Chapter XIX: Lead and Its Compounds (3)

(2) Litharge and red lead are used for making the paste, and as these come to the works in casks, the dry material is transferred from the cask to the worker’s bench by means of a shovel or trowel. Dust thus becomes scattered about in all directions. It is, therefore, desirable to have the floor of the workrooms moistened and swept daily. The mixing of the red lead and sulphuric acid should be done in a closed chamber or under an exhaust shaft.

(3) As regards the wearing of gloves by the men who paste the plates, reference is made to the difficulty of keeping the gloves in good repair. The same difficulty, as I have already mentioned, occurs in Britain. In some of the electric accumulator works the gloves worn are too short. The dry red lead occasionally gets inside the gloves, and as these tend to keep the hands hot and cause them to perspire, plumbism is rather encouraged than prevented, or skin eruptions develop. In order to avoid, therefore, as far as possible absorption of lead by the skin, two alternatives are put forward by the German Committee of Enquiry: (_a_) the work is not to exceed eight hours a day, to be broken by a pause of at least one and a half hours; or (_b_) there is to be one six-hours’ spell of work in the day. The Committee is in favour of the latter. Respirators for the men engaged in pasting are not considered necessary.

(4) In building up the batteries by means of solder, ordinary solder is not used, but a very pure lead instead, in order that the connections made between the plates may not be affected when they are subsequently exposed to the acid. To bind these plates together by solder, the heat from an oxygen or hydrogen blow-pipe flame is used, but frequently the temperature reaches a height sufficient to cause volatilisation of the lead, and statistics show that persons engaged in this occupation run a considerable risk of lead poisoning.

(5) Opinions were found to differ as to the effect of the dilute sulphuric acid vapour in the formation-room upon the workers. There was said to be medical testimony as to its good effects upon workpeople, who are the subjects of chronic bronchitis. Reference is made to the difficulty of providing fans for ventilation of these rooms owing to the deleterious action of the acid upon the metal contained in the fan, and yet some form of artificial ventilation is necessary.

The method adopted in the factory of determining the presence of lead in the air was the simple one of suspending, at the level of the worker’s head, a sheet of blotting paper, 100 centimetres square, previously moistened. Subsequent treatment with dilute acid and exposure to the action of sulphuretted hydrogen showed whether lead was present or not.

_Motor Cars._

In Paris, motor cars are much more in evidence than in this country. There are very few in London compared with the French capital. Dr Proust has reported four cases of lead poisoning in Paris, in women aged eighteen, nineteen, twenty-five, and thirty-nine years respectively, whose work consisted in coating with oxide of lead small leaden rods, and fixing them in position. All of these women entered the electrical department of motor car manufactories in good health. At the end of six weeks to two months they had colic, loss of appetite, constipation, and abdominal pain of such severity that they had to be taken to the hospital, and detained there under treatment for more than a fortnight. In one patient the symptoms of plumbism returned shortly after resuming work. With the dangerous nature of the occupation the employers were quite familiar. They not only paid a doctor to visit the works once a week to examine the workers, but they were in the habit of giving to the female workers honey and sulphur, iron pills, and half a litre of milk daily. Ample provision was made for washing; tooth-brushes were provided, also sulphur baths once a fortnight, and yet, notwithstanding these precautions, four of the women quickly developed symptoms of lead poisoning.

_Electric Tramways._

An accident of rather a peculiar character occurred on 8th Oct. 1901, on a tramway car in Paris. I state the facts for what they are worth. During the course of the evening, nearly a dozen of the travellers were suddenly seized with violent pains in the abdomen and by syncope, and were obliged to be treated at a chemist’s shop _en route_. On an inquiry being instituted, the opinion was expressed that the symptoms were due to poisoning caused by fumes given off by sulphuric acid acting upon the lead in the electric accumulators.

_Recommendations._

It is evident that as electricity will be the motor power of the future and will be turned into numerous channels of application, the number of electric accumulator works in Britain is sure to increase. The necessity for putting into force several of the recommendations mentioned in these pages is almost sure to arise. So far as the hygiene of the works is concerned, the same rules ought to apply to them as are now in force in red lead works.

_Soldering._

Common solder is an alloy of tin and lead, equal parts. Fine solder is composed of 2 parts of tin and 1 of lead; coarse solder, of 2 of lead and 1 of tin. The extensive consumption of tinned meats and fruits is responsible for some cases of plumbism, owing to the acid juices dissolving some of the lead out of the solder, but workmen who solder, _e.g._ tinkers, have been known to suffer from paralysis of the muscles of the fingers and hands, owing to volatilisation of the lead and inhalation of the fume.

_Typefounding_; _Printing_; _Typesetting_; _Linotyping_.

Type metal is an alloy of lead with ⅓ to ¼ of antimony. The antimony is added to harden the alloy, for lead is a soft metal. Occasionally small quantities of tin and copper are added, so that the alloy may be composed of 70 parts of lead, 18 of antimony, 10 of tin, and 2 of copper.

