Columbia Stotoettfitp mtljeCttpoOfottigork College of iPftpgictattg ano burgeons JLibtatp F PROPERTY OF FREDERICK B. RLIM 1 LEAD POISONING LEAD ISONING FROM THE^tD^DUSTgJAL, MEDICAL, AND ^dciAL POINTS OF VIE LECTURES DELIVERED AT THE ROYAL INSTITUTE OF PUBLIC HEALTH BY SIR THOMAS OLIVER M.A., M.D., M.R.C.P. CONSULTING PHYSICIAN, ROYAL VICTORIA INFIRMARY, AND. PROFESSOR OF THE PRINCIPLES AND PRACTICE OF MEDICINE, UNIVERSITY OF DURHAM COLLEGE OF MEDICINE, NEWCASTLE-UPON TYNE ; LATE MEDICAL EXPERT, DANGEROUS TRADES COMMITTEE, HOME OFFICE PAUL B. HOEBER 67 & 69 EAST 59TH STREET NEW YORK 1914 hx ol4 [Printed in England.] E. O. O. Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/leadpoisoningfroOOoliv PREFACE The growing interest taken in the subject of lead poisoning is my excuse for the publication in book form of the lectures delivered in the Royal Insti- tute of Public Health, Russell Square. No metal is more widely used in the arts and manufactures, and none lends itself to the increasing require- ments of modern life and industrial development more than lead. In the following pages I have tried to place before all who may read these lectures the channels by which lead gains en- trance into the body, the effects of the metal upon the organism, and how these effects may be got rid of. Although trades in which lead or its compounds are used will always be more or less dangerous, the extent to which industrial lead poisoning has been reduced is an excellent illus- tration of what legislation has accomplished, and of the good effected by Home Office inspection and regulations. What has been accomplished in this respect is but earnest of what can be. In viii PREFA CE the hope that by throwing additional light upon the subject such an object may be attained, this little book is launched upon the medical profession and the public. In the Appendix are printed, by permission of the Controller of H.M. Stationery Office, the Factory and Workshop Orders relating to lead poisoning. THOMAS OLIVER. 7, Ellison Place, Newcastle-upon-Tyne, August, 1914. CONTENTS PAGE Lead Smelting ..... 5 Manufacture of Red Lead - - 18 Manufacture of White Lead, or Lead Car- bonate - - - - - 22 Statistics of Industrial Lead Poisoning - 34 Lead Paints and Leadless Paints - - 55 Lead Poisoning among Painters - - 65 Manufacture of China and Earthenware - 68 Manufacture of Pottery as a Home Industry 76 Electrical Accumulator Works - - 82 Printing and Type Founding - - 83 Plumbing, Dyeing, Glass-Making, Tinning of Hollow Ware, and Diamond Cutting - 88 How is Lead Poisoning caused ? - - 92 Fume ------- 97 Lead or its Compounds in the Form of Dust 97 Onset of Symptoms, and its Relation to Ex- posure to Lead - - - - - 102 Channels of Entrance of the Poison - - 113 Symptomatology - - - .- - 122 The Blood in Saturnine Poisoning - - 123 Blue Line on the Gums - - - - 132 x CONTENTS PAGE Colic and Constipation - - - 136 Types of Industrial Plumbism - - - 140 Headache - - - - - - 141 Plumbism and Loss of Vision - - - 143 Nervous System - 147 Sensory Symptoms ----- 154 Saturnine Pseudo-General Paralysis : Wasser- mann Reaction ----- 156 General Pathological Review of the Subject 161 What Amounts of Lead are Harmful? - 165 Lead and Female Life - - - - 176 Lead and Motherhood • 176 Blood-Pressure Experiments - - - 185 Blood Pressure and Working in Lead- - 189 Chemical Examination of the Urine and of the Organs of the Body for Lead - - 192 Anomalous Symptoms due to Drinking Water Contaminated by Lead - - - - 193 What Constitutes Lead Poisoning? - - 196 Treatment : Preventive - 201 Treatment: Curative .... 209 Factory and Workshop Orders - - - 225 Index -....- - - - - - 288 LEAD POISONING FROM THE INDUSTRIAL, MEDICAL, AND SOCIAL POINTS OF VIEW Of the various metals used in the arts and manu- factures, none has, next to iron, a wider application than lead. Colours made from lead were in use long before the Christian era. When indiscrim- inately employed, lead and its compounds may become a source of much suffering. The number of trades in which the metal and its compounds are used is large. A few years ago Layet, a French physician, enumerated in industries in which lead is employed ; but, as new trades are being constantly developed, there is a growing demand for lead in one form or another. There are few industries, therefore, with which the metal is not directly or indirectly concerned. Lead mining and lead smelting are old British industries. Blocks of metallic lead have been found in the Midlands with the Roman arms stamped upon them. The world's production of 2 LEAD POISONING pig lead is estimated to be upwards of 1,200,000 tons per year. In our own country lead mining is confined to Derbyshire and the North of Eng- land, also to the Lowlands of Scotland. Formerly it was an important industry and a source of great wealth. After the discovery and introduction into this country of Spanish and Australian lead, the mining of the metal in Great Britain declined, owing to small prices and the fact that the foreign ores contained larger percentages of silver. Within recent years there has been a revival of lead mining in the North of England. As the mining is carried on in the remote dales and sparsely - populated moorland districts of the northern counties, where housing accommodation is inadequate, barracks have been erected for the men to sleep in. Housing conditions are better now than they were years ago. At that time, when the mines were in full working order, the barracks were hotbeds of tuber- culosis. The rooms were ill-ventilated and over- crowded ; the windows did not open ; the beds were arranged in rows too close to each other. No sooner, almost, were the beds vacated than they were occupied by men coming in from the other shift. Indiscriminate spitting was common, and, as many of the miners suffered from bronchitis, the expectoration was freely distributed upon the floor. Others, who lived at home, were obliged, INTRODUCTORY 3 when heated and tired after their hard day's work, to walk two or three miles across a bleak and wind-swept country, exposed to the weather. Hence the prevalence of bronchial affections in lead miners, and a preparation of the lungs for the reception of tubercle bacilli. Lead mines, unlike coal mines, are not ventilated. Some of them are wet and are entered by a drift. Entrance into and exit from other mines can only be accomplished by means of a series of ladders. Since there are no inflammable gases in lead mines, the men work with naked candles. Gun- powder is the explosive used to bring down the rock. Where powder has been fired, it requires a long time for the smoke to clear away and for the dust to settle. Miners who work in such an atmosphere become liable to bronchial and pul- monary catarrh, and especially to that type of lung disease caused by dust, known as silicosis, in which the spongy texture of the lung becomes converted into fibrous tissue. Miners who are the subjects of silicosis incur the risk of having tubercle subsequently grafted upon the injured lungs. Statistics show that pulmonary tuber- culosis is more prevalent among lead miners than among other persons living in the same district. Owing to the wetness of the mines, the men are liable to rheumatism. J 4 LEAD POISONING Apart from these maladies, lead miners are not an unhealthy class of men. Socially they are a contented body of men, frugal, temperate, and thrifty. They do not suffer from lead poisoning, because the lead in the ore is in almost the pure metallic form, known as galena. This exemption from plumbism does not apply to lead miners all the world over. A decade and a half ago, at the Broken Hill Mines in Australia, several of the miners suffered severely — there were even a few deaths — owing to the ore being in the form of carbonate. This ore, known as cerussite, is, prac- tically speaking, a crude white lead. It differs in composition from the ordinary white lead of commerce in the fact that, while < the manu- factured article is a hydrated lead carbonate or a mixture of hydrate and carbonate, cerussite is crystallized lead carbonate. The ore is friable, breaks down readily into a fine powder, is easily blown about the mine in the form of fine dust, and possesses, therefore, all the dangerous proper- ties of the white lead of commerce. The men who mined the cerussite suffered heavily in their health ; and no wonder, since in the sputum of three of them 2*o, r8, and i"6 grains of lead were found respectively. The 200-foot layer of carbonate ore at Broken Hill has been pretty well exhausted, so that at Broken Hill, as in England, the ore now LEAD SMELTING 5 raised is sulphide, or galena, and as a consequence lead poisoning among the miners has disappeared. Lead Smelting From lead poisoning — or, as it is sometimes called, saturnism, phimbism, colica pictonum, and colica pictofum — the British miner, as just stated, is free. The risk to health and life commences with smelting of the ore. People when travelling through lead-mining districts may have noticed here and there a tall, solitary chimney-stack on a hill-top, far removed from other buildings. Such a stack is usually the chimney by which fume generated during the smelting of lead escapes from a lead works which may be situated in the hollow a mile or more away. By means of an underground flue or series of flues 3 to 4 feet high, and made of brick or wood, the smoke and fume from the smelting furnace are conveyed into the open air. The fumes which escape from the stack are dangerous. For a considerable radius round a stack cattle must not graze. Both at home and on the Continent lead manufacturers have had to pay heavy damages to farmers and owners of stock for injury done to the herbage, and for the death of animals which had grazed in the im- mediate vicinity of the stack. The flues are sometimes of a sufficient height for men to 6 LEAD POISONING enter so as to remove the dust, which is rich in lead. However injurious to the surrounding country fumes escaping from lead-smelting works may be, they are a serious menace to the health and life of human beings and animals when the works are near a town. Broken Hill in New South Wales supplies an illustration. The consequences of having allowed dwelling - houses to be built in close proximity to lead-smelting works are there so evident that the experience about to be de- tailed should be a warning to all prospectors and managers of mining companies about to erect plant on virgin land. In 1892 there were employed in the Broken Hill Mines and Works 4,445 men. More than half of these worked on the surface. Around the works and within a radius of twelve miles there had grown up within five years a town with a population of 22,500. Five thousand of these people lived in a district called South Town, and were exposed to the fumes escaping day and night from the smelter stacks. Outside of the town the country is a waterless wilderness of salt bush country, almost uninhabited. Here sheep-farming is hazardous. During five years — 1888 to 1892 — there were 2,132 cases of lead poisoning of human beings, with n deaths, at Broken Hill. Owing to LEAD SMELTING 7 the comparatively low temperature at which lead volatilizes, the amount of fume poured forth from the twenty-eight smelters, each of 80 tons capacity, during twenty-four hours, was estimated to be equal to 15 tons weight of the metal used. Some of the fume in a finely attenuated form would float away to a considerable distance, while the remainder, consisting of heavier particles, would become deposited near the stacks. Samples of air tested a short distance from the stacks gave 7>V grain of lead per cubic foot, equivalent to 52 grains per 1,000 cubic feet of air. From glycerin-coated plates placed outside one of the hotels in the town there was collected, after eight hours, 3^- grains of lead, with traces of arsenic, per square foot of surface. The fume penetrated into the houses, and it contaminated reservoirs of drinking water to such an extent that in one sample \ grain of lead per gallon was found, and in another 5 J grains of lead per gallon. Although only eleven fatal cases of acute lead poisoning occurred during the five years alluded to, yet plumbism must have been the cause of much illness of a chronic nature and of an extent difficult to estimate. So bespoiled were the gardens that a child two and a half years old, who had plucked flowers and sucked them, died. On the flowers lead was found. Similarly, milch cows kept within a radius of one 8 LEAD POISONING to two miles died from lead poisoning. Among cats, dogs, and fowls, the mortality was extremely high. In the bodies of a horse, a dog, and a fowl, lead was found. There are sparrows at Broken Hill, but other birds are rare. Cage-birds can be kept, but only so long as the sand which is placed in the cages is brought some miles away from the town. Dogs kept at a smelting works in the neigh- bourhood of Newcastle-upon-Tyne developed a peculiar train of symptoms. They would run round and round, become convulsed, and drop down dead. These circus movements in plumbism are confined to animals. Wild birds which had eaten berries grown in close proximity to lead- smelting works have been picked up dead. These are minor matters compared with the condition of things which, as already stated, existed a few years ago at Broken Hill, where dogs and kittens were with difficulty reared and cage-birds kept. Poultry also died ; hens gradually became emaci- ated and ceased to lay eggs. Women, married and unmarried, suffered from menstrual disorders : abortion and premature births were frequent. At a large lead and zinc smelting works on the Con- tinent, with a frontage to a canal, the manager informed me that the ducks belonging to his workpeople became paralyzed in their limbs, so that they could no longer paddle. LEAD SMELTING 9 The dangers of lead smelting are now better known than formerly, and employers are taking greater pains to prevent fume escaping. There are economic reasons why they should do so. Since owners of lead-smelting works have in- creased the length of the flues there have been fewer claims for compensation by farmers than formerly. The bulk of the fume and smoke given off during smelting becomes deposited in the flues, so that only a minimum escapes from the chimney-stacks, and, as these are frequently ioo or 150 feet high, the fume is widely dispersed in an attenuated form by aerial currents. As the symptoms of lead poisoning in cattle differ from those observed in man, differ, too, between horses and oxen, and are perhaps not well known to the reader, it may be well for me to reproduce here the symptomatology given by Mr. Daniel Parr, veterinary surgeon, in his evidence before the Broken Hill Lead Inquiry Commission. As regards horses, the symptoms in the early stages are loss of appetite, coldness of the limbs and ears, a tucked-up appearance of the barrel, pulse 46 (a slight increase above the normal), rectal temperature 101/5 to 102 F., and the head depressed. At this period of the illness there are no indications of the animals having colic. Later on a grey discharge oozes from the io LEAD POISONING nostrils, there is excessive flow of saliva, and the animals keep champing their jaws. In a still later stage breathing becomes laboured ; some- times it is so difficult that the animal seems as if he were being suffocated, while the exhaled air has an extremely unpleasant odour. There are tremors, perspiration, and restlessness. The animal keeps lying down and rising up as if in pain. By this time the breathing has prob- ably become irregular and more difficult. There is frequent micturition, small quantities of urine being passed every few minutes. The horse keeps walking round and round until he loses control of his movements; he staggers, falls down in con- vulsions, and in three or four minutes he is dead. At death the temperature may be 106 or 107 F. In cattle loss of appetite is one of the early symptoms of plumbism. The cow ceases to chew the cud ; she stands apart from the herd, becomes restless, the eyes stare and the pupils are dilated. There are — foaming at the mouth ; pulse 65, slightly quicker than the normal ; a rectal tem- perature of 103 F., with respiration 25 — i.e., 10 above the normal. The muscles of the face and shoulders become the seat of spasmodic twitching. Later on the animal is observed to run round and round, or to rush forward, dashing her head to right or left, as if suffering from an LEAD SMELTING n inflammatory affection of the brain. In still later stages the pulse is found to have risen to 80 or more. There are grinding of the teeth, champ- ing of the jaws, a free flow of saliva from the mouth, and indications of abdominal pain. Con- vulsions supervene, and in these the animal dies. In other instances the breathing becomes laboured, and the cow dies gasping for breath, or she simply lies down, closes her eyes, and dies in coma, death being preceded by a marked fall of the tempera- ture. Parr found that 25 per cent, of the cows which became lead-poisoned died, and that, on account of the expense, the length of time required to be restored to health, and the after- effects of the plumbism — viz., uselessness of the cows as milkers for long afterwards — it was hardly worth while trying to recover them. Lead can be smelted by various methods, of which two alone need be described. Refractory and dross ores are treated in blast-furnaces, with hearths for removal of the lead and slag at the bottom. Each furnace is fed from above with coke and ore. Xix is driven into the lower part of the glowing charge by a strong blast. By the upper part of the furnace smoke and fume escape into one of the main flues, while the molten metal and the slag collect in the hearth and are run off periodically. There is a danger of the flue becom- 12 LEAD POISONING ing partially blocked, and of the fumes being reflected upon the workmen, by which may be explained such signs of plumbism, exhibited by smelters, as tremors, paresis or paralysis of the arms and hands, anaemia, and the presence of a blue line on the gums. The furnace-men also run the additional risk of having their health affected by the inhalation of carbon monoxide, which is given off during the incomplete combus- tion of the fuel. The percentage by volume of carbon monoxide escaping from lead blast-fur- naces varies from 3 '5 to io'8. As lead melts at 325° C. (617 F.), its vapour is given off at the ordinary heat of the furnace. In the Scotch hearth, which is smaller than the English blast-furnace, only galena is treated. The furnace is an open hearth. Upon this work- men place the charge. Two blast-pipes open into the charge from the back of the hearth. As the molten metal rises to the top of the well, or sump, of the hearth, it flows off by a small channel into a collecting pot in front of the furnace. The slag is also run off periodically into water and cooled. Fumes are given off during each of these pro- cesses. Usually there is a sufficient amount of lead left in the slag to render it worth while being remelted. Workmen, in breaking up the slag with a hammer, raise clouds of dust, which settles LEAD SMELTING 13 upon the timbers of the smelting shop, the clothes of the workmen, and upon any parcels of food the men may have brought with them. Dr. Edgar Collis,* His Majesty's Medical Inspector of Factories, basing his opinion upon an analysis of the fumes, maintains that in eight hours a man thus employed might inhale y^S grains of lead. It is not, of course, maintained that he does inhale this quantity. Of thirty-two blast-furnace men examined, Dr. Collis found in twenty-two a blue line on the gums, and in twelve of the men weak- ness of the extensor muscles of the hands and fingers. Cleaning out the flues is a dangerous occupa- tion, on account of the large quantities of lead which the dust contains. Lead fume, as indi- cated, is the volatile metallic vapour given off from the molten metal in the furnace when brought into contact with atmospheric air, also from the lead itself at extremely high tempera- tures, such as 1,200° C. ; but flue-dust, accord- ing to the quality of the lead ore used, is com- posed of particles of coke or unburnt carbon, silver, arsenic, antimony, reduced globules of metallic lead, lead in the form of oxide and sulphate, also quartz and limestone. Flue-dust is worth recovering, for it may contain as much as * "Special Report on Dangerous and Injurious Processes." 14 LEAD POISONING 30 per cent, of metallic lead. Hoffman* found that flue-dust contained as lead o"8 to 15 per cent, of the weight of the ore charged. In some of the lead works on the Continent of Europe flue-dust contains 16 to 26 per cent, of lead, and as much as 7 per cent, of arsenic. To recover the lead deposited in the dust, workmen enter the flues by manholes placed here and there along their course. In places 2 feet or more of dust may be found deposited in the flues, the removal of which by the shovel raises clouds of dust. To work in such a dusty atmosphere, the men are obliged to wear respirators. It is undesirable that the men should carry on this work for more than two hours without a break. If respirators are not worn, the men suffer from severe headache and feel extremely ill. Serious symptoms develop in men who have worked only a few days in the flues. At a large lead works with which I am familiar, two days were set aside recently for cleaning out the flues. Of thirteen men told off to do so, two of them on the second day suffered from vomiting, diarrhoea, and severe headache, accompanied by a rise of tempera- ture to 102 F. For a few days the men were very ill. Last summer, when in Allendale, I noticed upon a hillside some distance away a * Engineering and Mining jQurnal, 1906, p. 380. LEAD SMELTING 15 tall chimney-stack which was showing signs of decay. Dr. Murray of Allendale pointed out to me the smelting works of which it was a part, and which were quite a mile away from the chimney- stack. He gave me the following information : During the winter of 1912-13 he had treated two men for acute plumbism ; both of them suffered from a sharp attack of colic. For upwards of twenty years the smelting works had lain idle. It was known that the flues leading to the chim- ney-stack contained large quantities of deposit rich in lead. The two men referred to had under- taken to recover this, and had entered the flues by manholes. They had only worked two or three days, when they suffered so severely that they were obliged to give up the work. Where flues are closely packed and are on the slope, if the incline is sufficient, it is safer to flush them out with water, and allow the contents to run into reservoirs wherein the material can settle. Lead and its compounds in the form of sludge are less dangerous to the workmen than the dry dust shovelled out of the flues. Lead as it comes from the furnace is not always pure metal ; it may contain silver, gold, antimony, and other adulterants, which have to be removed. The two best - known methods for removing these are the Pattinson and the Parkes processes. 1 6 LEAD POISONING On Tyneside, the home of its introduction, the Pattinson process is mostly in use. The method is based upon the fact that lead crystallizes at a higher temperature than a mixture of lead and silver, so that the crust which forms on the surface, and which contains lead and silver, is skimmed off from time to time for further separa- tion and purification. In Parkes' process zinc is added to the lead. This in the melting-pot forms an alloy of lead, zinc, and silver, which rises to the surface of the molten metal, and can be skimmed off. The further stage of the process consists in separating these. The zinc is drawn off in the form of vapour in a dezincking apparatus, such as the Faber du Four retorting furnace. During the process of dezincking, zinc as well as lead fumes escape, and if the furnace-men inhale these fumes they are liable to suffer from nausea. Men employed in desilvering lead have frequently come under my care on account of plumbism, but on the whole fewer men thus employed have sought my advice than men engaged in some of the other departments in lead works. Allusion has been made to workmen suffering from nausea as a consequence of inhaling zinc and lead fumes during dezincking of the lead alloy. The smelting of zinc is of itself a frequent source of plumbism, for zinc ores frequently contain lead, LEAD SMELTING 17 Calamine ore contains 44 to 60 per cent, of zinc in the form of carbonate, but in blende ore, in addition to the zinc which is present in the form of sulphide, there may be lead to the extent of 9*3 to 18 per cent. In making spelter, blende ore is roasted in a calcining furnace in order to drive off the sulphur ; the residue may contain 1 to 10 per cent, of lead. To the burnt blende, calamine ore, zinc ashes, zinc oxide and chloride obtained from the skimmings of galvanized pots and retort crucibles, are added. Anthracite is also added, and the charge is placed in retorts and exposed to a high temperature. The zinc distils over, and is condensed in a crucible close to the retort. Not only are the workmen exposed to the influence of a high temperature, but they inhale fumes of lead and zinc, and in addition breathe an atmosphere rendered injurious and irritating to the lungs and bronchi by the sulphur dioxide given off at the same time. Con- sidering the small percentage of lead present in some samples of spelter, often not more than 2 per cent., plumbism is extremely frequent among the workmen. Between July 1, 1907, and Decem- ber 31, 1912, there were, according to Home Office returns, 77 cases of lead poisoning among spelter workers in South Wales alone. German physicians state that spelter workers are old and broken 2 1 8 LEAD POISONING down at forty. To the zinc fumes given off in spelter works are attributed the bronchitis, gastric and intestinal troubles, from which the men suffer, while to the lead fumes are attributed the nervous affections ; but where two kinds of metallic fumes are being inhaled simultaneously it is difficult to assign to each its proper share in the causation of symptoms. Manufacture of Red Lead Red lead, or minium (Pb 3 4 ), is a mixture of PbO with varying amounts of Pb 2 3 . It is pre- pared by placing pure lead in the open hearth of a reverberating furnace and heating it to a dull red- ness. During the process the material is raked from time to time. By slow oxidization the lead is converted into lead oxide (PbO). This, known as litharge or massicot — a green-looking substance — becomes yellow or yellowish-red on being washed. After having been washed so as to remove any pieces of unoxidized lead, the massicot is again heated, but at a lower temperature, when, owing to further oxidization, the massicot changes its colour to a bright red, and is called minium, or red lead. If the flue of the furnace is not drawing well, or if the mouth of the furnace is not well hooded, the fumes may be reflected upon the work- men during the oxidizing processes just mentioned. MANUFACTURE OF RED LEAD 19 Clouds of red dust invariably arise during the raking out of the finished product from the furnace. In the cupelling of lead, a blast of air is blown upon the molten metal in the furnace. The lead thus oxidized is by the force of the blast driven off the surface of the metal into a receiver. In the act of cooling the metal exfoliates. It breaks up into fine crystalline scales like coarse bran, known in the trade as flaked litharge. The process is carried out at extremely high temperatures. When the inner door of the furnace is opened, considerable quantities of fume escape, and, as this cannot all be carried off by the hooded exhaust which leads into the flue, the workmen, unless they stand well back at that particular moment, are likely to be enveloped in fume and to run the risk of inhaling some of it. Between 1900 and 1909 twenty-five men engaged in this work became ill through the effects of lead. The flues from the cupelling furnaces at one of the works which I recently visited are cleaned out once a year. In- side the flues there is a deposit of dust 5 to 6 inches deep. This dust contains 50 per cent, of lead. Some physicians regard the manufacture and use of red lead as only slightly dangerous to the health of workmen. Such is not my experi- ence, nor is it that of Medical Inspector E. R. 20 LEAD POISONING Stitt,* of the United States Navy, who reports the admission into the United States Naval Hospital, Canacao, P. I., of three seamen suffering from the encephalopathic type of plumbism, due to inhala- tion of red lead dust rising from dried surfaces when being chipped preparatory to being re- painted. But for the assistance obtained by a microscopical examination of the blood, and the finding therein of punctated erythrocytes, Stitt admits that the diagnosis might have been diffi- cult, although the presence of a blue line on the gums was extremely suggestive of plumbism. One of his patients became insane and had to be re- moved to an asylum, from which, after a consider- able length of time, he was discharged cured. Another of the men had colic ; there was a blue line on his gums, and in his blood basophilia. He developed severe epileptiform convulsions. These ceased ; by degrees the anaemia which he showed and the tremors he suffered from disap- peared. The men had been chipping red paint in the compartments of torpedo boats. Stitt's cases lend support to the opinion I have expressed, that extremely severe forms of plumbism are met with in red lead workers. Between 1900 and 1912 there occurred in * U.S. Naval Medical Bulletin, April, 1912, p. 161. Wash- ington Government Printing Office. MANUFACTURE OF RED LEAD 21 British red lead factories 134 cases of plumbism.* In one-fourth of the men the symptoms were severe. Sixteen of the men who had been ill had been introduced into red lead works simply as labourers to sweep up the floors. During the sieving, grinding and packing of litharge, clouds of dust rise. Thirteen of the cases above referred to were furnace-men. One patient was a brick- layer who was reconstructing a flaked litharge furnace. He contracted lead poisoning, and died from it. In one of the factories on the Continent a man who was carrying a small barrel of red lead let the barrel fall. It broke. Immediately the workman was enveloped in a cloud of red dust. Symptoms of acute plumbism developed, followed by paralysis of the extensor muscles of the wrists and fingers, which persisted for several months. Red lead is also manufactured by automatic processes, but, as the machinery is more or less patented, a description of it cannot be given. Suffice it to say that from the time the pig lead is fed into the closed melting-pot at one end, and where it is converted primarily into monoxide, also during its passage onwards through the colouring ovens to the place where it falls as finished red lead into the barrels for packing purposes, the * "Special Report on Dangerous and Injurious Pro- cesses," by Dr. Edgar Collis. 22 LEAD POISONING material is never handled by the men. Since there is a minus pressure inside the conduits, no dust is given out at any part of the machinery where the joints have become loose. By this method of manufacture fewer workmen are re- quired, the atmosphere is clearer, and the men run no risk except at the hopper where the red lead falls into the barrels. When this part of the machinery is effectively screened, the manufacture of red lead becomes an industry remarkably free from many of the risks hitherto incidental to it. Manufacture of White Lead, or Lead Carbonate Notwithstanding the opposition in many quar- ters to the use of white lead, there is still a great demand, if not an increasing one, for the pig- ment. It is estimated that, in 1910, 58,000 tons of white lead were manufactured in this country, and that 14,500 tons were imported from abroad. In Great Britain this particular department of the industry gives employment to 2,500 men, while the capital invested for manufacturing purposes cannot be far short of £1,500,000. In the United States of America the manufacture of white lead was begun in 1777. The annual production of white lead in the States is 100,000 tons. MANUFACTURE OF WHITE LEAD 23 By the term white lead is meant the carbonate. Lead sulphate is also a white pigment, but com- mercially it is always known by its chemical designation. Two of the best-known methods of making white lead are (1) the Dutch process, and (2) the chamber process. In the Dutch process thin perforated plates of metallic lead, called " wickets " or " grids," are taken to a stack, or corroding house, a large quadrilateral space, sub- sequently to be spoken of as the " blue bed," one side of which opens into a main passage. There are usually several stacks placed side by side in a row. On an average the stacks are 20 feet high and 16 by 13 feet. Upon the floor of the stack bark from a tanyard is strewn to the depth of 2 to 3 inches. On the bark are placed rows of wide-mouthed earthenware jars, 6 to 7 inches high, half filled with a 2 to 3 per cent, solution of acetic acid. The lead plates, known as " wickets " or " grids," are placed sideways on the top of the open jars. The lead used must be pretty pure, for the presence of silver, bismuth and copper are, from the white lead manufacturer's point of view, impurities, and interfere with the results. Upon the wickets is placed a layer of wooden planks. Bark is strewn upon the planks, and on the tan another series of jars containing acetic acid, and supporting metallic plates, is laid. 24 lead poisoning Thus, by a series of alternating layers, called in Scotland "heats," the stack becomes built up from bottom to top, care being taken, as the blue bed is being reared and as each layer is completed, to place planks across the open entrance, so as to confine the contents. The making up of a blue bed may be done by women. Home Office regu- lations allow of this. It does not require skilled labour. An unoccupied space of a few feet is left at the top of the stack, and at the sides pipes are inserted for the purposes of ventilation, the removal of vapour, and the prevention of too high a temperature. In a stack there are usually twelve layers of tan, jars, and lead plates, but in some works there are fifteen. Some managers believe that better results are obtained where there are only twelve rather than fifteen layers. If the layers are too many, less of the lead in the mid-zone of the stack is corroded. Although there is a considerable amount of handling of the wickets by the women who make up the blue bed, the work is not regarded as in- jurious. I have, however, known of women suffer- ing from colic when thus employed. When the blue bed is fully made up, the outer doors are closed, and the stack is left undisturbed for ioo to 130 days. In the course of a few days the temperature inside the stack rises. It may reach MANUFACTURE OF WHITE LEAD 25 8o° C, but manufacturers prefer a lower tempera- ture — 50 to 60° C. — and in order to secure this they frequently add, when making up the stack, old tan to the new, so as to prevent too rapid fermentation. Thompson is of the opinion * that the fermentation, or decomposition, which takes place within the stack is the result of the activity of bacteria within the tan, and that, as the process continues, the part played in the initial stages by micro-organisms is replaced by combustion. At the end of three months, when the stack is opened, it is known no longer as a " blue," but as a " white " bed. Into it women are not allowed to enter, for the stripping of the white lead and the removal of the uncorroded lead are dangerous. During the three months the stack was closed fermentation of the bark had been going on, attended by a rise of temperature. The acetic acid had vaporized, and had attacked the metallic lead, converting it into lead acetate ; but, as carbonic acid was at the same time given off from the tan, a double chemical action had taken place, whereby the lead acetate was converted into hydroxycarbonate. White lead is a basic compound containing two molecules of normal carbonate of lead in com- bination with one molecule of lead hydrate or lead oxide, and it has the formula 2PbC0 3 Pb(OH) a ._ * Journal of Society of Chemical Industry, 1909, p. 28, etc 26 LEAD POISONING It has been taught that white lead is a mechanical mixture of hydrate and carbonate of lead ; that the hydrated portion gives the spreading power to paints made from the pigment, and that the carbonate gives the opacity, but on this point recent opinions differ. Pure carbonate of lead is useless as a pigment. It is owing to its peculiar composition and the varying size of its molecules that it combines so well with oil " as to confer upon it as a paint that smooth working quality in the brush which enables painters readily to pro- duce a smooth and uniform coat, rendering it water- shedding and resistant to decay " (Noel Heaton). Corrosion or conversion of the metallic lead into carbonate is never quite complete. There is always a certain amount of the metal left. Cor- rosion is said to be good when 70 to 75 per cent, of the metallic lead has been converted into the carbonate. From every hundredweight of metallic lead used, 50 to 78 pounds of white lead are ob- tained. There is usually a trace of acetate of lead left between the metal and the superjacent car- bonate. Occasionally the white lead shows a delicate pink colour from the tan. Manufacturers prefer a hard — that is, a crisp — corrosion to a soft one. In most of the large white - lead • producing countries, men only are allowed to strip or empty MANUFACTURE OF WHITE LEAD 27 a white bed ; for it is dusty work, calling for water- spraying and for the wearing of respirators on the part of the men. The hands of the workmen become covered with white lead ; the fine powder adheres to the skin, particularly to the sides of the nails ; it also penetrates under the free end of the nails. The dust, too, lodges between the hairs of the beard and the moustache. From the respirators worn by the men considerable quan- tities of lead can be recovered. Emptying of a white bed is hard work. The material is carried away in wooden boxes by the men, or swung out of the stacks by means of machinery, and con- veyed to the wash-tubs to be crushed between wet rollers and washed, so as to have any lead acetate removed. The washed white lead forms a pulp. This, when thoroughly sedimented and dried in an oven, is sold as white lead, or it may be straightway mixed with linseed-oil and made into paint. One of the most dangerous operations in the manufacture of white lead is emptying the ovens or stoves. Formerly emptying of the stoves by hand labour gave rise to more cases of serious plumbism than any other process. By substi- tuting machine for hand labour, much sickness has been averted. The other method of dealing with the sedimented white lead is, as stated, to treat it at once with linseed-oil by the method 28 LEAD POISONING known in the trade as " pulping." When I was a member of the Potteries Commission of the Home Office, my attention was drawn to this method of treating the washed white lead by M. Besancon, during my visit to the white lead works of MM. Besancon, Expert et Cie., Paris. After having been washed and the excess of water removed by filter presses, the white lead is passed, through a series of rollers, during which linseed- oil is constantly being added. By degrees the oil replaces the water in the pulp, so that from