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CHRONIC LEAD-POISONING.

white or red lead as a cement for pipes and cisterns. For an instructive series of cases showing the effects of water thus poisoned, the reader is referred to a paper by De Mussey. (Dublin Quar. Jour., May, 1849; also Med. Gaz., vol. 44, p. 260.) These cases occurred at Claremont, among the members of the ex-royal family of France. The effects were traced to the use of water which had acquired an impregnation of lead by contact with that metal, in the proportion of one grain to the gallon. Thirteen out of thirty-eight persons were affected, and to such a degree that the nails of the toes and fingers in some acquired a bluish discoloration. The children of the family did not suffer. No symptoms appeared until after the water had been in use for a period of from five to seven months, and more than half of those who used the water escaped any ill effects. The presence of lead in public water-supplies has recently attracted great attention, in consequence of the pollution of the supplies of Sheffield, Keighly, Huddersfield, and Bacup. It appears that soft waters, especially if acid, are very prone to act injuriously upon leaden pipes. (Lond. Med. Rec., 1882, p. 430; Chem. News, 1882, ii. p. 88; Brit. Med. Jour., 1889, i. p. 992 et seq.)

Cases of poisoning are sometimes observed as the result of the acci dental introduction of lead into the system in wine, beer, cider, milk, lemonade, and other liquids. Earthenware glazed with litharge imparts lead to fat in dripping, also to acid liquids. Snuff is sometimes adulterated with red lead to improve its color, and some cases of lead-poisoning have occurred from the use of such snuff.

A spurious tinfoil, consisting chiefly of lead faced with tin, is much used as a covering or wrapper for articles of food. When exposed to damp, this metallic alloy undergoes chemical changes whereby subcarbonate of lead is produced. Children's farinaceous food has thus become impreg nated with lead. In tinned iron vessels there is often a large quantity of lead alloyed with the tin, as it is a much cheaper metal. Hamilton has noticed that lead-poisoning has been produced in India by the use of the tinned cooking-pots. (Lancet, 1877, i. p. 253.)

There is another unsuspected method by which lead may find its way into that common article of food-flour. It is sometimes a custom of millers to repair the holes in their millstones with melted lead. The lead is thus ground into and mixed with the flour. Alford states that fifteen or twenty persons, in different families, suffered from colic and other symptoms of chronic lead-poisoning, from this cause. The blue line on the gums was well marked. It was found that they had all had their own corn ground at the same mill. On examining the millstones they were found to be honeycombed with lead. There was on the surface of the stones about ten pounds of lead. (Brit. Med. Jour., 1877. i. p. 627.)

The workers in white lead, especially those engaged in the operation of stoving and grinding the compound, are most prone to suffer in a severe form from lead-poisoning. This has been made a matter of recent legisla tion, in order to protect the workpeople from the insidious effects of lead compounds.

[Judge Penrose (Philadelphia) reports that in 1886 whole families in New York were poisoned by using flour manufactured where lead had been used for filling cavities in the millstones by the mill-owners.]

POISONING WITH COPPER.

COPPER.

155

All the salts of copper are poisonous. The two most commonly known in commerce are the SULPHATE, or BLUE VITRIOL, and the SUBACETATE, or VERDIGRIS.