We have already dealt with the smelting of lead ore and the melting of pig-lead. The smelting of antimony ore is not attended with such serious risks to health as is the case with lead. One of the largest antimony works in this country is on Tyneside. I have had the privilege of visiting the works and of examining the workmen. The raw ore or sulphide comes from Japan. It is smelted with iron filings. No constitutional bad effects were noticeable in the men who smelt the ore. To some extent this freedom from illness may be due to the fact that the men are not closely exposed to the fume, and that, owing to good ventilation, the fumes were quickly got rid of. The only trouble the workmen seemed to experience, and it was more of a complaint than an illness, is that as the work is hot they perspire freely, and the skin in consequence becomes extremely irritable and itchy. An eruption appears on the skin. This at first shows itself as a crop of vesicles, which ultimately become pustular. Formerly more than now it was a medical practice in the treatment of disease to apply an ointment composed of tartrate of antimony to the skin in order to bring out a pustular eruption, which acted as a counter irritant. Knowing this to be the local action of antimony, it is easy to understand, therefore, the development of the skin eruption spoken of as “pox” upon the neck and upper part of the abdomen in antimony workers. Eulenburg says that exposure to the fumes of oxide of antimony is followed by pains in the region of the bladder and urethra, and by impotence in the male. My experience does not confirm this statement. Several of the men looked rather pale, probably as the result of exposure to the heat, and a few of them had suffered from gastro-intestinal pains like colic, usually relieved by taking a dose of Epsom salts. A case of industrial antimony poisoning is published in the Report of the Chief Inspector of Factories for 1900, p. 332. It is that of a man who had worked as an extractor of the metal, and who in consequence of having inhaled the fumes suffered from paroxysmal attacks of difficulty of breathing without any physical signs of disease in his lungs. He complained of a sense of constriction in his chest, nausea, a metallic taste in his mouth, backache, weakness in the muscles of his legs, profuse perspiration, headache, and dimness of vision.

It is, however, not so much with antimony as with the presence of lead in the printers’ type that we are here concerned. Printers’ colic was a much more common malady two or three decades ago than now. It is due to handling the type, and to the dust that is given off. Typefounders also suffer from plumbism, but in not a few cases the illness has been caused by the workpeople eating their food without previously washing their hands. Printers as a class are often pale and unhealthy looking. Much of this may be due to the fact that they work in overheated rooms for long spells at a time, and have late hours. H.M. Medical Inspector of Factories reports that during 1900 there were 17 cases of lead poisoning in printers. One of the patients died. Ten of the men were compositors, 4 were linotypists, and 2 stereotypers. Dr Stühler, of Berlin, taking his statistics from the reports of sick benefit societies, states that of 3000 printers in Berlin 313 were annually sick from lead colic, _i.e._, about 10.4 per cent. of printers’ compositors suffer from plumbism, either by absorption through the skin, caused by handling the type that has become oxidised during wear, or by swallowing the dust through eating with unwashed hands. Fromm discusses this subject, and alludes to the analyses of dust of printing-houses made by Stumpf, who found that it contained often as much as 14.43 per cent. of lead. In a report recently presented to the German Board of Health, Faber states that he found in the dust collected from the floor 11.51 per cent. of lead: that the dust taken from a shelf in the room contained 6.59 per cent. of lead, while dust collected in the gangway between the desks in the composing room of a newspaper office contained 4.7 per cent. of lead. In analysing the air of printing shops Keygi[64] found that the dust contained from 10 to 15 per cent. of lead, which came from the wear of the type. Inhalation of the dust of the oxidised metal in all probability, therefore, plays a very important part in the causation of plumbism in printers’ compositors. During 1900, printing was in Britain responsible for 17 cases of lead poisoning. In 2 of the cases there were symptoms of lead encephalopathy, one of which proved fatal, and in another there was paralysis. Ten of the patients were compositors and 4 were linotypists.

It has to be borne in mind that compositors do a great deal of their work in an artificial light. As they are obliged to handle type very freely, the skin on the inner aspect of the last phalanx of the right thumb, forefinger, and midfinger occasionally becomes thick and hard, also the skin of the last phalanx of the left thumb, and the interdigital eminences of the left hand. According to Choquet, typographers suffer from two distinct maladies, one directly due to the mechanical nature of their work, and the other attributable to the medium in which that work is carried on. Standing on their feet for long spells at a time, they run the risk of developing varicose veins, and as the rooms are either too brilliantly lighted, or the reverse, to affections of eyesight. Older compositors frequently show a trembling of the right hand, due to fatigue caused by grasping and distributing the type, but in producing this tremor plumbism no doubt plays a part. Analogous to writers’ palsy, the tremor is sometimes so persistent that it obliges the individual to renounce his work. The channels by which lead dust effects an entrance into the system are the buccal and nasal mucous membranes, the skin, the respiratory passages, and the alimentary canal. So slight are the initial troubles of the typographer, that for a time they are unperceived. Acute plumbism does not occur among compositors, it is always chronic. By degrees the individual begins to look pale; the skin becomes greyish and exhibits a slightly jaundiced tint; the appetite, too, fails, and digestion becomes weak, and obstinate constipation occurs. A blue line, if sought for, will be seen in the gums, and there is complaint of an unpleasant metallic taste in the mouth. The breath becomes fetid, and motor and sensory troubles develop, especially at those parts that have been brought into the closest contact with the type. Often commencing with a sense of fatigue in the muscles, the paresis proceeds to motor paralysis. In female typographers excessive menstrual losses, such as are known to occur in female white lead workers, have been noted.

