observed that the granite dust is lightish-grey in colour, with black
specks, and contains numerous flat, transparent splinters of quartz.
Sandstone dust, on the other hand, is a finer powder, it is yellowish,
and equal in colour throughout; it is rather an amorphous powder; in
some samples a few sharp-edged plates of quartz can be seen. From
microscopical appearances it might be assumed that granite dust would
be very much more hurtful to the workmen than sandstone, and yet,
according to Arlidge, _Diseases of Occupations_, p. 303, who made
special inquiries into this subject, the workmen employed around
Aberdeen in the cutting, dressing, and polishing of granite, are seldom
the victims of pulmonary disease attributable to their occupation. This
circumstance may be due to the igneous character of the rock, and the
small quantity of dust that is thrown off, especially in the act of
chiselling. Besides, as the particles of dust are of considerable size,
they would, if inhaled, be caught in the upper part of the respiratory
passages, and therefore not have the opportunity of inflicting damage
upon the lung. The fact remains that while Aberdeen granite workers
suffer from chronic bronchitis, they are remarkably free from the
pulmonary fibrosis to which stone masons and French millstone builders
are liable.
[Illustration:
FIG. 42.--Cement.
FIG. 43.--Sandstone.
FIG. 44.--Granite.
FIG. 45.--Lead Dust from Printing Shop, and
Type casting.
Microphotographs of Dusts developed in Dusty Trades. The
first twenty are reproductions after Migerka: the last six
after Bolam and Oliver.]
In Fig. 45, _lead_ dust, as obtained from a printer’s shop, the
particles are seen to vary in size and form. The particles are for the
most part round, and not unusually sharp. This dust is not harmful on
account of its form so much as dangerous through being absorbed into
the blood. The dust that is given off in _file-making_ contains
particles of iron as well as lead and charcoal (see p. 342), and this
is productive of a large amount of pulmonary disease in men and women
engaged in this trade. But with file-cutters as with printers and
typographers generally, the unhealthy and close workrooms in which
they follow their avocation are to some extent also responsible for
the lung diseases. As bearing upon this subject, the annual reports of
Benefit Societies are not without interest. The reports of the Benefit
Societies of the printers and type-casters of Vienna, from 1889–1892,
give the following percentage of illnesses:--
--------------------------------+----------+-----------+----------+
| Typists. | Printers. | Casters. |
| | | |
--------------------------------+----------+-----------+----------+
Tuberculosis | 2.8 | 1.7 | 1.6 |
Diseases of Respiratory Organs | 11.4 | 7.5 | 10.8 |
Disorders, etc., of Digestive „ | 7.5 | 5.1 | 7.1 |
--------------------------------+----------+-----------+----------+
Part 2 of Table.
--------------------------------+-----------+-----------+----------+
| Assistant | Female | Female |
| Workers. | Printers. | Casters. |
--------------------------------+-----------+-----------+----------+
Tuberculosis | 1.5 | 1.7 | 2.8 |
Diseases of Respiratory Organs | 7.5 | 9.0 | 11.1 |
Disorders, etc., of Digestive „ | 4.0 | 8.5 | 18.0 |
--------------------------------+-----------+-----------+----------+
It is the typist and caster who suffer most from diseases of the
respiratory organs, while among the printers and their assistants, the
average is just above the normal. So far as diseases of the digestive
organs are concerned, the printers suffer less than the others,
but there is a preponderating amount of sickness among the females
in nearly all branches of the industry. When the amount of general
sickness in these trades is examined, it is found that the averages
of total sickness are as follows: typists, 44.7; male casters, 41.2;
female casters, 91.2; while printers are only 27.9, and assistants
28.5. These remarks are introduced here to emphasise the fact that in
the printing trades it is not alone the dust that is injurious, but the
lead poisoning which it causes, and they also strengthen an opinion
expressed in other parts of this book, viz., that females are more
liable to plumbism than males, as the following figures also show. The
percentage of plumbism in male casters in Vienna is 8 per cent.; in
female casters it is 22.7 per cent.
In Fig. 47, dust developed during _needle-grinding_, the particles
of dust are frequently hook-like in appearance and sharp-edged. Lying
among these are also observed particles of quartz with edges that are
more or less sharp.
Fig. 48 represents dust from _mother-of-pearl grinding_. Hirt
regarded this trade as extremely dangerous. He found that 15 to 16 per
cent. of the men engaged in this trade died from phthisis. According
to Guggenbauer, turners of mother-of-pearl are said to suffer from a
peculiar affection of the bones (osteomyelitis) owing to absorption of
carbonate of lime from particles of the shell that have been inhaled.
It is said that obscure rheumatic-like pains subsequently occur, and
that the bones ulcerate. I have visited mother-of-pearl grinding shops
in Sheffield and interrogated the workers there, but have been unable
to find any evidence to support Guggenbauer’s contention. The grinding
in Sheffield is done by the wet process, and none of the men seem to
suffer in the manner alluded to.
_Flax dust_, Fig. 50, is injurious to the worker. It contains
mineral particles, vegetable cells, and broken stalks--so too does
_hemp_, Fig. 51. In the teasing and spinning of _cotton_,
Fig. 53, there is a considerable amount of dust raised in which
fine fibres of cotton are found, _Jute_, Fig. 52, shows
vegetable fibres which are often torn and ragged, and therefore
with difficulty detached from the bronchial mucous membrane. In
the figures representing dust obtained from _felt-making_,
_fur-brushing_, and _rag-cleaning_, may be observed various
forms of hairs and vegetable structures, with numerous foreign
particles adherent to and encircling them. Some of these particles
are of animal origin and may carry micro-organisms. The dust obtained
during _wheat-cleaning_, Fig. 61, contains pointed vegetable hairs
and numerous particles of organic and inorganic material, and would, if
inhaled, be particularly irritating to the bronchial mucous membrane.
[Illustration: FIG. 46.--Gilchrist-Thomas Slag.]
[Illustration: FIG. 47.--Needle Grinding.]
[Illustration: FIG. 48.--Mother-of-Pearl.]
[Illustration: FIG. 49.--Sawdust.]
[Illustration: FIG. 50.--Flax.]
[Illustration: FIG. 51.--Hemp.]
[Illustration: FIG. 52.--Jute.]
[Illustration: FIG. 53.--Cotton.]
[Illustration: FIG. 54.--Silk.]
[Illustration: FIG. 55.--Horn.]
[Illustration: FIG. 56.--Ivory.]
[Illustration: FIG. 57.--Felt Manufacture.]
[Illustration: FIG. 58.--Dust from Fur Brushing
Machine.]
[Illustration: FIG. 59.--Dust from Rag Cleaning.]
[Illustration: FIG. 60.--Bone Meal.]
[Illustration: FIG. 61.--Dust from Wheat Cleaning.]
[Illustration:
FIG. 62.--Ordinary Slag. Consett Iron
Works.
FIG. 63.--Basic Slag. North Eastern
Steel Works, Middlesbrough.
FIG. 64.--Ganister. Messrs Grayson,
Lowood & Co., Middlesbrough.
FIG. 65.--Dust from Fork Grinding
on dry stone. Sheffield.
FIG. 66.--Powdered Flint. Earthenware
Works, Stoke-on-Trent.
FIG. 67.--Glaze cleaned off Ware.
Stoke-on-Trent.
Microphotographs of Dusts, high-power. (T. Oliver and R. A.
Bolam).]
It is a well-known fact that some forms of basic slag are more
injurious than others. From a microscopical examination of the
various dusts sent to me by Commander Hamilton Smith and
Mr H. J. Wilson, H.M. Inspectors of Factories, and others (see
Microphotographs, Figs. 62–67, by Dr Bolam and myself), I do not find
sufficient evidence, judging by its appearance alone, to explain
why one kind of basic slag manure is so very much more harmful than
another. There may be chemical as well as physical causes at work in
the production of pathological changes in the bronchial mucous membrane
of those who work in basic slag. Some slags, for example, contain
larger quantities of lime than others.
THOMAS OLIVER.
CHAPTER XVIII
DUST WOMEN
Many readers are probably not aware that there is such a recognised
employment for women as the sifting and sorting of the refuse of our
houses. Any one wishing to observe how this work is carried on can
see it daily in the dust-yards and wharves of London. In these places
there are women who are actually spending their lives handling all
the obnoxious waste that a great city produces. Dust-carts bring
load after load of refuse to the yards. The drivers tip the contents
of the carts before the women, who are drawn up in line and whose
duty it is to sieve and sift this refuse, and then to sort into the
different baskets that are standing close by, such things as rags,
bones, string, cork, boots, paper, coal, broken glass, etc. It is a
dirty and dusty occupation, and as a rule the women have their clothing
covered and permeated by the dust, and their hair laden with it too,
notwithstanding the handkerchief or shawl that covers their head.
Wrapped with a piece of old sacking round their skirts and cloth bands
round their legs, they lean over their work and inhale the unsavoury
dust that has gone forth from the houses and the shops of the city. In
one sense it is fortunate that this unpleasant operation is conducted
in the open air, for therein to a large extent lies the comparative
harmlessness of the employment. From time to time the hands of the
women get cut by broken glass, and there is incurred the risk of
festering wounds and the danger of blood poisoning.
The story of dust women is told by Miss Emily Hobhouse in the
_Economic Journal_, September 1900, p. 411, from whose interesting
report I have drawn largely for the information supplied in this
article. Miss Hobhouse naturally raises the question as to how far the
sifting and sorting of refuse is a fitting and sanitary employment
for women. Theoretically it cannot be a pleasant one, considering
what the refuse may and does contain, and yet from the organic and
inorganic materials, the dead and dying organised heaps that leave
our houses as refuse, these women pick out certain things that are
sent to manufacturers and reappear for sale in the form of glue, soap,
bottles, and paper, while even such a thing as broken glass is rescued,
transported to Sweden, and comes back to this country in the form of
emery paper for polishing steel.
The employment of dust women is dwindling, and must perforce disappear
owing to the multiplication of destructors, the expense of dealing
with the ever-increasing refuse by means of sifters and sorters, and
the growth of public opinion, which is certainly opposed to regarding
this work as a proper employment for women. It is a well-known fact
that if a woman takes to refuse picking early in life she becomes
almost utterly unfit for any other employment. At the present time
the destructors do much of the work that has hitherto been done by
men and women, but these furnaces can only destroy certain things in
the refuse, and consequently leave a residue that has still to be
got rid of. The question of removing the increasing amount of refuse
from London and our large towns is a difficult one to solve. It has
an economic side which cannot be ignored. In some of the vestries of
London the clinker and fine ash that are removed from the destructor
are converted into mortar, and the steam that is generated by the
destructor is used for driving the machinery for grinding the mortar
and clinker. It has been ascertained by sanitary engineers that town
refuse has about ⅑ the heating power of coal, and that in a large city
like London it can be destroyed for 2s. 5d. per ton, a less sum than it
costs to barge it away. Some of the Boards of Works dispose entirely of
their refuse by destructors, while others only do so partially; some
again have their own yards or wharves, but not in all of them are women
employed. Twenty-six of the vestries let out the work to contractors,
many of whom, on account of the cheaper labour, employ women. In
London alone there are at least 300 women employed as dust sorters.
The wages given by the vestries, and the conditions of labour found
under them, are much superior to those under contractors. The vestries
pay the women 15s. a week, each day’s work, except Saturday, extending
from 5 o’clock A.M. to 5 P.M., but 7s. to 8s. a week is all that can
be obtained from the contractors. The broken-down appearance of the
women who work for contractors, and who are sweated beyond all bounds,
causes them to compare most unfavourably with the dust sorters for the
vestries.
The evidence obtained from officials, contractors, and the women
themselves rather went to show that the general health of the men and
women working in the dust-yards was good. Owing to being so much in the
open air the women seemed hale and well-coloured, and they contrasted
most favourably with those who were working in the factories or at
home. Occasionally such troubles occur among them as sore throat,
ophthalmia or “blight,” poisoned wounds, and among the elderly women
recurrent attacks of cold on the chest, due to exposure to severe
weather and the wet. On the whole, however, it would seem as if the
open air life agreed with the women. In some of the yards the sifting
is done by machinery, and the women only do the sorting. In these yards
the women complain of finding it hard to keep pace with the machinery
and of having to lift too heavy loads.
Under all circumstances dust-sorting is dirty and disagreeable work.
It is generally undertaken by women of the lowest class. The only zest
that is given to the occupation is the prospect of finding money.
Occasionally a copper, silver, or gold coin is found, and in most of
the yards the money belongs to the finder. Such a piece of good luck,
however, seldom benefits the individual, for it is made the excuse
for a drunken spree that often lasts for days. The work is hard and
exposed. It not only unfits women for other employment, but even for
the ordinary duties of housewife and motherhood. It destroys the
best instincts of maternity. The work takes the mother away from her
children, who are consequently ill-tended and often die from neglect.
Although several children may be born of these women, in many instances
none of them live beyond a few months, not by the employment affecting
the children through the mother, but because maternal duties are
totally disregarded. For these reasons, therefore, it is scarcely
desirable work for women under thirty years of age. It is with dust
women as with many of the laundry women in London; they form a class by
themselves, and so the work becomes more or less hereditary.
As to the occupation being unsanitary, medical opinion is divided. Dr
Thomas of Limehouse does not think it increases the death-rate, and
Dr Dudfield reports that he has not observed any bad effects upon the
health of the women. On the other hand, Dr Priestley states that while
he has not observed any actual injury to health from the sorting of
refuse, he thinks there cannot be any doubt that the trade is dangerous
to health, and on this ground he recommends its discontinuance.
The occupation is one which theoretically might be expected to be
prejudicial to health, and yet experience indicates that the women
become hardened to the work and immune to its possible evil effects.
It is an undesirable employment for women all the same. If it is to
continue, it ought to be brought under the supervision of the Factory
Department of the Home Office, and as the conditions of labour under a
private contract system are in this instance worse than when conducted
and controlled by municipal authorities, Vestries or Boards of Health
should retain the management of dust-yards in their own hands.
