Transcriber’s Notes
Text printed in italics has been transcribed _between underscores_,
bold face printed text =between equal signs=. Small capitals have
been replaced with ALL CAPITALS.
Literature references are numbered and listed per chapter at the
end of the chapter, footnotes (indicated by letters in square
brackets) will be found directly underneath the paragraph, table or
illustration to which they refer.
More Transcriber’s Notes may be found at the end of this text.
LEAD POISONING AND LEAD ABSORPTION
INTERNATIONAL MEDICAL MONOGRAPHS
_General Editors_ { LEONARD HILL, M.B., F.R.S.
{ WILLIAM BULLOCH, M.D.
_THE VOLUMES ALREADY PUBLISHED OR IN PREPARATION ARE:_
=THE MECHANICAL FACTORS OF DIGESTION.= By WALTER B. CANNON, A.M.,
M.D., George Higginson Professor of Physiology, Harvard University.
[_Ready._
=SYPHILIS: FROM THE MODERN STANDPOINT.= By JAMES MACINTOSH, M.D.,
Grocers’ Research Scholar; and PAUL FILDES, M.D., B.C., Assistant
Bacteriologist to the London Hospital.
[_Ready._
=BLOOD-VESSEL SURGERY AND ITS APPLICATIONS.= By CHARLES CLAUDE
GUTHRIE, M.D., Ph.D., Professor of Physiology and Pharmacology,
University of Pittsburgh, etc.
[_Ready._
=CAISSON SICKNESS AND THE PHYSIOLOGY OF WORK in Compressed Air.= By
LEONARD HILL, M.B., F.R.S., Lecturer on Physiology, London Hospital.
[_Ready._
=LEAD POISONING AND LEAD ABSORPTION.= By THOMAS LEGGE, M.D., D.P.H.,
H.M. Medical Inspector of Factories, etc.; and KENNETH W. GOADBY,
D.P.H., Pathologist and Lecturer on Bacteriology, National Dental
Hospital.
=THE PROTEIN ELEMENT IN NUTRITION.= By Major D. MCCAY, M.B., B.Ch.,
B.A.O., M.R.C.P., I.M.S., Professor of Physiology, Medical College,
Calcutta, etc.
=SHOCK: The Pathological Physiology of Some Modes of Dying.= By
YANDELL HENDERSON, Ph.D., Professor of Physiology, Yale University.
=THE CARRIER PROBLEM IN INFECTIOUS DISEASE.= By J. C. LEDINGHAM,
D.Sc., M.B., M.A., Chief Bacteriologist, Lister Institute of
Preventive Medicine, London; and J. A. ARKWRIGHT, M.A., M.D.,
M.R.C.P., Lister Institute of Preventive Medicine, London.
=DIABETES.= By J. J. MACLEOD, Professor of Physiology, Western
Reserve Medical College, Cleveland, U.S.A.
_A Descriptive Circular of the Series will be sent free on
application to the Publishers:_
LONDON: EDWARD ARNOLD
NEW YORK: LONGMANS, GREEN & CO.
INTERNATIONAL MEDICAL MONOGRAPHS
_General Editors_ { LEONARD HILL, M.B., F.R.S.
{ WILLIAM BULLOCH, M.D.
LEAD POISONING AND
LEAD ABSORPTION
THE
SYMPTOMS, PATHOLOGY AND PREVENTION,
WITH SPECIAL REFERENCE TO THEIR
INDUSTRIAL ORIGIN AND AN ACCOUNT OF THE
PRINCIPAL PROCESSES INVOLVING RISK
BY
THOMAS M. LEGGE, M.D. OXON., D.P.H. CANTAB.
H.M. MEDICAL INSPECTOR OF FACTORIES; LECTURER ON FACTORY HYGIENE
UNIVERSITY OF MANCHESTER
AND
KENNETH W. GOADBY, M.R.C.S., D.P.H. CANTAB.
