POISONING WITH LEAD.
Nearly at the beginning of my practice in medicine, I was called to see
a fine and hitherto healthy youth, twelve years old, but who had for
several weeks before application was made to me, complained of a steady
and sometimes severe pain in his bowels, attended with more or fewer
febrile symptoms and a loss of appetite.
In endeavoring to trace out carefully the causes of his disease, the
first thing that attracted my attention was his employment. His father
was a blacksmith, and being in moderate circumstances and destitute of
any other help besides this son, had for a considerable time required
him to perform the work of an adult, or nearly such. It had not been
suspected at the time, that the work injured him, though he had
sometimes complained of great fatigue, and of a slight weakness and
uneasiness in the place where the pain had now become fixed. As the
result of my investigations, I came to the conclusion that he had been
overworked, and certain ligaments of the bowels had been weakened.
My treatment in the case was at first mild and palliative, in the hope
that after a few days of rest the trouble would disappear. Instead of
this, however, it grew worse. At my special request, various counselling
physicians were called in; but I do not know that they were of any
service to me. No new light was thrown on the case, though we could all
converse very learnedly on the subject.
Like many other young practitioners, I was at that time apt to indulge
in gloomy fears about poisons. I seldom had a case of acute disease,
without suspecting their influence. I suspected poison now, and
accordingly made search into every possible nook and corner whence such
an influence could possibly have emanated. For a long time nothing could
be found.
One day, on examining a pot of pickled cucumbers which had hitherto
escaped observation, I found that a part of its glazing had been
destroyed by the acid. I no sooner saw this than I was ready to say,
_eureka_ (I have found it), and to inform the family and my patient. It
appeared that the pickles had been there for some time, and that the boy
had eaten of them very freely. The parents and friends, though they had
much confidence in the wisdom and skill of their physician, were very
slow to believe in the injurious tendency of the pickles. They admitted
the danger of such cases generally; but how could the boy be injured,
and not the rest of them? they asked. They forgot, or did not know, that
the poison would be more likely to affect one who was weakened in the
abdomen from other causes, than those who were sound; especially when he
took much more of it into his stomach than they did.
In my suspicion about lead poisoning, I had very little sympathy from
those around me. Even the counselling physicians had little confidence
in any such existing cause of disease. They were nearly as ready as
other people to leave the case in the dark, and to say, practically,
"The finger of Providence is here;" or, in other words, It comes of some
cause which God alone knows or _can_ know.
How much of human ignorance--ay, and of human credulity and folly,
too--is clustered round the well-known decision of many a court of
inquest; viz., "Died by the visitation of God!" What do they mean by it?
Do they suppose that since Satan or some other personage whom we call
Death, is guilty of striking us down here and there, those who are not
"struck with death" are struck down by the great Source of light and
life?
The far greater probability is, that they know not what they _do_ mean.
Mankind are not addicted to thinking, especially on subjects of this
sort. It is much easier, or at least much lazier, to refer all our ills
and complaints, as well as their unfavorable terminations, to God or
Satan, friend or foe,--to some agency exterior to themselves,--than to
consider themselves as the probable cause, and proceed to make diligent
search for their own errors.
Thus it was, in a remarkable degree, in the region where it was my lot
to meet and palliate and try to cure diseases. I say, here, _cure_; for
the idea would hardly have found a lodgment, at that early period, in
any human brain which could have been found in that region of rural
simplicity, hardly in my own somewhat more highly enlightened cranium,
that _medical men never cure_; and that when people get well, it is the
result of the operations and efforts of nature, or of nature's God, who
is doing the best thing possible to set matters right.
It was even deemed by many as not only foolish, but almost sacrilegious,
to say much about the causes of disease, and especially about lead. And
then to talk about lead as connected with the use of their favorite red
earthen, which had been in use time immemorial, and which had never, in
all past time, killed anybody, as they supposed, was the dictate of
almost any thing else rather than of good, sound, sober, common sense.
You can hardly imagine, at this day, in the year 1859, what an air of
incredulity the gaping countenances of the family and neighbors of my
young friend and patient presented, when I told them stories of lead
disease in different parts of the country, especially of such cases as
were then recent and fresh in my memory. One of these stories may not be
out of place in the present connection.
About the year 1812, the people of Elizabethtown, Penn., put up what
they called their apple butter in these same red earthen vessels,
glazed, as almost everybody now knows, with an oxyde of lead. There had
been a pottery established near the village that very year, and it was
thought not a little patriotic to purchase and use its products, thus
favoring the cause of home manufacture. Nearly every family, as it
appeared in the sequel, had bought and used more or fewer of these
vessels.
This was, of course, some time in the autumn. In the progress of a few
months a dreadful disease broke out in the village, which baffled the
skill of the best physicians, and consigned some forty or fifty of the
inhabitants to the grave. The cause, at first, was not at all suspected.
