THE ODOUR OF PAINT AS A CAUSE OF PLUMBISM.

1083 CASE 2.-Lance-corporal ; multiple grenade wounds of limbs and chest. There was a history on admission of abdominal pain for three days. Whilst, on account of this pain, waiting for a stretcher was wounded by a grenade, and AND the pain became intensified and changed its character. On admission the abdomen was rigid and tender, especially over THERAPEUTICAL. the gall-bladder. On laparotomy, blood was found in the cavity with bile in the neighbourhood of the bileperitoneal A small metallic fragment was found lying near the THE ODOUR OF PAINT AS A CAUSE OF of the cystic and hepatic ducts ; a drain was inserted junction PLUMBISM. wound healed The abdominal without the ducts. to down trouble, but there was sepsis of the limb wounds. A basal BY H. H. MOYLE, M.R.C.S., L.R.C.P. LOND. pleuro-pneumonia acting on an originally enfeebled physique proved fatal. I BELIEVE few cases of this form of lead poisoning have CASE 3.-Private; grenade wounds of spine (slight symbeen known and recorded, and I am somewhat reluctant to Admitted 24 after abdomen. hours and being ptoms) wounded. There was a hypersesthetic rigid abdomen, with commit myself to the above title, yet being fully alive to the constant and desire of to vomiting, pass very great dimoulty sometimes met in detecting the source of frequent signs fluid, urine. A catheter was passed, and a few drachms of clear the poisoning I cannot but help feeling that the following urine were drawn off. On laparotomy the peritoneal cavity cases are definitely due to the smell of paint only. The blood; there were large wounds of the upper following is the history. was full ofwith fouling of the peritoneum. The intestinal jejunum, A man, his wife, and child occupied a cottage of two living wounds were sutured and the peritoneal cavity cleansed. and two bedrooms, all small, which early in October, 1915, were inserted down to in the wounds the Drainage-tubes bowel and in the pelvis. No wounds of the urinary apparatus was papered inside and thoroughly painteinside and outwere found. After-progress : Vomiting continued for 36 hours side, extending over about three weeks, the occupants living and then ceased. There was no secretion of urine for 48 in the house as usual. The smell was commented upon at to one of the painters, eliciting the remark of hours; then urine was passed per urethram and by the the timetack and war time." At the end of November the "cheap upper abdominal tube. The suppression of urine was accom- man came to me complaining of vague pains in abdomen, panied by symptoms of uraamia. There was persistent nausea, and feeling of discomfort after food which at the diarrhoea. Death took place 72 hours after operation. time I treated for dyspepsia with bismuth, &c., with relief. CASE 4.-Shrapnel wound of abdomen. The general conSome days later I was called to see the wife, who was dition was bad. On laparotomy 11 large perforations of the from abdominal pains. On entering the house the ileum were found. Resection of bowel was done, Paul’s suffering smell of paint was most noticeable. tubes being used ; lateral anastomosis was performed a few On examination of the woman nothing definite could be days later. Death occurred five days after the second opera- made out. Temperature and pulse normal, and she being tion. Immediate anastomosis would probably have saved of a somewhat neurotic I decided that a little temperament this case. had been exaggerated and would be relieved if the pain CASE 5.-Multiple grenade wounds, including the liver. bowels were opened. The same evening I was again called Patient admitted with marked symptoms of bleeding. On to see her. The abdominal pains were worse, and perhaps laparotomy a large lacerated wound of the right side of referred to region of gall-bladder more than another, yet the liver was found with much blood in the peritoneal cavity. they were more or less vague. No history of a previous The wound was plugged. The patient failed to rally, death jaundice, and the appendix had been removed about 18 taking place ten hours later. months before. Temperature 99° F ; pulse normal. Satisfied CASE 6.-Shell wound of abdomen. Laparotomy was per- that there was no acute abdominal condition present I left formed and a medium-sized perforated wound of the small haustus tr. opii dr. for her. I saw the husband at same bowel was sutured, the pelvis being drained. After-progress time, found he had not been so well and had stayed in bed. ’was uneventful. On the following day the woman’s pains were decidedly On better. Temperature and pulse normal. On examination CASE 7.