Chapter XIX: Lead and Its Compounds (2)

I have dwelt at considerable length on female labour and casual employment in lead works, and I hope have shown that the abolition of women’s work in white lead factories has been followed by marked improvement both in the conditions of labour and in the reduced number of cases of plumbism. Female labour, however, is still very largely employed in other trades where lead compounds are used. It may therefore be expected that I should offer some explanation of the attitude I have assumed in regard to this important industrial question. Where the two sexes are as far as possible equally exposed to the influence of lead, women probably suffer more rapidly, certainly more severely than men. To a certain extent the reason is to be found in the fact that lead exercises an injurious influence upon the reproductive functions of women. It deranges menstruation. Usually there is an excessive loss at the monthly periods, which causes women to become anæmic; in a few instances, on the other hand, the loss is scanty. It is upon pregnant women that the metal exercises its worst effects. The ecbolic or abortifacient action of lead is beyond dispute. It is knowledge of this fact that has caused women of the lower classes when pregnant to resort to diachylon pills, which contain a small quantity of lead, for the purpose of producing miscarriage. When a white lead worker becomes pregnant it is almost impossible for her to go to the end of term if she continues to follow her employment. As a rule she mis-carries, but if, perchance, she goes to term, the child is either born dead, or dies shortly after birth from convulsions. In the liver and kidneys of still-born children of female lead workers that I submitted to Professor Bedson for chemical analysis, there were found minute quantities of lead. Chemical analysis, therefore, confirms clinical experience as regards the cause of death in these children. As to the injurious influence of lead upon maternity I shall give a few illustrations taken from my own and others’ experience. Mrs H., aged thirty-five, worked in a white lead factory for six years, before which she had four children born at full time. Since going to the lead works she has had nine miscarriages in succession and no living child. Mrs M., aged thirty, has had seven children and three miscarriages. The last two children were born and all the miscarriages took place after entering the lead factory. Mrs F. has had three miscarriages since taking up lead work. Mrs K., aged thirty-four, had four living children before going into the lead factory, and two living children afterwards. Still following her occupation, she had six miscarriages in succession, became the subject of plumbism, and was under my care in the Infirmary for a few months on account of colic and paralysis; she made a good recovery, but did not return to the lead factory; next pregnancy she went to term and had a living child, which survived. If additional medical testimony were required to support the opinion I have put forward as to the pernicious influence of lead upon maternity, it is to be found in that of M. Constantin Paul, a French physician, who has published in detail his experience of 15 pregnancies of 4 women working in a type foundry. Ten of these pregnancies ended in abortion, 2 in premature labour, 1 in a still-birth, and 1 in a living child, who died a few hours after birth. In another series the facts are just as instructive. Five women before working in lead had borne 9 children without one abortion. After exposure to lead there was a total of 36 pregnancies. Of these, 26 ended in abortion, 1 in premature labour, 2 in still-births, while 5 of the children born at full time died within one year after birth. Constantin Paul, grouping together a large number of pregnancies, viz., 123, found that of these, 64 ended in abortion, 4 in premature confinement, 5 children were born dead, and 20 of the infants died within the first twelve months. Of 1000 pregnancies reported by Tardien, 609 ended in abortion (_Poisons Industriels_, Office du Travail, Paris 1901, p. 5). In the potteries Miss Paterson and Miss Deane, two of H.M. Inspectors of Factories,[55] found that “out of the 77 married women reported as suffering from lead poisoning during this period (the year ended 31st March 1897) 15 have been childless and have had no miscarriages; 8 have had 21 still-born children, 35 have had 90 miscarriages, and of these, 15 have had no child born; 36 have had 101 living children, of whom 61 are still alive, the great majority of the 40 who are dead succumbed to convulsions in infancy.” Dr J. F. Arlidge,[56] Certifying Surgeon for Stoke, has published his experience of 239 married women working in lead processes in the china and earthenware industry. Of the children born before the mothers worked in lead 40.4 per cent. died. Of each 100 pregnancies there were 7.0 miscarriages, while, during or after lead employment, of the children born only 36.5 per cent. died, and the percentage of miscarriages was 11.8. Of the 239 women there were 71 who had had no children prior to working in lead. These 71 women had subsequently 302 children (of whom 114 died) and 38 miscarriages; that is, for every 100 children born 37.7 died, and 11.1 of every 100 pregnancies resulted in miscarriage. Dr J. F. Arlidge’s statistics show that in female pottery workers employed in lead processes the percentage of miscarriages is higher than in those engaged in other departments, but neither is this nor the death-rate of children born under these circumstances so great as M. Paul, Tardien, and I have found.

If lead exercises a prejudicial effect upon the reproductive powers of women it is also capable, although to a less degree, of diminishing the virility of men. Children of female lead workers almost invariably die of convulsions shortly after birth or during the first twelve months. If a child is the offspring of parents, both of whom are lead workers, it is puny and ill-nourished, and is either born dead, or dies a few hours after birth. The power of lead not only to kill the offspring but to destroy for the time being the child-bearing powers of woman is remarkable, and it is this circumstance, along with the fact that women suffer more readily and severely from lead poisoning, that are the main arguments for keeping them out of the dangerous processes in any industry in which lead compounds are used. It is through the intermediary of the temporary structure known as the “after-birth” that the poison is transmitted to the fœtus _in utero_. Roques (_Mouvement Medical_, 1872), is of opinion that a mother working in lead conveys through her milk to the child she is suckling the metallic poison, and that there is produced a slow and progressive deterioration of the infant’s constitution. Prof. Bedson has analysed for me the milk of suckling lead workers without finding any trace of lead therein. Whether or not lead is only occasionally present in the mammary secretion, it is undesirable that women who have an infant at the breast should work in the dangerous processes.