Whatever tends to interfere with the elimination of lead from the system encourages necessarily the development of plumbism. Alcohol has this tendency. It is said that if the skin of a compositor gets broken, the wound heals slowly and is apt to become erysipelatous, but I have not observed this. Some typographers are more susceptible to plumbism than others. It is largely a question of well or ill ventilated workrooms, and of personal resistance. Tanquerel found in France that the ages between thirty and forty years gave the largest amount of ill health, and that in the hot seasons of the year most cases occurred. Dr Motais, who is a member of the Departmental Council of Hygiene of Paris, in an address recently delivered at a conference of typographers, recited a story of animal life which had been told to him by some of the printers themselves. For twenty years these men had tried to keep cats in the workrooms. The animals were well fed; they received plenty of milk. For a time all would go well with them, and then the same train of symptoms would invariably develop; the eyes would lose their healthy lustre, the limbs become paralysed, and the animals die, presenting the same cerebral symptoms as are observed in the acute lead encephalopathy of man.

_Precautions._--Printing houses should be so situated that free currents of air can get to them, and not, as at present is too frequently the case, shut in by other buildings. Plenty of daylight and, if possible, sunlight are very desirable; daylight if introduced by one side should enter preferably on the left of the compositor, so that no shadow is thrown upon the case that contains his type. Light coming in from the roof obviates all this. So far as artificial lighting of the rooms is concerned, there is an opinion that the electric light is more hurtful than gas, and gas again more harmful than lamps. There should be tinted shades on the gas or lamps, green externally, white internally. The workroom should be well ventilated and without draughts; any dust generated should as far as possible be removed by fans. The type boxes should be kept clean and the floors periodically watered. By young compositors long hours ought to be avoided. No food should be eaten in the workrooms. Compositors should never do any work fasting, and should avoid smoking when at work. Excesses of all kinds ought to be avoided, particularly the immoderate use of alcohol. Milk should be freely taken. On the occurrence of colic, the individual should at once give up his work and be medically treated. Washing the hands and rinsing the mouth before eating are absolutely required, also a bath once a week, and the wearing of overalls when at work.

It is an old opinion attributed to the French physicians Tanquerel and Pidoux, that there exists an antagonism between plumbism and pulmonary tuberculosis. Facts so far as applied to compositors do not support this statement, hence the desirability of printing houses receiving plenty of sunlight, and of the undesirability of persons who are bronchitic or susceptible to lung diseases being allowed to work in printing houses, unless they are careful of how they dispose of their expectoration. One of the great foes of the printer is pulmonary phthisis. Much of this is undoubtedly preventible, since the disease is encouraged by the unhealthy conditions under which the work is carried on. Smith[65] found that the mortality from consumption was 60 per cent. greater than in most of the other trades. Of 799 deaths published by the London Society of Compositors for ten years, 1880–1889 inclusive, Arlidge found phthisis as the cause of death in 296, bronchitis and asthma in 85, pneumonia and pleurisy together were responsible for 67 deaths, paralysis and apoplexy for 61, and Bright’s disease for 21. Pulmonary phthisis caused 37 per cent. of the deaths. The largest number of deaths occurred between the ages of thirty and forty years. Since the statistics given by Dr Arlidge are more than ten years old, and as tabulated are not comparable with the general death-rate all over the country of persons between twenty to sixty-five years of age, I communicated with the Secretaries of the Typographical Association, also the London Society of Compositors, for their annual reports, from which I am able through the kind assistance of Dr Henry Armstrong, the Medical Officer of Health for Newcastle-on-Tyne, and his clerk, Mr Gillinder, to supply more recent information, as indicated in the following table (pp. 329–330).

These statistics unfortunately are not exactly comparable: the time periods are not the same for all three. This is unavoidable, owing to the census returns for later periods not having been published while I write. They are, however, not without value, for they strengthen the suspicion of greater liability of the printer to pulmonary disease.

The figures underlined in column 12 indicate the increased tuberculosis mortality rate of the two associations as compared with the whole of England and Wales. In column 11 it will be observed that in the Society of Compositors there is an increase in tubercular disease, but not great, over the corresponding rate for the entire country. It may be therefore taken as a fact that printers are more liable to tubercular consumption than men engaged in most other trades. In the half-yearly Report of the Typographical Association ending December 1900, there is a list of 74 deaths for the half-year in the Society, whose members number 16,179. Of these 74 deaths, 32 were caused by pulmonary disease, and of these 32 deaths, 22 were caused by tubercular disease, mostly pulmonary phthisis. There is an opinion, but it is erroneous, that smoking tobacco or chewing it is more or less a protection against plumbism, because the men expectorate; but apart from the fact of spitting being a dirty practice, the habit of expectorating upon a printer’s floor is to be discouraged, especially if the workman has a cough and is the subject of lung disease, for it is largely by means of the sputa thrown upon the floor and becoming dried that the bacilli of tubercle disseminate pulmonary consumption.

_MORTALITY TABLES OF TYPOGRAPHICAL ASS0C._

TYPOGRAPHICAL ASSOCIATION.