THOMAS OLIVER.
CHAPTER XIX
LEAD AND ITS COMPOUNDS
Of all the metals employed in the arts and industries, none lends
itself to such general applicability as lead. In its metallic state it
is so plastic that it can be readily moulded. It forms compounds which
for colour and persistence have enduring properties superior to most of
the metals. There are few articles of manufacture that have not been
directly or indirectly brought into contact with lead, and in many of
the newer industries the association is extremely close. The census for
1891 showed that there were 132,010 persons employed in lead processes.
Of these, 123,829 were painters, 2431 workers in leaden goods, and
5750 were lead-miners. If we add to these the numbers employed in the
potteries, electric accumulator works, etc., it will be at once seen
that a very large proportion of the artisan class is brought into
contact with lead. It is this wide use of the metal, the extremely
poisonous character of its compounds, and the peculiarly subtle manner
in which they act upon the human organism, that make lead a dangerous
substance. Besides, it is frequently present in the water, the aërated
beverages, and the wine we drink; the food we eat may be contaminated
by having been cooked in common earthenware or in cheap enamelled pots,
or by tinning as in canned goods. The acid juices of fruits or foods
may dissolve out the lead in the solder. The clothing we wear may have
been dyed by lead compounds, and thus not only industrially but in our
domestic and personal lives we are daily running the risk of plumbism.
_Lead-mining and the Health and Surroundings of the Miner._
Professor Louis, in his article on Mining, p. 538, has briefly alluded
to lead-mining. As in the following pages the subject of lead generally
is dealt with, I feel that the reader will have a fuller grasp of all
the points relating to lead and its history, if I slightly amplify
what he has said by throwing a little side-light upon the medical and
social aspects of the lead-miner’s life. Lead-mining in this country
is an extremely old industry. Bars of pig-lead have been found in
Derbyshire stamped with the imperial arms of Rome, indicating that the
Romans worked our mines and smelted the ore. Since 1401 lead-mining
has been carried on in the North of England, and has given employment
to many families in the remote dales of Cumberland and Durham. It
was formerly a source of very great wealth, but the mines have been
gradually closing, owing to the importation of cheaper lead and of ores
richer in silver than those that exist in this country. To-day it is
rather a decaying than a prosperous industry. At present only 15,000
tons of lead are melted annually on Tyneside. Most of it is foreign
pig-lead. During 1895 there were 250,000 tons of ore converted into
pig-lead in this country. It is perhaps more to the poverty of silver
in the native ore than to the cost of production of the raw material
that the diminished output of recent years is to be ascribed. It hardly
pays the proprietor to extract the silver when it is present in small
quantity. English pig-lead contains a very small percentage of silver,
seldom more than from 8 to 10 ounces to the ton. Foreign ores vary
as regards the amount of silver held. In Spanish ore there may be as
much silver as 40 to 80 ounces to the ton, and in Greek 80 ounces.
Australian ores show very great variations. In some of the veins the
ore contains 60 ounces to the ton, while in other samples there may be
500 ounces or even more.
So far as lead-mining in the North is concerned, the methods adopted
for obtaining the ore are antiquated. Owners are apparently afraid to
risk money in the enterprise, and as a consequence the means by which
lead is mined are much inferior to those for getting coal. Lead mines,
too, are not under the same Government regulations as collieries. Their
ventilation is bad, the roadways are ill kept, and the mines are often
damp, while the means of descent into, and ascent from, the mines,
by a series of ladders, are arduous for the workers. So far as the
mining of the ore is concerned, there is in this country practically
no risk to the miner from lead poisoning, for he is dealing with
almost a pure ore, viz., galena, which is a sulphide. Metallic lead
is harmless compared with its compounds, the oxide and carbonate. It
is this circumstance that explains why lead-miners at Broken Hill in
Australia suffer so severely from colic and convulsions, while their
confreres in England escape. The ore at Brocken Hill is very largely a
carbonate. The English lead-miner runs the ordinary risks to life and
limb from accidents, and in a special manner his health is endangered
by pulmonary consumption and rheumatism, largely the result of exposure
when returning from work heated and fatigued, also of the barrack
system in vogue in certain places for housing the miners.
There is not much lead-mining carried on in France, but where it is
there is freedom from plumbism among the miners as in our own country,
with the exception of an outbreak of colic that occurred among the
men who were working in the veins at Asprières (Aveyron), where the
mineral was found, like the Australian ore, to be composed mostly of
_cerusite_ or carbonate of lead. It is to a similar condition of
the ore in the lead mines of Sierra de Gador that are attributed the
400 to 500 cases of colic annually observed by Dr Bayer among 12,000
miners--a malady to which the crushing of the cerusite in the dry state
no doubt very largely contributes. (_Poisons Industriels_, Paris,
1901, p. 14.)
[Illustration: FIG. 68.--A LEAD MINE. Large
building on right is the lodging for the Miners; lower part
of building is occupied as a stable. Top of shaft seen high
up on left; lower down, the “level” or drift with hauling
machinery.]
The dales of Durham in which lead-mining is carried on are sparsely
populated: they are bleak, and swept by cold winds for the greater
part of the year. In many instances the miners live a considerable
distance from their work, and as railways have not yet penetrated into
these remote corners of England, the men have to cover the ground on
foot. Lead-miners are brought very little into touch with the outer
world. They form a class by themselves, and cling with affection to
their homes on the hillsides: they closely intermarry, and thus form
not only one family socially but industrially as well. Their wages
are small, seldom more than ten to twelve shillings a week, and yet,
unless compelled through sheer necessity to renounce their badly paid
and not too healthy occupation, they will not leave the district for
the more lucrative work of coal-mining. As a class they are thrifty,
intelligent, temperate, and religious. They are not long-lived.
Pulmonary phthisis is extremely prevalent among lead-miners. In close
proximity to some of the mines large “lodging shops” or “barracks”
have been erected, where many of the workmen stay during the week. In
one district, Dr William Robinson of Sunderland, formerly of Stanhope,
found that 166 miners occupied one of these shops during three or
four days and nights in the week. Often the barracks are in a filthy
condition, for they are badly kept. As the sleeping accommodation is
limited, the bedrooms are crowded to excess. In one room, 16 feet by
13½ and 9¾, there were 20 miners accommodated, _i.e._, at the rate
of 124 cubic feet of air per man, while the model regulations of the
Local Government Board require not less than 400. Most of the rooms
have no fireplaces: the windows are fixed, and consequently there is no
means of ventilation. As large numbers of men have to be accommodated,
the beds are crowded together in two tiers 3 feet 6 inches from each
other, so that there is barely space to pass between them. Since the
rooms are occupied by different sets of miners working alternate
shifts, the beds are hardly cooled before being again occupied, while
in consequence of the air of the rooms not being renewed, the stench
is overpowering. Bad as the sleeping accommodation is, the day rooms
are not any better. The closet accommodation, too, is scanty and often
badly placed. In his lodgings as well as at his work many a lead-miner
is exposed to the influence of very unwholesome atmospheric conditions,
the results of which are seen in his deteriorated constitution and
diminished resistance to disease. The air of the lodging-shops is
heavy with the effluvia from the bodies of their occupants. Sooner or
later lead-miners suffer from asthma and pulmonary catarrh, the end
of which is often tubercular consumption, and as the men expectorate
upon the floors of the sleeping-room, the tubercle bacilli find in
the badly-lit and ill-ventilated rooms the conditions which favour
their multiplication. In this manner, and apart from his work, the
lead-miner is brought under the influence of the microbe of pulmonary
phthisis. The excessive amount of carbonic dioxide in the mines, the
unconsumed products given off by the burning candles and those given
off by explosion of gunpowder, render the atmosphere of the mine for
the greater part of the twenty-four hours unhealthy. By the workman
who lives a few miles from the mines, and who has to walk home across
a bleak and wind-swept moor, tired and heated after a hard day’s
work and wearing wet clothes, colds on the chest are readily caught
and not readily got rid of. Out of these repeated pulmonary catarrhs
consumption is prone to develop. Commencing work in the open air as a
crusher and washer of ore, the son of a lead-miner--for the occupation
is largely hereditary--will for health compare most favourably with
any young artisan, but he has only to work a few years in the mine
when he becomes short-winded. Once this defect is induced it gradually
increases, and so at the age of forty to forty-five the lead-miner is
old for his years: an asthmatic, he is the subject of wheezing cough
and expectoration, and is often obliged to give up work entirely before
the age of fifty. Life, however, may be prolonged for years, for
the summer months bring abatement of the symptoms; the improvement,
however, is only temporary, for the cold winds of winter and spring
again light up the chest affection. Since in the mine the air is
dusty, and the worker inhales particles of grit, pathological changes
in the lungs are established similar to those mentioned in the chapter
on Dust and Disease. The lung of one lead-miner that I have is almost
solid from excess of fibrous tissue, and it feels as hard as stone, see
Fig. 39. On microscopical examination the alveolar structure of the
lung is found to be replaced by dense fibro-connective tissue. In the
expectoration of some of the lead-miners I have found tubercle bacilli.
The pulmonary disease of lead-miners, therefore, like that of workers
in dusty trades, may be either a simple form of fibrotic phthisis due
to inhalation of grit, or it may be a truly tubercular lesion grafted
on to the less formidable fibrosis. The average age at death of
lead-miners is about fifty. Nearly 50 per cent. of them die from chest
diseases. In the dales around Stanhope, in the county of Durham, the
death-rate from phthisis among a secluded population of lead-miners was
4.7, while in another part of the same Union composed of farmers it was
only 0.6.
_Lead-smelting._
While the miners in this country do not suffer from lead poisoning, the
same cannot be said of the men who smelt the ore. I have seen several
smelters die from plumbism. In a few instances I have witnessed son
after son in a family thus carried off before the age of thirty. The
fume that escapes from the flue of the smelting shop contains oxide
and sulphate of lead, and it is the inhalation of this that causes
plumbism. Usually the lead fume is conducted into a long flue, 5 feet
high and 3 feet wide; in some places the flue is carried up the side
of a hill for a mile or two before it terminates in the chimney.
This allows of the deposition from the fume of some of the oxide and
sulphate of lead which is recoverable. At one large smelting works
which I visited along with my colleagues on the White Lead Commission,
we found that recovery of the deposited lead by men entering the flues
was attended by such serious symptoms that we recommended two hours
at a stretch as the maximum time for men to work in cleaning out the
flues. Twenty cases of plumbism in lead-smelters were reported to the
Home Office in 1900.
[Illustration: FIG. 69.--OTHER VIEW OF LEAD
MINE. Crushing Machinery, etc., in shadow; Washing
Troughs, Sluices, “Sludges” in foreground.]
Although British galena contains usually but a very small quantity of
silver, this can be profitably extracted when present in the ratio
of even 2 of silver to 1000 of lead. Frequently the amount of silver
present in foreign ores is so large that manufacturers prefer to
extract the more valuable metal only. Desilvering of lead ore is
generally carried out by the Pattinson process, introduced in 1829.
Until that date silver was not extracted from galena. The ore had to
be converted into an oxide in order to separate the silver, and the
oxide resmelted to recover the lead, but unless the lead contained 8
to 11 ounces of silver to the ton it did not pay to extract it. While
its removal has increased the production of silver, its extraction is
by some authorities believed to have improved the quality of the lead.
On the other hand it is stated that lead pipes made from desilverised
ore are, when used for conveying drinking water into our houses, found
to be too soft. They are more readily acted upon by water, and become
consequently a more frequent cause of plumbism than the harder pipes
made from British galena, from which the silver has not been extracted.
The introduction of the Pattinson process has caused silver extraction
to become a special industry. The process depends upon the formation of
an eutectic alloy of silver and lead.[50] It is unnecessary to describe
the Pattinson process, since it is detailed in all text-books on
metallurgy and chemistry. Suffice it to say that the _desilvering_
plant usually contains five pots made of cast iron and set in masonry,
and by a series of melting and skimming, cooling and transferring
the separated silver and lead to a series of pots in succession,
all the silver, practically speaking, can be removed from the lead.
Although I have frequently examined men engaged in desilvering lead
I have rarely found them the subjects of plumbism. Two cases of lead
poisoning were reported to the Home Office in 1900 as having occurred
in silver-smelters.
_Red Lead_; _Lead Oxide_; _Litharge_; _Massicot_;
_Minium_.
Lead oxide, the yellow and red, is got by melting metallic lead in a
furnace exposed to atmospheric air. By means of a long iron rabble
a workman keeps raking the molten liquid so that it is brought into
intimate contact with the oxygen of the air. When removed from the
furnace and cooled, the product assumes a red or yellowish colour
according to the amount of oxygen it contains, and is known as the
red oxide of lead and minium, or as massicot. During the operation of
melting and raking the lead a certain amount of fume escapes from the
open mouth of the furnace. The fume ought to be removed by a strong
upward draught through a hooded chimney. Where this is not done and the
men approach too near the mouth of the furnace, fume is inhaled, with
the result that the workmen suffer from plumbism. A fairly large number
of red-lead makers become anæmic and suffer from colic and wrist-drop.
Great as is the risk run by the red-lead worker through inhaling the
fumes from the molten metal, it is less than that incurred during the
crushing and packing of the finished product. The substitution of
mechanical agitation of the molten lead in the furnace for that done
by hand by the workman would diminish the danger, since it would allow
the doors of the furnace to be closed, except during the charging of
the interior. The packing of casks with red lead should be conducted
in closed spaces provided with a hood and such means as will create an
effective draught. The workmen ought to wear overalls, have frequent
baths, and be inspected at least every fortnight by a doctor. Men can
work longer in red than in white lead without losing their health.
