PLUMBISM.
Acute poisoning by the soluble salts of lead will be referred to under Poisoning.
Chronic poisoning by lead is known as Plumbism or Saturnism, occurring in painters, plumbers, glaziers, and pottery operatives, and sometimes amongst the general community through contamination of the water supplied by leaden conduit pipes.
Prophylaxis.—The most effective preventive of chronic lead poisoning lies in absolute cleanliness. The condition usually arises from the intro duction of lead salts in minute quantities into the stomach by the operative eating his food without careful washing of his hands, and it is a well recognised fact that cleanly workmen very seldom suffer from plumbism. As it is also likely that absorption may take place through the skin, those coming into contact with lead should systematically see to the thorough cleansing of the entire skin by a bath in which soap and friction are employed at least once in every week.
The worker should never start his labour until after a morning meal, and a diet of milk and eggs possesses special prophylactic virtues. Where dry dust laden with leaden compounds exists in rooms in which the operative works he should be directed to keep Ins mouth shut as much as possible, and learn to breathe through his nose whilst working, or else to wear a respirator. lie should never eat his meals in his workshop.
Lemonade acidulated with Sulphuric instead of citric or tartaric acid is a commonly used prophylactic. A daily small dose of free Sulphur is, however, of more value in lozenge or electuary form. This latter plan also will insure against constipation, which must be carefully avoided, and if the sulphur fails to cause slight purging a morning dose of Magnesium Sulphate should be instituted.
Cider drinking is answerable for a proportion of cases of lead-poisoning owing to contamination of the beverage by passing through lead pipes, and this and the water supply should be investigated upon the first appear ance of suspicious symptoms.
Once a worker has become affected with well-marked symptoms and relieved by appropriate treatment, he should be advised to change his occupation as a preventive of future attacks, since the process of eliminat ing the poison is a very long and tedious one, and he is almost certain to return to his work before a complete cure is effected.
Curative Treatment.—This consists in the administration of Iodide of Sodium or Potassium in full doses with the view of dissolving out the lead salts accumulated in the muscles and other tissues. The soluble lead compound so formed enters the circulation, and is mainly eliminated by the mucous membrane of the bowel, and in order to effect its removal from the body Sulphate of Magnesium should be conjointly employed in order to form the insoluble sulphate of lead, which is speddily swept out by the purgative action of the saline, otherwise, as pointed out by Oliver, the patient may be repoisoned by lead which has become dissolved out of his own tissues.
Sulphur baths and the drinking of large quantities of natural sulphur water are also highly recommended. Stephens extols i-gr. doses of Permanganate of Calcium in pills.
The symptoms of chronic lead poisoning will require special treatment. Colic is the most urgent of these; it is usually associated with obstinate constipation. A large enema of tepid water should he slowly administered in order to thoroughly wash out the colon, or a pint of warmed Olive Oil may be injected when the faces are hardened, and, as stated in the article on Colic (p. 163), large doses of oil by the mouth are useful. The enema should be followed immediately by a full dose of Castor Oil or of Epsom Salt. Very severe abdominal pain will call for a full dose of Morphia hypodermically or Opium by the mouth, and it may be found that the opium acts sometimes as a laxative in these cases, and even when combined with Alum it may purge slightly, probably from its action in preventing irregular peristalsis. Belladonna also exerts a specific action upon the muscular nerve supply, and may he advantageously combined with the saline purgative. Poultices applied to the abdominal surface, if very warm and of large bulk, usually afford considerable relief.
Paralysis caused by lead poisoning should be treated locally by Elec tricity conjointly with constitutional measures as iodides and Sulphate of Magnesia for the elimination of the metal. The Faradic current gives the best results, and the Schnee 4-cell bath may conveniently be employed, as only the forearms and feet need be immersed, and by this means the interrupted, galvanic and sinusoidal currents may be used from time to time according to the results obtained in each case. But the entire hydro electric bath is a more valuable means of promoting elimination of the poison.
Massage should be assiduously employed to the " drop-wrist " muscles, and care should be taken by suitable splints to minimise the overaction of the unopposed flexors.
The parenchymatous injection of Strychnine, though on theoretical considerations condemned by some authorities, is of undoubted value in restoring the tone of the paralysed muscles. The best results are obtained by injecting r min. of the official solution, diluted with ro mins. of water at 4 or 5 places deeply into the muscle substance.
Brain symptoms as intense headache and convulsions should be relieved by small doses of Antipyrine combined with Bromides in full amount. Albuminuria should be treated on the lines indicated in the cirrhotic type of Bright's disease and arteriosclerosis.