Part 2 — CHAPTER XVIII. OF POISONING WITH LEAD. (continued 2)

The insoluble compounds, such as the carbonate, red oxide and protoxide, possess little irritant power. The experimentalists of Lyons found litharge to be irritant in large doses of half an ounce.^[1307] Orfila gave dogs large doses of the red oxide and carbonate without observing any signs of irritation in the stomach. A case has been published of a young woman who swallowed accidentally an ounce and a half of the carbonate without any bad effect whatever either at the time or afterwards;^[1308] and Dr. Ogston of Aberdeen has informed me he met with a similar case, that of a girl who took an ounce with the view of destroying herself, but without sustaining any harm whatever. In a remarkable case, published by Mr. Cross of London, in which six drachms were taken accidentally by a pregnant female instead of magnesia, vomiting and violent colic were produced, and afterwards fainting, paralysis of the extensor muscles, and contraction of the flexors; all of which symptoms, however, after enduring without abatement till eight hours after the poison was swallowed, gradually disappeared under antidotes and laxatives. But such a case bears no great resemblance either to the acute or chronic form of poisoning with lead, and was probably hysterical.^[1309] Orfila has found that an ounce and a quarter of sulphate of lead had no effect whatever on a dog.^[1310] Mr. Taylor mentions a case where the chloride of lead caused vomiting, but no other ill consequence.^[1311] Dr. Cogswell found that three drachms of iodide of lead caused in a dog merely depression and weakness for a few days; but forty grains killed a rabbit in twelve days, with symptoms of exhaustion and constipation; and doses frequently repeated, to the amount of eleven drachms in eighteen days, killed a dog under symptoms nearly the same.^[1312]

It may be presumed that all the compounds of lead which are soluble in water or in the animal fluids may produce in favourable circumstances the lead colic and palsy. Dr. A. T. Thomson, indeed,^[1313] has endeavoured to show by some experiments, that the carbonate is the only compound of lead which possesses this singular power; and that if the acetate of lead produces similar effects, it is only because that salt usually contains an excess of oxide which becomes 429carbonate from the action of free carbonic acid in the stomach and other parts of animals, or because the salt is decomposed by double decomposition from the accidental presence of alkaline carbonates. It does not appear to me, however, that the researches of Dr. Thomson, taken along with the prior inquiries of other physiologists, will bear out this conclusion. The experiments of Wibmer in particular would seem to show that the carbonate is at least not more active than the acetate; nor does it appear probable that the small doses of acetate given by him, seldom exceeding two or three grains at a time, could yield any carbonate in the alimentary canal of a dog, where there is commonly much free muriatic acid. Farther, in many of the instances of lead colic related above as produced by cider, wine, and other acid substances acting on lead or its oxide, the acid must have been so greatly in excess, that it was scarcely possible that carbonate of lead could have been formed afterwards by any ordinary accident. And even supposing the carbonate to be more active than other compounds in occasioning colic and palsy, as Dr. Thomson’s inquiries would tend to show, the fact may be admitted without necessarily leading to the inference, that it is the only active compound of lead, or that other preparations must be converted into the carbonate before they can act as slow poisons. For the superior activity of the carbonate may be owing to the great obstinacy with which its impalpable powder adheres to moist membranous surfaces, and the consequent greater certainty of its ultimate absorption. It certainly appears at least but consistent with a general law, to which hitherto no undoubted exception has been found, that the carbonate must be dissolved before it can act constitutionally.

The symptoms observed in man from the preparations of lead are of three kinds. One class of symptoms indicate inflammation of the alimentary canal: another spasm of its muscles: and a third injury of the nervous system, sometimes apoplexy, more commonly palsy, and that almost always partial and incomplete. Each of these classes of symptoms may exist independently of the other two; but the last two are more commonly combined.

The irritant effects of large doses of the soluble salts of lead come first under consideration. Of these the acetate, or sugar of lead may be taken as an example.

Here it will, in the first instance, be observed that, according to the experiments mentioned above, the acetate of lead, though certainly an irritant poison, is not very energetic,—being much less so than the vulgar generally believe, and far inferior to most of the metallic poisons hitherto treated of. This farther appears from the experience of physicians as to its effects in medicinal doses. The acetate has been often given in pretty large doses in medical practice; and although it has sometimes excited colic when continued too long, ordinary irritation of the stomach seems to have been rarely observed. Mr. Daniell, in a paper on its effects as a remedy for mercurial salivation, states that he gave it in doses of ten grains three times a day, and that he never observed it to excite any other unpleasant 430symptom except slight colic, which seldom came on till after the fourth dose.^[1314] I have often given it in divided doses to the amount of eighteen grains daily for eight or ten days, without remarking any unpleasant symptom whatever, except once or twice slight colic. Van Swieten even mentions a case in which it was given to the amount of a drachm daily for ten days before it caused any material symptom.^[1315]

Yet facts are not wanting to prove that acetate of lead in an improper dose will produce violent and immediate effects. The symptoms are then either those of simple irritation, or more commonly those of inflammation united with the peculiar spasmodic colic of lead, and sometimes followed by convulsions and coma, or by local palsy.

