-Christian
polemic’, served as a reference point for a range of artists and writers. As
John Golding describes them, ‘her books offer a short cut to a vast
panorama of occult thought and religion. Indeed, to artists who saw
themselves as being in a period of acute transition the tenets of Theosophy
must have seemed marvelously suggestive and adaptable.’37
The Theosophical Society is a study in textual fecundity. It not only
drew a large membership but also generated a considerable number of
publications, under both Blavatsky and such successors and associates
as Annie Besant, C. W. Leadbeater, Rudolf Steiner, A. R. Orage, and
G. R. S. Mead. Many internal discussions and debates played out in the
pages of its main journals, the Theosophist, Lucifer, and the Path, and in
such offshoot periodicals as Orage’s New Age and Mead’s the Quest. The
latter two were surprisingly ecumenical, often publishing avant-garde
literary work. In particular, the Quest, the journal of the Quest Society,
which was formed after Mead’s break with Besant and Leadbeater’s
Theosophical Society, promoted the philosophies of Nietzsche and Berg-
son.38 Mead knew Yeats, who introduced him to Pound in London
around 1911. Pound’s essay ‘Psychology and the Troubadours’ originated
as a Quest Society lecture, and was first published in the same issue of the
Quest as Yeats’s poem ‘The Mountain Tomb’.39 Pound also published
regularly in Orage’s New Age from 1912 through to 1920. In a particularly
striking convocation, Orage, Underhill, Pound, Yeats, Hulme, and Jessie
Weston regularly attended Quest Society gatherings at Kensington Town
Hall.40
Theosophy thus rested at the nexus of occultism, mysticism, and the
avant-garde. The central principles of its syncretic philosophy would
exercise a lasting influence over Yeats as well as Mondrian, Malevich,
and Kandinsky. Mondrian told a friend that he got ‘everything’ from
Theosophy.41 Kandinsky’s On the Spiritual in Art, one of the most
37
Owen, The Place of Enchantment, 29; Golding, Paths to the Absolute, 15.
38
Owen, The Place of Enchantment, 49.
39
James Longenbach, Stone Cottage: Pound, Yeats & Modernism (1988; repr. New York:
Oxford University Press, 1990), 21–2.
40 41
Surette, The Birth of Modernism, 34. Golding, Paths to the Absolute, 15.
influential artist statements of the century, is so thoroughly marinated in
Theosophical ideas that, as Hilton Kramer has noted, many of its passages
‘are barely intelligible without recourse to the ideas of Madame Blavatsky
and Rudolf Steiner’.42 Such was the potency of the Theosophical Society’s
programme that, decades after his 1890 departure from the group, Yeats
would project its principles erroneously onto the Indic texts he studied in
his final years.
Part of Theosophy’s appeal lay in its enshrinement of an inviolable
subjectivity: a transpersonal, transcendent Self of the kind set forth in the
Upanishads and other Indic scriptures. One of the fundamental tenets
of Theosophical doctrine is that the goal of human evolution is the full
realization of this divine subjectivity. Despite some uncertainty in Theo-
sophical circles over the precise ontological status of the Self—a confusion
I will discuss in the chapter on Yeats—it is by nature insusceptible to
empirical investigation and therefore reserves its sacredness, in the Elia-
dean sense of fullness of Being. The appeal of this doctrine speaks to a
nineteenth-century anxiety about the integrity of the individual self that
dates as far back as Schopenhauer and was deepened by the proliferation of
different, often mutually antagonistic visions of the human subject.
THE NATURE OF THE SUBJECT
It speaks to the aptness of Taylor’s ‘secularity 3’, with its mutually

destabilizing variety of moral and spiritual sources, that any meaningful
discussion of a stable human subject feels almost anachronistic; it suggests
what many would consider a discredited essentialism. As Robert Lang-
baum remarked in his 1987 essay ‘Can We Still Talk about the Romantic
Self?’, ‘the latest theoretical criticism has all but wiped out the self as a
legitimate subject for literary discourse’.43 Yet it is impossible to trace the
contours and assess the implications of a poet’s religious belief without
discussing how that belief situates the human subject. Yeats, Jones, and
Eliot operated from religiously determined visions of the ontological status
of the human self, all of which militated against a purely Cartesian
perspective.
Taylor, who has painstakingly traced a number of currents that con-
verged to form what we somewhat reductively call the Cartesian subject,
42
Hilton Kramer, The Triumph of Modernism: The Art World, 1987–2005 (Chicago:
Ivan R. Dee, 2006), 8.
43
Robert Langbaum, The Word from Below (Madison, WI: University of Wisconsin
Press, 1987), 20.
nonetheless names Descartes as the prime exemplar of a pivotal shift in
Western culture, one in which ‘both science and virtue require that we
disenchant the world, that we make the rigorous distinction between
mind and body, and relegate all thought and meaning to the realm of
the intra-mental’.44 This is the shift from a ‘porous self ’, susceptible to the
influence of purposive supernatural agencies and correspondences, to a
‘buffered self ’,45 the disenchanted self of the Enlightenment:
This is the ideal of the disengaged self, capable of objectifying not only the
surrounding world but also his own emotions and inclinations, fears, and
compulsions, and achieving thereby a kind of distance and self-possession
which allows him to act ‘rationally’ . . . Reason is no longer defined in terms of
a vision of order in the cosmos, but rather is defined procedurally, in terms of
instrumental efficacy, or maximization of value sought, or self-consistency.46
The buffered self enjoys a ‘sense of power, of capacity, in being able to order
our world’, and is tied to ‘images of power, of untrammelled agency, of
spiritual self-possession’.47 But what Jean-Pierre Dupuy starkly describes as
‘the Cartesian ambition to make man like God, the master and possessor of
nature’ leads to losses as well as gains.48 As Taylor observes, that very self-
possession ‘can also be lived as a limit, even a prison, making us blind or
insensitive to whatever lies beyond this ordered human world and its
instrumental–rational projects. The sense can easily arise that we are missing
something.’49 For Louis Dupré, the Cartesian turn led to a ‘disconcerting
emptiness of the foundational self ’, whose ‘poverty contrasts with Augustine’s
conception of the soul, which to him was the richest of all concepts’.50
Hence the elaboration of the Romantic expressivist self. As Jonathan
Culler has suggested, the very self-sufficiency of the buffered self made
possible its Romantic counter-self:
Lyric was finally made one of the three fundamental genres during the
romantic period, when a more vigorous conception of the individual subject
made it possible to conceive of lyric as mimetic: mimetic of the experience of
the subject . . . The lyric poet absorbs into himself the external world and
stamps it with inner consciousness, and the unity of the poem is provided by
this subjectivity.51
44 45
Taylor, A Secular Age, 131. Taylor, A Secular Age, 27.