Lead is a subtle poison. Most of its salts have in small doses no unpleasant taste nor odour, they are very soluble, and they produce their baneful effects sometimes in such an insidious manner that the health of the operative becomes so gradually undermined that he is often precipitated into a serious illness without any warning. In most instances, however, there are prodromata, for lead causes colic or severe pain in the abdomen. Usually this is one of the earliest symptoms to cause a lead worker to seek medical advice, while in others, as just mentioned, there is such a gradual deterioration of health that it is not until the system is thoroughly impregnated with lead and pathological changes have been established in the internal organs that the individual comes for relief. Lead poisoning is widespread owing to the large number of industries into which lead in some form or other enters, and the accidental contamination of our food and drink. The metal gains an entrance into the system through the respiratory passages, the digestive canal, and very occasionally through the skin. It has been demonstrated clinically that the injection of acetate of lead up the nostril has resulted in the absorption of the salt by the nasal mucous membrane, and the production of paralysis. How far very fine white lead dust falling upon the eyelids may be dissolved in the lachrymal secretion and be absorbed, I am not at present in a position to state. Inhaled as impalpable dust, it is drawn into the respiratory passages, where it is dissolved and passes into the blood, or it is suspended in the saliva in the mouth and swallowed. On reaching the stomach it is acted upon by the hydrochloric acid of the gastric juice, converted into a soluble salt, and absorbed. Elsewhere[57] I have given in detail a series of experiments showing the solubility of white lead in the juices of different parts of the digestive tract, which, while confirming, at the same time explains the important fact already known to managers of white lead factories, viz., the great danger of employés commencing work in the factory in the morning without having breakfasted. As lead is a direct poison to the system, nature does her best to eliminate it by the fæces and through the kidneys.

The symptoms of plumbism are manifold. Usually easy of recognition, they are sometimes so obscure as to render the malady difficult of detection even by a careful physician. One of the earliest signs is pallor of the countenance. There is developed a degree of anæmia which gradually increases until the features become altered and expressionless, a form of bloodlessness which since it is characteristic of lead poisoning, is spoken of as Saturnine cachexia. This becomes very pronounced, so that it is easy to recognise lead workers by sight. A few weeks’ work will transform a healthy-looking, florid young woman or man into a pallid and listless individual. During the time that pallor is developing, the individual often complains of a disagreeable metallic taste in the mouth, especially on rising in the morning, and of a distaste for food, so that he proceeds to his work in the morning without breaking his fast. There is no more certain way of courting plumbism than for any one to work in a factory where lead compounds are handled without having food in his stomach. This is a fact which the digestive experiments alluded to in my Gulstonian Lectures have placed beyond all question. It was therefore not only a humane action, but it was a wise step, from a white lead manufacturer’s point of view, when the employers gave a free breakfast to their hands before beginning work each morning in the factory, and it was a short-sighted policy that led them to abandon it.

Two forms of lead poisoning are met with, the _acute_ and _chronic_. It is with lead as with many other poisons. One individual may work for several months or years without suffering, while another may succumb to its harmful influence in as many weeks. The manufacture of white lead is one of the industries that will not allow of familiarity breeding contempt. The most careful worker may suffer, so too may the oldest who has passed unscathed for years. Alcoholic excess predisposes to plumbism. Why colic is such a common and early symptom of Saturnine poisoning is because the alimentary canal is one of the principal channels by which lead enters the system, and lead is known to have a special affinity for muscular fibre and nerve tissue, and to induce spasm. Colic is often attended by vomiting and by obstinate constipation. The pain is of varying degrees of severity. Sometimes it is so mild that the individual is able to follow his occupation but in discomfort. At other times it is so severe that he rolls about in agony, and is with difficulty kept in bed. Occasionally relieved by pressure of the hand upon the abdomen, it is under other circumstances often aggravated by it. The pulse is slow, small, and feeble during the attack, although at times it is found to be hard and showing high tension. In severe colic the individual is collapsed--the face wears an anxious expression--there is sleeplessness, and the function of the kidneys is seriously impaired. Notwithstanding the severe nature of the pain in lead colic and the general derangement of internal functions, the symptoms by degrees yield to treatment. After recovery most of those who have been ill return too early to their employment. One attack of plumbism unfortunately predisposes to another. On examining the mouth of a lead worker there is usually to be seen a bluish line along the margin of the gums close to the teeth. The gums are ulcerated, and in the case of old lead workers they are retracted, and thus expose a considerable length of the fang. Although a valuable help in diagnosis, the presence of the blue line on the gums must not be regarded as an indication that the individual possessing it is at the time suffering from lead poisoning, for the line may be present for months without there being either any complaint or any symptom of ill-health. It tells the tale that the individual has been exposed to lead, and that the metal is present in his system, so that when associated with certain other signs and symptoms the presence of the blue line on the gums clenches the diagnosis of plumbism. The line itself is due to a deposit of sulphide of lead in the epithelial cells of the gum or in the large connective tissue cells present along the ulcerated edges. The blue line is met with under two different circumstances. It may be observed on the sound gums of white lead workers who have recently entered a factory, and who have been employed for a few hours in emptying a stove. If the mouth is rinsed with water it disappears, a circumstance which shows that this line is simply a deposit of lead on and not in the gum. The other is much more permanent: it persists for months despite the use of mouth washes and the administration of medicine internally. I know of no mouth wash, tooth paste, or drug that is capable of removing the blue line from the gum under from eight to twelve weeks.