In one of Sir George Baker’s essays there is an instance of immediate and violent symptoms having been caused by a drachm taken twice with a short interval between the doses. The subject was a soldier who took it in milk to cure a diarrhœa. Five hours after the first dose he was seized with pain in the bowels and a feeling of distension round the navel. After the second these symptoms became much more acute; and he was soon after seized with bilious vomiting, loss of speech, delirium, and profuse sweating, while the pulse fell down to 40. He recovered, however, with the aid of diluents and cathartics.^[1316]

A case which proved rapidly fatal has been related in a French journal. A drummer in a French regiment, who was much given to drinking, stole some Goulard’s extract, and drank it for wine. Neither the first symptoms nor the dose could be ascertained. On the second day he was affected with loss of appetite, paleness, costiveness, and excessive debility; on the third day he had severe and excessive colic, drawing in of the belly, loss of voice, cold sweats, locked jaw, and violent convulsions; and he expired before the evening of the same day. The morbid appearances will be mentioned in their proper place. Sugar of lead was detected in the stomach.^[1317]

In both these instances the disorder excited partook very much of the character of the spasmodic colic which is caused by the gradual introduction of lead into the body; and in the last the whole course of the man’s illness was very like that of the worst or most acute form of colica pictonum. But in another example which came under my own notice, the symptoms were more nearly those of ordinary irritation,—namely, vomiting, burning, and pricking pain in the throat, gullet, and stomach, with trifling colic subsequently; but the patient recovered in two or three days. The quantity taken was supposed to exceed a quarter of an ounce. So, too, in a case which occurred to M. Villeneuve of Paris, the symptoms were chiefly vomiting and purging, with faintness and some convulsions. His patient swallowed intentionally above an ounce of acetate of lead in solution. 431Sulphate of soda and sulphate of magnesia were given promptly as antidotes; in an hour the symptoms had abated materially; and next day she was well.^[1318] This was the case in which Orfila found lead in the urine. Of the same nature, also, are two cases briefly alluded to by Mr. Taylor, as having been caused in London in 1840 by Goulard’s extract. The subjects, who were children, were seized with vomiting, purging, and other symptoms like those of Asiatic cholera; and both died within thirty-six hours.^[1319]

In another instance, related by Mr. Iliff of London, where an ounce of the acetate was accidentally swallowed in solution, the symptoms were at first colic pains and vomiting, in the course of a few hours vomiting and tenderness, and, after these symptoms receded, a peculiar state of rigidity and numbness, which was not entirely removed for several days. In this case no remedies were used for three hours; and even two hours later, when the stomach-pump was resorted to on account of the slightness of the vomiting, lead was found in the first fluid withdrawn,—a new proof of the feeble action of acetate of lead, compared with some other metallic poisons.^[1320]

So much for the operation of the acetate of lead in large doses. Physicians, however, are much better acquainted with the effects of lead when introduced in the body continuously and insidiously in minute quantities. For all tradesmen who work much with its preparations are apt to suffer in this way, and many other persons have been brought under its action in consequence of articles of food and drink being impregnated with it. The disease which is thus induced may be divided into two distinct stages.

The first stage is an affection of the alimentary canal, the leading feature of which is violent and obstinate colic. This symptom at times begins abruptly during a state of sound health; but much more commonly it is ushered in by a deranged state of the stomach, not unlike common dyspepsia, seldom so severe as to excite alarm, and commonly imputed at first to a wrong cause. There is general uneasiness and depression, a dingy yellowish complexion, weakness and numbness in the limbs, a sweetish styptic taste and fetid breath, a slaty tint of the teeth and gums, with a blue line along the margin of the gums where they touch the teeth, a slow hard pulse, great emaciation, loss of appetite and tendency to indigestion. This state, which was first well characterized by Mr. Wilson^[1321] of Leadhills, and has lately been more fully described by M. Tanquerel,^[1322] is of great moment as apprizing the workman of the necessity of taking active measures for preventing the more formidable effects, which otherwise are sure to follow. Of the warning symptoms none is so invariable or so characteristic as the blue line along the edge of the gums, an appearance which was first noticed by Dr. Burton of St. George’s, 432London,^[1323] and has been since observed in every case of lead colic, whether impending or present.—If alarm be not taken in time, the obscure complaints hitherto mentioned become attended by and by with uneasy sensations in the stomach, stretching ere long throughout the whole belly. At the same time the stomach becomes irritable, and the food is rejected by vomiting. Cramps in the pit of the stomach then arise, and extend to the rest of the belly, till at length the complete colic paroxysm is formed. The pain is sometimes pretty constant; sometimes it ceases at intervals altogether; but much more commonly there are remissions rather than intermissions; and it is remarked that both the remissions and exacerbations are much longer than those of common colic. The pain is very generally, yet not invariably, relieved by pressure; even strong pressure seldom causes any uneasiness, provided it be not made on the epigastrium; nay, some patients have been known to bear, with relief to the paroxysms, the weight of two or three people standing on the belly.^[1324] The belly is almost always hard, the abdominal muscles being contracted: sometimes it is rather full, more commonly the reverse, and the navel is often drawn in so as almost to touch the spine. The bowels all the while are obstinately costive. Either there is no discharge from them at all; or scanty, knotty fæces are passed with much straining and pain. This state, long supposed to depend on spasm, is now known to arise on the contrary from paralysis, of the intestinal muscular coat. In a few instances diarrhœa takes the place of the opposite affection. The urine is commonly diminished. The saliva has been described as greater than natural in quantity and bluish in colour; but Dr. Burton says he did not observe a single instance of this in forty cases which he carefully examined. From the beginning, or more generally after a few hours or days, the limbs are racked with diffuse cutting pains; which, according to Tanquerel, affect chiefly the limbs, especially near the joints, are worst at night, are often attended with cramps, and are relieved by pressure. The aspect of the countenance is dull, anxious, and gloomy: in advanced cases the expression of gloomy anxiety exceeds that of almost all other diseases. It appears from the latest works on this disease published in France, and particularly from the able treatise of Mérat, that the pulse is rarely accelerated, but on the contrary often retarded.^[1325] This does not accord with the experience of some earlier writers;^[1326] and in the few cases I have seen in this city the pulse has been always frequent. It cannot be questioned, however, that, as Mérat states, fever is not essential. The skin has a dull, dirty, cadaverous appearance, is often, though not always hot, and in either case is bedewed with irregular, clammy, cold perspiration.