46
Charles Taylor, Sources of the Self (Cambridge, MA: Harvard University Press,
1989), 21.
47 48
Taylor, A Secular Age, 300, 563. Dupuy, The Mark of the Sacred, 55.
49 50
Taylor, A Secular Age, 302. Dupré, Passage to Modernity, 118.
51
Jonathan Culler, ‘Lyric, History, and Genre’, in Virginia Jackson and Yopie Prins
(eds), The Lyric Theory Reader: A Critical Anthology (Baltimore: Johns Hopkins University
Press, 2014), 66.
Culler is describing what Taylor refers to as ‘radical individuation’, in
which authenticity of feeling and expression are paramount, and the inner
impulse of nature serves as ‘the substitute for grace’.52 But such a move
recalls Theodor Adorno’s cautionary note about lyric aspiration in general:
‘The lyric work hopes to attain universality through unrestrained indi-
viduation. The danger peculiar to the lyric, however, lies in the fact that its
principle of individuation never guarantees that something binding and
authentic will be produced.’53 As Baudelaire, Hulme, Eliot, and a host of
other modernist and postmodernist poets would insist, the expressivist
subject’s professed ability to give form and voice to the impulse of nature, be
it from a vernal wood or an inner vision, is liable to slide into sentimentality,
self-delusion, or even the sort of atomism that so much Romanticism
aspired to overcome.
The burgeoning discipline of psychology presented formidable chal-
lenges to both Enlightenment and Romantic notions of individual sub-
jectivity. As Alex Owen observes: ‘The researches of the 1880s and 1890s
had the effect of postulating a new and unstable subjectivity that bore
only a passing resemblance to the dominant Enlightenment concept of the
unified rational subject.’ This ‘fissile subject’, as Jean-Michel Rabaté terms
it, strives to maintain an illusory internal coherence when in fact it is
constantly formed and reformed by internal and external forces over which
the rational intellect has little, if any, control.54 The Freudian model in
particular transferred the locus of power and mystery from the sacred to
the subconscious.
But no thinker was more pitiless in his analysis of the buffered and the
Romantic selves than Nietzsche. In announcing the death of God, he
diagnosed the desacralizing effects of the buffered self. Hillis Miller
presents a neat summation of the Nietzschean critique: ‘Man has killed
God by separating his subjectivity from everything but itself. The ego has
put everything in doubt, and has defined all outside itself as the object
of its thinking power . . . When God and the creation become objects of
consciousness, man becomes a nihilist.’ In his most cogent passage on the
death of God, Nietzsche has his madman ask: ‘How shall we comfort
ourselves, the murderers of all murderers?’55 Though he declared himself
52
Taylor, A Secular Age, 376, 411.
53
Theodor Adorno, ‘On Lyric Poetry and Society’, in Jackson and Prins (eds), The Lyric
Theory Reader, 339.
54
Owen, The Place of Enchantment, 119; Jean-Michel Rabaté, 1913: The Cradle of
Modernism (Oxford: Blackwell, 2007), 141.
55
J. Hillis Miller, Poets of Reality (Cambridge, MA: Belknap/Harvard, 1966), 3;
Friedrich Nietzsche, The Gay Science, trans. Walter Kaufmann, Vintage Books edn (New
York: Random House, 1974), 181.
a disciple of Dionysus, Nietzsche’s great merit as a thinker lies precisely in
this fearless confrontation with the loss of the sacred, a development he
saw as both fraught with catastrophe and explosive with promise.
For Nietzsche, only the strongest can resacralize the cosmos, by effect-
ively divinizing themselves as their own supreme sources of value and
embracing the flux of Becoming as the variegated expression of the Will
to Power. Though this postulates, as Schwartz terms it, an ‘inversion of
Platonism’ and thus a rejection of Being in favour of Becoming, there is
arguably more than a dash of religion in it nonetheless, in that the Nie-
tzschean transvaluation of values can be seen as an attempt to wrench the
sacred into the realm of Becoming. As Erich Heller observes, Nietzsche is
‘one of the most radically religious natures that the nineteenth century
brought forth, but is endowed with an intellect which guards, with the
aggressive jealousy of a watchdog, all the approaches to the temple’.56
While Nietzsche inverted Platonism, the Symbolists reaffirmed it—yet
they did so in a way that reveals how religion itself can serve to decentre
the individual subject. In search of a language that ‘would make stronger
claims to transcendence’ than the discourses of Romanticism,57 the
French Symbolists, most notably Rimbaud and Mallarmé, attempted to
break away language not only from its pragmatic moorings but also from
any notion of an individual subject exercising poetic agency. Rimbaud’s
famous declaration that ‘“I” is another’ is paralleled by Mallarmé’s ‘I am
now impersonal and no longer the Stéphane you knew—but a capacity
possessed by the spiritual Universe to see itself and develop itself, through
what was once me’.58 Even late in his career, in his Oxford lecture ‘Crise de
Vers’, Mallarmé would aver that ‘the pure work of art implies the elocu-
tionary disappearance of the poet who yields the initiative to words’.59 This
move can be seen as an attempt to achieve what Peter Nicholls calls the
Romantic ‘dream of a perfectly transparent self ’.60 It is also an attempt to
relocate the sacred in the precincts of language.
The result, to borrow the terms of Jean-Luc Marion, is the poem as idol
rather than icon: instead of returning the reader’s gaze and directing it
beyond the text, the poem arrests the gaze, creating what Adorno rather
56
Schwartz, The Matrix of Modernism, 12; Erich Heller, The Artist’s Journey into the
Interior, 1st Vintage Books edn (1959; repr. New York: Vintage Books, 1968), 189.
57
Peter Nicholls, Modernisms: A Literary Guide (2nd edn, New York: Palgrave Mac-
millan, 2009), 25.
58
Arthur Rimbaud, Letter to Georges Izambard, in Rimbaud: Complete Works and
Selected Letters, trans. Wallace Fowlie (Chicago: University of Chicago Press, 1966),
303–4; Rosemary Lloyd, Mallarmé: The Poet and his Circle (Ithaca, NY: Cornell University
Press, 1999), 73.