-Lieutenant ; shell wound of abdomen. laparotomy seven perforations of the small bowel were of her mouth the teeth and gums were in excellent confound. Double resection was done, drains being inserted dition except for three-viz., upper canine and two lower down to the anastomosis and in the pelvis. After-progress bicuspids. The gums opposite these showed a definite blue line. I immediately examined the man’s mouth and found was uneventful, and the patient was discharged to England a well-marked blue line not only on the gums, but on cheeks three weeks after leaving CASE 8.-Shell wound of abdomen. Laparotomy revealed and lips which came into contact with gum margin. The cases presented the ordinary symptoms of lead a perforation of the stomach and haemorrhage from the ! coeliac axis. The perforations were sutured. Death ensued poisoning, that of the man being more severe than the 12 hours later. woman. Now as to source of poisoning. Occupation : The In all these cases the wounds were of such a nature that man does not come into contact with lead at all, while the woman in addition to her household work looks after railway recovery without operation was an apparent impossibility. gates Water-supply : Examination negative as to Perforating tilvaoid 1tloers.-Both cases were typical and crossing the diagnosis was made certain only by laparotomy. Each lead. Other fluids : Wife teetotal, man teetotal except for glass of cider. Food : Negative to direct contact. patient had had two antityphoid inoculations. Tests for occasional Fuel : Wood (unpainted) and coal. Usual china cups and A and B not In were made. one case the paratyphoid affected bowel was intensely inflamed, swollen, and sodden, plates, and nickel spoons, forks, &c. As already remarked, the paint smelt very strongly and and the perforafion was sutured with difficulty. Death took place 17 days later. At the necropsy the perforation was rather sticky to the touch, even eight weeks after painting. I found the food had been kept in a small unwas securely closed, a near-by ulcer had nearly perforated, and there was a general peritonitis partly loculated. The ventilated cupboard. With regard to actual contact with other case was of a milder character. The perforation was the paint by hands, this might occur in going upstairs to steady oneself (there being no hand-rail) by means of touchclosed and the after-progress was uneventful. a wall and partition. Otherwise there was no reason to ing Wounds pi Joints. touch any painted surface. In the bedroom the bed was In simple wounds with bleeding into the synovial cavity close up to the walls at foot, head, and one side. Two but with probably no marked "fouling"" of the joint cavity windows I have reason to believe were rarely opened. the wounds were excised down to the capsule. The joint In support of my title one knows that the illness caused was irrigated with saline and 5 c.c. of 10 per cent. solution by inhalation of paint odours is usually due to lead of iodoform in ether were injected. In cases complicated hydroxide acting on the oils and driers in the paint liberating by comminution of the bones entering into the formation of deleterious aldehydes, and Murrell says : "Sleeping in a the joint, the wounds of the soft parts were excised as freshly painted room has been known to cause lead thoroughly as possible. Loose fragments of bone were poisoning." I think that these two cases, living in a removed, and the wounds were irrigated with weak carbolic strong atmosphere of paint, and especially at night being or biniodide followed by saline. The injured bone received so close -to recently painted walls, certainly were the special attention, and fouled"areas were removed. victims of plumbism from a rather unusual source. It seems, Drainage-tubes were inserted down to the capsule with therefore, that a poor drying paint (? cheap), especially with separate drainage for the injured bone area. The results ieficient ventilation, may cause this illness, and more in cases of simple wounds were uniformly satisfactory; in particularly amongst those who occupy small rooms, and those of a severe type the results were also good so far as are thus brought into more intimate contact. they could be traced. Henstridge, Somerset.

Clinical Notes:

MEDICAL, SURGICAL, OBSTETRICAL,

ducts.

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