BLUE VITRIOL. Sulphate of Copper.-Symptoms.-The medicinal dose of sulphate of copper as an emetic is from five to fifteen grains, and, as a tonic, from one to three or four grains. It has been frequently given for the purpose of procuring abortion. In doses of half an ounce and upwards it acts as an irritant on adults, and a much smaller quantity would suffice to destroy infants or children. The salt speedily causes vomiting of the most violent kind; this sometimes expels the poison from the stomach and the person recovers. There is headache, with colicky pains in the abdomen, and purging; and in aggravated cases there are spasms of the extremities and convulsions. Perceval met with an instance in which violent convulsions were produced in a young woman by sixty grains of sulphate of copper. Paralysis, insensibility, and even tetanus, have preceded death when the poison was administered to animals. Among the symptoms occasionally met with in the human being may be mentioned jaundice. This has been observed to attend poisoning with the sulphate, as well as by Scheele's green. Two children, one eight and the other six years old, ate a quantity of wheat which had been washed in a solution of sulphate of copper. They were seized with incessant vomiting, the vomited matter being of a bluish or greenish color. The vomiting continued more or less for several days. There was no purging. The elder child recovered, but the younger was very much prostrated and died about two months afterwards. (Brit. Med. Jour., 1877, ii. p. 292.) In 1884 a girl was convicted of poisoning her mistress by introducing sulphate of copper into a jug of beer. The taste of the substance was perceived; the only results were severe vomiting. (Reg. v. Mary Baker, C. C. C., Oct. 1874.) In 1886, a man was convicted of attempting to murder his wife by administering to her sulphate of copper in spruce and peppermint water. He was sentenced to twenty years' penal servitude. (Reg. v. Reynolds, C. C. C., Sept. 1886.) The vomited matters are remarkable for being generally of a blue or green color; broken crystals of blue vitriol were discovered in them in a case in which the poison was taken in the state of coarse powder. If the green color of the vomited liquid is owing to altered bile, it will not acquire a blue tint on adding to a portion of it a solution of ammonia; but if caused by a salt of copper this change of color will serve to indicate the fact.

VERDIGRIS, or subacetate of copper, in large doses, produces similar symptoms.

Chronic poisoning by copper is occasionally seen among workers in this metal and its salts. The poison enters the system partly by the lungs in the form of dust, and partly by the skin in handling the metal or its salts. The marked symptoms are a coppery taste in the mouth, giddiness, pain in the bowels, vomiting, occasional diarrhoea, and wasting of the body. Clapton has pointed out another symptom, namely, a green line on the margin of the gums. He met with this in a sailor and in some working coppersmiths. (Med. Times and Gaz., 1868, i. p. 658.) The author saw two of these cases in 1868. The green line was well marked. The men brought with them a hammer used in their work. It had a greenish color, and this was proved by tests to be owing to the presence of copper. The perspiration from the hands in working had con

156

APPEARANCES-CHEMICAL ANALYSIS.

verted the copper into a basic chloride, and had thus led to its absorption by the skin. Several cases of chronic poisoning by copper among coppersmiths have been treated by Cameron, but this symptom was not noticed. (Med. Times and Gaz., 1870, 1, p. 581.) Gallippe (Sur le Cuivre) denies the injurious action of copper compounds upon the human body.

[Prof. Reese reports that poisoning by bronze-powder (an alloy of copper in very fine powder), used for printing in gold, is not infrequent. The powder is dusted over the prepared size, and it more or less mixes with the air of the apartment; it must consequently be inhaled into the lungs.

The Phila. Med. News and Abstract of Sept. 1880, quotes a case from the Brit. Med. Jour., July 24, 1880, of a boy aged 13, who died from inhaling bronze-powder in a printing establishment. He suffered from sickness, pain in the bowels, great distention and tenderness on pressure; no diarrhoea. He fell into collapse, and died on the twelfth day after commencing the work and the eighth day of his sickness. Death was found to have resulted from peritonitis; no inflammation of stomach or bowels. Dr. Tidy detected copper in the stomach and liver.]

Cases have, however, been observed of the injurious effects of preserved vegetables, the green color of which is often preserved by the use of sulphate of copper; and the cases of poisoning by sulphate of copper already referred to are conclusive against Gallippe's views.