This, the first stage of colica pictonum, may end in three ways. In the first place, the patient may recover at once from it as from an 433ordinary colic; and it is consolatory to know, that a first attack, taken under timely management, is for the most part easily made to terminate in that favourable manner. In such circumstances it rarely endures beyond eight days. But it is exceedingly apt to recur, if, for example, the patient expose himself to what in ordinary circumstances would cause merely a common colic or diarrhœa; and if he returns to a trade which exposes him again to the poison of lead, the disease is sure to recur sooner or later, and repeatedly, unless he observes the greatest precautions. In one or other of these returns, sometimes even in the first attack, the colic is not succeeded by complete recovery, but gives place to another more obstinate and more alarming disease. This secondary affection is of two sorts. One, which occurs chiefly in fatal cases, is a species of apoplexy. The other, which does not of itself prove fatal, is partial palsy.

In violent and neglected cases of colica pictonum, the colic becomes attended in a few days with giddiness, great debility, torpor, and sometimes delirium; as the torpor advances the pains in the belly and limbs abate; at length the patient becomes convulsed and comatose, from which state very few recover. Tanquerel, who is unnecessarily minute in subdividing the various affections produced by the poison of lead, distinguishes four kinds of affections of the head, coma, epilepsy, delirium, and a combination of all these.^[1327] A very rare termination allied to that now described is sudden death during the colic stage, without any symptom which would lead one to suspect its approach. A case of this kind has been related by M. Louis. His patient, five minutes after talking to the attendant of his ward, was found at his bedside in the agony of death; and no cause for so sudden a death could be found on dissection.^[1328] Somewhat similar was a case which occurred in 1838 at the hospital of La Charité at Paris. A man labouring for three days severely under the colic stage of the disease, began to breathe stertorously soon after straining at stool, and died in three hours.^[1329] In a case which occurred to Dr. Elliotson death was owing to concomitant perforation of the stomach, a concurrence which was probably accidental, but which was also once observed by Dr. Copland.^[1330]

In cases, on the other hand, which have not been neglected, and particularly when the attack is not the first, the departure of the colic often leaves the patient in a state of extreme debility, which by and by is found to be a true partial palsy, more or less complete. This affection is sometimes present before the colic departs, but is apt to escape notice till the pain abates. Occasionally it supervenes on a sudden, but more generally it is preceded by a sense of weariness, numbness and tremor of the parts. The palsy is of a peculiar kind. It affects chiefly the upper extremities, and is attended with excessive muscular emaciation. The loss of power and substance is most remarkable 434in the muscles which supply the thumb and fingers; and in every case which I have seen the extensors suffered more than the flexors. The paralysis is hardly ever complete, except perhaps in the extensors of the fingers. When it is considerable, the position of the hands is almost characteristic of the disease. The hands are constantly bent, except when the arms hang straight down by the side; they dangle loosely when the patient moves; he cannot extend them, and raises one arm with the aid of the other. The palsy is attended, according to Tanquerel, with diminished heat in the parts, and feeble pulsation in the arteries which supply them. There is seldom any loss of sensation in the affected parts. But the paralysis sometimes affects the nerves of the other senses. Thus two cases of paralysis of the nerves of vision have been related by Dr. Alderson of Hull;^[1331] and Tanquerel says this affection is not uncommon in Paris, and is attended with dilated and immovable pupils. The latter author also once met with deafness in the same circumstances.—Patients affected with lead palsy usually complain of racking pains in the limbs and arms, digestion is feeble, and trivial causes renew the colic. From this deplorable condition it is still possible to restore the sufferer to health, chiefly by rigorous attention to regimen. But he too often dies in consequence of a fresh attack of colic as soon as he returns to his fatal trade.

The lead palsy, however, does not always come on in this regular manner. Sometimes the primary stage of colic is wanting, so that the wasting of the muscles and loss of power are the first symptoms. I have seen a characteristic example of the kind in a sailor who had been employed for a month in painting a vessel. He had great weakness and wasting of the arms and hands, particularly of the ball of the thumb; but except a tendency to indigestion, costiveness, and transient slight pain of the belly, he had suffered no previous disorder of the intestines. I have seen the paralytic affection confined to the extensors of one hand in a compositor, and Dr. Chowne met with a similar affection of both hands in a gas-fitter.^[1332] Dr. Bright observed palsy without colic in the case of a painter three times in the course of seven years.^[1333]—In like manner, according to Tanquerel, the neuralgic affection may occur severely without any precursory colic; and the same author has witnessed both coma and convulsions in the same circumstances.