It is upon the nervous system that the worst effects of lead are seen. Usually after having experienced one or more attacks of colic, but sometimes without these, a lead worker suddenly or gradually loses power in his hands and fingers. His hands become paralysed, hang powerless by his side, and the patient is said to be suffering from “wrist drop.” This renders him unable to feed or dress himself. Both hands are usually affected, but not in equal degree. Bilateral paralysis is always suggestive of some form of metallic poisoning. In “wrist drop” the extensor muscles of the fingers and wrists rapidly waste. As a rule the affection is painless, but in some instances the loss of power is preceded by muscular tenderness. The muscles of the shoulders and upper arm, too, may be affected, or the weakness affects the muscles of the foot, and causes “ankle drop.” When the malady is of a more pronounced type the muscles of the trunk become paralysed. In this form the individual is perfectly helpless: he lies like a log, unable to turn or move himself in bed, and for the time being his condition is usually one of danger. It is characteristic of lead paralysis even in such minor forms as “wrist drop,” that it not only completely unfits the individual to earn his living, but to attend to his own personal wants. The paralysis is slow to disappear even when medicine, massage, and electricity are used.

One of the worst forms of acute plumbism is what is known as acute lead _encephalopathy_, and to this women seem to be more predisposed than men. A female lead worker has perhaps been observed by her friends to have been getting paler and paler, and to have lost her appetite. She complains on getting up in the morning of severe headache which prevents her taking food, but notwithstanding these she goes to work, and is probably not more than an hour or two in the lead factory when she is seen to fall on the floor in convulsions. She is unconscious, and the convulsions come and go. In this condition she is taken home or to an infirmary, where within the next two days she dies, never having regained consciousness; or by the third day consciousness returns, but she keeps moaning on account of severe pain in her head. It is now noticed that she is blind; she loathes her food and is often sick. Recovery is slow. The power of vision may be gradually restored, or it remains permanently lost, and thus it happens that, at a comparatively early age, a young woman who has only worked in the dangerous processes of a white lead factory for a few weeks or months, and who has suffered from acute encephalopathy, not only swims for her life during the seizure, but may be rendered permanently blind, and thereby completely unable ever afterwards to earn her living. In the form of lead encephalopathy that I have just portrayed, there is usually some premonitory headache before the individual is struck down in convulsions, but in not a few instances the warning is of another kind, and of such a nature that it may be overlooked even by experienced medical men. I refer to symptoms of hysteria occurring unexpectedly in a young female lead worker. The patient does not seem ill. There is rather an exaltation than depression of her mental faculties and her feelings, and yet out of what appears to be ordinary hysteria the patient may pass into a state of coma, with or without convulsions, and die within three or four days. Under any circumstance it is a very fine line that divides functional from organic disease of the brain, and in lead poisoning this is particularly the case. To _toxic hysteria_, therefore, which often masks a deeper malady and is apt to throw both the friends of the patient and the medical attendant off their guard, I attach considerable importance as a premonition of acute lead encephalopathy. We have seen that after recovery from acute encephalopathy a patient may remain temporarily or permanently blind, and there may or may not be paralysis, but in some instances the mind is so shattered by the illness that complete consciousness is never regained. The patient passes into a state of acute mania, which is usually fatal, or the symptoms are subacute, recovery is incomplete, and the individual passes the remainder of his or her days in an asylum.

The question of insanity in lead workers has been very ably dealt with by Dr Robert Jones,[58] the Medical Superintendent of the London County Asylum, Claybury, Essex. Taking the proportion of 1 lead worker, in the broad sense of the word, to every 58 of the adult population, there ought to be in Claybury 18 male patients belonging to that class. As a matter of fact, however, out of 1050 males in the asylum, there are 35 who have been lead workers, plumbers, painters, and glaziers, but excluding pottery workers and miners. In examining the histories of 3500 male patients admitted into Claybury, Dr Jones found that of these 133 were artisans, who in their trade had possibly become impregnated with lead; their occupation was as follows:--

Painters 75
Decorators 13
Plumbers 18
Gasfitters 13
Labourers in lead works 6
Grainers 3
Gasmeter Makers 2
Colour Grinder 1
File Cutter 1
Tea Lead Roller 1
---
133
---

Of these, 19 had signs of lead poisoning upon admission, such as paralysis, colic, and blue line on gums, while in 22 there was a history of convulsions (encephalopathy), headache, giddiness, and paralysis. Of the 133 cases the following is the analysis of their mental condition:--