KEY to headers:

A: All Causes.
B: Bronchitis.
C: Pneumonia.
D: Phthisis.
E: Consumption.
F: Tuberculosis, etc.
G: Lung Diseases, including Bronchitis, Pneumonia, Phthisis, etc.
H: Tuberculosis, including Phthisis, and all other forms.

+-----------------------+---------+-----------------------------+---------+----------+ | | | |TOTAL |Death-rate| | | | DEATHS FROM |DEATHS | per 1000 | | | | |FROM | Members. | | | +----+----+---------+----+----+---------+----------+ | | | | | | | | |Per |Per | | | | | | | | | |col.|col. | | | No. of | | | | | | | 9. | 10. | | ||Members.| A | B | C | D | E | F | G | H | I | J | +-----------------------+---------+---------+----+----+----+----+----+----+----+-----+ | 1894. =1= | =2= | =3=| =4=| =5=| =6=| =7=| =8=| =9=|=10=|=11=|=12= | |Half-year ended June 30| 12,417 | 61| 7 | 2 | 21 | ...| 2 | 30 | 23 | ...| ... | | „ „ Dec. 29| 12,544 | 46| 2 | 2 | 11 | ...| 1 | 15 | 12 | ...| ... | | +---------+----+----+----+----+----+----+----+----+----+---- + | Whole year {| 12,480 |}107| 9 | 4 | 32 | ...| 3 | 45 | 35 | 3.6| 2.8 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ | 1895. | | | | | | | | | | | |Half-year ended June 29| 13,378 | 78| 6 | 9 | 23 | ...| 6 | 38 | 29 | ...| ... | | „ „ Dec. 28| 13,593 | 65| 6 | 5 | 16 | ...| 3 | 27 | 19 | ...| ... | | +---------+----+----+----+----+---------+----+----+----+-----+ | Whole year {| 13,485 |}143| 12 | 14 | 39 | ...| 9 | 65 | 48 | 4.8| 3.6 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ | 1896. | | | | | | | | | | | | |Half-year ended June 27| 13,673 | 75| 5 | 7 | 17 | ...| 2 | 29 | 19 | ...| ... | | „ „ Dec. 26| 13,906 | 68| 2 | 8 | 26 | ...| 1 | 36 | 27 | ...| ... | | +---------+----+----+----+----+----+----+----+----+----+-----+ | Whole year {| 13,784 |}143| 7 | 15 | 43 | ...| 3 | 65 | 46 | 4.7| 3.3 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ | 1897. | | | | | | | | | | | | |Half-year ended June 26| 13,862 | 82| 6 | 8 | 19 | ...| 4 | 33 | 23 | ...| ... | | „ „ Dec. 25| 14,405 | 54| 4 | 2 | 21 | ...| 1 | 27 | 22 | ...| ... | | +---------+----+----+----+----+----+----+----+----+----+-----+ | Whole year {| 14,133 |}136| 10 | 10 | 40 | ...| 5 | 60 | 45 | 4.2| 3.2 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ | 1898. | | | | | | | | | | | | |Half-year ended June 25| 14,602 | 77| 5 | 3 | 22 | ...| 2 | 30 | 24 | ...| ... | | „ „ Dec. 31| 15,075 | 69| 5 | 1 | 19 | ...| 1 | 25 | 20 | ...| ... | | +---------+----+----+----+----+----+----+----+----+----+-----+ | Whole year {| 14,838 |}146| 10 | 4 | 41 | ...| 3 | 55 | 44 | 3.7| 3.0 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ | 1899. | | | | | | | | | | | |Half-year ended June 24| 15,393 | 78| 7 | 6 | 23 | ...| 3 | 36 | 26 | ...| ... | | „ „ Dec. 30| 15,854 | 99| 2 | 13 | 39 | ...| 4 | 54 | 43 | ...| ... | | +---------+----+----+----+----+----+----+----+----+----+-----+ | Whole year {| 15,623 |}177| 9 | 19 | 62 | ...| 7 | 90 | 69 | 5.8| 4.4 | | {|(average)|} | | | | | | | | | | | +=========+====+====+====+====+====+====+====+====+====+=====+ +-----------------------+---------+----+----+----+----+----+----+----+----+----+-----+ | Average for 6 years | 4.5| 3.4 | +=========================================================================+====+=====+

LONDON SOCIETY OF COMPOSITORS.

+----------+--------+-----+----+----+----+-----+----+----+----+-----+-----+ |Year 1897 | 10,780 | 126 | 13 | 10 | 33 | ... | 11 | 56 | 44 | 5.2 | 4.0 | | „ 1898 | 11,079 | 141 | 10 | 5 | 40 | 1 | 11 | 56 | 51 | 5.0 | 4.6 | | „ 1899 | 11,415 | 132 | 11 | 9 | 28 | 1 | 7 | 49 | 35 | 4.3 | 3.0 | +----------+--------+-----+----+----+----+-----+----+----+----+-----+-----+ | Average for 3 years | 4.8 | 3.9 | | | | === | +-------------------------------------------------------------+-----+-----+ | ENGLAND AND WALES.--_Per 1000 Population (1881–90)._ | +-------------------------------------------------------------------+-----+ | Mean Annual Death-rate of male persons, 20–65 years of age 4.5 | 1.8 | | | === | +-------------------------------------------------------------------+-----+