the end roller a practically finished paint escapes, yet one not quite free from water. The remaining water is extracted by placing the material in a closed iron cylinder heated by a steam jacket and kept under a reduced pressure. By this means nearly all the water is removed, only part of a decimal point being left. Struck by the cleanliness of M. Besancon's factory, the absence of dust, and the freedom of the men from lead poisoning, I reported the circumstance to the Home Secretary (then Sir Matthew White Ridley), who at once circularized the British manufacturers, with the result that the firms which have adopted the process mostly sell the white lead in the form of paint ; but, as by this method of manufacture drying chambers or ovens have been abolished, the factories have become freer from lead poisoning. MANUFACTURE OF WHITE LEAD 29 In the chamber process longer and thinner sheets of metallic lead are used than in the Dutch process. These are suspended over a series of rails in a chamber, and the door is hermetically closed. Hot acetic acid vapour and carbon dioxide obtained from burning coke are driven into the chamber by pipes from below. Changes of a chemical nature, similar to those described as occurring in the blue bed in the Dutch process, are induced ; but in the chamber process corrosion is more rapid, for in fifty to sixty days the metal is converted into white lead, the temperature of the chamber having been kept pretty regularly at about 6o° C. Before opening out the chamber, steam is injected into it to moisten the material and to render it less dusty to the men when removing it. Before the men enter the chamber the door is kept open for some hours, so as to allow the temperature to fall. In this country there has been an outcry against the use of white lead, which is not lessening, especially since France has passed a law forbid- ding the use of lead for decorative purposes, and which comes into force at an early date (1915). Considered from an historical point of view, it is hardly likely that an industry which has been in existence for more than 2,000 years will readily disappear. Trade customs die hard. Lead com- 30 LEAD POISONING pounds have such a varied and extensive field of application that it will be difficult to find substi- tutes for them in some of the arts and manufac- tures. From its antiquity alone the trade is entitled to some consideration, even while we admit that lead and its compounds are dangerous. Something of the age of the industry may be learned from an address given by C. A. Klein * to the Paint and Varnish Society, London. Cerussa as a cosmetic is alluded to by Xenophon (430- 355 B.C.). An earthenware box belonging to this period was recently unearthed, and found to con- tain a mixture of white lead and whiting. This powder, like that used by the ladies of Florence in the fourteenth century, had been resorted to for the purpose of heightening beauty — a practice apparently not without danger, since it drew from Cennino Cennini a warning homily. The cerussa referred to by Xenophon was probably a powder obtained by grinding a native lead carbonate ore, such as is still known as cerussite. According to Vitruvius (100 B.C.), the Rhodians made white lead by pouring vinegar into vessels over vine twigs contained therein, and on the twigs they placed metallic lead. The vessels were covered over to prevent evaporation. On these being opened after -* Oil and Colour Trades Journal, December 6 and 13, 1913, p. 1973, et C- MANUFACTURE OF WHITE LEAD 31 a specified time, the lead was found to have become converted into cerussa. The Rhodian product was regarded as an article of great com- mercial value. Considering the method of its preparation, it would at first appear as if the sub- stance obtained was a basic acetate of lead, and not a carbonate ; but basic acetate of lead when ex- posed to atmospheric air becomes gradually con- verted into carbonate. A certain amount of carbonic acid would, however, probably be present, since, during decomposition of the twigs upon which the lead was laid, also in consequence of decomposition of the vinegrated grape pulp likely to occur as well, carbonic acid would be evolved, and would assist in the conversion of metallic lead into carbonate. This simple method of convert- ing metallic lead into carbonate by the action of acetic acid and of carbonic acid evolved during fermentation of the residuum of pressed grapes is still followed at Klagenfurth, in Carinthia. Cen- turies ago the heat-producing agents required for the conversion of metallic lead into carbonate were manure and other decaying organic material. Not only is heat evolved from these, but carbonic acid as well. In order to increase for corroding purposes the carbonic acid given off from manure, the Dutch in 1622 added wine-lees and chalk to vinegar. They also improved the stack process 32 LEAD POISONING then in existence, and became active competitors with the Venetians. England at this period was awaking. In 1662 the first patent was granted to Eland, and in 1749 Creed obtained a patent to manufac- ture white lead by what is now known as the chamber process. At this date not only was Newcastle-upon-Tyne a recognized seat of the trade, but it was here that was introduced the use of spent tan bark in the corroding stacks, and which has been ever since an important element in the manufacture of white lead by the Dutch process. The patent for the use of tan bark was granted to Richard Fishwick, then a partner in the now well-known firm of Messrs. Walker, Parker and Co., Newcastle-upon-Tyne. As thus modified, the Dutch process has still many adherents. Opinions differ as to the relative values of white lead manufactured by the Dutch method (fourteen weeks) and that by the chamber process (eight weeks). Regarded from the hygienic point of view, the chamber process is cleaner, time is saved in the corrosion, more of the metal is said to be corroded, and there is a saving of labour in filling and emptying the chambers. Mr. Noel Heaton * considers chamber white lead to be brighter in colour, probably owing to the absence of tan * Journal of the Royal Society of Arts, March 14, 1913- MANUFACTURE OF WHITE LEAD 33 influence, to be finer in the grain and more uniform, but many master-painters with whom I have discussed the question prefer white lead made by the Dutch process. That the material thus produced must possess the good qualities ascribed by them to it is shown by the fact that the Dutch process still remains in many factories the sole method of making white lead. Nay, more than this : of the 275,000 tons of white lead produced by various processes, the approximate quantities given by Klein are — Stack, i.e., Dutch, process .. Chamber Miscellaneous Tons. 180,000 45,000 50,000 In Great Britain it is estimated that 70 per cent, of the white lead is manufactured by the Dutch process, and in the United States 80 per cent. Estimating the total production of white lead in the world to be 275,000 tons, it is interesting to see how the various countries contribute to it : United States Great Britain Germany France Belgium Russia Italy ... Holland Spain ... Canada English Tons Dry. . 120,000 • 55.ooo • 36,500 20,000 15,000 14,500 4.500 2,500 2,500 2,500 3 34 LEAD POISONING Statistics of Industrial Lead Poisoning In the Annual Report of the Chief Inspector of Factories, 1912, Dr. T. M. Legge has presented in tabular form the number of cases of lead poisoning notified to the Home Office for thirteen years — 1900 to 1912 inclusive. Compulsory notification of cases of industrial lead poisoning has proved of invaluable service, not only in supplying informa- tion to the Home Office of the presence of plumbism in a particular factory, but of drawing attention to the possible existence of defects, structural or otherwise, and of the necessity of immediately remedying them. In white lead factories alone the deaths were as follows : Year. Cases. Deaths. 1 goo 358 6 1901 189 7 1902 143 1 1903 109 2 1904 116 2 !9 5 90 1906 108 7 1907 7i 1908 79 3 1909 32 2 1910 34 1 1911 4 1 2 1912 23 Total i>393 33 INDUSTRIAL LEAD POISONING 35 That is, of those suffering from plumbism 2'2 per cent. died. As showing the difference in the mortality rates of lead poisoning due to working in white lead factories and lead poisoning following upon work- ing in other trades in which white lead is used, the following table, taken from the same source, will not be out of place : All Cases of Industrial Lead Poisoning notified to Home Office, with Number of Deaths. Year. Cases. Deaths. 1900 1,058 38 1901 863 34 1902 629 H 1903 614 *9 1904 597 26 I9°5 592 23 1906 632 33 1907 578 26 1908 646 32 1909 553 30 1910 505 38 1911 669 37 1912 587 44 Total 8,523 394 Taking the total cases of lead poisoning, the fatal cases are 4*5 per cent. ; but if we deduct the cases and deaths of lead workers, the mortality rate is 5*06, as against the 2*2 per cent, fatal 36 LEAD POISONING cases in white lead workers. This difference in the mortality rate is not without significance; it suggests that it is among white lead workers that the regulations issued and enforced by the Home Office have been most productive of good. The 8,523 cases of lead poisoning occurred among persons employed in eighteen industries. The number of cases notified in 1900 and 1901 were respectively 1,058 and 863, and for 1911 and 19 12 they were 669 and 587. While the number of cases notified has declined, the same cannot be said of the fatalities. In 1900 and 1901 the fatal cases were 38 and 34 respectively, but in 1911 and 1912, although, according to the tables, fewer cases were reported, there were 37 and 44 deaths respectively. Control of dust in industrial occupations in which white lead and lead compounds are manu- factured or handled has done much to bring about a reduction in the number of cases of plumbism. It is Dr. Legge's opinion that, if the amount of lead present in the air breathed is less than 5 milligrammes per 10 cubic metres of air, saturnine encephalopathy and paralysis will not occur. Taking ten hours as the period of an ordinary working day, it is estimated that during that time 4! cubic metres of air pass in and out of the lungs. The inhalation of 2 milligrammes INDUSTRIAL LEAD POISONING 37 of lead daily in the form of fume or dust would in the course of a year set up lead poisoning. If such an amount of lead reached the lung in each working day, something like 600 milligrammes, or 10 grains, of lead might be absorbed in the course of one year ; but there is no evidence to support this mathematical contention. Dr. Ludwig Teleky of Vienna informs us that a daily dose of a little more than 1 milligramme of lead taken for several months will cause plumbism, and that a daily dose of 10 milligrammes will cause symptoms of severe saturnine intoxication in a very short time. We can, of course, never be quite sure of the quantity of lead which reaches the lungs and is retained there in men who are working in, and breathing, an atmosphere laden with lead dust, for much of the dust is caught in the nasopharynx and is swallowed, or it is trapped in the upper respiratory passages and does not reach the lungs at all. - The results of the notification of lead poisoning are extremely interesting as showing the changes which have taken place both in the personnel of the workers and in the hygiene of certain trades. In 1900 the largest number of cases of plumbism occurred in the white lead trade — viz., 358, with 6 deaths ; in earthenware and pottery there were 200 cases reported and 8 deaths. In 1912 the manufacture of white lead no longer occupies the 38 LEAD POISONING unenviable first place on the list of trades in which plumbism occurs. This position is taken by the earthenware and pottery industry, with 80 cases and 14 deaths, and closely upon it comes coach-building, with 84 cases and 7 deaths, as against 70 cases with 5 deaths for igoo, or an increase of i"2 per cent. Smelting of metals, which in 1900 gave 34 cases with 1 death, gave in 1912 56 cases with 7 deaths; printing, with 18 cases and 2 deaths in 1900, furnished in 1912 37 cases without a death. On the other hand, the manufacture of white lead, which was formerly regarded as one of the most dangerous of all the lead industries, with its 358 cases and 6 deaths in 1900, gave in 1912, with no deaths recorded against it, 23 cases. These figures refer only to plumbism occurring in persons mostly at work ; they convey no intimation of the number of deaths caused by kidney and other internal diseases, and which are consequences of chronic plumbism in persons many of whom had years previously worked in lead factories. The undesirable position occupied by coach and house painting on the list of occupations in which plumbism occurs is not confined to Great Britain alone. On the Continent the same event is taking place. The rapid rise of the motor-car industry is largely responsible for the increase in the number of cases notified. Lead poisoning is INDUSTRIAL LEAD POISONING 39 more prevalent among house painters than it ought to be. Painters when at work are not always strictly observant of details of personal hygiene. The practice of holding the brush be- tween the teeth, of holding putty, which is a lead product, in the palm of the hand, of not always having the opportunity of washing before eating, or of misusing the opportunity when it exists, predisposes them to plumbism. Inhalation of dust given off during the sand-papering of dried painted surfaces, also of the fumes given off during the burning off of old paint, are sources of lead poisoning. The clothes worn by the men become stained with paint. I have treated women who had washed the overalls of their menfolk, who were house painters, for double wrist-drop, and in the water removed from the wash-tubs I found large quantities of lead. In these cases the poison either was absorbed through the skin by friction during the act of washing, was inhaled as dust on shaking the clothes before washing them, or was inhaled as fine particles in the steam. People have suffered severely in health through having slept in newly-painted rooms. There is an account in the textbooks of an outbreak of lead colic among the crew of a freshly-painted French man-of-war. All persons are not equally susceptible to the harmful emanations from painted surfaces. Some people cannot be exposed to the 4o LEAD POISONING odour of paint without experiencing headache followed by retching and vomiting. It would be interesting to know precisely what are the harmful emanations given off from a painted surface. Professor C. Baly, of Liver- pool, found, on spectroscopic examination of the air drawn from over newly - painted surfaces, evidence of the presence of lead ; but a further series of experiments led him to alter this state- ment, and to attribute the influence for harm to " unsaturated aldehydes," or the volatile emana- tions given off by certain lead paints. Taking the two substances, white lead and sulphate of lead, and mixing them separately with linseed-oil in exactly the same manner, he noticed that there was a difference in the odour evolved. When the emanations from the white lead surface were examined by the spectroscope, they were found to contain a substance which absorbed ultra- violet radiations given off at a temperature of 6o° to 65 C. Sulphate of lead mixed with linseed- oil did not give exactly the same results as the carbonate, while dry white lead gave a negative result. It is maintained that if, in the emanations there is present a sufficiency of " unsaturated aldehyde," not only is the odour nauseating, but it causes a sense of tiredness attended by headache and followed by diarrhoea, symptoms suggestive INDUSTRIAL LEAD POISONING 41 of some form of intoxication. Baly did not find evidence of lead in the emanations in the second series of experiments, but of "unsaturated alde- hydes," or substances given off more readily by the hydroxide of lead than by the carbonate, also by other oxides of lead and binoxide of manganese. At ordinary temperatures the volatile substance is given off in the following proportions : Zinc white and basic sulphate of lead ... 1 White lead 15 Lead hydroxide ... ... ... ... ... 25 The symptoms alluded to as occurring in persons who inhale the emanations from freshly- painted surfaces are therefore by Baly believed to be caused by aldehyde compounds, and not by lead. He is of the opinion that the cause for harm would greatly disappear if zinc white or basic sulphate of lead was used instead of white lead or minium, but in all cases it is necessary to reduce to the smallest quantity possible the amount of " dryer " employed, for the addition of turpentine to the paint increases the amount of aldehyde. Baly thinks that the rapidity with which the symptoms develop is rather, but not absolutely, against lead poisoning. Professor H. E. Armstrong and Mr. C. A. Klein* take the view that the production of * Society of Chemical Industry, " The Behaviour of Paint under the Conditions of Practice," February 3, 1913. 42 LEAD POISONING volatile products is not peculiar to white lead, but is common to all drying agents. According to them, no lead is found in the vapour given off by paints during drying. The vapours consist of " volatile thinners " and oxidation products of the oil which are common to all paints. The products of oil-drying are absolutely harmless, but the vapours arising from the turpentine are responsible, they believe, for the toxic effects observed in persons who have slept in recently- painted rooms. The effects would thus be in no way due to lead, since they might be produced by all paints which contain turpentine. As to what the emanations from freshly-painted surfaces really are, it is apparent that the last word has not been said. Chemical experiment and medical experience can alone solve the problem. Air withdrawn from a bell-jar in which metal boxes recently painted with white lead had been placed, when passed through a 10 per cent, solution of sulphuric acid, was found to contain lead. There may be other harmful substances present in paint than lead. Messrs. Heim and Hebert exposed moulds, especially Penicilium glaacutn, to air in closed bell-jars under the following conditions : (a) Air alone ; (6) air which might have been infected with lead ; and (c) air in contact with fresh paint. In (a) the moulds developed by the third day ; INDUSTRIAL LEAD POISONING 43 in (b) shortly after the third day ; while in (c) not only was there considerable delay in development, but the colonies which developed were few. Another mould, Aspergillus niger, had its growth similarly arrested. These ex- periments do not prove that lead was the harmful agent. Trillat did not find that white lead or oil, singly or combined, checked vegetable growth, but that freshly-mixed paint containing turpentine in addition had the power of doing so. A guinea-pig exposed in a bell-jar to air drawn over a newly-painted surface died within eighteen hours from acute congestion of the lungs, but the death was probably the result of breathing terebinthinated vapour; for in one of my own experiments a mouse which had only been once for two hours in a large bell-jar, through which turpentine vapour was passed, died three days afterwards from acute pulmonary congestion and minute haemorrhages. To some persons turpen- tine is a rank poison ; it causes headache and vomiting. And yet turpentine alone can hardly be the cause of all the symptoms observed in persons who have been sleeping or living in newly- painted rooms, for Trillat found that, if the paint was made with zinc white instead of lead carbon- ate, even although it contained the same amount of turpentine, no symptoms developed. This would suggest that there is something of a harmful 44 LEAD POISONING nature developed when white lead, linseed-oil, and turpentine, are mixed together. Trillat's obser- vations await confirmation. I have had to treat men who, after mixing white lead with certain oils, suffered severely from headache, retching, and vomiting, and not when other oils were used, but the symptoms developed were not those of lead poisoning. They suggested poisoning of another type than that caused by lead. I have kept animals in hutches exposed to vapours given off from newly-painted surfaces for weeks without symptoms developing ; and yet I recently had to treat a London medical practitioner who had lived at home during the few weeks the interior of his house was being painted, and who had not only suffered from severe colic, but developed albuminuria and profound anaemia. As lead was found in his urine, the diagnosis was plumbism, but a doubtful point subsequently arose as to the source of the plumbism, for when ill the patient had gone to a small Yorkshire town the drinking water of which had been contaminated by lead. Henry A. Gardner,* assistant director, the Insti- tute of Industrial Research, Washington, U.S.A., * " The Toxic and Antiseptic Properties of Paints," Educational Bureau, Paint Manufacturers' Association of the United States, Bulletin 41, 19 14. INDUSTRIAL LEAD POISONING 45 finds, after an extended research into the character of the volatile vapours given off by various paint materials, that, as paint vapours do not contain metallic ingredients, they cannot be held account- able for lead poisoning. The most important outcome of his tests is the discovery of carbon monoxide in the vapours of drying paints. To inhalation of this gas Gardner attributes the anaemia from which painters suffer. In the drying of thin layers of linseed-oil there is an absorption of oxygen, accompanied by the evolution of carbon dioxide and carbon monoxide. A small quantity of formic acid is also given off. The amount and character of the volatile substances are affected by the type of pigment used. Aldehydic substances are also given off from drying oil paints, which have a bactericidal effect upon pathogenic bacteria, a point to which I will allude farther on. Gardner's tests were carried out in a large linoleum works where tons of linseed-oil were being used. His views are extremely interesting, and give material for reflection, for as medical men we wish to know more than we do of the harmful effects upon workmen of the repeated inhalation of minute quantities of carbon monoxide. " Symptoms such as sallow complexion, general lassitude, emaciation, and inco-ordination, caused by the inhalation of carbon monoxide over long periods 46 LEAD POISONING of time, might be mistaken for symptoms of lead poisoning." It is to be remembered that it is, with painters, not so much the putting on of fresh paint which is the cause of symptoms, as the chipping off of old and dried paints. Gardner's researches have struck a new line, and on that account are interesting and valuable. They seemed to me to be so valuable that I exposed a guinea-pig to the vapour given off by a leadless paint, and another guinea-pig to vapour from a lead paint. Although at the end of five hours the first animal seemed uncomfortable, shortly after it was removed from the bell-jar, and placed on the laboratory floor, it was soon all right again. The experiment was repeated for three days — six hours' exposure each day — without any bad effects. The other animal, which was exposed to the vapours from lead paint, at the end of three hours seemed uncomfortable. Its move- ments were inco-ordinated, and there was marked polyuria. The animal staggered if it attempted to walk, or it kept rolling over and over, trying to regain its feet. Next day the animal was found dead. The signs enumerated were not those of lead poisoning. On examining the blood removed from the heart, carbon monoxide was found by one of my colleagues and myself. There appeared recently in the daily papers INDUSTRIAL LEAD POISONING 47 the details of an inquiry into the death of an infant, two years old, in the workhouse at Bath. This occurred during the painting of a corridor, which continued for five days. The finding was " Death from lead poisoning." Two other children and one woman had also been ill. The paint was said to contain 10 pounds of white lead in 12 pounds' weight of paint. The corridors had frequently been painted before without any mishap. There is no evidence that in this case death was due to plumbism. Much more likely it was the result of inhalation of vapours given off during drying of the oil. Linseed-oil in drying, as we have already seen, increases in weight, owing to absorption of oxy- gen. Various decomposition products are formed, amongst which may be mentioned formic acid, acetic acid, carbon dioxide, carbon monoxide, and aldehydes, but as to which of these is the agent for harm, it is impossible to say. All we can say is that carbon monoxide is possible. Some of the dryers which are added to paints are more harmful than others. In my laboratory a rat exposed for a few hours daily to the vapour given off from a spirit containing benzole ex- perienced no inconvenience, but exposure of the animal under similar conditions to a spirit con- taining turpentine, used by a local firm of paint 43 LEAD POISONING manufacturers for mixing paints killed it, death being due to pulmonary congestion. Turpentine is a reducing agent : it absorbs oxygen so as to form with it a resinous body ; this combination is hastened in the presence of lead oxide. According to Von Jaksch,* the symptoms complained of by men after working in an atmosphere impregnated with turpentine are headache, dizziness, dry throat, cough, bronchitis, strangury, and the presence of blood in the urine. As the kidneys are the main organs by which turpentine is eliminated from the body, pain in the back is frequently complained of. The men become nervous and excited, their gait is staggering. Drs. E. R. Hayhurst and T. E. Flynn, along with Mr. R. H. Nicolls,t made a detailed examination of sixty-two painters and varnishers in Chicago. All but fifteen of the men had worked more than ten years. Nearly all of them stated that after working with turpentine they became drowsy, suffered from headache, had nausea, vomiting, loss of appetite, and dizziness. Minor forms of bladder trouble, of inflammation of the eyes and of the skin, were common. In fourteen of the men — i.e., 31 "8 per cent. — there were evidences of * " Die Vergiftungen," p. 405. Wien and Leipzig, 1910. t Report of Commission on Occupational Diseases, State of Illinois, 1911. INDUSTRIAL LEAD POISONING 49 organic disease of the kidneys, while an equal number of them complained of their throat and lungs. Dr. Alice Hamilton is of the opinion that, as ship-painters have to carry on their work in con- fined spaces, symptoms of turpentine poisoning occur in them more frequently than in house- painters. Setting aside the classic form of wrist- drop and colic, there is little doubt that the acute illness house-painters suffer from is not always plumbism, but is the result of the inhalation of vapours given off by the materials with which the pigments are mixed. The exact nature of these vapours is, as already stated, not known. During an examination of 100 painters in Chicago, February to April, 1913, in response to questions addressed to them by Dr. Emery R. Hayhurst, as to what the men themselves considered the most unhealthy part of their occupation, practically all of them stated that they were rendered temporarily sick by the vapours evolved from turpentine and benzine. Much of this type of toxaemia from which the men suffer is the result of the increasing use of quickly-drying paints. In addition to turpentine, petroleum spirit and benzine are being used. In my own experiments I have not found benzine spirit so quickly harmful to animals as turpentine. This may have been due to the 4 50 LEAD POISONING small percentage of benzine present. Benzine causes sleepiness. Men working with paint con- taining it complain of headache, noises in the ears, and dizziness ; they stagger as if intoxicated, they have lapses of memory and hallucinations of sight and hearing. A painter thus poisoned by benzine vapour feels like a man who has been intoxicated overnight by alcohol. Where men are working in the close spaces of ships, and no air is circulating, the symptoms of poisoning may become alarming. Currents of air are intentionally excluded because drying takes place more quickly. The men under these circumstances may be found by their mates in a state of collapse or of unconsciousness ; they maybe breathing heavily, and their pulse rapid. They should be carried into the open air at once. Prolonged exposure to vapour containing minute quantities of these varieties of petroleum spirit is followed by impaired digestion, tremor, nervous- ness, muscular weakness, chronic bronchitis, and defective memory, symptoms indicating that the poisonous vapours have a special affinity for nerve tissue. Von Jaksch found certain forms of chronic skin troubles in painters using pigment mixed with benzine. Clearly, therefore, turpentine, petroleum spirit, and benzine, when used as dryers of paints, give rise, each of them, to a series of symptoms sui INDUSTRIAL LEAD POISONING 51 generis. Benzole, which is occasionally used for removing paint and varnish, is a volatile liquid con- taining several hydrocarbons. Although it contains only 40 per cent, of benzine, it is more volatile and more dangerous than benzine (Von Jaksch). In- halation of benzole or benzine vapour may, under certain circumstances, be rapidly fatal. Beinhaaer found that it caused disintegration of the red blood- corpuscles, haemorrhages upon mucous membranes and into various organs which presented signs of parenchymatous degeneration.* In acute benzole poisoning the symptoms are headache, dizziness, a flushed face followed by cyanosis, nervous excite- ment not unlike that caused by alcohol, also hallu- cinations, delirium, and coma. In chronic cases of benzole or benzine poisoning the gums and lips become inflamed and ulcerated ; the condition of the gums recalls that observed in scurvy. The peculiar train of symptoms observed in persons who have been exposed to emanations from newly-painted surfaces, and which are not always those of lead poisoning, must be my excuse for this rather long digression. Reverting to the subject of plumbism in house-painters, the men who suffer most are those who mix the colours, * " Hygiene of the Painters' Trade," Bulletin of the U.S. Bureau of Labour Statistics, Dr. Alice Hamilton, May 13, i9 J 3- 52 LEAD POISONING also those who use them. House-painters prob- ably become ill less frequently through inhaling vapour than from breathing the dust given off during sand-papering of flat surfaces or during the smoothing of these with pumice-stone. In 1907, during a Government inquiry in Austria, 208 painters were examined in a particular district. Fifty of the men gave a history of lead poison- ing; of these, 23 stated that their first attack of plumbism developed after dry sand-papering lead- painted surfaces. Of 100 painters examined by E. R. Hayhurst in Chicago, 99 complained of the lead paint dust given off during sand-papering, and of these men 27 had had genuine attacks of plumbism. The use of water with pumice-stone allays dust. Moistening the sand-paper with oil in no way interferes with the results from a decorative, and is of assistance from a health, point of view. Old painted surfaces have to be prepared for fresh coatings by being burnt off, by chipping and sand-papering. The flame from a gasoline lamp causes the paint to shrivel and to curl up. Men when doing this particular kind of work have complained of feeling ill, but it is a question as to how far the symptoms are those of plumbism. The odours evolved during the burning off of old paint are anything but agreeable. They cause INDUSTRIAL LEAD POISONING $3 headache and sickness. Does the stithe which is given off contain lead ? Professor Julius Stieg- litz,* of the Chemical Department of the Univer- sity of Chicago, hardly thinks it is possible for lead to be given off by the painted surface during the short time the gasoline flame is in contact with it. The temperature is not high enough. If, on the other hand, the flame is allowed to play long enough upon the painted surface, and smoke should rise, the smoke is capable of carrying away mechanically lead particles with it. Such symp- toms as headache, retching, and a feeling of malaise, therefore, would probably be under ordinary conditions the result of the overheated oil of the old paint rather than the result of lead intoxication ; but whether it be this or not, it is desirable that after every hour or two of work done the burnt-off paint which has fallen to the ground should be swept, gathered, and removed, before it has had time to become dried and pulverized. House-painters employed on internal decorative work are, when compared with outside men, more exposed to the vapours from recently-painted surfaces, also to the dust from dried paint. More sand - papering is done inside than outside our houses. There is a growing demand in Great * Bulletin of the U.S. Bureau of Labour Statistics, 1913.. P- 35- 54 LEAD POISONING Britain for zinc white and lithopone for internal decoration. In the United States the painting of signboards is a special trade. It is highly skilled labour. Young men are apprenticed to the trade for four years. During the last fifteen years a change has been creeping over this trade. " Signboards " are now prepared in the painters' shops. Lead is one of the commonest pigments used both on iron and wood. Although the occu- pation is not so healthy as it was when all the work was carried on out of doors, yet, since sand- papering is not required to any extent, the work is much healthier than that of a house-painter. Ship-painting, so far as the decoration of saloons and cabins is concerned, is highly skilled work. As in coach-painting, several coats of paint have to be applied. The paint frequently contains lead and turpentine, and when the surface is dry it has to be sand-papered. Apart from the use of rapidly-drying spirit paints, there is little danger to men when painting the outside of a ship, for the work is carried on in the open air, so that vapours are readily dispersed. It is the inside work which is trying to the men, for when the final coats are reached the paint frequently con- tains lead and zinc white in equal parts, with turpentine only and no linseed-oil. This is the part of the work the men object to ; but, as stated LEAD PAINTS AND LEADLESS PAINTS 55 earlier, the symptoms are probably due more to turpentine than to lead, judging from the strangury, hsematuria, and pain in the back, com- plained of. The remarks apropos of the finer decorative work inside houses and ships apply equally to the painting of railway carriages, coaches, and automobiles. Painters of agricultural implements occasionally suffer from plumbism when the red paint contains lead, but, as much of the work is carried on in the open air, there is less risk to the men than in indoor painting. Lead Paints and Leadless Paints We can hardly avoid considering the question of lead versus leadless paints. Any reliable opinion upon the relative commercial and decorative values of white lead paint and paint made with zinc oxide can only be furnished by technical chemists, colour manufacturers, master-decorators, and practical house and ship painters. Among these experts there is, unfortunately, a great variety of opinion. Their divergent views render it diffi- cult for other people to express an opinion. The question as to whether, from a purely decorative point of view, the use of white lead paints should be entirely disallowed is a matter in regard to which in this country no satisfactory decision has as yet been arrived at. It is therefore one con- 56 LEAD POISONING cerning which, before any legislation is attempted, a body of experts should be invited by the British Government to carry out a series of experiments in different parts of the country, and to report to the Home Office. There is no need for undue haste in the matter. France has passed a law totally prohibiting the use of lead paints after 1915, but doubts have been expressed both in France and in other countries as to the wisdom of the step. I have already alluded to the antiquity of the white lead industry, and to the difficulty of abolishing old trade customs. These remarks apply here equally well. Total prohibition of the use of lead paints was tried in Switzerland in 1904, and abandoned as being impracticable. The White Lead Commission of the Netherlands reported that zinc white paints withstand the action of sulphuretted hydrogen better than white lead paints, but that they do not withstand the action of the sulphurous acid present in the atmosphere so well as paints made with white lead — that is to say, for internal decoration zinc white is as good as, if not better than, white lead, but that for outside work white lead is superior. Since 1909 Belgium has prohibited the sale and use of dry white lead, but she allows the sale of this material mixed and ground in oil. Germany permits the sale of white lead paint already mixed LEAD PAINTS AND LEADLESS PAINTS 57 and ready for use. Austria prohibits the use of white lead for the interior of houses. No uniform international attitude has as yet been assumed in regard to this important question. It is one to which the International Association of Labour Legislation is giving attention. There is nothing to support the statement which is current in some quarters, that British house-painters are prejudiced in favour of lead paints. Knowing the danger incidental to their use, they have nothing to gain by using them to the exclusion of others. Zinc oxide and litho- pone, the latter a compound of zinc sulphide and barium sulphate, have been recommended as substitutes for lead carbonate. As pigments these undoubtedly possess valuable properties. The high degree of opacity owned by white lead, the readiness with which it obliterates uneven sur- faces and produces a dense white effect with very little material, render it difficult for it to be re- placed by substitutes. For external decoration lead carbonate stands exposure to the weather well. There is less division of opinion in regard to zinc white giving equally as good results as lead carbonate in internal work. Noel Heaton maintains that zinc white has neither the fineness nor the density of white lead, nor is S3 LEAD POISONING there that peculiar influence exerted upon oil by it whereby the absorption of oxygen is increased and the paint caused to dry quickly. To the circumstance of white lead being a basic com- pound containing two molecules of normal car- bonate of lead and one of hydroxide is attributed the power it possesses of combining with oil to form a paint capable of producing a smooth working quality in the brush which all painters like. It is, however, one of the advantages claimed for zinc white that the paint made from it is not so readily discoloured by sulphuretted hydrogen gas. Instead of becoming changed, like lead paint, by this gas into a black sulphide, it becomes the white sulphide of zinc which, as already stated, is one of the constituents of litho- pone. Judging from the Report of the Nether- lands Government and our own experience at home, it is not the sulphuretted hydrogen in the air of our large towns which is the discolouring agent, so much as the sulphurous and sulphuric acids which are being given off in increasing quantities into the atmosphere owing to the larger consumption of coal-gas for illuminating and cooking purposes. Coal-gas attacks zinc white more readily than it does white lead. It is said — and this is a point to which we shall return — that greater skill and care are required with zinc LEAD PAINTS AND LEA DL ESS PAINTS 59 than lead paints, and that they must be applied in thin layers. Zinc white requires from 16 to 20 per cent, of oil to grind it into a stiff paste with a minimum of turpentine. Oxide of zinc is not a dryer like white lead. Dr. A. P. Laurie,* of the Heriot-Watt College, Edinburgh, raises on this point an important question as to what is meant by " drying." As applied to water the term means loss by evapora- tion, but as regards spirit varnish it means evaporation of spirit and an undissolved resin left behind. In the drying of linseed-oil the oil absorbs oxygen, and the fatty acid of the oil becomes converted into oxy-linoleic acid, which is the most stable form linseed-oil can assume. Raw linseed-oil when exposed to the air takes days to dry, but the drying process can be hastened by treating the oil with white lead. The white lead is of itself a drier, so that of two surfaces painted respectively with white lead and zinc, each con- taining its proper proportion of oil and exposed to the air, the surface, painted with white lead dries the more quickly. Laurie maintains, not- withstanding the fact of the painted surface being thinner, that weight for weight zinc white has as good covering power as the carbonate of lead. Cruickshank Smith gives as the spreading capacity * " The Paint Question," J. Cruickshank Smith, 1909. 