There is no truth in the statement that they are _absolutely_
free from the severer forms of plumbism. As a rule, I have found the
symptoms of lead poisoning in massicot makers on the average milder
than those observed in white-lead workers; but the result depends upon
the proximity and length of exposure to lead compounds rather than
upon the particular nature of the compound itself--always, of course,
remembering that the more soluble the lead compound the greater the
danger. Some physicians have had quite other experience. Layet, for
example, in a paper read before the Congress of Hygiene at Turin, 1880,
stated that minium is more dangerous than white lead, and that the form
of poisoning is just as severe, if not more so. He had found red-lead
makers more liable to what is known as encephalopathy, _i.e._, the
cerebral type of Saturnism, than white-lead workers.
[Illustration: FIG. 70.--A “Blue” Bed in a White
Lead Factory, showing tan in lowest part, and resting on it
rows of earthenware pots containing acetic acid. Resting
upon the pots in left hand corner can be seen thin sheets of
metallic lead.]
[Illustration: FIG. 71.--Female carrying Basins
filled with Washed White Lead from Vat to Stoves.]
_White Lead_; _Carbonate of Lead_ (_Céruse_, Fr.)
All the soluble salts of lead are capable of inducing plumbism, and
of these the carbonate is perhaps the most prolific cause of lead
poisoning. In Britain most of the white lead of commerce is made by the
_old Dutch_ process. Thin sheets of metallic lead (wickets) are
taken to the stacks or blue beds. The floor of the stack is covered
by a layer of tan, and on the tan is arranged a series of earthenware
pots containing dilute acetic acid. Upon the pots are placed the
sheets of lead. Boards are laid over these, and thus the first layer
is formed. Tan is thickly strewn over the boards, and when this has
reached a sufficient thickness, other rows of pots partially filled
with dilute acetic acid and covered over by thin sheets of lead are
arranged on the tan, and the whole is covered over by boards. This
second layer is followed by others similarly constructed, until by a
succession of tiers the ceiling is reached, when the doorway is built
up by boards and kept closed for a period varying from ten to fifteen
weeks, during which the conversion of blue into white lead by corrosion
takes place. The stacks are ventilated by means of a shaft at each
corner. Once the “blue” beds are made up and the doorway closed, the
tan begins to get warm and evolve carbonic acid. In consequence of this
heat the acetic acid becomes volatilised, and through the interaction
between the lead and acetic acid on the one hand, and the carbonic acid
on the other, chemical changes of a nature not thoroughly understood
occur, which ultimately end in the production of the basic carbonate of
lead, or what is popularly known as white lead. When this conversion
is believed by the manufacturer to have taken place, the stack is
opened. It is then no longer spoken of as a “blue” but as a “white”
bed. Workpeople enter the white bed to strip it of the corroded lead.
What was originally placed in the blue bed as a thin layer of metallic
lead has become converted, if the corrosion has been satisfactory, into
a much thicker plate made up of a white crisp incrustation of lead
carbonate, which often conceals from view very thin pieces of unaltered
metallic lead. In stripping the white lead off the unchanged metal a
considerable amount of dust is given off, the inhalation of which was
previously much more frequently a cause of plumbism in the workpeople
than now, owing to the fact that present regulations require that the
white beds must be watered by means of a “rose.” The carbonate and
unaltered lead removed from the white beds used formerly to be taken
direct to the rollers, crushed and washed, so as to separate the two.
After washing, the white lead is placed in earthenware vessels and
taken to the stoves to be dried. The emptying or drawing of stoves has
been the cause of a larger number of severe and fatal cases of lead
poisoning than any other department in a white lead factory. Until 1898
the filling and emptying of stoves was very largely done by women,
young and middle-aged, but the work was found to be so detrimental to
female life that the White Lead Commission recommended that no woman
or girl should be allowed to work in the stoves. I have known young
women die from plumbism within three months after entering a white
lead factory and working in the stoves. It takes from three to five
days for the white lead to become thoroughly dried in the old form
of stoves, after which it is packed into casks. Since the White Lead
Commission published its Report there have been many improvements in
stoves. There are many now in use which will tend still to diminish
plumbism. In some factories wagons ladened with basins of moist
white lead are run on rails into the drying chamber, while in others
the white lead is made to fall mechanically on to a series of large
revolving discs in a closed chamber heated by air. Packing is often a
dusty and dangerous process if it is not conducted in a confined space
ventilated by a shaft and fan. The white lead is mixed with oil and
converted into paint. When visiting the white lead works in Paris of
Messrs Expert-Besançon et Cie., a short while ago, I found that while
the old Dutch method of manufacture was in use there was an immunity
from plumbism among the employés that created a favourable impression
upon me. That freedom I found was in the main due to the following
circumstances: (1) no female labour was employed; (2) stoving was
practically done away with; (3) the white lead was taken direct from
the stacks to the rollers, where it was crushed and washed; then (4)
passed through a series of rollers and mixed with oil, which gradually
displaced the water,[51] so that a perfectly finished paint escaped
from the last roller, practically free from, or containing only a very
small percentage of water, and was passed automatically into casks,
thus abolishing some of the dusty and dangerous processes as well as
the handling of the white lead; (5) careful personal supervision of the
workers, and attention to cleanliness; (6) regular medical inspection;
and (7) alternation of employment. I reported to the Secretary of State
upon these facts, with the result that they were laid before the white
lead manufacturers of this country, many of whom adopted in a modified
form the practice observed in Besançon’s works. English makers have
since then informed me that it not only saves labour and therefore
cheapens production (the product itself not suffering in quality), but
has materially diminished the number of cases of lead poisoning in
their factories.
White lead can be made by other methods. In what is known as the
_chamber_ process strips of lead are suspended over parallel bars
in a chamber, which is heated by steam, and into which carbonic
acid is passed, while acetic acid is present in pans on the floor.
The result is the same, viz., formation of white lead by a process of
corrosion, only the conversion is much more rapid, being four or five
weeks as against the ten to fifteen required by the stack process.
The subsequent treatment of the white lead is the same in both cases.
Much of the white lead manufactured in Germany is made by the chamber
process, and in that country emptying the chamber is regarded as
dangerous to health.
[Illustration: FIG. 72.--Interior of Stove for
drying White Lead.]
By the old Dutch process an excellent and very pure white lead is no
doubt produced. The drawbacks to the method are that it is tedious,
and that some parts of the process are extremely dusty, and therefore
dangerous. There have been various attempts to manufacture lead
carbonate by quicker methods, and of these the method of obtaining
white lead by the action of acetic acid and glycerine upon the red
oxide may be mentioned. In it the first step consists in reducing
metallic lead to litharge by placing pig-lead in a furnace and allowing
a jet of steam to play upon the vapour of the molten metal. The lead
oxide is subsequently crushed into a fine powder. This, as I saw it,
can be a very dusty and dangerous process. The red oxide is placed in
large revolving barrels along with acetic acid and glycerine, and the
churning is allowed to go on for about two hours. A greenish-white
liquid is the result, and this is allowed to escape from the barrels
into storage vats, from which it is conveyed into large cylinders
called _carbonators_. Into these carbonating tanks carbonic
dioxide obtained from burning coke and lime is conveyed, and the
gas is allowed to bubble through the mass for about an hour, when
carbonate or white lead is formed. After running off the supernatant
liquid, the deposited lead carbonate is removed through pipes to the
_presses_, where it is washed and any acetate that may cling to
it is removed. After this it is taken to the stoves, into which it is
run on a series of long narrow wagons, the workmen not entering the
stove at all. By the third day it is sufficiently dried to be ready for
packing or mixing with oil to make paint. This method of manufacture is
known as the _precipitation_ process. In it there is no handling
of the white lead until it reaches the presses. The dangerous parts of
the process are: (1) the grinding of the lead oxide: this is dusty;
(2) the pressing: in this the men handle the white lead, and as a
consequence I have observed in young workmen marked anæmia, tremor
of muscles, colic, and the presence of a deep blue line on the gums;
and (3) filling the barrels with the finished white lead, when danger
arises from inhalation of dust. In some works ammonia is substituted
for glycerine. Conducted as an experiment, white lead manufactured on
the lines just detailed is extremely satisfactory, but financially it
is not very successful. Although the precipitation process is more
rapid it is more costly, and as a consequence factory after factory
which has adopted this method has been obliged to close.
In the manufacture of white lead by the _Bischof_ process the
first stage consists, after converting metallic lead into litharge,
in the reduction of the litharge to suboxide in gas-tight cylinders
by means of water gas at a temperature of about 300° C. The suboxide
is moistened in mechanical mixers with water, and converted into
hydrate. By means of carbonic acid, dilute acetic acid and glycerine,
the hydrate is converted into white lead in a gas-tight apparatus, and
after separation of the liquid and washing of the sludge, the aqueous
white lead is mixed with oil by mechanical means, and becoming thus
ordinary white lead paint, it is packed ready for the market. No female
labour is employed in the factory. The manufacture of white lead by
the Bischof process at the time of writing is still to a large extent
experimental, but it gives promise of commercial success. As the work
is done by machinery, and is for the most part wet, there is no dust
given off. The only possible unhealthy part of the process I observed
was the mixing of the suboxide of lead with water, but where this is
done mechanically, as I presume it can be in chambers provided with
ventilating shafts, all danger can be averted.
In white lead factories the dangerous processes are emptying the
white beds, washing the incompletely converted metallic lead plates,
crushing, grinding, sifting, filling the pots with white lead for the
stoves, emptying the stoves and packing the barrels with the dry white
lead. It is the continual absorption into the body of very minute
quantities of lead compounds either by the pulmonary or digestive tract
that causes plumbism. The skin, too, offers another channel by which
it may enter the system. Although it is usually in the form of dust
that lead enters the body, it can also enter it in the form of fume,
and possibly, too, mixed with steam in which the particles of lead are
either dissolved or suspended.
Lead carbonate is an extremely fine white powder, and is largely sought
after as a pigment by house painters, by plumbers for searing joints,
and by pottery manufacturers for making the glazes in which the ware is
dipped. As a pigment it is said by a large number of house decorators
to be superior to any other. There is a decided preference in the
trade, too, for that made by the stack process. It always commands a
higher price, the reason being that it is believed to have much greater
covering power than white lead made by some of the other processes.
On account of white lead being such a dangerous product, both in its
manufacture and manipulation, the question of finding a suitable
substitute has often been raised. This subject was carefully gone into
by the White Lead Committee a few years ago.
Zinc white, for example, was recommended, but the opinion come to was
that while zinc oxide was practically free from the dangers incidental
to lead carbonate, and answered well for internal decoration, for
covering purposes and endurance in all kinds of weather there was no
pigment equal to white lead. It is this widespread belief among house
painters generally that makes white lead such a valuable commercial
product.
The question of finding a substitute for white lead has not been
confined to Britain alone. One hundred and twenty years ago, Courtois
presented to the Academy of Dijon some zinc white, which was
remarkable on account of its permanence, and in 1783 Guyton de Morveau
recommended, from hygienic motives and on account of its chemical
properties, zinc oxide for lead carbonate. Ten years ago a small
representative committee reported to the Commission des Logements
Insalubres of the city of Paris upon zinc white as a likely substitute.
As far back as 1849 the Minister of Public Works ordered that all the
Government buildings in France were to be painted with zinc oxide
instead of lead carbonate, and although in 1852 the Minister of the
Interior followed with a similar request to the various prefects,
the resolution remained a dead letter. It was indicated to a fresh
committee, appointed in 1891, that from an economic and industrial
point of view, zinc white was inferior to white lead, that it had
no great covering power, little durability, that it cost more, and
that therefore the painting of State buildings by it would entail an
unjustifiable expense. Some persons, on the other hand, held the belief
that zinc white possessed just as good covering properties, so long as
it was mixed with a larger proportion of oil and less of turpentine,
and that the painter gave a sufficient amount of attention to his
work so as to make the coating flat, also that it was not so readily
blackened by sulphurous vapours. As for the increased expense, it was
to be remembered that if zinc white costs more, it is also less heavy,
and therefore weight for weight gives a larger body of material. The
Commission, taking into consideration the hygiene of dwellings, the
health of the workers, and the interest of landlords, and having the
choice of two substances before it, of which one is almost harmless,
and the other a strong poison, adopted the following resolutions: (1)
the employment of zinc white to the exclusion of white lead will be
specified in all the orders for painting; (2) the Commission renews the
wish expressed in 1880 in regard to the exclusion of white lead in all
public works. No special action followed these recommendations. Within
the last few months the question has again been raised in France, and
on this occasion more vigorously than before. The operative painters
met in congress, and passed resolutions denouncing the use of lead in
the manufacture of paint, and demanding that the law for compensation
for accidents should be extended to include cases of plumbism. To the
painters’ representatives the Minister of Commerce, at a personal
interview, while admitting that the law on accidents was imperfect,
stated that it was too soon to hope for its amendment. He undertook to
do all he could to enforce the decree of 1849, that no more lead should
be employed in painting and decorating State buildings. In France zinc
sulphide, oxysulphide, and oxide have all been tried as substitutes
for white lead, but although there is a belief that these can replace
lead carbonate, there is an unwillingness on the part of architects
and house-painters to discontinue the use of lead. In Britain
other chemical compounds in addition to the above have been tried,
_e.g._ sulphate of barium, but although this is a beautifully
white substance, it does not mix so well with oil nor has it the
covering power of white lead. The surface of the object painted can be
seen through the coating of barium sulphate, a circumstance probably
due to the fact that the barium salt exists in a more highly developed
crystalline form than the lead compound.
In March 1901 the Comité Consultatif d’Hygiène of France reported upon
this subject[52] that the manufacture of white lead has become less and
less the harmful industry it was owing to the Expert-Besançon process
of grinding and mixing the white lead in water, with the subsequent
addition of oil as it passes through the rollers, careful medical
examination of the workmen employed, and the removal from the works
of those who seem to be susceptible to plumbism, or are inclined to
the free use of alcohol. The Committee of Hygiene recognises that
in house painters, want of cleanliness, also the excessive use of
alcohol and absinthe, are responsible for much of the lead poisoning,
and therefore, since it is impossible to regulate and control the
habits of these men, they ought to be provided with paints which do
not contain such an injurious substance as white lead. In zinc white
the committee is of opinion that a proper substitute can be found for
lead for most purposes. Many architects and builders still object to
the use of zinc white, but there are many, on the other hand, who claim
for it the same advantages as regards covering power and endurance,
and who maintain that when exposed to sulphuretted vapour it forms a
sulphide which is white compared with the black sulphide similarly
obtained from lead. The zinc coating dries more slowly, and there is
therefore some loss of time; the work of laying on, too, may be a
little more difficult, and for polishing purposes zinc mastics do not
harden so well. Zinc is not so good in calico-printing as white lead.
