IN SPITE OF THE ZEAL of those responsible for the administration of the Public Health and Factory Acts, it is an open secret that plumbism abounds; at which there can be little wonder when one considers that a mere recital of the sources of lead and the modes of its access to the human body would occupy several pages of an ordinary volume.

Lead as an abortifacient

That lead is a powerful abortifacient has repeatedly been emphasized and fully established during investigations into many industrial processes, and that it has been, and is still being, used illegally for that purpose is equally beyond question.

In 1902 Oliver mentions explicitly the use of Diachylon pills for criminal abortion, and from that time forward medical journals have recorded cases so regularly and frequently as to prove that the practice has become quite prevalent.

In my neighbourhood, plumbism is sometimes contracted in the pursuit of certain occupations, notably in the process of “tinning” metal hollow-ware, and it is then the occasion of compensation claims and disputes under the Employers Liability Act.

Many of the victims are young women employed in dipping articles in the molten metal, or in wiping off any excess after being so dipped. The metal used contains only a small percentage of lead.

Apart from these occuptional cases, lead poisoning began to show itself some ten years ago among women of child-bearing age. The leading features of the illness when the medical attendant was first consulted were those of abortion: namely, metrorrhagia, abdominal pain and anaemia; and here no doubt the diagnosis rested in some of the earlier cases. The discovery of a blue line on the gums by the admission of wilful self-administration, invariably in the form of Diachylon pills. These were either home-made or obtained from hawking vendors.

Altogether at least thirty or forty cases have come under my notice, and only in three or four have I failed to obtain a culpable admission – in these exceptional cases it has transpired that the patients had taken what they believed to be pennyroyal obtained from a hawker – but, seeing that lead was undoubtedly present, I have suspected that possibly it had been added to the herbs by the seller, who presumably relied on it to effect what the unsophisticated drug would otherwise fail to do, the patient being meanwhile unaware of any dangerous addition to the harmless decoction she intended to take. In such enquiries, however, prevarication is so rampant that one hesitates to accept the most solemn assurances.

The risks to the mother vary considerably, but without exception colic, anaemia, and debility are present; the latter, and a tendency to grave nervous disorders, being sometimes quite alarming. Diarrhoea is by no means rare, perhaps oweing to the fact that the pills are at times compounded with aloes.

The gingival blue line was in all cases the deciding factor of the diagnosis, being so pronounced that one never had any hesitation in its acceptance; in one case not only were the gums and the insides of the cheeks discoloured, but the margins of the tongue were so dark as to resemble bilberry staining. One learns to regard this marked discolouration as evidence in itself that the metal was self-administered.

Criminal administration of lead is by no means confined to the poor and ignorant, although among them it is much more prevalent than among the wealthier and better informed. In the latter, the blue line is less striking, doubtless owing to relative absence of the oral sepsis and decomposition necessary to its production.

Plumbism through beer

I discovered a few months ago evidence of lead in a married woman living in a certain locality. I inspected all the members of her family, and found that whilst the husband showed lead, the children, including a daughter who was a tinner, were exempt. Following the enquiry, I found six others of her immediate neighbours with the same symptoms – one had been under hospital treatment for some months. All the victims, five males and three females, were adults of the poorer class, and their children were, without exception, unaffected.

The poison was traced to a cheap beer obtained from a certain public-house. Those who drank it as in-customers only, seem always to have escaped, as also the out-customers who selected beers of a higher price.

The evidence was so conclusive that I wrote to the Home Office asking how far it was incumbent on me to report the outbreak, but, as it was not associated with any industrial occupation, they were unable to take official cognizance of it. They suggested, however, that it might be expedient to furnish the evidence to the Medical Officer of Health or to the Food and Drugs Inspector, either directly or through them; but as an official investigation might have brought on the publican possibly undeserved obloquy and loss of business, I preferred the simpler step of advising him quietly of my suspicions.

It transpired that the beer was from a brewery supplying several other houses, at none of which complaint had arisen, and that it was the custom at the affected house to add to the cheapest kind supplied exclusively to out-customers, all beer, of whatever quality, which had been drawn each morning, after having stood throughout the night in the lead pipes connecting the barrel in the cellar to the machine in the bar, a practice entirely contrary to that said to obtain in the trade, of rejecting each day the first gallon or so drawn. The publican expressed gratitude for the hint, and hastened to correct his error, with the result that, from that time, no further cases have been observed, and those affected have slowly recovered.