IN our last issue we had something to say on the subject of Aluminium poisoning. This month it is the turn of lead. It would seem that whilst the lower members of the world of creation are provided with instincts which warn them against eating or drinking poisonous substances man has developed a positive craving for harmful foods and drinks. Last month we told of Dr. Le-Hunte Coopers efforts to warn his fellow humans against the dangers of Aluminium, as used in cooking utensils.
Today we are calling attention to articles in the British Medical Journal of August 8th on the no less pressing dangers of lead. The poisonous properties of lead have been known to the medical world for generations, but the many convenient properties of the metal have been too tempting to exclude its use.
How extensive that use is may be gathered from correspondence in recent issues of the British Medical Journal. We are reproducing in this number two letters which appeared on August 1st, revealing in very vivid fashion the extent to which lead- poisoning is being carried on through the water supplies and through the pipes used for the conduction of drinking water.
It would almost appear that the particular feature by which man proves his superiority over the lower creation is the taste he has developed for poisoning himself with an endless variety of foods, drinks and medicaments which he had much better leave alone. For the most part animals reject substances which are inimical to their existence. As they approach the level of the human, the fatal taste for poisons begins to appear. Monkeys like their superiors have often developed a taste of intoxicants and have been found, when opportunity has offered in a state which has been described as “drunk as a lord” of creation.
We cannot do better than reproduce here the two letters above referred to.
SIR, I have just been reading with the greatest interest the two instructive and valuable papers on lead poisoning in the Journal of July 18th, by Dr. Edwin Bramwell and Dr. Norman Porritt. On first reading these communications it seemed as though every possible source of the poison and its mode of entry had been exhausted; but yet there is another which, in my knowledge as a doctor practising in a rural district in Wilts, whose experience goes back to 1871, was the cause of more than fifty per cent. of the many scores of cases of plumbism which I was called upon to treat. The cause I allude to is the drinking of “home made” wine fermented in a red glazed pan; the glaze for these utensils was made from a lead compound, but it was readily dissolved in the acid of the fruit, with which it was in contact for some days.
The cottagers nearby always had good gardens, and grew quantities of fruit, such as gooseberries, currants, rhubarb, plums, and in a few cases even grapes were to be seen on their walls. Parsnips and elderberries, though much used, did not seem to be such great offenders probably from having less free acid in their contents. I found after some years, on a few occasions, where it was possible to exclude every kind of wine (and, of course, other recognised sources), that the same consequences ensued from the drinking of ginger-beer made with lemons and ginger and sugar, and fermented in a red glazed pan.
The symptoms were of the acute kind abdominal pain, much vomiting, obstinate constipation, a sallow complexion, yellowish conjunctivae, and the blue line on the gums. I noted also one other very easily overlooked source of the poison. A cider press with a leaden tray to catch the expressed apple juice went round to many farms in the district, and left in its trail many blue lines, yellow eyes, and much stomach ache! I am etc.
R. LEWIS WILLCOX, M.R.C.S., L.R.C.P.
Salisbury, July 20th.
SIR, I was much interested to see the papers on plumbism contributed to the Journal of July 18th by Dr. Bramwell and Porritt, as for a considerable number of years I have been studying this question in my own area.
I am in thorough agreement with Dr. Porritt that there are two types of plumbism that is, a classical type, which is quoted in textbooks, and a mild and insidious form, which very often escapes notice, and which may only be found out by sudden exacerbation of symptoms. I have noticed the following types of illness occur, due to the taking of minute quantities of lead:.
Marasmus, wasting, and general debility in young infants.
Premature birth, and congenital debility in infants.
Neuritis of various forms.
Mental depression and, in one case, encephalitis.
Severe anaemia, followed by death.
Epileptiform convulsions in adults.
During last year the infantile mortality rate, in an area I know of, supplied with a very lead-soluble water, was 134, while that of an area in the same district in which the water had been treated to prevent lead solubility was 56; the following causes of deaths were noted among children in the lead-soluble area:.
2. Infantile convulsions and infantile enteritis.
3. Convulsions and enteritis with jaundice.
5. Epileptiform convulsions. Twins both died within fourteen days after birth.
6. Inanition. Twins both died within fourteen days after birth.
In this area lead is found in the water supply of every house in which there is a lead pipe, and in Cases 5 and 6 the mother had been living, just up to confinement, in a house in which the amount of lead in the water was found to be 0.47 grain per gallon, or nearly 1/2 grain per gallon. I see Dr. Porritt found that 1/14 grain could cause symptoms. In this particular supply nearly all the samples show an amount of lead greater than 1/10 grain, and some as much as 3/4 grain per gallon.
I might state that this supply is being dealt with, and a filtration and dosing plant will be installed very shortly to prevent the action of the water on the lead pipes, so that the residents in this area in future will have an exceedingly pure supply, because the water itself is of a most excellent quality (prior to going into the pipes).
For a number of years an investigation of the water north-west of Derbyshire was carried out by Dr. Thresh and myself, details of which will be found in the book, Examination of Water Supplies, by Thresh and Beale. In this investigation we found that it was the length of water service pipe that was the determining factor in causing large amounts of lead to be dissolved, rather than the pressure of water. We came to the conclusion also that 0.05 part per 100,000 of lead was the largest amount that could be taken with safety, and also that silicate of soda was effective in some instances in preventing lead solubility. I am inclined to think however, that the addition of lime to the silica would render it more effective.
Dr. Porritt mentions lead as being the cause of maternal mortality. I thoroughly agree with him, and I would like to suggest that in those districts with a high maternal and infantile mortality in which there is any suspicion of the water being lead-soluble the supply should be examined for the presence of lead (that is, supply from the tap). I am, etc.,.
ERNEST MILLIGAN, M.D., D.P.H.
M.O.H., Glossop and Glossop-dale.