In thus expounding the subject of lead poisoning in printers, I have rather drawn attention to dangers that were more common in the past than exist at present, for, fortunately in this country at least, plumbism among compositors is very much on the wane. It is seldom that we meet with cases of printer’s colic in these days, owing very largely to the change in the method of printing newspapers. Until recently the printing of newspapers was done by ordinary type, the compositor setting the type by touch and not by sight. He quickly picked out the required letters, deftly inserting the nail of his thumb into the groove on one side of the type. It was through these operations that the skin of the fingers became thickened, and lead dust got under his finger nails. Having set and printed the paper, he had to take up, wash the type in lye, and subsequently distribute it, _i.e._, put each type back into its proper place. The distribution of the type required even more care than the setting of it, for a type wrongly distributed became a source of future trouble. Printing by hand type is rapidly on the decline, and is being replaced by stereotyping and linotyping. For newspaper printing there are now several fast printing machines in existence. Stereotyping has made it possible to print from a stamped cylinder without making direct use of the individual type. Endless rolls of paper, too, feed the printing machines. As many as 10,000 thirty-two page periodicals can be thrown off in an hour, but by perfecting the apparatus, as in Hoe’s machine, as many as 24,000 are capable of being thrown off in an hour. It is in typesetting machines with automatic distribution that the greatest progress has been made. The Merganthaler linotype machine, which is used for newspaper printing, produces and gathers in order successive bars of metal, each of the required length and breadth of a line, and bearing on its upper surface the type which prints the line. In the machine are small brass matrices, representing the different letters, etc. When the operator presses a finger-key on the board in front of him a single matrix bearing the required letter falls out of the magazine, and is carried to the assembling block, where the various matrices are set up, side by side, in a line or row. Subsequently these are transported to the face of a vertical mould wheel. Into the face of the mould molten type-metal is pumped, and thus a slug or linotype is produced. As the formation of the slugs is effected automatically, the operator does not handle the metal, consequently plumbism is rare, only two cases of lead poisoning in linotypists appearing in the Annual Report of the Chief Inspector of Factories for 1899, and four in 1900.

The new methods of printing have certainly diminished the numbers of cases of lead poisoning among printers, but the introduction of linotyping is losing us, as a people, an art. No person contends that, for finish, linotyped printing is equal to that obtained by hand-set type. Except for book-printing, in which the letters stand out boldly and clearly, and which as a trade is being relegated to a few towns, stereotyping and linotyping are in our own country rapidly eliminating typography. Since this is unavoidable, it is to be hoped that linotyping will yet further improve, for badly-printed newspapers are trying to the eyes. On the Continent most of the small newspapers are still printed by hand-set type, and consequently lead poisoning among printers is more prevalent there than here.

Compositors working the linotype machine run little risk of lead poisoning if they keep themselves and the workrooms clean. In linotypists the danger is not in handling the metal, for the need of doing this is rare; it is rather through inhalation of the fumes of the molten lead or from oxidation of lead particles that are lying about on the machine and floor. I have met with a few cases of colic in linotypists, but the attacks of pain have been mild and much more quickly got over than in compositors who use the ordinary type. In some, too, I have observed some of the milder derangements of the nervous system, mostly functional, that are the result of plumbism.

_Plumbing._

Plumbers are not a long-lived class. They suffer from lead poisoning in consequence of handling sheet-lead, pipes made from the same metal, also from working with white lead. They often complain of a sweet metallic taste in the mouth during the beating of the lead and the application of solder.

Gasfitters and plumbers run the risk of being poisoned also in another manner, to which allusion may be incidentally made here. When making the necessary connections between the pipes going into the houses and the mains, the gas in the latter is not shut off on account of its requirement by consumers. As a consequence of exposure to coal gas escaping from the main pipes, the workmen occasionally become dizzy and unconscious, lose their eyesight for several minutes, as well as the muscular power of their limbs. They have to be removed by their fellow-workmen, who often administer an emetic of salt and water when consciousness has sufficiently returned to enable them to swallow. The vomited matter smells strongly of coal gas. The symptoms are known as “gassing” by the workmen. In some of the men who have thus suffered I have found that complete muscular power had not returned to the limbs three months after the accident, that the knee-jerks were exaggerated, and that the patients were nervous and the subject of tremor. Albumen or sugar may be temporarily present in the urine.

