Form 324.
Janua1'y, 1921.
FACTORY DEPAltTMENT,
HOME OFFICE.

MEMORANDUM
ON

INDUSTRIAL
LEAD
P()ISONING..

LONDON,
PRINTED AND PUBLI~RED BY
MAJESTY'S STATIONERY OFFICE.
To be purcbased throuzh any Bookseller or directly from
H.M. STATIONERY OFFW]] at the following addresscss
[~PERIAL HOUSE. KINGSWAY. LONDON, w.a,2, and
28, ABIWlDON STREET. LONDON, S.W.l:
37, PETER STREET, MANOHESTER:
1, ST. ANDREW'S ORESOENT, OARDIFF:
23, FORTH STREET, EDINBURGH;
or from E. PONSONBY, LTD., 116, GRAFrOl'l STREET, DUBLIN.

ars

1921.
Price 3d. Net.

Form 324.
January, 1921.

INDUSTRIAL LEAD POISONING.
Valuable information as to the frequency, symptoms, and
etiology of lead poisoning is obtained from the statutory obligation
placed on medical practitioners in Great Britain and Ireland by
Section 73 of the Factory and Workshop Act, 1901, to notify to
ILM. Chief Inspector of Factories cases of lead poisoning contracted in a factory or workshop, and from the subsequent reports
made by the Certifying Factory Surgeons. Industrial plumbism
is practically always the result of inhalation and absorption, from
either the alimentary or pulmonary tracts or both, of dust and
fumes. Uncleanliness and carelessness on the part of the worker
are contributory causes.
The susceptibility of women to the
influence of lead is usually accepted as being greater than that of
men. Figures in the. pottery industry seem to show that women
are about twice as susceptible as men, but this may be due either
to the relatively greater danger in the processes in which women
predominate, or to their average shorter duration of employment.
The records of plumbism show that two-fifths of all reported
cases occur during the first eighteen months of employment.
There is, at all events, no doubt as to the baleful influence exerted
by lead on the uterine functions. Disorders of menstruation
.are common, the tendency to miscarriage in some lead workers
is so pronounced that only after giving up the work altogether
.can full term be reached. The Recommendation of the General
Conference of the International Labour Organisation held at
Washington in 19~9 urged that " In view of the danger involved
to the function of maternity, and to the physical development
of women, and young persons under the age of 18 years, they
should be excluded from employment in the following processes :Ca) In furnace work in the reduction of zinc or lead ores.
(b) In themanipulaaion', treatrnent., or reduction of ashes
containing lead, and in the desilverising of lead.
(c) In melting lead or old zinc on a large scale.
(d) In the manufacture of solder or alloys containing more
than 10 per cent. of lead.
(e) In the manufacture of litharge, massicot., red lead, white
lead, orange lead, or sulphate, chromate or silicate
(frit.) of lead.
~f) In mixing and pasting in the manufacture or repair of
electric accumulators."
Tt was further recommended" That the employment, of women
and young persons under the age of 18 years in processes involving
the use of lead compounds be permitted only subject to the.
following conditions:Ca) Locally applied exhaust, ventilation, so as to remove dust,
and fumes a,t the point of origin.
(b) Cleanliness of tools and workrooms.

3
Notification to Government. authorities of an cases of lead
poisoning, and compensation therefor.
{d) Periodic. medical examination of the persons employed in
such processes.
(e) Provision of sufficient and suitable, cloakroom, washing,
and mess room accommodation, and of special protective clothing.
(t) Prohibition of bringing food or drink into workrooms. "

{c)

These points have been embodied in the" Women and Young
Persons (Employment in Lead Processes) Act, 1920."
For 20 years past the, principal branches of manufacture which
have been observed to be- connected with lead poisoning have
been classified under the following headings, which will serve to
call attention to the sources of danger and also help to confirm
diagnosis of plumbism in a, person engaged in such oocupation-eTABLE.

Industry.

1.

f.. verage

Average Average Average
1900-04, 1905-U9. 1910-14. 1915-19.
I

.Smelting of Metals...
...
...
(a) Lead smelting, 121,. (b) Desilverising, 11,. (c) Spelter, 64,. (d)
Other, 4.
Brass,..
...
...
'"
'"
(a) Polishing, 19,. (b) Chandelier
fitters, 7,. (c) Casting, &c., 11.
'Sheet Lead and Lead Piping-....
Melting Pot, 16,. Elsewhere, 17.
Plumbing and Soldering...
'"
(a) Red and White Lead, 70,. (b)
Soldering and lead burning, 88.
Printing- ...
..,
...
'"
'"
(a) Compositors, 69,. (b) Stereotypers,
Linotypers, &c.,54,. (c) Others, 23.
File Gutting->
...
'"
...
...
(li) Cutting, 53,. (b) Hardening, 12.
Tinning- ...
...
...
'"
'"
(a) Hollow-ware, 36; (b) Iron drums
and kegs, 18,. (c) Harness furniture, 10.
White Lead'
...
'"
...
Red Lead...
'"
...
Pottery- .••
...
'"
(a) Dipping, 79,. (b) Dippers' assistants, 45; (c) Warecleaning, 54,.
(d) Glost placing, 82; (e) Majolica
painting, /5,. Cl) Ground laying,
(g) Colour and litho dusting,
-,. (h) ,Enamel colour and
glaze blowing, 22,. (i) Colour
makers and millers and mixers of
glaze or colour, 24,. (j) Other
persons in contact with lead, 10.

