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- pathy. 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 valves. 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.