_House Painting._

House painting is a prolific cause of plumbism. Dr Stühler, of Berlin, who obtained his facts from benefit societies, states that of 3000 painters in Berlin 313 or 10.4 per cent. were annually off work from the effects of lead poisoning. In Paris, Gautier found that out of 14,000 painters and varnishers 250 on an average attended the hospitals on account of plumbism, and that an equal number was treated at home, making a total percentage of 3.5. Of late the admissions into the hospitals of cases of lead poisoning have been increasing notwithstanding the regulations issued by the French Government, and the fact that the patients coming from white lead works have been getting fewer. This circumstance is explained by other industries sending more patients than formerly, and of these industries house painting has contributed the largest number. During the years 1894–98 this trade alone, and colour-grinding, contributed 223 patients, while white lead works only sent 4, and the occupation of plumbing 22. Of 86 fatal cases of lead poisoning in Paris during the five years mentioned, 43 occurred in painters, 2 in plumbers, and only 1 in a white lead worker. In consequence of the large amount of plumbism that prevails among house painters in Paris, it is Gautier’s contention that the occupation should be brought under closer Government supervision. The same remark applies equally to the trade in our own country. Lead poisoning among house painters is much more prevalent than people imagine. Taking a few monthly reports at random, there were 12 cases of plumbism in house painters (with 1 death) reported to the Home Office during the month of June 1900; in the month of November 1900 there were reported 11 cases of lead poisoning (including 2 deaths) among house painters and plumbers, and in the following month 14 cases of lead poisoning (including 4 deaths) in house painters and plumbers. During 1900 there were 199 cases of lead poisoning in house painters and plumbers reported to the Home Office. These figures show that if Saturnine poisoning in house painting was notifiable, both it and plumbing would be found to be trades that are the cause of a great amount of sickness, of which at the present time we hear very little. During the year 1899 upwards of 100 cases of lead poisoning were notified, while from district registrars information was received of 18 fatal cases of plumbism attributed to the occupation of house painting. Notification of lead poisoning in house painters is not compulsorily required by the Home Office. Cases of industrial lead poisoning, also arsenic, phosphorus, mercury, and cases of anthrax, are obliged to be reported to the Chief Inspector of Factories by the medical men who attend the patients, and by employers, but an exception is made in regard to house painting, one of the reasons being that as painters pursue their avocation largely in the open air and in houses away from the employer’s premises, it is difficult to say where the poisoning was contracted. Industrial lead poisoning to be notifiable to the Home Office must have occurred in places that are controlled by the Factory and Workshop Acts. When a painter, who is following his occupation in a factory or workshop and is engaged in grinding or mixing colours, develops lead poisoning, the illness has to be notified. As the Act stands at present, the Home Office cannot deal with certain forms of industrial lead poisoning, nor have the factory inspectors power to enforce improved conditions of labour. In view of house painting being ultimately brought under _Special Rules_, it is very desirable that all cases of sickness in house painters and deaths from plumbism should be reported. To the ordinary medical practitioner, who has been informed that he must report all cases of occupational lead poisoning coming under his care, it is embarrassing for him to draw a distinction between lead poisoning caught by one man filling a barrel with dry lead carbonate in a workroom, and another man who uses this as a paint in decorating the interior of a house or shop, and yet while the former is notifiable, the latter is not, although the same cause is in operation in both. The sphere of Home Office influence ought therefore to be extended so as to include house painting, and this might be done under the Act that allows the Home Secretary on sufficient evidence to schedule a trade as dangerous.

There are several ways in which painters and colour-mixers become the victims of lead poisoning. The men who grind or mix the colours run the risk of inhaling the dust. Unless this process is carried on either in closed spaces or in airy and well-ventilated rooms, the atmosphere becomes thick and can only be cleared by means of a fan. In this country there are, excluding house painters, upwards of 6000 persons employed in the manufacture, mixing, and grinding of paints and colours. Of 48 cases of plumbism that occurred among these persons in 1899, 30 were grinders and 7 of them packers.

For the purposes of house painting, the pigments are generally mixed with oil and a turpentine body. It has sometimes been thought that the lead poisoning of painters is due to the inhalation of the terebinthated vapour that rises from the painted surface. That this is a possible source is shown by the outbreaks of “belly ache,” or _colique sèche_, that occurred a few years ago in the Tropics, and played sad havoc with the sailors of the French Navy. For a long period the nature of the illness was not recognised. It was thought by some to be a neurosis of the abdominal sympathetic nervous system, and due to chill, while other physicians regarded it as a form of malarial disease. Lefèvre, the Director of the Naval Sanitary Board at Brest, ultimately gave it as his opinion that “the _colique sèche_ of the French Navy is nothing more than lead poisoning, and the reason why colic was more frequent among French sailors than those of other countries was due to the fact that lead entered more into the construction of their ships of war. It formed the tanks for holding the drinking water and the pipes for carrying the water; it was present in the paint of the cabins, in the enamel of the drinking-cups, and in the cooking utensils.” Out of this number of possible causes some of the cases of _colique sèche_ might have been due to sleeping in cabins newly painted with lead compounds, although drinking contaminated water would be the more probable cause. A common cause of lead poisoning in house painters is inhalation of the fume evolved during the burning-off of old paint. When engaged for long at this kind of work the men complain of headache, nausea, and occasionally have colicky pains in the abdomen. There is yet another manner in which plumbism may develop, and this occurs in finer work, where several coats of paint have to be applied. After what is called laying-on of the prime colours and puttying with white lead comes the flat colouring. When the coats of paint have become dry the workman is obliged to use sandpaper to rub the surface flat. In doing this a considerable amount of dust is given off which is rich in white lead. It is inhalation of this dust that so frequently induces colic and paralysis of the hands in house painters. Carelessness and ignorance are frequently contributing causes. Men, while laying-on the white paint with a flat knife, have often been observed using the hollow of their left hand as a reservoir for the paint. If there is any erosion of the skin, absorption of the poison is sure to follow. Layers-on are an unhealthy class of men. In Paris alone there occurred 18 deaths during the years 1898 and 1899 in a small union of 200 members, the greatest age at death being 35 years.

