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THE ASSOCIATION OF BAD TEETH AND LEAD POISONING.
346
restoring a child, called Elisha’s method of I am, Sir, yours faithfully, respiration ?
artificial
-
LEONARD HILL.
THE ASSOCIATION OF BAD TEETH AND LEAD POISONING. To the Editor of THE LANCET. SIR,-The interesting annotation on the subject of lead poisoning which appears in THE LANCET of Jan. 18th, p. 183, makes me think that perhaps the following notes which I have made on the subject in my capacity of appointed surgeon under the Factory Acts, may be of interest to your readers. In lead and spelter works there are a large number of men who have what is usuallv termed a lead or saturnine appearance, as well as certain signs and symptoms that are supposed to be characteristic of lead. The tongue is oftentimes pale, flabby, and tooth-indented. The man suffers from constipation or a tendency thereto ; he complains of malaise and an indisposition to work, and a general expression of These symptoms, together with a certain discomfort. amount of pain due to gastric distension, if found in in lead or spelter works, are sure to a man working But lead to a certificate notifying lead poisoning. above a reference to any text-book will show that the symptoms, which I have taken almost seriatim from Taylor’s book on medicine, are those under the heading of gastric indigestion. In all the men at the works who present the above symptoms I have found that the teeth are in a very bad condition and the mouth extremely foul. Were I to use my powers of suspension from work I might easily disorganise the works, for such a large number would have to be suspended. My plan, however, is to draw the man’sattention to the foulness of his mouth and the consequences that arise therefrom, with the result that many of them have had their teeth extracted and all need for suspension has disappeared, the men presenting an appearance of sound health at the end of two to three months, the colour reappearing in their cheeks, their malaise lessened, their tongue clean, and all stomachic discomfort removed. When the men have dirty mouths they do not seem to mind what extra amount of dirt they put into their mouths, for without hesitation they put their lead-dusted fingers in to pick their teeth and smoke cigarettes down to the fag-end, which is always thickly coated with lead. Now that lavatories and mess-rooms are provided, they do take more care about washing their hands before eating, bu, this is due to the fact that they are driven there by the management as well as the cosy comfort of the rooms themselves. When, however, a man h? s been to the dentist and had his teeth removed, it is always noticeable that he is more particular as to what he puts in his mouth, and an improved moral force gives evidence of its presence. In connexion with lead poisoning there are two questions that require an answer : the first is, Why are there more cases in hot summers ? and the second, Why do healthy young men fresh from the country show -evidence of lead poisoning in a very short time after starting in the lead works ? The answer to the first is to be found in the fact that men with foul teeth are always in, or bordering on, a state of dyspepsia, for the filthy material from the teeth acts as a poison to the gastric mucous membrane, with the result that this membrane is extremely likely to become inflamed and its blood-vessels considerably dilated, especially when i, the fruit is cheap and large quantities of it are eaten in an unripe condition. With this engorgement it is easy to understand how the lead, instead of being adsorbed, becomes absorbed and the system poisoned. With regard to the oftentimes quick appearance of lead symptoms in healthy fresh men from the country, the explanation is easy, for with foul mouths and a gluttonous appetite for food hitherto unattainable on account of their low wages, they develop an attack of gastritis which causes lead absorption and the typical symptoms more or less masked by those of gastritis. In the case of the fresh men it cannot be due to the fact that they inhale more than the other men who have developed somewhat of an immunity against lead poisoning, for no such immunity exists or has Were inhalation the chief cause of even been suggested. lead absorption one would naturally expect to find lead
some of the foremen and managers, but these on account of their cleanly habits are saved. Nor can it be held in connexion with hot summers that the dust about the works is increased, for before furnaces there is always dust, and during the storms of winter this dust is much more likely to be blown about. The point is one of very great importance, especially when treatment is considered, for if the cause lie in the preliminary gastritis it is important to note that iodides are contraindicated, since the more soluble lead salt that is formed has a greater chance of being absorbed. What, then, should be our method of dealing with these cases ? The best method seems to me undoubtedly to give such drugs as tend to allay or remove the gastritic condition, and the best drug for these cases is, I think, calcium permanganate. I am, Sir, yours faithfully, G. ARBOUR STEPHENS.
poisoning amongst
-
HOSPITAL NURSING IN ITALY. To the Editor of THE LANCET.
