The lead palsy, however, does not always come on in this regular manner. Sometimes the primary stage of colic is wanting, so that the wasting of the muscles and loss of power are the first symptoms. I have seen a characteristic example of the kind in a sailor who had been employed for a month in painting a vessel. He had great weakness and wasting of the arms and hands, particularly of the ball of the thumb; but except a tendency to indigestion, costiveness, and transient slight pain of the belly, he had suffered no previous disorder of the intestines. I have seen the paralytic affection confined to the extensors of one hand in a compositor, and Dr. Chowne met with a similar affection of both hands in a gas-fitter.[1332] Dr. Bright observed palsy without colic in the case of a painter three times in the course of seven years.[1333]—In like manner, according to Tanquerel, the neuralgic affection may occur severely without any precursory colic; and the same author has witnessed both coma and convulsions in the same circumstances.
Colica pictonum, with the collateral disorders specified above, is the only disease which has been distinctly traced to the operation of lead insidiously introduced into the body. But many other disorders have been ascribed to its agency. Boerhaave seems to have imagined that consumption might be so induced; and Dr. Lambe thought that to this cause may be traced the increased prevalence of “scrofula, phthisis, dropsy, chronic rheumatism, stomach complaints, hypochondriasis, and the host of nervous complaints which infest modern life.”[1334] These conjectures are wholly destitute of foundation in fact.
In whatever form lead is habitually applied to the body, it is apt to bring on the train of symptoms mentioned above;—the inhalation of its fumes, the habitual contact of any of its compounds with the skin, the prolonged use of them internally as medicines, or externally as unguents and lotions, and the accidental introduction of them for a length of time with the food, may sooner or later equally induce colica pictonum.
Instances have occurred of colic being produced by the prolonged employment of the compounds of lead inwardly in medical practice. Such cases are so uncommon that it is evident some strong constitutional tendency must co-operate. But it is in vain to deny, as some do, that the medicinal employment of preparations of lead internally is unattended with any risk whatever of slow poisoning. Dr. Billing of Mulhausen relates a case of death, apparently from the comatose affection succeeding the colic stage of poisoning with lead, in the instance of a boy of fifteen, to whom he gave acetate of lead in gradually increasing doses for six weeks, till he took two grains daily.[1335] Tanquerel met with a case of colic produced by 130 grains taken in fourteen days, and another occasioned by 149 grains in sixteen days.[1336] Sir George Baker has mentioned similar instances.[1337] It would even appear that metallic lead may have the same effect when taken inwardly. Thus Dr. Ruva of Cilavegno has related the case of a man who was violently attacked with the colic form of the effects of lead after taking six ounces of shot by direction of a quack for the cure of dyspepsia, and was seized again with the same symptoms six days afterwards on taking four ounces more. On the second occasion he had violent colic, great feebleness of the limbs, constant vomiting of any thing he swallowed, severe headache, and other analogous symptoms, of which he was not effectually cured for seven weeks.[1338] A case somewhat similar, but less severe, has been described by Dr. Bruce.[1339]—With regard to lead colic being excited by unguents and lotions applied to the surface of the body, Sir George Baker mentions a case of violent colic brought on by litharge ointment applied to the vagina; he adds that children have been thrown into convulsions by the same substance sprinkled on sores: and he quotes Zeller for a case where symptoms of poisoning were occasioned by sprinkling the axilla with it, as a cure for redness of the face.[1340] Dr. Wall, in a letter to the preceding author, mentions his having seen the bowels affected by Goulard’s extract applied to ulcers; in another paper he has given two unequivocal cases, in one of which colic was brought on by saturnine lotions applied to a pustular disease, and in the other by immersing the legs twice a day for ten days in a bath of the solution of acetate of lead:[1341] and lately Dr. Taufflieb of Barr observed lead colic to arise from the continued use of diachylon plaster during eleven weeks for dressing an extensive ulcer.[1342] Such accidents are exceedingly rare, and some auxiliary cause must have favoured the operation of the poison in the cases now noticed; for every one knows that free use is made of lead unguents and lotions, yet we seldom hear of any bad consequences.—These cases, however, will probably remove the doubts which some entertain of the possibility of lead colic being induced by the application of the compounds of lead to the sound skin in those trades which compel the workmen to be constantly handling them. At the same time it must be admitted, that in all these trades there exists a more obvious and ready channel for the introduction of the poison; because the workmen are either exposed to breathe its fumes, or are apt to transfer its particles from the fingers into the stomach with their food.—Of all exposures none is more rapid and certain than breathing the vapours or dust of the preparations of lead. But for that very reason workmen who are so exposed seldom suffer; because the greatness of the risk has led to the discovery of means to avert it, and the openness of the danger renders it easy for the workmen to apply them. Tanquerel mentions a singular case of a woman who was attacked in consequence of the fine dust of white lead ascending through chinks in the floor from a room below, where a perfumer was in the practice of grinding and sifting that substance.[1343]—It may be added that Dr. Otto of Copenhagen has published an extraordinary instance of fatal lead-colic, originating in the habitual use of Macuba snuff adulterated with twenty per cent. of red lead.[1344]
To these observations on the various ways in which lead insidiously enters the system a few remarks may be added on the trades which expose workmen to its influence. The most accurate information on this subject is contained in the work of Mérat.
