Lead poisoning

“ Acute poisoning by lead is not common. Industrially it hardly ever occurs. Zinn [1] states that, out of 200 cases of industrial lead poisoning in his clinic in Berlin, only one was to be regarded as an acute case. In most instances the poisoning is due to swallowing some compound of lead, either as an abortifacient or to commit suicide. ”

“ From attrition dust may lie thick in the compartments, and when at work there is always tendency for small quantities of this dust to be dispersed. While this is the principal source of poisoning, inasmuch as dust containing lead must adhere to the fingers, lead may thus enter the system with food or when smoking. It is quite as easy, also, to believe that lead poisoning may result from solvent action of the blood and tissue fluids on small spicules of lead type which penetrate the skin as to credit the well-substantiated cases of plumbism ensuing on retention of bullets or shot in the body. ”

“ As I said, I have two friends suffering from lead-poisoning. One is merely deadly white and languid, and seems to be devoid of energy—and I notice there is a trembling as of palsy. The other has lost the use of her right hand. She lives next door, and is very dear to me, and I desire to know whether the lead in both cases will lead to further mischief, or whether the poison can be counteracted and the patients recovered. ”

“ Sometimes lead poisoning manifests itself in violent pains in the joints—generally the knee, more rarely in the shoulder and elbow. In specially severe cases brain trouble supervenes—violent headache, convulsions, unconsciousness or blindness. Finally lead poisoning may set up disease of the kidneys—Bright’s disease and gout.
Women suffering from lead poisoning frequently miscarry. Children born alive may, in consequence of lead poisoning, die in their first year. Children fed at the breast are poisoned through the milk. ”

“ Chronic lead-poisoning is pre-eminently a disease of the industrial arts. The means of obviating or diminishing the dangers of those exposed by their occupation to the preparations of lead will be considered under the head of Prophylaxis. ”

“ A special liability to take lead into the stomach exists in persons working at the painters' trade and other occupations involving contact with lead and its salts. It has been shown that the eating of food handled with paint-smeared hands brings about the ingestion of considerable quantities of lead and, when long continued, results in lead poisoning. ”

“ The fall in the number of fatal cases attributed to lead poisoning, as is perhaps to be expected, seeing that the great majority are deaths from chronic lead poisoning, does not run parallel with the diminution in the number of cases. ”

“ The prognosis of simple colic in women is about as good as for males, but if an attack of abortion is associated with lead poisoning, eclampsia often supervenes and permanent mental derangement may follow. In the dementia associated with lead poisoning the prognosis is not so grave as in other forms of dementia, especially alcoholic, but depression is an unfavourable symptom. The mania of lead poisoning is not so noisy as that of alcoholic mania, but where there is suspicion of alcoholic as well as lead poisoning the prognosis is exceedingly grave. ”

“ The histological examination of the various organs exhibits the same microscopical hæmorrhages as are found in the cases of chronic poisoning to be described later.
Although acute lead poisoning is rare in industrial experience, it may occur from time to time. Several cases are on record where a workman developed an acute attack of poisoning as a result of immersion in a white lead beck; another case is described which followed immersion in a tank of solution of lead acetate. ”

“ It is rarely possible in such persons to find any lead excreted through the kidney. Occasionally, however, such persons, after working a considerable time in a dangerous lead process, become suddenly poisoned, and inquiry frequently discloses the fact that some disturbing factor, either intercurrent illness, alcoholic excess, etc., has occurred, or that the breathing of a big dose of dust has precipitated the symptoms of general lead poisoning. ”

“ Lead-poisoning, either in its obscure form (producing uric acid in the blood, and, as a consequence, indigestion and other evils) , or in the acute form (as lead colic and various nervous affections) , is most frequent among those who are habitually exposed to the influence of the metal in its different preparations, viz., workers of lead, house-painters, artists, gilders, workers of arsenic, workers of gold, calico-printers, colourists, type-founders, type-setters, shot-founders, potters, faience makers, braziers, and many others. ”

“ The knowledge gained in dealing with industrial poisoning clinically receives very strong corroboration from these inhalation experiments, for it is a well-known fact that many persons engaged in dusty trades exhibit a species of immunity to lead poisoning. It is true that some susceptible persons, as has already been pointed out, very rapidly show signs of poisoning, even with a dosage producing no effect in other persons working under similar conditions ”

“ Where lead is in organic combination, as is the case in the urine of persons suffering from lead poisoning, it is not decomposed by hydrogen sulphide, and the method is therefore not applicable in such cases, but is useful in water examination. ”

“ Young persons are regarded as more liable to lead poisoning than adults, although it is difficult to obtain definite figures on the point, the duration of employment acting as a disturbing factor in estimating the susceptibility of young persons. ”

“ The symptoms of chronic lead poisoning vary within very wide limits, from colic and constipation up to total blindness, paralysis, convulsions and death. They are thus described by Dr J. T. Arlidge (Diseases of Occupations) :—
The poison finds its way gradually into the whole mass of the circulating blood, and exerts its effects mainly on the nervous system, paralysing nerve-force and with it muscular power. ”

“ In addition to the chemical examination of tissues from a person who has died of suspected lead poisoning, it is of the highest importance to make histological examinations, as the naked-eye appearance of post-mortem examination is frequently insufficient to give any clue to the cause of the poisoning. ”

“ There was no evidence at all to show that these persons were more careless, or had been more exposed to lead dust, than any other of the persons with whom they worked, or that the work they were engaged upon was more likely to have caused illness to them than to other workers. Persons with a fresh complexion and red hair have been noted to be more susceptible to lead poisoning than dark-haired persons. ”