60 LEAD POISONING in square yards per hundredweight the following : Oxide of zinc, 870; red lead, 424; white lead, 614 to 806; the prices per hundredweight in shillings being 46, 28, and 28 to 32, respectively ; and the estimated numbers of tons required for painting the surfaces in twenty years being 4, 4, and 5 to 6. When the proposed interdiction of lead paints was being discussed in the French Legislative Assembly, opinions of experts upon the relative merits of zinc and lead were quoted. It was stated that the naval engineers of Rouen, after three years' experience of both pigments, preferred zinc to lead, since the white colour of the paint did not blacken under the influence of sulphur. Equally favourable to zinc were the opinions of the naval engineers of Bordeaux. At the request of the French Government, experiments dealing with the covering and enduring power of the two paints were carried out at the Annexe of the Pas- teur Institute, Paris. A Commission nominated by the Society of Public Medicine and of Hygiene undertook a series of experiments with the object of comparing surfaces painted with zinc and lead bases. The Commission was composed of Dr. L. Martin, M. Livache (a chemist), and M. Vaillant (an architect), along with Messrs. Mauger, Wernet, and Rigolet, representing the building trades of Paris. LEAD PAINTS AND LEAD LESS PAINTS 61 In 1902, under the supervision of this Commis- sion, a working painter applied paints containing zinc and lead bases to similar surfaces, and a few months afterwards the following report was published : (1) The colour and the polish of zinc white are equal to those of white lead ; (2) the covering power and drying are practically the same. In order to test the enduring properties of the paints, it was necessary to allow atmospheric agents to exercise their destructive influence over a longer period. It was therefore arranged to examine the painted surfaces a year afterwards. In October, 1903, the Commission reported that there was no appreciable difference between the paintings so far as concerned their reaction to atmospheric influences, and that both for internal and external painting the results were absolutely comparable. Since 1903 three additional examinations of the painted surfaces have been made — viz., on Sep- tember 30, 1904, October 11, 1905, and October 31, 1906, all the reports of which confirm the previous statement. Zinc sulphide and lithopone are also spoken of as substitutes for lead carbonate. Lithopone is obtained by the double decomposition of barium sulphide and zinc sulphate. The precipitate con- sists of barium sulphate and zinc sulphide. The 62 LEAD POISONING precipitate, which is beautifully white, is washed, dried, ground, and mixed with oil to form a paste which has all the appearance of white lead paint. Lithopone was placed upon the market as a substitute for white lead. Petit says that it has less covering power than lead, owing to the large quantity of barium sulphate it contains — viz., 67 per cent. Applied to iron surfaces, the zinc sulphide of the lithopone is said to part with its sulphur to the metal and to form iron sulphide, also that, while the zinc sulphide mixes readily enough with oil, yet, owing to a process of vulcanization, it is liable to undergo decomposition. Dr. Ignace Kaup informs us that the master- decorators of Vienna have recently been substi- tuting zinc white, also lithopone, for lead car- bonate in private dwellings, but that for public buildings white lead and varnish are still used. Only recently several of the workmen when paint- ing a large Government building in Vienna became ill. The illness, rightly or wrongly, was attributed to plumbism. Master-painters both at home and abroad are divided in their opinions as to the value of lithopone. Some hold that it does not retain its colour well, and that its covering power is not so good as that of white lead. It is said to be all right on plaster, but not so satisfac- LEAD PAINTS AND LEADLESS PAINTS 63 tory on wood, especially if the wood is new. Lithopone possesses the advantage of being about 4s. per hundredweight cheaper than white lead. In some of the Swiss railway carriage works only zinc white and lithopone are used. It is hardly necessary to discuss at length the question of the use of sulphate of lead as a sub- stitute for lead carbonate. From a paint point of view both have about equal values. Although it has hitherto been generally believed that lead sulphate is less soluble in the juices of the alimentary canal than the carbonate, and there- fore less likely to be absorbed, the data obtained from recent experiments are conflicting. Lead sulphate can therefore not be regarded as a sub- stitute for the carbonate, since it would only be replacing one lead paint by another. As I wished to know the opinion of British master painters and decorators upon the relative merits of zinc white and lead carbonate, I applied to the Employers' Association, and in April, 1913, received the following information : Of 45 master- painters who replied, 43 expressed themselves in favour of white lead for the exterior of buildings ; for inside work 17 preferred zinc white to lead. For internal decoration there is no reason why zinc white should not be more frequently used than it is, but for the external painting of houses 64 LEAD POISONING the majority of master-painters seem to be in favour of lead paint. There is a hygienic aspect of house-painting to which attention ought to be drawn. I refer to the antiseptic properties of paints. Two years ago Professor H. J. Hutchens and I carried out a series of experiments with various paints to test their germicidal powers. The micro-organism used was the Bacillus coll. The experiments ex- tended over a period of three and a half months. We found that vapour from drying paint at y]° C. possessed definite bactericidal properties ; it retarded and prevented the growth of micro-organ- isms. Paints which had been dried for forty-eight hours exercised a similar influence, but after five days they no longer possessed such power. Simi- lar results were obtained by H. A. Gardner. Like myself, he attaches considerable importance to the circumstance, for by painting chambers with an oil pigment we have an efficient means of destroy- ing bacteria in rooms which have been occupied by persons who were the subjects of contagious disease. During painting the rooms should be well ventilated, but when finished they should be closed for a day or two, to allow of the vapours exercising their antiseptic influence upon the walls and contents. LEAD POISONING AMONG PAINTERS 65 Lead Poisoning among Painters In Great Britain it is difficult to estimate the amount of lead poisoning in painters, owing to notification of plumbism being voluntary, also to the fact that house and ship painting do not come within the Factory Act. The figures received under voluntary notification show lead poisoning to be even more prevalent among painters than was expected, also that it is increasing. These remarks apply equally to painters in Germany, France, Austria, and the United States. Painters have a higher mortality than the general popula- tion. In Berlin in 1903 the general death rate per 1,000 inhabitants was ir6i, but for painters it was 14. Fleck* gives as the mortality rates of German painters 1*3 per cent, from lead poisoning ; nervous diseases, 7*8 per cent. ; heart, kidney and liver disease, 20*8 per cent. Figures taken from the Prudential Insurance Company of America show the deaths from the same causes to be 1 '5, io # 7, and 35*0, per cent, respectively. Among German painters diseases of the respiratory organs caused 41*6 per cent, of deaths, and in the United States 263 per cent. Taking all the paint industries — and in these are * Weyl, " Handbuch- der Arbeiter Krankheiten," p. 513, Jena, 1908. 5 66 LEAD POISONING included house, coach, ship, and automobile paint- ing — the cases of plumbism reported to the Home Office* were: 154 cases with 4 deaths in 1908; 197 cases with 9 deaths in 1909 ; 159 cases with 12 deaths in 1910 ; 316 cases with 12 deaths in 191 1 ; and 204 cases with 12 deaths in 1912. Coach- painting furnishes the largest number of cases of plumbism. Between 1900 and 1909 there were reported to the Home Office 1,973 cases of lead poisoning with 380 deaths of house-painters. In the tables furnished by Dr. Legge one important fact stands out, and that is the large amount of paralysis among the men. Tancquerel des Planches found the percentage of paralysis in lead-poisoned French house-painters to be 8, and Teleky 14*5 in Aus- trian painters. During the period above men- tioned the British tables show the percentage to be 227. Teleky distinguishes between painters employed on the outside of buildings and those employed in decorating rooms. Of 100 painters of the interior of houses, 31*2 of the men were off ill annually — 0*7 from lead poisoning, and 3*4 from tuberculosis ; while of 100 painters employed on outside work, 47*4 of the men were off ill annually — yy from plumbism, and 4*3 from tuberculosis. If * Annual Report of the Chief Inspector of Factories, 1912. LEAD POISONING AMONG PAINTERS 67 the figures for Berlin are taken, there were between 1900 and 1909 on an average 376 men off ill per year ; if 100 members only are considered, 46^9 men were off ill per year — 8'ii of these from plumbism. The smaller number of cases of lead poisoning among the Vienna painters who were employed on inside work is to be explained by the circumstance that other metals than lead were being used in the paint : for if similar lead paint had been used internally as externally, the cases would have been more numerous. That is the conclusion we come to from the following : In Vienna, for internal painting, there were used annually 1,600 hundred- weights of white lead. This amount of material caused 163 cases of lead poisoning. For outside painting 4,750 hundredweights were used, and this gave rise to 50 cases of lead poisoning. In the United States it was found that 1 in every 6 painters, and in Austria 1 in 4, gave a history of having had plumbism in one or other of its minor forms ; but, bearing in mind what has been stated in the preceding pages regarding the increase in the number of drying agents now used, it is more than probable that part of the illness the men suffered from was of the nature of an intoxi- cation from turpentine and its congeners, or from carbon monoxide, as suggested by Gardner, rather than lead ; for if there is one circumstance peculiar 68 LEAD POISONING to the plumbism of painters, it is that, owing to the gradual absorption of lead, the malady develops slowly and is usually associated with some such lesion of the nervous system as paraly- sis or with implication of the kidneys. It is seldom that a painter dies from uncomplicated and acute lead poisoning. Among the common complaints of painters may be mentioned constipation and headache. Some writers state that 50 per cent, of the men suffer thus. This is, I think, pitching the number too high. House, ship, and coach painters are credited with a large number of ailments, of which the following may be mentioned : Colic, ringing noises in the ears, vertigo, rheu- matic pains, nocturnal micturition, disagreeable taste in the mouth, disordered sensations, imper- fect vision, epistaxis, loss of appetite, sleepless- ness, diarrhoea, tremors, gout, and depression of spirits. Manufacture of China and Earthenware This important industry, although met with in various parts of England and Scotland, is mostly located in the north of Staffordshire, where, when first commenced, it was close to the clay and coal fields, and where at the present time it gives employment directly and indirectly to several CHINA AND EARTHENWARE 69 thousands of people. The district is known as the Potteries. The manufacture of pottery is a frequent cause of plumbism, owing mainly to the presence of lead in the glaze — that is, the liquid into which the ware is dipped. When, in 1S9S, Sir Edward Thorpe and I were sent by the Home Secretary to the Potteries to inquire into the prevalence of lead poisoning among the workpeople, we found several of the small master-potters using glazes which con- tained 20 to 30 per cent, or more of raw lead. By reducing the amount of lead in this glaze, and the Home Office introducing other reforms, lead poisoning in the manufacture of pottery has during the last decade considerably declined. Exposure of workpeople to small quantities of lead dust over an extended period is sufficient to cause symptoms of plumbism. Although in pottery workers the percentage of paralysis is fairly high, it is not always proportional to the length of employment in the factory. In only a small percentage of persons working in pottery is lead poisoning fatal — only o'l in persons employed in lead processes, or, in other words, 1 in 1,000. The following are the numbers of cases of lead poison- ing and the deaths notified to the Home Office as occurring in the china and earthware trades of the United Kingdom : 7o LEAD POISONING 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 80 14 Cases Deaths 200 8 106 5 87 4 97 3 106 4 84 3 107 4 103 9 117 12 58 5 77 11 92 6 It is noteworthy that, while there is a marked declension in the number of cases of lead poisoning notified as occurring in lead workers, the sliding scale is not uniform, but interrupted. The deaths from plumbism have not fallen, but risen, as the cases notified have become fewer. To explain the rising mortality rate, it is possible, as some writers maintain, that medical men are straining to bring within the category of death from lead poisoning diseases due to other causes. The modern medical practitioner is more familiar with chronic plumbism that was his predecessor, so there may be a disposition on the part of some of them to attribute to lead deaths due to other causes. On the other hand, opposed to this is the important fact that deaths are still taking place from lead without the true cause being recognized. Fourteen years ago Sir Edward Thorpe and I, in our report to the Home Secretary, recommended that there should be a considerable reduction in the amount of lead in the glaze ; that the lead should be "fritted," so as to render it more insoluble ; that wherever possible leadless should CHINA AND EARTHENWARE y\ be substituted for leaded glazes ; and that female labour should be abolished in certain depart- ments wherein lead or its compounds are used. " Fritted " lead, which is made by firing white lead with silica or boric acid, is a brittle, glass- like material. Thus " fritted," or " vitrified," the lead becomes less soluble in acids, and therefore less dangerous to the workers, than the carbonate of lead. Where lead carbonate — i.e., raw lead — is used in a factory, the men who mix the glaze, the dippers who plunge the ware into it, and the dippers' assistants who remove and carry away the ware, incur the risk of becoming poisoned by lead. In dipping the ware into the glaze the men work with their sleeves rolled up ; they immerse the pieces quickly, swirl them round when lifting them out of the tub, and as a consequence there is a good deal of splashing. The material splashed upon the floor and bench becomes dried, and is subsequently raised into the air of the dipping- room in the form of very fine dust. It is therefore desirable that the lead in the glaze should be changed into such a chemical and physical state as to be rendered comparatively insoluble in the stomach if swallowed, or in the respiratory passages if inhaled. When fritted, lead fulfils this requirement, for when melted at a high tem- perature with silica the metal becomes imprisoned 72 LEAD POISONING in such a manner as to be attacked less readily by the acid of the gastric juice, and therefore less likely to be absorbed into the system. If the frit- ting has been well done, only a minute quantity of the lead remains in a soluble form. Glazes made with fritted lead are spoken of as glazes of a low solubility. As a result of experiments carried out by Thorpe, it was evident that there ought to be in pottery manufacture a standard of insolubility for fritted lead glazes. The standard of insolubility recommended was that glazes should not yield more than 2 per cent, of lead, calculated as lead monoxide, when acted upon by a weak solution of hydrochloric acid under certain specified condi- tions. This 2 per cent, standard of insolubility was regarded by the manufacturers as too high. A compromise between the manufacturers and the Home Office was effected, and a standard of 5 per cent, insolubility agreed to. A test which gives approximately the amount of lead in pottery glaze has been suggested by Mr. H. R. Rogers,* H.M. Inspector of Factories. This consists in treating glaze with hydrofluoric acid for forty seconds, and of absorbing the liquid with filter-paper. The lead is precipitated on the paper as sulphate ; thereafter any of the sulphate * " Report of a Series of Experiments for Determining the Amount of Lead in the Glaze of Finished Ware." CHINA AND EARTHENWARE 73 which is soluble in water is washed away. The lead on the paper is precipitated as sulphide ; the tints produced vary according to the proportion of lead in the glaze. In Austria a rough-and-ready test is made upon pottery by the factory inspectors. In some parts of the country cooking utensils are dipped in glazes rich in raw lead. These with other kinds of domestic ware are sold in the market-place. The factory inspector takes certain dishes, and pours upon them a small quantity of diluted acetic acid. After a few minutes the fluid is poured off and tested for lead with a sulphide. If the brown tint obtained is of such a depth as to indicate the presence of lead in considerable quantity the ware is not allowed to be sold. Since the publication of the Thorpe-Oliver report, sub- sequent Home Office Committees have reported upon the prevalence of lead poisoning among potters, and introduced improvements, with the result that, although the conditions are not as satisfactory as they ought to be, they yet show con- siderable improvement to those which existed a few years ago. In the following table is given the number of cases of lead poisoning among dippers and ware cleaners in the United Kingdom, taken from the Annual Report of the Chief Inspector of Factories for 1912 :• 74 LEAD POISONING Cases of Lead Poisoning among Pottery Workers in Great Britain. Processes. T3 >. O "5. . 5 S- -0 O N a « a; o\ <£ Cases reported. Attack Rate per 1,000 employed. Average. Average. ion. 1907- 1910. 1903- 1906. 1899- 1902. 1912. 1911. 1907- 1910. 1903- 1906. 1899- 1902. In dipping- house : Dippers p ' Dippers' fM. Assistants \ F. 786 150 4 6 3 397 18 3 6 16 6 2 14 17 6 3 13 18 4 3 18 26 7 7 17 23 7 15 20 40 4 35 22 40 7 33 23 30 7 46 34 68 15 45 Ware fM. Cleaners \F. 115 461 1 15 15 1 15 2 18 3 3° 9 33 33 9 33 20 41 30 65 Total {£■ 1364 22 18 21 23 36 16 13 15 17 27 1008 21 35 34 40 54 21 35 34 42 5« Dipping is anything but cleanly work. The hands and forearms of the dipper are repeatedly being dipped into glaze containing lead. One in forty-three of these men suffer from plumbism, probably more from inhaling the dried lead glaze than from absorption through the skin. Dippers' assistants are usually young persons. At present young persons of fifteen years of age may be employed ; but where lead glazes are used no great hardship would be inflicted if the age was raised to seventeen. Female dippers' assistants are more liable to plumbism than male assistants, as seen from the table. CHINA AND EARTHENWARE 75 In some factories, particularly in France, gloves are worn by the men and women who dip the ware, or the pieces are lifted by means of tongs, and thereby immersed in the glaze. The less there is of splashing and the cleaner a dipping-house is kept, so will dippers and their assistants be freer from plumbism, for it is the dried glaze on the floor, the tubs, benches, boots and clothes of the workpeople, which constitutes the danger. Much good would be effected, too, by washing or swilling of the floor every day or two. In my earlier visits to the Potteries, I was struck by the large amount of sickness among the majolica paintresses. Many of them looked ill. They were pale and the subjects of saturnine cachexia. At the periods I refer to, glazes con- taining large quantities of raw lead were being used. Majolica painting is not skilled work. The glaze is roughly applied by hand ; many of the women are careless, and there is much splashing of the glaze. Among majolica painters the cases of lead poisoning reported for 1912 were 1 male and 3 females; in 1911 no males, 4 females. In enamel colouring and glaze blowing there were 2 cases of lead poisoning in males in 1912, and 11 in females ; in 191 1 no males, 2 females. Persons employed in making litho transfers for the transfer of colours to china and earthenware are exposed to the risks of plumbism. 76 LEAD POISONING Manufacture of Pottery as a Home Industry In Great Britain we see nothing of the injury to health brought about by the manufacture of pottery in the home such as is seen, for example, in Hungary. In order to study the question, I have visited Hungary on four occasions. The pursuits of the people are mostly agricultural. Here and there, scattered throughout the country, are villages occupied by working potters who carry on their trade in the home. The rooms in which the family live and sleep are those in which the clay is turned and the ware dipped ; and as there are large quantities of raw lead in the glaze, not only do many of the potters themselves suffer from lead poisoning, but also the women and children. On the occasion of my visit to Hodmezovasarhely, eighty master-potters met me to discuss questions as to whether something could not be done to diminish or abolish the ravages of plumbism. Nearly one-half of the men who met me were paralyzed in the legs or face. Most of them were under forty years of age. Some of them had been paralyzed five or six years. Several of the wives and children were also paralyzed. A few of the children were blind as a consequence of saturnine encephalopathy ; others were imbecile and had never walked, although upwards of four years of POTTERY AS A HOME INDUSTRY 77 age. In another village — Csakvar — I found the potters were using a glaze containing 60 per cent, of lead carbonate. The dipping of the ware was carried on in the same room as that in which the family lived and slept. On analyzing the dust taken from the shelves of the rooms. Dr. Adalbert Chyzer, who accompanied me, found that it con- tained 0*63 to i'o8 per cent, of lead. He also found in the blouse worn by a little boy, the son of a potter, 0*243 grain of lead, and in his cap 0*0144 grain of lead. In the clothes which en- wrapped an infant lying in its cradle lead was also found. On the gums of some of the children I observed a well-marked blue line. Many of the boys and girls were anaemic. The children of these Hungarian potters are born into and reared in an atmosphere impreg- nated with lead, owing to the glaze on the floor, which has been splashed from the dipping-tub, becoming dried and raised into the air as fine dust. So high is the infant mortality rate that in some of the pottery villages there is hardly a child to be seen. In the homes of the potters domestic animals can hardly live. This is especi- ally true of cats. A few years ago, at the request of the Home Secretary of Hungary, I reported upon the lead poisoning of the potters, and I recommended to the Government, among other things, the advisability of having the dipping and 78 LEAD POISONING drying of the ware carried on away from the homes of the potters, in a communal workshop, also the necessity of using smaller percentages of lead, and where possible the use of fritted instead of raw lead. In August, 1913, I was again in Hungary, and at the request of the Minister of Commerce I visited Csakvar with M. Szanto, of the Museum of Social Service, Budapest, in order to see for myself the manufacture of pottery under the conditions I had recommended. In passing through Csakvar we were joined by Dr. Grasser, with whom five years previously I had discussed the problem of how to prevent lead poisoning of the potter, his wife and children. At the com- munal workshop, where fritted lead glaze is made and sold and dipping of the ware carried on, we met Count Esterhazy, who with his father has played an important part in trying to improve the health conditions under which pottery as a home industry is carried on in Hungary. On visiting the homes of the potters who bought and used the fritted lead, not only were they cleaner and brighter than those who still adhered to the old custom of mixing the glaze in the living-room, and of dipping the ware therein, but the health of the potters had considerably improved. So much was this the case that Dr. Grasser, in his desire to find for me a lead-poisoned potter's child, had sought through all the village without POTTERY AS A HOME INDUSTRY 79 finding one. The following table, kindly supplied to me by Dr. Grasser, shows how severely scourged with lead poisoning Csakvar has been since igoo, and the satisfactory declension since the manu- facture of pottery has become less of a home industry. From igoo to igi2 Dr. Grasser treated 434 cases of lead poisoning — 322 men and 102 women. Children are not included. It is not contended that the fewer cases of lead poisoning during the last few years are entirely the result of the recommendations made by the Hungarian medical men and myself in igoS, for the number of families engaged in the manu- facture of pottery has declined, the men have become more temperate as regards the use of alcohol, and many of them have taken up agri- cultural work during certain periods of the year; 80 LEAD POISONING but notwithstanding these, the campaign against plumbism in the Hungarian villages has been followed by encouraging results owing to the im- proved conditions under which the work is now carried on. There have been fewer cases of plum- bism among the married women, whilst amongst the children the malady has, practically speaking, disappeared. The large number of trades in which lead is used, and with injury to the persons occupied in them, makes it impossible for me to deal with each trade separately, and to point out the dangers incidental to it. One or two trades, how- ever, may be mentioned. File-cutting by hand is one. Among file-cutters the sickness and mor- tality rates from plumbism and tuberculosis are high. The transverse and crossed marks which are seen on a file are made by hand by means of a chisel and hammer. The tool about to be dealt with is strapped on to a bed or cushion of metallic lead. After having been cut on one side, the file- cutter reverses the file, at the same time rubbing it with charcoal or chalk. Chisel and hammer are again used, and in doing so much fine dust is raised. In dust removed from the wooden " stock " on which the man or woman sits astride when cutting the file, there was found 14*82 and 22*28 grains of lead per 100. Most of this is lead in metallic form, but, as oxidation is always going POTTERY AS A HOME INDUSTRY 81 on, much of the lead is being constantly trans- formed into a readily soluble oxide. Sheffield is the cradle of the file-cutting industry, and there it is carried on also in the homes. The workshops and dwelling-houses in which the trade is carried on are dirty. File-cutters are not a cleanly body of men. To want of cleanliness, to inhalation of dust, to the habit of not washing before eating, also to working in close and ill-ventilated rooms, must be attributed the high mortality of file- cutters hitherto. File-cutters are no longer igno- rant of the dangers of their occupation, so that while in 1899 and igoo there were 41 and 40 cases of lead poisoning notified, with 1 and 3 deaths respectively, in 1909 there were only 8 cases reported and no deaths. During the ten years 1900 to 1909 inclusive there were reported in the United Kingdom 241 cases of plumbism in file-cutters. Of these 19 terminated fatally. As the men who temper or harden the files by plunging them into a bath of molten lead also incur the risk of be- coming lead-poisoned, hoods ought to be erected above the baths, so that the fumes are carried away from the workers. Instead of plunging the cut files into a bath of molten lead in order to harden them, the same result can be obtained by inserting them between hot iron bars, and in this 6 82 LEAD POISONING way one danger is at least got rid of. Attempts have been made to replace by various substitutes the lead cushion on which the file is cut, but so far no pad has been found which possesses the elasticity and other required properties offered by lead. File-cutters are extremely conservative in their work, and are averse to innovations. So, too, are the men who use the files. Machine-made files are, however, coming more into general use, and they are gradually replacing those made by hand. In one way and another a change is creep- ing over the file-cutting industry of this country. Electrical Accumulator Works The increasing uses to which electricity is being applied, and the growing demand for storage batteries, have given an impetus to electrical accumulator works both at home and abroad. A paste made of red lead and sulphuric acid is rubbed into the perforated metal plates which are used in the construction of electrical batteries. In rubbing in the paste the men wear indiarubber gloves, but as a result of friction, also of wear and tear, the gloves become thin and torn, so that through the slits in the gloves some of the paste gets rubbed into the skin. The men who mix the red lead and acid are exposed to dust. During eleven years ending 1909, there were 317, not including 6 fatal, cases of lead poisoning notified PRINTING AND TYPE FOUNDING 83 as occurring in men employed in electrical accu- mulator works. Most of the plumbism occurs in the men who are employed in the mixing depart- ment, but their fellow-workmen who cast the plates, and those who solder them by means of a blowpipe, also suffer from saturnism by inhaling the fumes. Printing and Type Founding Another occupation in which the dangers of lead poisoning are frequently observed is that of printing, also type founding. In addition to plumbism, printers are peculiarly liable to tuber- culosis, owing to the work being carried on in close, warm, and ill-ventilated rooms, whereby the possibility of infection is favoured. Some writers maintain that lead poisoning of itself predisposes to tuberculosis. The only way in which it can do so is by reducing the general vital resistance of the individual. When tuberculosis develops in a lead- poisoned person the phthisis usually runs a rapid */ course. Between 1900 and 1909 there were noti- fied 200 cases of plumbism in printers, and of these 17 were fatal. Considering the large number of printers in this country, it cannot be said that lead poisoning is extremely prevalent among them, and yet when the malady develops the symptoms are unusually severe and persis- tent. In the dust given off by British type 84 LEAD POISONING 14 per cent, of lead was found, but this is only one-third of what has been found in Continental printing-shops. Type-founders and linotypists suffer from plumbism through inhalation of the fumes of the molten metal. If we take the statistics of the London Society of Compositors, it will be observed that there are fewer cases of plumbism among the members than of tuberculosis. Professor Halm* of Munich has shown, taking the figures for Vienna and Berlin from 1901 to 1907, that the number of cases of plumbism and the mortality from tuberculosis run concurrently. In Vienna the sickness from plumbism per 100 members of one of the sick- clubs during eight years declined 48 per cent., and during the same period the deaths from tuberculosis declined 57 per cent. In Berlin during the years 1901 to 1907 lead poisoning declined 46 per cent., and the deaths from tuber- culosis 40 per cent. Comparing the polygraphic trades one with another, it was noticed that, while the highest figures for plumbism were given by printers and type-founders, the highest death-rate from tuberculosis also occurred in printers and type founders. Hahn is of the opinion that the predisposition to pulmonary tuberculosis on the part of printers is the result of chronic lead poison- ing ; but if this alone were the cause, why should * " Die Giesundheit." PRINTING AND TYPE FOUNDING 85 the relationship be so noticeable in printers, to the exclusion of other trades? We do not find, for example, pulmonary tuberculosis prevalent to any abnormal extent in white-lead workers, and yet they are exposed to a form of dust finer and richer in lead than are printers. Printers, file-cutters, and potters, succumb to pulmonary phthisis in large numbers, a circumstance less due to the chemical than to the physical qualities of the dust inhaled and the conditions under which it is inhaled. Other factors than lead, therefore, are probably in operation to explain the high mor- tality rate of tuberculosis in printers. Infection, and the fact of the work being carried on too frequently in overheated, ill-ventilated, and arti- ficially-lighted rooms, are the more likely causes. The following table, taken from Hahn's paper already alluded to, bears upon the subjects I have referred to ; while as a contribution to the relation- ship of tuberculosis and lead poisoning experi- ments carried out by G. Loriga* may be men- tioned. To ten guinea-pigs he gave for one month nitrate of lead in food, to ten guinea-pigs sulphate of lead was given, while another group of ten were fed normally. Of each group eight were infected with tuberculosis. The animals which received lead declined in weight more rapidly than those fed normally. The nitrate-of-lead-fed animals lost * 77 Ramazzini, 1912, Hft. I. and II. 86 LEAD POISONING Sickness Rates from Lead Poisoning and Death Rates from Tuberculosis, per ioo Members, of Male and Female Members of the Vienna Book-Printers' Sick-Fund. [I = Cases of lead poisoning. 11 = Deaths from tuberculosis.] Per 100 members 1901 1902 1903 1904 1905 1906 1907 Per 100 members 4.0 4.0 9 9 8 8 7 7 G 6 J S 4 4 3 3 2 2 1 J 3.0 3.0 9 9 8 a 7 \ 7 6 \ 6 S \ S 4 \ 4 3 \ 1 — ■ 3 2 2 7 I Z..0 2.0 9 9 8 8 7 7 6 6 5 5 4 P 4 3 3 2 2 1 1 1.0 1.0 9 9 8 8 7 7 6 6 S S 4 4 3 II 3 2 2 I 1 0.0 0.0 PRINTING AND TYPE FOUNDING 87 Sickness Rates from Lead Poisoning and Death Rates from Tuberculosis, per 500 Members, among Compositors and Printers of the Berlin Local Sick-Fund for the Book- Printing Trades. [I — Cases of lead poisoning. 11 = Deaths from tuberculosis.] Per 500 members 1901 1902 1903 1904 1905 1906 1907 Per 500 members. 