A fresh danger has been recently introduced into house painting. A few months ago a house painter, aged 40, was admitted into the Newcastle Infirmary suffering from extreme blueness of the face, lips, ears, hands and fingers, and from colic. He had also a very blue line on his gums. The illness was plumbism, but with something superadded. He had been engaged in removing the varnish and paint from old Venetian blinds, and had been using a dark brown liquid with a pungent, penetrating odour, known in the trade as a special patent. During the process of rubbing and swilling the blinds, and subsequently of sandpapering them, a strong sickening odour arose, which caused him to vomit and to have severe headache. The vapour, too, caused him to become so drowsy that he would almost fall asleep. He would feel giddy, but had no difficulty in walking, nor was his eyesight affected. The man was pale as well as blue, he had a haggard expression, and there was the most marked cyanosis possible. He had colic and constipation. His internal organs were healthy, including the kidneys. He had marked tremor of both hands, but no paralysis. It was quite clear that there was an acute intoxication of some kind or another, over and above lead poisoning. Several examinations of the urine were made by Dr R. A. Bolam, who had charge of the patient, with the view of establishing the nature of the poison. The symptoms reminded me of those observed in men who are employed in painting ships with quickly-drying spirit paints. It was thought at first that the symptoms were due to the presence of aniline oil in the “patent,” or of some chemical akin to the pyridine group of compounds. The case is an illustration of the danger incidental to the use of highly volatile, complex, and unstable chemical compounds whose nature is not quite known, whose effects upon the human body can only be learnt by experience, and which have for their object, from a trade point of view, rapid execution of work.

Painters of ships’ cabins suffer from plumbism as much if not more than house painters, since they are often obliged to work in close, confined spaces; so, too, do the painters of the back of mirrors, from using red lead; also painters of agricultural implements, etc.

It is worthy of mention that shipbuilders have found in the red oxide of iron a cheaper and safer pigment for painting the outside of steel plates than red lead.

The question as to whether any comparatively harmless substitute for white lead can be found for house painting is discussed at p. 293, _q.v._

_Coach Painting._

Lead poisoning in coach and carriage painters is far from being rare. In the painting of carriages there are often as many as eighteen coats of paint and varnish applied. Frequently the work is done in rather close and very ordinarily ventilated places. In Newcastle it is the practice of large firms of coach makers to give a carriage three coats of primary paint, six of filling up, three or four of oil colours, two of varnish colour, _i.e._ oil and varnish mixed, and, finally, about four coats of varnish. The colours used are white lead, dry and ground in oil: lampblack, ultramarine, yellow chromes, zinc white, and others known by particular names in the trade. “Driers” are also used, such as sugar of lead and terebene. Coach painters become the subjects of plumbism chiefly through inhaling the dust when sandpapering to get a good surface. They suffer from colic and wrist-drop. Many of the cases approach in severity the lead poisoning of file cutters. Dr Morison Legge states that the percentage of chronic plumbism among coach painters is greater than among file cutters.

Several cases of plumbism have occurred in the painting of new carriages, also in the breaking-up and burning of the wood of old railway carriages. Thirty-four of the cases of plumbism reported during 1900 as having taken place in coachbuilders. occurred in men engaged in railway shops.

It is almost unnecessary to repeat that in all places where lead paints are being handled and used, as in workshops, factories, ships and dockyards, there should be adequate washing accommodation, with plenty of soap, towels, and nail-brushes, and sufficient time ought to be given to the men to wash before leaving work.

_Glass Polishing._

After glass and crystal have been cut they have to be polished. The polishing is generally conducted on a revolving wheel or table made of wood, and upon which water, containing rouge or putty powder in suspension, is allowed to drip. When the article to be polished is a plane surface, _e.g._ a mirror, the wheel is a horizontal one revolving on a vertical axis. The water containing the rouge or putty powder escapes by a narrow opening from a conical vessel placed above the wheel. When finer work is required, _e.g._ the polishing of wine-glasses, electric-light globes, etc., the water drops on to a hard brush, which is attached to the external rim of a vertical wheel, from four to six inches in diameter, running at a high speed and revolving on a horizontal axis. For this kind of polishing putty powder alone is used. In some factories the liquid putty powder is fed on to the brush by a boy; in others the supply, as already mentioned, is automatic. Several samples of putty powder were sent to the Dangerous Trades Committee, and subjoined is the analysis of two of them:--

A. B.

Oxide of tin 29.72 per cent. 28.96
Oxide of lead 70.28 „ 68.07

In the very free use of this putty powder, rich in lead, the clothes and hands of the workers become bespattered by the thick spray thrown off from the rapidly-revolving wheels. Putty powder administered to animals in their food causes symptoms of Saturnine poisoning almost as quickly as white lead. In the evidence given before the Dangerous Trades Committee there was abundant proof of the extremely harmful effects of the use of putty powder in glass polishing. Many of the workers examined had suffered from colic, while others had been obliged to give up their employment on account of paralysis of the fingers and hands. It was ascertained that several of the male workers had died from acute convulsive seizures due to poisoning by lead. Another point to which attention was drawn was, that plumbism might develop in workmen in a glass-polishing shop who were not engaged in the actual process of polishing, and who had therefore not been directly brought into contact with the putty powder. This was due to the dried liquid on the floor becoming rubbed and trodden upon, rising as dust into the atmosphere, and being inhaled by the workmen in the shop.