Colica pictonum, with the collateral disorders specified above, is the only disease which has been distinctly traced to the operation of lead insidiously introduced into the body. But many other disorders have been ascribed to its agency. Boerhaave seems to have imagined that consumption might be so induced; and Dr. Lambe thought that to this cause may be traced the increased prevalence of “scrofula, phthisis, dropsy, chronic rheumatism, stomach complaints, hypochondriasis, and the host of nervous complaints which infest modern life.”^[1334] These conjectures are wholly destitute of foundation in fact.

435In whatever form lead is habitually applied to the body, it is apt to bring on the train of symptoms mentioned above;—the inhalation of its fumes, the habitual contact of any of its compounds with the skin, the prolonged use of them internally as medicines, or externally as unguents and lotions, and the accidental introduction of them for a length of time with the food, may sooner or later equally induce colica pictonum.

Instances have occurred of colic being produced by the prolonged employment of the compounds of lead inwardly in medical practice. Such cases are so uncommon that it is evident some strong constitutional tendency must co-operate. But it is in vain to deny, as some do, that the medicinal employment of preparations of lead internally is unattended with any risk whatever of slow poisoning. Dr. Billing of Mulhausen relates a case of death, apparently from the comatose affection succeeding the colic stage of poisoning with lead, in the instance of a boy of fifteen, to whom he gave acetate of lead in gradually increasing doses for six weeks, till he took two grains daily.^[1335] Tanquerel met with a case of colic produced by 130 grains taken in fourteen days, and another occasioned by 149 grains in sixteen days.^[1336] Sir George Baker has mentioned similar instances.^[1337] It would even appear that metallic lead may have the same effect when taken inwardly. Thus Dr. Ruva of Cilavegno has related the case of a man who was violently attacked with the colic form of the effects of lead after taking six ounces of shot by direction of a quack for the cure of dyspepsia, and was seized again with the same symptoms six days afterwards on taking four ounces more. On the second occasion he had violent colic, great feebleness of the limbs, constant vomiting of any thing he swallowed, severe headache, and other analogous symptoms, of which he was not effectually cured for seven weeks.^[1338] A case somewhat similar, but less severe, has been described by Dr. Bruce.^[1339]—With regard to lead colic being excited by unguents and lotions applied to the surface of the body, Sir George Baker mentions a case of violent colic brought on by litharge ointment applied to the vagina; he adds that children have been thrown into convulsions by the same substance sprinkled on sores: and he quotes Zeller for a case where symptoms of poisoning were occasioned by sprinkling the axilla with it, as a cure for redness of the face.^[1340] Dr. Wall, in a letter to the preceding author, mentions his having seen the bowels affected by Goulard’s extract applied to ulcers; in another paper he has given two unequivocal cases, in one of which colic was brought on by saturnine lotions applied to a pustular disease, and in the other by immersing the legs twice a day for ten days in a bath of the solution of acetate of lead:^[1341] and lately Dr. Taufflieb of Barr observed lead colic to arise from 436the continued use of diachylon plaster during eleven weeks for dressing an extensive ulcer.^[1342] Such accidents are exceedingly rare, and some auxiliary cause must have favoured the operation of the poison in the cases now noticed; for every one knows that free use is made of lead unguents and lotions, yet we seldom hear of any bad consequences.—These cases, however, will probably remove the doubts which some entertain of the possibility of lead colic being induced by the application of the compounds of lead to the sound skin in those trades which compel the workmen to be constantly handling them. At the same time it must be admitted, that in all these trades there exists a more obvious and ready channel for the introduction of the poison; because the workmen are either exposed to breathe its fumes, or are apt to transfer its particles from the fingers into the stomach with their food.—Of all exposures none is more rapid and certain than breathing the vapours or dust of the preparations of lead. But for that very reason workmen who are so exposed seldom suffer; because the greatness of the risk has led to the discovery of means to avert it, and the openness of the danger renders it easy for the workmen to apply them. Tanquerel mentions a singular case of a woman who was attacked in consequence of the fine dust of white lead ascending through chinks in the floor from a room below, where a perfumer was in the practice of grinding and sifting that substance.^[1343]—It may be added that Dr. Otto of Copenhagen has published an extraordinary instance of fatal lead-colic, originating in the habitual use of Macuba snuff adulterated with twenty per cent. of red lead.^[1344]

To these observations on the various ways in which lead insidiously enters the system a few remarks may be added on the trades which expose workmen to its influence. The most accurate information on this subject is contained in the work of Mérat.

He places foremost in the list miners of lead. In this country miners are now rarely affected, because the frequency of colica pictonum among them formerly led their masters to study the subject, and to employ proper precautions for removing the danger. It has been stated by Dr. Percival, and is generally thought, that the whole workmen in lead mines are apt to be attacked with the colic,—those who dig the sulphuret as well as those who roast the ore.^[1345] If this idea were correct, it would be in contradiction with the general principle in toxicology, that the metals are not poisonous unless oxidated. But the opinion is in all probability founded on error; for, according to information communicated to me by Mr. Braid, and confirmed since by personal investigation, the workmen at Leadhills who dig and pulverize the ore, although liable to various diseases connected with their profession, and particularly to pectoral complaints, never have lead colic till they also work at the smelting furnaces. 437Next to miners may be ranked manufacturers of litharge, red-lead and white-lead. The workmen at these manufactories are exposed to inhale the fumes from the furnaces or the dust from the pulverizing mills. It has been chiefly among the workmen of a former white-lead manufactory in the neighbourhood of Edinburgh that I have had an opportunity of witnessing the lead colic. By a simple change the proprietor made in the process, and which will be mentioned presently, the disease was almost extirpated some years before the manufactory was given up.