4,9 4,9 8 I 8 7 7 6 6 J 5 4 4 3 3 2 2 1 1 4-.0 4,0 9 9 8 8 7 7 6 6 S J 4 4 3 3 Z 2 1 1 3, a 3,0 9 9 8 3 7 I 7 6 6 S II 5 4 4 3 3 2 2 ; 1 2.0 2,0 9 9 8 8 7 7 6 6 S 5 4 4 3 II 3 2 ^ 1 7 ho 1,0 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 7 0,0 O.O 88 LEAD POISONING weight more quickly than those which received sulphate. One of the nitrate-fed animals died of lead poisoning, and seven of the tuberculous group after an average of seventy-nine days. Those of the sulphate group died after an average of ninety- one days, and the non-lead animals after ninety- two days. Loriga maintains, as a result of these experiments, that plumbism creates a predisposi- tion to tuberculosis. It should be remembered, however, that there is only one day's difference as regards the date of death between the sulphate- fed animals and those which received no lead at all. Among printers and lead-smelters, as in all dusty occupations, the effect of dust and tubercu- losis combined is always greater than the influence of either separately ; but, as already stated, there are, as regards printers, other circumstances in operation, such as the influence of overheated and ill-ventilated workrooms. Plumbing, Dyeing, Glass-making, Tinning of Hollow Ware, and Diamond Cutting Of other trades in which lead poisoning occurs, mention may be made of plumbing, dyeing, glass- making, glass-polishing, the tinning and enamel- ling of hollow ware, lace-making, cutting of precious stones, such as diamonds and rubies. Plumbers suffer from saturnism through hand- ling metallic lead pipes, through using red and PRINTING AND TYPE FOUNDING 89 white lead for jointing purposes, also through handling putty. There is a belief that putty made with white lead keeps better than putty made without it, and that the putty made with red lead used by engineers sets more quickly and hardens better. Whatever may be the advantages con- ferred upon putty by lead, its presence therein adds considerably to the risks to health of those who use it. Many cases of plumbism have been traced to the use of putty powder in the polishing of glass. On analysis the powder has been found to contain as much as 70 per cent, of lead carbonate. Persons employed in dyeing yarn by chromate of lead, dyeing of silk and thread, also in printing colours upon calico, may become the subjects of plumbism. In glass-works where electric lamps are made I have observed severe forms of plumbism in men who mix the sand, salt cake, and red lead, pre- paratory to the mixture going into the furnace. Unless precautions are taken, the atmosphere soon becomes dusty and a source of danger to those who breathe it. I have seen healthy men who, within fourteen weeks of having taken up this employment in a glass-works, had become anaemic, had lost half a stone in weight, and were suffering from severe headache. On examining the men at work, I found their teeth covered with red particles of the oxide of lead, so that in these men a 9o LEAD POISONING considerable quantity of the poison was becoming dissolved in the mouth and was being swallowed. Dr. Septimus Bodger, of Studley, Warwickshire, has drawn my attention to several cases of lead poisoning among women and girls employed in putting glass tops on the long hatpins worn by women. In many of the workers there was a well- marked blue line on the gums. Most of them were anaemic ; pregnant females had miscarried in larger numbers than women employed in other trades in the district. The glass which was used came from Germany, and contained a large quantity of lead. In what is called the tinning of hollow ware, the interior of the vessel is swilled with molten metal, a mixture of lead and tin. As tin is the more expensive, there may be as much as 70 per cent, of lead present in the molten metal used for tinning cheap goods. Not only do the men who swill the interior of hollow ware suffer, but the people who eat the food which has been cooked in the vessels are also liable to be poisoned by lead. Formerly the white enamel used for coating the interior of culinary ware contained large quantities of lead, but within recent years this metal has been replaced by a harmless substitute. In the enamelling of iron baths, the men who grind the fritted lead (boro-silicate), and who put the enamel on the bath, frequently become lead- PRINTING AND TYPE FOUNDING gl poisoned. The material is put on the bath, in the form of a fine powder through a sieve, when the iron bath is still extremely hot, the temperature being frequently as high as 1,500° F. I have known an engraver become paralyzed as an incident in his occupation. Although etching is made on copperplate, there is fre- quently on the surface a small quantity of lead. The engraver referred to was in the habit, when at work, of putting the tip of the steel pencil into his mouth, with the result that he developed a well-marked blue line on his gums, had colic, and suffered from double wristdrop. We do not find plumbism in lace-workers in Great Britain, but on the Continent it is not unknown, owing to lead being added to increase the weight of the lace. In Austria the use of lead for this purpose has recently been prohibited. The cutting of diamonds is an old industry of Amsterdam. At the time of my visit to the diamond cutting shops of that city eight years ago, the industry gave employment to 8,000 men. The rooms in which the men work are overheated. In order to cut a diamond it has to be fixed in a mass of molten metal, the size of a walnut, com- posed of 60 parts of lead and 40 of tin. Thus fixed it is polished by hand or by a small wheel revolving very rapidly. Owing to the large amount of lead dust, usually lead oxide, floating 92 LEAD POISONING in the atmosphere the men suffer from colic and wristdrop. At Reichenberg in Bohemia similar symptoms are met with in the men who cut precious stones. How is Lead Poisoning caused ? Food and drinking water contaminated by lead are sources of plumbism ; so, too, are certain occu- pations in which lead is carried into the atmosphere in the form of fume and dust. The malady occurs also as a consequence of the self-administration of ./diachylon, or lead plaster, for the purpose of procuring abortion. Canned foods, particularly preserved foods which have an acid reaction — e.g., sliced pineapple — become possible causes of plumbism, through dissolving out the lead in the solder. One of my patients, an unmarried woman twenty-eight years of age, became seriously ill through eating tinned salmon. She became anaemic, developed wristdrop, her gums showed an intense blue line, and her urine contained lead. The paralysis slowly disappeared, but her health was never the same afterwards. Two years after her apparent recovery the urine still contained lead. Drinking water gathered on peaty ground has frequently an acid reaction, and is capable of dissolving lead. Water possessing plumbo-solvent HOW IS LEAD POISONING CAUSED? 93 power has been the cause of widespread suffering, owing to lead poisoning assuming endemic propor- tions. This has been the case in several of the towns and villages of Yorkshire. The plumbo- solvency of drinking water varies with the season of the year. It is apt to be increased at the end of a long drought, owing to the rain washing out the humic or ulmic acid contained in the peat. Houston, of the Local Government Board, a few years ago drew attention to the acidity of peat, and the part it plays in the presence of bacteria. If to a sterile decoction of peat micro-organisms obtained from peat are added, the liquid becomes acid, and is found to possess strong plumbo-solvent powers. Two non-motile, non-liquefying bacteria have been isolated from peat by Houston. These organisms possess separately the properties of acidity and plumbo-solvency. In my own experi- ments, drinking waters richest in bacteria, not of peaty origin, possessed slightly greater solvent power upon lead than those poor in micro- organisms. Distilled water attacks lead with greater vehemence than might be expected. In fact, unless glass vessels are used in the process of distillation, it is difficult to get the ordinary distilled water of commerce completely free from lead. Ordinary drinking water acts upon lead owing largely to the oxygen dissolved in the 94 LEAD POISONING water. The presence of calcium carbonate in the water gives a protective coating to the interior of lead pipes, provided the water remains free from acid. Such salts as nitrates and chlorides in water exercise a distinctly corroding influence upon lead. Carbonic acid has a similar influence. Silicates, on the other hand, possess protective properties. On the addition to drinking water of fragments of limestone, magnesium limestone, and chalk, waters which were previously strongly plumbo - solvent lose this property, and are rendered safe for domestic purposes. Usually only very small quantities of the protective agent are required — e.g., 2 to 3 grains of lime, ij grains of powdered chalk, or whiting, added to the gallon of water, being sufficient. One method which has been found most serviceable is filtering of the water through sand rich in silicates and strewn with fragments of limestone. In associa- tion with my colleague, Professor R. A. Bolam, I have carried out several experiments with drinking waters which, owing to their high plumbo- solvency, were causing widespread and serious harm, further extension of which was only prevented by prompt and appropriate chemical treatment of the water. I give in the following tables the amounts of lead dissolved daily by 50 c.c. of drinking water. The tables show what can be effected by treatment, also the necessity of con- HOW IS LEAD POISONING CAUSED? 95 stant watchfulness on the part of a water company when it is known that the water supplied possesses strong plumbo-solvent powers. Our plan is to immerse a piece of lead pipe in water, and to leave it, testing the fluid daily. June, 1901. June, 1912. Unfil- tered Water. The Same Water treated. Water from Same Source treated. June 15 ... „ 16 ... „ 17 ... „ 18 ... „ 19 ... „ 20 ... „ 21 ... „ 22 ... » 23 ... » 24 ••• >, 25 ... ,, 26 ... „ 27 ... 28 „ 29 ... „ 30 ... 07 1-05 1-25 1-4. r8 i-8 19 2'0 2"I 2"2 2 "3 2- 4 2 '4 2'5 2-6 2-6 0-15 o*3 o - 35 0-4 0-4 °"45 °"45 o - 45 o - 45 o-5 o'5 °"5 o'5 o'5 o-5 June 17 ... „ 18 ... „ 19 ... ,, 20 ... „ 21 ... ,, 22 ... ,, 23 ... M 24 ... „ 25 ... „ 26 ... „ 27 ... „ 28 ... „ 29 ... „ SO .- Pipes im- mersed 0-05 o - i 0-15 0-2 0-25 No deter- mination 0-3 o'35 0-4 0-4 °'4 °"4 No deter- mination The above are amounts of lead in milligrammes per ^ litre of water. Compare with these the amounts of lead dissolved by the waters supplied by another water company : 9 6 LEAD POISONING M (not treated). N (treated). July 9 ... Pipes immersed ,, 10 ... 3'2 o'5 , ii , 12 ... 5 '3 6-i o-55 o-8 , 13 ••• — °*95 , 14 ••• — I/O , 15 ••• vi , 16 ... i'i The above are amounts of lead in milligrammes per | litre of water. The effect of treatment is apparent in N. When- ever drinking water has once been found to exhibit strong plumbo-solvent powers, in the interests of the public it is absolutely necessary that the water should be submitted from time to time to plumbo- solvency tests, for the capacity of the water to take up lead varies with the seasons of the year, also with the weather ; and, besides, the silica and lime- stone which form the protective material laid down in the filtering bed are being gradually washed away, or their influence is weakened, and ought therefore to be periodically renewed. A feature of the widespread plumbism due to contaminated drinking water is that women and children are likely to suffer more than men, and that usually there is among the adult female popu- lation a larger number of miscarriages. Occasion- ally, in some of the towns supplied with a high plumbo-solvent water, the number of miscarriages, FUME 97 admittedly difficult to know accurately, is equal to, if not greater than, the live births in the affected area. Another point of interest, too, is that the destruction of immature infant life occurs without most of the women exhibiting symptoms of lead poisoning, or even showing a blue line on their gums. Fume. Fume escaping from the stacks of a lead-smelt- ing works has, as we have seen, caused the death of animals grazing in adjoining fields. It is a cause of sickness, too, in the men who smelt the ore. Some men are more readily affected by fume than others. Symptoms of plumbism may de- velop slowly; in a similar manner, structural changes in the internal organs, such as the kidneys and arteries may develop slowly and insidiously, and cause cerebral haemorrhage at an early age, so that it may be said through functional conditions to pathological changes we are led stage by stage to the final result, which cannot also but be regarded as a consequence of plumbism. Lead or its Compounds in the Form of Dust. Dust is the agent most provocative of plumb- ism. All lead compounds, whether oxide, chloride,, 7 98 LEAD POISONING carbonate, sulphate, nitrate, or chromate, are harm- ful. Lead gains access to the human body through the skin, by the respiratory organs, and by the mouth and alimentary canal. The substi- tution of wet for dry methods of manufacture of white lead has reduced the amount of illness among workers ; so, too, has abolition of hand labour in the emptying of white beds and in the drying departments. It is characteristic of lead poisoning that the absorption of minute quantities of lead continued daily for a few weeks or months is not only more likely to produce symptoms than one or two fairly large doses taken in rapid succession, but that the plumbism which develops will probably be more severe and persistent. Some persons are more prone to be affected by lead than others. There is an individual and a family predisposition to lead poisoning. Women and young persons, especially young females, are more readily affected by lead than men. My experience leads me to affirm not only the greater susceptibility of women to plumbism, but also to the worst types of it. It was on this account that I recommended to the Home Office the abolition of female labour in the dangerous processes of white lead manufacture, a step which has been followed by the happiest results. Other circumstances than sex predispose LEAD IN THE FORM OF DUST 99 to plumbism — e.g., poverty and its attendant ills. In my Goulstonian Lectures on Lead Poisoning, I drew attention to the fact that men and women who commenced their daily work in a lead factory without taking food became more readily affected than those who had breakfasted before going to the factory. A simple breakfast of bread and hot milk, tea, or coffee, provided by the employer, is one of the best preventives of plumbism amongst his factory hands. Alcoholism strongly predis- poses to plumbism. Intemperate habits make men careless when at work and less cleanly in their habits. Excessive indulgence in alcohol destroys the taste for food. Men addicted to drink ought not to be allowed to work in a lead factory. In my experiments upon animals, I found that those which received alcohol in addi- tion to lead were more readily poisoned than those which received lead alone. From appearances only it is not always easy to foretell who are the persons most likely to suffer from plumbism, but medical men whose function it is to examine applicants for work in a lead factory do well not to accept anaemic persons, those whose glandular system is wrong, whose digestion is not normal, per- sons suffering from constipation or who have kidney disease. One of the most searching examinations of applicants for work in a lead factory known to ioo LEAD POISONING me is that carried out by Dr. Irvine, of Lemington- on-Tyne, at one of the largest lead-works in New- castle-upon-Tyne. After inquiring into previous occupation, the heart and lungs are auscultated, the gums are carefully searched for possible traces of a blue line, the urine is tested for albumin, a /sphygmogram is taken, and the blood-pressure re- corded. It is needless to say that any man with albuminuria is rejected ; so, too, all applicants who have a blood-pressure above 140 millimetres of mercury. To this rather searching examination and the weekly medical visit I attribute the re- markable freedom of the men in this particular factory from plumbism. In lead-works, chewing and smoking of tobacco, especially cigarette-smoking, must be absolutely forbidden. Men who chew are apt when at work to draw out of their waistcoat pocket with their soiled fingers a piece of tobacco which may or may not be coated with lead dust. Some work- men are under the erroneous impression that chewing tobacco when at work prevents them becoming lead-poisoned, but on examining the mouth of these men the well-marked blue line on the gums, the discoloured teeth, and the unhealthy condition of the gums generally, do not lend support to this opinion. The abolition of the use of tobacco in a large white lead works in LEAD IN THE FORM OF DUST 101 Nantes was followed by results interesting enough to be recorded here. The average number of men employed in the works was 670. In 1902 the management forbade smoking for two years. In 1901 there had been twenty-six cases of lead poisoning in the factory, and in 1902 the number had risen to forty-two. The year after smoking was forbidden there were nine cases of plumbism, and in 1904 there were only four cases. It is not claimed by the manager that the improvement in the health of the men after 1902 was entirely the result of the prohibition of smoking, for some minor improvements had been introduced in the method of drying the white lead ; but, taking this and all things into consideration, the manager was disposed to regard the better health of the men and their freedom from lead poisoning as the result of their abstaining from the use of tobacco when at work. While penning these notes I have seen a man twenty-six years of age, a mixer in a glass-works, with marked saturnine cachexia and (V well-marked blue line on his gums, who tells me that immediately the foreman leaves the room he and his comrades remove their respirators and smoke cigarettes. Wilfulness added to ignorance thus defeats the objects sought to be attained by regulations. The employment of casual labour should on these grounds be discouraged. Where 102 LEAD POISONING men are regularly employed in a lead factory there is always less sickness among them ; and although some of the workmen are not as careful as they ought to be, they are yet more cleanly than casual labourers. In a white lead factory there must always be a certain amount of casual employment, for much of the work is unskilled, the men do not stay long at the work, and the supply of labour is not always equal to the demand. Onset of Symptoms, and its Relation to Exposure to Lead. Since idiosyncrasy plays an important part in the development of the malady, it is impossible to assign a date when symptoms of plumbism may show themselves in persons exposed to lead. One man may suffer from colic within a fortnight after taking up work in a white lead factory, while his comrade working alongside of him may not suffer for several months, or perhaps not at all. To idiosyncrasy must be added the influences of such personal qualities as cleanliness and temperance. I have seen a young woman die from saturnine encephalopathy ten weeks after taking up work in a white lead factory. One attack of plumbism pre- disposes to another ; but here again idiosyncrasy is an important factor, for some men may have one attack of colic and recover, or they suffer from loss ONSET OF SYMPTOMS 103 of power of the hands and wrists, and this passes away, so that the men return to the lead factory and are able to follow their occupation for years without becoming ill. Such cases are not infre- quent ; they are interesting from a recovery point of view. In many lead workers there is observed a long period of presaturnism, extending, it may be, over a series of years, during which the men look pale and their gums show a well-marked blue line ; but elimination of the metal apparently keeps pace with absorption, for lead is found in the urine and faeces, so that these men continue to follow their employment not complaining, and yet not feeling quite well. Sooner or later, but still without complaint of colic or of loss of muscular power — sometimes, too, without the pres- ence of a blue line on the gums — they become the subjects of ill-health, the symptoms and physical signs suggest kidney disease and arterio- sclerosis, both of which are recognized patho- logical effects of chronic plumbism. If we take as the simplest type of plumbism the case of a person who has drunk water contami- nated by lead, or a woman who has taken diachylon pills, the symptoms usually first complained of are severe abdominal pain referred to the neighbour- hood of the umbilicus, to one or other side of it, pain of an aching nature, relieved by pressure in 104 LEAD POISONING some instances, and in others aggravated by it. The colic is frequently accompanied by vomiting, and usually, but not always, by obstinate con- stipation. Abdominal pain may be the only symptom. A few days or weeks afterwards, and without necessarily being preceded by colic, the patient complains of weakness followed by loss of power in both hands and wrists. In lead workers symptoms of plumbism do not always develop quickly. The rate of poisoning is usually slow. Friends may have noticed and remarked upon the increasing pallor of the face, or it may be that the workman himself has complained of a metallic taste in the mouth in the morning, a disagreeable breath, disinclination for food, recurrent headache, colic, and ill-defined pains in the limbs. Head- ache may be the only symptom of plumbism, and it is characteristic of the headache that it is extremely severe. Lead taken in drinking water is already in solution, but when swallowed in the form of diachylon or as dust in food, the compound has first to be dissolved in the gastric juice of the stomach before it can be absorbed by the mucous membrane and passed into the blood. In a series of digestion experiments carried out for me by Professor Bedson, of the Armstrong College, New- castle-upon-Tyne, it was found that the gastric ONSET OF SYMPTOMS 105 juice possessed strong solvent powers over white lead ; the lead carbonate became converted into chloride, which is extremely soluble and dialyzable. Lead chloride passes fairly rapidly through animal membrane. Pepsin alone had no effect upon lead. The principal solvent in the stomach for lead is the dilute hydrochloric acid of the gastric juice. Lead chloride in intimate contact with proteid becomes lead albuminate, which is rather an insoluble and indiffusible substance. In the digestion experiments carried out by Bedson, it was found that if digestion of proteid food was going on at the same time the amount of lead dissolved was insignificant. This circumstance is of great importance from the point of view of the prevention of plumbism, and is one of the strongest reasons for employers giving a free meal to all workpeople before commencing work in a lead factory for the day. The more recent experiments of Carlson of Chicago support my contention. He found that where lead is added to gastric juice and milk, and the mixture is incubated at body temperature for ten hours, not enough lead goes into solution to give even a qualitative test of lead. Only in two instances where lead carbonate paint dust was used was there a qualitative test of lead obtained. If a fresh addition of hydrochloric acid was made, lead was dissolved in proportion to the 106 LEAD POISONING hydrochloric acid added. The hydrochloric acid of the gastric juice is under ordinary circumstances fixed by the protein of the milk, and neutralization is effected by the alkaline salts present in the milk. It is generally believed that it is as lead chloride that lead when swallowed passes into the system from the stomach, and one reason why herbivorous animals, such as the rabbit, are not so rapidly brought under the influence of lead as omnivorous animals may be the relative deficiency of acid in their gastric juice. Messrs. Moore, Oldershaw, and Williams,* are of the opinion that, taking into account the action and dosage of such a heavy metal as lead, the relative development of the intestinal mucous membrane must be considered when the question of absorption is being dealt with. In such om- nivorous animals as cats and dogs, heavy metals are far more toxic proportionally than they are in herbivorous animals, owing to the shorter intes- tine of the omnivor. As lead under these circum- stances tends to accumulate in the intestine, death occurs during the process of elimination. According to these writers, the intestinal mucous membrane is to be regarded as a path of elimina- tion rather than of absorption. It is to be remem- bered that this remark applies to lead which was * British Medical Journal, August 2, 1913. ONSET OF SYMPTOMS 107 introduced into the system by hypodermic ad- ministration, and not by the mouth. Lead administered hypodermically behaves like the ions of other heavy metals ; it is eliminated by the intestinal mucous membrane, and in its excretion it causes irritation and congestion of the mem- brane ; but it is otherwise when lead is swallowed, for digestion of the metal is completed within the alimentary canal itself, and absorption takes place from it. Where a soluble salt of lead unites with proteid it forms an insoluble albuminate, in which it has generally been held that the lead is simply retained mechanically in the albumin, but this is not the opinion come to byT. M. Clague and my- self as the result of experiment. If such a sub- stance is present in blood, a fluid rich in chloride, Moore holds that the lead may become reconverted into a soluble chloride in the presence of the con- tained sodium chloride. In this form it would readily circulate through the body and pass out by the kidneys. Legge and Goadby are of the opinion that, as lead particles are taken up by leucocytes, in whose interior the lead becomes converted into peptonate or albuminate, the lead is probably eliminated through the kidney in this colloidal form. Lead leaves the body in larger quantities by the faeces than by the urine. After the administration of lead salts by the mouth, 108 LEAD POISONING Carlson found that 63 per cent, of the lead given as carbonate, and 95 per cent, as sulphate, escaped by the fasces. When carrying out for me a series of digestive experiments, Professor Bedson found that bile dissolved three times more lead than gastric juice. Pancreatic juice rather hindered than encouraged the solution of lead. During pancreatic digestion alone no lead was dissolved in most of the experi- ments. Bedson's experiments were made with lead carbonate. It has been claimed by some writers that lead sulphate, owing to its lesser degree of solubility in the gastro-intestinal juices, is less harmful to persons working in it than is lead carbonate. Goadby is not of this opinion. He found that, while 0*048 and 0*042 per cent, of lead carbonate were dissolved, the quantities for lead sulphate were 0*080 and 0*046. Ur. Alice Hamilton* gives a series of digestion experiments which were carried out in the Hull Physiological Laboratory of Chicago University by Messrs. A. J. Carlson and A. Woelfel. Goadby, as the result of his experiments, was led to regard lead sulphate as more soluble in gastric juice than lead carbonate ; but Carlson, also making use of human gastric juice, found on an average 1*12 * " Hygiene of the Painters' Trade," Bureau of Laboui Statistics, Bulletin 120. Washington, 1913. ONSET OF SYMPTOMS 109 grains of lead carbonate dissolved for 0*97 of basic lead sulphate. Carlson states that the greater solubility of lead sulphate in the gastric juice is a chemical impossibility. It is hardly necessary to remind readers that it is the hydrochloric acid of the gastric juice which is the principal solvent of lead salts. The Chicago Professor took basic lead sulphate paint dust, also basic lead carbonate paint dust, and he found that gastric juice dis- solved 9*5 per cent, of the sulphate and 46*1 per cent, of carbonate. In a series of three experi- ments with human gastric juice, he found that 0*1235 gramme of lead sulphate was dissolved, equivalent to 24 per cent. ; that in gastric juice with peptone 0*1330, or 26 per cent., was dissolved; whereas with lead carbonate the amounts were 0*2992 gramme, or 59'S per cent., and in the peptone experiment 64 per cent. Instead of lead sulphate being more readily dissolved in gastric juice, Carlson found the carbonate to be twice more soluble than the sulphate. In my own experiments I found lead carbonate to be more toxic than sulphate. Goadby found cats more readily poisoned by lead sulphate than by carbonate. Blum, on the other hand, found sulphate of lead to be less poisonous than the carbonate. Carlson administered lead sulphate paint dust and basic lead carbonate paint dust in no LEAD POISONING meat to dogs, and he found that the dogs which received lead carbonate paint dust developed severe symptoms of lead poisoning within twenty-four to forty-eight hours after the first feeding ; whereas dogs fed upon sulphate paint dust did not show symptoms of poisoning until after three to four feedings, or from seventy-two to ninety-six hours afterwards. Cats were exposed to a similar ordeal, with the result that lead carbonate and lead carbonate paint dust were found by Carlson to be more distinctly poisonous than basic lead sulphate and lead sulphate paint dust. I have given the details of these experiments owing to the contro- versial opinions expressed by various writers in regard to the comparative toxic values of lead carbonate and lead sulphate. Experiments upon animals have helped to solve some of the problems connected with lead poisoning. Animals are not all alike in their behaviour towards lead, nor are human beings. Some are more susceptible than others. As regards animals, dogs and cats are readily brought under the influence of lead, but rats, especially wild-rats, also rabbits, are not so quickly in- fluenced. Whether, as regards the rat, owing to the long association of his race with the metal, and the comparative ease with which the animal can gnaw through lead pipes without suffering, a ONSET OF SYMPTOMS in kind of immunity to plumbism has been developed, I am not prepared to say. Rabbits, on account of being vegetable feeders, may on that account be more resistant than other animals. One of my laboratory rabbits took lead almost daily for three years. During that period it received by pipette 1,095 grains of nitrate of lead, equivalent to 684 grains of metallic lead. Usually one attack of plumbism predisposes to another. Long con- tact with the metal does not necessarily confer immunity. Lead is unlike many poisons. There can be no trifling with it. I have known men who had worked in a lead factory for thirty years without suffering from plumbism, yet become ill after such a long term of service. Dr. Walter Straub of Freiburg has recently* suggested a method of inducing lead poisoning in animals which several years ago I had made use of. He injected under the skin of the back of a rabbit, on September 1, 1908, a quantity of freshly-precipitated lead carbonate. On Novem- ber 7 the animal appeared to be quite well. Subsequently there slowly developed paralysis of the fore- limbs, and a few days afterwards the hind- limbs became the seat of spastic paraplegia. The 1/ muscles affected were mostly the abductors. The paralysis continued until the death of the animal. * Munchener Medizin. Wochenschrift, January 6, 1914. 112 LEAD POISONING The animal died on January 30, igog — i.e., 124 days after receiving the lead — without having lost weight and without its appetite having been im- paired. At the post-mortem examination of the body a considerable quantity of unabsorbed lead was found at the site of the injection. Cats similarly treated died within seven to twelve weeks after the injection, from bulbar paralysis, and with a distinct loss of body-weight. Erlenmeyer, who was associated with Straub, has given a good description of plumbism in cats. Aschoff found, on microscopical examination, structural changes in the spinal medulla, but not in all the animals. In one there was marked cellular infiltration of Goll's and Burdach's columns. Professor H. Schridde examined the blood of one of the cats before it died, but failed to find evidence of baso- philia. The pathological findings are interesting, for bulbar symptoms are extremely rare in man. While in some of Straub's animals which showed signs of plumbism a large quantity of lead remained unabsorbed, others in whom all the lead had been absorbed did not show any symptoms of plumbism at all. The amount of lead absorbed during the eight to ten weeks the animals lived varied from o'i to 0*2 gramme, a small quantity admittedly, but it is common knowledge that it is the absorption of minute quantities of lead which CHANNELS OF ENTRANCE OF THE POISON 113 gives rise to symptoms. Straub therefore regards o*3 gramme — i.e., 5 grains — of lead as capable of inducing plumbism. Channels of Entrance of the Poison. Considering the frequent opportunities offered to lead to enter the body by the skin, this surface cannot be regarded as a common mode of entrance, and yet serious symptoms, and even fatal results, have followed the application of lead externally. Wrist-drop is met with in men who cut leather on lead slabs. This may partly be the result of friction of the hand against the lead slab causing the dust to penetrate the moist skin, or it may be the result of the inhalation of fine particles of oxide of lead which come from the slab. Tanc- querel des Planches tells us that in the Paris hospitals colic was never known to have followed the application of lead to the skin This is not my experience. I have treated an actress for colic, headache, and amaurosis with haemorrhages IS into the retina, due to the use of cosmetics, and the reason why symptoms do not more frequently follow the use of cosmetics containing lead may be that the fat in the paste blocks the pores of the skin. ^Hair-dyes which contain lead have caused serious symptoms, while their use in one instance to my ■9 1 ' H4 LEAD POISONING knowledge caused death. Dr. G. B. Morgan, of Sunderland, informs me that he was consulted by a maiden lady, seventy-two years of age, on account of a drooping of the left upper eyelid, double vision, muscular pains, severe headache, increasing feebleness, and constipation. In addi- \J tion both arms were paretic, and there was diver- gent squint of the left eye. A week afterwards, as there was no improvement in the symptoms, Dr. Morgan ordered 7 grains of potassium iodide to be added to each dose of the medicine. On the following day the lady was found dead in bed. At the post-mortem examination nothing was found in the brain or in any part of the body to explain the symptoms and death. Two medical men who were present at the autopsy remarked upon the beautiful black hair of such an old woman. Two weeks afterwards a niece called upon Dr. Morgan, and gave him some powders which she had found in her aunt's chest of drawers. On analysis these were found to contain acetate of lead and sulphur. There was not the least doubt that the powders were used to dye the hair, and that the illness which developed was a consequence of their use. The iodide of potas- sium had redissolved lead which was lying in an insoluble form in the body and caused the rapidly fatal toxaemia. CHANNELS OF ENTRANCE OF THE POISON 115 Notwithstanding the above, the skin remains an uncommon mode of entrance of lead into the body. It is, however, a surface by which lead may be eliminated from the body. In some of my hospital patients Professor Bedson found lead in the perspiration. Lead enters the body by the respiratory organs and passages. Men when working in the dusty atmosphere of a white lead factory cannot but inhale dust. Most of this is caught in the naso- pharynx and is swallowed, but some of the finer particles are carried onwards by the inspired air into the lungs. In whatever part of the respira- tory passages lead-dust becomes deposited, it is brought under the influence of moisture and heat. The fluids secreted are alkaline, and as carbonic acid is passing to and fro over the surface during inspiration and expiration, the lead carbonate is probably converted into bicarbonate, dissolved and absorbed. Several years ago Alderson drew atten- tion to absorption of lead by the respiratory organs as likely to induce more serious symptoms than when lead was introduced into the body by other channels. Goadby,* as the result of experi- ment, has arrived at a similar opinion : he main- tains that " lead-dust circulating in the air is many times more dangerous than lead actually * " Lead Poisoning and Lead Absorption," p. 98. n6 LEAD POISONING swallowed." The amount of lead-dust which reaches the lungs by inhalation must be small. The plumbism which follows inhalation of lead- dust may therefore be due not to lead having reached the lung, but caught in the mouth and throat or on any portion of the respiratory passages. That fine particles of lead carbonate can reach the lung there is no doubt. Laborde found that guinea-pigs exposed to an atmosphere in which white lead dust was suspended died within two hours, and that in the lungs there were small haemorrhages, probably the result of irritation. On the other hand, Professor K. B. Lehmann of Wurzburg and his assistant Saito, notwithstanding the fact of the respiratory passages being the channel of entrance of the dust, found that only 12 per cent, of the lead reached the lungs, and that 70 per cent, was found in the alimentary canal. While penning these notes I examined, as stated earlier, two men employed in mixing red lead, salt-cake, and sand in a glass works. On the occasion of my visit they were wearing respirators, but they had evidently been just affixed, for on examining the mouth of one of the men who had only been a fortnight in the works, and who was ignorant of the risk he was running, I found a well-marked blue line on the gums, and in the other man, who had worked CHANNELS OF ENTRANCE OF THE POISON 117 four weeks in the factory, there was not only a deep blue line on both gums, but on the teeth a bright red deposit of fine granules of the oxide of lead. These men were breathing an atmosphere which contained red lead dust, and while possibly some of it reached the lungs, the bulk of it was being caught on the teeth and in the mouth, where it would become dissolved in the saliva and swallowed. Admitting that the lungs and the respiratory passages are frequent channels of entrance of lead into the system, I am of the opinion that it is by the alimentary canal, even when lead has primarily reached the upper part of the respiratory passages, that most of the poison enters the body. Reaching the stomach, it is acted upon by the hydrochloric acid of the gastric juice, whereby it is rendered soluble, and is absorbed unless proteid food is being digested at the same time, when only minute quantities of lead will be absorbed, the bulk of the poison being thrown out in the faeces. Soluble lead salts readily pass through any portion of the alimentary canal by osmosis into the veins, by which they are carried to the liver. This 1/ circumstance partly explains the fact of the liver containing considerable quantities of lead after death. The following histories and tables taken from my Goulstonian Lectures show the amounts n8 LEAD POISONING of lead which Professor Bedson found in the internal organs of some of my infirmary patients who died from plumbism. Elizabeth T., aged 22, single, had worked off and on during two and a half years in a white lead factory. At the end of the first three months she had to give up work on account of colic. On subsidence of the pain she returned to the factory, and worked seven weeks, when she was again obliged to desist on account of colic. Eleven months previously to coming under my care she had suffered from severe headache, followed by partial blindness. At this period she remained away from the factory for two months. On returning to work she again suffered from head- ache, also from pains in her joints, and her eyesight became worse. Urine was free from albumin. At the time of admission to the infirmary patient was menstruating. Patient died in a convulsion the day after being admitted. At the autopsy there was observed a blue line on the gums. The lungs were healthy; heart weighed 10^ ounces, the wall of the left ventricle was slightly thickened, the valves were healthy, also the endocardium ; liver and spleen were healthy. From the pelvis of the right kidney there escaped a few drops of a purulent-looking fluid, but there CHANNELS OF ENTRANCE OF THE POISON 119 was no injection of the lining membrane, and the kidney substance generally appeared to be healthy, so too that of the left kidney. The interior of the uterus was covered with sanious material, probably menstrual. On examining the brain, the subarachnoid fluid was found to be excessive in the interpeduncular space and around the pons. The cerebellum was pale compared with the cerebrum. The surface of the brain was healthy, and the vessels were not unduly injected. On section the brain tissue was generally pale ; there were few puncta hemorrhagica ; two to three drachms of serum in the lateral ventricles ; the spinal cord was pale and hard. Case of Elizabeth T. Total Lead in Weight of Organ. Grains of Lead Name of Organ. Parts per per Weight Million. of Organ. Ounces. Lung ' 7-6 29-0 0*0964 Heart ... 4-12 IO-5 0*0189 Liver ... 37-8 60-5 I'OOO Spleen I2T> 6'5 0-0341 Kidneys IO"0 5-25 - 0229 Cerebrum 9-8 | 24-8$ Cerebellum ... 