Mania 37
Melancholia 33
Dementia 19
Dementia with Epilepsy 10
Dementia with General Paralysis 24
(?) General Paralysis 7
Alcoholic Mania 3
---
133
---

“The proportion of general paralytics among these possible lead cases is 18 per cent.: the average yearly percentage of general paralytics to the total average number of male patients admitted into asylums for the five years 1893–97 was 13.1, and it appears to me there is a strong presumptive evidence that lead may be a factor in the cause of general paralysis of the insane.” Elsewhere[59] I have drawn attention to the association of lead poisoning and general paralysis, and indicated that as there is in the plumbic form a larger percentage of recoveries than in general paralysis proper, the probability is that the malady is not exactly of the same nature, but is rather a pseudo-general paralysis. Dr Jones summarises his conclusions thus: (1) that lead poisoning is a contributory factor to insanity; (2) that the mental symptoms may be grouped among one or other of the following varieties: (_a_) toxæmia, with sensory disturbances, which tend to get well; (_b_) hallucinations of sight and hearing, usually chronic and irrecoverable; (_c_) general paralysis with tremors, increased knee-jerks, inco-ordination, listlessness, and dementia, which tend to get well.

So far I have depicted the acute rather than the chronic form of lead poisoning. There still remains that form in which the individual, after having been exposed for a lengthened period to the influence of lead, and having experienced one or more attacks of colic, indicating that his system is becoming impregnated with lead, is never well; he is profoundly anæmic, is the subject of frequent headache, imperfect vision, and incomplete wrist drop. Albumen is present in the urine, and there is a slight degree of dropsy of the face, hands, and feet, physical signs that point with these just mentioned to structural alterations having occurred in the kidneys, liver, heart, and blood-vessels, retina, and nervous system. Life drags on from day to day, only to end in a lingering illness, or it is brought to a sudden close either by uræmic convulsions, or in consequence of rupture of a blood-vessel in the brain. At the post-mortem examination in chronic cases the kidneys and liver are found to be hard and their secreting structure replaced by a low form of connective tissue, while in acute lead encephalopathy the brain may be dry on its surface and retracted, on section hard and dry, or watery and pale, the blood-vessels being congested. On microscopic examination very delicate changes have been found in some of the large nerve-cells of the brain and spinal cord, and also in the structure of the liver and kidneys. What, then, is the cause of death in acute lead encephalopathy? In most of my own fatal cases, lead was detected in the liver, kidneys, muscles, and brain, etc. To the fact that lead has been found in the brain, and has probably formed some complex chemical compound with it, may be attributed the convulsive seizures, insanity, and possibly, too, death. At the most it has always been a very minute quantity of lead that has been found in the brain after death. In one of my patients Professor Bedson found on chemical analysis only O.779 grain in a brain and cerebellum that together weighed 51.5 ounces: while from another brain and cerebellum that weighed 48 ounces, he obtained only 0.634 grain of lead. From another brain Professor Bedson removed 4.04 milligrammes of lead, while in a case reported by Mr Wynter Blyth there were 99.7 milligrammes of sulphate of lead found in the brain and 17.4 in the cerebellum. A brain whose nerve-cells have become poisoned by lead cannot functionate as in health, but as in some of the rapidly fatal cases of encephalopathy, occurring in young female lead workers hitherto healthy, no trace of the metal was detected in the brain on careful chemical examination, death must have been caused by some other circumstance than the hypothetical presence of lead in the brain. The human body is a laboratory, wherein even in health animal products are hourly being formed, and which if retained in the system would poison the individual. Were it not for the activity of such eliminating organs as the kidneys and bowels, life would be constantly menaced by this auto-intoxication. Lead in some people rapidly induces structural changes in the liver and kidneys, or it quickly interferes with the functional activity of these organs, so that poisonous materials generated by the individual himself are not removed. It is the circulation of these in the system and their action upon the brain, aided probably by the presence of a soluble compound of lead in the blood, that is the cause of the convulsions and death in some cases of acute lead encephalopathy. Occasionally lead workers are admitted into hospital suffering from convulsions and delirium, which are not due to lead, or at any rate to lead alone. In many of these cases there is a strong alcoholic history, that it is difficult to say how much is due to lead and how much to alcohol. Alcohol we know predisposes to plumbism.

_Treatment--Preventive and Curative._

Of precautionary measures requiring mention I would allude to the avoidance of excess of all kinds on the part of the workpeople, including the use of alcohol; to the need of nutritious food, plenty of milk, and the avoidance of acid fruits; attention to personal cleanliness as secured by frequent washing, change of working clothes, good ventilation of the workrooms, and the wearing of respirators.