He places foremost in the list miners of lead. In this country miners are now rarely affected, because the frequency of colica pictonum among them formerly led their masters to study the subject, and to employ proper precautions for removing the danger. It has been stated by Dr. Percival, and is generally thought, that the whole workmen in lead mines are apt to be attacked with the colic,—those who dig the sulphuret as well as those who roast the ore.[1345] If this idea were correct, it would be in contradiction with the general principle in toxicology, that the metals are not poisonous unless oxidated. But the opinion is in all probability founded on error; for, according to information communicated to me by Mr. Braid, and confirmed since by personal investigation, the workmen at Leadhills who dig and pulverize the ore, although liable to various diseases connected with their profession, and particularly to pectoral complaints, never have lead colic till they also work at the smelting furnaces. Next to miners may be ranked manufacturers of litharge, red-lead and white-lead. The workmen at these manufactories are exposed to inhale the fumes from the furnaces or the dust from the pulverizing mills. It has been chiefly among the workmen of a former white-lead manufactory in the neighbourhood of Edinburgh that I have had an opportunity of witnessing the lead colic. By a simple change the proprietor made in the process, and which will be mentioned presently, the disease was almost extirpated some years before the manufactory was given up.
Next in order, perhaps in the same class with colour-makers, are house-painters. The causes of their liability is the great quantity of the preparations of lead contained in the paints they use. It would appear that lead colic is most frequent among people of that trade in cities of the largest size. In Geneva, as I am informed by my friend Dr. C. Coindet of that place, colica pictonum is now almost unknown and never occurs among painters. In Edinburgh it is also little known among painters. A journeyman painter, a patient of mine in the Infirmary, had been seventeen years in the trade, and yet did not know what the painters’ colic or lead palsy meant. In London, according to the Dispensary reports, and in Paris, according to the tables of Mérat, many workmen of that trade suffer. I have been informed by an intelligent workman, once a patient of mine, who had been a journeyman painter both in London and Edinburgh, that the number of his acquaintances who had been affected with colic in the metropolis was incomparably greater than here. This man ascribed the difference to the working hours being more in the former place, so that the men had not leisure enough to make it worth their while to clean themselves carefully in the intervals. This appears a rational explanation. I do not know how the great prevalence of colic among painters in Paris is to be accounted for.
Plumbers, sheet-lead manufacturers, and lead-pipe makers, are also for obvious reasons apt to suffer; but as they are not necessarily exposed to the vapours of lead, and suffer only in consequence of handling it in the metallic form, it ought to be an easy matter to protect them. They themselves conceive that a very hazardous part of their occupation is the removing the melted lead from the melting pot, to make the sheets or pipes; but this operation cannot be dangerous if the melting pots are properly constructed.
A few cases of lead colic occur among glass-blowers, glaziers, and potters, who use the oxide of lead in their respective trades.
There are a few also among lapidaries and others, who use it for grinding and polishing, and among grocers and colourmen who sell its various preparations. Printers seldom suffer from the colic, but are generally thought liable to partial palsy of the hands, which is ascribed to frequent handling of the types. I have met with one case apparently of this nature.
Lead is not the only metal to which the power of inducing colica pictonum has been ascribed. Mérat has mentioned several instances of the disease occurring among brass-founders and other artizans who work with copper.[1346] Tronchin quotes Scheuchzer for a set of well-marked cases in a convent of monks, where the malady was supposed to have been traced to all the utensils for preparing and keeping their food having been made of untinned copper.[1347] The same author mentions two cases, one of which came under his immediate notice, where the apparent cause was the long-continued use of antimonial preparations internally.[1348] Mérat likewise found a few iron-smiths and white-iron-smiths in the lists kept at one of the Parisian hospitals.[1349] Chevallier alleges that colic occurs at times among money-changers at Paris, and others who constantly handle silver.[1350] Cases have even been noticed by Mérat among varnishers, plasterers, quarrymen, stone-hewers, marble-workers, statuaries, saltpetre-makers;[1351] and Tronchin enumerates among its causes the immoderate use of acid wine or of cider, checked perspiration, sea-scurvy, and melancholy. But the only substance besides lead, whose operation in producing colica pictonum has been traced with any degree of probability, is copper; and even among artizans who work with copper the disease is very rare. As to the other tradesmen mentioned by Mérat, it is so very uncommon among them, that we may safely impute it, when it does occur, to some other agent besides what the trade of the individual exposes him to; and in general the secret introduction of lead into the body may be presumed to be the real cause. Still, however, the connection of colica pictonum with other causes besides the poison of lead is upheld by so many facts, and is believed by so many authorities, that this disease cannot be safely assumed, even in its most characteristic form, as supplying undoubted evidence of the introduction of lead into the system. Dr. Burton thinks it will when the blue line at the edge of the gums is seen.