342

8

7

7

1

13

9

7

2

201

23'
29'

13'

10

18

13

3

183'
13
1195

763
9
941

311
8

17
11

6710

196

8,.

(30526-1)

40'

wi, 2207&-FD 5/349 5,500 2/21 H. St.

G.1

4
TABLE

I.-continued.
Average Average Average Average
1900-04. 1905-09. 1910-14. 1915-19.

Industry.

...

5
31
4

1
21
12

-

...

32
461
64 4

25 1
391
75 4

36
20

775

40 1
12
233

...

...

291

24 1

313

16~

...
...

...
...

46 3
66"

45 2
65 2

492
733

161
482

'"

'"

753 27

599 28

548 34

279 21

...

...

...

...

...

...

Total ...

I

5
61
6

...
...

I

...
...
...

Litho Transfer-making
'"
Glass Cutting and Polishing
'"
Enamelling(c) Iron and glass, 10 j Cb) Copper
letters, 1 J. (c) Opal signs, 3'J
Cd) Porcelain enamelling, 47.
Electric Accumulators
Paints and Colours
'"
Coach Building- ...
'"
(c) Railways and tramways, 185 j
Cb) Motor cars, 78 j Cc) Perambulators, 21 j Cd) Other, 102.
ShipbuildingGovernment Dockyards, 46 j Other,
107.
Paint used in other industries
Other Industries...
(c) Tempering springs, 10 J' Cb) Other
contact with molten lead, 91 j
Cc) Metal sorting, 7 j Cd) Handling
lead, 12 j (e) Shot, 2 j (f) Other
contact with metallic lead, 27j
Cg) Indiarubber, 26 j Ch) Glass
making, 3 j Ci) Yarn dyed with
yellow chromate of lead, 32 j
(j) Other lead compounds, 116 j
Cle) Other binning, 7 j Cl) Coopering, 4 j Crn) Other, 30.

...
...

-

2

I

The principal figures relate to cases, the small figures to deaths. Fatal cases _
not reported in previous years are included as both cases and deaths.

The figures in italics after the processes relate to the actual
number of cases included in Returns during the 5 years, 1910-14.
The diminution in the number of cases in the period 1915-19
is an effect of the war which adversely affected several lead
industries.
Close analysis of the reports by the Certifying Factory
Surgeons, following on the medical practitioner's notification,
has brought out certain essential facts about lead poisoning.
Thus, comparison can be made of the cases reported in three fiveyearly periods from 1900 to 1914; in respect of (1) increase or
decrease in the number recorded; (2) severity of attack ;(3)
number of attack-s-that is, whether first, second, third or
chronic; (4) main symptoms, and shows the progress made in
prevention. Taking the figures as a whole, the most noticeable
feature is reduction in severity and in the number of chronic cases.

5

n.

TABLE

Severity of Attack. _

,Moderate. I·
I Not Total.
_,' Slight. I stated.
i
I
I
i
i
'
! F. I :i\I. Ii F. I M. F.I M. F. M. I F.
564

Severe.

M. I
I
1900_1904fOases
.• ~ ~,020 1137 640 128 1,B24 273'
l Per cent .... 33'2 24'31 20'8 '22'7 43'1 48'41
1905-1909 { Cases
... 568 67 I 749! 141 1,198 .2231
Per cent ..•. 22'1 15'31 29'2 '32'3 46'7 51'0,
1910-1914 { Oases
... 450 271 790: 117 1,184 -1411
Per cent .... 18'4 9'31 32'2140'2 48'2 48'5 i

i

i

0

I

I

I

88
2'8
50
1'9
27
1'1

i

i

I

26 3,072
4'6 100
6 2,565
1.4 100
6 2,451
2'1 100

100
437
100
291
100

i

I.

Number of Attack.

-Ist,

I

I

,

i

M. 1 F .•
2,019 419!
65'7 74'3\
1,781 380 i
69'4 86'91
1,863 2601
76'0 189'4,

I

I

3rd or
chronic.

I I
IF. M.I F.

I

1900-1904 { Oases
.. ,
Per cent ....
1905-1909 { Oases
...
Per cent....
1910-1914 { Oases
.. ,
Per cent ....

