Chapter LXXV: Section IV: Of the Treatment of Poisoning with Lead

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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