The work of Mérat contains some interesting numerical documents, illustrative of the trades which expose artisans to colica pictonum. They are derived from the lists kept at the hospital of La Charité in Paris, during the years 1776 and 1811. The total number of cases of colica pictonum in both years was 279. Of these, 241 were artisans whose trades exposed them to the poison of lead, namely, 148 painters, 28 plumbers, 16 potters, 15 porcelain-makers, 12 lapidaries, 9 colour-grinders, 3 glass-blowers, 2 glaziers, 2 toy-men, 2 shoemakers, a printer, a lead-miner, a leaf-beater, a shot-manufacturer. Of the remainder, 17 belonged to trades in which they were exposed to copper, namely, 7 button-makers, 5 brass-founders, 4 braziers, and a copper-turner. The remaining twenty-one were tradesmen, who worked little, or not at all with either metal, namely, 4 varnishers, 2 gilders, 2 locksmiths, a hatter, a saltpetre-maker, a winegrocer, a vine-dresser, a labourer, a distiller, a stone-cutter, a calciner,[1352] a soldier, a house-servant, a waiter, and an attorney’s clerk.—Age or youth seems not to afford any protection against the poison. Of the 279 cases, 24 were under twenty, and among these were several painter-boys not above fifteen years old; 113 were between nineteen and thirty; 66 between twenty-nine and forty; 38 between thirty-nine and fifty; 28 between forty-nine and sixty; and 10 older than sixty. These proportions correspond pretty nearly with the relative number of workmen of similar ages.—Among the 279 cases fifteen died, or 5·4 per cent.
There seems to have lately been little or no diminution in the frequency of the disease in Paris. In 1833–4–5–6, there were treated in the hospitals 1541 cases, or 385 annually; of whom one in 39½ died. And in 1839–40–41 there were 761 cases, or 252 annually; of whom one in 24½ died. Of 302 cases in 1841 no fewer then 266 were from white-lead manufactories.[1353]
The morbid appearances caused by poisoning with lead are in some respects peculiar.
In acute poisoning, from the irritant action of its soluble salts, as in the case of the drummer poisoned by Goulard’s extract, the lower end of the gullet, the whole stomach and duodenum, part of the jejunum, and the ascending and transverse colon, have been found much inflamed, and the villous coat of the stomach as if macerated. In Mr. Taylor’s two cases Dr. Bird found the villous coat of the stomach gray, but otherwise natural; and the intestines were much contracted.
The stomach in the first of these cases contained a reddish-brown, sweetish, styptic fluid, in which lead was detected by chemical analysis,[1354]—an important medico-legal fact, since the man survived nearly three days. Some valuable observations have been made by Professor Orfila as to the presence of lead in the textures of the stomach in such instances. When small doses of acetate or nitrate of lead were administered to dogs and allowed to act for two hours only, the villous coat presented numerous streaks of white points, which contained lead, as hydrosulphuric acid blackened them. These points, though less distinct, were still visible, when the animals were allowed to live four days after the excess of salt had been removed; and even after seventeen days, although no such appearance remained, lead could still be detected in the tissues of the stomach.[1355]
The blood in animals is sometimes altered. Dr. Campbell found it fluid. In a dog poisoned with litharge, the experimentalists of the Veterinary School at Lyons found it of a vermilion colour in the veins, and brighter than usual in the arteries.[1356] Mitscherlich also found it unusually red and firmly coagulated.[1357]
The appearances in the bodies of those who have died of the various forms of lead colic are different, and wholly unconnected with inflammation.
The valuable work of Mérat contains four inspections after death from the acute or comatose form of colica pictonum. The bodies were plump, muscular and fat. The alimentary canal was quite empty, and the colon much contracted,—in one to an extraordinary degree. The mucous coat of the alimentary canal was everywhere healthy. He therefore infers that the disease is an affection of the muscular coat only. It is a striking circumstance, and conformable with what will be afterwards established in regard to the true narcotics, that although both of the men died convulsed and comatose, no morbid appearance was visible within the head.[1358] Another case, which confirms the foregoing facts, has been described by Mr. Deering. It was that of a lady who died convulsed after suffering in the usual manner, and in whose body no trace of disease could be detected any where.[1359] Senac informed Tronchin that he had dissected above fifty cases of colica pictonum, and found no morbid appearances.[1360] Schloepfer’s observations on animals are to the same effect. In rabbits which died of colica pictonum the great intestines were excessively contracted, but all the other organs of the body were healthy except the liver, which was dark and brittle.[1361] Mitscherlich observed in his animals extravasation of blood into the intestines, also sometimes into the cavities of the pleura and peritoneum, and occasionally under the peritoneal covering of the kidneys.[1362] The only instance I have met with where morbid appearances were found within the head, was in a case mentioned by Sir G. Baker, of a gentleman who died apoplectic after many attacks of colica pictonum, and in whom the brain was found unusually soft, and blood extravasated on its surface to the amount of an ounce.[1363]
The appearances in those who have been long affected with the paralytic form of colica pictonum have been rarely observed in modern times. I am indebted to my late colleague, Dr. Duncan, Junior, for an account of the appearances in the intestinal canal of a plumber, who had been long and frequently afflicted with colica pictonum and its sequelæ. The intestines were dark, tender, and far advanced in putrefaction. The cardiac orifice of the stomach was so narrow that it would admit a goose-quill. The mesenteric glands were enlarged and hardened. The thoracic duct was surrounded by many large bodies like diseased glands, exactly of the colour of lead, and composed of organized cysts containing apparently an inorganic matter. The analysis of this matter was unfortunately neglected. The muscles in similar circumstances are much diseased. When the paralysis is not of long standing, it appears from the experiments of Schloepfer (whose animals survived about three weeks), that the whole muscular system becomes pale, bloodless, and flaccid. When the palsy is of long standing, this change increases so much, that the muscles in some parts, as in the arms and thumbs, acquire the colour and general aspect of white fibrous tissue. Some observations on the nature of these changes will be found in the essays of Sir G. Baker.[1364] The facts are communicated by Mr. John Hunter. On examining the muscles of the arm and hand of a house-painter who was killed by an accident, Mr. Hunter found them all of a cream colour, and very opaque, their fibres distinct, and their texture unusually dry and tough. These alterations he at first imagined might have been the result merely of the palsy and consequent inactivity of the muscles, but on finding the same alterations produced by the direct action of sugar of lead on muscle, he inferred that the poison gradually effected a change either on the muscles directly, or on the blood which supplied them.