5i*5 0779 Pons 22*6 — ■ — Spinal cord ... ri6 — — Large intestine 377 — — LEAD POISONING . pi i/i 2 « j* g Bi X a S •See tJcE TJ E "S s i2 c Name of Organ. lolic E Lead i ligram real E Lead i ligram ous E: Lead i ligram TO C - b/J ^ Si § < }jktAtA\iW%i^, _j v_/>>_A A i\J\ LL'UWuL.v^ ,_ \M/WMMWlAJv\\^^ a*« , ™vyv um^llkiaaiAUk-Uw duLiM 111 jUj i vywwvw^ WATER CONTAMINATED BY LEAD 193 centimetres of freshly prepared sulphuretted hydrogen. A dark coloration indicates lead i all other metals being known to be absent). The estimation of the amount of lead is effected by a comparison of the coloration produced under like conditions with a standard lead solution. Several methods of detecting lead in urine and organic compounds are described in the textbooks — also of detecting lead in the organs after death. As the methods are complex and require con- siderable knowledge of analytical chemistry, I prefer to have all these examinations carried out for me by competent chemists, and in view of the questions which might be raised in cases con- nected with the Workmen's Compensation Act, I would advise medical practitioners to refer such examinations to analytical chemists whose skill and verity are beyond question. Anomalous Symptoms due to Drinking Water Contaminated by Lead. I have not the slightest doubt that there are many cases of illness attended by obscure nervous symptoms of which no explanation can be given, and which are illustrations of atypical plumbism. Patients thus suffering are seen and treated by medical men without the true nature of their malady being recognized. This is likely to occur 11 V i 9 4 LEAD POISONING when there is no history of exposure to lead offered by the patient or elucidated by the physician. Where the teeth are kept clean by brushing, and there is no blue line on the gums, one important sign, at least, of plumbism is want- ing ; and where colic has never been so severe or recurrent as to have impressed itself upon a patient, another recognized symptom of plumbism is absent. An increase in the number of mis- carriages or of stillbirths in a town or district should cause medical men to suspect lead either in the drinking-water or in drugs taken sur- reptitiously. If neuralgia be set aside, severe headache in the absence of signs of cerebral tumour, organic disease of the brain, and the possibility of structural defects of the eyes may, if attended by anaemia or cachexia, be reasonably regarded as toxaemic. The phenomena to which I want specially to draw attention as suggesting plumbism are a gradual enfeeblement of the physical and mental powers with loss of weight, impaired locomotion, also a train of nervous symptoms, of which sleeplessness, intense depres- sion of spirits, forgetfulness, inability to apply oneself to mental work, with at times symptoms simulating hysteria or general paralysis are the most prominent. These symptoms in the absence of a blue line on the gums or of a history of colic WATER CONTAMINATED BY LEAD 195 are frequently due to plumbism, as shown by a chemical examination of the urine. Owning such a cause, the symptoms are exhibited by persons under unexpected circumstances, both as regards place and social position, that it is no surprise medical men are thrown off their guard. In many of the cases there is no basophilia, but lead is found in the urine during life, and in the internal organs after death. In many of the cases the cause of the illness has been the domestic use of drinking-water possessing high plumbo- solvent powers. Given an affected area, the consequences may be far-reaching, as the sequel shows. Some months ago I was asked by a medical friend to see in consultation with him a series of cases which, notwithstanding their atypical character, were undoubtedly plumbism. One of the patients, a young married woman, had recently been con- fined. During the course of her convalescence, and when, from an obstetrical point of view, there was nothing to cause acute abdominal pain, she became the subject of severe headache. Her infant, although at the breast, was losing flesh instead of gaining it, was constantly crying and pulling up his legs as if in pain. Some of the mother's milk was sent to me for analysis, and in it Professor Bedson found 0*4 part of lead per million ; he also found lead in the mother's urine. i 9 6 LEAD POISONING Breast-feeding was discontinued, and from that moment the infant ceased to have pain and began to increase in weight. Had I not known of the endemic plumbism, a true diagnosis of the infant's condition might not have been made. The child might have gone on suffering, and probably would have died. Under treatment the mother also made a satisfactory recovery. What Constitutes Lead Poisoning ? The Workmen's Compensation Act, and the claims by working men arising out of it have im- posed duties upon medical practitioners not always easily discharged. The diagnosis of lead poisoning may be easy or it may be difficult. In Great Britain law has decided that certain diseases of occupation which have been scheduled shall be considered as accidents from a compensation point of view. When men and women who have been working in lead become ill they are naturally disposed to regard the illness as in some way or other dependent upon their occupation. The burden of proof that they are suffering from lead poisoning is thrown upon the workpeople. Should the claim be substantiated, the employer in whose service the previous twelve months were spent is liable for compensation. Since, however, plumb- ism is of gradual development, and a workman may WHAT CONSTITUTES LEAD POISONING? 197 have been employed in more than one lead factory during the previous twelve months, the liability is divided amongst the various employers. Given a history of work in lead, the presence of a blue line on the gums, history of colic, presence of anaemia, basophilia, double wrist-drop, and the detection of lead in the urine, there is no difficulty in diagnosing the malady as plumbism. The difficulty arises when most of the usual signs and symptoms of lead poisoning are absent. It is generally admitted that the presence of a blue line on the gums is no proof that the individual is suffering from plumbism. It is only a sign that there is lead in the system, or that the individual has been brought into contact with lead. On the other hand, the Burt oni an j ine, when accompanied by \y/ other signs and symptoms, is most valuable so long as such a possible cause as bismuth, for L^ example, can be excluded. Some physicians find in basophilia a reliable test of plumbism. When present it is of assistance. I have not found basophilia the help it has been to other physicians. Personally, I rely more upon the detection of lead in the urine. Its presence therein is an indication that the metal is in the system, and is being eliminated. On the other hand, lead may be found in the urine of lead workers without the men betraying plumbism. 198 LEAD POISONING These men, however, are on the border-line. Let elimination be checked, and symptoms at any ,/time may arise. The presence of lead in the urine occupies the same relationship to saturnism as Koch's bacillus does to tuberculosis, Eberth's bacillus to typhoid fever, and Klebs - Loffler bacillus to diphtheria. Men and women may be typhoid carriers, they may be distributing the germs everywhere, and spreading typhoid fever, while they themselves are not suffering from the disease. What then are they suffering from ? With the word " suffering " we have come to associate too much the idea of pain, a sense of annoyance, or a feeling of discomfort, whereas it only means bearing or sustaining. A man who is unaccustomed to stimulants, and who has exceeded the limits of moderation on a particular occasion, is the subject of, or is said to be temporarily suffering from, alcoholic intoxication ; but the man who keeps nipping all day long, and who is never drunk, may show fewer signs of intoxi- cation, although of the two men he is the greater alcoholic, and the less likely to be brought back within the range of the normal. In a similar manner a man may have a blue line on his gums, and lead be present in the urine, without such a person suffering from plumbism. The child of a female lead worker dies shortly after birth, and in WHAT CONSTITUTES LEAD POISONING? 199 the internal organs lead is found. The mother had never been off ill, and yet her infant dies from the effects of plumbism, due to lead conveyed from the maternal blood. She is a lead carrier. There is the death from plumbism without the mother having exhibited symptoms, and yet she was not free from lead or the possible presentation of symptoms from it, for it occasionally happens that after a confinement such a mother becomes paralyzed in her arms, a condition which, setting aside possible obstetrical causes, is rightly or wrongly regarded as due to lead. When, we ask, did such a patient become lead-poisoned ? Was it only when she developed paralysis ? Or was she not pas- sively lead-poisoned all the time? In this problem of lead poisoning it seems to me that we must get rid of complaints, and the expression of suffering immediately relative to lead, and deal with the effects of the metal generally. As in chronic alcohol- ism, so in plumbism the old lead worker who has never been off ill, who breaks down in health or dies without having shown the ordinary signs and symptoms of plumbism, is not less the victim of the malady and entitled to compensation than the man or woman who, a few months after taking up the work, has developed colic or wrist-drop. In a sense he is more entitled to compensation, for by his long term of service he has contributed more 200 LEAD POISONING to the trade, and has cost his employer less than those men or women who have broken down in health in the earlier stages of their working career. * There is another question. It is not only that patients presenting obscure symptoms must have their symptoms carefully scrutinized, but also the complaints of those who consult medical men for the side issues of plumbism. A painter seeks medical advice for gout. This disease is known to be an indirect result of lead. It is also and much more frequently the result of constitutional causes and conditions in no way associated with lead. But for having worked in lead the proba- bility is that the painter would not have had gout. Is such a patient entitled to compensation ? Or take another illustration : contracted kidney is a recognized consequence of long exposure to lead. This form of Bright's disease might develop in a plumber, for example, just as in any other person, and be in no way connected with lead, but because it is a more frequent cause of death in persons exposed to lead than in other persons, saturnine nephritis has ccme to be recognized in a court of law as a disease of occupation, and compensation has been given to the relatives. Particularly is this so, when on chemical analysis lead has been found in the internal organs. On the other hand, the absence of lead in the internal organs does not WHAT CONSTITUTES LEAD POISONING? 201 prove that the case was not lead poisoning. In one of my own patients who died from acute saturnine encephalopathy no lead was found in the brain, and yet there was no doubt as to death having been caused by exposure to lead. Under any circum- stances it is only a minute quantity of lead which is present in the body, and a more minute quantity still which is circulating in the blood and causing harm. It is impossible to give such a compre- hensive definition of plumbism as will include all cases. In industrial plumbism two types of the malady are met with — active and latent. It is in latent plumbism that the difficulty of diagnosis arises, for a man who is passing lead in his urine may not be suffering at the time from plumbism, and yet at any moment active manifestations of the disease may show themselves even months after the individual has retired from the factory. Treatment : Preventive. The treatment of lead poisoning is preventive and curative. In making a tour of inspection of a white or a red lead factory, the workmen in some of the departments are observed to be paler than men employed in other occupations. Although they are pale and unhealthy-looking, and although also on their gums a delicate blue line is observed, 202 LEAD POISONING these men are not suffering from plumbism. They are all able to follow their employment, for the bulk of the lead which is being taken into the system is not all being retained : elimination keeps pace with absorption. In the case of several of the workers it is a slender line which separates lead absorption from lead intoxication. A work- man who has been for years daily absorbing and eliminating lead, who has been becoming paler and paler, is occupying a delicate position. A slight check to the activity of his emunctory organs, and what was until then a pre-saturnine condition — that is, a condition preparatory to, but not actually one of, saturnism — becomes gradually one of lead poisoning. It would be a prudent act on the part of factory surgeons and employers to give workmen who, judging from pre-saturnine cachexia, are thus brought to the verge of breaking down in health, a holiday for a fortnight two or three times a year, so that absorption of lead might be interrupted, and elimination promoted. The good effects of absence from work and rest are in some persons rapidly apparent. In lead factories where the economic conditions do not permit of the hands being given temporary respite from work, there should be alternation of employ- ment. It is a mistake to keep workmen always in the white or red lead processes ; they should from time TREATMENT : PREVENTIVE 203 to time be transferred to the yard or given some outdoor kind of employment. The British Home Office regulations compare most favourably with those of other countries, and on the whole they are attended to. As regards personal hygiene the workers are not always as true to themselves as they ought to be. The lead industry is considerably improved to what it was years ago, and there is an increasing desire on the part of most manufacturers to do all they reason- ably can to render the trade as free from risk to health as possible. The abolition of female 1/ labour, and the substitution for it of male labour in dangerous processes, although resented at the time by some employers on the ground of derange- ment of work, difficulty of finding male labour, and expense, is now generally admitted to have been a step in the right direction. It has purified the industry, and averted suffering. Attention to details of personal cleanliness, the work of the day never begun without food having been taken, provision of ample washing and bathing facilities by owners, wearing of overalls by employees, change of clothing and of boots when work is finished, no eating when at work, nor until after washing, no chev/ing of tobacco, or of smoking when y at work, are regulations which are productive of good. 204 LEAD POISONING L--^"Periodical but frequent medical examination of the workers, once a week of persons employed in dangerous processes, with power to suspend, has also been of signal service in reducing the number of cases of plumbism. It would pay employers to set aside a good room in the factory for the medical examination of the workers. The room should be bright and with plenty of daylight ad- mitted by a window in the roof. Since dust is the enemy of the worker, all efforts must be made to render the workrooms as free from dust as possible, either by improving methods of manufacture, whereby little or no dust is generated, by preventing its escape into the workroom, or its removal there- from by means of fans. Fumes should be simi- K larly dealt with. Hearty co-operation of employer and employed in regard to regulations is a neces- sity. In the arts and sciences lead cannot be readily dispensed with. Where possible it is desirable, from a health point of view, that a substitute should be found for lead. It is, how- ever, not total abolition of lead that is called for so much as more hygienic methods of its manu- facture, always remembering that lead compounds, wherever and whenever handled or operated upon, are products of a distinctly poisonous character. The prevention of plumbism should begin not after the men have entered a factory, but before TREATMENT : PREVENTIVE 205 they commence work in it. A cursory medical examination of applicants for work is not enough. It must be thorough. At one of the large lead factories in Newcastle- upon-Tyne Dr. Irvine has instituted a procedure to which I have already drawn attention. It is well worthy of being adopted elsewhere. Any person applying for work is not only questioned as to his health and previous occupation, but his mouth and teeth are examined, and their con- dition noted; the urine is tested for albumin; a sphygmogram is taken, also a blood-pressure record. If, on applying for work, a man has a blood pressure of 140 millimetres Hg, such an applicant is refused. By these means Dr. Irvine has kept the works practically free from plumbism. By the substitution of mechanical and automatic methods for hand labour in the transference of raw white lead and the packing of finished lead products much has been gained from a health point of view, while in the manufacture of red lead, the introduction of minus pressure methods whereby air is drawn into the closed machinery rather than expelled from it, also the grinding and mixing of colours in closed machinery, have rendered the atmosphere of lead factories com- paratively free from dust. In white lead factories the substitution of mechanical methods of filling 206 LEAD POISONING and emptying the drying-stoves, the use of closed drying-ovens with inside peripheral canals into which the dried lead carbonate can be raked, have robbed drying of much of its dangers. In some white lead factories ovens or stoves have been dispensed with altogether. In making white lead paint it is not necessary to dry the lead first. The pigment removed from the white beds can be passed through crushers and washed, and after- wards passed on through a series of rollers between which the pulp comes into contact with oil. The water is gradually displaced by the oil, with the result that, practically speaking, a finished white lead paint containing only a mere trace of water escapes from the last cylinder. This method of directly treating the white lead obviates the necessity of handling the product and of drying it. In all dusty processes the shifts should not be too long, for if men are wearing respirators, and the work is hard, breathing becomes difficult, and the men become overheated. In cleaning out the Hues of a lead-smelting factory, the men should not work longer than two hours at a stretch with- out having an hour's rest. A workman suspended on account of illness or indisposition should not, if he has been absent over a fortnight, be allowed to resume work in a lead factory without undergoing a medical examination as to the state of his health TREATMENT : PREVENTIVE 207 and physical fitness. Since some persons are more susceptible to lead than others, any indica- tion of impending impairment of health should become cause for the medical examiner and employer removing a worker at once to outside labour. Since poverty and general deprivation predispose to plumbism, it is safer to draw work- men from the class above the abjectly poor. No person addicted to alcohol should be employed in lead. At the close of each shift the men before leaving the factory should carefully wash their hands and forearms, brush their nails, gargle the throat, and douche the nostrils with mild saline solution. At one large factory on Tyneside the men are given daily small chocolate - coated tabloids containing sulphide of soda. It is claimed that these possess a distinctly preventive influence against plumbism. Workers in lead should see to it that they do not suffer from con- stipation. All lead factories should be so situated that the various workplaces can be freely flushed with currents of air. Plans for new lead factories should be submitted to the Home Office for confirmation and suggestion. For the maintenance of hygienic conditions inside a factory, several dust-collecting systems are in use to collect lead escaping into the air. Care must be taken to see that these exhaust 208 LEAD POISONING pipes are kept clear, otherwise they get choked with dust, and become worse than useless. The cleaning of machinery, also the cleaning and chip- ping of the stones used for grinding and mixing white lead, are attended with danger. Every hopper and machine containing lead in the form of dust should be provided with a dust-exhaust. All melting-pots should be hooded. By ventilation and provision of exhausts wherever possible, respirators may be dispensed with. During structural alterations in lead factories the greatest care should be exercised, and all workmen, whether they belong to the factory or not, should be apprised of the dangers they may be exposed to, as the following case shows : A few years ago it was found necessary to enlarge the capacity of the plant in a white lead factory without stopping the manufacture. Large numbers of men were em- ployed, and a foreman was appointed to super- intend the work, so far as concerned keeping the labourers right in matters of cleanliness and the wearing of respirators. How signally this man failed in his duty the sequel shows. Not only did he himself become lead-poisoned, but within a space of two months there were forty cases of lead poisoning in the factory ; two of the men died, two were paralyzed in hands and feet; in the remainder the symptoms were of a slighter character, so that TREATMENT : PREVENTIVE 209 they soon recovered. Most of the men who became poisoned were working on construction. By dis- charging all the intemperate men, hiring a special foreman and placing him in charge of the bath- rooms, with instructions to report and cause to be discharged any man seen leaving the premises or eating without thoroughly washing himself and changing his clothes, by appointing a doctor to the works, and having a weekly medical examination, the results were highly satisfactory. No serious case of lead poisoning has occurred since then. To prevent endemic plumbism caused by drink- ing-water gathered on peaty soils, water companies v should have the deliveries tested lor plumbo- solvency two or three times a year, so that proper amounts of chalk, limestone, or other correctives may be added ; and to render water free from lead in the household supply the water should be passed through filters made from animal charcoal rich in phosphate. Treatment: Curative. As anaemia is an early sign of plumbism, a workman suspended from the factory should be encouraged to spend most of his time in the open \j air. He should be given a mild iron tonic, with or without magnesium sulphate. If colic is 14 210 LEAD POISONING moderately severe it should be treated by applica- tion of warmth to the abdomen, or by a warm bath, and if there is sickness an effervescing soda and bismuth mixture containing a few drops of nepenthe should be given When there is obstinate I constipation in addition to colic, castor oil is ( called for. Croton oil in i-drop doses may be administered if constipation is extreme, but i ounce of olive oil in warm milk taken by the / mouth, or a rectal enema of olive oil and warm water should be tried first. In some cases the abdominal pain is so severe as to call for the administration of morphia hypodermically. Even when the bowels have been freely opened by aperients the abdominal pain may continue for a few days. This type of pain is aggravated by pressure. It can be relieved by administering sodium monosulphite in § or i grain doses three or four times a day. On the recommendation of Dr. Stevens of Cardiff I have given with great relief to patients suffering from lead colic perman- ganate of calcium in ^-grain doses thrice daily. For colic a mixture of potassium iodide and magnesium sulphate is sometimes ordered. This should not be adopted as a routine treatment, for potassium iodide has the power of dissolving lead which has been lying inert and stored in the tissues, of causing it to circulate in the blood and TREATMENT : CURATIVE 211 thereby of intensifying the saturnine intoxication. As regards the treatment of wrist-drop, some patients find relief by resting the hand on a splint and carrying it in a sling. Massage and electricity give good results, either alone or combined with the internal administration of 2 or 3 minims of liquor strychniae, or 5 minims or more of tincture of nux vomica. To the nux vomica mixture a few grains of iodide of potassium may be added. For epileptiform convulsions large doses of the bromides may be given by the mouth or by the rectum ; nitrite of amyl may be inhaled, or lumbar puncture performed. An enema of mustard and warm water may be administered if, in addition to con- vulsions, there is constipation. For chronic plumbism where there are anaemia, albuminuria, and such symptoms suggestive of interstitial nephritis as headache, imperfect vision, swollen features, and oedema of the feet, also emaciation, the medical treatment resolves itself into ordinary care of the patient and treatment of his symptoms generally. Opinions are divided as to whether, when a doctor detects albumin in the urine of an old lead worker in whom there is no doubt as to the existence of interstitial nephritis, such an individual should be compulsorily obliged to retire from work in the lead factory. Experience shows that men can go on working 212 LEAD POISONING in a lead factory for years, and enjoy fairly good health, even though they are the subjects of chronic kidney disease, and experience equally shows when such men have been obliged to with- draw from the factory, that, owing to their diminished weekly income, as they are unable to obtain proper food, they worry and become ill. The detection of albumin in the urine of a com- paratively young lead worker is another thing altogether. He ought to give up work in lead. As a supplement to the preventive and curative treatment of plumbism, I should like to draw attention to another line of treatment with which the names of Mr. T. M. Clague, of Newcastle- upon-Tyne, and myself are associated. It is the double electrical bath treatment. Dr. Lewis Jones was kind enough a few years ago to contribute to my book, " Dangerous Trades," an article on the electrical treatment of plumbism. He showed how, under the single bath electrical treatment, patients, when paralyzed, made a quicker recovery than without it. Massage and medicinal treatment were by it rendered more effective. Patients who are the subjects of lead .poisoning keep eliminating lead by the kidneys and by the bowels. Electrolysis causes lead to pass by a process akin to osmosis from the body to the electrodes in the bath in which the patient TREATMENT : CURATIVE 213 is immersed. The experimental evidence that lead can be extracted from the body of man by electrolysis is not free from sources of error, for the amount of the metal in the body at any time must be small, probably not more than a few grains, so that there would be in a dipolar bath — that is, a bath into which both poles are placed — considerable difficulty in finding measurable quantities of lead deposited on the electrodes in the bath. In the single bath the lead deposited on the positive pole appears as peroxide, and on the negative pole it is found, according to Dr. Lewis Jones, in a spongy metallic form. There is always the possibility of lead found in the bath- water having come from the skin of the workman. For example, it might be lead which had simply been lying on the surface of the body, or lead in the process of elimination by the glands of the skin, but admitting these as possible sources of the metal, there is not the least doubt that electrolysis favours the elimination of lead from the body by the skin. In a paper* published a few months ago, I drew attention to the use of the double electrical bath which had been suggested to me by Mr. T. M. Clague, to whom I had applied for assistance as to the possibility of removing lead from a * Lancet, August 23, 1913. 214 LEAD POISONING rabbit the subject of experimental lead poisoning. During the three years the animal was under ob- servation he had received 1,096 grains of nitrate of lead, the equivalent of 684 grains of metallic lead. After having taken a few hundred grains of nitrate of lead, the animal became painlessly paralyzed. It was then that I asked whether, by means of electrolysis, lead could not be removed from the body of the animal, and the opportunity given to him of regaining health. As a result of the double electrical bath the paralysis quickly disappeared, and the animal made a good recovery. The fore-limbs of the animal were placed in one bath along with the negative pole, and the hind-limbs in another bath with the positive pole, the chest and abdomen of the animal resting on a soft cushion of cotton wadding. After a bath of an hour's duration lead was found on the negative electrode, and in the bath-water. Several weeks after the rabbit had regained its health and vigour, small doses of lead were again administered, with the result that the animal for a second time became paralyzed. Treated by the double electrical bath, the paralysis dis- appeared, and the rabbit was soon in the vigour of health once more. After a respite of a few months, lead administered for the third time caused paralysis : this was attended by progressive TREATMENT : CURATIVE 215 general emaciation and followed by death, the electrical bath treatment not having again been brought into operation. In the internal organs, especially in the spleen, considerable traces of lead were found. The points of professional interest are the length of time the animal took lead, three years, also the large quantity of it, 1,096 grains of nitrate ; twice recovery from paralysis, and restoration to health under the influence of electrical bath treatment. During life the faeces contained lead, showing that all the time the animal was receiving lead it was also elimi- nating it. The theory of the action of the double electrical bath is as follows : when an electrical current is passed through a solution of a salt, the acid radicle collects upon the positive pole while the base NaCl travels to the negative. Thus „ „^ after passage Znb(J 4 CI of an electrical current appear as ^-„- at the Na positive pole, and -^r- at the negative. The two Zn entities in each salt are called ions. They possess the power of traversing membranes. When a solu- tion containing them is applied to the skin, and an electrical current is passed at the same time, ioniza- 216 LEAD POISONING Hon occurs. Introduction of metallic drugs into the human body by this means has been attended with distinct success. The method of application is as follows : The joint or limb about to be treated can either be placed in a bath containing the salt in solution, or a pad of lint soaked in the medica- ment can be laid upon the particular part, and an electrode laid upon it, while the other pole is applied to an indifferent part of the body. If a bath is used, more current can be passed, and as a consequence more ions can be introduced. Such in a few words is ionization. Electrical treatment of lead poisoning by the two-bath system is de-ionization. In this method of treatment the electrical current passes through the body : it breaks up any lead compound which may be present ; it carries the acid radicle to the positive pole, and the base to the negative. The apparatus is simple. A wooden tub is required for the feet of the workman, and into it tepid water is placed, while for the hands and forearms similar provision is made. A series of tubs can be arranged so that several men can take the bath at one and the same time. The electrical part of the apparatus consists of a battery, a milliamperemeter, and a rheostat for regulating electrical pressure, also wires and electrodes in the form of grids. The bath is given for half an hour or a little longer TREATMENT : CURATIVE 217 every day or every second or third day, according to whether it is being used for curative or preventive purposes. A voltage of 16 is gener- ally sufficient, and a milliamperage of 20 to 40. The positive pole is placed in the foot-bath, and the negative in the arm-bath. The electrodes, made from aluminium, should be free from lead. If the electrical current, as regulated by the rheostat, is introduced gradually, no shock is felt, nor is any unpleasant sensation experienced by the men. On the other hand, if the hands or feet are brought into direct contact with the electrodes the skin may become red and painful, and ulceration even may follow. Care must therefore be taken by those using the bath that such accidents do not occur. Occasionally the skin becomes red and irritable at the water-level mark, due to disruption of the common salt added to the bath-water to reduce resistance to the passage of the electrical current. Objections have been raised in regard to the electrolytic treatment of plumbism, the principal one being that there is no evidence to show that lead can be removed from the body. To that I unhesitatingly give the answer that lead has been detected on the electrodes and in the water after the baths. As the amount of lead in the body ot a workman at any particular time is extremely 218 LEAD POISONING small only minute traces of the metal can be found. One disturbing circumstance in the electrical bath treatment of lead workers is the possible presence of the metal or its compounds on the skin. But where plumbism is due to drinking contaminated water, this possibility does not hold, and yet in patients thus suffering lead was found on the electrodes and in the bath-water. Another source of lead, apart from the patient about to be treated, is the water of the bath : this may have been taken from lead pipes ; and also there is the possibility of the common salt which was added to the bath having contained traces of lead. But apart from these, and where the greatest care was taken to eliminate all possible sources of error, lead has been found on the electrodes and in the water after the electrical bath treatment of lead workers. At one of the large lead works in Newcastle- upon-Tyne an independent analytical chemist, Mr. H. Dunford Smith, was invited to arrange and supervise a double electrical bath, and to make an analysis of the grids and of the bath-water. A man who was working in the desilvering depart- ment, who had never been ill, whose gums did not show a blue line or his face pronounced anaemia, was selected by Mr. Dunford Smith for the experi- ment. It was felt that the test was a severe one, TREATMENT : CURATIVE :t 9 there being so many men in the works more likely to have been absorbing lead than this desilverer. One of the primary requirements was that the man must sit with feet and legs in warm water for an hour ; also that the hands and forearms must be similarly immersed. The water was then to be changed. During the next part of the experiment the workman's limbs were simply to remain in the bath as before ; the bath-water was to be removed and examined, fresh water was then to be placed in the tubs, and the electrical current turned on. The bath experiment lasted from one to two hours on two successive days. During the two days the man did no work in the factory. The follow- ing is a copy of the analysis by Mr. H. Dunford Smith : Lead in Foot Water Arm Water Gramme Gramme January 15 : Without current (no salt) ... '0005 00006 With current (100 grammes salt) . 0"0044 0^0045 Aluminium grids 0*0003 0-00033 January 16 : Without current (no salt) ... 0006 OOO083 With current (100 grammes salt) .. C0038 OOO57 Aluminium grids None "00005 The urine was found to be free from lead. From this man there was removed by electrolysis I grain in the first day's bath, and in the second j- 1 -- grain. This analysis from an independent and disinterested source is extremely valuable. 220 LEAD POISONING It was only to be expected that a line of treat- ment of plumbism so novel in some respects as that recommended by Mr. Clague and myself should be assailed and have to run the gauntlet of criticism. It is therefore encouraging to learn that in the United States not only is the electrical bath treatment of lead poisoning well known, but in the hands of some persons it has given satisfactory results. I extract from a letter sent to me by Dr. Francis D. Patterson, medical officer to Messrs. Harrison Bros., white lead and paint works in Philadelphia, also medical officer to the Electric Storage Battery Company, dated May 15, 1914, the following reference to the points under con- sideration : " Re the electrolytic baths : I am using them as a routine method of prevention at these works and at the works of the Electric Storage Battery Company, and the results I am obtaining are in every way most gratifying, so much so that I am convinced it is the greatest advance which has ever been made in dealing with the problem of any occupational disease. I had a man who had acute lead colic, who was relieved after two hours in the bath, and another case, one of wrist-drop, in which, after three weeks' treatment, his paralysis is almost gone. In cases where I am using it as a precau- tion I have had analysis made of the water from TREATMENT : CURATIVE 221 the baths, and the following are some of the results : Bath- Water. Hand, negative; foot, 0*057 grain lead. Hand, negative ; foot, 0*113 ,, Hand, 0-087 grain ; foot, 0-115 » Hand, negative ; foot, 0*453 „ Hand, negative ; foot, 0*438 ,, " I have a large number of equally conclusive cases. They were only put in the bath after a thorough scrubbing of their hands and feet." Upon Dr. Patterson's unsolicited and favourable report I make no comment : it embodies the opinion of a medical man who has had great experience of the diagnosis and treatment of industrial lead poisoning. The workmen, taken as a whole, appreciate the bath. Only from three men have I received un- favourable opinions : (a) one said that he neither felt better nor worse after the bath ; (6) that it set up diarrhoea ; (c) that it made his skin extremely irritable. Nearly all the men have expressed them- selves as feeling refreshed and invigorated after the bath — a feeling of fitness to which they had been unaccustomed for months previously. In them the blue line on the gums could be observed to be gradually disappearing, pallor of the face was being replaced by a ruddy glow of health, and the mus- cular power had considerably improved. The effect 222 LEAD POISONING 91 w ^.- 01 J« 2 -5=*^ -.. 06 62 M £2 ..,•-'""' ez ■*" r 22 ZZ . ■" «i -Q 02 55 2^«_ fc < 61 r- -""■'" ^ | 81 CD 91 El "^•^. ^ ^ II 1 01 ■■^f 1 9 ^ 1 t- ^ 1 — 2 / i 62 \ ^^^-~ ■• LZ 52 ZZ 81 CO ■ — ^ ^■•" 51 C7> — " :="• — El / > o II ^■^ 8 ■ 9 ^•"'" * oe , ^" > ». 82 52 _^.-*'" £2 y ~ """ ■ — 12 o -•-" 81 91 ) TREA TMENT : C URA 77 VE CM C\J^ cm O in O mo moin — OO <*> o> ao 00 r- Si en" \ Si 2" \ \ CM •*** CM to" ><^ **'" cm \ CM / cm CM CM CM^ "*"-- CM > \ 1 i i CM "Z^\ -s^ i i i in CM *-> ~ ~ o o a> oo cr> t- 224 LEAD POISONING of the baths is in most instances — as shown in the charts — an improvement of the muscular grip. No uniform result was noticed as regards the blood pressure. It seemed to raise low blood pressures gently and to reduce gradually those which were high. The double electrical bath as a means of preventing plumbism is far and away beyond the ordinary warm bath which is required of lead workers weekly by Home Office regulations. Should the experience of other physicians confirm what I have written about the double electrical bath, it might with great advantage take the place of the weekly warm bath. The objection might be raised that if the double electrical bath removes lead, might it not also remove other metals of use to the economy, such as iron, and thereby tend to increase any anaemia which might be present ? Mr. Clague and I carried out several experiments to test this possi- bility. As lead is the more electrolyzable metal, it always came away first. In only a few instances was iron removed, and then in extremely minute quantities compared with lead. Another thing which might be claimed for the double electrical bath is that, since it removes lead from the body, which is found in the bath- water and on the electrodes, it might be used in doubtful cases for diagnostic purposes. FACTORY AND WORKSHOP ORDERS For the Process of File-Cutting by Hand* 1903. No. 507. Whereas the process of file-cutting by hand has been certified in pursuance of Section 79 of the Factory and Workshop Act, 1901,! to be dangerous; I hereby, in pursuance of the powers conferred on me by that Act, make the following Regulations, and direct that they shall apply to all factories and workshops (including tenement factories and tenement workshops) or parts thereof in which the process of file-cutting by hand is carried on : Provided that the Chief Inspector of Factories may by certificate in writing exempt from all or any of these Regulations any factory or workshop in which he is satisfied that the beds used are of such composition as not to entail danger to the health of the persons employed. 