SIR,-In THE LANCET of Dec. 7th, 1912, p. 1619, yonr Italian correspondent comments very severely on hospital nursing in Italy. Incidentally he mentions the"Regina Elena," concerning which I should like permission to furnish some details. The Scuola Convitto Regina Elena (Nurses’ Home) now contains 75 bedrooms, eight sisters’ and nurses’ sitting-rooms, dining-room, matron’s offices, servants’ quarters, and laundry. At first the nursing of 80 patients was given in charge of an English matron and sisters. The school then consisted of 18 to 20 nurses, matron and assistant matron, coming out from England, and of 16 Italian probationers who came from all parts of Italy. To-day the staff consists of matron, 14 English sisters, including home sister, massage sister, night superintendent, 17 certificated Italian The patients nurses, and 35 Italian probationers (in all 67). nursed by them now number 240. Many applications for admission as probationers are under consideration, and a site is being chosen for the building of a new nurses’ home with 400 to 450 beds, so as to make it possible to take over the entire nursing of the 1200 to 1350 Policlinico patients. H. M. the Queen of Italy will next month present medals to Italy’s first 17 hospital-trained nurses, nurses trained on Florence Nightingale lines-that is, not mainly (or even exclusively) by lectures, but by the bedside of a sufficient number of the patients, for whose sake we believe that all hospitals, doctors, and nurses exist. I am, Sir, yours faithfully, D. A. SNELL (Matron).
THE STATISTICS OF MORBIDITY AND MORTALITY. To the Editor of THE LANCET. SIR,-The Royal Statistical Society has appointed a committee to report on the statistics of morbidity and mortality in the United Kingdom which are available. Doubtless there
many valuable collections published in various parts of the country by hospitals and institutions which are not known to the society. May I invite the authorities of such institutions to communicate with me about any collected data, published or otherwise, which they may have by them ?-I am, Sir, yours faithfully, REGINALD DUDFIELD, are
Chairman of the Committee.
Royal Statistical Society, 9. Adelphi-terrace, Strand, London, W.C., Jan. 28th, 1913.
DONATIONS AND BEQUESTS.-The late Mrs. Sarah Annie Ward, of York, has bequeathed £4000 to the Cancer Hospital at Brompton, and .E.150 to the Men’s Convalescent Home, Rhyl.-Mr. Mark Kippax, of Blackpool, retired cotton manufacturer, left net personalty .S24,422. Subject to one life interest he bequeathed £1000 each to the Victoria Hospital for Burnley and District and to the Victoria
Hospital, Blackpool.
restoring a child, called Elisha’s method of I am, Sir, yours faithfully, respiration ?
artificial
-
LEONARD HILL.
THE ASSOCIATION OF BAD TEETH AND LEAD POISONING. To the Editor of THE LANCET. SIR,-The interesting annotation on the subject of lead poisoning which appears in THE LANCET of Jan. 18th, p. 183, makes me think that perhaps the following notes which I have made on the subject in my capacity of appointed surgeon under the Factory Acts, may be of interest to your readers. In lead and spelter works there are a large number of men who have what is usuallv termed a lead or saturnine appearance, as well as certain signs and symptoms that are supposed to be characteristic of lead. The tongue is oftentimes pale, flabby, and tooth-indented. The man suffers from constipation or a tendency thereto ; he complains of malaise and an indisposition to work, and a general expression of These symptoms, together with a certain discomfort. amount of pain due to gastric distension, if found in in lead or spelter works, are sure to a man working But lead to a certificate notifying lead poisoning. above a reference to any text-book will show that the symptoms, which I have taken almost seriatim from Taylor’s book on medicine, are those under the heading of gastric indigestion. In all the men at the works who present the above symptoms I have found that the teeth are in a very bad condition and the mouth extremely foul. Were I to use my powers of suspension from work I might easily disorganise the works, for such a large number would have to be suspended. My plan, however, is to draw the man’sattention to the foulness of his mouth and the consequences that arise therefrom, with the result that many of them have had their teeth extracted and all need for suspension has disappeared, the men presenting an appearance of sound health at the end of two to three months, the colour reappearing in their cheeks, their malaise lessened, their tongue clean, and all stomachic discomfort removed. When the men have dirty mouths they do not seem to mind what extra amount of dirt they put into their mouths, for without hesitation they put their lead-dusted fingers in to pick their teeth and smoke cigarettes down to the fag-end, which is always thickly coated with lead. Now that lavatories and mess-rooms are provided, they do take more care about washing their hands before eating, bu, this is due to the fact that they are driven there by the management as well as the cosy comfort of the rooms themselves. When, however, a man h? s been to the dentist and had his teeth removed, it is always noticeable