In a late elaborate inquiry into the pathology of lead-colic, M. Tanquerel has arrived at the conclusion, that “the pathological phenomena are not caused by anatomical changes cognisable by the senses,” and that such appearances as may be found are the effects, not the cause, of the disease.[1365]
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]
Baryta and its salts, the last genus of the metallic irritants which requires particular notice, are commonly arranged among earthy substances, but on account of their chemical and physiological properties, may be correctly considered in the present place. These poisons are worthy of notice, because they are not only energetic, but likewise easily procured, so that they may be more extensively used, when more generally known.
Three compounds of this substance may be mentioned, the pure earth or oxide, the muriate, or chloride of barium, and the carbonate. The pure earth, however, is so little seen, that it is unnecessary to describe its chemical or physiological properties.
The Carbonate of Baryta is met with in two states. Sometimes it is native, and then commonly occurs in radiated crystalline masses, of different degrees of coarseness of fibre, nearly colourless, very heavy, and effervescing with diluted muriatic acid. It is also sold in the shops in the form of a fine powder of a white colour, prepared artificially by precipitating a soluble salt of baryta with an alkaline carbonate. It is best known by its colour, insolubility in water, solubility with effervescence in muriatic acid, and the properties of the resulting muriate of baryta.
The Muriate of Baryta, or chloride of barium, is the most common of the compounds of this earth, having been for some time used in medicine for scrofulous and other constitutional disorders. It is procured either by evaporating the solution of the carbonate in hydrochloric acid, or by decomposing a more common mineral, the sulphate, by means of charcoal aided by heat, dissolving in boiling water the sulphuret so formed, and decomposing this sulphuret by hydrochloric acid.
It is commonly met with in the shops irregularly crystallized in tables. It has an acrid, irritating taste, is permanent in the air, and dissolves in two parts and a half of temperate water.
The solution is distinguished from other substances by the following chemical characters. From all other metallic poisons hitherto mentioned, it is easily distinguished by means of hydrosulphuric acid, which does not cause any change in barytic solutions. From the alkaline and magnesian salts it is distinguished by the effects of the alkaline sulphates, which have no visible action except on the barytic solution, and cause in it a heavy white precipitate, insoluble in nitric acid. From the chlorides of calcium and strontium, it is to be distinguished by evaporating the solution till it crystallizes. The crystals are known not to be chloride of calcium, because they are not deliquescent. The chloride of strontium (which resembles that of barium in many properties, but which must be carefully distinguished, as it is not poisonous), differs in the form of the crystals, which are delicate six-sided prisms, while those of the barytic salt are four-sided tables, often truncated on two opposite angles, sometimes on all four,—by its solubility in alcohol, which does not take up the chloride of barium,—and by its effect on the flame of alcohol, which it colours rose-red, while the barytic salts colour it yellow. The chloride of barium is known from other soluble barytic salts, by the action of nitrate of silver, which throws down a white precipitate.