59 60
Lloyd, Mallarmé, 232. Nicholls, Modernisms, 48.
irritably called a ‘poetic event’ whose ‘false glitter is the complement to the
disenchanted world from which it extricates itself ’.61 But what fascinates
here is the profound asceticism at the heart of Mallarmé’s aesthetic—and
even undergirding the extravagances of Rimbaud. Both advocate the
discipline of self-negation; Rimbaud seems at times ‘determined to destroy
the very axis of the self ’.62
The impulse here—as borne out by Rimbaud’s renunciation of poetry
and turn to Catholicism—is fundamentally religious. Nathan Scott has
rightly suggested that ‘the particular horizon where Rimbaud collapsed
was the point at which his own desperate need . . . for metaphysical and
religious order collided with the spiritual void of the nineteenth cen-
tury’.63 And asceticism, especially in religious forms inclined towards the
mystical but also in the aesthetic programme adopted by Mallarmé, can
have as its goal ‘an intensification of subjectivity’ that transcends the
restrictions of individuated consciousness.64 Where God, or Language,
or Mallarmé’s Void is the absolute subject, the individual self is necessarily
an object—to some extent an obstacle blocking access to Being—and
must be in some fashion overcome. The twentieth-century contemplative
Thomas Merton describes this dynamic:
The self-centered awareness of the ego is of course a pragmatic psychological
reality, but once there has been an inner illumination of pure reality, an
awareness of the Divine, the empirical self is seen by comparison to be
‘nothing,’ that is to say contingent, evanescent, relatively unreal, real only in
relation to its source and end in God, considered not as object but as free
ontological source of one’s own existence and subjectivity.65
The Anglican theologian (later Archbishop of Canterbury) William Temple
frames the same point in less mystical terms, decrying the limitations of
‘purely moral progress, which consists in lengthening the radius of the circle
drawn round the self as centre’—such that ‘[God] is, for me, my God, not
God whose I am’.66 This decentring of the ‘empirical self ’ appears most
markedly in the work of Eliot, where it effectively spiritualizes his poetics of
impersonality, but it surfaces also in the writings of Jones, and even in the
more ecstatic late poems of Yeats.
61
Adorno, ‘On Lyric Poetry’, 344; Jean-Luc Marion, God without Being: Hors-Texte,
trans. Thomas A. Carlson (Chicago: University of Chicago Press, 1991), 7–22.
62
Nicholls, Modernisms, 29.
63
Nathan A. Scott, Jr, The Broken Center: Studies in the Theological Horizon of Modern
Literature (New Haven: Yale University Press, 1966), 14.
64
Gavin Flood, The Truth Within: A History of Inwardness in Christianity, Buddhism,
and Hinduism (Oxford: Oxford University Press, 2013), 205.
65
Thomas Merton, Zen and the Birds of Appetite (New York: New Directions, 1968), 26.
66
William Temple, Nature, Man and God (1934; repr. New York: Macmillan, 1949),
395, 394.
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For the purpose of histological examination it is essential that
portions of the brain, spinal cord, liver, kidney, and intestine, should
be examined microscopically. The nervous tissue should be placed
in formalin and Müller’s fluid, and a portion in alcohol for the
examination of the fibres. The liver, kidney, etc., should be placed in
5 per cent. formaldehyde. The tissues are then treated by the
ordinary histological methods, and sections prepared. With nervous
tissue it is essential that those prepared for the examination of the
cells should be made by the celloidin method; the others may be
treated by imbedding in paraffin. The points to be sought for in the
tissues are sufficiently indicated in the chapter on Pathology and
Symptomatology, but may be briefly recapitulated:
In the brain, as well as in all the tissues, careful search should be
made for minute microscopical hæmorrhages, and for evidences of
old hæmorrhages in the form of small masses of fibrous tissue, etc.
Parenchymatous degeneration, chromatolysis of nuclei, etc., nerve
degeneration.
The arteries and veins should also receive close scrutiny, as the
presence or absence of arteritis should be noted.
In the kidney particularly, search should be made for both
interstitial and parenchymatous nephritis.
The liver frequently shows signs of microscopic hæmorrhage, and
it is as well, in taking a portion of tissue for examination, to choose
those portions which appear to be specially congested.
In the brain and spinal cord and nervous tissue, search is to be
made for the same hæmorrhages as already noted. In addition, the
condition of the nerve fibres should be noted, the presence or
absence of periaxial neuritis, as well as degeneration of the axis
cells, and the various ganglion cells both in the brain and spinal cord
should be closely examined for chromatolysis and nuclear atrophy.
No evidence is afforded by micro-chemical tests of any of the
sections thus obtained, except those of the lung. It may be possible
in the case of the lung to determine the presence of lead granules in
the alveolar cells, and attention should be paid to this. It is possible
also that some evidence may be afforded by examination
microscopically of the red bone-marrow.
The intestinal walls should be examined for evidence of lead
particles.
If any dark staining, deep or superficial, be found in the intestine, it
should be removed for chemical analysis. Necrotic areas of the
intestinal wall should be sought for.
Hæmatology.—For all practical purposes, the best stain for
detection of basophile granules in the erythrocytes is Wright’s
modification of Romanowski’s stain. This stain may be obtained in
appropriate tablets, and may be prepared immediately before use,
although a stain which has been standing for ten days or a fortnight
gives much better results than a quite new stain. The stain consists
of a solution of polychrome methylene blue, together with eosin in
methyl alcohol, and the method of procedure is as follows:
Blood is obtained by a small puncture, and slides smeared and
allowed to dry. Immediately on drying the slip is flooded with the
stain, and allowed to remain for two minutes. This causes fixation. At
the end of the two minutes the stain is diluted with an equal volume
of distilled water, and allowed to remain on for a further three
minutes. At the end of this time the stain is poured off, and the slip
washed in distilled water for another three minutes, or until the
characteristic purple-violet appearance is produced. It is better to
examine such films with an oil-immersion lens, the oil being placed
directly upon the films, and not covered with a cover-slip, as the
action of Canada balsam tends to decolorize the blue. If such
specimens are required to be kept, the oil may be washed off with
xylol. It is possible to observe basophile staining with a good sixth,
but an oil-immersion lens gives much the best result. The typical
staining produced by this means gives darkish bodies scattered
about the red corpuscles, staining sometimes deeply as the nuclei of
the white corpuscles. In other cases the appearance is like that of
fine dust scattered throughout the cell. In addition to these two
forms, the whole red cell may take on a slight generalized lilac tint,
the normal cells remaining free from granules, and stained red by the
eosin. Search of 100 fields of the microscope should be made, and if
no basophile granules are found in such fields it is unlikely that they
will be found.