Next in order, perhaps in the same class with colour-makers, are house-painters. The causes of their liability is the great quantity of the preparations of lead contained in the paints they use. It would appear that lead colic is most frequent among people of that trade in cities of the largest size. In Geneva, as I am informed by my friend Dr. C. Coindet of that place, colica pictonum is now almost unknown and never occurs among painters. In Edinburgh it is also little known among painters. A journeyman painter, a patient of mine in the Infirmary, had been seventeen years in the trade, and yet did not know what the painters’ colic or lead palsy meant. In London, according to the Dispensary reports, and in Paris, according to the tables of Mérat, many workmen of that trade suffer. I have been informed by an intelligent workman, once a patient of mine, who had been a journeyman painter both in London and Edinburgh, that the number of his acquaintances who had been affected with colic in the metropolis was incomparably greater than here. This man ascribed the difference to the working hours being more in the former place, so that the men had not leisure enough to make it worth their while to clean themselves carefully in the intervals. This appears a rational explanation. I do not know how the great prevalence of colic among painters in Paris is to be accounted for.

Plumbers, sheet-lead manufacturers, and lead-pipe makers, are also for obvious reasons apt to suffer; but as they are not necessarily exposed to the vapours of lead, and suffer only in consequence of handling it in the metallic form, it ought to be an easy matter to protect them. They themselves conceive that a very hazardous part of their occupation is the removing the melted lead from the melting pot, to make the sheets or pipes; but this operation cannot be dangerous if the melting pots are properly constructed.

A few cases of lead colic occur among glass-blowers, glaziers, and potters, who use the oxide of lead in their respective trades.

There are a few also among lapidaries and others, who use it for grinding and polishing, and among grocers and colourmen who sell its various preparations. Printers seldom suffer from the colic, but are generally thought liable to partial palsy of the hands, which is ascribed to frequent handling of the types. I have met with one case apparently of this nature.

Lead is not the only metal to which the power of inducing colica pictonum has been ascribed. Mérat has mentioned several instances 438of the disease occurring among brass-founders and other artizans who work with copper.^[1346] Tronchin quotes Scheuchzer for a set of well-marked cases in a convent of monks, where the malady was supposed to have been traced to all the utensils for preparing and keeping their food having been made of untinned copper.^[1347] The same author mentions two cases, one of which came under his immediate notice, where the apparent cause was the long-continued use of antimonial preparations internally.^[1348] Mérat likewise found a few iron-smiths and white-iron-smiths in the lists kept at one of the Parisian hospitals.^[1349] Chevallier alleges that colic occurs at times among money-changers at Paris, and others who constantly handle silver.^[1350] Cases have even been noticed by Mérat among varnishers, plasterers, quarrymen, stone-hewers, marble-workers, statuaries, saltpetre-makers;^[1351] and Tronchin enumerates among its causes the immoderate use of acid wine or of cider, checked perspiration, sea-scurvy, and melancholy. But the only substance besides lead, whose operation in producing colica pictonum has been traced with any degree of probability, is copper; and even among artizans who work with copper the disease is very rare. As to the other tradesmen mentioned by Mérat, it is so very uncommon among them, that we may safely impute it, when it does occur, to some other agent besides what the trade of the individual exposes him to; and in general the secret introduction of lead into the body may be presumed to be the real cause. Still, however, the connection of colica pictonum with other causes besides the poison of lead is upheld by so many facts, and is believed by so many authorities, that this disease cannot be safely assumed, even in its most characteristic form, as supplying undoubted evidence of the introduction of lead into the system. Dr. Burton thinks it will when the blue line at the edge of the gums is seen.

The work of Mérat contains some interesting numerical documents, illustrative of the trades which expose artisans to colica pictonum. They are derived from the lists kept at the hospital of La Charité in Paris, during the years 1776 and 1811. The total number of cases of colica pictonum in both years was 279. Of these, 241 were artisans whose trades exposed them to the poison of lead, namely, 148 painters, 28 plumbers, 16 potters, 15 porcelain-makers, 12 lapidaries, 9 colour-grinders, 3 glass-blowers, 2 glaziers, 2 toy-men, 2 shoemakers, a printer, a lead-miner, a leaf-beater, a shot-manufacturer. Of the remainder, 17 belonged to trades in which they were exposed to copper, namely, 7 button-makers, 5 brass-founders, 4 braziers, and a copper-turner. The remaining twenty-one were tradesmen, who worked little, or not at all with either metal, namely, 4 varnishers, 2 gilders, 2 locksmiths, a hatter, a saltpetre-maker, a winegrocer, a vine-dresser, a labourer, a distiller, a stone-cutter, a calciner,^[1352] a soldier, a house-servant, a waiter, and an attorney’s clerk.—Age or youth seems not to afford any protection against the poison. Of the 279 cases, 24 439were under twenty, and among these were several painter-boys not above fifteen years old; 113 were between nineteen and thirty; 66 between twenty-nine and forty; 38 between thirty-nine and fifty; 28 between forty-nine and sixty; and 10 older than sixty. These proportions correspond pretty nearly with the relative number of workmen of similar ages.—Among the 279 cases fifteen died, or 5·4 per cent.