1. The number of stocks in any room shall not be more than one stock for every 350 cubic feet of air space in the room ; and in calculating air space for the purpose of this Regulation any space more than 10 feet above the room shall not be reckoned. 2. After the 1st day of January, 1904, the distance between the stocks measured from the centre of one stock to the centre of the next shall not be less than 2 feet 6 inches, and after the 1st day of January, 1905, the said distance shall not be less than 3 feet. * These Regulations were gazetted June 23, 1903. t 1 Edw. 7, c. 22. 225 15 226 LEAD POISONING 3. Every room shall have a substantial floor, the whole of which shall be covered with a washable material, save that it shall be optional to leave a space not exceeding 6 inches in width round the base of each stock. The floor of every room shall be kept in good repair. 4. Efficient inlet and outlet ventilators shall be provided in every room. The inlet ventilators shall be so arranged and placed as not to cause a direct draught of incoming air to fall on the workmen employed at the stocks. The ventilators shall be kept in good repair and in work- ing order. 5. No person shall interfere with or impede the working of the ventilators. 6. Sufficient and suitable washing conveniences shall be provided and maintained for the use of the file-cutters. The washing conveniences shall be under cover and shall comprise at least one fixed basin for every ten or less stocks. Every basin shall be fitted with a waste pipe dis- charging over a drain or into some receptacle of a capacity at least equal to one gallon for every file-cutter using the basin. Water shall be laid on to every basin either from the main or from a tank of a capacity of not less than Itt gallons to every worker supplied from such tank. A supply of clean water shall be kept in the said tank while work is going on, at least sufficient to enable every worker supplied from such tank to wash. 7. The walls and ceiling of every room, except such parts as are painted or varnished or made of glazed brick, shall be limewashed once in every six months ending the 30th of June and once in every six months ending the 31st of December. 8. The floor and such parts of the walls and ceiling as are not limewashed and the benches shall be cleansed once a week. 9. If the factory or workshop is situated in a dwelling- house the work of file-cutting shall not be carried on in any room which is used as a sleeping place or for cooking or eating meals. FACTORY AND WORKSHOP ORDERS 227 10. Every file-cutter shall when at work wear a long apron reaching from the shoulders and neck to below the knees. The apron shall be kept in a cleanly state. 11. A copy of these Regulations and an Abstract of the provisions of the Factory and Workshop Act, 1901,* shall be kept affixed in the factory or workshop in a conspicuous place. 12. It shall be the duty of the occupier to carry out Regulations 1, 2, 3, 4, 6, 7, and 11 ; except that, in any room in a tenement factory or tenement workshop which is let to more than one occupier, it shall be the duty of the owner to carry out these Regulations, except the last clause of Regulation 6, which shall be carried out by the occupiers. It shall be the duty of the occupier or occupiers to carry out Regulation 8. It shall be the duty of the occupier or occupiers and of every workman to observe Regulations 5, 9, and 10. These Regulations shall come into force on the 1st day of September, 1903. A. Akers-Douglas, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 19th June, 1903. For the Manufacture of Electric Accumulators^ 1903. No. 1004. Whereas the manufacture of electric accumulators has been certified in pursuance of Section 79 of the Factory and Workshop Act, 1901,$ to be dangerous ; I hereby, in pursuance of the powers conferred on me by that Act, make the following Regulations, and direct that they shall apply to all factories and workshops or parts thereof in which electric accumulators are manufactured. * 1 Edw. 7, c. 22. t These Regulations were gazetted November 24, 1903. X 1 Edw. 7, c. 22. 228 LEAD POISONING In these Regulations " lead process"* means pasting, cast- ing, lead burning, or any work involving contact with dry compounds of lead. Any approval given by the Chief Inspector of Factories in pursuance of these Regulations shall be given in writing, and may at any time be revoked by notice in writing signed by him. Duties of Occupier. i. Every room in which casting, pasting, or lead burning is carried on shall contain at least 500 cubic feet of air space for each person employed therein, and in computing this air space, no height above 14 feet shall be taken into account. These rooms and that in which the plates are formed, shall be capable of through ventilation. They shall be provided with windows made to open. 2. Each one of the following processes shall be carried on in such manner and under such conditions as to secure effectual separation from one another and from any other process : (a) Manipulation of dry compounds of lead ; (b) Pasting; (c) Formation, and lead burning necessarily carried on therewith ; (d) Melting down of old plates. Provided that manipulation of dry compounds of lead carried on as in Regulation 5 (b) need not be separated from pasting. 3. The floors of the rooms in which manipulation of dry compounds of lead or pasting is carried on shall be of cement or similar impervious material, and shall be kept constantly moist while work is being done. The floors of these rooms shall be washed with a hose pipe daily. * The term "lead process" to which a defined meaning is given is printed throughout in italics. FACTORY AND WORKSHOP ORDERS 229 4. Every melting pot shall be covered with a hood and shaft so arranged as to remove the fumes and hot air from the workrooms. Lead ashes and old plates shall be kept in receptacles specially provided for the purpose. 5. Manipulation of dry compounds of lead in the mixing of the paste or other processes, shall not be done except (a) in an apparatus so closed, or so arranged with an exhaust draught, as to prevent the escape of dust into the workroom ; or (b) at a bench provided with (1) efficient exhaust draught and air guide so arranged as to draw the dust away from the worker, and (2) a grating on which each receptacle of the compound of lead in use at the time shall stand. 6. The benches at which pasting is done shall be covered with sheet lead or other impervious material, and shall have raised edges. 7. No woman, young person, or child shall be employed in the manipulation of dry compounds of lead or in pasting. 8. (a) A duly qualified medical practitioner (in these Regulations referred to as the "Appointed Surgeon ") who may be the Certifying Surgeon, shall be appointed by the occupier, such appointment unless held by the Certifying Surgeon to be subject to the approval of the Chief In- spector of Factories. (b) Every person employed in a lead process shall be examined once a month by the Appointed Surgeon, who shall have power to suspend from employment in any lead process. (c) No person after such suspension shall be employed in a lead process without written sanction entered in the Health Register by the Appointed Surgeon. It shall be sufficient compliance with this Regulation for a written certificate to be given by the Appointed Surgeon and attached to the Health Register, such certificate to be replaced by a proper entry in the Health Register at the Appointed Surgeon's next visit. (d) A Health Register in a form approved by the Chief 230 LEAD POISONING Inspector of Factories shall be kept, and shall contain a list of all persons employed in lead processes. The Appointed Surgeon will enter in the Health Register the dates and results of his examinations of the persons employed and particulars of any directions given by him. He shall on a prescribed form furnish to the Chief Inspector of Factories on the ist day of January in each year a list of the persons suspended by him during the previous year, the cause and duration of such suspension, and the number of examina- tions made. The Health Register shall be produced at any time when required by H.M. Inspectors of Factories or by the Certify- ing Surgeon or by the Appointed Surgeon. 9. Overalls shall be provided for all persons employed in manipulating dry compounds of lead or in pasting. The overalls shall be washed or renewed once every week. 10. The occupier shall provide and maintain — {a) A cloakroom in which workers can deposit clothing put off during working hours. Separate and suitable arrangements shall be made for the storage of the overalls required in Regulation 9. (b) A dining-room unless the factory is closed during meal hours. 1 1. No person shall be allowed to introduce, keep, prepare or partake of any food, drink, or tobacco, in any room in which a lead process is carried on. Suitable provisions shall be made for the deposit of food brought by the workers. This Regulation shall not apply to any sanitary drink provided by the occupier and approved by the Appointed Surgeon. 12. The occupier shall provide and maintain for the use of the persons employed in lead processes a lavatory, with soap, nail brushes, towels, and at least one lavatory basin for every five such persons. Each such basin shall be provided with a waste pipe, or the basins shall be placed on a trough fitted with a waste pipe. There shall be a constant supply of hot and cold water laid on to each basin. FACTORY' AND WORKSHOP ORDERS 231 Or, in the place of basins the occupier shall provide and maintain troughs of enamel or similar smooth impervious material, in good repair, of a total length of two feet for every five persons employed, fitted with waste pipes, and without plugs, with a sufficient supply of warm water con- stantly available. The lavatory shall be kept thoroughly cleansed and shall be supplied with a sufficient quantity of clean towels once every day. 13. Before each meal and before the end of the day's work, at least ten minutes, in addition to the regular meal times, shall be allowed for washing to each person who has been employed in the manipulation of dry compounds of lead or in pasting. Provided that if the lavatory accommodation specially reserved for such persons exceeds that required by Regula- tion 12, the time allowance may be proportionately reduced, and that if there be one basin or two feet of trough for each such person this Regulation shall not apply. 14. Sufficient bath accommodation shall be provided for all persons engaged in the manipulation of dry compounds of lead or in pasting, with hot and cold water laid on, and a sufficient supply of soap and towels. This rule shall not apply if in consideration of the special circumstances of any particular case, the Chief Inspector of Factories approves the use of local public baths when conveniently near, under the conditions (if any) named in such approval. 15. The floors and benches of each workroom shall be thoroughly cleansed daily, at a time when no other work is being carried on in the room. Duties of Persons Employed. 16. All persons employed in lead processes shall present themselves at the appointed times for examination by the Appointed Surgeon as provided in Regulation 8. No persons after suspension shall work in a lead process, 232 LEAD POISONING in any factory or workshop in which electric accumulators are manufactured, without written sanction entered in the Health Register by the Appointed Surgeon. 17. Every person employed in the manipulation of dry compounds of lead or in pasting shall wear the overalls provided under Regulation 9. The overalls, when not being worn, and clothing put off during working hours, shall be deposited in the places provided under Regulation 10. 18. No person shall introduce, keep, prepare, or partake of any food, drink (other than any sanitary drink provided by the occupier and approved by the Appointed Surgeon), or tobacco, in any room in which a lead process is carried on. 19. No person employed in a lead process shall leave the premises or partake of meals without previously and care- fully Gleaning and washing the hands. 20. Every person employed in the manipulation of dry compounds of lead or in pasting shall take a bath at least once a week. 21. No person shall in any way interfere, without the concurrence of the occupier or manager, with the means and appliances provided for the removal of the dust or fumes, and for the carrying out of these Regulations. These Regulations shall come into force on the 1st day of January, 1904. A. Akers-Douglas, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 21st November, 1903. For the Manufacture of Paints and Colours * 1907. No. 17. Whereas the manufacture of paints and colours has been certified in pursuance of Section 79 of the Factory and Workshop Act, 1901^ to be dangerous ; * These Regulations were gazetted January 25, 1907. + 1 Edw. 7, c. 22. FACTORY AND WORKSHOP ORDERS 233 I hereby in pursuance of the powers conferred on me by that Act make the following Regulations, and direct that they shall apply to all factories and workshops in which dry carbonate of lead or red lead is used in the manufacture of paints and colours or chromate of lead is produced by boiling, provided as follows ; (1) The Regulations shall not apply to factories and workshops in which paints and colours are manufactured, not for sale, but solely for use in the business of the occupier ; or to factories or workshops in which only the manufacture of artists' colours is carried on ; or to the manufacture of varnish paints. (2) Regulation 2, and so much of Regulation 3 as prevents the employment of a woman in manufacturing lead colour, shall not apply to the packing in parcels or kegs not ex- ceeding 14 lb. in weight, unless and until so required by notice in writing from the Chief Inspector of Factories. (3) Regulations 4, 5, 6, 11, and 12 shall not apply to factories or workshops in which the grinding of lead colour occupies less than three hours in any week, unless and until so required by notice in writing from the Chief Inspector of Factories. Definitions.* For the purpose of these Regulations — " Lead colour '' means dry carbonate of lead and red lead, and any colour into which either of these substances enters. " Lead process " means any process involving the mixing, crushing, sifting, grinding in oil, or any other manipulation of lead colour giving rise to dust ; or the manufacture and manipulation of chromate of lead produced by boiling in the colour house. It shall be the duty of the occupier to observe Part I. of these Regulations. * The terms "lead colour" and "lead process" to which defined meanings are given are printed throughout in italics. 234 LEAD POISONING It shall be the duty of all persons employed to observe Part II. of these Regulations. Part I. Duties of Employers. i. No lead colour shall be placed in any hopper or shoot without an efficient exhaust draught and air guide so arranged as to draw the dust away from the worker as near as possible to the point of origin. 2. No lead process shall be carried on, save either — (a) with an efficient exhaust draught and air guide so arranged as to carry away the dust or steam as near as possible to the point of origin ; or (6) in the case of processes giving rise to dust, in an apparatus so closed as to prevent the escape of dust. Provided that this Regulation shall not apply to the immersion and manipulation of lead colour in water. 3. No woman, young person, or child shall be employed in manipulating lead colour. 4. Every person employed in a lead process or at the roller mills connected with the grinding in oil of lead colour (hereinafter referred to as the roller mills *) shall once in each calendar month, on a date of which notice shall be given to every such person, be examined by the Certifying Surgeon of the district or other duly qualified medical prac- titioner (hereinafter referred to as the Appointed Surgeon) if appointed for the purpose by the Chief Inspector of Factories by a certificate under his hand and subject to such conditions as may be specified in that certificate. The Certifying or Appointed Surgeon shall have power to suspend from employment in any lead process or at the roller mills. 5. No person after suspension in accordance with Regula- * The term "roller mills" to which a defined meaning is given is printed throughout in italics. FACTORY AND WORKSHOP ORDERS 235 tion 4 shall be employed in any lead process or at the roller mills without written sanction entered in the Health Register by the Certifying or Appointed Surgeon. 6. A Health Register in a form approved by the Chief Inspector of Factories shall be kept and shall contain a list of all persons employed in any lead process or at the roller mills. The Certifying or Appointed Surgeon will enter therein the dates and results of his examinations of such persons with particulars of any directions given by him. The Health Register shall be produced at any time when required by any of His Majesty's Inspectors of Factories or by the Certifying or Appointed Surgeon. 7. Overalls shall be provided for all persons employed in lead processes or at the roller mills ; and shall be washed or renewed at least once every week. 8. The occupier shall provide and maintain for the use of all persons employed in lead processes or at the roller mills — (a) a cloakroom or other suitable place in which such persons can deposit clothing put off during working hours, and separate and suitable arrangements for the storage of overalls required by Regulation 7 ; (b) a dining-room, unless all workers leave the factory during meal hours. 9. No person shall be allowed to introduce, keep, prepare, or partake of any food, drink (other than a medicine pro- vided by the occupier and approved by the Certifying or Appointed Surgeon), or tobacco in any room in which a lead process is carried on. Suitable provision shall be made for the deposit of food brought by persons employed. 10. The occupier shall provide and maintain in a cleanly state and in good repair for the use of persons employed in lead processes or at the roller mills a lavatory containing either — (a) at least one lavatory basin for even- five such persons, fitted with a waste pipe, or placed in a 236 LEAD POISONING trough having a waste pipe, and having a constant supply of cold water laid on and a sufficient supply of hot water constantly available ; or (b) troughs of enamel or similar smooth impervious material, fitted with waste pipes without plugs, and having a constant supply of warm water laid on. The length of such troughs shall be in a proportion of not less than two feet for every five persons employed in lead processes or at the roller mills. He shall also provide in the lavatory soap, nail brushes, and a sufficient supply of clean towels renewed daily. Part II. Duties of Persons Employed. 11. All persons employed in lead processes or at the roller mills shall present themselves at the appointed time for examination by the Certifying or Appointed Surgeon as provided in Regulation 4. 12. No person after suspension under Regulation 4 shall work in a lead process or at the 1 oiler mills in any paint and colour factory or workshop to which these Regulations apply without written sanction entered in the Health Register by the Certifying or Appointed Surgeon. 13. All persons employed in lead processes or at the roller mills shall wear the overalls provided under Regulation 7 and shall deposit such overalls and any clothing put off during working hours in the places provided under Regula- tion 8. The overalls shall not be removed by persons employed from the factory or worshop. 14. No person shall introduce, keep, prepare, or partake of any food, drink (other than a medicine provided by the occupier and approved by the Certifying or Appointed Surgeon), or tobacco in any room in which a lead process is carried on. 15. All persons employed in lead processes or at the roller FACTORY AND WORKSHOP ORDERS 237 mills shall carefully clean and wash their hands before leaving the premises or partaking of any food. 16. No person shall, without the permission of the occupier or manager, interfere in any way with the means and appliances provided for the removal of dust, steam, or fumes, and for the carrying out of these Regulations. These Regulations shall come into force on 1st February , 1907. H. J. Gladstone, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, January 21, 1907. For the Heading of Yarn dyed by Means of a Lead Compound* 1907. No. 616. Whereas the process of heading of yarn dyed by means of a lead compound has been certified in pursuance of Section 79 of the Factory and Workshop Act, 1901,! to be dangerous ; I hereby, in pursuance of the powers conferred on me by that Act, make the following Regulations, and direct that they shall apply to all factories in which the said process is carried on. Provided that if the Chief Inspector of Factories is satis- fied, with regard to any such factory, that the heading of yarn dyed by means of a lead compound will not occupy more than three hours in any week, he may, by certificate, suspend Regulations 2, 3, 4, 7 (a), and 8 (a), or any of them. Every such certificate shall be in writing, signed by the Chief Inspector of Factories, and shall be revocable at any time by further certificate. * These Regulations were gazetted August 13, 1907. •j- 1 Edw. 7, c. 22. 238 LEAD POISONING Definitions.* "Heading" means the manipulation of yarn dyed by means of a lead compound over a bar or post, and includes picking, making-up, and noddling. " Employed " means employed in heading of yarn dyed by means of a lead compound. " Surgeon " means the Certifying Factory Surgeon of the district or a duly qualified medical practitioner appointed by certificate under the hand of the Chief Inspector of Factories, which appointment shall be subject to such con- ditions as may be specified in that certificate. " Suspension " means suspension by written certificate in the Health Register, signed by the Surgeon, from employ- ment in heading of yarn dyed by means of a lead com- pound. Duties. It shall be the duty of the occupier to observe Part I. of these Regulations. It shall be the duty of all persons employed to observe Part II. of these Regulations. Part I. Duties of Employers. i. No yarn dyed by means of a lead compound shall be headed unless there be an efficient exhaust draught so arranged as to draw the dust away from the worker, as near as possible to the point of origin. The speed of the draught at the exhaust opening shall be determined at least once in every three months and recorded in the General Register. 2. No person under 16 years of age shall be employed. 3. A Health Register, containing the names of all persons employed, shall be kept in a form approved by the Chief Inspector of Factories. * Terms to which defined meanings are given are printed throughout in italics. FACTORY AND WORKSHOP ORDERS 239 4. Every person employed shall be examined by the Surgeon once in every three months (or at shorter intervals if and as required in writing by the Chief Inspector of Factories) on a date of which due notice shall be given to all concerned. The Surgeon shall have power of suspension as regards all persons employed, and no person after suspension shall be employed without written sanction from the Surgeon entered in the Health Register. 5. There shall be provided and maintained for the use of all persons employed — (a) a suitable cloakroom for clothing put off during working hours ; (b) a suitable meal-room separate from any room in which heading of yarn dyed by means of a lead compound is carried on, unless the works are closed during meal hours ; and, if so required by notice in writing from the Chief Inspector of Factories, (c) suitable overalls and head-coverings which shall be collected at the end of every day's work, and be washed and renewed at least once every week ; (d) a suitable place, separate from the cloakroom and meal-room, for the storage of the overalls and head-coverings. 6. There shall be provided and maintained in a cleanly state and in good repair, for the use of all persons employed, a lavatory, under cover, with a sufficient supply of clean towels, renewed daily, and of soap and nail brushes, and with either — (a) a trough with a smooth impervious surface, fitted with a waste pipe without plug, and of such length as to allow at least two feet for every five such persons, and having a constant supply of warm water from taps or jets above the trough at intervals of not more than two feet ; or 240 LEAD POISONING (b) at least one lavatory basin for every five such persons, fitted with a waste pipe and plug or placed in a trough having a waste pipe, and having either a constant supply of hot and cold water or warm water laid on, or (if a constant supply of heated water be not reasonably prac- ticable) a constant supply of cold water laid on and a supply of hot water always at hand when required for use by persons employed. Part II. Ditties of Persons Employed. 7. Every person employed shall — (a) present himself at the appointed time for examina- tion by the Surgeon as provided in Regulation 4 ; (b) wear the overall and head-covering (provided in pursuance of Regulation 5 (c) ) while at work, and shall remove them before partaking of food or leaving the premises, and shall deposit in the cloakroom, provided in pursuance of Regula- tion 5 (a), clothing put off during working hours ; (c) wash the hands before partaking of food or leaving the premises. 8. No person shall — (a) work in heading of yarn dyed by means of a lead compound after suspension, without written sanction from the Surgeon entered in the Health Register ; (b) introduce, keep, prepare, or partake of any food or drink, or tobacco, in any room in which heading of yarn dyed by means of a lead compound is carried on ; (c) interfere in any way, without the concurrence of the occupier or manager, with the means and appli- FACTORY AND WORKSHOP ORDERS 241 ances provided for the removal of the dust, and for the carrying out of these Regulations. H. J. Gladstone, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 6th August, 1907. For the Smelting of Materials containing Lead, the Manufacture of Red or Orange Lead, and the Manufacture of Flaked Litharge* 1911. No. 752. In pursuance of Section 79 of the Factory and Workshop Act, 1901,^ I hereby make the following Regulations, and direct that they shall apply to all factories and workshops or parts thereof (other than laboratories), in which any of the following processes are carried on : — THE SMELTING OF MATERIALS CONTAINING LEAD ; THE MANUFACTURE OF RED OR ORANGE LEAD ; THE MANUFACTURE OF FLAKED LITHARGE. These Regulations shall come into force on October 1st, 191 1, except that so much of Regulations 2 and 3 as requires the provision of efficient exhaust draught shall come nto force on May ist, 19 12. Definitions.^ In these Regulations : — "Lead material" means — (i.) material containing not less than five per cent, of lead, including lead ore, bullion ore (lead ore rich in precious metals), red lead, orange lead, and flaked litharge, and * These Regulations were gazetted August 18, 1911. t 1 Edw. 7, c. 22. X Terms to which defined meanings are given are printed throughout the Regulations in italics. 16 242 LEAD POISONING (ii.) zinc ore, and material resulting from the treatment thereof, containing not less than two per cent, of lead ; except ores which contain lead only in the form of sulphide of lead. "Furnace," " melting pot," •" retort," " condensing chamber," mean structures as aforesaid which are used in the treatment of lead material. " Flue " means a flue leading from a furnace. " Lead process " means — (i.) manipulation, movement or other treatment of lead material, whether by means of any furnace, melting pot, retort, condensing chamber, flue, or otherwise ; and (ii.) cleaning or demolition of any furnace, melting pot, retort, condensing chamber, flue, or part thereof or reconstruction thereof with material which has formed part of any such structure. "Surgeon" means the Certifying Factory Surgeon of the district or a duly qualified medical practitioner appointed by written certificate of the Chief Inspector of Factories, which appointment shall be subject to such conditions as may be specified in that certificate. " Suspension " means suspension from employment in any lead process by written certificate in the Health Register, signed by the Surgeon, who shall have power of suspension as regards all persons employed in any lead process. " Damp " means sufficiently moist to prevent the escape of dust. "Efficient exhaust draught" means localized ventilation effected by heat or mechanical means, for the removal of gas, vapour, fumes or dust so as to prevent them (as far as practicable under the atmospheric conditions usually pre- vailing) from escaping into the air of any place in which work is carried on. No draught shall be deemed efficient which fails so to remove smoke generated at the point where such gas, vapour, fumes or dust originate. FACTORY AND WORKSHOP ORDERS 243 Duties. It shall be the duty of the occupier to observe Part I. of these Regulations. It shall be the duty of every person employed to observe Part II. of these Regulations. Part I. — Duties of Occupiers. 1. Where a lead process is carried on so as to give rise to dust or fumes, (a) the floor, other than sand beds, shall be maintained in good condition ; and (b) the floor, except such portion as is permanently set apart for the deposit of lead material, shall be sprayed with water at least once a day. 2. (1) No lead material (other than ingots of metal) shall be deposited or allowed to remain on any part of the floor not permanently set apart for the purpose, and no lead material (other than ingots of metal) shall be moved to a furnace, unless such lead material is — (a) damp ; or (b) under an efficient exhaust draught ; or (c) so enclosed as to prevent the escape of dust into the air of any place in which work is carried on. (2) Provided, however, that where none of the above conditions are practicable, lead material may be moved to a furnace by persons wearing suitable respirators. 3. None of the following processes shall be carried on except with an efficient exhaust draught : — melting old or dirty scrap lead ; heating lead material so that vapour containing lead is given off ; cooling molten flaked litharge ; or, unless carried on in such manner as to prevent escape of gas, vapour, fumes or dust into any place in which work is carried on — 244 LEAD POISONING feeding any furnace or retort ; manipulating lead material in any furnace or retort ; removing lead material from any furnace or retort ; placing in any hopper or shoot, or packing, red or orange lead or flaked litharge. 4. No sack which has contained lead material shall be cleaned, and, except in the process of sampling, no lead material shall be broken up, crushed or ground, unless such sack or lead material is damp, or is placed in an apparatus so enclosed as to prevent the escape of dust. 5. No lead material giving off vapour containing lead shall be removed from the efficient exhaust draught required by Regulation 3, unless in a receptacle with an efficient cover. 6. No person shall be allowed to enter any furnace, melt- ing pot, retort, condensing chamber, or Hue, until it has been ventilated. 7. No person shall be allowed to remain in any flue (unless damp) or condensing chamber for more than three hours without an interval of at least half an hour. 8. There shall be provided suitable overalls for the use of all persons employed in any of the following processes ; which overalls, when required for such use, shall be washed, cleaned or renewed at least once every week : — (a) cleaning any flue (unless damp) or condensing chamber ; (b) demolishing any part of a furnace, melting pot, retort, condensing chamber, or flue, unless either damp or under an efficient exhaust draught ; (c) reconstructing any part of a furnace, melting pot, retort, condensing chamber, or flue, with material which has formed part of any such structure, unless damp ; {d) breaking up, crushing, or grinding, in the process of sampling, lead material, unless either damp or placed in an apparatus so enclosed as to prevent the escape of dust ; (e) placing in any hopper or shoot, or packing, red or orange lead or flaked litharge. FACTORY AND WORKSHOP ORDERS 245 9. There shall be provided suitable respirators for the use of all persons employed in any process named in Regulation 2 (2) or in Regulation 8 ; which respirators, when required for such use, shall be washed or renewed at least once every day. 10. No person under 16 years of age, and no female, shall be employed in any lead process. 11. There shall be provided and maintained for the use of all persons employed in any lead process : — (a) a suitable meal-room, unless the works are closed during meal hours ; (b) a suitable place or places for clothing put off during working hours ; and (c) a suitable place or places for the storage of overalls provided in pursuance of Regulation 8 ; which place or places shall be separate from those required by paragraphs (a) and (b) of this Regulation ; all of which shall be so located as not to be exposed to dust or fumes from any manufacturing process. 12. There shall be provided and maintained in a cleanly state and in good repair for the use of all persons employed in any lead process : — (a) a lavatory, under cover, with a sufficient supply of clean towels, renewed daily, and of soap and nail brushes, and with either : — (i.) a trough with a smooth impervious sur- face, fitted with a waste-pipe without plug, and of such length as to allow at least two feet for every five such persons employed at any one time, and having a constant supply of warm water from taps or jets above the trough at intervals of not more than two feet ; or (ii.) at least one lavatory basin for every five such persons employed at any one time, fitted with a waste-pipe and plug, and having either a constant supply of hot and cold water or warm 246 LEAD POISONING water laid on, or (if a constant supply of heated water be not reasonably practicable) a constant supply of cold water laid on, and a supply of hot water always at hand when required for use by such persons ; and {b) sufficient and suitable bath accommodation (douche or other) with hot water laid on, unless the water supply provided under paragraph (a) is so arranged that a warm douche for the face, neck and arms can be taken. Provided that, when the number of persons so employed at any one time is temporarily increased by reason of Hue cleaning, it shall not be necessary to provide (by reason only of such temporary increase) additional accommodation in pursuance of paragraph (a) of this Regulation if adequate time is allowed to all such persons for washing immediately before each meal (in addition to the regular meal times), and immediately before the end of the day's work. 13. (a) Every person employed in a lead process shall be examined by the Surgeon once in every calendar month (or at such shorter or longer intervals as may be prescribed in writing by the Chief Inspector of Factories) on a date of which due notice shall be given. (b) A Health Register containing the names of all persons employed in any lead process shall be kept in a form approved by the Chief Inspector of Factories. (c) No person after suspension shall be employed in any lead process without written sanction from the Surgeon, entered in the Health Register. Part II. — Duties of Persons Employed. 14. (a) Every person employed in any lead process shall deposit in the place or places provided in pursuance of Regulation 1 1 (b) all clothing put off during working hours. (b) Every person for whose use an overall is provided in pursuance of Regulation 8 shall wear the overall when employed in any process named in that Regulation, and FACTORY AND WORKSHOP ORDERS 247 remove it before partaking of food or leaving the premises, and deposit it in the place provided under Regulation 11 (c). (c) Every person for whose use a respirator is provided in pursuance of Regulation 9, shall wear the respirator while employed in any process to which Regulation 2 (2) or Regulation 8 applies. 15. No person employed shall introduce, keep, prepare, or partake of any food or drink (other than a non-alcoholic drink approved by the Surgeon), or make use of tobacco, in any place in which any lead process is carried on ; Provided that, except in processes named in Regulation 8, this Regulation shall not prevent any person from using tobacco, other than a cigar or cigarette, if his hands are free from lead. 16. Every person employed in any lead process, or in any- place where any lead process is being carried on, shall, before partaking of food, wash the face and hands, and before leaving the premises, wash the face, neck, and arms, in the lavatory provided in pursuance of Regulation 12. 17. Every person employed in any lead process shall present himself at the appointed time for examination by the Surgeon, in pursuance of Regulation 13 (a). 18. No person employed shall, after suspension under these Regulations, or under any other Regulations or Special Rules applying to factories or workshops where any process involving the use of lead is carried on, work in any lead process without written sanction from the Surgeon entered in the Health Register. 19. No person employed shall interfere in any way, without the concurrence of the occupier or manager, with the means provided for the removal of gas, vapour, fumes, and dust, and for the carrying out of these Regulations. W. S. Churchill, One of His Majesty's Principal Secretaries of State Home Office, Whitehall, August 12, 1911. 248 LEAD POISONING For the Manufacture and Decoration of Pottery.' 5 ' 1913. No. 2. In pursuance of Section 79 of the Factory and Workshop Act, 1901,1 I hereby make the following Regulations, and direct that they shall apply to all factories and workshops in which the manufacture or decoration of pottery or any process incidental thereto is carried on ; including factories and workshops in which lithographic transfers, frits, or glazes are made for use in the manufacture or decoration of pottery. Provided that, if at any time it is shown to the satisfac- tion of the Secretary of State in the case of any manufac- ture or process or any operation forming part thereof, that injury to health is adequately prevented byother appliances or under other conditions than those prescribed by these Regulations, he may, by Order, modify the whole or any part of the Regulations, so far as they apply to such manufacture or process. Any such Order may be revoked, modified, or extended by further Order. And provided, further, in regard to Regulation 10 (a), the Secretary of State may, by Order — (i.) grant exemptions from this Regulation in the case of any special branch of the industry if it can be shown that every means has been tried for the purpose of conforming to the prescribed limit ; (ii.) substitute a limit higher than 70 Fahrenheit in the case of printing or other specified shops, if it can be shown to be necessary. Definitions.