PATHOLOGIST AND LECTURER ON BACTERIOLOGY, NATIONAL DENTAL HOSPITAL
APPOINTED SURGEON TO CERTAIN SMELTING AND WHITE
LEAD FACTORIES IN EAST LONDON
LONDON
EDWARD ARNOLD
NEW YORK: LONGMANS, GREEN & CO.
1912
[_All rights reserved_]
GENERAL EDITORS’ PREFACE
The Editors hope to issue in this series of International Medical
Monographs contributions to the domain of the Medical Sciences on
subjects of immediate interest, made by first-hand authorities who have
been engaged in extending the confines of knowledge. Readers who seek
to follow the rapid progress made in some new phase of investigation
will find therein accurate information acquired from the consultation
of the leading authorities of Europe and America, and illuminated by
the researches and considered opinions of the authors.
Amidst the press and rush of modern research, and the multitude of
papers published in many tongues, it is necessary to find men of proved
merit and ripe experience, who will winnow the wheat from the chaff,
and give us the present knowledge of their own subjects in a duly
balanced, concise, and accurate form.
This volume deals with a subject of wide interest, for lead is dealt
with in so many important processes of manufacture--in the making of
white lead; pottery glazing; glass polishing; handling of printing
type; litho-making; house, coach, and motor painting; manufacture of
paints and colour; file-making; tinning of metals; harness-making;
manufacture of accumulators, etc.
The authors bring forward convincing evidence, experimental and
statistical, in favour of the causation of lead poisoning by the
inhalation of dust. This makes prevention a comparatively simple
matter, and the methods of prevention are effective, and will
contribute greatly to the health of the workers and the prevention of
phthisis, which is so prevalent among lead-workers. Exhaust fans and
hoods, or vacuum cleaners, for carrying away the dust formed in the
various processes--these are the simple means by which the dust can be
removed and the workers’ health assured.
LEONARD HILL.
WILLIAM BULLOCH.
_September, 1912._
AUTHORS’ PREFACE
Progress in the knowledge of the use of lead, the pathology of lead
poisoning, and the means of preventing or mitigating the risk from it,
has been rapid of late years, and has led to much legislative action
in all civilized countries. The present is a fitting time, therefore,
to take stock of the general position. We have both, in different
ways, been occupied with the subject for several years past, the
one administratively, and the other experimentally, in addition to
the practical knowledge gained by examining weekly over two hundred
lead-workers.
The present treatise takes account mainly of our own persona
experience, and of work done in this country, especially by members
of the Factory Department of the Home Office, and certifying and
appointed surgeons carrying out periodical medical examinations in lead
factories. The book, however, has no official sanction.
We are familiar with the immense field of Continental literature
bearing on legislation against lead poisoning, but have considered any
detailed reference to this outside the scope of our book, except in
regard to the medical aspects of the disease.
Most of the preventive measures mentioned are enforced under
regulations or special rules applying to the various industries
or under powers conferred by the Factory and Workshops Act, 1901.
Occasionally, however, where, in the present state of knowledge,
particular processes are not amenable to the measures ordinarily
applied, we have suggested other possible lines on which the dangers
may be met. We have not reprinted these regulations and special rules,
as anyone consulting this book is sure to have access to them in the
various works published on the Factory Acts.
The practical value of the experimental inquiry described in Chapter
VI., and the light it seems to throw on much that has been difficult to
understand in the causation of lead poisoning, has led us to give the
results in detail.
One of us (K. W. G.) is responsible for Chapters I., III., and V. to
XI., and the other (T. M. L.) for Chapters II. and XII. to XVII.;
but the subject-matter in all (except Chapter VI., which is the work
entirely of K. W. G.) has been worked upon by both.
Our thanks are due to the Sturtevant Engineering Co., Ltd., London;
Messrs. Davidson and Co., Ltd., Belfast; the Zephyr Ventilating Co.,
Bristol; and Messrs. Enthoven and Sons, Ltd., Limehouse, for kindly
supplying us with drawings and photographs.