Putty powder is a frequent cause of lead poisoning. The master polishers have for years tried to find a substitute for it. In many factories rouge is used. This is considered by many of the employers to be innocuous. On analysing rouge powders for the Dangerous Trades Committee, Professor Thorpe found that they contained commercial oxide of tin: that in one powder 0.13 per cent. of arsenious acid was present, and in another a trace of the same substance. Probably not much danger would follow the use of rouge powders containing such a mere trace of arsenic, but their employment would not be altogether free from risk; besides, since it can be shown that the presence of arsenic is not essential, then it ought to be eliminated altogether. The difficulty in regard to the use of harmless rouge powders is rather a technical or industrial question than medical. Do they answer the purpose as well as putty powder? The Dangerous Trades Committee found that opinions were much divided upon the point. Some of the glass polishers stated that rouge did not give such a fine effect, and that it took a longer time. On the whole, however, the results obtained have been such as to encourage employers to adopt it more freely. Where putty powder has been interdicted by the masters and only rouge used, the health of the workmen has wonderfully improved.

A few years ago M. Geroult proposed to the French glass polishers and crystal manufacturers, metastannic acid as a partial substitute for the putty powders that contained a large percentage of lead, and which had been the cause of several fatal cases of plumbism. The Academy awarded the Montyon prize to Geroult for his discovery. For the last ten years the new method has been followed in the glass works of Baccarat, and has given the most satisfactory results. Dr Schmitt, the surgeon to the works, says, that since 1891, the date of the substitution of the new for the old method, there has not been one single case of lead poisoning among the crystal cutters and glass polishers, nor an acute attack of plumbism in those workers who had previously suffered from lead poisoning. Formerly the putty powder contained 62 per cent. of lead, but in that recommended by Geroult there is only 20 per cent., and even with a smaller percentage of lead good manufacturing results can be obtained.

Glass polishing is one of those trades in which personal cleanliness of the worker can do a very great deal to prevent plumbism, and, knowing this, employers ought to provide ample washing accommodation and appliances; overalls should be worn; no food should be taken into or eaten in the workshop. All polishing should be conducted as far as possible in semi-enclosed cupboards, with draught tubes and fans, and the feeding of the wheels should be done automatically. There ought also to be frequent periodical medical examination of the workers, with power to suspend in case of signs of plumbism. These were the recommendations of the Dangerous Trades Committee, and as one result of their being put into practice the Medical Inspector of Factories, in his Report for 1899, says he is satisfied that the introduction of fans has materially diminished the danger of lead poisoning in the process of glass polishing. It has, practically speaking, abolished the bespattering of the workmen’s clothes and the splashing formerly observed during glass polishing.

_File Cutting._

Hand file cutting, although still giving employment in this country to a fairly large number of people, is generally stated to be a decaying industry. This is controverted by Dr John Robertson, Medical Officer of Health, Sheffield. It is, however, an unhealthy trade. In 1898 there were 46 cases of lead poisoning reported in file cutters, in 1899 the number was 41, and in 1900 there were 40 cases. The centre of the industry is Sheffield, but the manufacture is carried on in London, Glasgow, Rainhill, and Birmingham. There are upwards of 2000 hand file cutters in Sheffield alone. In the Annual Report on the health of the City of Sheffield, 1900, it is stated that there are 2040 persons engaged in 546 hand file cutting shops. Files can be cut both by hand and by machinery, but as file cutting by machinery is usually carried on in modern and well-ventilated factories, this method of manufacture need not detain us, for it is a healthy occupation, there being no lead used in the process. It is otherwise with hand file cutting. Seated on a “stock,” the hand file cutter has in front of him a stone block, into the centre of which a small piece of bar steel called a “stiddy” is inserted, and on this stiddy is placed a piece of metallic lead, which is called the “bed.” The file about to be cut is strapped on to the bed. The lines that are seen on a file are made by means of a chisel and hammer, each line representing a blow. The reason for using the lead bed to strike the file upon is, that while there may be as little recoil as possible, there shall yet be sufficient resistance to develop the line in its entirety as a result of the blow given by the hammer and chisel. As a consequence of constantly striking files of uniform size a groove comes to be formed on the lead bed, into which succeeding files easily fit. When he has cut one face of the file, the workman rubs that side with charcoal, turns it over, and then proceeds to cut the other side, after which both faces are briskly rubbed. The file cutter grips the chisel between the index finger and thumb of the left hand, and in order to get a good grip of the chisel, he often licks his finger. A good deal of strain is experienced by the fingers in a day’s work. The steel hammer used by a cutter generally weighs from 7½ to 9 lbs., and as each line on a file represents one stroke of the hammer, and there are often on large files as many as 3800 lines, it is estimated that in the course of one day a file cutter will lift a weight equal to several tons. A Gateshead file cutter, who consulted me recently, works with a hammer 7 lbs. in weight; he cuts files 16 inches in length. Each file receives 1500 “bats,” and he makes one and a quarter dozen of files daily, working eight to eight and a half hours. In the course of a day’s work he lifts 157,500 lbs. weight.