There are some things therefore, the committee admits, that lead may
be better for than zinc. It is also admitted that even zinc oxide may
be accidentally contaminated by small quantities of arsenic and lead,
also that it is slightly more expensive--for example, it costs 0.0152
franc more for each metre of work done. The committee concludes its
report by stating that both in the manufacture of zinc white and in its
application as a paint it is free from the dangers incidental to lead,
and therefore it is worthy of a lengthened trial as forming the basis
of colours for house painting, since there is a considerable amount of
educated opinion to show that it can be substituted for white lead.
The French Government is asked to set the example by having the public
buildings painted with oxide of zinc.
No industry, unless, perhaps, it be that of pottery manufacture, has
caused so much plumbism as the manufacture of white lead, and yet in
none has strict attention to regulations and personal hygiene been so
productive of good as in these two industries.[53] The bulk of the
work is unskilled labour. In Newcastle and neighbourhood, until the
last three years, most of the work in the dangerous processes was
performed by women who led rather a casual life, and who took to the
trade as a last resource, owing to the idleness, illness, or death of
their parents or husbands. They were mostly of the poorest class,
and were often ill-fed and ill-clad. After a few weeks or, at the
most, a few months of pretty regular employment in a lead factory,
particularly if much of the time was spent in stripping the white
beds or emptying the stoves, young women would suffer severely from
plumbism. As already stated, I have known young women who were strong
and healthy when they entered a white lead factory, die from Saturnine
poisoning within three months. In one instance a young woman had, to my
knowledge, only worked forty days, spread over a period of nine weeks,
when she succumbed to lead poisoning. I am firmly convinced that women,
especially young women, are much more susceptible to plumbism than
men. The predisposition to lead poisoning is in both sexes doubtless
spread over all periods of life, but so far as occupation exposure to
lead is concerned, my opinion is (1) that women are more susceptible
than men; (2) that while female liability is greatest between the ages
of eighteen and twenty-three years, that of men is later; and (3)
that while females rapidly break down in health under the influence
of lead, men can work a longer time in the factory without suffering,
their resistance apparently being greater. In addition to a sexual
predisposition to plumbism there is also an individual and a family
tendency as well. It is difficult to explain this susceptibility of
certain persons to lead poisoning. As to the fact, however, there is no
doubt. It is partly a constitutional, and it may be partly a temporary
and accidental condition. We find illustrations of constitutional
predisposition to certain maladies in the greater liability of some
people, for instance, to contract infectious diseases than others,
in the readiness, for example, with which they catch typhoid fever
and suffer severely from it. We have similar illustrations of the
influence of age in the early years of adult life being those in which
enteric fever is most severe. As an indication of how susceptibility
to plumbism may be accidentally and temporarily developed, I would
instance the influence of poverty, which, by preventing the purchase
of wholesome and abundant food, allows the gastric juice probably to
dissolve out more of the lead that has been swallowed. No doubt much
of the greater prevalence of plumbism hitherto observed in women who
have worked in white lead factories is to be explained by the fact
that they have until recently worked in larger numbers than the men in
the dangerous processes, for since June 1898, the date in which the
Home Office required that male should replace female labour in these
processes, the number of cases of plumbism in the men has increased,
and correspondingly decreased among the women. Taking for example
my own district, the number of cases of plumbism notified to the
Home Office from Newcastle-upon-Tyne for the two six months’ periods
preceding and succeeding June 1898, the date of the displacement of
female by male labour, is as follows:--
NOTIFICATIONS. FATAL CASES.
Males. Females. Males. Females.
1st December 1897 to 31st May 1898 19 66 1 4
\ / \ /
\ / \ /
85 5
1st June to 30th November 1898 82 12 0 2
\ / \ /
\ / \ /
94 2
Between January and October 1898, Dr M. Legge states that there were
received at the Home Office from certifying surgeons, 192 reports of
plumbism. Of these the stoves supplied 76 patients and the white beds
31. The ages of the workers being--
Under 20 yrs. 20 to 30. 30 to 40. 40 to 50. 50 to 60. Over 60 yrs.
7 84 58 24 15 1
In three instances the patients had worked less than one week in the
factory. In four-fifths of the total cases the lead poisoning took
the form of colic, in the remaining one-fifth paralysis and cerebral
symptoms.
Next to the susceptibility of women generally, and of young women
in particular, I would say that all young adult life offers less
resistance to plumbism than mature and middle age. In the House of
Commons, 17th February 1898, the Home Secretary stated that there had
been 37 cases of lead poisoning in factories and lead works among boys
under eighteen years of age which had proved fatal.
Looking back upon the tables just presented, it will be observed that
when males undertake the work hitherto discharged by females in white
lead factories they develop plumbism in a ratio which might raise
doubt in the mind of the reader as to the susceptibility of women to
plumbism being greater than that of men. Admitting for the moment that
the susceptibility is equal in the two sexes, and the fact, too, that
in both the illness may be severe, still I unhesitatingly assert that
in the main the symptoms are neither so severe in men, nor does the
malady run so rapidly to a fatal termination as it does in women. In a
word, females contract lead poisoning more readily, the symptoms are
usually more acute, they suffer more severely, and they succumb to it
more quickly than males. In women acute lead poisoning is more prone
to assume the cerebral type than in men. We have, it is true, only the
experience of the last three years to enable us to form an opinion as
to the abolition of female labour in the dangerous processes of white
lead manufacture having been a wise recommendation on the part of the
White Lead Commission, but limited as the time is, the records of the
Newcastle-upon-Tyne Royal Infirmary are not devoid of interest on this
point.
LEAD POISONING.
_In-patients admitted into Royal Infirmary, Newcastle-upon-Tyne._
+------+--------+-------------------+--------------------+-----------+
|Year. | Total. | Recoveries. | Deaths. | Remaining |
| | | | | on Books. |
+------+--------+--------+----------+--------+-----------+-----------+
| | | Males. | Females. | Males. | Females. | |
| 1892 | 44 | 15 | 27 | 2 | 1 | 2 |
| 1893 | 32 | 5 | 25 | ... | ... | 2 |
| 1894 | 31 | 7 | 20 | ... | ... | 4 |
| 1895 | 35 | 11 | 18 | 1 | ... | 5 |
| 1896 | 38 | 12 | 22 | ... | 2 | 2 |
| 1897 | 21 | 7 | 12 | 1 | 1 | ... |
| 1898 | 36 | 22 | 12 | ... | ... | 2 |
| 1899 | 20 | 19 | 1 | ... | ... | ... |
| 1900 | 14 | 14 | ... | ... | ... | ... |
+------+--------+--------+----------+--------+-----------+-----------+
It will be observed that the number of deaths is equal for the
two sexes.
A decade ago the Newcastle Infirmary wards were scarcely ever clear
of a case or two of lead poisoning. At present weeks or months may
pass without one being in the wards. Beyond male labour having been
substituted for that of females in the dangerous processes in the
factories, and the circumstance that men are believed to do more work
than women, I am not aware that there has been any reduction[54] in
the number of people engaged in white lead manufacture on Tyneside that
will explain the smaller number of cases of plumbism coming into the
Infirmary, nor beyond the workhouses is there any other institution in
this neighbourhood, other than the Royal Infirmary, to which patients
suffering from plumbism could go. During 1898, the year in which men
exchanged places with the women in the dangerous departments in white
lead factories, the number of cases of plumbism admitted into the
Infirmary was slightly greater than for one or two of the previous
years, a circumstance possibly explained by the greater irregularity
of work on the part both of the men and women, and the fact that the
men were of a casual class and had not become accustomed to the work.
Immediately after the abolition of female labour, not only is there
observed a marked fall in the number of female admissions, but there
is this astonishing feature, that while during 1900 only 14 cases,
all males, were admitted, for the first time in the history of the
Newcastle Infirmary within our memory a whole year passed without
even one female being received. During the last three years, as also
during 1893–1894, no death from acute lead poisoning took place in
the Infirmary. There has been, too, a remarkable absence lately in
the Newcastle daily press of announcements of coroner’s inquests
having been held upon fatal cases of lead poisoning in the district
compared with what there was a few years ago. Nothing could be stronger
testimony to the wisdom of the Home Office in having enforced the
recommendations than these facts. Although the manufacturers at the
time strongly resisted the recommendation of the White Lead Committee,
I believe they now admit that it was a proper step, also that work
under the present system is better done than formerly, and that there
is less sickness among the employés. The difficulty of substituting
male for female labour, which manufacturers anticipated and which was
their principal objection, has not been realised; the men do more
work, and therefore the cost of production has not been increased,
although wages have been higher; the men, too, are more cleanly.
Improved methods of manufacture and diminished handling of products
have doubtless contributed also to this satisfactory result. As the men
have come to recognise the dangerous character of their occupation,
and have made up their minds to follow it until they can get something
better, they have become more careful, and therefore suffer less in
proportion from plumbism. Casual work and irregularity of employment
certainly play a not unimportant part in causing lead poisoning. The
casual labourer is often ignorant and careless. As these pages are
passing through the press, a man who had been stripping a white bed in
a factory on Tyneside was found eating food with hands unwashed and
covered with dust, while his face and beard showed only too plainly
the presence of the same material. He stated that he had not been
informed of any danger, and that no regulations had been read out to
him. How easily, therefore, lead poisoning may be caused and almost as
easily prevented. Dr Morison Legge found that of 1463 persons employed
off and on in white lead works, the incidence of lead poisoning was 6
per cent. of the average number regularly employed, and in those with
casual employment 39 per cent. Taking the whole number of hands passing
through white lead factories in a year, the difference between these
two, however, is less marked than at first appears, the numbers being
5 per cent. for the employed and 8.3 for the casual workers. Out of
thirteen factories with regular employment four of them had no cases of
plumbism to report at all, even although in one of these factories 110
persons were employed, whereas from two factories in which there was a
large amount of casual employment 50 cases of plumbism were reported.
The reasons why casual hands suffer more than those regularly employed
are to be found in their carelessness and want of personal cleanliness,
intemperate habits as regards alcohol, tobacco-chewing when at work,
and unwillingness to wear respirators. During 1900 there were reported
to the Home Office 356 cases of plumbism in white lead workers, but Dr
Legge says, if two firms, one in Newcastle and the other in London,
were excluded from the 18 firms, the total would fall to 175.
I have dwelt at considerable length on female labour and casual
employment in lead works, and I hope have shown that the abolition
of women’s work in white lead factories has been followed by marked
improvement both in the conditions of labour and in the reduced
number of cases of plumbism. Female labour, however, is still very
largely employed in other trades where lead compounds are used. It
may therefore be expected that I should offer some explanation of
the attitude I have assumed in regard to this important industrial
question. Where the two sexes are as far as possible equally exposed to
the influence of lead, women probably suffer more rapidly, certainly
more severely than men. To a certain extent the reason is to be found
in the fact that lead exercises an injurious influence upon the
reproductive functions of women. It deranges menstruation. Usually
there is an excessive loss at the monthly periods, which causes women
to become anæmic; in a few instances, on the other hand, the loss is
scanty. It is upon pregnant women that the metal exercises its worst
effects. The ecbolic or abortifacient action of lead is beyond dispute.
It is knowledge of this fact that has caused women of the lower classes
when pregnant to resort to diachylon pills, which contain a small
quantity of lead, for the purpose of producing miscarriage. When a
white lead worker becomes pregnant it is almost impossible for her to
go to the end of term if she continues to follow her employment. As a
rule she mis-carries, but if, perchance, she goes to term, the child
is either born dead, or dies shortly after birth from convulsions. In
the liver and kidneys of still-born children of female lead workers
that I submitted to Professor Bedson for chemical analysis, there were
found minute quantities of lead. Chemical analysis, therefore, confirms
clinical experience as regards the cause of death in these children.
As to the injurious influence of lead upon maternity I shall give a
few illustrations taken from my own and others’ experience. Mrs H.,
aged thirty-five, worked in a white lead factory for six years, before
which she had four children born at full time. Since going to the lead
works she has had nine miscarriages in succession and no living child.
Mrs M., aged thirty, has had seven children and three miscarriages.