Basophile staining is not more pathognomonic of lead poisoning
than of any other form of anæmia, but may be regarded as a highly
important confirmatory diagnostic sign.
A differential count of the leucocytes present may be also made on
the same film in which basophile staining is observed; 300 should be
counted at least. In a typical case of lead poisoning it is found that
diminution in the polymorphonuclear leucocytes has taken place with
a corresponding increase of the lymphocytes, and possibly also the
large mononuclears, and probably a slight increase in the number of
eosinophiles.
This hæmatological method of diagnosis is of the utmost
importance in lead poisoning. A differential count such as is given on
p. 137, showing a large diminution in the polymorphonuclears, an
increase in the lymphocytes, evidence of changes in the red cells,
consisting of basophile staining, alteration in the shape of individual
cells, poikilocytosis, with vacuolation, is strong presumptive evidence
of lead absorption.
To complete the hæmatological examination, the hæmoglobin
should be estimated. This is best performed with Haldane’s
instrument—an exceedingly simple one to use. The estimation of the
number of red cells and white cells present is useful, but does not by
any means give such valuable information as does the differential
count and search for basophile granules.
Blood-Pressure.—Several methods are available for the
estimation of the blood-pressure. The pressure may be roughly
estimated as too high or too low by means of the finger. The
presence of thickening of the arteries may be also estimated in this
way, but for determining the absolute blood-pressure it is necessary
to use one or other of the instruments on the market. The estimation
of blood-pressure is an important point in relation to the suspected
presence of arterio-sclerosis, and should be performed wherever
possible. Sphygmographic tracings may also be taken. Such a
tracing in a case of typical poisoning gives a peculiar form of curve,
which, however, may be present in alcoholism and heavy work, and
arterio-sclerosis of many types.
Urine Examination.—In suspected cases of lead poisoning the
examination of the urine may reveal the presence of lead. In
addition, albumin is frequently present, especially in the early stages
of kidney inflammation. The ordinary tests for albumin should be
carried out, and it is also advisable to examine the urine
spectroscopically, as at times hæmoglobin, methæmoglobin,
hæmatoporphyrin, may be present in small quantities, each of which
can be detected by means of spectroscopic examination. Blood is
not common in the urine of lead-poisoned persons, although
microscopically hæmorrhages undoubtedly take place in the kidney.
These hæmorrhages are interstitial, and as a rule do not cause any
blood-pigment to be passed in a quantity that can be determined. It
is as well, however, to centrifugalize the urine, and examine the
deposit for red blood-cells.
The presence of hæmatoporphyrin, as suggested by Steinberg[10],
is probably due to hæmorrhages in the intestine, and its presence in
the urine should be regarded with suspicion in a lead-worker.
Where a lead-worker is suffering from continued absorption of
lead, even without the manifestation of other symptoms, a change
has been noted in the acidity of the blood—namely, a loss of normal
alkalinity. The estimation of the alkalinity or acidity of the blood direct
is an exceedingly difficult process, but much information may be
obtained by careful estimation of the acidity of the urine, and of the
acidity of the urine in relation particularly to the phosphates.
Joulie[11] has pointed out the extreme value which may be
obtained from a knowledge of the urinary constituents by the means
of estimation of the acidity with suchrate of chalk. The reagent is
made by slaking lime in such a way that the resulting compound is
practically dry. A quantity of this—about 25 grammes—is then
thoroughly shaken up with 10 per cent. solution of cane-sugar,
allowed to stand, and the solution titrated against decinormal acid
until it is of one-twentieth normal. The urine is then estimated
directly, the suchrate is run into the 25 c.c. of urine until a faint white
flocculent precipitate appears. The number of c.c. of the solution of
suchrate is then noted, and multiplied by the factor of the solution.
This gives the acidity related to the phosphate and other organic acid
contents, and is similar to the method used to determine the acidity
of wines.
The second estimation consists of estimating the phosphates
present by means of a standard solution of uranium nitrate, using
either potassium ferrocyanide or cochineal as an indicator. The
specific gravity of the urine is also determined. The result is then
expressed in terms of this specific gravity, or, rather, in the terms of
the density of the urine in relation to distilled water, and the whole
answer returned per litre. By this method it is not necessary to obtain
a twenty-four hours sample of the urine, the urine passed first thing
in the morning being taken for examination.
By using this density figure the quantity of acid and phosphate is
expressed in relation to the density, the equation being—
The observed acidity
= Acidity per litre.
The density per litre
The phosphate content is expressed in the same manner, while
the ratio of phosphate to acidity gives the ratio of excretion of
phosphate to acidity.
There is in lead-workers a considerable diminution in the amount
of phosphate excreted, and, as has been pointed out by Garrod and
others, lead apparently produces alteration in the solubility of the uric
acid content of the blood, and may therefore allow of its
decomposition. Probably lead as a urate is stored up in the tissues.
For further particulars of this method of the estimation of the urine,
the reader is referred to “Urologie Pratique et Thérapeutique
Nouvelle,” by H. Joulie.
An examination of the fæces of persons suspected of lead
poisoning may often give definite results both of the presence of lead
and hæmatoporphyrin. If small hæmorrhages have occurred high up
in the intestine, the presence of hæmatoporphyrin in the fæces may
result. The substance may be easily determined by means of the
characteristic absorption bands. A quantity of fæces is taken and
extracted with acid alcohol, and the filtrate examined
spectroscopically. Urobilin bands are commonly present, and,
particularly, where much constipation exists these bands are very
well marked. There is no difficulty whatever, however, in
distinguishing them from the characteristic bands of acid
hæmatoporphyrin.
Examination of the Fæces for Lead.—The moist method or
chemical examination
given above is the best one to apply for the determination of lead in
the fæces. As has already been pointed out, lead is commonly
excreted in the fæces, and, if only about 2 milligrammes per diem
are being excreted by the fæces in a lead-worker, the quantity
cannot be regarded as indicative of poisoning. One of us (K. W. G.)
has at times found as much as 8 to 10 milligrammes of lead excreted
in the fæces of persons engaged in a lead factory, and exhibiting no
signs or symptoms whatever of lead poisoning. If, however, the
quantity of lead in the fæces rises to anything above 6 milligrammes
per diem, there is definite evidence of an increased absorption of
lead, and if at the same time clinical symptoms be present,
suggesting lead poisoning, such a chemical determination is of the
first importance.