A year ago, M. Armand Gautier presented to the Prefect of Police in Paris a report in which he showed that in Paris alone there were upwards of 30,000 persons exposed to the fumes, dust, and combinations of lead, and that the hospital treatment of the working people whose illness was due to lead poisoning cost the municipality a very large amount of money every year. In an earlier report presented to the Council d’Hygiène, and dealing with the admissions into the hospitals between 1870–80, he showed that this expense corresponded to a residence of 11,140 days in these institutions. In 1881 the French Government appointed a Commission to inquire into the prevalence of lead poisoning, and to draw out regulations. The enforcement of the rules was followed by a decided improvement in the number of cases. From 1881 to 1883 the number of patients fell from 552 to 421, and the number of days spent by patients in the hospitals fell one-half. This satisfactory decrease, however, was not maintained, despite the fact that the Clichy white lead works, which used to contribute nearly 50 per cent. of lead cases, was closed, and new methods of production had been introduced. So far as white lead works are concerned, there is not the least doubt that the substitution of the moist for the dry method of dealing with lead carbonate materially diminished the amount of ill-health among the workpeople, and yet, while this improvement was taking place, the number of cases of plumbism rose all over Paris, owing to an increase in the amount of lead used in other trades, which had not attended to hygienic requirements. The number of fatal cases also of lead poisoning in Paris rose. Of 552 patients ill between 1877 and 1880, 5 died; of 248 ill between 1887 and 1889, 16 died; of 302 ill between 1890 and 1893, died; while of 314 ill between 1894 and 1897, 17 died. The fact therefore remains that since 1881, when fresh and more stringent regulations for French white lead workers were introduced, the number of patients suffering from lead poisoning, and dying from it, in Paris, has risen. The explanation of this anomaly is to be found in the fact that the victims of plumbism are no longer supplied by the white lead works in the same proportion as formerly, but that they come from other industries that have not yet been brought under the regulations. Of these industries house painting has contributed the largest number of patients. This trade, along with colour grinding, supplied no less than 223 patients during the years 1894 to 1898. The proof that improvement in methods of manufacture, _e.g._ the substitution of the wet for the dry method, has been satisfactory, is shown by the fact that before the introduction of the regulations of 1881, white lead operatives occupied the second line on the list of dangerous trades, to-day they occupy the sixth. It is in consequence of the increasing prevalence of Saturnine poisoning in house painters that the agitation at present going on in Paris against the use of white lead as a pigment, and alluded to in previous pages, has reached such dimensions.

A few years ago the white lead works at Clichy furnished for a long period nearly one-half of the cases of plumbism admitted into the hospitals of Paris. Demolition of this factory was followed by a rapid diminution in the number of cases of lead poisoning seeking admission. This circumstance shows that in some factories the conditions under which the work is carried on are more unhealthy than in others. On Tyneside we are not without a similar experience. There are some white lead works in which there is always more plumbism than in others, and the explanation is that either the works are older and the ventilation worse, or that the general management is in some way or other not so good. It is the same class, often the same people, who work in all the factories, for they occasionally migrate from one to another, and yet there remains the undesirable fact of a larger amount of sickness among the hands in some of the works than in others. As an illustration, take for example the lead-poisoned patients admitted into the Royal Infirmary, Newcastle-upon-Tyne, from October 1890 to March 1893--

Factory _A_ 52 cases.
“ _B_ 15 „
“ _C_ 8 „
“ _D_ 5 „
“ _E_ ... „
Other factories 8 „
----
88
====

Of 88 patients, one factory, not the largest, supplied nearly two-thirds of the total admissions. As illustrating the preventableness of industrial white lead poisoning, it is worth mentioning that in one of the largest and best conducted factories in the Newcastle district, there has only been one fatal case of lead poisoning within the last twenty years, and since the enforcement by the Home Office of the recommendations of the White Lead Committee, the factory that sent 52 out of the 88 cases stated in the preceding table to the Infirmary in two and a half years, at present scarcely sends one patient per annum. Lead-poisoned females are now practically never met with in Newcastle, and male patients are becoming every year rarer. As long ago as 1849, Combe proposed that instead of washing, then drying the white lead in stoves, and subsequently packing it in barrels for sale, it would be safer from a worker’s point of view, since it would rid the atmosphere of dust, if the lead carbonate on its removal from the white beds were ground and washed at once in water, then forced to travel through a series of rollers and washers into oil under rollers. The oil displaces the water, and as a consequence the white lead escapes from the last roller as finished paint.[60] In order to obtain the white lead as a paint, the soft paste as it comes from the grinding stones, and which contains 15 to 20 per cent. of water, can be at once mixed and incorporated as it passes through the rollers with increasing fractions of 10 per cent. of oil. The water is thus gradually eliminated from the paste, so that the product as it escapes from the last roller contains hardly 1 per cent. of water, can be packed, and is ready for the market. Mr T. H. Leathart of Newcastle-on-Tyne, who has adopted this method in his works,[61] informs me that the paint is, practically speaking, free from water, there being not even .5 per cent. of it in the finished product. By the adoption of this method of manufacture there has not only been a saving of labour, but better health among the workmen, owing to the absence of dust. This small change in the method of manufacture has had a wonderful influence on health. The grinding and packing of all dry white lead should be conducted in hermetically-sealed compartments. Even to this there is the drawback that as time goes on, owing to the vibration of the machinery, the joints of the wood and iron become loose and the dust escapes. The defect, however, can be easily remedied.

