540 MEDICAL JURISPRUDENCE Chronic lead poisoning occurs in India from the use of ghee (clarified butter) stored in brass or copper vessels lined inside with tin. Ghee becomes impregnated with lead derived from the tin, which sometimes contains it as an impurity, and forms a poisonous salt, oleate of lead. The poison may also be conveyed into the system by taking the food cooked in tinned vessels—the common practice in India. Candy<J7 quotes the cases of chronic lead poisoning observed by Mankad and Fozdar in Ahmedabad. Chronic lead poisoning may occur from absorption of lead through the raw or intact skin. Gottheil98 reports that a patient suffered from chronic lead poisoning after local applications to extensive burns of dilute Burow's solution of aluminium acetate holding in suspension lead sulphate, and died after eight weeks. Bagchi" has shown that in Bengal, Hindu married women, who are in the habit of applying vermilion to the scalp above the middle of the forehead where the hair is usually parted, often suffer from chronic lead poisoning, as the vermilion which contains red lead mixed with a red synthetic dye is absorbed through the scalp. The use of hair oil which is so common among women, helps to hold the lead in contact with the scalp by forming lead soap with the fatty acids of the oil, and thus favours absorp- tion, especially if the epithelium of the scalp is damaged. Symptoms.—A sweetish metallic taste in the mouth; foul tongue ; foetid breath; a blue line on the gums, especially of the upper jaw, but it is absent if there are no teeth or if they are kept clean. This is due to the decomposed food in the mouth forming hydrogen sulphide, which forms sulphide of lead. The patient complains of dyspepsia, becomes emaciated and anaemic, and has a sallow earthy complexion. The pulse is slow and of high tension, the blood pressure being greatly increased. The blood shows the presence of punctate basophilia among the red corpuscles and diminution of the haemoglobin con- / tent, The red corpuscles and polymorphonuclears are diminished, while the '' lymphocytes, large mononuclears and eosinophils are increased in numbers. Interstitial nephritis and general arteriosclerosis are often present. The urine contains albumin, lead and haematoporphyrin. Menstrual derange- ments, miscarriages and still-births are common in women, while sterility is a noticed in both men and women. | The chief prominent symptoms are colic and constipation, arthralgia, 1 encephalopathy and paralysis. 1. Colic and Constipation (Dry Belly-ache).—Colicky pain felt round the umbilicus is very intense, but is relieved by pressure. The abdominal muscles are retracted, though hard and tense. There is obstinate constipa- tion. Tenesmus is usually present, but diarrhoea is very rare. 2. Arthralgia.—The patient complains of rheumatic pain of a shooting nature in the bones and large joints, such as the knees, elbows and shoulders, but the small joints are not affected. Contractions and twitchings of the muscles may be present. 3. Encephalopathy.—This involves cerebral and psychical affections, such as intense headache, dizziness, insomnia, anaesthesia, optic neuritis, amau- rosis, convulsions, hallucinations, delirium, insanity, eclampsia and coma. 4. Paralysis.—Paralysis first affects the extensor muscles of the forearm and fingers except the supinator longus and causes " wrist drop " and " claw shaped hand". It then spreads to the extensors of the foot/resulting in dropped foot". The tibialis anterior is generally not affected. The muscles begin to waste, and the condition resembles that of acute anterior poliomyelitis. This is due to the purely motor type of lead neuritis in 97. Ind. Med. Gazette, March 1933, p. 136; see also Ind. Med. Gag., Oct. 1937, p. 595. 98. Jour. Amer. Med. Assoc., 191Q, 54, p. 1056 99. Ind. Med. Gaz., Jan. 1941, p. 23.