In estimating the presence of lead in fæces, it may be necessary
to deal with the separation of iron, which may be precipitated as
phosphate and filtered off, the quantitative estimation being
proceeded with in the filtrate.
Lead is much more commonly present in the fæces of lead-
workers than in the urine, and it is better to examine the fæces rather
than the urine in suspected cases.
REFERENCES.
[1] Gautier: Meillère’s Le Saturnisme, p. 74.
[2] Marsden and Abram: The Lancet, vol. i., p. 164, 1897.
[3] Shufflebotham and Mellor: Ibid., vol. ii., p. 746, 1903.
[4] Hebert: Comptes Rendus, tome cxxxvi., p. 1205, 1903.
[5] Fresenius and von Babo: Liebig’s Annalen, vol. xlix., p. 287, 1884.
[6] Glaister: Medical Jurisprudence and Toxicology. 1910.
[7] Dixon Mann: Forensic Medicine and Toxicology, p. 496.
[8] Vernon Harcourt, A.: A Method for the Approximate Estimation of
Small Quantities of Lead—Transactions of the Chemical Society, vol. cxvii.,
1910.
[9] King Alcock, S.: Brit. Med. Journ., vol. i., p. 1371, June 24, 1905.
[10] Steinberg: International Congress Industrial Hygiene. Brussels, 1910.
[11] Joulie, H.: Urologie Pratique et Thérapeutique Nouvelle.
CHAPTER XI
TREATMENT
In laying down the general lines of treatment for both lead
poisoning and lead absorption, it is essential in the first place to
distinguish carefully between the two states; for although lead
absorption may gradually drift into definite lead intoxication and lead
poisoning, with all the classical symptoms associated with the
saturnine cachexia, a large number of cases, particularly those in
industrial processes, do not and should not progress beyond the
early symptoms of lead absorption. The treatment, therefore, will
depend in the first place on whether the case be one so constantly
met with in industrial processes, where generalized symptoms of
lead absorption are manifest without any definite and disabling
symptoms traceable and sufficiently pronounced to enable a
diagnosis of lead poisoning to be made.
The facts given in the chapter on Pathology, on the methods of
entrance of lead, on the toxic manifestations, and the blood-
changes, and, above all, the facts relating to microscopical
hæmorrhages and other profound changes in the bloodvessels, point
clearly to the lines along which the general treatment for
amelioration, prevention, or cure of poisoning should be undertaken.
The treatment of the so-called “presaturnine state,” or what is
preferably termed the “state of lead absorption,” is one that the
appointed surgeon or certifying surgeon in lead factories or other
processes in which lead is manufactured or used, is constantly
called upon to treat. Lead poisoning is a definite entity as a disabling
disease, whereas lead absorption, although the prodromal stage of
such disease, cannot be defined as actual lead poisoning, as in
many instances persons may show signs of continued lead
absorption, but their powers of elimination can be maintained at such
a level that the ratio of absorption to elimination remains in
equilibrium.
With the preventive treatment of lead poisoning we have dealt in
another place (see p. 199). What is particularly required here is the
medicinal treatment, which may be helpful in preventing lead
absorption passing on to definite lead poisoning.
For many years it has been customary in the treatment of men
employed in lead works to give occasional purgatives, and it is,
moreover, a common and proper precaution to keep a stock of some
simple aperient medicine, preferably saline composed of sodium
sulphate and magnesium sulphate, at the works in charge of the
foreman, so that any man who so desires may obtain a dose of an
ordinary aperient mixture. We have seen from the pathological
evidence that the largest proportion of lead is excreted by the bowel,
and that, therefore, the sweeping away of the bowel contents—
particularly where constipation is set up—will naturally tend to
remove from the body a good deal of the lead which has been
already excreted into the intestine and which may presumably
become reabsorbed unless it be swept away. In a large electric
accumulator factory Epsom salts in the form of the granular
effervescing preparation is much appreciated. In winter 50 per cent.,
and in summer 90 per cent. of the men are said to take a daily dose.
In an important white-lead works chocolate tablets containing hypo-
(thio-)sulphite of sodium are supplied to the workers.
Another medicine made use of in lead works is the sulphuric acid
lemonade, this being acidulated with sulphuric acid and flavoured
with lemon. It is very questionable whether this substance has any
definite effect in the special direction in which it is supposed to work
—namely, that of forming an insoluble sulphate of lead in the
stomach and so preventing its absorption. The use of this drug was
suggested on the presumption that lead poisoning as a rule took its
origin from the dust swallowed and converted into a soluble form in
the stomach. As we have seen, there is very little evidence that this
entrance of lead is of much importance, although it does
occasionally take place. Furthermore, from the experiments of one of
us [K. W. G.[1]], it has been found that the sulphate of lead is at any
rate as soluble as other lead salts, such as white lead or litharge,
when acted upon by normal gastric juice.
With regard to the drinks supplied to workers in lead factories, it is
highly important that some form of fluid should be supplied which the
men may drink without harm, particularly in the more laborious forms
of employment, and, above all, in the factories where smelting,
desilverizing, etc., of lead is carried on. In these factories the use of
some type of lemonade containing sodium citrate is to be
recommended, as it has been shown that one of the pathological
effects of lead absorption is to produce an increased viscosity of the
blood, and the use of such drugs tends to some extent to diminish
this. A drink containing a few grains of sodium citrate to the ounce
and flavoured with lemon is freely drunk by workmen engaged in the
laborious processes.
Finally, as a general routine treatment, it is advisable to keep at
the factory some form of mixture containing iron, which may be given
to those persons who are showing signs of slight anæmia, generally
associated with some degree of constipation, and it is therefore
better to use a form of iron cathartic. This medicine should also be
kept in the care of the foreman, who will see that it is administered to
the men properly. In this way any persons who at the weekly
examination exhibit signs of anæmia may be promptly treated, and
what is more, the surgeon is assured that the workmen in question
actually obtain the medicine prescribed regularly.
During the routine weekly or monthly examination, or at whatever
intervals the medical examination takes place, particular attention
should be paid to the records kept of the state of health of the
various persons, and whenever possible alteration of employment
should always be enjoined when early signs of anæmia make their
appearance.