The last two children were born and all the miscarriages took place
after entering the lead factory. Mrs F. has had three miscarriages
since taking up lead work. Mrs K., aged thirty-four, had four living
children before going into the lead factory, and two living children
afterwards. Still following her occupation, she had six miscarriages
in succession, became the subject of plumbism, and was under my care
in the Infirmary for a few months on account of colic and paralysis;
she made a good recovery, but did not return to the lead factory; next
pregnancy she went to term and had a living child, which survived. If
additional medical testimony were required to support the opinion I
have put forward as to the pernicious influence of lead upon maternity,
it is to be found in that of M. Constantin Paul, a French physician,
who has published in detail his experience of 15 pregnancies of 4
women working in a type foundry. Ten of these pregnancies ended in
abortion, 2 in premature labour, 1 in a still-birth, and 1 in a living
child, who died a few hours after birth. In another series the facts
are just as instructive. Five women before working in lead had borne
9 children without one abortion. After exposure to lead there was a
total of 36 pregnancies. Of these, 26 ended in abortion, 1 in premature
labour, 2 in still-births, while 5 of the children born at full time
died within one year after birth. Constantin Paul, grouping together a
large number of pregnancies, viz., 123, found that of these, 64 ended
in abortion, 4 in premature confinement, 5 children were born dead,
and 20 of the infants died within the first twelve months. Of 1000
pregnancies reported by Tardien, 609 ended in abortion (_Poisons
Industriels_, Office du Travail, Paris 1901, p. 5). In the potteries
Miss Paterson and Miss Deane, two of H.M. Inspectors of Factories,[55]
found that “out of the 77 married women reported as suffering from
lead poisoning during this period (the year ended 31st March 1897)
15 have been childless and have had no miscarriages; 8 have had 21
still-born children, 35 have had 90 miscarriages, and of these, 15
have had no child born; 36 have had 101 living children, of whom 61
are still alive, the great majority of the 40 who are dead succumbed
to convulsions in infancy.” Dr J. F. Arlidge,[56] Certifying Surgeon
for Stoke, has published his experience of 239 married women working in
lead processes in the china and earthenware industry. Of the children
born before the mothers worked in lead 40.4 per cent. died. Of each
100 pregnancies there were 7.0 miscarriages, while, during or after
lead employment, of the children born only 36.5 per cent. died, and
the percentage of miscarriages was 11.8. Of the 239 women there were
71 who had had no children prior to working in lead. These 71 women
had subsequently 302 children (of whom 114 died) and 38 miscarriages;
that is, for every 100 children born 37.7 died, and 11.1 of every 100
pregnancies resulted in miscarriage. Dr J. F. Arlidge’s statistics
show that in female pottery workers employed in lead processes the
percentage of miscarriages is higher than in those engaged in other
departments, but neither is this nor the death-rate of children born
under these circumstances so great as M. Paul, Tardien, and I have
found.
If lead exercises a prejudicial effect upon the reproductive powers of
women it is also capable, although to a less degree, of diminishing the
virility of men. Children of female lead workers almost invariably die
of convulsions shortly after birth or during the first twelve months.
If a child is the offspring of parents, both of whom are lead workers,
it is puny and ill-nourished, and is either born dead, or dies a few
hours after birth. The power of lead not only to kill the offspring
but to destroy for the time being the child-bearing powers of woman
is remarkable, and it is this circumstance, along with the fact that
women suffer more readily and severely from lead poisoning, that are
the main arguments for keeping them out of the dangerous processes
in any industry in which lead compounds are used. It is through the
intermediary of the temporary structure known as the “after-birth”
that the poison is transmitted to the fœtus _in utero_. Roques
(_Mouvement Medical_, 1872), is of opinion that a mother working
in lead conveys through her milk to the child she is suckling the
metallic poison, and that there is produced a slow and progressive
deterioration of the infant’s constitution. Prof. Bedson has analysed
for me the milk of suckling lead workers without finding any trace of
lead therein. Whether or not lead is only occasionally present in the
mammary secretion, it is undesirable that women who have an infant at
the breast should work in the dangerous processes.
Lead is a subtle poison. Most of its salts have in small doses no
unpleasant taste nor odour, they are very soluble, and they produce
their baneful effects sometimes in such an insidious manner that the
health of the operative becomes so gradually undermined that he is
often precipitated into a serious illness without any warning. In
most instances, however, there are prodromata, for lead causes colic
or severe pain in the abdomen. Usually this is one of the earliest
symptoms to cause a lead worker to seek medical advice, while in
others, as just mentioned, there is such a gradual deterioration
of health that it is not until the system is thoroughly impregnated
with lead and pathological changes have been established in the
internal organs that the individual comes for relief. Lead poisoning
is widespread owing to the large number of industries into which
lead in some form or other enters, and the accidental contamination
of our food and drink. The metal gains an entrance into the system
through the respiratory passages, the digestive canal, and very
occasionally through the skin. It has been demonstrated clinically
that the injection of acetate of lead up the nostril has resulted
in the absorption of the salt by the nasal mucous membrane, and the
production of paralysis. How far very fine white lead dust falling
upon the eyelids may be dissolved in the lachrymal secretion and be
absorbed, I am not at present in a position to state. Inhaled as
impalpable dust, it is drawn into the respiratory passages, where it is
dissolved and passes into the blood, or it is suspended in the saliva
in the mouth and swallowed. On reaching the stomach it is acted upon by
the hydrochloric acid of the gastric juice, converted into a soluble
salt, and absorbed. Elsewhere[57] I have given in detail a series of
experiments showing the solubility of white lead in the juices of
different parts of the digestive tract, which, while confirming, at
the same time explains the important fact already known to managers of
white lead factories, viz., the great danger of employés commencing
work in the factory in the morning without having breakfasted. As lead
is a direct poison to the system, nature does her best to eliminate it
by the fæces and through the kidneys.
The symptoms of plumbism are manifold. Usually easy of recognition,
they are sometimes so obscure as to render the malady difficult
of detection even by a careful physician. One of the earliest
signs is pallor of the countenance. There is developed a degree of
anæmia which gradually increases until the features become altered
and expressionless, a form of bloodlessness which since it is
characteristic of lead poisoning, is spoken of as Saturnine cachexia.
This becomes very pronounced, so that it is easy to recognise lead
workers by sight. A few weeks’ work will transform a healthy-looking,
florid young woman or man into a pallid and listless individual. During
the time that pallor is developing, the individual often complains of
a disagreeable metallic taste in the mouth, especially on rising in
the morning, and of a distaste for food, so that he proceeds to his
work in the morning without breaking his fast. There is no more certain
way of courting plumbism than for any one to work in a factory where
lead compounds are handled without having food in his stomach. This
is a fact which the digestive experiments alluded to in my Gulstonian
Lectures have placed beyond all question. It was therefore not only a
humane action, but it was a wise step, from a white lead manufacturer’s
point of view, when the employers gave a free breakfast to their
hands before beginning work each morning in the factory, and it was a
short-sighted policy that led them to abandon it.
Two forms of lead poisoning are met with, the _acute_ and _chronic_.
It is with lead as with many other poisons. One individual may work
for several months or years without suffering, while another may
succumb to its harmful influence in as many weeks. The manufacture of
white lead is one of the industries that will not allow of familiarity
breeding contempt. The most careful worker may suffer, so too may
the oldest who has passed unscathed for years. Alcoholic excess
predisposes to plumbism. Why colic is such a common and early symptom
of Saturnine poisoning is because the alimentary canal is one of the
principal channels by which lead enters the system, and lead is known
to have a special affinity for muscular fibre and nerve tissue, and
to induce spasm. Colic is often attended by vomiting and by obstinate
constipation. The pain is of varying degrees of severity. Sometimes it
is so mild that the individual is able to follow his occupation but
in discomfort. At other times it is so severe that he rolls about in
agony, and is with difficulty kept in bed. Occasionally relieved by
pressure of the hand upon the abdomen, it is under other circumstances
often aggravated by it. The pulse is slow, small, and feeble during
the attack, although at times it is found to be hard and showing high
tension. In severe colic the individual is collapsed--the face wears
an anxious expression--there is sleeplessness, and the function of
the kidneys is seriously impaired. Notwithstanding the severe nature
of the pain in lead colic and the general derangement of internal
functions, the symptoms by degrees yield to treatment. After recovery
most of those who have been ill return too early to their employment.
One attack of plumbism unfortunately predisposes to another. On
examining the mouth of a lead worker there is usually to be seen a
bluish line along the margin of the gums close to the teeth. The gums
are ulcerated, and in the case of old lead workers they are retracted,
and thus expose a considerable length of the fang. Although a valuable
help in diagnosis, the presence of the blue line on the gums must not
be regarded as an indication that the individual possessing it is at
the time suffering from lead poisoning, for the line may be present
for months without there being either any complaint or any symptom of
ill-health. It tells the tale that the individual has been exposed
to lead, and that the metal is present in his system, so that when
associated with certain other signs and symptoms the presence of the
blue line on the gums clenches the diagnosis of plumbism. The line
itself is due to a deposit of sulphide of lead in the epithelial cells
of the gum or in the large connective tissue cells present along
the ulcerated edges. The blue line is met with under two different
circumstances. It may be observed on the sound gums of white lead
workers who have recently entered a factory, and who have been employed
for a few hours in emptying a stove. If the mouth is rinsed with
water it disappears, a circumstance which shows that this line is
simply a deposit of lead on and not in the gum. The other is much more
permanent: it persists for months despite the use of mouth washes and
the administration of medicine internally. I know of no mouth wash,
tooth paste, or drug that is capable of removing the blue line from the
gum under from eight to twelve weeks.
It is upon the nervous system that the worst effects of lead are
seen. Usually after having experienced one or more attacks of colic,
but sometimes without these, a lead worker suddenly or gradually
loses power in his hands and fingers. His hands become paralysed,
hang powerless by his side, and the patient is said to be suffering
from “wrist drop.” This renders him unable to feed or dress himself.
Both hands are usually affected, but not in equal degree. Bilateral
paralysis is always suggestive of some form of metallic poisoning. In
“wrist drop” the extensor muscles of the fingers and wrists rapidly
waste. As a rule the affection is painless, but in some instances the
loss of power is preceded by muscular tenderness. The muscles of the
shoulders and upper arm, too, may be affected, or the weakness affects
the muscles of the foot, and causes “ankle drop.” When the malady is
of a more pronounced type the muscles of the trunk become paralysed.
In this form the individual is perfectly helpless: he lies like a
log, unable to turn or move himself in bed, and for the time being
his condition is usually one of danger. It is characteristic of lead
paralysis even in such minor forms as “wrist drop,” that it not only
completely unfits the individual to earn his living, but to attend to
his own personal wants. The paralysis is slow to disappear even when
medicine, massage, and electricity are used.
One of the worst forms of acute plumbism is what is known as acute lead
_encephalopathy_, and to this women seem to be more predisposed
than men. A female lead worker has perhaps been observed by her friends
to have been getting paler and paler, and to have lost her appetite.
She complains on getting up in the morning of severe headache which
prevents her taking food, but notwithstanding these she goes to work,
and is probably not more than an hour or two in the lead factory when
she is seen to fall on the floor in convulsions. She is unconscious,
and the convulsions come and go. In this condition she is taken home or
to an infirmary, where within the next two days she dies, never having
regained consciousness; or by the third day consciousness returns, but
she keeps moaning on account of severe pain in her head. It is now
noticed that she is blind; she loathes her food and is often sick.
Recovery is slow. The power of vision may be gradually restored, or it
remains permanently lost, and thus it happens that, at a comparatively
early age, a young woman who has only worked in the dangerous
processes of a white lead factory for a few weeks or months, and who
has suffered from acute encephalopathy, not only swims for her life
during the seizure, but may be rendered permanently blind, and thereby
completely unable ever afterwards to earn her living. In the form
of lead encephalopathy that I have just portrayed, there is usually
some premonitory headache before the individual is struck down in
convulsions, but in not a few instances the warning is of another kind,
and of such a nature that it may be overlooked even by experienced
medical men. I refer to symptoms of hysteria occurring unexpectedly
in a young female lead worker. The patient does not seem ill. There
is rather an exaltation than depression of her mental faculties and
her feelings, and yet out of what appears to be ordinary hysteria the
patient may pass into a state of coma, with or without convulsions,
and die within three or four days. Under any circumstance it is a very
fine line that divides functional from organic disease of the brain,
and in lead poisoning this is particularly the case. To _toxic
hysteria_, therefore, which often masks a deeper malady and is apt
to throw both the friends of the patient and the medical attendant
off their guard, I attach considerable importance as a premonition of
acute lead encephalopathy. We have seen that after recovery from acute
encephalopathy a patient may remain temporarily or permanently blind,
and there may or may not be paralysis, but in some instances the mind
is so shattered by the illness that complete consciousness is never
regained. The patient passes into a state of acute mania, which is
usually fatal, or the symptoms are subacute, recovery is incomplete,
and the individual passes the remainder of his or her days in an asylum.
The question of insanity in lead workers has been very ably dealt with
by Dr Robert Jones,[58] the Medical Superintendent of the London County
Asylum, Claybury, Essex. Taking the proportion of 1 lead worker, in the
broad sense of the word, to every 58 of the adult population, there
ought to be in Claybury 18 male patients belonging to that class. As
a matter of fact, however, out of 1050 males in the asylum, there are
35 who have been lead workers, plumbers, painters, and glaziers, but
excluding pottery workers and miners. In examining the histories of
3500 male patients admitted into Claybury, Dr Jones found that of these
133 were artisans, who in their trade had possibly become impregnated
with lead; their occupation was as follows:--
Painters 75
Decorators 13
Plumbers 18
Gasfitters 13
Labourers in lead works 6
Grainers 3
Gasmeter Makers 2
Colour Grinder 1
File Cutter 1
Tea Lead Roller 1
---
133
---
Of these, 19 had signs of lead poisoning upon admission, such as
paralysis, colic, and blue line on gums, while in 22 there was a
history of convulsions (encephalopathy), headache, giddiness, and
paralysis. Of the 133 cases the following is the analysis of their
mental condition:--
Mania 37
Melancholia 33
Dementia 19
Dementia with Epilepsy 10
Dementia with General Paralysis 24
(?) General Paralysis 7
Alcoholic Mania 3
---
133
---
“The proportion of general paralytics among these possible lead cases
is 18 per cent.: the average yearly percentage of general paralytics
to the total average number of male patients admitted into asylums for
the five years 1893–97 was 13.1, and it appears to me there is a strong
presumptive evidence that lead may be a factor in the cause of general
paralysis of the insane.” Elsewhere[59] I have drawn attention to the
association of lead poisoning and general paralysis, and indicated that
as there is in the plumbic form a larger percentage of recoveries than
in general paralysis proper, the probability is that the malady is not
exactly of the same nature, but is rather a pseudo-general paralysis.
Dr Jones summarises his conclusions thus: (1) that lead poisoning is
a contributory factor to insanity; (2) that the mental symptoms may
be grouped among one or other of the following varieties: (_a_)
toxæmia, with sensory disturbances, which tend to get well; (_b_)
hallucinations of sight and hearing, usually chronic and irrecoverable;
(_c_) general paralysis with tremors, increased knee-jerks,
inco-ordination, listlessness, and dementia, which tend to get well.