Vegetable and animal fluids do not decompose the solution of chloride of barium, except by reason of the sulphates and carbonates which most of them contain in small quantities. But the action of its tests may be distinguished, although the salt has not undergone decomposition. In that case the most convenient method of analysis is to add a little nitric acid, which will dissolve any carbonate of baryta that may have been formed,—to filter and then throw down the whole baryta in the form of sulphate, by means of the sulphate of soda,—and to collect the precipitate, and calcine it with charcoal for half an hour in a platinum spoon or earthen crucible, according to the quantity. A sulphuret of baryta will thus be procured, which is to be dissolved out by boiling water, and decomposed after filtration by muriatic acid. A pure solution is thus easily obtained. Orfila has lately proposed a process more complex in its details, but the same in principle.[1380]
The action of the barytic salts on the body is energetic. Like most metallic poisons, they seem to possess a twofold action,—one local and irritating, the other remote and indicated by narcotic symptoms. This narcotic action is more decided and invariable than in the instance of any of the metallic poisons hitherto noticed. Such at least is the result of the experiments of Sir B. Brodie,[1381] which have since been amply confirmed by Professor Orfila[1382] and Professor Gmelin.[1383] Orfila found that when the chloride was injected into the veins of a dog in the dose of five grains only, death ensued in six minutes, and was preceded by convulsions, at first partial, but afterwards affecting the whole body. Sir B. Brodie found the same effects follow in twenty minutes, when ten grains were applied to a wound in the back of a rabbit,—the convulsions being preceded by palsy, and ending in coma. Half an ounce when injected into the stomach excited the same symptoms in a cat, and proved fatal in sixty-five minutes, though the animal vomited. Schloepfer observed, that when a scruple, dissolved in two drachms of water, was injected into the windpipe of a rabbit, it fell down immediately, threw back its head, was convulsed in the fore-legs, and died in twelve minutes.[1384] Gmelin observed in his experiments that it caused slight inflammation of the stomach, and strong symptoms of an action on the brain, spine, and voluntary muscles. He found the voluntary muscles destitute of contractility immediately after death; yet the heart continued to contract vigorously for some time, even without the application of any stimulus. From some experiments made on horses by Huzard and Biron, by order of the Société de Santé of Paris, it appears that the hydrochlorate, when given to these animals in the dose of two drachms daily, produced sudden death about the fifteenth day, without previous symptoms of any consequence.[1385] In the experiments now related, very little appearance of inflammation was found in the parts to which the poison was directly applied. It is also worthy of remark that the heart does not seem to have been particularly affected; and yet according to the recent researches of Mr. Blake, the barytic salts are the most powerful of all inorganic poisons in their action on the heart, when they are injected into the veins. A quarter of a grain of the chloride appreciably depresses arterial action; two grains completely arrest the heart’s contractions in twelve seconds; and when it is injected back into the aorta from the axillary artery, it causes at first some obstruction to the capillary circulation, but soon arrests the action of the heart, as when it is introduced into the veins.[1386]
The pure earth appears to produce nearly the same effects in an inferior dose. When swallowed, the symptoms of local irritation are more violent; but death ensues in a very short space of time, and is preceded by convulsions and insensibility. The stomach after death is found of a reddish-black colour, and frequently with spots of extravasated blood in its villous coat.
The carbonate in a state of minute division is scarcely less active than the hydrochlorate, since it is dissolved by the acid juices of the stomach. A drachm killed a dog in six hours; vomiting, expressions of pain, and an approach to insensibility preceded death; and marks of inflammation were found in the stomach.[1387] Pelletier made many experiments on the poisonous properties of the carbonate. Fifteen grains of the native carbonate killed one dog in eight hours, and another in fifteen.[1388] Dr. Campbell found it to be a dangerous poison, even when applied externally. Twelve grains introduced into a wound in the neck of a cat, excited on the third day languor, slow respiration, and feeble pulse; towards evening the animal became affected with convulsions of the hind-legs and with dilated pupils; and death followed not long afterwards.[1389] This substance, before its real nature was known, used at one time to be employed in some parts of England as a variety of arsenic for poisoning rats.
The salts of baryta are absorbed in the course of their action. The chloride has been detected by Dr. Kramer both in the blood and urine by incineration with carbonate of potash, washing the ashes with weak solution of carbonate of potash, dissolving the residue in diluted nitric acid, and testing the solution for baryta.[1390] Orfila has also obtained baryta, by his process alluded to above, in the liver, kidneys, and spleen of animals killed by the chloride.[1391]
The symptoms produced by the salts of baryta in man have seldom been particularly described. An instance is shortly noticed in the Journal of Science, where an ounce of the hydrochlorate was taken by mistake for Glauber’s salt, and proved fatal. The patient immediately after swallowing it felt a sense of burning in the stomach; vomiting, convulsions, headache, and deafness ensued; and death took place within an hour.[1392] A similar case, fatal in two hours, has been related by Dr. Wach of Merseburg. A middle-aged woman who, though generally in good health, had suffered for a day or two from pains in the stomach, took one morning a solution of half an ounce of chloride of barium by mistake for sulphate of soda. She was soon seized with sickness, retching, convulsive twitches of the hands and feet, vomiting of clear mucus, great anxiety, restlessness, and loss of voice; and she died under constant efforts to vomit, and violent convulsive movements, but with her faculties entire.[1393]
Unpleasant effects have been observed from too large doses of the chloride administered medicinally. A case is mentioned in the Medical Commentaries of a gentleman who was directed to take a solution as a stomachic, but swallowed one evening by accident so much as seventy or eighty drops. He had soon after profuse purging without tormina, then vomiting, and half an hour after swallowing the salt excessive muscular debility, amounting to absolute paraplegia of the limbs. This state lasted about twenty-four hours, and then gradually went off.[1394] I have known violent vomiting, gripes, and diarrhœa produced in like manner by a quantity not much exceeding the usual medicinal doses.