The surgeon should spare no pains to determine if any of the
workmen are confirmed alcoholics, and such persons should be
removed from work in dangerous processes, while at the same time
care should also be taken to eliminate any persons suffering from
those diseases which are known to be predisposing causes of lead
poisoning. The card system of registration of any symptoms noted or
treatment given facilitates supervision of the health of the men.
In times of stress where some particularly dangerous process is in
operation, as, for instance, where portions of a building which has
become thoroughly impregnated with lead dust is being pulled down,
or where machines are being altered, removed, or rebuilt, especial
care should be exercised with the workmen so employed, and it is
advisable in such cases to adopt preventive measures on the
supposition—generally correct—that such persons are absorbing a
larger quantity of lead owing to their peculiarly dusty employment
than they were under normal circumstances. At such times, also, it
may be advisable to administer some form of mild iron cathartic to all
persons employed in the factory for, say, a week at a time. It must
not be supposed, however, that these methods of treatment in any
way supersede the precautions for the prevention of lead poisoning
by mechanical and hygienic means; they are merely additional
precautions which may be put in force under special circumstances.
The Treatment of Lead Poisoning.—The treatment of definite
lead poisoning, as the treatment of lead absorption, is directed
towards the elimination of the poison, the promotion of repair to the
damaged tissues, and special treatment directed towards those
special organs which suffer mostly in lead poisoning. At the same
time, special treatment of urgent symptoms may be called for; but in
the treatment of the urgent symptoms the fact of the general
elimination of the poison must not be lost sight of.
We have already seen that the channel through which the poison
leaves the body is mainly the fæces. Treatment must therefore be
directed, as in the former instance (lead absorption), towards
eliminating the poison by this means as much as possible, both by
the use of enemata, and later the use of sulphate of magnesia,
which may be added to the ordinary fluid enema; and it is far better
in obstinate cases of constipation and colic to give enemata than to
continue with the huge doses of salines or other aperients, such as
croton-oil, elaterinum, or castor-oil.
Colic.—Lead colic may be simple, acute, recurrent, or chronic
and continued. In whatever form colic appears pain is invariably
referred to the lower part of the abdomen, frequently into the groins,
and occasionally to the umbilicus. The pain has to be distinguished
particularly from acute gastritis, and occasionally from appendicitis,
and sometimes from that of typhoid fever. Acute colitis—not common
in this country—and dysentery, may, to some extent, simulate the
pain of lead colic, but John Hunter’s[2] original definition of “dry
bellyache” conveys very vividly the type of pain. Occasionally
diarrhœa may be met with, but as a rule obstinate constipation is
present. In continued colic, or chronic colic, sometimes lasting for
several months, obstinate constipation is the rule. In the simple
acute colic the pain passes off in the course of five or six days,
generally disappearing about four days after the lower intestine has
been thoroughly cleared.
The pain of lead colic is relieved by pressure upon the abdomen,
whereas that of gastritis and most other forms of abdominal pain
may be generally elicited along the descending colon and splenic
flexure; mucus is commonly found in the stools, especially the first
evacuation, after obstinate constipation occasionally of several days’
duration associated with an ordinary attack of lead colic. Blood may
be passed, but this symptom is not common. The pain in the acute
form is paroxysmal; it is rarely persistent, being typically intermittent.
During the paroxysm distinct slowing of the pulse-rate with an
increased blood-pressure takes place, and the administration of
vaso-dilators—such, for instance, as amyl nitrite—during a paroxysm
rapidly relieves the pain and lowers the blood-pressure, and in this
way distinguishes acute colic of lead poisoning from, say, subacute
appendicitis.
Vomiting may or may not be present, though the patient usually
complains of feeling sick, but there may be at times vomiting of a
frothy mucus.
It is unusual for a patient to die from acute colic, but acute
paroxysms have been recorded in which yielding of the blood-
vessels of the brain has occurred.
Recurrent colic is as a rule less severe than the simple acute form,
but may last for several weeks, clearing up for three or four days at a
time and then recurring with little diminution in violence from the first
attack. Such cases are probably due to the gradual excretion of lead
by the intestine, and should be treated on this supposition.
In the continued or chronic colic the pain may persist for as long
as two months, during the whole of which time the patient complains
of uneasiness and even constant pain in the lower part of the
abdomen, which becomes considerably worse after each
evacuation, and almost invariably is associated with exceedingly
obstinate constipation. It is this type of case that olive-oil or liquid
paraffin relieves, while in the acuter forms drastic purgatives such as
castor-oil, croton-oil, or pulv. jalapæ comp. may be administered.
For the treatment of pain in colic one of the various vaso-dilators
should be used, as, in addition to the spasm of the intestine, a very
considerable vaso-constriction of the whole of the vessels in the
mesenteric area occurs. Amyl nitrite gives immediate relief, but the
effect passes off somewhat rapidly, whilst scopolamine, although
taking somewhat longer to act, is better for continuous use, as its
action is longer maintained. Sodium nitrite, liquor trinitrini, and
antipyrin are also of use. Atropin may be used, but it is perhaps
better given in conjunction with magnesium sulphate.
Whatever form of purgative is given, some form of anodyne should
be combined. Drissole and Tanquerel[3] are said to have obtained
excellent results with croton-oil; one drop is given, followed seven or
eight hours later by another, and then by an enema of 2 pints of
normal saline. After two or three days the croton-oil may be again
given, one drop at a time each day. In addition, Tanquerel made use
of belladonna and opium together, finding that their combined action
was better than that of opium alone, as the physiological effect of
belladonna probably assists in preventing the intestinal cramp.
Hoffmann[4] recommends the use of olive-oil and opium, giving 3
to 4 ounces of olive-oil. He says that this relieves the spasm of the
pylorus, and is of particular use where severe vomiting is associated
with the colic. This use of olive-oil, first suggested by Hoffmann in
1760, and revived by Weill and Duplant[5] in 1902, is somewhat
interesting, in view of the modern tendency to administer paraffinum
liquidum in the treatment of chronic constipation.
Briquet[6] recommends 4 grammes of alum and 4 grammes of
dilute sulphuric acid three times daily, with the addition of 0·05
gramme of pulv. opii at night. Briquet says that although the
purgative method rapidly diminishes the colic, the elimination of the
poison does not take place as rapidly as by means of the treatment
he recommends, though it is open to doubt whether the use of either
of these two drugs is likely to produce any further neutralization or
excretion of absorbed lead than sulphate of magnesia. It is quite
certain that the magnesium sulphate does not act as a neutralizer of
the poison, as in a factory where sulphate of lead is manufactured
some cases of definite lead poisoning occurred, in which at least half
must have been due to the inhalation of lead sulphate dust. Under
these circumstances it seems hardly worth while to attempt to form a
sulphate of lead in the body. The action of magnesium sulphate and
other salines, however, in promoting the flow of fluid towards the
intestines, and rapidly diluting and washing out the contents, tend to
eliminate such lead as has already been excreted into the bowel.