In 1899 the Chief Inspector of Factories issued special rules for white lead works, which were an advance upon those of previous years, and which have undoubtedly diminished plumbism in this industry. It is unnecessary to reproduce these rules here, but the main points included in them are that plans for new works or structural alteration of old factories must be submitted to the Chief Inspector of Factories; white beds must be watered when being emptied; drying stoves are to be ventilated, and no person is allowed to draw a Dutch stove on more than two days in any week; no women are allowed to work in the white beds, rollers, washbecks or stoves, or in any place where dry white lead is packed, or in other work exposing her to white lead dust; there must be weekly medical examination of every person employed in a lead process, with suspension in the case of illness, and medical re-examination before returning to work; suitable respirators, overalls, and head-coverings must be provided by the occupiers; adequate washing appliances are required, with cessation of work ten minutes before each meal-time and the end of the day’s work for the purpose of washing. The duties of persons employed are similarly defined, and any person obtaining employment under an assumed name or on any false pretence is liable to a penalty. It is enacted, too, (Factory and Workshop Act, 1891, sections 9 and 11) that the rules shall be kept posted up in conspicuous places in the factory, so that they can be conveniently read by the persons employed. Any person who is bound to observe the rules and fails to do so, or acts in contravention of them, is liable to a penalty. In such cases the occupier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing, and to the best of his power, enforcing the rules, to prevent contravention or non-compliance. To extreme temperance in the use of alcohol, and to a weekly or fortnightly alternation of employment for the workpeople in the factory, I attach great importance as preventive agents.

A sanitary drink has to be provided for the workers by the employers. It is usually composed of Epsom salts and lemon juice, or some other acid, dissolved in water. The provision of an acidulated drink for persons employed in white lead works is a subject to which the members of the White Lead Commission gave considerable attention, but I candidly confess that the Committee never attached any great importance to it as a means of preventing plumbism. The theory upon which its administration is based is that the sanitary drink converts any lead which may have been swallowed into the rather insoluble sulphate, and that thereby the risk of plumbism is diminished. When the drink contains a slight excess of acid, then instead of being a safeguard it may become the reverse. Besides, after all, lead sulphate is not very much less insoluble in gastric juice than lead carbonate, and the men who go to the barrel to obtain the sanitary drink are not careful enough to rub their moustache clean before drinking. Within limits, when carefully prepared and not too acid, the sanitary drink possesses certain advantages on account of its being a mild aperient, but beyond this it is only doubtfully a preventive. The workpeople should be given to understand that there is no real antidote to lead poisoning, and that they must be constantly on their guard against it. Personal cleanliness is, I repeat, of the greatest importance. Such drinks as the acid lemonade just described, milk and coffee, etc., however useful they may be of themselves, cannot altogether prevent lead poisoning, and it is unwise therefore to allow the workpeople to shelter themselves under this belief.

_Curative._--During the attack of colic, warm applications to the abdomen, and the administration of a mild aperient, such as magnesium sulphate or castor oil, especially if there is constipation, and there is the prospect of the medicine being retained on the stomach. Occasionally a warm bath may be called for, or if pain is severe, the administration of a hypodermic injection of morphia. In milder cases, or when the immediate urgency of the colic has passed away, iodide of potassium is a good eliminant, but the internal administration of this drug in plumbism requires caution, since it may dissolve out lead that has been deposited in the tissues, flush the blood with a soluble lead salt, and thereby aggravate, and often dangerously too, the symptoms of lead poisoning. For paralysis the internal administration of iodide of potassium with nux vomica, and the use of massage will, in most cases, succeed, but recovery is usually slow and often incomplete. Electricity gives encouraging results, and as practised in the manner suggested by Dr Lewis Jones (see p. 375), has been productive of a great amount of good. For acute lead encephalopathy the subcutaneous injection of pilocarpine and the inhalation of nitrite of amyl have in my hands answered well. Bleeding, and the injection of large quantities (about 500 centimetres) of an artificial serum made from sulphate of soda, 5 grammes; common salt, 1 gramme; corrosive sublimate, 0.05 gramme; and distilled water, 200 centimetres, under the skin of the abdomen, is a line of treatment that finds favour with many French physicians. I need scarcely add that lead poisoning is too serious a malady for its treatment to be undertaken by the laity without the advice of a doctor.