I

2nd.

Not [I
stated. I
i
1

I
I

Total.

i

I[ F.564

M.
M.[ F. NI.
462 87 I 460 I 26 131 I 32 3,072 i
15'0 15'4115'014'6 4'31 5'7 100 1
409 32 - 298 20 77 i 512,5651
15'9 7'3111'61 4'6 3'011'1100
305 17 251
8 32 I 6 2451
12'5 5'8/10'21 2-7 131 2'1 'WO!

i

i

:

100
437
100
291
100

I

In seeking to ascertain the cause for this reduction in severity,
the next table must be consulted, which gives the symptoms
recorded. Usually a combination of symptoms is stated, and each
one has been entered under the appropriate heading.
TABLE IlL-TABLE SHOWING TOTAL OF SYMPTOMS.
Main Symptoms.

,

-

I;

!

Gastric. I Allremia.\
I

;

Headache.
I

~I.

1900-04 {Ca;;es ... 2,521
82']
Per cent.
1905-09 { Cases ... 1,991
Per cent.
77'6
1910-14 f Cases _ ... 1,853
l Per cent. 75'7

F. M. F.
431 619 132
76'4 20'2 23'4
348 854 193
7% 33'3 44.2
225 825 112
7Nl 33'7 38'5

I P arehio.. 11th
! Encepha- ! Rheu- IOther.
opa y.,: matico
t

o

I,

I F.

I
I

I

i
I

M.I

M.' F. M.
M. F.,
F.
278 120 577 68 113 45 1289 I 64
9-0 2]'3 18'8 12'0 3'7 8.0 9-4111'3
261 135 613 85 87 17 ,279 i 43
10'2 30'9 23'9 19·0 3'4 3'9 110'91 9'8
3031 81 333 15 53 10 293! 28
12-4,27'8 13'6 5'2, 2'6 [3'4112'0 9'6

I

I

'

}1.! F.
47
1'5
.129
5'0
186
7'6

5
0'9
11
2'5
12

4-l

The total number of symptoms, therefore, greatly exceeds the
number of cases, but this does not affect the correctness of the
estimate of each one on the total number of cases reported. The
ayrnptoms which generally lead to the report of cases as " severe"

6
are paralysis and encephalopathy, and these are shown to have
been reduced in the third period. 'I'abulation of these figures over
a number of years has consistently shown that paralysis is more
frequently met with in men than in women, while the reverse
is the case with encephalopathy. The forms of paralysis and,
separately, the cases in which weakness or loss of power in the
particular muscles was stated, are given in the following Table : -

IV.
Forms of Pamlysis, 1910-1914.
TABLE

Total 1910-1914.
Part affected.

,

Paralysis.

I Weakness of

--

I Total
I

or
! loss of power
! of muscles.

--

I

---

6
44
3
26
102
261
30
42'
9
26
23

£)

Arms and leg

{Complete
Partial
Complete
'
L egs .. .
... "'\ Partial
Complete
.B ot h f orearms { Partial
· h f
{ Complete
R ig
t orearm
Partial .

14
3
6
102
100
30
22
9
10
19

r

Left forearm ... { ~~~r~tte
Fingers
Neuritis (including numbness of
hands and arms)
Other (including paralysis of
deltoid, muscles of speech,
locomotor ataxy, and general
paralysis)

30
20
161
20
16
4

18

18

14

I

16- 2 ,---253
606
,

Total

353

j

Red~.1Ction in the severe cerebral symptoms is very important,
as their occurrence must be regarded as due to inhalation of lead
dust or fume in excessive amount, and indicates failure, therefore,
at some point or other in precautionary measures.
TABLE

V.

Encephalopathy, 1905-1919.
Symptom.

Total
1905-1909.

Total
1910-1914.

Total
1915-1919.

Epilepsy and Epileptiform
attacks.
Mental Defect...
Optic neuritis ...

64

39

8

13
20

16
5

3
6

97

60

17

Total

7

Analysis of 247 death certificates (including those of 132 house
painters) in which lead poisoning was entered as directly or indirectly the cause showed that Bright's. disease, cerebral
hsamorrhage, paralysis, or chronic lead poisoning, either alone or
as a combination of symptoms, accounted for at least 195 (78'9
per cent.), and encephalopathic symptoms for 8 (3'2 per cent.).
Reference to Table 1. shows that the continued diminution in
cases is not accompanied relatively by a corresponding fall in the
number of deaths of which information is received. This seeming
anomaly is the result of more frequent association now than
formerly, following on the operation of the \V orkmen's Compensation Act, 1906, 'of lead poisoning on death certificates of
lead workers suffering from chronic nephritis and its sequelee.
The attack rate per thousand among those exposed to lead
poisoning in some lead industries can be shown approximately as
in the following table.
'I'he fact should not be forgotten, however, that reported cases
of lead poisoning in common with other forms of industria]
disease do not represent quite all the incidence :-latent, unrecognised and neglected cases undoubtedly exist as with other notifiable diseases.
TABLE

•

Approximate
Number of
Persons Employed in Lead
Processes.