A number of other drugs have been given from time to time for the
purpose of forming an insoluble compound with the metal in the
intestine, such, for instance, as sulphur in many forms, which is still
much used in French hospitals. Peyrow[7] advises sulphide of soda,
whilst Meillère prefers potassium sulphide as being less irritating. He
considers sulphuretted hydrogen a proper prophylactic against
reabsorption. Both experimental work and clinical observation show
that a change to sulphide does take place in the lower bowel, and
that staining of this part of the intestine is due to lead sulphide; but
as the figure on Plate II. shows, the lead may exist in the form of
granules of a dark nature, deeply embedded in the intestinal wall,
besides being situated in the exterior.
Stevens[8] suggests the use of ¹⁄₂-grain doses of calcium
permanganate thrice daily to relieve pain.
A certain number of other drugs may be also made use of from the
point of view of diminishing the pain, and one French observer
advocates the hypodermic injection of cocaine, but it is doubtful
whether any good would follow from such a procedure. Hypodermic
injections of morphia should be given whenever the pain is great,
and diaphoretics as well as diuretics should also be given, such, for
instance, as ammonium acetate, citrate of potash, or soda.
Chloroform water and chloral and bromine water may be also used,
and when no other drug is at hand, the inhalation of chloroform will
rapidly relieve the acute vaso-motor spasms associated with colic.
During the attack of colic, and for at least a day subsequent to its
disappearance, the patient should be kept on a fluid diet; milk is
best, and 10 grains of sodium citrate should be added to each glass
of milk. After the colic has subsided, a light farinaceous diet should
be given, and it is better not to give meat until at least a week has
elapsed. Alcohol is to be avoided.
The Anæmia of Lead Poisoning.—As has been pointed out in
Chapter VIII (p. 135), the anæmia of lead poisoning is one due to the
destruction of the red blood-cells. This is evidenced not only by the
curious sallow complexion, by the occasional presence of
hæmatoporphyrin in the fæces and urine, and often by the curious
yellow of the sclerotics, but also by an increase in the viscosity of the
blood itself. Moreover, the urine of persons suffering from lead
poisoning is invariably highly coloured, and may even show the
presence of methæmoglobin. As the anæmia is generally a symptom
of continued lead absorption for a long period, and does not
necessarily occur with every case of colic—in fact, acute colic may
often supervene without any symptoms of continued anæmia—the
persons suffering from lead anæmia should be removed from their
direct contact with the dangerous processes, and should be given, if
possible, work in the open air. Iron and arsenic may be used,
preferably in combination, whilst the iodide of iron often gives good
results. Whatever preparation of iron is given, care should always be
exercised in avoiding any constipating effect, and the free action of
the bowel should be maintained, together with a liberal supply of
milk. Potassium iodide may be also given.
With regard to the action of potassium iodide, there is division of
opinion amongst various physicians as to the efficacy of the drug in
the elimination of lead from the body. At the same time a very large
number of persons hold that the administration of fairly large doses
of potassium iodide in the case of a person suffering from chronic
lead absorption may at times be associated with sudden
exacerbation of the disease, and that the drug apparently may
determine the production of acute symptoms, such as
encephalopathy or paralysis, when these have not been previous
features of the case. Our experience supports this statement, and on
more than one occasion one of us (K. W. G.) has seen a distinct
increase of symptoms follow the administration of large doses of
potassium iodide. From a comparison with other cases it seems that
these symptoms would have been unlikely to make their appearance
without some secondary cause. Against this point of view must be
quoted further experiments already referred to by Zinn[9], who found
that when lead iodide was administered to experimental animals
iodine alone was found in the urine; but it must be pointed out that
no estimations were made of the fæces, and it is possible that a
certain amount of lead was eliminated in this way. What exactly is
the action of iodide on the solubility of lead in the body it is difficult to
say; yet the use of iodine compounds has been followed with
considerable success in a number of chronic inflammatory diseases,
and it is possible that it may have the action of splitting off the
particular lead compound from its organic association with the
tissues, especially as it is well known that iodine plays a very
important rôle in the process of cell metabolism. Another point which
tends to support the use of iodine is the fact that the other two
halogens, bromide and chloride, both of which enter largely into cell
metabolism, also have a slightly beneficial effect on the excretion of
lead. The dose of the iodine given should not be large to commence
with, 3 grains three times a day is sufficient, the dose being run up to
some 30 or 40 grains per diem, the symptoms meanwhile being
carefully watched.
Other symptoms often associated with the anæmia of lead
poisoning are—
Rheumatic Pains.—These pains are suggestive of muscular
affection, and are possibly due to minute hæmorrhages occurring in
the muscle tissue, which have been discovered in the muscles of
experimentally poisoned animals. For the rheumatic pains
diaphoretics and citrates of soda and potassium may be given.
Lumbago.—The lumbago constantly complained of in chronic
lead poisoning and even in the early stage of lead absorption, is very
generally related to chronic constipation rather than to a definite
affection of the lumbo-sacral joints.
Nephritis.—Affections of the kidney associated with lead
poisoning are almost entirely confined to sclerosis. The presence of
albumin in the urine is not a very common symptom. As has been
pointed out already, the presence of lead in the urine is by no means
a regular feature of lead poisoning, though it may at times be
present, and the urine should always be examined for changes in the
kidneys; but as a number of cases of chronic lead poisoning are
associated with alcohol poisoning, the changes in the kidney cell are
almost certain to be present. On p. 95 the illustration showing the
disease in the kidney produced by experimental dosage with lead,
and the kidney of a fatal case of lead poisoning in a man who at the
same time had a strong alcoholic history, shows fairly definitely the
difference between these two points.
Acute nephritis occurs so rarely in the course of industrial lead
poisoning that it cannot be considered to be a disease due to lead.
In chronic nephritis treatment should be along the ordinary lines
and the same remark applies to enlargement of the liver.