“ In addition to the diseases mentioned which may be said to predispose to lead poisoning, certain other diseases have been stated to be predisposed to by the action of lead. It is no doubt a fact that where chronic anæmia, wasting, loss of subcutaneous fat, decreased muscular power, and general lowering of the metabolic activity of the body, are produced, an individual so affected may be supposed to be more susceptible to certain infectious diseases, and among these stress has been laid on the alleged association of phthisis with lead absorption. ”

“ Lead poisoning of industrial origin rarely occurs in the acute form. Practically all cases coming under the notice of either appointed surgeons, certifying surgeons, or even in the wards of general hospitals, are of the subacute or chronic type. There is no reason to suppose that lead compounds are used more frequently by the workers in lead industries as abortifacients than by other persons. ”

“ Very real difficulty exists in determining from naked-eye appearances at a post-mortem examination whether the cause of death be due to chronic plumbism or not. The changes produced by several other forms of intoxication, notably chronic alcoholism, produce many of the same changes in the tissues as lead. Inspection of the organs in the case of plumbism can only give rise to a surmise that the cause of death is due to lead poisoning. ”

“ A critical examination of the very large amount of literature published on lead poisoning negatives the idea that acute and chronic poisoning differ fundamentally in their pathology, and observers are found describing identical pathological lesions resulting from acute or chronic industrial poisoning. It is impossible to review the whole of the existing literature. ”

“ Gastro-intestinal symptoms, therefore, can be produced without the direct ingestion of the drug, and colic is a symptom of generalized blood-infection rather than a localized irritative action on the intestinal mucosa. This question, again, is more related to pathology than ætiology, and is dealt with in that section. But mention may be made here of the fact that a number of observers, more lately Meillère, have laid it down as an axiom that experimental production of lead poisoning in animals gives no criterion [14] or evidence of lead poisoning produced in man industrially. ”

“ Any little cloud constantly made at work is sure, if breathed, to set up lead poisoning. Where lead colours are used wet, danger arises from the splashing of the material and its subsequent drying into dust. ”

“ Lead poisoning is the most frequent and important chronic industrial poisoning; the symptoms are very varied and associated with the most different groups of organs. We shall describe the typical course of a case of industrial lead poisoning, laying stress, however, on the fact that numerous cases follow an irregular course, in that special symptoms or complications of symptoms are in some especially accentuated, while in others they become less marked or are absent altogether. ”

“ Use of lead colours, especially by painters and decorators, causes relatively much lead poisoning. Apart from ignorance of danger on the part of the worker, and lack of personal cleanliness, unsuitable methods of working add to the danger, [133] especially dry rubbing of painted surfaces, which gives rise to much dust containing lead. Again, the crushing and mixing of lumps of white lead and rubbing lead colours with the hand are very dangerous. ”

“ Price states: “The chief industrial poisons are lead, arsenic and mercury, although phosphorus, copper, zinc, brass, and chromium poisoning are frequently met with in various industries.”
Lead Poisoning
The symptoms produced by lead poisoning are: lead colic in acute cases, loss of appetite, cramps, pain in the joints. There will be bluish lines found along the edge of the gums; wrist drop and loss of motor function in the hands and feet; arteriosclerosis, indigestion, restlessness during sleep, anemia, lead palsy, loss of strength and weight and constipation. ”

“ Because these are but samples of many cases; and I know that you must be familiar with all the symptoms and consequences of lead-poisoning. I am associated with girls working in the deadly processes of colour-dusting, glost-placing and ground-laying, majolica-painting and ware-cleaning after the dipper. A stitch in time saves nine. I may be of use, as I am in the bank, and in daily intercourse with those in whom the poison is beginning to work, or who are merely menaced. ”

“ During the current century the closer study of the etiological relations of disease has revealed many unsuspected sources of lead-poisoning in the arts, and of lead contamination, both accidental and intentional, in articles of food, drink, and luxury. ”

“ The diagnosis of lead poisoning is not in itself of any great difficulty where any one of the classical symptoms of lead poisoning is present, such as lead colic, paresis, or the characteristic lead anæmia or cachexia. ”

“ After thirty-five years of age, certificates of death from lead poisoning are almost always filled in in association with other diseases which are the usual causes which lead to mortality generally. But neither phthisis, nor pneumonia, nor any acute disease of the heart or lungs, nor valvular disease of the heart, nor, indeed, any acute febrile condition, can have direct relation with—i.e., be a sequela of—lead poisoning. ”

“ The pathology and symptoms of such acute lead poisoning depend in the first place upon the nature of the salt of lead swallowed, as, for instance, after swallowing sugar of lead a burning taste is complained of, with acute gastric pain, generally coming on within an hour of taking the poison, salivation, metallic taste in the mouth, acute hiccough, and griping pain in the abdomen. ”

“ Chyzer has described the striking conditions in Hungary. There there are about 4000 potters, of whom 500 come into contact with lead glaze. Chronic lead poisoning is rife among those carrying on the occupation as a home industry. Members of the family contract the disease from the dust in the living rooms. ”

“ The contention that, because lead workers die from certain diseases more frequently than “all males,” such diseases must be the sequelæ of lead poisoning is untenable unless other recognized causes of the diseases in question have been excluded. For excess of deaths from phthisis and respiratory diseases the conditions of work and exposure to inhalation of mineral and metallic dust or vitiation of atmosphere, in pottery, spelter, printing works, and file-cutting workshops, sufficiently account. ”