_September, 1912._
CONTENTS
CHAPTER PAGE
I. HISTORICAL--CHEMISTRY OF LEAD 1
II. ÆTIOLOGY 7
III. SUSCEPTIBILITY AND IMMUNITY 27
IV. STATISTICS OF PLUMBISM 44
V. PATHOLOGY 62
VI. PATHOLOGY--_Continued_ 81
VII. SYMPTOMATOLOGY AND DIAGNOSIS 110
VIII. EXCRETION OF LEAD 127
IX. THE NERVOUS SYSTEM 140
X. CHEMICAL INVESTIGATIONS 165
XI. TREATMENT 184
XII. PREVENTIVE MEASURES AGAINST LEAD POISONING 199
XIII. PREVENTIVE MEASURES AGAINST LEAD POISONING--_Continued_ 221
XIV. PREVENTIVE MEASURES AGAINST LEAD POISONING--_Continued_ 230
XV. DESCRIPTION OF PROCESSES 242
XVI. DESCRIPTION OF PROCESSES--_Continued_ 265
XVII. DESCRIPTION OF PROCESSES--_Continued_ 288
INDEX 305
LIST OF PLATES
FACING
PAGE
PLATE I. 92
PLATE II. 93
PLATE III. 95
PLATE IV. 276
LEAD POISONING AND LEAD ABSORPTION
CHAPTER I
HISTORICAL--CHEMISTRY OF LEAD
The use of lead for various industrial processes and for painting was
well known to the ancients. Pliny[1] speaks of white lead, and a method
of corroding lead in earthen pots with vinegar, sunk into a heap of
dung, as the means by which white lead was made for paint. Agricola
mentions three forms of lead--white lead, a compound which was probably
bismuth, and metallic lead itself. The alchemists were acquainted with
the metal under the name of “saturn,” the term signifying the ease
with which the nobler metals, silver and gold, disappear when added to
molten lead.
Colic caused by lead was also known in ancient times, and is
described by Pliny; many other writers refer to it, and Hippocrates
was apparently acquainted with lead colic. Not until Stockhusen[2],
however, in 1656, ascribed the colic of lead-miners and smelters to the
fumes given off from the molten liquid was the definite co-relation
between lead and so-called “metallic colic” properly understood,
and the symptoms directly traced to poisoning from the metal and
its compounds. Æthius, in the early part of the sixteenth century,
gave a description of a type of colic called “bellon,” frequently
associated with the drinking of certain wines. Tronchin[3], in 1757,
discovered that many of these wines were able to dissolve the glaze
of the earthenware vessels in which they were stored, the glaze being
compounded with litharge.
In our own country, John Hunter[4] describes the frequent incidence of
“dry bellyache” in the garrison of Jamaica, caused by the consumption
of rum which had become contaminated with lead. Many other writers in
ancient and historical books on medicine have written on the causation
of colic, palsy, and other symptoms, following the ingestion of salts
of lead; and as the compounds of lead, mainly the acetate or sugar of
lead, were freely used medicinally, often in large doses, opportunities
constantly occurred for observing the symptoms produced in susceptible
persons. It is not to the present purpose to examine the historical
side of the question of lead poisoning, but those interested will find
several valuable references in Meillère’s work “Le Saturnisme”[5].
Lead was used in the seventeenth and eighteenth centuries particularly,
and in the earlier part of the nineteenth, for its action upon the
blood. In view of experimental evidence of the action of lead on the
tissues, particularly the blood, this empirical use has interest. Salts
of lead were found to be hæmostatic, and were therefore used for the
treatment of ulcers because of the power, notably of lead acetate, of
coagulating albuminous tissue. It was also used in the treatment of
fevers, where again it is quite possible that the administration of a
lead salt, such as an acetate, produced increase in the coagulability
of the blood. At the same time spasms of colic and other accidents
followed its use. There is practically no disease to which the human
body is subject which was not treated by lead in some form or another.
Lead, with the addition of arsenic, was given for malaria, while its
use in phthisis was also common. The present use of diachylon plaster
is an instance of the continuous use of a salt of lead medicinally, as
also is the lotion of the British Pharmacopœia containing opium and
lead.