There seems to have lately been little or no diminution in the frequency of the disease in Paris. In 1833–4–5–6, there were treated in the hospitals 1541 cases, or 385 annually; of whom one in 39½ died. And in 1839–40–41 there were 761 cases, or 252 annually; of whom one in 24½ died. Of 302 cases in 1841 no fewer then 266 were from white-lead manufactories.^[1353]

Section III.—Of the Morbid Appearances caused by Lead.

The morbid appearances caused by poisoning with lead are in some respects peculiar.

In acute poisoning, from the irritant action of its soluble salts, as in the case of the drummer poisoned by Goulard’s extract, the lower end of the gullet, the whole stomach and duodenum, part of the jejunum, and the ascending and transverse colon, have been found much inflamed, and the villous coat of the stomach as if macerated. In Mr. Taylor’s two cases Dr. Bird found the villous coat of the stomach gray, but otherwise natural; and the intestines were much contracted.

The stomach in the first of these cases contained a reddish-brown, sweetish, styptic fluid, in which lead was detected by chemical analysis,^[1354]—an important medico-legal fact, since the man survived nearly three days. Some valuable observations have been made by Professor Orfila as to the presence of lead in the textures of the stomach in such instances. When small doses of acetate or nitrate of lead were administered to dogs and allowed to act for two hours only, the villous coat presented numerous streaks of white points, which contained lead, as hydrosulphuric acid blackened them. These points, though less distinct, were still visible, when the animals were allowed to live four days after the excess of salt had been removed; and even after seventeen days, although no such appearance remained, lead could still be detected in the tissues of the stomach.^[1355]

The blood in animals is sometimes altered. Dr. Campbell found it fluid. In a dog poisoned with litharge, the experimentalists of the Veterinary School at Lyons found it of a vermilion colour in the veins, and brighter than usual in the arteries.^[1356] Mitscherlich also found it unusually red and firmly coagulated.^[1357]

The appearances in the bodies of those who have died of the various forms of lead colic are different, and wholly unconnected with inflammation.

440The valuable work of Mérat contains four inspections after death from the acute or comatose form of colica pictonum. The bodies were plump, muscular and fat. The alimentary canal was quite empty, and the colon much contracted,—in one to an extraordinary degree. The mucous coat of the alimentary canal was everywhere healthy. He therefore infers that the disease is an affection of the muscular coat only. It is a striking circumstance, and conformable with what will be afterwards established in regard to the true narcotics, that although both of the men died convulsed and comatose, no morbid appearance was visible within the head.^[1358] Another case, which confirms the foregoing facts, has been described by Mr. Deering. It was that of a lady who died convulsed after suffering in the usual manner, and in whose body no trace of disease could be detected any where.^[1359] Senac informed Tronchin that he had dissected above fifty cases of colica pictonum, and found no morbid appearances.^[1360] Schloepfer’s observations on animals are to the same effect. In rabbits which died of colica pictonum the great intestines were excessively contracted, but all the other organs of the body were healthy except the liver, which was dark and brittle.^[1361] Mitscherlich observed in his animals extravasation of blood into the intestines, also sometimes into the cavities of the pleura and peritoneum, and occasionally under the peritoneal covering of the kidneys.^[1362] The only instance I have met with where morbid appearances were found within the head, was in a case mentioned by Sir G. Baker, of a gentleman who died apoplectic after many attacks of colica pictonum, and in whom the brain was found unusually soft, and blood extravasated on its surface to the amount of an ounce.^[1363]

The appearances in those who have been long affected with the paralytic form of colica pictonum have been rarely observed in modern times. I am indebted to my late colleague, Dr. Duncan, Junior, for an account of the appearances in the intestinal canal of a plumber, who had been long and frequently afflicted with colica pictonum and its sequelæ. The intestines were dark, tender, and far advanced in putrefaction. The cardiac orifice of the stomach was so narrow that it would admit a goose-quill. The mesenteric glands were enlarged and hardened. The thoracic duct was surrounded by many large bodies like diseased glands, exactly of the colour of lead, and composed of organized cysts containing apparently an inorganic matter. The analysis of this matter was unfortunately neglected. The muscles in similar circumstances are much diseased. When the paralysis is not of long standing, it appears from the experiments of Schloepfer (whose animals survived about three weeks), that the whole muscular system becomes pale, bloodless, and flaccid. When the palsy is of long standing, this change increases so much, that the muscles in some parts, as in the arms and thumbs, acquire the 441colour and general aspect of white fibrous tissue. Some observations on the nature of these changes will be found in the essays of Sir G. Baker.^[1364] The facts are communicated by Mr. John Hunter. On examining the muscles of the arm and hand of a house-painter who was killed by an accident, Mr. Hunter found them all of a cream colour, and very opaque, their fibres distinct, and their texture unusually dry and tough. These alterations he at first imagined might have been the result merely of the palsy and consequent inactivity of the muscles, but on finding the same alterations produced by the direct action of sugar of lead on muscle, he inferred that the poison gradually effected a change either on the muscles directly, or on the blood which supplied them.

In a late elaborate inquiry into the pathology of lead-colic, M. Tanquerel has arrived at the conclusion, that “the pathological phenomena are not caused by anatomical changes cognisable by the senses,” and that such appearances as may be found are the effects, not the cause, of the disease.^[1365]

Section IV.—Of the Treatment of Poisoning with Lead.

The treatment of poisoning with lead, and the mode of protecting workmen from its influence, will now require a few remarks.