_Chromate of Lead; Dye Works._

The use of chrome dyes has been followed by lead poisoning which in a few instances has ended fatally. Chrome dyeing by means of lead compounds was one of the unhealthy occupations relegated by the Home Secretary to the Dangerous Trades Committee for its opinion. The dye is obtained by mixing a solution of bichromate of soda or potass with sugar of lead, or by acting upon lead carbonate with a solution of bichromate of soda or potass. In the Final Report of the Dangerous Trades Committee, p. 26, it is stated how the different colours may be got. To obtain _deep orange colour_, hanks of yarn are dipped first in a solution of lime, and then in a solution of brown sugar of lead; the dip is again repeated, and after this the hanks are dipped in bichromate of potass or soda, and finally they are boiled in lime water. For _yellow chrome_ colour the treatment is similar, with the exception that the goods are not boiled in lime water, but washed in dilute hydrochloric acid. To obtain _chrome lemon_ colour, the yarn is dipped first in an alkaline lead solution, then in bichromate of soda, and subsequently washed in cold water. _Green chrome_ is got by dipping the lemon-stained yarn in an indigo bath. In all of these processes the bichromate of soda acts upon the lead and produces a chromate. This forms not so much a dye as a coloured coating on the surface of the fibre of the yarn. In the process of dyeing no risk to health is incurred by the workpeople. The danger commences when the goods have become dried and the coloured dust of chromate of lead is given off, as may be seen in the noddling and bundling departments of a factory. In several large dye works, both in England and Scotland, I have seen the girls who handle and pull the yarn covered with yellow dust, found them anæmic, complaining of headache, and showing a well-marked blue line on their gums, while several of them complained that they had suffered from colic, and been off work through it for a time. In some instances more serious symptoms developed. A fatal termination is not unknown. The contents of the stomach when vomited often exhibit the same colour as the yarn the girls handle. In one mill there was quite an epidemic of lead poisoning among the women owing to some of them, on account of the cold weather, having stopped the running of the fan. As a consequence the atmosphere of the carding-room became impregnated with yellow dust, and many of the girls became ill, one of them dying from unmistakable lead poisoning. When the fan was re-started all the illness disappeared. Improved ventilation puts an end to poisoning in chrome dye works. The dust-laden air ought to be drawn down and away from the workers. In the dyeing of cotton, lead compounds are similarly used, but an effort is being made to supplant these by aniline and vegetable dyes. Whether aniline colours are capable of entirely taking the place of lead chromate under all circumstances of climate, etc., still remains to be seen. The opinions of manufacturers are divided upon the point of aniline dyed goods standing exposure to the sun like those coloured by lead chromate. Some maintain that the colours are not so permanent. The subject is therefore not yet ripe for the expression of an absolute opinion. Another danger to which workers in chrome dyeing works are exposed, is the occurrence of chrome holes or scars on the hands of the men who work with the bichromate solution. Perforation of the septum of the nose does not occur.

_Calico Printing._

This subject may be conveniently discussed with that immediately preceding. The pattern is printed on the cotton cloth in lead salts. The cloth is then passed through a solution of bichromate of soda. Only the letters or portions of the pattern that have been printed in lead retain the chrome colour. There is no risk to the operative in the process of printing. The danger resides rather in the dust given off in the drying-room, to which the cloth is taken. Here, owing to the heat of the room and the handling of the calico, a certain amount of dust may be present. The question of aniline substitutes for lead has been discussed by manufacturers, but among them there is no unanimity upon the matter, especially in those engaged in the export trade. In indigo blue dye works where the calico is printed with copper sulphate and lead acetate, the men may suffer as much from the copper as the lead.

_Enamelling of Iron Plates and Hollow Ware._

The enamelling of iron plates is an industry which is mostly confined to Birmingham and Wolverhampton and their immediate neighbourhood. Enamelled iron plates are used for advertising purposes, for announcing the names of railway stations, etc. The process of manufacture consists in first cleansing the iron plate, smearing it with gum-water, and sifting a fine dust on to it, or in allowing to trickle over it powder suspended in water. The powder may contain as much as 25 per cent. of lead, or in some instances no lead at all. The plate having been coated in one of these ways is placed in a furnace and exposed to an intense heat. On removal it is seen on cooling to have received its first coat of enamel. In order to obtain the required red, blue, or brown colours the plate is subsequently swilled. The colours are put on at first roughly with a broad brush, and then a finer one so as to get an even surface, after which it is smoothed by a camel’s hair brush. The plate thus swilled is allowed to dry on hot pipes at a moderate temperature. The process up to this stage is wet, and therefore not dangerous, besides the lead compounds used are often fritted, and these are known to be very insoluble. It is in the subsequent treatment known as stencilling that the danger commences. This part of the work is generally done by women, who by means of a nail-brush rub off the colour on the surface of the plate which is exposed through the openings cut in the stencil, and which correspond to the alphabetical letters, etc., of the advertisement. This is a very dusty process. The atmosphere of the workroom becomes thick from the coloured particles of dust given off from the plate, and these fall upon the hair and clothing of the workpeople. There is often a large percentage of lead in the dust, so that when this is inhaled for several hours, during each working day in the week, it becomes a cause of plumbism occasionally of a severe character, and running to a fatal termination.

Brushing-off through the stencil is usually performed over perforated tables down which there is a strong draught, but if the aspirating force is weak the dust rises and impregnates the atmosphere, so that it is almost impossible to see across the workroom. After the plate has been stencilled it is again placed in the furnace, and the processes of swilling, drying, stencilling, and firing are repeated according to the kind of colours required in the advertisement. These processes may be repeated as many as eight or nine times. Red and other compounds of lead are largely used for enamelling, and may be present to the extent of from 25 to 33 per cent. Formerly arsenic was also used, but such serious consequences followed that its employment has been discontinued.

In this industry, as in white lead works, it is the young female operatives who are the most susceptible to plumbism. A few years ago there was a great amount of ill-health among the hands owing to imperfect ventilation of the workrooms. The White Lead Committee recommended that there should be a medical inspection of all the workers once a month, and that no girl under 20 years of age should be employed as a brusher-off in the stencilling process; that no female should be employed without medical testimony as to her fitness for the work, experience having shown that anæmic, scrofulous, and ill-nourished persons are more predisposed to plumbism than those that are healthy; that after an illness of any kind a medical certificate should be furnished. The Committee would have been glad if the employers could have seen their way to give half a pint of milk every forenoon to each of the workers, for experience has shown, both in this country and abroad, that milk is to some extent a prophylactic against plumbism. Dr Morison Legge,[62] in his report upon the enamelling of iron plates, says that for last year only 10 cases of lead poisoning occurred in 689 persons engaged in the dangerous processes. He attributes the fact of the cases being few to the periodic medical examination, the removal of dust by fans, and the encouraging efforts which are being made by large firms to substitute other things for lead.

