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LEAD                                                                  541

which either proximal or distal parts of the limbs may be involved, usually
the muscles which the patient uses most constantly in his work are affected.

Tremors, which are increased by movements, are observed in the
muscles before paralysis sets in.

Treatment.—This consists in the removal of the patient from the influence
of the poison. Medicinal doses of potassium or sodium iodide, parathyroid
and parathormone should be administered to assist the elimination of lead
through the kidneys. • Sodium bicarbonate should be given in large doses
of 20 to 30 grammes a day divided in four or five portions, as it increases the
output of lead owing to the transformation of the insoluble tribasic lead
phosphate to the soluble dibasic phosphate through the liberated carbonic
acid.1 A capsule containing 15 grains of ammonium chloride should be
administered regularly every four hours, followed by liberal quantities of
water. Intravenous injection of 15 cc. of a 20 per cent solution of calcium
gluconate or 10 cc. of a 5 per cent solution of calcium chloride should be
administered slowly to relieve intestinal colic. Saline purgatives, such as
magnesium sulphate and sodium sulphate, should be given to remove lead
from the bowels. An acid dietjiefixnent injoalfilliin, vitamin C, hot baths,
sulphur baths, galvanism an<Tmassage should also be tried for removing the
poison from the system. Hypodermic injections of strychnine hydrochloride
may be administered for paralysis.

Lumbar puncture and sedatives should be tried in cases of encephalo-

Adequate exhaust ventilation in lead manufactories, scrupulous personal
cleanliness and periodic medical examination of the workers by a factory
surgeon to detect the earliest signs of "lead poisoning are the chief measures
which are recommended to prevent chronic lead poisoning. Every day the
workers should take ajjje^ichjsu^                        with a lot of milk and

should drink water contal^g^minuie" doses of sulphuric acid. They should
be given four drachms of magnesium or sodium sulphate as a saline purgative
once a week.

Post-mortem Appearances.—Not constant. A blue line along the margin
of the gums. The paralysed muscles are flaccid, and show fatty degenera-
tion. The intestines are contracted and thickened. The liver and kidneys
are found hard and contracted, the seat of granular degeneration. The heart
may be hypertrophied, and there may be atheroma of the aorta and aortic

Detection of Lead in Urine.—In impending or doubtful cases of plumbism
it is necessary to analyse urine and faeces for the presence of lead. Mere
detection of lead is not sufficient for a positive diagnosis of lead poisoning,
but the actual quantity should be determined, inasmuch as traces of lead
may be found in the •urine and faeces of healthy people owing to the fact
that small quantities of lead are ingested with such articles of food, as
sausages, meat, beans, cherries, apples and other fruits. It has been esti-
mated that the average American excretes from 0.02 to 0.08 mg. of lead per
litre of urine and from 0.03 to 0.1 mg. per .gramme ash of faeces.2 From
investigations carried out in Calcutta, Bagchi and Ganguli3 have shown that
the average lead content per litre of normal urine is 0.008 mg. in Hindus,
0.014 mg. in Mahomedans and 0,031 mg. in Anglo-Indians, while the average
lead content per litre of normal faeces is about ten times the amount elimi-

1.   Aufo  and  his  collaborators,  Lead  Poisoning,   Baltimore,   J926;   Leschke,   Clinic.
Toxic., Eng. Transl. by Stewart and Dorrer, 1934, p. 25.

2.   Kehoe and his colleagues, Jour, of Indiistr. Hygiene, Sept. 1933; Brit Med. Jour.,
April 28, 1934, p. 766.                         .....

3.   Ind. Jour, of Med. Res., Vol. XXV, No. 1, July 1937, p. 174; see also Boyd and
Ganguli, Ind. Jour, of Med, Res,, Vol. XX, 1932, p. 75.