For the irritant form of poisoning, a safe and effectual antidote exists in any of the soluble alkaline or earthy sulphates. If none of these be at hand, then the alkaline carbonates may be given, particularly the bicarbonates, which are not so irritating as the carbonates. The phosphate of soda is also an excellent antidote. If the patient does not vomit, it will be right also to give an emetic of the sulphate of zinc. In other respects, the treatment does not differ from that of poisoning with the irritants generally.

Colica pictonum is usually treated in this country with great success by a practice much followed here in colic and diarrhœa of all kinds,—the conjunction of purgatives with anodynes. A full dose of a neutral laxative salt is given, and an hour afterwards a full dose of opium. Sometimes alvine discharges take place before the opium acts, more commonly not till its action is past, and occasionally not for a considerable time afterwards. But the pain and vomiting subside, the restlessness and irritability pass away, and the bowels return nearly or entirely to their natural condition. Sometimes it is necessary to repeat the practice. It is almost always successful. I have seldom seen the second dose fail to remove the colic, leaving the bowels at worst in a state of constipation. Dr. Alderson of Hull, who has had many opportunities of treating the workmen of a white-lead manufactory there, says powerful purgatives, such as croton-oil, are highly serviceable in severe cases, and are borne well notwithstanding the extreme debility often present.^[1366] M. Tanquerel says he has found this treatment more effectual in Paris than any 442other means.^[1367] When the pulse is full and strong, I have seen venesection premised with apparent advantage; in some instances it appeared to me to be called for by the flushing of the face and the violence of the spasms; and I have never seen it otherwise than a safe remedy, notwithstanding the fears expressed by Dr. Warren and others.^[1368]

The hospital of La Charité in Paris has long enjoyed a high reputation for the treatment of this disease. In the first place a decoction is given of half an ounce of senna in a pound of water, mixed with half an ounce of sulphate of magnesia and four ounces of the wine of antimony. Next day an ounce of sulphate of magnesia and three grains of tartar-emetic are administered in two pounds of infusion of cassia, to keep up the operation of the first laxative. In the evening a clyster is given, containing twelve ounces of wine and half as much oil. After this the patient is made to vomit with tartar-emetic, then drenched with ptisanes for several days, and the treatment is wound up with another dose of the first purgative succeeded by gentle anodynes. I am not aware of any particular advantage possessed by this complicated and tormenting method of cure, which is not equally possessed by the simpler plan pursued in Britain.

In 1831 M. Gendrin announced to the French Institute that he had found sulphuric acid to be at once the most effectual remedy, and the most certain preventive, for the injurious effects of lead; and he has subsequently spoken in strong terms of the utility of this treatment.^[1369] But the experience of others does not bear out his conclusions.^[1370]

Among the many other methods of cure that have been proposed for the primary stage of this disease, salivation by mercury deserves to be particularized. It appears to have been often used with success, the colic yielding as soon as ptyalism sets in.^[1371] If the case, however, is severe, there is no time to lose in waiting for the action of the mercury to commence.

The treatment in the advanced period of the disease, when palsy is the chief symptom remaining, depends almost entirely on regimen. The patient must for a time at least quit altogether his unlucky trade. He should be allowed the most generous food he can digest. He ought to take frequent gentle exercise in the open air, but never to fatigue. The hands being the most severely injured of the affected parts, and at the same time the most important to the workman, the practitioner’s attention should be directed peculiarly to the restoration of their muscular power. This appears to be most easily brought about by frictions, electricity, and regulated exercise, the hands being also supported in the intervals by splints extending from the 443elbows to the fingers. The dragging of the emaciated muscles by the weight of the dangling hands certainly seems to retard recovery.—Strychnia has also been repeatedly found of service in restoring muscular action. Tanquerel states that electricity and strychnia, but especially the latter, have appeared to him by far the most efficacious remedies both for muscular paralysis and for amaurosis.—In the head affections the best treatment consists in relying on nature and merely combating symptoms; and blood-letting is of no use, however much it may seem to be indicated by the coma and convulsions.

When a person has been once attacked with colica pictonum, he is more easily attacked again. Hence if he is young enough, he should, if possible, change his profession for one in which he is not brought into proximity with lead. Few, however, have it in their power to do so. The prophylaxis, therefore, or mode of preventing the influence of the poison, becomes a subject of great importance; and more particularly when we consider the vast number of workmen in different trades, whose safety it is intended to secure.

On this subject many useful instructions are laid down in the work of Mérat. He very properly sets out with insisting on the utmost regard being paid to cleanliness,—a point too much neglected by most artizans, and particularly by those to whom it is most necessary, the artizans who work with the metals. In proof of the importance of this rule, he observes he knew a potter, who contracted the lead colic early in life when he was accustomed to go about very dirty, but for thirty years after had not any return of it, in consequence simply of a scrupulous attention to cleanliness. In order to secure due cleanliness three points should be attended to. In the first place, the face and hands should be washed once a day at least, the mouth well rinsed, and the hair occasionally combed. Secondly, frequent bathing is of great consequence, both with a view to cleanliness and as a general tonic; so that masters should provide their workmen with sufficient means and opportunities for practising it. Lastly, the working clothes should be made, not of woollen, but of strong, compact linen, should be changed and washed at least once and still better twice a week, and should be worn as little as possible out of the workshop. While at work a cap of some light impervious material should always be worn.