At length, however, from a careful examination of facts, it was
ascertained that the disease which had proved so fatal must have had its
origin in the glazing of these vessels. The sickness abated only when it
had attacked all whose bowels--already weakened by some other cause or
causes--were duly prepared for the poisonous operation of the lead. It
is indeed true that the physicians supposed the disease came to a stand
on account of the overwhelming tendency of huge doses of calomel, which
they gave to almost everybody who had used the apple butter; but of this
there was no satisfactory evidence. It ceased, as I believe, and as I
have already intimated, because--except in the case of those who were
enfeebled by other causes, nature was too strong for it, or her
recuperative powers too energetic.
Now this story illustrates a case which, in magnitude or in miniature,
is in our country of almost every-day occurrence; and the only reason
why the results everywhere else are not like those at Elizabethtown, is
simply this: that there is not so much of the poison used in any one
village, at the same time, as there was at that place in the
circumstances which have been mentioned. One is sick here, another
there, and another elsewhere. In one, owing to peculiar predisposition
or habit, it takes the shape of fever; in another, of palsy; in another,
of eruptions or boils; in another, of bowel complaint. And as all these
and many other diseases have been known before, and have been induced by
other causes equally unobserved or obscure, we have fallen into the
habit of supposing that these things must needs be, do what we will. In
other words, God the Creator, is supposed to have made the world and
appointed to us, for trial or otherwise, these various forms of disease;
and they are for the most part dealt out to us arbitrarily; or, if not
arbitrarily, by chance or hap-hazard.
But to return to the young man. There was such a hostility of the public
mind to the idea that his disease was induced or even aggravated by
lead, that I receded in part from my suspicions. At least, I proceeded,
with fresh energy and enthusiasm, to search for other and more probable
or popular causes. Cause there must have been, of some sort, I was
confident; while to all my efforts of this kind the friends of the boy
stood opposed. They did not, it is true, say much against it; but then
it was perfectly evident from all their conversation and conduct that
they regarded it as not only idle, but presumptuous, perhaps wicked. How
can it be, they seemed to say, by those looks and actions which so often
speak louder than words, that this young doctor is always trying to
ferret out the causes of disease, while Dr ---- (my predecessor) never
attempted any such thing, but rather dissuaded us from it?
Yet thus it was precisely. For three long months I was endeavoring to
meet and obviate the symptoms of a disease which I secretly believed was
induced by lead, but of which I had no such strong evidence as would
have justified the positive affirmation that it was so, or prevented me
from searching for other causes. This state of mind was by no means
favorable to my success as a medical practitioner; for it somehow
greatly impaired or weakened their general confidence in my wisdom and
skill. Had I, on the other hand, "looked very wise," declared the
disease to be so and so, with great pertinacity, and adhered, through
good report and through evil, to my opinion, whenever it was assailed,
and withal manifested no desire to receive medical counsel, I should
have had a larger measure of their esteem, and a very much larger
measure, as a professional man, of their confidence. They might then
have thought me a very wise and good physician.
A man who wishes to be greatly popular in the world must learn the ways
of the world, and walk in them more or less, whether they are crooked or
straight. He must not be over-modest, or over-honest; nor must he be
over-solicitous to improve his own mind or heart, or encourage others,
by precept or example, to walk in the way of improvement. He must not
only make up his mind to take the world as it is, but to suffer it to
remain so. The world does not like to be found fault with; it has a
great deal of self-confidence.
The young man, in the end, recovered; not, as I now believe, in
consequence of the treatment, but in spite of it. Had he been nursed
carefully from the first, and kept from every source of irritation, both
external and internal, even from food, except a very little of the
mildest sort, just enough to keep him from absolute starvation; and had
his air been pure and his temper of mind easy, cheerful and hopeful, he
would probably have recovered much sooner than he did, and with far
better prospects for the future. But he had been frightened about
himself, from the very first, by my own inquiries about poison,--which
had unwarily been communicated to him,--and his fears never wholly
subsided.
How much wisdom from both worlds does it require in order to be a
physician! The office of a medical man, I repeat, is one of the noblest
under the whole heaven. The physician is, or should be, a missionary. Do
you regard this assertion as extravagant or unfounded? Why, then, was it
made an adjunct, and more than an adjunct, in the first promulgation of
the gospel, and this, too, by the gospel's divine Author? Why is it that
our success in modern times, in spreading the gospel, has been
greater--other things being equal--in America or China, in proportion as
its preachers have attended to the body as well as to the soul?
At the time of my commencing the practice of medicine, I was no more fit
for it than I was to preach the cross of Christ; that is, I was almost
entirely unqualified for either profession. I was honest, sanguine,
philanthropic, but I was uneducated. I knew very little, indeed, of
human nature; still less did I know of the sublime art of becoming all
things to all men, in the nobler and more elevated sense of the great
apostle Paul. I would yield to no other compromise than such as he
encourages, of course. Let us be honest and truthful, though the heavens
fall.