Dr. Wilson of London has lately described a distinct case of poisoning with the carbonate. The quantity taken was half a tea-cupful; but emetics were given, and operated before any symptoms showed themselves. In two hours the patient complained of dimness of sight, double vision, headache, tinnitus, and a sense of distension in the stomach, and subsequently of pains in the knees and cramps of the legs, with occasional vomiting and purging next day; for some days afterwards the head symptoms continued, though more mildly, and she was much subject to severe palpitations; but she was in the way of recovery when the account of her case was published.[1395] Mr. Parkes mentions that, according to information communicated to him by the proprietor of an estate in Lancashire, where carbonate of baryta abounds, many domestic animals on his estate died in consequence of licking the dust of the carbonate, and that it once proved fatal to two persons, a woman and her child, who took each about a drachm.[1396] Dr. Johnstone says he once swallowed ten grains of this compound, without experiencing any bad effect.[1397]
In animals the mucous membrane of the stomach is usually found of a deep-red colour, unless death take place with great rapidity, in which case the alimentary canal is healthy. In all the animals, which in Dr. Campbell’s experiments were killed by the application of the muriate to wounds, the brain and its membranes were much injected with blood; and in one of them the appearances were precisely those of congestive apoplexy.
In Wach’s case the stomach was dark brownish-red externally, and the small intestines brighter red. Internally the stomach presented uniform deep redness, with clots of blood, and bloody mucus scattered over it; and near the cardiac end there was a perforation, above half an inch in diameter within, and half as wide at the outside, and surrounded with swollen edges and extensive thickening of the villous coat. The small intestines were internally very red and lined with red mucus interspersed with clots of blood. The great intestines were extremely contracted. The lungs were gorged, the heart full of dark liquid blood, and the cerebral vessels distended. Chloride of barium was detected in the stomach and intestines. The perforation in this case was evidently an accidental concurrence.
The treatment of this variety of poisoning consists chiefly in the speedy administration of some alkaline or earthy sulphate, such as the sulphate of soda or sulphate of magnesia. The poison is thus immediately converted into the insoluble sulphate of baryta, which is quite inert. Two drachms of muriate of baryta were injected by Orfila into the stomach of a dog, and eight minutes afterwards two drachms of sulphate of soda. The gullet was then secured by a ligature. At first efforts were made to vomit, and in an hour sulphate of baryta was discharged with the alvine evacuations. There was neither insensibility nor convulsions; and the next morning the animal evidently suffered only from the ligature on the gullet. This fact not only proves the efficacy of the sulphate, but likewise shows that in the kinds of poisoning where diarrhœa occurs, the poison is very soon discharged, and ought therefore to be looked for in the evacuations from the bowels.[1398]
A few observations may be here added on the effects of the salts of strontia on the animal frame. These compounds bear a close resemblance to the salts of baryta, and the two earths were consequently long confounded together till Dr. Hope pointed out their distinctions. One of the most striking differences is, that the salts of the strontia are very feebly poisonous. Some experiments of this purport were made by M. Pelletier of Paris,[1399] and by Blumenbach; but the most accurate researches are those of Professor Gmelin. He found that ten grains of the chloride in solution had no effect when injected into the jugular vein of a dog,—that two drachms had no effect when introduced into the stomach of a rabbit,—that half an ounce was required to cause death in that way,—that two drachms of the carbonate had no effect,—and that two drachms of the nitrate, dissolved in six parts of water and given to a rabbit, merely caused increase of the frequency and hardness of the pulse and a brisk diarrhœa.[1400] Mr. Blake also found that small doses of the salts of strontia have little effect when injected into the veins; but that forty grains arrest the action of the heart in fifteen seconds.[1401]
The fourth order of the irritant poisons contains a great number of genera derived from the vegetable kingdom, and at one time commonly arranged in a class by themselves under the title of Acrid Poisons. The order includes many plants of the natural families Ranunculaceæ, Cucurbitaceæ, and Euphorbiaceæ, and other plants scattered throughout the botanical system. It likewise comprehends a second group consisting of some acrid poisons from the animal kingdom, namely, cantharides, poisonous fishes, poisonous serpents, and animal matters become poisonous by disease or putrefaction.
The vegetable acrids are the most characteristic poisons of this order. They will not require many details, as they are seldom resorted to for criminal purposes, and their mode of action, their symptoms, and their morbid appearances are nearly the same in all.
We are chiefly indebted to Professor Orfila for our knowledge of their mode of action. He has subjected them to two sets of experiments. In the first place, he introduced the poison in various doses into the stomach, sometimes tying the gullet, sometimes not: and, secondly, he applied the poison to the subcutaneous cellular tissue by thrusting it into a recent wound.