THE CHEMISTRY OF LEAD.
=Physical Properties.=--Lead belongs to the group of heavy metals, and
occupies a position between bismuth and thorium in the list of the
atomic weights, the atomic weight being 206·4, and density 11·85. It
is blue-grey in colour, and its softness and facility to form a mark
upon paper are well known. Lead melts at a temperature of 325° C., and
at this temperature a certain (if negligible) amount of volatilization
takes place, which vapour becomes reprecipitated in the form of an
oxide. Use is made of the volatility of the metal at the higher
temperatures, 550° C. and upwards, in the oxidation of lead from a
mixture of lead, silver, and gold; the oxide of lead, or litharge, is
partially collected and absorbed by the crucible, but the greater part
is mainly removed from the surface of the liquid metal as it is formed,
while the richer metal is left in the crucible.
Chemically speaking lead is a tetrad, and forms a number of organic
derivatives, especially through the intervention of a particular
oxide, minium. Lead forms metallic alkalies and alkaline earths,
resembling silver in this direction, and also metallic compounds
with zinc and copper; in this point it is very similar to silver.
Small quantities of lead present in other metals--as, for instance, a
small trace in gold--alter its physical qualities to a great extent;
whilst the addition of minute traces of other metals to lead--as, for
instance, antimony--cause it to become hard, a fact made use of in the
manufacture of shot.
A number of oxides of the metal are known: two varieties of protoxides
(massicot and litharge), protoxide hydrate, and bioxide. Sulphide, or
galena, represents the chief form in which lead is found in Nature, and
from which the actual metal is produced by metallurgical processes.
The salts of lead may be divided as follows:
1. The carbonates or hydrated carbonates employed in a large number
of industrial and other processes, which are the cause of much lead
poisoning.
2. The acetates, both normal and basic, which are particularly
concerned in the production of white lead--at any rate in the process
of converting metallic lead into the hydrated carbonate through the
medium of acetic acid and steam.
3. Chromate of lead, which is used as a pigment, and also in dyeing
yarns, etc.
4. The nitrates and chlorides; the chloride particularly is used as an
oxidizing agent (plumbing, soldering, tinning of metals).
5. The silicates, silico-borates, silico-fluoborates, which constitute
the many varieties of glass and crystals used in optical instruments,
and the various glazes and enamel colours used in the potteries.
There are a large number of other derivatives, but these are not of
special interest to the subject in hand.
=The Action of Water upon Lead.=--The action of water on lead was known
even to the ancients, Pliny and Galen having written on the subject.
At times, and under certain conditions, as much as 20 milligrammes per
litre have been found, as in the Bacup epidemic, and 14 milligrammes
per litre in the epidemic at Claremont. Bisserie[6] in 1900 made an
exhaustive inquiry into the action of water upon lead; he gives the
following conclusions:
1. Water and saline solutions attack lead more or less readily when it
is in combination with another metal, such as solder, copper, bronze,
iron, or nickel, the result being a hydrated oxide.
2. The maximum effect is produced with water slightly acid and with
solutions of chlorides or nitrates. With these it is not necessary to
have other metals present, and if the water is thoroughly aerated the
pure metal is attacked.
3. Bicarbonates and carbonic acid exercise by themselves an action
on wet lead, but the carbonate of lead formed in the process adheres
firmly to the surface of the metal, and prevents any further action.
4. Sulphates act in the same way, but in less degree.
5. This protective action is much diminished when the water is even
slightly charged with nitrates or organic material. Pouchet has pointed
out that lead branch-pipes fixed to iron water-pipes, thus producing an
“iron-lead couple,” set up definite electro-chemical changes, and tend
to increase the rate at which solution of lead in the pipe water takes
place.