% In these Regulations : " Pottery " includes earthenware, china, tiles, and any other articles made from clay, with or without the addition of other material. * These Regulations were gazetted January 7, 191 3. t 1 Edw. 7, c. 22. X Terms to which defined meanings are given are printed throughout in italics. FACTORY AND WORKSHOP ORDERS 249 " Coarse ware" means pottery not shaped by compres- sion of powdered material, and not fired more than once in the process of manufacture. In the case of a fireclay works in which the ware is generally fired only once, the whole of the works may, with the approval in writing of the Chief Inspector of Factories, be regarded as a coarse ware factory, notwithstand- ing that some of the clay ware is hardened by fire before any slip or body coating is applied to the fireclay body ; subject, however, to the following conditions : (i.) no slip or body coating shall be applied before such hardening ; (ii.) neither the ware so hardened nor any subsequently applied slip or body coat- ing shall be sandpapered or treated by any other process which would generate dust ; (iii.) the approval of the Chief Inspector of Factories shall be kept attached to the general register, and shall be subject to the further conditions, if any, specified therein, and shall be revocable by further notice in writing. " Leadless glaze " means a glaze which does not contain more than one per cent, of its dry weight of a lead compound calculated as lead monoxide. " Low solubility glaze " means (1) a glaze which does not yield to dilute hydrochloric acid more than five per cent, of its dry weight of a soluble lead compound calculated as lead monoxide when determined in the manner de- scribed below ; or (2) a glaze containing no lead or lead com- pound other than galena. 250 LEAD POISONING A weighed quantity of dried material is to be continuously shaken for one hour, at the common temperature, with i, coo times its weight of an aqueous solution of hydrochloric acid contain- ing C25 per cent, of HC1. This solu- tion is thereafter to be allowed to stand for one hour, and to be passed through a filter. The lead salt contained in an aliquot portion of the clear filtrate is then to be precipitated as lead sulphide, and weighed as lead sulphate. " Galena " means the native sulphide of lead con- taining not more than five per cent, of a soluble lead compound calculated as lead monoxide when determined in the manner described in the definition of low solubility glaze. Galena shall not for the purpose of these Regulations be deemed to be an unfritted lead compound. " Leadless glaze factory" means a factory the occupier of which has given an undertaking, to the satis- faction of the Chief Inspector of Factories, that none but leadless glaze shall be used therein, and in which none but leadless glaze is in fact used. "Low solubility glaze factory " means a factory the occupier of which has given an undertaking, to the satisfaction of the Chief Inspector of Factories, that none but low solubility glaze shall be used therein, and in which none but low solubility glaze is in fact used. "Majolica painting" includes painting in majolica or other glaze. " Surgeon " means the Certifying Factory Surgeon of the district, who shall have, as regards all persons examined by him in pursuance of these Regulations, power of suspension and of permis- sion to work, by certificate which may either be FACTORY AND WORKSHOP ORDERS 251 entered in the health register by the Surgeon personally, or be sent by him to the occupier. " Entered in the health register " means — (a) Entered in the prescribed register kept at the factory in pursuance of Regula- tion 3 ; or (b) Entered in the portable register pre- scribed for the use of casual workers. " Suspension " means suspension, by signed certificate of the Surgeon, from employment in any process in which examination by the Surgeon is required by these Regulations. "Permission to work" means permission, by signed certificate of the Surgeon, either — (a) Terminating a suspension, or (b) Permitting employment of a certain speci- fied kind. " Potter's shops " includes any place where tiles or other articles are made by pressing clay dust, as well as every place where articles of pottery are shaped by a plastic or other process. " Wedging of clay " means the treatment of clay which has not been pugged or rolled, by raising one piece of clay by hand and bringing it down upon another piece ; but does not include the process, frequently known as " slapping of clay," in which two pieces of clay, each small enough to be held in one hand, are slapped together. " Workroom " shall not, for the purposes of Regula- tion 10, include any stove or drying chamber which is not entered by workers except for the purpose of carrying ware in or out or turning it. " Bedding" means the placing of flat ware in powdered flint for the biscuit firing when the sagger or box containing the ware is filled up with powdered flint. 252 LEAD POISONING " Flinting" means the placing of flat ware in powdered flint for the biscuit firing when the sagger or box containing the ware is not filled up with powdered flint. " Scouring " includes fine brushing, as well as sand- papering, brushing, and every other" scouring process, as applied to biscuit ware. " Stopping of biscuit ware " means the filling up of cracks in ware which has been fired once and before glaze is applied to it. " Glost placing " includes the operations of carrying saggers of ware into the glost oven and carrying them out again after the glost firing, as well as the operation of placing the ware in the saggers for glost firing ; but not placing of ware on cranks or similar articles prior to their transfer to saggers or kilns by other persons. ''Flow material" means any material containing lead, which is placed in saggers, with a view to its entire or partial volatilization during the glost firing of the ware. " Thimble picking" means the picking over, sorting, or rearranging for further use, of thimbles, stilts, spurs, strips, saddles, or any similar articles which have been used for the support of articles of pottery during the process of glost firing. "Efficient exhaust draught" used in connection with a process means an exhaust draught which effectu- ally removes, as near as possible to the point of origin, the dust generated in the process. No draught shall be deemed to be efficient which fails effectually to remove smoke generated at any point where dust originates in the process. FACTORY AND WORKSHOP ORDERS 253 Part I. — Duties of Occupiers. 1. Age and Sex. (a) No women, young person, or child shall be employed in the following processes : X (i.) Stopping of biscuit ware with a material which yields to dilute hydrochloric acid more than five per cent, of its dry weight of a soluble lead compound calculated as lead monoxide when determined in the manner described in the definition of low solubility glaze ; * (ii.) weighing out, shovelling, or mixing of unfritted lead compounds in the preparation or manu- facture of frits, glazes, or colours ; *f (iii.) lawning of glaze, except where less than a quart of glaze is lawned at a time for the worker's own use ; J (iv.) preparation or weighing out of flow material, (*) (+) ( v cleaning, as prescribed in Regulation 12, of floors of potters' shops or stoves or any place in which any process included in the Schedule is carried on ; * (vi.) cleaning, as prescribed in Regulation 17, of boards used in the dipping house, dipper's drying room, ware cleaning room, or glost placing shop ; *X (vii.) cleaning of mangles or any part thereof ; % (viii.) washing of saggers with a wash which yields to dilute hydrochloric acid more than five per cent, of its dry weight of a soluble lead com- * The Regulations in question are marked * ; or in case of partial or conditional exemption (*). f The Regulations in question are marked f ; or in the case of partial or conditional exemption (t). % The Regulations in question are marked J ; or in case of partial or conditional exemption (\). 254 LEAD POISONING pound calculated as lead monoxide when deter- mined in the manner described in the definition of low solubility glaze. (b) No young person or child, other than a male young person who wedges clay only for his own use, shall be employed in the wedging of clay; and no woman shall be so employed without a certificate of permission to work. (c) No young person or child shall be employed in the carrying of clay, or other systematic carrying or lifting work, without a certificate of permission to work, specifying the maximum weight which he or she may carry ; and no young person or child so employed shall be allowed to lift or carry any weight in excess of that named in the certifi- cate. Provided that : — (i.) No certificate shall permit the carrying of more than 30 lb. by anyone under 16 years of age ; and (ii.) No girl under 16 years of age and no boy under 15 years of age shall be allowed to carry clay, except that such a worker who is working for himself or herself, and is not an attendant of another worker, shall be allowed to carry such clay as is to be used by himself or herself in making articles of pottery. (d) No female shall be employed for more than seven days as a wheel-turner for a thrower, without a certificate of permission to work. (e) No girl under 16 years of age shall be employed as a lathe treader. *t (/) No young person or child shall be employed as a dipper. *t (g) No girl under 17 years of age and no boy under 16 years of age shall be employed as a dipper's assistant or ware cleaner. *t (//) No woman, young person, or child shall be employed as a glost placer, except in the placing of china furniture or electrical fittings ; and no girl under 17 years FACTORY AND WORKSHOP ORDERS 255 of age and no boy under 16 years of age shall be employed as a glost placer in the placing of china furniture or electrical fittings. Except that male young persons over 16 years of age may be employed in the process of glost placing for the purpose of preparing saggers and assisting in the sagger-house during the drawing of ovens, provided that they shall not place any ware in the saggers. *(k) In low solubility glaze factories : — (i.) No person under 16 years of age shall be employed as a dipper ; (ii.) No person under 15 years of age shall be employed as a dipper's assistant, ware cleaner, or glost placer. (*) (J) (0 Except as provided in Regulation 1 (k) (ii.) no person under 16 years of age shall be employed in any process included in Part I. of the Schedule ; and no person under 15 years of age shall be employed in any process in- cluded in Part II. of the Schedule. (w) No female shall carry a sagger full of ware ; but (i.) the moving of such a sagger from one part of a bench to a contiguous part of the same bench on the same level ; or (ii.) the moving of such a sagger by any two females from a bench to the nearest convenient floor space in the same workroom if no saggers so moved are piled to a greater height than four feet, shall not be deemed to be a contravention of this require- ment. 2. Periodical Examinations. (*) (t) (+) ( a ) All persons employed in any process included in Part I. of the Schedule shall be examined once in each calendar month by the Surgeon ; and all persons employed in any process included in Part II. of the Schedule shall be examined once in every twelve months by the Surgeon. 256 LEAD POISONING (b) All persons for whom certificates of permission to work are required by Regulation i shall be examined by the Surgeon within seven days of the commencement of their employment in a process in which such a certificate is required. (c) All young persons and children employed in the carrying of clay, or other systematic carrying or lifting work, shall be re-examined by the Surgeon twice in the first period of six months, and once in each period of six months thereafter until they attain the age of 18. (d) Any female examined for employment as a wheel- turner shall be presented for re-examination at a later date, if the Surgeon considers it necessary. (*) (t) (X) ' e) The fees for all medical examinations made in pursuance of these Regulations shall be paid by the employer and shall not be charged to the worker, whether he be in regular or casual employment. Provided that casual workers examined at the Surgeon's surgery shall pay a fee of one shilling for each certificate entered in the portable register ; this fee shall be refunded by the occupier who first employs the worker after such examina- tion ; and the occupier shall record in the portable register the fact that the fee has been refunded. (*) (t) ■(+) (/) A notice shall be affixed in a prominent place in the factory, showing clearly the time appointed for the. Surgeon's periodical visit ; and an amending notice shall be affixed forthwith if it is found necessary to alter the date or hour ; wherever possible, not less than three days' notice of a change of date shall be given. (*) (t) (+) (§) A private room shall be provided for all medical examinations. No one shall be present except such other medical man as the Surgeon may with the worker's consent admit ; and in addition in the case of a female any one female relative may be present, or alterna- tively any one workwoman in the factory approved by the worker and the Surgeon. (*) (t) (+) (h) No person after suspension shall be allowed to work in any process in which examination by the Surgeon FACTORY AND WORKSHOP ORDERS 25; is required by these Regulations, without a certificate of permission to work. 3. Health, etc., Register. (*) (+) (|) (a) A register, in the form or forms prescribed, shall be kept, in which the Surgeon ma}' enter the dates and results of his visits, the number of persons examined in pursuance of these Regulations, and particulars of any directions given by him. This register shall contain a correct list of all persons emplo3 r ed in the processes included in the Schedule, and of all persons for whom a certificate has been obtained in pursuance of Regulation 1 ; as well as all other particulars required to be entered in the register in pursuance of these Regulations. (*) (t) (|) (6) The register shall be open to the inspec- tion of any worker so far as concerns the entries relating to that worker. All such entries as indicate the general health of the worker shall be so expressed as to be readily understood both by occupiers and persons employed. {*) (+) (±) (c) When a certificate of suspension or permis- sion to work is sent by the Surgeon to the occupier, it shall be forthwith attached to the register, and shall be kept so attached until replaced by a personal entry by the Surgeon in the register. 4. Overalls and Head-Coverings. (*) (±) (a) The occupier shall provide and maintain suitable overalls and head-coverings for all persons employed in the processes included in the Schedule ; except that head-coverings need not be provided for persons employed in majolica painting or glost placing. (*) (+) (b) Head-coverings shall be adequate to protect the hair from dust, and shall be worn in such a manner as to be effective for this purpose. (*) (c) The occupier shall provide and maintain suitable aprons of a waterproof or similar material which can be sponged daily, for all dippers, dippers' assistants, and ware 17 258 LEAD POISONING cleaners ; provided that, if the front of the overall supplied to any such worker in pursuance of these Regulations is made of a material which can be sponged daily, no separate apron need be provided for that worker. (*) (+) (d) No person shall be allowed to work in any process included in the Schedule without wearing the above-named overalls and head-coverings, as well as aprons when provided in pursuance of the preceding paragraph ; except that head-coverings need not be worn by persons employed in majolica painting or glosf placing. (*) (e) All aprons made of waterproof or similar material, and all overalls or parts of overalls made of such material, shall be thoroughly cleaned daily by the wearers by sponging or other wet process. All other overalls or parts of overalls and all head-coverings shall be washed or renewed at least once a week ; and the occupier shall pro- vide for washing, renewal, and necessary repairs of all overalls and head-coverings to be done either at the factory or at a laundry ; and no worker shall be allowed to take home any overalls, head-coverings, or aprons provided in pursuance of these Regulations. (*) (+) 00 All overalls, head-coverings, and aprons provided in pursuance of these Regulations, when not in use or being washed and repaired, shall be kept in proper custody ; for this purpose there shall be provided a cupboard or cupboards or room or rooms suitably situated and sufficiently large to hold the overalls, head-coverings, and aprons ; a separate peg shall be provided for each Worker who is required by these Regulations to wear overalls. 6. Food. (.*) (J) ( a ) No person shall be allowed to keep, or pre- pare, or partake of any food, drink, or tobacco, or to remain during meal-times in any place in which is carried on any process included in the Schedule, or the process of towing, or the process of tile-making by the compression of dust, or any other process which the Inspector of Factories FACTORY AND WORKSHOP ORDERS 259 for the district shall certify as sufficiently dusty to render the room in which it is carried on an unsuitable place, in his opinion, for persons to remain during meal-times. (*) (J) {b) Mess-room accommodation shall be provided for the workers employed in the processes included in the Schedule, and for such others as are excluded from their own workrooms during meal-times in pursuance of para- graph (a) of this Regulation. (*) (;) (c) This accommodation shall consist of a clean, well-ventilated, and well-lighted room or rooms in which no manufacturing process is carried on ; it shall be at or near the factory, and shall be sufficiently large to accom- modate all the workers employed in the processes included in the Schedule and all others who are excluded from their own workrooms during meal-times in pursuance of para- graph (a) of this Regulation, allowing floor space in accord- ance with the following scale : — In mess-rooms for — 6 persons and under it»i sq. ft. per person. Over 6 persons and up to 12 ... 7^ „ „ „ 12 „ „ 20 ... 6 >, 20 „ „ 28 ... si „ ,, 28 „ ,, any number 5 „ ,, (*) (±) (d) Provided that if the Inspector of Factories for the district shall certify that in his opinion the special circumstances of any factory are such as to render the provision of mess-room accommodation for all such workers unnecessary, it shall be sufficient to provide accommoda- tion, calculated on the above scale, for such a proportion of all such workers as is named on the certificate of the Inspector; but in no case shall this proportion be less than one-third, subject, in cases of difficulty, to appeal to H.M. Chief Inspector of Factories ; and the Inspector for the district shall have the right, at any time, to cancel or amend any such certificate. (*) (+) ( e ) All mess-rooms provided in pursuance of this 260 LEAD POISONING Regulation shall be furnished with proper tables and seats ; provision shall be made for maintaining a proper temperature not below 55 degrees Fahrenheit ; and all mess-rooms shall be thoroughly cleaned daily at the occupier's expense. (*) (|) (/) No person shall be allowed to take into a mess-room any overall, head-covering, or apron, worn in a process included in the Schedule. (t) (i) The washing conveniences prescribed by the Regulations shall not be maintained in any mess-room. (*) (!) V 1 ) A suitable place for the deposit of food shall be provided for each worker using the mess-room. Such provision shall not be made in a room in which any manufacturing process is carried on, and shall be subject in each case to the approval of the Inspector of Factories for the district. (*) (J) (^') Adequate facilities shall be provided to enable workpeople to heat their food. (*) (!) (0 A supply of milk, or cocoa made with milk, shall be provided for all women and young persons work- ing in processes included in Part I. of the Schedule, who commence work before 9 a.m. Not less than half a pint shall be provided for each such worker at the expense of the occupier. 7. Suppression of Dust. (a) The following processes shall not be carried on without the use of an efficient exhaust draught : — J (i.) The fettling of flat ware, whether china or earthenware, by towing or sandpapering, pro- vided that this shall not apply to the occasional finishing of pieces of china or earthenware without the aid of mechanical power ; J (ii.) The sand-sticking of sanitary ware ; % (iii.) Any other process of fettling on a wheel driven by mechanical power, except where : FACTORY AND WORKSHOP ORDERS 261 (a) The fettler is fettling, as an occasional operation, only ware of his or her own making ; or (b) The fettling is done wholly with a wet sponge or other moist material ; or (c) The fettling is done by the worker who has made the articles, whilst the latter are still in a moist state. i (iv.) The sifting of clay dust for making tiles or other articles by pressure, except where : (a) This is done in a machine so enclosed as effectually to prevent the escape of dust ; or (b) The material to be sifted is so damp that no dust can be given off. t (v.) The pressing of tiles from clay dust, an exhaust opening being connected with each press ; this clause shall also apply to the pressing from clay dust of articles other than tiles, unless the material is so damp that no dust is given off. t ivi.) The fettling of tiles made from clay dust by pressure, exxept where the fettling is done wholly on or with damp material ; this clause shall also apply to the fettling of other articles made from clay dust, unless the material is so damp that no dust is given off. i (vii.) The processes of bedding and flinting. J (viii.) The brushing of earthenware biscuit, unless the process is carried on in a room provided with efficient general mechanical ventilation or other ventilation which is certified by the Inspector of Factories for the district as adequate, having regard to all the circum- stances of the case. % (ix.) Scouring of biscuit ware which has been fired in powdered flint, except where this is done in machines so enclosed as effectually to prevent the escape of dust. 262 LEAD POISONING X (x.) Batting of biscuit ware which has been fired in powdered flint. X (xi.) Glaze blowing. f ( x "- ) Ware cleaning after the application of glaze by dipping or other process, except as set forth later in this Regulation. 1 (xiii.) The preparation of weighing out of flow material which yields to dilute hydrochloric acid more than five per cent, of its dry weight of a soluble lead compound calculated as lead monoxide when determined in the manner described in the definition of low solubility glaze. | (xiv.) The lawning of dry colours, except where not more than an ounce at a time is lawned for use in painting. X (xv.) Ground laying, including the wiping off of colour after its application to the surface of the ware. X (xvi.) Colour dusting, whether under-glaze or on- glaze, including the wiping off of colour after its application to the surface of the ware. | (xvii.) Colour blowing or aerographing, whether under-glaze or on-glaze, including the wiping off of colour after its application to the surface of the ware. | (xviii.) The making of lithographic transfers, in- cluding the wiping off of colour after its application to the surface of the transfer sheets. (b) In the process of mould-making, every bin or similar receptacle used for holding plaster of Paris shall be provided with an efficient exhaust draught so arranged as to prevent the escape of plaster of Paris dust into the air of the workplace ; except where a cover is provided for the bin or other receptacle, and the plaster of Paris is conveyed in a sack, the mouth of which is tied and only loosened after it has been placed in the bin or other receptacle. FACTORY AND WORKSHOP ORDERS 263 (c) The dry grinding of materials for pottery bodies shall be done either with an efficient exhaust draught for the removal of dust, or in machines so enclosed as effectually to prevent the escape of dust ; except that it shall not be deemed necessary in pursuance of this Regulation to provide an exhaust draught to remove small amounts of dust given off at the hopper of an enclosed machine in the course of feeding the same, if an outlet into an exhaust duct or to the outside air is fitted to the receptacle into which the powdered material is delivered. (d) In the process of sand-sticking of sanitary ware, suit- able provision shall be made for collecting any material which falls on the floor. I (e) In the process of making tiles from clay dust by pressure, supplies of material shall be conveyed to the work benches in such a manner as to disperse as little dust as possible into the air ; clay dust shall not be carried into any press shops in sacks except where hoppers or similar receptacles are provided for receiving the clay dust, in which case a sack in sound repair shall be used and the mouth of the sack shall be tied and only loosened after it has been placed in the hopper or other receptacle, which shall be provided with a cover. This clause shall also apply to the making from clay dust of articles other than tiles, unless the material is so damp that no dust is given off. % (/) After one year from the date on which these Regulations come into force, biscuit flat ware which has been bedded for firing shall not be removed from the saggers after firing, except at a bench fitted with an efficient exhaust appliance for the removal of dust. % (g) Flat-knocking and fir ed-flint- sifting shall be carried on only in enclosed receptacles, which shall be connected with an efficient exhaust draught unless so contrived as to prevent effectually the escape of dust. * (//) In the process of ware cleaning of earthenware after the application of glaze by dipping or other process, wherever it is practicable to use damp sponges or other 264 LEAD POISONING damp materials they shall be provided in addition to the knife or other instrument, and shall be used. *t (k) Nothing in these Regulations shall render it compulsory to provide an exhaust draught for ware clean- ing if this process is carried on entirely with the use of wet materials ; or if the ware cleaning be done within 15 minutes after the moment when the glaze was applied ; but an efficient exhaust draught shall always be provided and used if any dry materials or implements, such as knives or scrapers, are used after the glaze is dry or more than 15 minutes after the moment when the glaze was applied. * (/) In the process of ware cleaning, after the applica- tion of glaze by dipping or other process, sufficient arrange- ments shall be made for any glaze scraped off, which is not removed by the exhaust draught, to fall into water. All water troughs or other receptacles provided in pursuance of this clause shall be cleaned out and supplied with fresh water as often as necessary, and in no case less often than once a week ; and no scrapings of glaze shall be allowed to collect in a dry condition on the sides of the water receptacle. Where grids or gratings are fitted over the water trough or other receptacle named in the foregoing paragraph, they shall be kept clean by repeated sponging or wiping with wet material during the time that the process of ware cleaning is being carried on. No boards or other articles shall be placed, even temporarily, on any such water trough, in such a way as to interfere with the efficient use of the trough . (111) In all processes the occupier shall, as far as practic- able, adopt efficient measures for the removal of dust and for the prevention of any injurious effects arising there- from. (/;) Every process for which an exhaust draught is prescribed shall be carried on inside a hood or exhaust funnel ; provided that, where the occupier can show that this is impracticable, it shall be sufficient if the work is done within the effective range of an exhaust opening. FACTORY AND WORKSHOP ORDERS 265 8. Respirators. (a) No person shall be allowed to work without wearing a suitable and efficient respirator, such as a damp sponge tied across the mouth and nostrils, in any of the following processes : — (i.) The emptying of sacks of plaster of Paris into a bin in a mould-making shop ; * (ii.) The weighing out, and shovelling, or mixing of unfritted lead compounds, in the preparation or manufacture of frits, glazes or colours con- taining lead, or any process carried on in a room wherein any such weighing out, shovelling, or mixing has taken place within the previous thirty minutes ; unless an efficient exhaust draught is provided to prevent the escape of dust into the air of the workplace. (b) All respirators required by this Regulation shall be provided and maintained in a cleanly state by the occupier ; and each respirator shall bear the distinguishing mark of the worker to whom it is supplied. 9. Ventilation. I (a) Every place in which any worker or workers are employed shall be thoroughly ventilated. I (b) All workrooms in which articles are left to dry shall be ventilated in such a way as to insure a continuous movement of the air in the room in a direction away from the workers and towards the articles in question. I (c) All drying stoves shall be ventilated direct to the outside air by shafts having upward inclinations and ter- minating vertically, or by louvres in the roof, or by other effective means. J (d) All mangles shall be so ventilated as to provide for the maintenance of a flow of air into the hot chamber from the adjoining workroom. 266 LEAD POISONING In the case of vertical or " tower" mangles : (i.) The pipes for heating the mangle shall be fixed above the top of any opening at which workers put in or take off wares ; and (ii.) There shall be a free outlet into the air above, so formed and placed as to insure an outflow what- ever the direction of the wind. t (c) Fresh air shall, where practicable, be admitted to all workrooms by inlets placed along the sides of the room at a height of as nearly as possible 6 feet above the floor level, hopper opening being used for the purpose wherever possible. 1 (/) Where it is not practicable to provide such fresh air inlets, arrangements shall be made for the entry of an adequate amount of pure air by a flue with apertures at intervals along its length, or other means, which will secure an even distribution of the air through the room. l (g) In no case shall fresh air inlets be so arranged that a draught can blow direct from them on to any worker. 1 (//) Wherever the natural air currents are found to be insufficient without assistance to afford thorough ventila- tion, exhaust fans or other artificial means of creating a current of air shall be provided and maintained in use. J (k) Where an exhaust draught is provided for the re- moval of dust generated in a manufacturing process, pre- cautions shall be taken to prevent dust being drawn into the general atmosphere of the room from other sources of dust in places in the vicinity ; communication with such places shall be stopped wherever possible, and the fresh air inlets hereinbefore mentioned shall be so arranged as to insure that no extraneous dust is drawn towards the workers by the exhaust draught. 12. Floors. % (a) The floors of all slip-houses shall be kept thoroughly clean. ; (b) In all potters' shops, including such drying stoves as FACTORY AND WORKSHOP ORDERS 267 are entered by workpeople, and in all places where the following processes are carried on, viz : — * Making or mixing of frits, glazes, or colours contain- ing lead, *f Application of majolica, or other glaze, by blowing, painting, or any other process except dipping, Preparation, or weighing out, of flow material, Ground laying, including the wiping off of colour after this process, Colour dusting f whether on-glaze or under-glaze, Colour blowing 1 deluding the wiping oft of colour I after either of these processes, Colour grinding for colour blowers, Lithographic transfer making, the following Regulations shall apply : — (i.) There shall be provided and maintained : — (a) Either impervious floors ; (b) Or wooden floors with a thoroughlv smooth and sound surface, constructed in such a substantial manner as to be free from permanent sag, and main- tained in such repair that the}- can be properly cleaned bv a moist method, and that no dust can fall through into rooms below, (ii.) The floors, when the rooms are in use, shall be thoroughly cleaned dailv, bv a moist method, by an adult male after work has ceased for the day, and before 3 a.m. next morning ; except that in rooms in which ground laying is done, the cleaning prescribed by this Regulation may be done before work commences in the morning, provided that in no case shall any work be carried on in the room within one hour after such cleaning as aforesaid has ceased. (iii.) Scraps of clav and other debris, including any which have collected under benches, shall not be allowed to accumulate undulv, and all such 268 LEAD POISONING scraps and debris shall be carried out at least once a day. Scraps of clay in potters' shops shall be damped before being carried out. In all drying stoves which are entered by workpeople, boxes shall be provided for the reception of broken or waste clay ware, (iv.) Suitable provisions shall be made forlthe storage of all moulds when not in use. In existing installations, the tops of drying stoves shall not be used for this purpose unless it is shown to the satisfaction of the Inspector of Factories for the district that no other suitable place is available. In any new erections, suitable pro- visions shall be made without utilizing the tops of stoves for this purpose, unless the top of the stove is made into a separate chamber. | (c) The floors of all biscuit placing and glost placing shops shall be impervious, even floors, of brick, flag or similar hard material, and shall be kept in good repair ; they shall be thoroughly sprinkled and swept by an adult male whenever the work of setting in an oven has ceased, and under any circumstances at least once a day. *t| {d) The floors of all dipping houses, dippers' drying rooms, and ware cleaning rooms shall be washable im- pervious floors, and shall be thoroughly cleaned daily by an adult male, after work has ceased for the day, with a sufficient supply of water and a mop or similar implement ; provided that, in the case of china dippers' drying rooms, this cleaning may be done before work commences in the morning, instead of after work has ceased for the day. The floors of all dipping houses, dippers' drying rooms, and ware cleaning rooms erected after the date on which these Regulations come into force, shall be properly sloped towards a drain. J (e) In any new erection where steam pipes are used for heating a drying stove, dippers' drying room, or any place where articles are left to dry, the pipes shall, if possible, be fixed in the form of a rack of horizontal pipes FACTORY AND WORKSHOP ORDERS a6g in a vertical plane. Where this is impossible, the pipes shall be fixed in such a position as to allow a thorough cleaning under and around them. In existing installations, if it is impracticable to comply with the preceding paragraph, the steam pipes shall be enclosed in a box in such a manner as to permit of the thorough cleaning of all parts of the box on which persons may walk or stand, and adequate measures shall be taken to prevent dust escaping from within the box. Slides, drawers, trap-doors or other contrivances shall be pro- vided wherever necessary to facilitate cleaning under pipes. All stillages shall be so arranged as to allow the floor to be thoroughly cleaned underneath them. (/) In all workrooms not specially mentioned in the fore- going paragraphs of this Regulation, the following Regula- tions shall apply : — All floors shall be maintained in such repair that they can be properly cleaned by a moist method, and shall be so cleaned daily. All ashes, dirt or other debris, including any which have accumulated under benches, shall be carried out daily. (g) The above requirement as to the daily cleaning of floors by a moist method shall not apply to places where saggers, retorts or crucibles are made, or to those parts of floors on or immediately above which articles of pottery are necessarily left overnight, if adequate provision is made for the cleaning of the floors as soon as the articles are removed. 13. Work Benches. The following Regulations shall apply to work benches in potters' shops, and in places where processes named in the Schedule are carried on : — (*) % ( a ) Work benches, if not covered with sheet metal or constructed with an impervious surface, shall be strongly and solidly constructed of 270 LEAD POISONING closely jointed timber, and the surface of the work benches shall be well maintained. (*) | (b) All work benches in use shall be thoroughly cleaned daily by a moist method. 14. Lead House. * (a) Raw lead .compounds shall not be handled except with at least 5 per cent, of added moisture. * (b) They shall, further, be kept in their original packages until weighed out, and the tub or other receptacle contain- ing them shall be so fitted either with a cover or a damp screen as to prevent the issue of any lead dust from its mouth. *| (c) In every lead-house, except such as are used for less than eight hours in any week, a special lavatory basin with a supply of hot and cold water, nail brush, soap and towel shall be provided and maintained ; and a solution of soluble sulphides shall be providedi in which workers in the lead house shall rinse their hands after washing so as to show if they are free from lead. 1 5 . Dipping House, etc. *t (a) In dipping houses, all parts of walls sufficiently near to any dipping tub to be splashed with glaze shall be tiled, or painted with washable paint, or otherwise treated in such a manner as to permit of thorough cleaning by a wet process. *t .J^b) The above-named parts of walls, as well as the dipping tubs and any other objects which are splashed with glaze, shall be thoroughly cleaned daily by a wet process. (c) All dipping houses and ware cleaning rooms shall be well lighted ; neither dipping nor ware cleaning shall be done in places which, in ordinary fine weather, are dependent on borrowed light or artificial light during the hours of daylight. FACTORY AND WORKSHOP ORDERS 271 1 6. Threading-up. *t| In the process of threading-up, rubber or other washers, used to keep articles apart when being dipped, shall be thoroughly washed in a colander after each dipping. Wires shall also be washed after each dipping. 