Appearances. In the few fatal cases which have been hitherto examined, the mucous membrane of the stomach and intestines has been found more or less thickened and inflamed, and in some cases eroded and softened. The gullet has presented an inflammatory appearance. In one case of poisoning by verdigris the stomach was inflamed and thickened, especially towards the intestinal opening, the orifice of which, from the general thickening, was almost obliterated. The small intestines were throughout inflamed, and perforation had taken place, so that part of the green liquid was effused into the abdomen. The large intestines were distended in some parts and contracted in others, and the rectum was ulcerated on its inner surface. (Orfila, Toxicologie.) The lining membrane of the intestines has been found throughout of a deep-green color, owing to small particles of the copper salt (verdigris) adhering to it.

Chemical Analysis.-The salts of copper, whether in the solid state or in solution, are generally known by their blue or green color. Tests -1. Solution of Ammonia gives, in a solution of a salt of copper, a bluish-white precipitate, which is soluble in an excess of the test, forming a deep violetblue liquid. 2. Ferrocyanide of potassium gives, in a very diluted solution, a rich claret-red precipitate. If the quantity of copper is small, the liquid acquires merely a light-red color; if large, the precipitate is of a deep red-brown color and of a gelatinous consistency. Ferrocyanide of potassium will act on the violet-blue solution produced by ammonia, provided a few drops of acetic acid are added in order to neutralize the ammonia. One portion of the liquid may thus be tried with the two tests. 3. Sulphuretted hydrogen gas and sulphide of ammonium give a deep chocolate-brown precipitate, even in an acid solution, or, if the copper is in small proportion, merely a light-brown color. 4. A slip of polished iron (a common needle) suspended by a thread in the liquid slightly acidu lated with sulphuric acid is speedily coated with a red layer of copper, even when the salt is in very small proportion. The iron thus coated may be washed, immersed in ammonia, and exposed to air. The liquid becomes slowly blue, and may then be tested with ferrocyanide of potassium as above. A minute quantity of copper may be thus easily detected. 5. The

DETECTION OF COPPER IN THE TISSUES.

157

electrolytic test. If a few drops of the copper solution are placed on platinum-foil, slightly acidulated with a diluted acid, and the platinum is then touched through the solution with a rod of zinc, metallic copper, of its well-known red color, is immediately deposited on the platinum. When the quantity of copper is very small, there is merely a brown stain; but a blue liquid is formed by pouring on it ammonia and exposing it to air. A coil of fine platinum and zinc wire may be substituted for the foil.

Copper in organic liquids.—Copper is liable to be precipitated by certain organic matters, e. g. albumen, fibrin, and mucous membrane; but some of these organic compounds are easily dissolved by acids, or even by an excess of the solution of copper salt. A portion at least of the salt of copper is, therefore, commonly held dissolved. In such cases the liquid is usually of a greenish color, and has a strong coppery or metallic taste, even when the copper salt is in far less than a poisonous proportion. Having filtered the organic liquid, let a portion of it be placed in a clean platinum capsule. A few drops of diluted sulphuric acid should be added and a rod of zinc introduced. Wherever the platinum is touched by the zinc metallic copper is deposited; and, after having in this way coated the platinum capsule, the surplus liquid may be poured off and the capsule well washed out. The deposited copper, which is of a deep-red color, is then dissolved in nitric acid, and the tests are applied after the excess of acid has been driven off by heat, and the residue dissolved in water. In place of nitric acid and heat, a solution of ammonia may be poured on the metallic deposit in the cold. Under exposure to air the metal is oxidized and dissolved in a few minutes, forming a blue solution. This ammoniacal solution may be neutralized with acetic acid and ferrocyanide of potassium then added. The red color of the deposit on platinum is characteristic of copper, and the mode of testing here advised renders the results conclusive.

In the tissues. Dry and incinerate the organic matter over a Bunsen burner provided with an iron tube. If the ordinary burner with brass tube be used, some copper will be volatilized from the burner and deposited on the ashes. Digest the residuary ash in pure hydrochloric acid by heat and then evaporate nearly to dryness. This residue may be dissolved in a small quantity, of water and a polished needle immersed in it for some hours. The metallic deposit, if any, on the needle may be recognized as copper, either by its color or by the action of ammonia.