_Tinning and enamelling of the hollow ware_ used for culinary and domestic purposes is an industry confined for the most part to Wolverhampton, Bilston, and Dudley. The iron kettle or saucepan about to be tinned is first cleaned or prepared by being swilled in a mixture of dilute hydrochloric acid and chloride of zinc. The process of _tinning_ consists in dipping the utensil into a trough containing molten tin and lead in the proportion sometimes of 60 per cent. of metallic lead and 40 of tin. Owing to tin being the more expensive metal, the cheaper ware is often dipped in a composition of 70 per cent. of lead and 30 of tin. The dangers incidental to tinned hollow ware are twofold: first, if the workman who dips the utensil in the molten lead is not careful, cleanly, and temperate as regards the use of alcohol, he may suffer from lead poisoning; and secondly, the poorer working classes, who buy the cheaper ware, which has been nominally tinned but is in reality leaded, also run the risk of becoming poisoned by the food either having become contaminated by lead in the act of cooking or subsequently. When the cauldrons containing the molten metal, into which the workman plunges the pans, etc., are hooded, the fumes are not so readily inhaled. It is a common belief among these men that the poison enters the system when they are wiping off the metal from the hot sauce-pans, etc., by means of tow. In the white enamelling of iron hollow ware many manufacturers are now using a leadless glaze with every promise of success.

The enamelling of copper letters or tablets is shown by Dr Legge to be a source of plumbism. Four cases were reported to the Home Office in 1900. The danger occurs during the “brushing on” and “wooling off” of a black enamel powder, which was found to contain as much as 67.0 per cent. of lead.

_Electric Accumulator Works and Lead Poisoning._

The manufacture of electric accumulators for telegraph and telephone purposes and for motor cars has become a very important industry, and is likely to become still more important as time goes on. There is one process in the manufacture which is distinctly dangerous. The workmen who rub the red lead, made into a paste by means of dilute sulphuric acid, on to embossed or perforated plates occasionally suffer from plumbism. When the plate leaves the workman its interstices look as if they were filled with red clay. Both sides of the plate have to be treated by the workman, whose hands are generally covered with indiarubber gloves. During the mixing of the dry red lead or litharge with the dilute sulphuric acid a considerable amount of dust is created. The indiarubber gloves which are worn by the men who fill the perforations in the plates with the lead paste become in time thin and worn, or they get torn, and as a result certain parts of the hands of the men become coated with the red composition. By this means, as the work entails a considerable amount of friction, lead poisoning may readily occur. In visiting electric accumulator works, I found several of the workmen, especially the younger men, extremely pale, and suffering from headache; some of them had been laid off with colic, and they presented a well-marked blue line on their gums.

The colic of electricians is not a new disease. In one electric accumulator works in La Hague in 1894, there occurred 37 cases of plumbism in 252 male workers; and in another factory in Wiesbaden 12 cases of lead poisoning occurred in 90 workers. Of 30 patients suffering from lead colic admitted into the Hospital Bichât, Paris, during 1899, Talamon says more than one-half were electricians, the remainder being made up of painters, plumbers, and typographers. So prevalent had lead poisoning become in Germany that the Imperial Health Office directed an inquiry[63] to be made into the conditions of labour in electric accumulator works. In consequence of this, special rules were issued, and as these now govern the industry in Germany, it will not be out of place if I quote at some length from the Report, a translation of which has been kindly placed in my hands by Dr Morison Legge. The information embodied in the Report was collected by a circular letter of the Chancellor, and deals with the extent of the manufacture of accumulators and the dangers of working. From one factory alone the following particulars were received as to the special incidence of plumbism in particular processes.

+------------------+-----------+---------------+-----------+
| | Number | Number of | |
| Occupation. | Employed. | Cases of Lead | Per cent. |
| | | Poisoning. | |
+------------------+-----------+---------------+-----------+
| Casting | 30 | 3 | 10.0 |
| Pasting | 30 | 9 | 30.0 |
| Soldering | 16 | 6 | 37.5 |
| Trimming | 30 | 4 | 13.3 |
| Plumbing | 30 | 9 | 30.0 |
| Section Building | 60 | 5 | 8.3 |
+------------------+-----------+---------------+-----------+

As regards remedial measures, special attention was directed to: (1) casting and preparation of the plate; (2) mixing the paste; (3) actual pasting; (4) the drying and building into batteries of the various segments; (5) forming and changing plates. As regards these various headings the information gathered is as follows:--

(1) Ordinary lead, often containing a trace of antimony, is used for casting the plates. From the surface of the lead in the melting pots fume rises (oxide of lead), so that it is recommended to have the melting pots arranged that they can be provided with an efficient hood and shaft leading either into the open air or into a chimney. The need for these precautions lies in the fact that not only are the fumes of lead and antimony harmful when inhaled, but commercial lead often contains traces of arsenic, varying from 0.1 to 7.9 per cent.