17. Boards. * ((7) Every board on which dipped ware has been placed shall, on each occasion after it has been used for one set of articles and before being used for another, be thoroughly cleaned with clean water by an adult male. * (b) "Nailed" or "pegged" boards shall be cleaned under a strong jet of water ; no new boards of this description shall be introduced except where necessary to hold china furniture or other special articles which cannot be carried on ribbed or plain boards. (*) (I) (c) Boards for use in processes included in Parti, of the Schedule shall be clearly marked by painting them red at the ends and for a distance of at least six inches from each end of the board on both sides, so as to dis- tinguish them from other boards which do not come into contact with lead. Boards so marked shall not be used in any department unless they have been thoroughly cleaned, and shall not be used in the clay department under any circumstances. Boards not so marked shall not be taken into any place where a process included in Part I. of the Schedule is carried on ; but this shall not apply to placing shops in which both biscuit and glost ware are being placed, provided that the boards used for biscuit ware are kept separate and returned to their respective departments without any contact with the boards used for glost ware. 18. Mangles. *% All mangle shelves shall be thoroughly cleaned by a wet process by an adult male on a fixed day in each week, after work has ceased for the day. The day on which this 272 LEAD POISONING cleaning is to take place shall be fixed by entry in the register kept in pursuance of Regulation 3. 19. Thimble Picking. (*) (t) I All material collected from floors or work benches shall be riddled in an enclosed receptacle before it is taken to a thimble picking room. 20. Majolica Painting. The following Regulations shall apply to the process of majolica painting : — *} (a) A sponge and bowl of. clean water, to rinse the fingers, shall be 'provided on the work bench beside each person employed in majolica painting. *l (b) In all majolica painting shops where there is no adjoining lavatory accommodation, there shall be provided in the room a lavatory sink with a tap, a constant supply of water, and towels. *! (c) All splashes of glaze falling on the benches, or surrounding objects, shall be immediately removed with a wet sponge or other wet material. *| (d) No floor or work bench shall be deemed to have been thoroughly cleaned, in accordance with Regulation 12 or 13, unless all splashes of glaze have been completely removed. *J (e) Mottling, or any similar method of applying glaze, shall only be carried on under the Regu- lations applying to majolica painting. *+ (/) All cleaning and scraping, including panel- cutting, after majolica dipping, painting, or blowing, shall be deemed to be ware cleaning, and shall only be done in compliance with the rules for the latter process. FACTORY AND WORKSHOP ORDERS 273 2 1 . Cotton- Wool in Ground Layi?ig, Colour Dusting, and Lithographic Transfer Making. I All pieces of cotton-wool or similar materials which have been used in the process of ground laying, or colour dusting, or lithographic transfer making, shall be kept in a proper receptacle. All pieces of waste cotton-wool or similar materials which have been so used shall be immediately burnt. 22. Aerographing. 1 (a) No short-sighted person shall be employed to do glaze or colour blowing, unless wearing suitable glasses. No person shall be employed as a glaze or colour blower, unless the Surgeon has entered in the health register a certifi- cate stating that he has examined the worker's sight and is satisfied that he or she can be so employed without breach of this Regulation. ± (b) All hoods in which the blowing of glaze or colour is carried on shall be thoroughly cleaned daily by a wet process. ± (c) Glaze or colour blowing shall not be done with the mouth. % (d) Decoration on unfired clay ware by means of coloured clay slips shall not be regarded as colour blowing for the purposes of any of the Regulations applying specially to the latter process. 23. Lithographic Transfer Making. % Machines used in lithographic transfer making shall not be brushed down, but shall be cleaned either — (a) with moist materials, such as oily rags, in such a manner as not to disperse any dust into the air ; or (b) by means of an exhaust current of air, such as that afforded by a vacuum-cleaner. 274 LEAD POISONING 24. Separation of Processes. (*) (t) + ( a ) Thimble picking or threading-up shall not be carried on except in a place sufficiently separated from any process included in the Schedule. (*) (!) iP) When a process included in the Schedule is being carried on in a room where other work is also done. (i.) Either the place where the scheduled process is carried on shall be screened off from the rest of the room by a partition not less than eight feet high, (ii.) Or all persons working in the room shall be deemed to be persons employed in the scheduled process. 25. Hours of Employment. (a) No person employed in a process included in Part I. of the Schedule, except in glost placing and lithographic transfer making, shall be employed for more than four hours without an interval of at least half an hour for a meal. No person shall be employed in the process of glost placing or in the process of lithographic transfer making for more than 4J hours, or in any other process for more than 5 hours, without an interval of at least half an hour for a meal. (*) (+) (P) No woman or young person who is employed in any process included in Part I. of the Schedule shall be employed in the factory in any capacity for more than 48 hours in any week. (*) (c) No adult male who is employed as a dipper, dipper's assistant, or ware cleaner shall be employed in the factory in any capacity for more than 48 hours in any week, provided that where such an adult male worker has been employed in a process included in Part I. of the Schedule, for not more than 8 hours in any one day or 30 hours in all in a week, he may be employed during the same week on work not involving contact with lead up to a limit of 54 hours for that week. FACTORY AND WORKSHOP ORDERS 275 (*) (d) No adult male who is employed as a glost placer shall be employed in the factory in any capacity for more than 54 hours in any week. (*) [e] Except that it shall be permissible to emplo}^ adult male dippers, dippers' assistants, ware cleaners, and glost placers overtime in addition to the prescribed weekly periods of 48 and 54 hours ; provided that such overtime shall not, in any factory to which these Regulations apply, exceed 4 hours in any week, or 36 hours in any period of twelve months. The occupier shall enter in the prescribed register particulars of all such overtime, and shall also send notice, with the prescribed particulars, to the Inspector of Factories for the district, before eight o'clock in the evening of any day when a man is employed overtime in pursuance of this exception. An occupier who avails himself of this exception shall, if called upon, produce to the Inspector of Factories for the district evidence of press of orders or other circumstance rendering the overtime necessary. Adult male dippers, ware cleaners, and glost placers may be employed, in addition to the above-named hours, as sitters-up with an oven after the termination of the period of employment on one day in the week and before the commencement of the period of employment on the next day ; provided that no such worker shall be employed in any capacity within 12 hours of the cessation of the period of sitting-up. (/) In potters' shops, and in any place where towing or any other dusty process is carried on, including any process for which a certificate by an Inspector of Factories has been given in pursuance of the first paragraph of Regula- tion 6, no women or young person shall be employed for more than 9^ hours in any day or for more than 6J hours on Saturday. (g) All the above weekly and daily periods shall be the maximum permissible periods of actual work, exclusive of meal-times. 276 LEAD POISONING 26. Affixing of Regulations. (*) (t) I n addition to the printed copies of these Regula- tions required to be kept posted up in pursuance of Section 86 of the Factory and Workshop Act, 1901 * there shall be kept constantly affixed in every potters' shop and in every place in which any process included in the Schedule is carried on, a notice printed in bold type so that it can be easily read, setting forth those portions of the Regulations which apply to that particular work-place. 27. Observance of Regulations. (a) A person or persons shall be appointed who shall see to the observance, throughout the factory, of the Regula- tions, and whose duty it shall be to carry out systematic inspection of the working of all the Regulations in the departments for which they are individually responsible. The names of the persons so appointed shall be recorded in the register. (b) Each person so appointed shall be a competent person fully conversant with the meaning and application of the Regulations in so far as they concern the depart- ments for which he is responsible. He shall keep in the factory a book in which he shall record any breach of the Regulations, or any failure of the apparatus (fans, etc.) needed for carrying out the provisions, that he may have observed, or that may have been brought to his notice within the preceding 24 hours, together with a statement of the steps then taken to remedy such defects or to prevent the recurrence of such breach. Each entry in such book shall be dated and initialled by the person appointed, who at the end of each week shall make a further entry stating that the inspection required by paragraph (a) has been carried out, and that all the defects observed or brought to his notice have been recorded in the book. Such book shall be kept in the factory for at least six months after the latest entry therein. * 1 Edw. 7, C. 23. FACTORY AND WORKSHOP ORDERS 277 (c) Accurate extracts, clearly and legibly expressed, shall be made of these entries once a week, and signed by the occupier or someone whom he may appoint, and displayed during the following week in a conspicuous place in the departments to which they refer, and copies of all such extracts shall for the same time be displayed in a con- spicuous place in the mess-rooms. 28. Samples for Analysis. (a) The occupier shall allow any of His Majesty's Inspectors of Factories to take at any time sufficient samples for analysis of any material in use or mixed for use. (b) Provided that the occupier may at the time when the sample is taken, and on providing the necessary appliances, require the Inspector to take, seal, and deliver to him a duplicate sample. (c) But no analytical result shall be disclosed or published in any way except such as shall be necessary to establish a breach of these Regulations. Part II. — Duties of Persons Employed. 29. Periodical Examinations. (*) (+) (+) ( a ) All persons employed in the processes included in the Schedule shall present themselves at the appointed times for examination by the Surgeon as provided in Regulation 2. (*) (+) (+) (°) No person after suspension shall work in any process in which examination by the Surgeon is required by these Regulations without a certificate of permission to work. 30. Overalls, etc. (*) (1) {a) All persons employed in any process included in the Schedule shall, when at work, wear overalls, head- coverings, and aprons, as required by Regulation 4. The said overalls, head-coverings, and aprons shall not be worn outside the factory or workshop, and shall not be removed 278 LEAD POISONING therefrom except for the purpose of being washed or repaired. No overalls, head-coverings or aprons, provided in pursuance of Regulation 4, shall, under any circumstances, be taken to a worker's home. (*) (I) (&) The head-coverings provided in accordance with Regulation 4 shall be worn in such a manner as effectually to protect the hair from dust, and the hair must be so arranged as to permit of this. (*) (+) (c) The overalls, head-coverings, and aprons, when not being worn, and clothing put off during working hours, shall be deposited in the respective places provided by the occupier for such purposes under these Regulations. (d) Respirators shall be worn as required by Regulation 8. 31. Food. (*) (+) ( a ) No person shall introduce, keep, prepare, or partake of any food, drink, or tobacco, or remain during meal-times in any place in which is carried on any process included in the Schedule, or the process of towing, or the process of tile-making by the compression of dust, or any other process which the Inspector of Factories for the district shall certify as sufficiently dusty to render the room in which it is carried on an unsuitable place, in his opinion, for persons to remain during meal-times. (*) (+) (b) Every worker for whom milk or cocoa is pro- vided in accordance with Regulation 6 shall drink the same, unless a medical certificate is produced showing cause for exemption from this requirement. 32. Ventilation — Dust. No person shall in any way interfere, without the know- ledge and concurrence of the occupier or manager, with the means and appliances provided by the employers for ventilation, and for the removal of dust. 33. Washing. (*) (I) i a ) No person employed in any process included in the Schedule shall leave the works or partake of meals FACTORY AND WORKSHOP ORDERS 279 without previously and carefully cleaning and washing his or her hands. (*) (t) (b) No person employed shall remove or damage the washing basins or conveniences provided under these Regulations. 34. Clea7iing of Work Places. The persons appointed by the occupiers shall clean the several floors, walls, work benches, appliances and other objects regularly as prescribed in these Regulations. 35. Boards. * (a) The boards used in the dipping house, dippers' drying room, or glost placing shop shall not be used in any other department, except after being cleaned, as directed in Regulation 17. * (6) No board on which dipped ware has been placed shall be used for a second set of dipped articles until it has been thoroughly cleaned, in accordance with Regulation 17. Where a convenient grid or other suitable contrivance is provided for depositing such boards after use and before being cleaned, the worker who has removed the ware from any such board shall place the board thereon. (*) (c) Boards which are marked for use in lead pro- cesses shall not be used in any department unless they have been thoroughly cleaned, and shall not be used in the clay departments under any circumstances. 36. Avoidance of Dust, etc. Every worker shall so conduct his or her work as to comply strictly with these Regulations, and to avoid, as far as practicable, making or scattering dust, or refuse, or causing accumulation of such. R. McKenna, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall. 2nd January, 1913. 280 LEAD POISONING SCHEDULE. Part I. — Lead Processes. * (a) Making or mixing of frits, glazes, or colours containing lead. * (b) Dipping or other process carried on in the dipping house. * (c) Application of majolica, or other glaze, by blowing, painting, or any other process except dipping. * (d) Drying after the application of glaze by dipping, blow- ing, painting, or other process. * (e) Ware cleaning after the application of glaze by dipping, blowing, painting, or other process. * (/) Placing of ware on cranks or similar articles prior to their transfer to saggers or kilns for the glost firing. * (g) Glost placing. J (h) Washing of saggers with a wash which yields to dilute hydrochloric acid more than five per cent, of its dry weight of a soluble lead compound calculated as lead monoxide when determined in the manner described in the definition of low solubility glaze. J (k) Preparation, or weighing-out, oiflow material. J (I) Ground laying, including the wiping off of colour after this process. . . _ , , ,. (whether on - glaze or under - glaze, hi) Colour dusting \ . , ,. .,° „ r ° including the wiping off of colour % («) Colour blowing ( after either of these processes# J (o) Colour grinding for colour blowers. t (p) Lithographic transfer making. J (q) Any other process in which materials containing lead are used or handled in the dry state, or in the form of spray, or in suspension in liquid other than oil or similar medium, pro- vided that the stopping of biscuit ware with a material containing lead shall not be deemed to be a process included in this Schedule. Part II. — Other Processes. X (r) Scouring of biscuit ware which has been fired in powdered flint. I (s) Emptying of biscuit ware which has been fired in powdered flint, from the baskets or other receptacles in which it has been conveyed to the biscuit warehouse or scouring shop. FACTORY AND WORKSHOP ORDERS 281 APPENDIX. Codes of Special Rules established uxder the Factory and Workshop Acts, 1891 and 1895. 1. For the Manufacture of White Lead. In these Rules " persons employed in lead process " means a person who is employed in any work or process involving exposure to white lead, or to lead or lead com- pounds used in its manufacture, or who is admitted to any room or part of the factor}- where such process is carried on. Any approval given by the Chief Inspector of Factories in pursuance of Rules 2, 4, 6, 9, or 12 shall be given in writing, and may at any time be revoked by notice in writing signed by him. Duties oj Occupiers. 1. On and after July 1st, 1899, no part of a white lead factory shall be constructed, structurally altered, or newly used, for any process in which white lead is manufactured or prepared for sale, unless the plans have previously been submitted to and approved in writing by the Chief Inspector of Factories. 2. (a) Every stack shall be provided with a standpipe and movable hose, and an adequate supply of water dis- tributed by a rose. (b) Every white bed shall, on the removal of the covering boards, be effectually damped by the means mentioned above. Where it is shown to the satisfaction of the Chief In- spector of Factories that there is no available public water service in the district, it shah be a sufficient compliance with this Rule if each white bed is, on the removal of the covering boards, effectually damped by means of a watering can. 3. Where white lead is made by the chamber process, the chamber shall be kept moist while the process is in operation, and the corrosions shall be effectually moistened before the chamber is emptied. 282 LEAD POISONING 4. (a) Corrosions shall not be carried except in trays of impervious material. (b) No person shall be allowed to carry on his head or shoulder a tray of corrosions which has been allowed to rest directly upon the corrosions, or upon any surface where there is white lead. (c)* All corrosions before being put into the rollers or washbecks, shall be effectually damped, either by dipping the tray containing them in a trough of water or by some other method approved by the Chief Inspector of Factories. 5. The flooring round the rollers shall either be of smooth cement or be covered with sheet lead, and shall be kept constantly moist. 6. On and after January 1st, 1901, except as hereinafter provided — (a) Every stove shall have a window, or windows, with a total area of not less than 8 square feet, made to open, and so placed as to admit of effectual through ventilation. (b) In no stove shall bowls be placed on a rack which is more than 10 feet from the floor. (c) Each bowl shall rest upon the rack, and not upon another bowl. {d) No stove shall be entered for the purpose of drawing until the temperature at a height of 5 feet from the floor has fallen either to 70 F., or to a point not more than io° F. above the temperature of the air outside. (e) In drawing any stove or part of a stove there shall not be more than one stage or standing place above the level of the floor. Provided that if the Chief Inspector approves of any other means of ventilating a stove, as allowing of effectual * The following addition to Rule 4 (c) is in force in one works : — " Provided that the damping of the corrosions shall not be required if efficient exhaust ventilation is applied at the washbecks in such manner as to prevent the inhalation of dust by the workers when putting the corrosions into the washbecks or rollers." FACTORY AND WORKSHOP ORDERS 283 through ventilation, such means may be adopted, notwith- standing paragraph (a) of this rule ; and if he approves of any other method of setting and drawing the stoves, as effectually preventing white lead from falling upon any worker, such method may be followed, notwithstanding paragraphs (b) and (e) of this Rule. 7. No person shall be employed in drawing Dutch stoves on more than two days in any week. 8. No dry white lead shall be deposited in any place that is not provided either with a cover or with a fan effectually removing the dust from the worker. 9. On and after January 1st, 1900, the packing of dry white lead shall be done only under conditions which secure the effectual removal of dust, either by exhaust fans or by other efficient means approved in each case by the Chief Inspector of Factories. This rule shall not apply where the packing is effected by mechanical means entirely closed in. 10. The floor of any place where packing of dry white lead is carried on shall be of cement, or of stone set in cement. 11. No woman shall be employed or allowed 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. 12. {a) A duly qualified medical practitioner (in these Rules referred to as the " Appointed Surgeon ") shall be appointed by the occupier for each factory, such appoint- ment to be subject to the approval of the Chief Inspector. (b) No person shall be employed in a lead process for more than a week without a certificate of fitness granted after examination by the Appointed Surgeon. (c)* Every person employed in a lead process shall be * The following Rule is in force in one works in substitution for Rule 12 (c) : — " Every person employed in a lead process shall once in each calendar month, on a date of which notice shall be given to every person, be examined by the Appointed Surgeon, who shall have power to suspend from employment in any lead process." 284 LEAD POISONING examined once a week by the Appointed Surgeon, who shall have power to order suspension from employment in any place or process. (d) No person after such suspension shall be employed in a lead process without the written sanction of the Appointed Surgeon. (e) A Register in a form approved by the Chief Inspector of Factories shall be kept, and shall contain a list of all persons employed in lead processes. The Appointed Sur- geon will enter in the Register the dates and results of his examinations of the persons employed, and particulars of any directions given by him. The Register shall be pro- duced at any time when required by H.M. Inspectors of Factories or by the Certifying Surgeon or by the Appointed Surgeon. 13. Upon any person employed in a lead process com- plaining of being unwell, the occupier shall, with the least possible delay, give an order upon a duly qualified medical practitioner. 14. The occupier shall provide and maintain sufficient and suitable respirators, overalls, and head-coverings, and shall cause them to be worn as directed in Rule 29. At the end of every day's work they shall be collected and kept in proper custody in a suitable place set apart for the purpose. They shall be thoroughly washed or renewed every week ; and those which have been used in the stoves, and all respirators, shall be washed or renewed daily. 15. The occupier shall provide and maintain a dining- room and a cloak-room in which workers can deposit clothing put off during working hours. 16. No person employed in a lead process shall be allowed to prepare or partake of any food or drink except in the dining-room or kitchen. 17. A supply of a suitable sanitary drink, to be approved by the Appointed Surgeon, shall be kept for the use of the workers. 18. The occupier shall provide and maintain a lavatory FACTORY AND WORKSHOP ORDERS 285 for the use of the workers, with soap, nail brushes, and at least one lavatory basin for every five persons employed. Each such basin shall be fitted with a waste pipe. There shall be a constant supply of hot and cold water laid on, except where there is no available public water service, in which case the provision of hot and cold water shall be such as shall satisfy the Inspector in charge of the district.* The lavatory shall be thoroughly cleaned and supplied with clean towels after every meal. There shall, in addition, be means of washing in close proximity to the workers of each department, if required by notice in writing from the Inspector in charge of the district. There shall be facilities, to the satisfaction of the Inspector in charge of the district, for the workers to wash out their mouths. 19. Before each meal, and before the end of the day's work, at least ten minutes in addition to the regular meal times, shall be allowed to each worker for washing. A notice to this effect shall be affixed in each depart- ment. * The following Rule is in force in certain works in substitu- tion for paragraph 1 of Rule iS : — "The occupier shall provide and maintain in a cleanly state and in good repair for the use of persons em- ployed a lavatory containing either — ' ' (a) At least one lavatory basin for every five such persons, fitted with a waste pipe, or placed in a trough having a waste pipe, and having a constant supply of hot and cold water, or warm water, laid on ; or " (6) Troughs of enamel or similar smooth im- pervious material, fitted with waste pipes without plugs, and having a constant supply of hot and cold water, or warm water, laid on. The length of such troughs shall be in a proportion of not less than 2 feet for every five persons employed. " He shall also provide in the lavatory, soap, nail brushes, and a sufficient supply of towels." 286 LEAD POISONING 20.* The occupier shall provide and maintain sufficient baths and dressing rooms for all persons employed in lead processes, with hot and cold water, soap, and towels, and shall cause each such person to take a bath once a week at the factory. A bath register shall be kept, containing a list of all persons employed in lead processes, and an entry of the date when each person takes a bath. This register shall be produced at any time when re- required by H.M. Inspectors of Factories or by the Certi- fying Surgeon or by the Appointed Surgeon. 21. The dressing-rooms, baths, and w.c.'s shall be cleaned daily. 22. The floor of each workroom shall be cleaned daily, after being thoroughly damped. Duties of Persons Employed. 23. No person shall strip a white bed or empty a chamber without previously effectually damping as directed in Rules 2 and 3. 24. No persons shall carry corrosions, or put them into the rollers or washbecks, otherwise than as permitted by Rule 4. 25. No person shall set or draw a stove otherwise than as permitted by Rules 6 and 7. 26. No person shall deposit or pack dry white lead other- wise than as permitted by Rules 8 and 9. 27. Every person employed in a lead process shall present himself at the appointed times for examination by the Appointed Surgeon, as provided in Rule 12. * The following proviso to Rule 20 is in force in one works : — " Provided that this Rule shall not apply if the Chief Inspector of Factories approves the use of the local public baths when conveniently near, under the con- ditions (if any) named in such approval," FACTORY AND WORKSHOP ORDERS 287 The following marks used in the Health Register of Lead Factories are those recommended by the Home Office to Certifying Factory Surgeons and to medical men appointed to lead works : - means worker passed without comment. a ,, a blue line on the gums, or an indication thereof. a ° be ,, increasing impairment of general health. c ,, pregnancy without suspension. d ,, suspension or transfer for reasons other than lead. x ,, carelessness or unsuitability for lead work. dx „ suspension for such reasons. 1 7 ,, anaemia. b INDEX Abductor muscles, affected, 150 Abortion, 8, 92, 153 Acute lead poisoning, 140. See Saturnine encephalopathy Aerographing, Home Office reg- ulations, 273 Albumin in spinal fluid, 158 Albuminuria, 141, 174, 191, 21 1, 212 Alcoholism predisposes to plum- bism, 99, 162 Aldehyde in lead paints, 40, 41, 45 Alimentary canal, 117, 166 Amaurosis and amblyopia, 113, 144. See Blindness Anaemia, 77, 129, 132, 191, 197, 209, 211 pernicious, 126 Anaesthesia, 154 Analgesia, 154 Aniline poisoning and basophi- lia, 125 Antiseptic properties of paints, 6 4 Appendicitis, lead poisoning mis- taken for, 139 Arteries, changes in, and arterio sclerosis, 97, 103, 191 Barium sulphate a substitute for lead, 57, 61 Basic sulphate of lead, 41 Basophilia, 20, 112, 123, 157, 197 Baths, electric, 212,222 in factories, 203, 209 weekly, required by Home Office, 224, 286 Benzine, 49 Benzole, 51 Bladder affected in lead poison- ing, 48, 153 Blend ore, 17 Blindness, 76, 118, 144, 154 Blood-films, method of staining, 131 Blood, basophile red corpuscles, 130, 159, 169 eosinophils, 132 in saturnine poisoning, 20, 48, 123, 127, 159, 161, 169 pressure, 185, 188, 205 red corpuscles, disintegra- tion of, 51 reduction of, 122 white corpuscles, 132 " Blue bed," 23, 176 Boro-silicate, 90. See "Grit- ted " lead Brain, 119, 142, 145, 156, 187, 189, 194 haemorrhages in cortex of, 119, 146 vessels of, 189 Broken Hill Mines, lead fumes at, 7 Bronchial affections, prevalence of, among lead miners, 3 Bulbar paralysis in cats, 168 INDEX 289 Bulbar paralysis, rare in man, 112, 171 Burdach's column, 112, 169 Burtonian line on gums, 133, 197. See Gums Cachexia -1 128, 194, 202 Calamine ore, 17 Canned foods and lead poison- ing, 92 Carbon dioxide, 45, 47 monoxide, 12, 45, 67 Cases of lead poisoning, histories and tables, 1 18 Casual labour in lead factories, 102, 162 Cats, lead poisoning in, 1 to, 112 Cattle poisoned by lead fume, 5 symptoms of lead poisoning in, 9 Central nervous system affected, 147 Cerebellum, 120 Cerebral haemorrhage, 97, 146, 192 tumour, 191 Cerebro-spinal fluid, 157, 159 Cerussa, 31 Cerussite, 4 "Chamber" process in manu- facture of white lead, 23, 29, 3. 2 China and earthenware, manu- facture of, 68 Cirrhosis of liver, 172 Coal gas, action of, on zinc white, 58 Colic, 20, 136, 140, 144, 164. 194, 197, 209 Compositors, 124. See Printers Constipation, 68. 99, 114, 136, 140, 171, 210 Convulsions, 20, 118, 136, 141, 146, 175, 178, 211 in infancy, 178 Cosmetics, lead poisoning due to, 113 Cupelling, 19 Delirium and delusions, 141, 155 Diachylon, 92, 103, 130, 139, 147. 153 Diamond cutting, 91 Diarrhoea, 140 Diplopia, 153 "Dipping'' of earthenware, 71, Distilled water and its action upon lead, 93 Dogs and lead poisoning, no Drinking water, lead in, 44, 92, 165, 193 from peaty soil, 92 " Dryers " in paints, 41 benzole, 47 turpentine, 47 white lead, 59 Drying-ovens, air of, in white lead factory, 167 Dust. See Lead dust "Dutch" process in manufac- ture of white lead, 23, 29, 32 Dyeing of yarn by chromate of lead, 89, 241 Electrical accumulators, 82, 163, 164 manufacture of, Home Office orders, 227 treatment for plumbism, 211, 222 Elimination of lead by the faeces, 161 by the urine, 169, 170 Emanations from newly painted room, 39 benzine, 50 petroleum spirit, 49 turpentine, 48 Enamelling, 90 Encephalopathy, 20 Eosinophiles, 132 Epileptic seizures, 20, 146 Erythrocytes, punctated, 20, 123, 127 Exhausts, 2o8 ; 264 19 290 LEAD POISONING J Eye: disc, alterations of, 144, 154 fundus oculi, 143 small haemorrhages in fundus, 154 inflammation of, 48 paralysis of muscle, 133, 154 pupils, unequal, 153 retinal hemorrhages, 153 Factory and Workshop Orders, 225 Faeces, lead eliminated by, 107, 117, 161 Female labour, abolition of, in dangerous processes, by the Home Office, 98, 176, 203 File-cutting, 80 and pulmonary tuberculosis, 85 Home Office Orders, 225 File-cutters, high mortality among, 81 " Flinting," 252 Flue-dust, 13 Flues, cleaning out of, 14, 206 Food not to be taken into lead works, 203 Home Office Orders, 258 Formic acid, 45, 47 "Fritted " lead, 71, 90 Fume, 5, 7, 13, 16, 97, 166, 204 Galena, 4, 12, 249 Gastric juice, action on lead, 105 General paralysis, 156, 194 Gingivitis, 132 Glass works, lead poisoning in, 89 Glaze, high percentage of lead in, 69 leadless, 249 " Glost placing," 252 Goll's column, cellular infiltra- tion in, 112, 169 Goulstonian Lectures, Oliver, 99, ii7 Gout, 200 Guinea-pigs, lead poisoning in, 46 Gums, blue line on, 12, 77, 90, 97, 100, 103, 117, 128, 131, 154, 194, 197 inflamed in benzine poison- ing, 5 1 ulcerated, 134 Haematoporphyrin in urine, 175 Haemoglobin, 122, 129 Haemorrhages in brain, 97, 119, 146, 149 in fundus, 143, 154 in intestine, 175 in mucous membranes, 5 1 Hair-dyes containing lead, 113 Hallucinations, 50 Hat-pins, glass-topped, 90 Headache, 114, 141, 154, 292 Heart, effect of lead upon, 119, 185, 189 Home Office, plans for new factories submitted to, 207 reforms introduced by, in the Potteries, 69, 72 Regulations, 98, 140, 176, 203, 225 Reports, 17, 34, 35, 66, 69, 73 Hours of employment in pot- teries, 274 Hungarian potters, 79 Hydrochloric acid, 166, 192 in the gastric juice, action of, on lead, 105 Hygiene, personal, among lead workers, 203 Hyperesthesia in peroneal type of lead paralysis, 152 Hyperalbuminosis, 157 Hysteria, saturnine, 142, 194 Imbecile children, 76 INDEX 291 Industrial lead poisoning, statis- tics, 34 Inequality of the pupils, 138 Infancy, deaths in, 77, 178, 199 Insanity, following lead poison- ing, 20, 155 Interstitial nephritis, 173, 211 Intestinal mucous membrane, action of lead on, 106 Intestine, 120 bluish- black patches on, 171 haemorrhages in. 175 Iron sulphide, 62 Kidneys, 49, 68, 97, 103, 139, 145, 171, 191, 200, 212 Knee-jerk, 156 Lace workers, plumbism among, on the Continent, 91 Lamina cribrosa, 146 Larynx, muscles of, affected, 153 Lead, acetate of, 31, 114 albuminate, 134, 17 1 carbonate. See "White lead channels of entrance into body, alimentary, respira- tory, 115, 117 chloride, 97, 105 chromate, 98 dust, 71, 97, 116 from slag, 12 suppression of, in in- dustrial occupations, 36, 204, 260 elimination of, by feces and urine, 107, 108 factories, preventive methods in, 205 glazes, a standard of in- solubility for, 72 hydroxide, 41 miners and lead poison- . ing, 4 liable to pulmonary tuberculosis, 3 Lead miners liable to rheuma- tism, 3 mines not ventilated, 3 nitrate, 98, 186 oleate, 154 oxide, 41, 97 paints and leadless paints, 55 paralysis, types of, 15 1. See also Paralysis in children, 152 pipes and drinking-water. 93 . poisoning, causes of. 92 chronic, 38, 155, 159, 173. 199 effects on offspring of, 183 what constitutes, 196 red. See Red lead small quantities harmful. 166 sulphate, 23, 40, 63, 98, 108 sulphide, 133, 171 white. See White lead respiratory organs, 115 skin, 113 " Leadless glaze," 249 ' ; Lead process," 233 Leucocytosis, 132, 157 Linseed oil, 27, 40, 44, 47, 59, 206 Litharge, 18 flaked, manufacture of, Home Office Order, 241 Lithopone. 57, 61 Liver, 65, 117, 120, 171 cells, atrophy of, 172 Majolica painting, 75, 250, 272 Manganese binoxide, 41 Mania, acute, in lead poisoning, 141 Memory, affected, 30 Metabolism, 162 Minium, 4 Miscarriages, 8, 96, 178. 194 292 LEAD POISONING Muscles, abductor, 150 anti-brachial, 151 biceps, 151 brachialis anticus, 151 deltoid, 151 groups affected, Aran- Duchenne, 151 Dejerine-Klumpke, 151 Duchenne-Erb, 151 extensor, 13, 150 of eyeballs paralyzed, 153 of leg affected, 152 psoas, 152 supinator longus, 150 supra- and infra-scapular, effect of lead on, 185 Muscular atrophy, 157 Nephritis, 173, 200, 211 Nerve cells in visual centres of brain, 144 Nervous system, 147 Neuro-retinitis, 143, 154 Nitrobenzene poisoning, 125 Notification of plumbism volun- tary in Great Britain, 65 CEdema of the feet, 211 Ophthalmoscopic changes, 143 Optic nerve, 145 Ore, 4 Pain, 154 Painted surfaces, emanations from, 39, 55 Painters, 38, 39, 65 Paints, manufacture of, Home Office Orders, 232 Paralysis, 66, 111, 130, 147, 152, 163, 168, 178, 182 among painters, 66, 68 among pottery workers. 69, 76 of hands and arms, 12, 21, 152, 182, 199 of muscles of eye, 133, 144 respiratory, 153 Peaty soils, water from, 93, 209 Petroleum spirit, vapour from, 49 Phagocytic cells of gum, 134 Plumbers and lead poisoning. 88 l Plumbism. See Lead poisoning I Potassium iodide, 114, 134, 171, 210 Potters and lead poisoning, 70 and pulmonary tuberculo- sis, 85 Hungarian, 76 Pottery, manufacture of, 68 and decoration of, Home Office Orders, 248 Pregnancy, lead poisoning and, 178 Premature births caused by lead poisoning, 8, 178 Presaturnism, period of, 103 Printers, lead poisoning among, 83,86 tuberculosis among, 83, 87 Printing and type founding, 83 of colours on calico, 89 Pseudo-general paralysis, 156, 160 Ptosis, 153 Putty, 89 Rabbits, lead poisoning in, 11 1 Red blood corpuscles, 123. See also Blood Red lead, 18, 6o, 82, 88, 116, 140, 205 Home Office Orders regard- ing manufacture, 241 Respiration not directly affected by lead, 188 Respirators, 101, 206, 208, 265 Respiratory organs, 115 paralysis, 153 Retina, alterations of, 144 Rheumatism, lead miners liable to, 3 INDEX 293 Salivary giands, 175 Sand-papering painted surfaces, 39) S 2 Saturnine encephalopathy, 76, 102, 140, 142, 201 nephritis, 200 pseudo-general paralysis, 156 "Scouring" of earthenware, 252 Sensory symptoms, 154 Silicosis, 3 Skin, entrance of lead by, 113 inflammation of, 48 Slag, n Smelting, 5 Home Office Orders, 241 methods of, 11 Parkes' process, 16 Pattison process, 16 Spasm of bloodvessels of brain, 142, 144 of small arteries of eye, . x 44 Spastic paralysis, 168 paraplegia, 11 1 Spelter, 17 Sphygmogram, 1 90, 205 Sputum, cerussite in, 4 Squint, 114 Stereotyping machines, 167 Stillbirths, 178, 194 Sulphide of soda, tabloids of, given to workmen, 207 Sulphocyanide of potassium in saliva, 134 Sulphur, 114, 157 baths, treatment by, 157 Sulphuretted hydrogen, action of, upon painted surfaces, 58, 133 Symptomatology, 102, 122 Syphilis, 156 Teeth, decayed, effect of, 134 Tinning of hollow ware, 90 Tobacco, use of, harmful when at work, 100, 203 Toxic products, foimation of, in the system, 161 Treatment, curative, 209 preventive, 201 Tremors, fibrillary, of hand, 152 important sign of plumbism, 154 Tuberculosis, pulmonary, among file-cutters, 85 among miners, 3 among potters, 85 among printers, 83, 85 Turpentine, 41, 42, 43, 48, 67 Underground flue, 5 Unilateral tenderness and sweat- ing, 138 Uraemia, 139 Urine, albumin in, 141, 191, 212 chemical examination of, 192 hsematoporphyrin in, 175 lead present in, 92, 129, 132, 143, 169, 195, 197 lead thrown out of body by, 169, 170 Ventilation, 207 Home Office Regulations for, 265 Vision, loss of, 143 Vulcanization, 62 Wassermann reaction, 157 Water poisoned by lead fume, 7 See Drinking water "Weight, loss of, in lead poison- ing, 122 "White" bed, 25, 98 White lead, 4, 22, 41, 57, 71, 98, 108, 116, 205 Home Office Orders re- garding manufacture of 281 legislation in France re- garding, 29 294 LEAD POISONING White lead, manufacture of, 22 use of, by plumbers, 89 Women and lead poisoning, 8, 74, 98, 176 employed in making up " blue-beds," 24 Workmen's Compensation Act, 196 Wrist-drop, 49, 91, 113, 134. 147, 151, 154, 197,211 Yarn, dyeing of, with lead com- pound, 237 Zinc, 16, 17 chloride, 17 fumes, 18 oxide, 17, 57, 59 sulphate, 61 sulphide, 17, 57, 61 white, 41, 54, 57, 61 H. K. LEWIS, 136, GOWER STREET, LONDON •Axs DUEI DATE s fl CT 1 1? >3 OCT? Em the £-'* "TT,.^ ■ w . .*»* '■'-. _» sf» as M E OAtttt SEP.. 30 W& V _ P.'*" •n7K - : i j . - «c * _j*i u*m IjiW <£?•*" 5fe 9^ : n c f f 1 1999 ULV/ V I i ■ .•j 201-6503 Printed In USA. R 2 RA1231.L4 0L4 1914 Oliver, T. Lead poisoning. ON PEI May M I tsq SONAL RES 7 -V ^/ mfy COLUMBIA UNIVERSITY LIBRARIES 0037546350 I SI*