In the former way he found that, unless the gullet was tied, the animal soon discharged the poison by vomiting, and generally recovered; but that, if the gullet was tied, death might be caused in no long time by moderate doses. The symptoms were seldom remarkable. Commonly efforts were made to vomit; frequently diarrhœa followed; then languor and listlessness; sometimes, though not always, expressions of pain; very rarely convulsions; and death generally took place during the first day, often within three, six, or eight hours. The appearances in the dead body were redness over the whole mucous coat of the stomach, at times remarkably vivid, often barely perceptible, and occasionally attended with ulcers; very often a similar state of the whole intestines, more especially of the rectum; and in some instances a slight increase of density, with diminished crepitation, in patches of the lungs.
When the poison, on the other hand, was applied to a recent wound of the leg, the animal commonly whined more or less; great languor soon followed; and death took place on the first or second day, without convulsions or any other symptom of note. It was seldom that any morbid appearance could then be discovered in the bowels. But in every instance active inflammation was found in the wound, extending to the limb above it and even upwards on the trunk. Every part affected was gorged with blood and serum; and an eschar was never formed. The appearances in short were precisely those of diffuse inflammation of the cellular tissue, when it proves fatal in its early stage.[1402]
Since these poisons do not appear to act more energetically through a wound than through the stomach, it has been generally inferred that they do not enter the blood, and consequently that the local impression they produce is conveyed to distant organs through the nerves. This inference is correct in regard to such species of the vegetable acrids as act in small doses. But the validity of the conclusion may be questioned when the poison acts only in large doses, as in the case with many of those now under consideration. For they cannot be applied to a wound over a surface equal to that of the stomach, and may therefore be more slowly absorbed in the former than in the latter situation. And, in point of fact, a few plants of the present order have been found to act through the medium of absorption, as soon as chemistry discovered their active principles, and thus enabled the physiologist to get rid of fallacy by using the poison in small quantity. This principle has been proved to be in some plants a peculiar resin, in others a peculiar extractive matter, in others an oil, in others an alkaloid, and in others a neutral crystalline matter. But in all there exists some principle or other in which are concentrated the poisonous properties of the plant. Some of these principles appear to act through the medium of the blood.
There is no doubt, however, but many plants of the present order, as well as their active principles, have a totally different and very peculiar action. They produce violent spreading inflammation of the subcutaneous cellular tissue, and acute inflammation of the stomach and intestines, without entering the blood; and death is the consequence of a sympathy of remote organs with the parts directly injured.
As to their forming a natural order of poisons, it is evident, that if a general view be taken of their properties, they are distinguished by obvious phenomena from the three orders hitherto noticed. But if their effects on man be alone taken into account, when of course their influence on the external surface of the body must be left out of view, nothing will be discovered to distinguish them from several of the metallic irritants.
The symptoms occasioned in man by the irritant poisons of the vegetable kingdom, are chiefly those indicating inflammation of the villous coat of the stomach and intestines. When taken in large doses, they excite vomiting soon after they are swallowed; by which means the patient’s life is often saved. But sometimes, like the mineral poisons that possess emetic properties, the vegetable acrids present a singular uncertainty in this respect: they may be retained without much inconvenience for some length of time. If this should happen, or if the dose be less, in which case vomiting may not be produced at all, or if only part of a large dose be discharged at an early period by vomiting,—the other phenomena they give rise to are sometimes fully developed. The most conspicuous symptom then is diarrhœa, more or less profuse. The diarrhœa and vomiting are commonly attended by twisting pain of the belly, at first remittent, but gradually more constant, as the inflammation becomes more and more strongly marked. Tension, fulness and tenderness of the belly, are then not unfrequent. The stools may assume all the characters of the discharges in natural inflammation of the intestinal mucous membrane, but an additional character worthy of notice is the appearance of fragments of leaves or flowers belonging to the plant which has been swallowed. At the same time there is generally excessive weakness. Sometimes, too, giddiness and a tendency to delirium have been observed. But the latter symptoms are rare: if they occurred frequently, it would be necessary to transfer any poison which produced them to the class of narcotico-acrids.
The properties now mentioned have long ago attracted the attention of physicians, and led them to introduce many vegetable irritants into the materia medica. In fact they comprehended a great number of the most active, or, as they are technically called, drastic purgatives. Among others, elaterium, euphorbium, gamboge, colocynth, scammony, croton, jalap, savin, stavesacre, are of this description. The effect of most of them, however, is so violent and uncertain, that few are now much used except when combined with other milder laxatives.
The morbid appearances they leave in the dead body are the same with those noticed under the head of their mode of action,—more or less redness of the stomach, ulceration of its villous coat, redness of the intestines, and especially of the rectum and colon, which are often inflamed when the small intestines are not visibly affected.
In the following account of the particular poisons of this order, a very cursory view will be taken of their physical and chemical properties. A knowledge of these properties will be best acquired from any author on the materia medica; and an account of them would be misplaced in a work which professes to describe only the leading objects of the medical jurist’s attention.
A great number of genera might be arranged under the present head. But the following list comprehends all which require mention. Euphorbia, or spurge, the ricinus, or castor-oil tree, the jatropha, or cassava-plant, croton-oil, elaterium, or squirting cucumber, colocynth, or bitter-apple, bryony, or wild cucumber, ranunculus, or buttercup, anemone, stavesacre, celandine, marsh marigold, mezereon, spurge-laurel, savine, daffodil, jalap, manchineel, cuckow-pint.