So far I have depicted the acute rather than the chronic form of lead
poisoning. There still remains that form in which the individual,
after having been exposed for a lengthened period to the influence of
lead, and having experienced one or more attacks of colic, indicating
that his system is becoming impregnated with lead, is never well; he
is profoundly anæmic, is the subject of frequent headache, imperfect
vision, and incomplete wrist drop. Albumen is present in the urine,
and there is a slight degree of dropsy of the face, hands, and feet,
physical signs that point with these just mentioned to structural
alterations having occurred in the kidneys, liver, heart, and
blood-vessels, retina, and nervous system. Life drags on from day to
day, only to end in a lingering illness, or it is brought to a sudden
close either by uræmic convulsions, or in consequence of rupture of a
blood-vessel in the brain. At the post-mortem examination in chronic
cases the kidneys and liver are found to be hard and their secreting
structure replaced by a low form of connective tissue, while in acute
lead encephalopathy the brain may be dry on its surface and retracted,
on section hard and dry, or watery and pale, the blood-vessels being
congested. On microscopic examination very delicate changes have
been found in some of the large nerve-cells of the brain and spinal
cord, and also in the structure of the liver and kidneys. What, then,
is the cause of death in acute lead encephalopathy? In most of my
own fatal cases, lead was detected in the liver, kidneys, muscles,
and brain, etc. To the fact that lead has been found in the brain,
and has probably formed some complex chemical compound with it, may
be attributed the convulsive seizures, insanity, and possibly, too,
death. At the most it has always been a very minute quantity of lead
that has been found in the brain after death. In one of my patients
Professor Bedson found on chemical analysis only O.779 grain in a
brain and cerebellum that together weighed 51.5 ounces: while from
another brain and cerebellum that weighed 48 ounces, he obtained only
0.634 grain of lead. From another brain Professor Bedson removed 4.04
milligrammes of lead, while in a case reported by Mr Wynter Blyth
there were 99.7 milligrammes of sulphate of lead found in the brain
and 17.4 in the cerebellum. A brain whose nerve-cells have become
poisoned by lead cannot functionate as in health, but as in some of the
rapidly fatal cases of encephalopathy, occurring in young female lead
workers hitherto healthy, no trace of the metal was detected in the
brain on careful chemical examination, death must have been caused by
some other circumstance than the hypothetical presence of lead in the
brain. The human body is a laboratory, wherein even in health animal
products are hourly being formed, and which if retained in the system
would poison the individual. Were it not for the activity of such
eliminating organs as the kidneys and bowels, life would be constantly
menaced by this auto-intoxication. Lead in some people rapidly induces
structural changes in the liver and kidneys, or it quickly interferes
with the functional activity of these organs, so that poisonous
materials generated by the individual himself are not removed. It is
the circulation of these in the system and their action upon the brain,
aided probably by the presence of a soluble compound of lead in the
blood, that is the cause of the convulsions and death in some cases of
acute lead encephalopathy. Occasionally lead workers are admitted into
hospital suffering from convulsions and delirium, which are not due to
lead, or at any rate to lead alone. In many of these cases there is
a strong alcoholic history, that it is difficult to say how much is
due to lead and how much to alcohol. Alcohol we know predisposes to
plumbism.
_Treatment--Preventive and Curative._
Of precautionary measures requiring mention I would allude to the
avoidance of excess of all kinds on the part of the workpeople,
including the use of alcohol; to the need of nutritious food, plenty
of milk, and the avoidance of acid fruits; attention to personal
cleanliness as secured by frequent washing, change of working clothes,
good ventilation of the workrooms, and the wearing of respirators.
A year ago, M. Armand Gautier presented to the Prefect of Police in
Paris a report in which he showed that in Paris alone there were
upwards of 30,000 persons exposed to the fumes, dust, and combinations
of lead, and that the hospital treatment of the working people whose
illness was due to lead poisoning cost the municipality a very large
amount of money every year. In an earlier report presented to the
Council d’Hygiène, and dealing with the admissions into the hospitals
between 1870–80, he showed that this expense corresponded to a
residence of 11,140 days in these institutions. In 1881 the French
Government appointed a Commission to inquire into the prevalence of
lead poisoning, and to draw out regulations. The enforcement of the
rules was followed by a decided improvement in the number of cases.
From 1881 to 1883 the number of patients fell from 552 to 421, and the
number of days spent by patients in the hospitals fell one-half. This
satisfactory decrease, however, was not maintained, despite the fact
that the Clichy white lead works, which used to contribute nearly 50
per cent. of lead cases, was closed, and new methods of production
had been introduced. So far as white lead works are concerned, there
is not the least doubt that the substitution of the moist for the dry
method of dealing with lead carbonate materially diminished the amount
of ill-health among the workpeople, and yet, while this improvement
was taking place, the number of cases of plumbism rose all over Paris,
owing to an increase in the amount of lead used in other trades, which
had not attended to hygienic requirements. The number of fatal cases
also of lead poisoning in Paris rose. Of 552 patients ill between 1877
and 1880, 5 died; of 248 ill between 1887 and 1889, 16 died; of 302 ill
between 1890 and 1893, died; while of 314 ill between 1894 and 1897, 17
died. The fact therefore remains that since 1881, when fresh and more
stringent regulations for French white lead workers were introduced,
the number of patients suffering from lead poisoning, and dying from
it, in Paris, has risen. The explanation of this anomaly is to be found
in the fact that the victims of plumbism are no longer supplied by the
white lead works in the same proportion as formerly, but that they
come from other industries that have not yet been brought under the
regulations. Of these industries house painting has contributed the
largest number of patients. This trade, along with colour grinding,
supplied no less than 223 patients during the years 1894 to 1898. The
proof that improvement in methods of manufacture, _e.g._ the
substitution of the wet for the dry method, has been satisfactory, is
shown by the fact that before the introduction of the regulations of
1881, white lead operatives occupied the second line on the list of
dangerous trades, to-day they occupy the sixth. It is in consequence of
the increasing prevalence of Saturnine poisoning in house painters that
the agitation at present going on in Paris against the use of white
lead as a pigment, and alluded to in previous pages, has reached such
dimensions.
A few years ago the white lead works at Clichy furnished for a long
period nearly one-half of the cases of plumbism admitted into the
hospitals of Paris. Demolition of this factory was followed by a rapid
diminution in the number of cases of lead poisoning seeking admission.
This circumstance shows that in some factories the conditions under
which the work is carried on are more unhealthy than in others. On
Tyneside we are not without a similar experience. There are some white
lead works in which there is always more plumbism than in others, and
the explanation is that either the works are older and the ventilation
worse, or that the general management is in some way or other not so
good. It is the same class, often the same people, who work in all the
factories, for they occasionally migrate from one to another, and yet
there remains the undesirable fact of a larger amount of sickness among
the hands in some of the works than in others. As an illustration,
take for example the lead-poisoned patients admitted into the Royal
Infirmary, Newcastle-upon-Tyne, from October 1890 to March 1893--
Factory _A_ 52 cases.
“ _B_ 15 „
“ _C_ 8 „
“ _D_ 5 „
“ _E_ ... „
Other factories 8 „
----
88
====
Of 88 patients, one factory, not the largest, supplied nearly
two-thirds of the total admissions. As illustrating the preventableness
of industrial white lead poisoning, it is worth mentioning that in one
of the largest and best conducted factories in the Newcastle district,
there has only been one fatal case of lead poisoning within the last
twenty years, and since the enforcement by the Home Office of the
recommendations of the White Lead Committee, the factory that sent 52
out of the 88 cases stated in the preceding table to the Infirmary in
two and a half years, at present scarcely sends one patient per annum.
Lead-poisoned females are now practically never met with in Newcastle,
and male patients are becoming every year rarer. As long ago as 1849,
Combe proposed that instead of washing, then drying the white lead in
stoves, and subsequently packing it in barrels for sale, it would be
safer from a worker’s point of view, since it would rid the atmosphere
of dust, if the lead carbonate on its removal from the white beds were
ground and washed at once in water, then forced to travel through a
series of rollers and washers into oil under rollers. The oil displaces
the water, and as a consequence the white lead escapes from the last
roller as finished paint.[60] In order to obtain the white lead as
a paint, the soft paste as it comes from the grinding stones, and
which contains 15 to 20 per cent. of water, can be at once mixed and
incorporated as it passes through the rollers with increasing fractions
of 10 per cent. of oil. The water is thus gradually eliminated from
the paste, so that the product as it escapes from the last roller
contains hardly 1 per cent. of water, can be packed, and is ready for
the market. Mr T. H. Leathart of Newcastle-on-Tyne, who has adopted
this method in his works,[61] informs me that the paint is, practically
speaking, free from water, there being not even .5 per cent. of it in
the finished product. By the adoption of this method of manufacture
there has not only been a saving of labour, but better health among
the workmen, owing to the absence of dust. This small change in the
method of manufacture has had a wonderful influence on health. The
grinding and packing of all dry white lead should be conducted in
hermetically-sealed compartments. Even to this there is the drawback
that as time goes on, owing to the vibration of the machinery, the
joints of the wood and iron become loose and the dust escapes. The
defect, however, can be easily remedied.
In 1899 the Chief Inspector of Factories issued special rules for white
lead works, which were an advance upon those of previous years, and
which have undoubtedly diminished plumbism in this industry. It is
unnecessary to reproduce these rules here, but the main points included
in them are that plans for new works or structural alteration of
old factories must be submitted to the Chief Inspector of Factories;
white beds must be watered when being emptied; drying stoves are to be
ventilated, and no person is allowed to draw a Dutch stove on more than
two days in any week; no women are allowed to work in the white beds,
rollers, washbecks or stoves, or in any place where dry white lead is
packed, or in other work exposing her to white lead dust; there must be
weekly medical examination of every person employed in a lead process,
with suspension in the case of illness, and medical re-examination
before returning to work; suitable respirators, overalls, and
head-coverings must be provided by the occupiers; adequate washing
appliances are required, with cessation of work ten minutes before each
meal-time and the end of the day’s work for the purpose of washing.
The duties of persons employed are similarly defined, and any person
obtaining employment under an assumed name or on any false pretence is
liable to a penalty. It is enacted, too, (Factory and Workshop Act,
1891, sections 9 and 11) that the rules shall be kept posted up in
conspicuous places in the factory, so that they can be conveniently
read by the persons employed. Any person who is bound to observe the
rules and fails to do so, or acts in contravention of them, is liable
to a penalty. In such cases the occupier also is liable to a penalty
unless he proves that he has taken all reasonable means by publishing,
and to the best of his power, enforcing the rules, to prevent
contravention or non-compliance. To extreme temperance in the use of
alcohol, and to a weekly or fortnightly alternation of employment for
the workpeople in the factory, I attach great importance as preventive
agents.
A sanitary drink has to be provided for the workers by the employers.
It is usually composed of Epsom salts and lemon juice, or some other
acid, dissolved in water. The provision of an acidulated drink for
persons employed in white lead works is a subject to which the members
of the White Lead Commission gave considerable attention, but I
candidly confess that the Committee never attached any great importance
to it as a means of preventing plumbism. The theory upon which its
administration is based is that the sanitary drink converts any lead
which may have been swallowed into the rather insoluble sulphate,
and that thereby the risk of plumbism is diminished. When the drink
contains a slight excess of acid, then instead of being a safeguard
it may become the reverse. Besides, after all, lead sulphate is not
very much less insoluble in gastric juice than lead carbonate, and
the men who go to the barrel to obtain the sanitary drink are not
careful enough to rub their moustache clean before drinking. Within
limits, when carefully prepared and not too acid, the sanitary drink
possesses certain advantages on account of its being a mild aperient,
but beyond this it is only doubtfully a preventive. The workpeople
should be given to understand that there is no real antidote to lead
poisoning, and that they must be constantly on their guard against it.
Personal cleanliness is, I repeat, of the greatest importance. Such
drinks as the acid lemonade just described, milk and coffee, etc.,
however useful they may be of themselves, cannot altogether prevent
lead poisoning, and it is unwise therefore to allow the workpeople to
shelter themselves under this belief.
_Curative._--During the attack of colic, warm applications to the
abdomen, and the administration of a mild aperient, such as magnesium
sulphate or castor oil, especially if there is constipation, and
there is the prospect of the medicine being retained on the stomach.
Occasionally a warm bath may be called for, or if pain is severe, the
administration of a hypodermic injection of morphia. In milder cases,
or when the immediate urgency of the colic has passed away, iodide of
potassium is a good eliminant, but the internal administration of this
drug in plumbism requires caution, since it may dissolve out lead that
has been deposited in the tissues, flush the blood with a soluble lead
salt, and thereby aggravate, and often dangerously too, the symptoms of
lead poisoning. For paralysis the internal administration of iodide of
potassium with nux vomica, and the use of massage will, in most cases,
succeed, but recovery is usually slow and often incomplete. Electricity
gives encouraging results, and as practised in the manner suggested
by Dr Lewis Jones (see p. 375), has been productive of a great amount
of good. For acute lead encephalopathy the subcutaneous injection of
pilocarpine and the inhalation of nitrite of amyl have in my hands
answered well. Bleeding, and the injection of large quantities (about
500 centimetres) of an artificial serum made from sulphate of soda, 5
grammes; common salt, 1 gramme; corrosive sublimate, 0.05 gramme; and
distilled water, 200 centimetres, under the skin of the abdomen, is
a line of treatment that finds favour with many French physicians. I
need scarcely add that lead poisoning is too serious a malady for its
treatment to be undertaken by the laity without the advice of a doctor.
