[852] The gate-keeper of a graveyard at Bordeaux continually used the remnants of crosses, covered with lead paint, to replenish his fire; the chimney smoked; gradually paralysis of the extensors of the right wrist developed itself, and he suffered from colic and other signs of lead-poisoning.—Marmisse, Gaz. des Hôpit., No. 25, 1866.
In 1882, a very interesting case occurred at Keighley, in which a mechanic, aged 42, died from the supposed effects of lead-poisoning, induced from drinking the town water, which was proved by Mr. Allen to contain about 3⁄5 of a grain of lead per gallon. For six months he had been out of health, and a week before his death he suffered from colic, vomiting, constipation, and a blue line round the gums, and occasional epileptiform seizures. After death the kidneys were found granular, and the heart somewhat enlarged. The viscera were submitted to Mr. Allen for analysis; no lead was found in the heart or brain, a slight, non-estimable trace in the kidneys, and about a grain was separated from the liver and spleen. Dr. Tidy, who was called in as an expert, gave a very guarded opinion, rather against the theory of direct lead-poisoning; and the verdict returned by the jury was to the effect that the deceased died from granular kidney, accelerated by lead-poisoning. Murder by the administration of doses of sugar of lead is rare, but such a case has occurred.
At the Central Criminal Court, in December 1882, Louisa Jane Taylor was indicted for poisoning Mary Ann Tregillis at Plumstead, and convicted. From the evidence it appeared that the prisoner, who was thirty-six years of age, came to reside with Mr. and Mrs. Tregillis, an aged couple of eighty-five and eighty-one years respectively. The prisoner was proved to have purchased at different times an ounce and half an ounce of sugar of lead, and to have added a white powder to the medicine of Mrs. Tregillis. The illness of the latter extended from about August 23 to October 23—a period of two months. It is difficult to say when the first dose could have been given, but it was probably some time between August 13 and 23, while the administration, without doubt, ceased on or before October 6, for on that date different nursing arrangements were made. The symptoms observed were nausea, vomiting, pain in the pit of the stomach, burning in the throat, very dark teeth, a blue line round the gums, and slight jaundice. There was great muscular weakness, with trembling of the hands, and a week before death there was paralysis of the right side.
Lead was discovered in most of the viscera, which were in great part normal, but the kidneys were wasted, and the mucous membrane blackened. The actual quantity of lead recovered by analysis was small, viz., 16·2 mgrms. (1⁄4 grain) from the liver; from 8 ounces of brain, 3·2 mgrms. (1⁄20 grain); from half of the stomach, 16·2 mgrms. (1⁄4 grain); and from the spleen, the kidneys, and the lungs, small quantities. It is, therefore, probable that, if the whole body had been operated upon, the yield would have been more than ·15 grm. (a little over 2 grains); but then, it must be remembered that the deceased lived, at least, seventeen days after the last dose.
§ 787. Post-mortem Appearances.—In acute cases of poisoning by the acetate, there may sometimes be found a slight inflammatory appearance of the mucous membrane of the stomach and intestines. Orfila considered that streaks of white points adherent to the mucous membrane were pathognomonic; but there have been several cases in which only negative or doubtful signs of inflammatory or other action have presented themselves. A general contraction of the intestines has often been noticed, and is of considerable significance when present; so also is a grey-black mucous membrane caused by deposited lead sulphide. Loen found in dogs and guinea-pigs, poisoned by lead, local inflammation areas in the lungs, liver, and kidneys; but in no case fatty degeneration of the epithelial cells of the liver, kidneys, or intestines. As a rule, no unabsorbed poison will be found in the stomach; the case related by Christison, in which a person died on the third day after taking at a single dose some large quantity of acetate of lead; and at the autopsy a fluid was obtained from the stomach, which had a sweet metallic taste, on evaporation smelt of acetic acid, and from which metallic lead was obtained—is so very extraordinary in every respect, that its entire accuracy is to be questioned. In death from chronic lead-poisoning, there is but little that can be called diagnostic; a granular condition of the kidneys, and all the pathological changes dependent on such a condition, are most frequently seen. If the patient has suffered from colic, a constriction of portions of the intestine has been noticed; also, in cases in which there has been long-standing paralysis of groups of muscles, these muscles are wasted, and possibly degenerated. In instances, again, in which lead has induced gout, the pathological changes dependent upon gout will be prominent. The blue line around the gums, and sometimes a coloration by sulphide of lead of portions of the intestines, may help a proper interpretation of the appearances seen after death; but all who have given any attention to the subject will agree that, simply from pathological evidence, it is impossible to diagnose chronic lead-poisoning.
§ 788. Physiological Action of Lead.—The action of lead is still obscure, but it is considered to have an effect mainly on the nervous centres. The paralysed muscles respond to the direct current, but not to the induced, leading to the suspicion that the intramuscular terminations of the nerves are paralysed, but that the muscular substance itself is unattacked. On the other hand, the restriction of the action to groups of muscles supports the theory of central action.
The lead colic is due to a true spasmodic constriction of the bowel, the exciting cause of which lies in the walls of the bowel itself; the relief given by pressure is explained by the pressure causing an anæmia of the intestinal walls, and thus lessening their sensibility. The slowing of the pulse produced by small doses is explained as due to a stimulation of the inhibitory nerves; and, lastly, many nervous phenomena, such as epilepsy, &c., are in part due to imperfect elimination of the urinary excreta, causing similar conditions to those observed in uræmia.