that he is more particular as to what he puts in his mouth, and an improved moral force gives evidence of its presence. In connexion with lead poisoning there are two questions that require an answer : the first is, Why are there more cases in hot summers ? and the second, Why do healthy young men fresh from the country show -evidence of lead poisoning in a very short time after starting in the lead works ? The answer to the first is to be found in the fact that men with foul teeth are always in, or bordering on, a state of dyspepsia, for the filthy material from the teeth acts as a poison to the gastric mucous membrane, with the result that this membrane is extremely likely to become inflamed and its blood-vessels considerably dilated, especially when i, the fruit is cheap and large quantities of it are eaten in an unripe condition. With this engorgement it is easy to understand how the lead, instead of being adsorbed, becomes absorbed and the system poisoned. With regard to the oftentimes quick appearance of lead symptoms in healthy fresh men from the country, the explanation is easy, for with foul mouths and a gluttonous appetite for food hitherto unattainable on account of their low wages, they develop an attack of gastritis which causes lead absorption and the typical symptoms more or less masked by those of gastritis. In the case of the fresh men it cannot be due to the fact that they inhale more than the other men who have developed somewhat of an immunity against lead poisoning, for no such immunity exists or has Were inhalation the chief cause of even been suggested. lead absorption one would naturally expect to find lead
some of the foremen and managers, but these on account of their cleanly habits are saved. Nor can it be held in connexion with hot summers that the dust about the works is increased, for before furnaces there is always dust, and during the storms of winter this dust is much more likely to be blown about. The point is one of very great importance, especially when treatment is considered, for if the cause lie in the preliminary gastritis it is important to note that iodides are contraindicated, since the more soluble lead salt that is formed has a greater chance of being absorbed. What, then, should be our method of dealing with these cases ? The best method seems to me undoubtedly to give such drugs as tend to allay or remove the gastritic condition, and the best drug for these cases is, I think, calcium permanganate. I am, Sir, yours faithfully, G. ARBOUR STEPHENS.
poisoning amongst
-
HOSPITAL NURSING IN ITALY. To the Editor of THE LANCET.
SIR,-In THE LANCET of Dec. 7th, 1912, p. 1619, yonr Italian correspondent comments very severely on hospital nursing in Italy. Incidentally he mentions the"Regina Elena," concerning which I should like permission to furnish some details. The Scuola Convitto Regina Elena (Nurses’ Home) now contains 75 bedrooms, eight sisters’ and nurses’ sitting-rooms, dining-room, matron’s offices, servants’ quarters, and laundry. At first the nursing of 80 patients was given in charge of an English matron and sisters. The school then consisted of 18 to 20 nurses, matron and assistant matron, coming out from England, and of 16 Italian probationers who came from all parts of Italy. To-day the staff consists of matron, 14 English sisters, including home sister, massage sister, night superintendent, 17 certificated Italian The patients nurses, and 35 Italian probationers (in all 67). nursed by them now number 240. Many applications for admission as probationers are under consideration, and a site is being chosen for the building of a new nurses’ home with 400 to 450 beds, so as to make it possible to take over the entire nursing of the 1200 to 1350 Policlinico patients. H. M. the Queen of Italy will next month present medals to Italy’s first 17 hospital-trained nurses, nurses trained on Florence Nightingale lines-that is, not mainly (or even exclusively) by lectures, but by the bedside of a sufficient number of the patients, for whose sake we believe that all hospitals, doctors, and nurses exist. I am, Sir, yours faithfully, D. A. SNELL (Matron).
THE STATISTICS OF MORBIDITY AND MORTALITY. To the Editor of THE LANCET. SIR,-The Royal Statistical Society has appointed a committee to report on the statistics of morbidity and mortality in the United Kingdom which are available. Doubtless there
many valuable collections published in various parts of the country by hospitals and institutions which are not known to the society. May I invite the authorities of such institutions to communicate with me about any collected data, published or otherwise, which they may have by them ?-I am, Sir, yours faithfully, REGINALD DUDFIELD, are
Chairman of the Committee.
Royal Statistical Society, 9. Adelphi-terrace, Strand, London, W.C., Jan. 28th, 1913.
DONATIONS AND BEQUESTS.-The late Mrs. Sarah Annie Ward, of York, has bequeathed £4000 to the Cancer Hospital at Brompton, and .E.150 to the Men’s Convalescent Home, Rhyl.-Mr. Mark Kippax, of Blackpool, retired cotton manufacturer, left net personalty .S24,422. Subject to one life interest he bequeathed £1000 each to the Victoria Hospital for Burnley and District and to the Victoria
Hospital, Blackpool.