Heart.—Symptoms due directly to disease of the heart are rarely
caused by lead alone. The heart muscle may suffer in the same way
as the other muscles of the body, and in lead poisoning in animals
distinct hæmorrhages are found between the muscular fibres in the
heart muscle, and it is therefore probable that a form of myocarditis
may exist in lead poisoning. This, together with the increased arterial
tension, may cause dilatation, but the symptoms are those related
more to the general condition of arterio-sclerosis than to any direct
heart lesion, and as a rule these symptoms do not call for any
special treatment.
Treatment of Nervous Manifestations in Lead Poisoning.—
With one or two exceptions, the diseases of the nervous system
associated with lead intoxication only appear when actual lead
poisoning is established. Certain evidences of affection of the
nervous system are occasionally seen in the prodromal stage, or
stage of lead absorption. These may be merely temporary and
disappear often under treatment, by change of employment and
reduction in the quantity of lead absorbed. Thus, dilatation of the
pupils—the reaction to light being extremely sluggish or absent—is
often a feature of the later stages of the condition of lead absorption.
Tremor may also be a symptom, the outstretched hands exhibiting a
fine undulatory movement, often increased on attempting to perform
some act such as touching the nose, or touching the two fingers
together, and when these symptoms occur they must always be
regarded as of somewhat grave import. But it must be remembered
that tremor may occur as a common complication of alcoholic cases,
and further, follows excessively hard manual work, though there is
usually little difficulty in distinguishing between the various forms.
The symptomology of nervous diseases associated with lead
poisoning has already been carefully set out in Chapter IX., and the
pathological changes underlying these symptoms in Chapter V.
Of the general treatment, little needs to be added to what has
already been stated for the treatment of lead anæmia and general
lead intoxication. Iron and arsenic (not strychnine, especially in
presence of colic), and other similar drugs, should be employed
together with iodides either as potassium iodide or as an injection in
the form of an organic compound, of which there are several
varieties on the market.
The injection of normal serum has been advised, as well as saline
injections, and in some instances venesection has been practised,
but it is doubtful whether anything is to be gained by this form of
treatment.
Further, it has been stated that some lead is excreted through the
skin, and for this reason sulphur baths, bathing in sulphuretted
hydrogen water, etc., have been recommended to neutralize any
lead that has gained access to the skin. Serafini[10] has claimed that
by means of electrolytic baths a certain amount of lead can be found
present in the water after continuous passing of a current, and it has
been supposed by these observers that the lead has been actually
driven out of the body under the action of the electric current. It is, of
course, possible that such lead as is discoverable in the water was
merely that which had already become incorporated with the
patient’s skin through mechanical contact.
Whatever form of treatment be adopted of a general type, the
patient must certainly be removed from the chance of any further
lead absorption; a person who is suffering from wrist-drop or other
form of paresis should not be employed in any portion of a lead
works where he may come into contact with any form of lead or its
compounds for at least a year after the paresis has disappeared, and
even then it is inadvisable for such a person to return to any form of
dangerous lead work.
The electrical treatment of the injured nerves and muscles should
be undertaken energetically; both the galvanic or faradic currents
may be used. Probably the best form is the galvanic. A small
medicinal battery may be utilized, the method of application being as
follows: One pole of the battery should be placed over the affected
muscle, and the other pole placed in a basin of water into which the
patient’s hand is dipped. The current should then be passed. It is
better not to use a current of too great intensity, particularly at the
start, although it is found in practice that a much greater current can
be borne in the early stages of the treatment than when the muscles
and nerves commence to recover. As a rule the patient experiences
no inconvenience whatever from a considerable current during the
first week of his affection, but at the end of a fortnight or three weeks
less than one-third of the initial current can be borne. The current
should not be passed continuously, but should be used for a short
time and then shut off, being again switched on for five or six
minutes, and then again shut off. The applications may also be
modified by placing one hand in the vessel of water and stroking the
affected muscle and nerve with the free electrode. The application of
the current should be for not more than half an hour at a time, and
may be applied twice in the twenty-four hours. It is quite easy to
instruct the patient to perform the electrical treatment for himself in
this manner when the paresis is affecting either the upper or lower
extremity.
With the faradic current the circuit should be closed while the
current is at a minimum, and then the quantity of current raised to
some 15 to 20 milliampères.
For affections of the lower extremity the application may be made
by means of one of the usual baths in which the foot is immersed,
the other electrode being placed on the back or other suitable
position. If both the lower extremities are involved, then both feet
should be placed in a bath into each of which the source of electricity
is connected.
Ionization by means of the faradic current may also be made use
of. For this purpose one of the halogens, preferably iodine or
chlorine, should be used, it being remembered that chlorine and
iodine ions enter from the negative pole, so that in such a case the
bath in which the affected limb is placed must be connected with the
negative pole of the battery.
Subsequently, with either form of electrical treatment, the part
should be well rubbed, and passive movements as well as massage
are an advantage in promoting the return of normal function. As the
muscles gradually return towards their normal state, graduated
muscular exercises should be used.
When treated in the first week or two of the onset, lead paresis
frequently recovers, and in a person suffering from lead palsy for the
first time, confined only to the hands or to a group of muscles in the
shoulder, prognosis is good. The prognosis of palsy of the lower
limbs is not so good.
Paralysis of the facial nerve is occasionally seen in lead poisoning,
and where this occurs it should be treated as previously
recommended, by means of iodides in association with localized
electrical treatment. One pole of the battery should be placed below
the external auditory meatus, and the other one passed over the
face on the affected side.
In long-standing cases where no attempt has been made at
treatment in the early stages of the disease, and where considerable
muscle degeneration has already taken place, the prognosis as a
rule is very bad. Efforts should always be made in an early case by
passive movements and massage of the affected muscles to
improve their nutrition as far as possible. The diet should be light,
and alcohol should not be given at any time.
Affections of the Central Nervous System.—The typical form
of affection of the central cerebral nervous system caused by lead, is
lead encephalopathy. The disease may be insidious in its onset, and
may be preceded by a long stage of chronic headache with slight or
total remissions. Headaches may last for several months before the
actual acute stage of the disease is reached. In the examination of
several brains of persons who have died from lead encephalitis,
microscopic sections of the brain have shown signs of hæmorrhages
which must have taken place some considerable time prior to death,
and were no doubt associated with the headache that had been
complained of for some time previously, before the onset of the fatal
illness. (See Plate III.) Persistent headache occurring in a lead-
worker should always be regarded with grave suspicion, and such a
case should be treated on the assumption that it is an early case of

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