_Chromate of Lead; Dye Works._
The use of chrome dyes has been followed by lead poisoning which in
a few instances has ended fatally. Chrome dyeing by means of lead
compounds was one of the unhealthy occupations relegated by the Home
Secretary to the Dangerous Trades Committee for its opinion. The dye
is obtained by mixing a solution of bichromate of soda or potass with
sugar of lead, or by acting upon lead carbonate with a solution of
bichromate of soda or potass. In the Final Report of the Dangerous
Trades Committee, p. 26, it is stated how the different colours may
be got. To obtain _deep orange colour_, hanks of yarn are dipped
first in a solution of lime, and then in a solution of brown sugar of
lead; the dip is again repeated, and after this the hanks are dipped
in bichromate of potass or soda, and finally they are boiled in lime
water. For _yellow chrome_ colour the treatment is similar, with
the exception that the goods are not boiled in lime water, but washed
in dilute hydrochloric acid. To obtain _chrome lemon_ colour, the
yarn is dipped first in an alkaline lead solution, then in bichromate
of soda, and subsequently washed in cold water. _Green chrome_
is got by dipping the lemon-stained yarn in an indigo bath. In all of
these processes the bichromate of soda acts upon the lead and produces
a chromate. This forms not so much a dye as a coloured coating on the
surface of the fibre of the yarn. In the process of dyeing no risk to
health is incurred by the workpeople. The danger commences when the
goods have become dried and the coloured dust of chromate of lead is
given off, as may be seen in the noddling and bundling departments of
a factory. In several large dye works, both in England and Scotland, I
have seen the girls who handle and pull the yarn covered with yellow
dust, found them anæmic, complaining of headache, and showing a
well-marked blue line on their gums, while several of them complained
that they had suffered from colic, and been off work through it for
a time. In some instances more serious symptoms developed. A fatal
termination is not unknown. The contents of the stomach when vomited
often exhibit the same colour as the yarn the girls handle. In one mill
there was quite an epidemic of lead poisoning among the women owing
to some of them, on account of the cold weather, having stopped the
running of the fan. As a consequence the atmosphere of the carding-room
became impregnated with yellow dust, and many of the girls became
ill, one of them dying from unmistakable lead poisoning. When the fan
was re-started all the illness disappeared. Improved ventilation puts
an end to poisoning in chrome dye works. The dust-laden air ought to
be drawn down and away from the workers. In the dyeing of cotton,
lead compounds are similarly used, but an effort is being made to
supplant these by aniline and vegetable dyes. Whether aniline colours
are capable of entirely taking the place of lead chromate under all
circumstances of climate, etc., still remains to be seen. The opinions
of manufacturers are divided upon the point of aniline dyed goods
standing exposure to the sun like those coloured by lead chromate.
Some maintain that the colours are not so permanent. The subject is
therefore not yet ripe for the expression of an absolute opinion.
Another danger to which workers in chrome dyeing works are exposed, is
the occurrence of chrome holes or scars on the hands of the men who
work with the bichromate solution. Perforation of the septum of the
nose does not occur.
_Calico Printing._
This subject may be conveniently discussed with that immediately
preceding. The pattern is printed on the cotton cloth in lead salts.
The cloth is then passed through a solution of bichromate of soda. Only
the letters or portions of the pattern that have been printed in lead
retain the chrome colour. There is no risk to the operative in the
process of printing. The danger resides rather in the dust given off in
the drying-room, to which the cloth is taken. Here, owing to the heat
of the room and the handling of the calico, a certain amount of dust
may be present. The question of aniline substitutes for lead has been
discussed by manufacturers, but among them there is no unanimity upon
the matter, especially in those engaged in the export trade. In indigo
blue dye works where the calico is printed with copper sulphate and
lead acetate, the men may suffer as much from the copper as the lead.
_Enamelling of Iron Plates and Hollow Ware._
The enamelling of iron plates is an industry which is mostly confined
to Birmingham and Wolverhampton and their immediate neighbourhood.
Enamelled iron plates are used for advertising purposes, for announcing
the names of railway stations, etc. The process of manufacture consists
in first cleansing the iron plate, smearing it with gum-water, and
sifting a fine dust on to it, or in allowing to trickle over it powder
suspended in water. The powder may contain as much as 25 per cent. of
lead, or in some instances no lead at all. The plate having been coated
in one of these ways is placed in a furnace and exposed to an intense
heat. On removal it is seen on cooling to have received its first
coat of enamel. In order to obtain the required red, blue, or brown
colours the plate is subsequently swilled. The colours are put on at
first roughly with a broad brush, and then a finer one so as to get
an even surface, after which it is smoothed by a camel’s hair brush.
The plate thus swilled is allowed to dry on hot pipes at a moderate
temperature. The process up to this stage is wet, and therefore not
dangerous, besides the lead compounds used are often fritted, and these
are known to be very insoluble. It is in the subsequent treatment
known as stencilling that the danger commences. This part of the work
is generally done by women, who by means of a nail-brush rub off
the colour on the surface of the plate which is exposed through the
openings cut in the stencil, and which correspond to the alphabetical
letters, etc., of the advertisement. This is a very dusty process. The
atmosphere of the workroom becomes thick from the coloured particles
of dust given off from the plate, and these fall upon the hair and
clothing of the workpeople. There is often a large percentage of
lead in the dust, so that when this is inhaled for several hours,
during each working day in the week, it becomes a cause of plumbism
occasionally of a severe character, and running to a fatal termination.
Brushing-off through the stencil is usually performed over perforated
tables down which there is a strong draught, but if the aspirating
force is weak the dust rises and impregnates the atmosphere, so that it
is almost impossible to see across the workroom. After the plate has
been stencilled it is again placed in the furnace, and the processes
of swilling, drying, stencilling, and firing are repeated according to
the kind of colours required in the advertisement. These processes may
be repeated as many as eight or nine times. Red and other compounds of
lead are largely used for enamelling, and may be present to the extent
of from 25 to 33 per cent. Formerly arsenic was also used, but such
serious consequences followed that its employment has been discontinued.
In this industry, as in white lead works, it is the young female
operatives who are the most susceptible to plumbism. A few years
ago there was a great amount of ill-health among the hands owing to
imperfect ventilation of the workrooms. The White Lead Committee
recommended that there should be a medical inspection of all the
workers once a month, and that no girl under 20 years of age should
be employed as a brusher-off in the stencilling process; that no
female should be employed without medical testimony as to her fitness
for the work, experience having shown that anæmic, scrofulous, and
ill-nourished persons are more predisposed to plumbism than those that
are healthy; that after an illness of any kind a medical certificate
should be furnished. The Committee would have been glad if the
employers could have seen their way to give half a pint of milk every
forenoon to each of the workers, for experience has shown, both in this
country and abroad, that milk is to some extent a prophylactic against
plumbism. Dr Morison Legge,[62] in his report upon the enamelling of
iron plates, says that for last year only 10 cases of lead poisoning
occurred in 689 persons engaged in the dangerous processes. He
attributes the fact of the cases being few to the periodic medical
examination, the removal of dust by fans, and the encouraging efforts
which are being made by large firms to substitute other things for lead.
_Tinning and enamelling of the hollow ware_ used for culinary
and domestic purposes is an industry confined for the most part to
Wolverhampton, Bilston, and Dudley. The iron kettle or saucepan about
to be tinned is first cleaned or prepared by being swilled in a mixture
of dilute hydrochloric acid and chloride of zinc. The process of
_tinning_ consists in dipping the utensil into a trough containing
molten tin and lead in the proportion sometimes of 60 per cent. of
metallic lead and 40 of tin. Owing to tin being the more expensive
metal, the cheaper ware is often dipped in a composition of 70 per
cent. of lead and 30 of tin. The dangers incidental to tinned hollow
ware are twofold: first, if the workman who dips the utensil in the
molten lead is not careful, cleanly, and temperate as regards the use
of alcohol, he may suffer from lead poisoning; and secondly, the poorer
working classes, who buy the cheaper ware, which has been nominally
tinned but is in reality leaded, also run the risk of becoming poisoned
by the food either having become contaminated by lead in the act of
cooking or subsequently. When the cauldrons containing the molten
metal, into which the workman plunges the pans, etc., are hooded, the
fumes are not so readily inhaled. It is a common belief among these men
that the poison enters the system when they are wiping off the metal
from the hot sauce-pans, etc., by means of tow. In the white enamelling
of iron hollow ware many manufacturers are now using a leadless glaze
with every promise of success.
The enamelling of copper letters or tablets is shown by Dr Legge to be
a source of plumbism. Four cases were reported to the Home Office in
1900. The danger occurs during the “brushing on” and “wooling off” of
a black enamel powder, which was found to contain as much as 67.0 per
cent. of lead.
_Electric Accumulator Works and Lead Poisoning._
The manufacture of electric accumulators for telegraph and telephone
purposes and for motor cars has become a very important industry, and
is likely to become still more important as time goes on. There is one
process in the manufacture which is distinctly dangerous. The workmen
who rub the red lead, made into a paste by means of dilute sulphuric
acid, on to embossed or perforated plates occasionally suffer from
plumbism. When the plate leaves the workman its interstices look as
if they were filled with red clay. Both sides of the plate have to
be treated by the workman, whose hands are generally covered with
indiarubber gloves. During the mixing of the dry red lead or litharge
with the dilute sulphuric acid a considerable amount of dust is
created. The indiarubber gloves which are worn by the men who fill the
perforations in the plates with the lead paste become in time thin and
worn, or they get torn, and as a result certain parts of the hands
of the men become coated with the red composition. By this means, as
the work entails a considerable amount of friction, lead poisoning
may readily occur. In visiting electric accumulator works, I found
several of the workmen, especially the younger men, extremely pale, and
suffering from headache; some of them had been laid off with colic, and
they presented a well-marked blue line on their gums.
The colic of electricians is not a new disease. In one electric
accumulator works in La Hague in 1894, there occurred 37 cases of
plumbism in 252 male workers; and in another factory in Wiesbaden
12 cases of lead poisoning occurred in 90 workers. Of 30 patients
suffering from lead colic admitted into the Hospital Bichât, Paris,
during 1899, Talamon says more than one-half were electricians, the
remainder being made up of painters, plumbers, and typographers. So
prevalent had lead poisoning become in Germany that the Imperial
Health Office directed an inquiry[63] to be made into the conditions
of labour in electric accumulator works. In consequence of this,
special rules were issued, and as these now govern the industry in
Germany, it will not be out of place if I quote at some length from the
Report, a translation of which has been kindly placed in my hands by Dr
Morison Legge. The information embodied in the Report was collected
by a circular letter of the Chancellor, and deals with the extent of
the manufacture of accumulators and the dangers of working. From one
factory alone the following particulars were received as to the special
incidence of plumbism in particular processes.
+------------------+-----------+---------------+-----------+
| | Number | Number of | |
| Occupation. | Employed. | Cases of Lead | Per cent. |
| | | Poisoning. | |
+------------------+-----------+---------------+-----------+
| Casting | 30 | 3 | 10.0 |
| Pasting | 30 | 9 | 30.0 |
| Soldering | 16 | 6 | 37.5 |
| Trimming | 30 | 4 | 13.3 |
| Plumbing | 30 | 9 | 30.0 |
| Section Building | 60 | 5 | 8.3 |
+------------------+-----------+---------------+-----------+
As regards remedial measures, special attention was directed to: (1)
casting and preparation of the plate; (2) mixing the paste; (3) actual
pasting; (4) the drying and building into batteries of the various
segments; (5) forming and changing plates. As regards these various
headings the information gathered is as follows:--
(1) Ordinary lead, often containing a trace of antimony, is used for
casting the plates. From the surface of the lead in the melting pots
fume rises (oxide of lead), so that it is recommended to have the
melting pots arranged that they can be provided with an efficient hood
and shaft leading either into the open air or into a chimney. The need
for these precautions lies in the fact that not only are the fumes
of lead and antimony harmful when inhaled, but commercial lead often
contains traces of arsenic, varying from 0.1 to 7.9 per cent.
(2) Litharge and red lead are used for making the paste, and as these
come to the works in casks, the dry material is transferred from the
cask to the worker’s bench by means of a shovel or trowel. Dust thus
becomes scattered about in all directions. It is, therefore, desirable
to have the floor of the workrooms moistened and swept daily. The
mixing of the red lead and sulphuric acid should be done in a closed
chamber or under an exhaust shaft.
(3) As regards the wearing of gloves by the men who paste the plates,
reference is made to the difficulty of keeping the gloves in good
repair. The same difficulty, as I have already mentioned, occurs in
Britain. In some of the electric accumulator works the gloves worn are
too short. The dry red lead occasionally gets inside the gloves, and as
these tend to keep the hands hot and cause them to perspire, plumbism
is rather encouraged than prevented, or skin eruptions develop. In
order to avoid, therefore, as far as possible absorption of lead by
the skin, two alternatives are put forward by the German Committee of
Enquiry: (_a_) the work is not to exceed eight hours a day, to be
broken by a pause of at least one and a half hours; or (_b_) there
is to be one six-hours’ spell of work in the day. The Committee is in
favour of the latter. Respirators for the men engaged in pasting are
not considered necessary.
(4) In building up the batteries by means of solder, ordinary solder is
not used, but a very pure lead instead, in order that the connections
made between the plates may not be affected when they are subsequently
exposed to the acid. To bind these plates together by solder, the heat
from an oxygen or hydrogen blow-pipe flame is used, but frequently the
temperature reaches a height sufficient to cause volatilisation of the
lead, and statistics show that persons engaged in this occupation run a
considerable risk of lead poisoning.
(5) Opinions were found to differ as to the effect of the dilute
sulphuric acid vapour in the formation-room upon the workers. There was
said to be medical testimony as to its good effects upon workpeople,
who are the subjects of chronic bronchitis. Reference is made to the
difficulty of providing fans for ventilation of these rooms owing to
the deleterious action of the acid upon the metal contained in the fan,
and yet some form of artificial ventilation is necessary.
The method adopted in the factory of determining the presence of lead
in the air was the simple one of suspending, at the level of the
worker’s head, a sheet of blotting paper, 100 centimetres square,
previously moistened. Subsequent treatment with dilute acid and
exposure to the action of sulphuretted hydrogen showed whether lead was
present or not.