Houston[7], in an extensive and very full report on the effect of
water upon lead, especially undertaken for the purpose of inquiry into
the contamination of supplies of drinking water by means of lead,
distinguishes two species of action--namely, plumbo-solvency, which
is brought about by the acidity of the water in contact with lead;
and a second kind of action, erosion, determined to some extent by
the dissolved air in the water. He came to the conclusion that the
plumbo-solvency and erosive action of water on metallic lead differed
considerably, and that the protective layer or plumbo-protective
substance did not always protect lead pipes from the solvent action of
water.
=Chemical Characters of Lead Salts.=--A short summary of the chemistry
of lead salts may not be out of place.
A soluble salt of lead, such as the acetate or nitrate, is precipitated
by (1) hydrogen sulphide or alkaline sulphide as a brown or black
precipitate, which is insoluble in ammonium sulphide. In dilute
solutions this sulphide is, however, appreciably soluble in mineral
acids, and may introduce errors in analysis, especially as the
solubility is distinctly increased by the presence of certain earthy
salts. The sulphide produced through the action of alkaline sulphide on
a soluble salt of lead is less soluble than is the corresponding acid
sulphide. Soluble salts of lead are at once precipitated by albumin or
peptone; the resulting precipitate has no stable composition.
Under certain conditions definite colloidal precipitates are formed,
particularly in the presence of sulphide of copper or mercury. (2)
Sulphuric acid or soluble sulphates produce a precipitate of lead
sulphate insoluble in excess of the precipitating salt or sulphuric
acid, and only slightly soluble in alkaline solutions. This method
is the one generally adopted for gravimetric determination of a lead
salt. (3) Potassium chromate produces a precipitate of chromate of
lead very little soluble in acid, but soluble in caustic alkali. (4)
Potassium iodide produces a yellow lead iodide, soluble on heating, and
reprecipitating and crystallizing on cooling. (5) Alkaline chlorides
and hydrochloric acid produce needle-like crystals of lead chloride
soluble on heating, and reprecipitating on cooling. (6) Potassium
nitrate in conjunction with a copper salt (copper acetate) produces
a precipitate of a triple copper, lead, and potassium nitrate,
crystallizing in characteristic violet-black cubes. This reaction is
one made use of in the qualitative determination of small quantities of
lead in organic fluids (see p. 167).
All the precipitates of lead salts, with the exception of the sulphide,
are soluble in fixed alkalies, in ammonium acetate, ammonium tartrate,
and ammonium citrate. It is possible to determine the presence of lead
in a large volume without evaporating down the whole bulk of fluid. By
this means liquid containing lead is treated with sulphide of copper,
sulphide of mercury, or baryta-water. Meillère states that he has
detected the presence of as small a quantity as 1 milligramme of lead
in 1,000 c.c. of water in this manner without evaporating the liquid.
Where lead is in organic combination, as is the case in the urine of
persons suffering from lead poisoning, it is not decomposed by hydrogen
sulphide, and the method is therefore not applicable in such cases, but
is useful in water examination.
=Electrolytic Reactions.=--Solutions of lead are easily electrolyzed,
and give a precipitate of lead at the cathode; simultaneously the
peroxide is produced at the anode, and the reaction is acid. In nitric
acid solutions Riche pointed out that the whole of the lead is carried
to the anode, and this is the reaction made use of in the determination
of lead present in the urine (see p. 172).
The presence of copper in an electrolyte regulates the precipitation
of lead oxide, copper alone being deposited at the cathode, and at
the same time the presence of a small quantity of copper promotes the
destruction of organic materials.
REFERENCES.
[1] PLINY: lxxxiii., 11, N.c.v.
[2] STOCKHUSEN: De Litharg. Fumo, etc. Goslar, 1656.
[3] TRONCHIN: De Colica Pictonum. 1758.
[4] JOHN HUNTER: Observations of Diseases of the Army in Jamaica.
London, 1788.
[5] MEILLÈRE, G.: Le Saturnisme. Paris, 1903.
[6] BISSERIE: Bull. Soc. Pharmacol. May, 1900.
[7] HOUSTON: Local Government Board Annual Report, 1901-02,
supplement, vol. ii.