Traces of copper have been found in many kinds of food, as well as in the tissues of the body, irrespective of the introduction of a copper salt as a poison. Thus copper has been detected in various green pickles, in preserved peas and other vegetables. It has been used in these cases as an artificial coloring. In prosecutions under the Sale of Food and Drugs Act, the question has arisen whether such a quantity of copper as 0.28 grain in a pound would render the article injurious as food. Copper is a noxious substance, and there is a penalty on the wilful admixture of any noxious substance with any article intended for food, whatever the proportion may be. In some cases, a grain and a half of sulphate of copper has been found in a pound of peas. The restrictions on the regreening of preserved vegetables in France have been recently removed.

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TARTAR EMETIC-SYMPTOMS.

CHAPTER XIV.

TARTAR EMETIC.-ANTIMONIAL WINE.-SYMPTOMS.-APPEARANCES.-CHRONIC POISONING.— CHEMICAL ANALYSIS.-CHLORIDE OR BUTTER OF ANTIMONY.-POISONING WITH SALTS OF ZINC AND IRON.-POISONING WITH CHROMATES.

TARTAR EMETIC.

Tartar Emetic, or Tartarated Antimony, is met with in commerce as a heavyish white powder, freely soluble in twenty parts of water and less soluble in alcoholic liquids. It is used in medicine, and more largely in veterinary medicine.

Antimonial Wine, i. e. the official solution of tartarated antimony in sherry wine (two grains in one fluidounce), may easily be mistaken for ordinary sherry. The editor had a laboratory attendant who was made seriously ill by drinking this medicine, which he had pilfered. Tartar emetic is a constituent of many proprietary and patent cough medicines; and these, when taken in excess, may produce a powerful depressant action upon the system.

Symptoms and Effects. When tartar emetic is taken in a poisonous dose, a strong metallic taste is perceived in the mouth during the act of swallowing. There is great heat, with constriction of the throat and difficulty of swallowing, violent burning pain in the region of the stomach, followed by incessant vomiting, profuse purging, faintness, and extreme depression. The pulse is small and rapid, and sometimes imperceptible; the skin cold and clammy, and covered with a clammy perspiration; the respiration painful. Should the case prove fatal, death may be preceded by giddiness, insensibility, great prostration of strength, and sometimes violent spasms of the muscles of the limbs, which may assume either a clonic or a tetanic character. Such are the symptoms in an acute case of poisoning by this substance. The quantity actually required to destroy life is small. One drachm taken at a dose proved fatal in ten hours, in spite of early and frequent vomiting. (Med. Gaz., vol. 45, p. 801.) In a case in which a girl took a teaspoonful of tartar emetic by mistake, recovery took place in three weeks. She suffered from enteritis, and, as an after-effect, her hair fell off. (Brit. Med. Jour., 1876, ii. p. 492.) A man took eighty grains. There was only slight vomiting an hour after he had taken it; but this became subsequently very violent, attended with severe cramps in the legs and profuse perspiration. He recovered in two days. (Brit. Med. Jour., 1877, i. p. 674.) In 1881 a young man was killed in six hours by a dose of fifteen grains of tartar emetic. The characteristic pustular eruption of tartar emetic, often observed on the skin after its local application, was found on the mucous membrane of the stomach. (Friedreich's Blätt. f. Gerichtl. Med., 1882, p. 8.)

On April 18, 1876, Mr. Bravo, æt. 30, a barrister, was poisoned by tartar emetic. After dining with his wife, and whilst alone in his room at 6.30 P. M., he was suddenly seized with violent sickness and vomiting. When seen at 10.30 P. M., by Moore, he was lying back in a chair, totally unconscious; the breathing was noisy, and the heart's action was barely perceptible. He did not appear to suffer pain, and his appearance was not unlike that of a person under the effects of a narcotic. He had pre