The first plants to be noticed belong to the natural order Euphorbiaceæ, namely, the euphorbia, ricinus, jatropha, and croton.
Euphorbium is the inspissated juice of various plants of the genus euphorbia or spurge, but is principally procured from the E. officinarum, a species that abounds in Northern Africa. It contains a variety of principles; but its chief ingredient is a resin, in which its active properties reside. It has been analysed by Braconnot, Pelletier, Brandes,[1403] and Drs. Buchner and Herberger. According to Brandes the resin forms above 44 per cent. of the crude drug, and is so very acrid, that the eyelid is inflamed by rubbing it with the finger which has touched the resin, even although it be subsequently washed with an alkali.[1404] According to the most recent analysis, that of Drs. Buchner and Herberger, this resin is a compound substance, which consists of two resinous principles, one possessing in some degree the properties of an acid, and the other the properties of a base. The latter, which they have called euphorbin, is considered by them the true active principle of euphorbium.[1405] It will be mentioned under the head of Jalap, that they have taken the same view of the nature of other resinous poisons.
Orfila found that a large dog was killed in twenty-six hours and a half by half an ounce of powder of euphorbium introduced into the stomach, and retained there by a ligature on the gullet.
The whole coats of the stomach, but especially the villous membrane, were of a deep-red or almost black colour; the colon, and still more the rectum, were of a lively red internally, and their inner membrane was checkered with little ulcers. Two drachms of the powder thrust into a wound in the thigh, and secured by covering it with the flaps of the incision, killed a dog in twenty-seven hours; and death was preceded by no remarkable symptom except great languor. The wounded limb was found after death highly inflamed, and the redness and sanguinolent infiltration, which were alluded to in the general observations on the vegetable acrids, extended from the knee as high up the trunk as the fifth rib,—a striking proof of the rapidity with which this variety of inflammation diffuses itself.[1406] Mr. Blake concludes from his experiments, that euphorbium, when injected in a state of solution in the jugular vein, acts by obstructing both the pulmonary and systemic capillaries, and so preventing the passage of the blood into the left side of the heart; but that the heart is not primarily acted on.[1407]
The most common symptoms occasioned in man by euphorbium are violent griping and purging, and excessive exhaustion; but it appears probable that narcotic symptoms are also at times induced. A case of irritant poisoning with it has been related in the Philosophical Transactions; but it is not a pure one, as a large quantity of camphor was taken at the same time. Much irritation was produced in the alimentary canal; but by the prompt excitement of vomiting and the subsequent use of opium the patient soon recovered.[1408] Mr. Furnival has related a fatal case which arose from a farrier having given a man a tea-spoonful by mistake for rhubarb. Burning heat in the throat and then in the stomach, vomiting, irregular hurried pulse, and cold perspiration were the leading symptoms; and the person died in three days. Several gangrenous spots were found in the stomach, and its coats tore with the slightest touch.[1409] The operation of this substance is so violent and uncertain, that it has long ceased to be employed inwardly in the regular practice of medicine, and has been even excluded from some modern Pharmacopœias. It is still used by farriers as an external application; and in the Infirmary of this city I met with a fatal case of poisoning in the human subject, which was supposed to have been produced by a mixture containing it, and intended to cure horses of the grease. Pyl has related the proceedings in a prosecution against a man for putting powder of euphorbium into his maid-servant’s bed; and from this narrative it appears, that, when applied to the sound skin, it causes violent heat, itching and smarting, succeeded by inflammation and blisters.[1410] Dr. Veitch denies that the powder has any such power;[1411] but the effects described by Pyl correspond with popular belief.
Probably all the species of euphorbium possess the same properties as E. officinarum. Orfila found that the juice of the leaves of E. cyparissias and lathyris produces precisely the effects described above. Sproegel applied the juice of the latter to his face, and was attacked in consequence with an eruption like nettle-rash; and he found that it caused warts and hair to drop out.[1412] Vicat mentions analogous facts, and Lamotte notices the case of a patient who died in consequence of a clyster having been prepared with this species instead of the mercurialis.[1413] The seeds and root of the E. lathyris or caper-spurge are used by the inhabitants of the northern Alps in the dose of fifteen grains as an emetic; and very lately the oil of the seeds has been employed in Italy as an active purgative, which in the dose of two or eight grains is said to possess all the efficacy of croton oil.[1414] MM. Chevallier and Aubergier have also found the seeds of the E. hybeua and their expressed oil to be very energetic. The seeds yield 44 per cent. of oil, which in the dose of ten drops produces copious watery evacuations without pain, and resembles closely croton-oil in its effects.[1415] The E. esula appears to be a very active species. Scopoli says that a woman who took thirty grains of the root died in half an hour, and that he once knew it cause fatal gangrene when imprudently applied to the skin of the belly.[1416] Withering observes that all the indigenous species blister and ulcerate the skin, and that many of them are used by country people for these purposes.[1417]