_Motor Cars._
In Paris, motor cars are much more in evidence than in this country.
There are very few in London compared with the French capital.
Dr Proust has reported four cases of lead poisoning in Paris, in
women aged eighteen, nineteen, twenty-five, and thirty-nine years
respectively, whose work consisted in coating with oxide of lead small
leaden rods, and fixing them in position. All of these women entered
the electrical department of motor car manufactories in good health. At
the end of six weeks to two months they had colic, loss of appetite,
constipation, and abdominal pain of such severity that they had to be
taken to the hospital, and detained there under treatment for more than
a fortnight. In one patient the symptoms of plumbism returned shortly
after resuming work. With the dangerous nature of the occupation the
employers were quite familiar. They not only paid a doctor to visit
the works once a week to examine the workers, but they were in the
habit of giving to the female workers honey and sulphur, iron pills,
and half a litre of milk daily. Ample provision was made for washing;
tooth-brushes were provided, also sulphur baths once a fortnight, and
yet, notwithstanding these precautions, four of the women quickly
developed symptoms of lead poisoning.
_Electric Tramways._
An accident of rather a peculiar character occurred on 8th Oct. 1901,
on a tramway car in Paris. I state the facts for what they are worth.
During the course of the evening, nearly a dozen of the travellers were
suddenly seized with violent pains in the abdomen and by syncope, and
were obliged to be treated at a chemist’s shop _en route_. On an
inquiry being instituted, the opinion was expressed that the symptoms
were due to poisoning caused by fumes given off by sulphuric acid
acting upon the lead in the electric accumulators.
_Recommendations._
It is evident that as electricity will be the motor power of the
future and will be turned into numerous channels of application, the
number of electric accumulator works in Britain is sure to increase.
The necessity for putting into force several of the recommendations
mentioned in these pages is almost sure to arise. So far as the hygiene
of the works is concerned, the same rules ought to apply to them as are
now in force in red lead works.
_Soldering._
Common solder is an alloy of tin and lead, equal parts. Fine solder is
composed of 2 parts of tin and 1 of lead; coarse solder, of 2 of lead
and 1 of tin. The extensive consumption of tinned meats and fruits
is responsible for some cases of plumbism, owing to the acid juices
dissolving some of the lead out of the solder, but workmen who solder,
_e.g._ tinkers, have been known to suffer from paralysis of the
muscles of the fingers and hands, owing to volatilisation of the lead
and inhalation of the fume.
_Typefounding_; _Printing_; _Typesetting_; _Linotyping_.
Type metal is an alloy of lead with ⅓ to ¼ of antimony. The antimony
is added to harden the alloy, for lead is a soft metal. Occasionally
small quantities of tin and copper are added, so that the alloy may
be composed of 70 parts of lead, 18 of antimony, 10 of tin, and 2 of
copper.
We have already dealt with the smelting of lead ore and the melting
of pig-lead. The smelting of antimony ore is not attended with such
serious risks to health as is the case with lead. One of the largest
antimony works in this country is on Tyneside. I have had the privilege
of visiting the works and of examining the workmen. The raw ore
or sulphide comes from Japan. It is smelted with iron filings. No
constitutional bad effects were noticeable in the men who smelt the
ore. To some extent this freedom from illness may be due to the fact
that the men are not closely exposed to the fume, and that, owing to
good ventilation, the fumes were quickly got rid of. The only trouble
the workmen seemed to experience, and it was more of a complaint than
an illness, is that as the work is hot they perspire freely, and the
skin in consequence becomes extremely irritable and itchy. An eruption
appears on the skin. This at first shows itself as a crop of vesicles,
which ultimately become pustular. Formerly more than now it was a
medical practice in the treatment of disease to apply an ointment
composed of tartrate of antimony to the skin in order to bring out a
pustular eruption, which acted as a counter irritant. Knowing this to
be the local action of antimony, it is easy to understand, therefore,
the development of the skin eruption spoken of as “pox” upon the neck
and upper part of the abdomen in antimony workers. Eulenburg says that
exposure to the fumes of oxide of antimony is followed by pains in the
region of the bladder and urethra, and by impotence in the male. My
experience does not confirm this statement. Several of the men looked
rather pale, probably as the result of exposure to the heat, and a
few of them had suffered from gastro-intestinal pains like colic,
usually relieved by taking a dose of Epsom salts. A case of industrial
antimony poisoning is published in the Report of the Chief Inspector
of Factories for 1900, p. 332. It is that of a man who had worked as
an extractor of the metal, and who in consequence of having inhaled
the fumes suffered from paroxysmal attacks of difficulty of breathing
without any physical signs of disease in his lungs. He complained of
a sense of constriction in his chest, nausea, a metallic taste in
his mouth, backache, weakness in the muscles of his legs, profuse
perspiration, headache, and dimness of vision.
It is, however, not so much with antimony as with the presence of lead
in the printers’ type that we are here concerned. Printers’ colic was
a much more common malady two or three decades ago than now. It is due
to handling the type, and to the dust that is given off. Typefounders
also suffer from plumbism, but in not a few cases the illness has been
caused by the workpeople eating their food without previously washing
their hands. Printers as a class are often pale and unhealthy looking.
Much of this may be due to the fact that they work in overheated
rooms for long spells at a time, and have late hours. H.M. Medical
Inspector of Factories reports that during 1900 there were 17 cases of
lead poisoning in printers. One of the patients died. Ten of the men
were compositors, 4 were linotypists, and 2 stereotypers. Dr Stühler,
of Berlin, taking his statistics from the reports of sick benefit
societies, states that of 3000 printers in Berlin 313 were annually
sick from lead colic, _i.e._, about 10.4 per cent. of printers’
compositors suffer from plumbism, either by absorption through the
skin, caused by handling the type that has become oxidised during
wear, or by swallowing the dust through eating with unwashed hands.
Fromm discusses this subject, and alludes to the analyses of dust of
printing-houses made by Stumpf, who found that it contained often as
much as 14.43 per cent. of lead. In a report recently presented to
the German Board of Health, Faber states that he found in the dust
collected from the floor 11.51 per cent. of lead: that the dust taken
from a shelf in the room contained 6.59 per cent. of lead, while dust
collected in the gangway between the desks in the composing room of a
newspaper office contained 4.7 per cent. of lead. In analysing the air
of printing shops Keygi[64] found that the dust contained from 10 to
15 per cent. of lead, which came from the wear of the type. Inhalation
of the dust of the oxidised metal in all probability, therefore,
plays a very important part in the causation of plumbism in printers’
compositors. During 1900, printing was in Britain responsible for 17
cases of lead poisoning. In 2 of the cases there were symptoms of lead
encephalopathy, one of which proved fatal, and in another there was
paralysis. Ten of the patients were compositors and 4 were linotypists.
It has to be borne in mind that compositors do a great deal of their
work in an artificial light. As they are obliged to handle type very
freely, the skin on the inner aspect of the last phalanx of the
right thumb, forefinger, and midfinger occasionally becomes thick
and hard, also the skin of the last phalanx of the left thumb, and
the interdigital eminences of the left hand. According to Choquet,
typographers suffer from two distinct maladies, one directly due to
the mechanical nature of their work, and the other attributable to
the medium in which that work is carried on. Standing on their feet
for long spells at a time, they run the risk of developing varicose
veins, and as the rooms are either too brilliantly lighted, or the
reverse, to affections of eyesight. Older compositors frequently show
a trembling of the right hand, due to fatigue caused by grasping and
distributing the type, but in producing this tremor plumbism no doubt
plays a part. Analogous to writers’ palsy, the tremor is sometimes
so persistent that it obliges the individual to renounce his work.
The channels by which lead dust effects an entrance into the system
are the buccal and nasal mucous membranes, the skin, the respiratory
passages, and the alimentary canal. So slight are the initial troubles
of the typographer, that for a time they are unperceived. Acute
plumbism does not occur among compositors, it is always chronic. By
degrees the individual begins to look pale; the skin becomes greyish
and exhibits a slightly jaundiced tint; the appetite, too, fails, and
digestion becomes weak, and obstinate constipation occurs. A blue line,
if sought for, will be seen in the gums, and there is complaint of an
unpleasant metallic taste in the mouth. The breath becomes fetid, and
motor and sensory troubles develop, especially at those parts that have
been brought into the closest contact with the type. Often commencing
with a sense of fatigue in the muscles, the paresis proceeds to motor
paralysis. In female typographers excessive menstrual losses, such as
are known to occur in female white lead workers, have been noted.
Whatever tends to interfere with the elimination of lead from the
system encourages necessarily the development of plumbism. Alcohol
has this tendency. It is said that if the skin of a compositor gets
broken, the wound heals slowly and is apt to become erysipelatous,
but I have not observed this. Some typographers are more susceptible
to plumbism than others. It is largely a question of well or ill
ventilated workrooms, and of personal resistance. Tanquerel found in
France that the ages between thirty and forty years gave the largest
amount of ill health, and that in the hot seasons of the year most
cases occurred. Dr Motais, who is a member of the Departmental Council
of Hygiene of Paris, in an address recently delivered at a conference
of typographers, recited a story of animal life which had been told
to him by some of the printers themselves. For twenty years these men
had tried to keep cats in the workrooms. The animals were well fed;
they received plenty of milk. For a time all would go well with them,
and then the same train of symptoms would invariably develop; the eyes
would lose their healthy lustre, the limbs become paralysed, and the
animals die, presenting the same cerebral symptoms as are observed in
the acute lead encephalopathy of man.
_Precautions._--Printing houses should be so situated that
free currents of air can get to them, and not, as at present is too
frequently the case, shut in by other buildings. Plenty of daylight
and, if possible, sunlight are very desirable; daylight if introduced
by one side should enter preferably on the left of the compositor,
so that no shadow is thrown upon the case that contains his type.
Light coming in from the roof obviates all this. So far as artificial
lighting of the rooms is concerned, there is an opinion that the
electric light is more hurtful than gas, and gas again more harmful
than lamps. There should be tinted shades on the gas or lamps, green
externally, white internally. The workroom should be well ventilated
and without draughts; any dust generated should as far as possible be
removed by fans. The type boxes should be kept clean and the floors
periodically watered. By young compositors long hours ought to be
avoided. No food should be eaten in the workrooms. Compositors should
never do any work fasting, and should avoid smoking when at work.
Excesses of all kinds ought to be avoided, particularly the immoderate
use of alcohol. Milk should be freely taken. On the occurrence of
colic, the individual should at once give up his work and be medically
treated. Washing the hands and rinsing the mouth before eating are
absolutely required, also a bath once a week, and the wearing of
overalls when at work.
It is an old opinion attributed to the French physicians Tanquerel
and Pidoux, that there exists an antagonism between plumbism and
pulmonary tuberculosis. Facts so far as applied to compositors do not
support this statement, hence the desirability of printing houses
receiving plenty of sunlight, and of the undesirability of persons
who are bronchitic or susceptible to lung diseases being allowed to
work in printing houses, unless they are careful of how they dispose
of their expectoration. One of the great foes of the printer is
pulmonary phthisis. Much of this is undoubtedly preventible, since the
disease is encouraged by the unhealthy conditions under which the work
is carried on. Smith[65] found that the mortality from consumption
was 60 per cent. greater than in most of the other trades. Of 799
deaths published by the London Society of Compositors for ten years,
1880–1889 inclusive, Arlidge found phthisis as the cause of death in
296, bronchitis and asthma in 85, pneumonia and pleurisy together were
responsible for 67 deaths, paralysis and apoplexy for 61, and Bright’s
disease for 21. Pulmonary phthisis caused 37 per cent. of the deaths.
The largest number of deaths occurred between the ages of thirty and
forty years. Since the statistics given by Dr Arlidge are more than
ten years old, and as tabulated are not comparable with the general
death-rate all over the country of persons between twenty to sixty-five
years of age, I communicated with the Secretaries of the Typographical
Association, also the London Society of Compositors, for their annual
reports, from which I am able through the kind assistance of Dr Henry
Armstrong, the Medical Officer of Health for Newcastle-on-Tyne, and his
clerk, Mr Gillinder, to supply more recent information, as indicated in
the following table (pp. 329–330).
These statistics unfortunately are not exactly comparable: the time
periods are not the same for all three. This is unavoidable, owing to
the census returns for later periods not having been published while I
write. They are, however, not without value, for they strengthen the
suspicion of greater liability of the printer to pulmonary disease.
The figures underlined in column 12 indicate the increased tuberculosis
mortality rate of the two associations as compared with the whole of
England and Wales. In column 11 it will be observed that in the Society
of Compositors there is an increase in tubercular disease, but not
great, over the corresponding rate for the entire country. It may be
therefore taken as a fact that printers are more liable to tubercular
consumption than men engaged in most other trades. In the half-yearly
Report of the Typographical Association ending December 1900, there
is a list of 74 deaths for the half-year in the Society, whose members
number 16,179. Of these 74 deaths, 32 were caused by pulmonary disease,
and of these 32 deaths, 22 were caused by tubercular disease, mostly
pulmonary phthisis. There is an opinion, but it is erroneous, that
smoking tobacco or chewing it is more or less a protection against
plumbism, because the men expectorate; but apart from the fact of
spitting being a dirty practice, the habit of expectorating upon a
printer’s floor is to be discouraged, especially if the workman has a
cough and is the subject of lung disease, for it is largely by means of
the sputa thrown upon the floor and becoming dried that the bacilli of
tubercle disseminate pulmonary consumption.
_MORTALITY TABLES OF TYPOGRAPHICAL ASS0C._
TYPOGRAPHICAL ASSOCIATION.
KEY to headers:
A: All Causes.
B: Bronchitis.
C: Pneumonia.
D: Phthisis.
E: Consumption.
F: Tuberculosis, etc.
G: Lung Diseases, including Bronchitis, Pneumonia, Phthisis, etc.
H: Tuberculosis, including Phthisis, and all other forms.