Next to cleanliness, the most important article of the prophylaxis relates to the means for preventing the food being impregnated with lead. For this end it is essential that the workmen never take their meals in the workshop, and that before eating they wash their lips and hands with soap and water, and brush out all particles of dirt from the nails. It is also of moment that they breakfast before going to work in the morning.

Derangements of the digestive organs should be watched with great care. If they appear to arise from the poison of lead, the individual should leave off work with the very first symptom, and take a laxative. Habitual constipation should be provided against.

The nature of the diet of the workmen is of some consequence. It 444should be as far as possible of a nutritive and digestible kind. Mérat condemns in strong terms the small tart wines generally used by the lower ranks of his countrymen. They constitute a very poor drink for all artizans; and are peculiarly ill adapted for those who work with lead, because, besides being at times themselves adulterated with that poison, they are also apt to disorder the bowels by their acidity. Beer is infinitely preferable. Various articles of diet have been recommended as tending to impede the operation of the poison. Hoffmann recommends brandy, the efficacy of which few workmen will dispute. There is some reason for believing that the free use of fat and fatty articles of food is a preservative. Dehaen was informed by the proprietor and the physician of a lead mine in Styria, that the work-people were once very liable to colic and palsy, but that, after being told by a quack doctor to eat a good deal of fat, especially at breakfast, they were exempt for three years.^[1372] Another fact of the kind was communicated to Sir George Baker by a physician at Osterhoüt, near Breda. The village contained a great number of potters, among whom he did not witness a single case of lead colic in the course of fifteen years; and he attributes their immunity to their having lived much on cheese, butter, bacon, and other fatty kinds of food.^[1373] Mr. Wilson says, in his account of the colic at Leadhills in Lanarkshire, that English workmen, who live much on fat meat, suffer less than Scotchmen, who do not.^[1374]

Professor Liebig says that lead colic is unknown in all white-lead manufactories, where the workmen use as a beverage lemonade or sugar-water acidulated with sulphuric acid; and it was stated above that the same announcement has been made by Mr. Gendrin. This, however, is doubtful. The prophylactic effects of sulphuric acid have been denied in France by M. Tanquerel,^[1375] and M. Grisolle;^[1376] the latter of whom in particular says that no advantage whatever was derived from it at the white-lead manufactory of Clichy near Paris.

Some have likewise proposed as an additional preservative, that the exposed parts of the body should be anointed with oily or fatty matters. But Mérat maintains with some reason, that the lead will be thereby enabled to penetrate the cuticle more easily by friction and pressure.

The observance of the preceding rules will depend of course in a great measure on the intelligence and docility of the workmen. It would appear that particular care should be taken in hot weather, statistical facts having shown that three times as many workmen are attacked in Paris during the month of January as in July.^[1377]

Some other objects of much consequence are to be attained by the humanity and skill of the masters.

The workshop should be spacious, and both thoroughly and systematically 445ventilated, the external air being freely admitted when the weather will allow, and particular currents being established, by which floating particles are carried away in certain invariable and known courses. Miners and others who work at furnaces in which lead is smelted, fused, or oxidated, should be protected by a strong draught through the furnaces. According to Mr. Braid, wherever furnaces of such a construction were built at Leadhills, the colic disappeared; while it continued to recur where the furnaces were of the old, low-chimneyed form. Manufacturers of litharge and red-lead used formerly to suffer much in consequence of the furnaces being so constructed as to compel them to inhale the fine dust of the oxides. In drawing the furnaces the hot material is raked out upon the floor, which is two or three feet below the aperture in the furnace; and the finer particles are therefore driven up and diffused through the apartment. But this obvious danger is now completely averted by a subsidiary chimney, which rises in front of the drawing aperture, and through which a strong current of air is attracted from the apartment, the hot material on the ground performing the part of a fire.

In white-lead manufactories a very important and simple improvement has been effected of late in some places by abandoning the practice of dry-grinding. In all manufactories of the kind, the ultimate pulverizing of the white lead has been long performed under water. But in general the preparatory process of rolling, by which the carbonate is separated from the sheets of lead on which it is formed, continues to be executed dry. This is a very dangerous operation, because the workmen must inhale a great deal of the fine dust of the carbonate. In a white-lead manufactory which formerly existed at Portobello, the process was entirely performed under water or with damping; and to this precaution in a great measure was imputed the improvement effected by the proprietor in the health of the workmen, and their superior immunity from disease over those of Hull and other places, where the same precaution was not taken at that time. The only operation latterly considered dangerous at the Portobello works was the emptying of the drying stove, and the packing of the white lead in barrels; and the dust diffused in that process was kept down as much as possible by the floor being maintained constantly damp. By these precautions, by making the workmen wash their hands and faces before leaving the works for their meals, and by administering a brisk dose of castor oil on the first appearance of any complaint of the stomach or bowels, the manufacturer succeeded in extirpating colica pictonum entirely for several years.—This trade continues to be a very pernicious one in France; for no fewer than 266 cases of colic were admitted into the Parisian hospitals in 1841 from the white-lead manufactories in and near the capital. Yet facts are not wanting there to prove that with proper care the disease may be all but extirpated. A French manufacturer, whose workmen at one time suffered severely, had no case of colic among them for nine years after breaking them in to the observance of due precautions.^[1378] Another says, from his 446own experience and information obtained at other works, he is satisfied the risk is very much greater among the intemperate than among sober workmen.^[1379]