Industry.

1914•
I 1913'-1

I

(1)

White lead...
...
Vitreous enamelling
Tinning of metals ...
Electric accumulators
Paints and colours .
Pottery...
.
Smelting of metals ..
Coach paintmg
.
I<'ile cutting...
...
Printiug
...
...

VI.

(2)

(3)

... I
... i
I
... I
... I

1,201
1,119
933
768
878
492
1,475
1,543
1,400 1,287
'" 1
7,085 4,661
2,827
... [2,878
... i 29,308 29,308
. ' . 1 _5,556 1_ 5 ,556
08,777 08,777
'"

... I

I

Number of
Reported

Attack-rate
per
'I'housand.

Ca.e~.

1911.11;l,2'jl,i913"I'~~~ 1911.11912.11913.\1914.
(4)

41
19
13
24
21
92
48
104
18
32

(5), (6)

(7)

! 2n'

I
I
,

I
1'

I

I
1

29
5
9
9
15
44
38
19' 1 22
80 I 62
56 I 26
84 I 71
13 I 14
37 I 21

I

i
I

I

29,
11
10
41
21
28
36
57
11
23

(8)

29 I:
22
21
21 I
14 i
15 I
17 I
4 1
31
0'5:

(9) 1(10)

I 2410
10
I '3016

17
5:
17 j'
30
13,
13 I
23 I

9
9

31
2
21
3
0'6 I 0'4 I

(11)

26
14
2(}
27
1&
6
13
2
2
Qo4

Briefly, the precise cause of the incidence in the 18 industries,
mentioned in Table I. isIn smelting of metals from the fume and dust inhaled at the
blast and refining furnaces, in desilverising from the fume given
off at the cupola, and from the dust and fume in preparation
of litharge; in spelter (zinc manufacture) from the fumes given
off from the small amount of lead (2-3 per cent.) which comes
off as fume in the distillation of the charge; in brass, a rather
indefinite group having the one point in common of work in
connection with brass, the cause in casting would be from the

8
.small quantity of lead (1-5 per cent.) added to soften the metal,
in polishing from the small amount of lead in the abraded dust,
and in chandelier fitting from testing by the mouth (now much
less common than formerly) the efficiency of the joint when made
with a paste of white lead; in sheet lead and lead piping from
the dust in skimming off the dross from the molten metal and
handling the old and dusty oxidised lead piping, etc., in plumbing
and soldering, from handling red and white lead for jointing, from
soldering with a bit and, more certainly, from lead burning with
oxy-hydrogen or oxy-acetylene blow pipe flame ; in printing from the
dust in the type cases and drossing molten metal; in file making
from the use of lead beds, and in file hardening, i.e., tempering,
from the fume in the bath of molten lead into which the file is
:plunged; in tinning from the chemical interaction between hydroohloric acid used in cleaning and the molten mixture (usually
half tin and half lead) evolving soluble lead chloride vapour. In
,white lead works the remarkable diminution in reported plumbism
iis due to (1) improved structural conditions; (2) adoption of
nneohanioal means (cranes, rails, hoists, etc.) for conveyance of
material in substitution for hand carrying; (3) exhaust ventilation where dust arises as in packing and paint mixing; (4)
periodic medical examination; (5) diminution in height of the
stoves or adoption of mechanical drying stoves and (6) conversion
of white lead into paint by means of direct mixture with oil while
in the pulp stage. 'I'he reduction in the case of red lead is due
ito the adoption of automatic mechanical methods-the mechanics
-engaged in repairs are J:Jf:lwthe persons to suffer. The cause of
\lead poisoning in pottery manufacture is from dust and splashing
"in the processes of dipping, ware cleaning, aerographing, etc.
Diminution in this large industry is due mainly to the improved
>conditions, notably in exhaust ventilation locally applied to remove dust and fumes at the point of origin, and increase of the
use of low solubility and Ieadless glazes.' Poisoning in glass
cutting arises from the spray of putty powder (lead oxide); in
enamelling from the powdered gla,ze (in this industry leadless
have largely replaced lead glazes).
The electric accumulator industry is that now exposing workers
to the greatest risk of plumbism. Analysis of 200 cases shows
incidence to be proportionately as follows : -

Casting, 9'5; pasting (including miaJing and drossing), 31'0 ;
. lead burning, 15' 5; trimming, filing, sawing, wire brushing, and cleaning, 19'0 : trucking and handling plates, 9' 5 ;
.81nelting and handling old accumulator plates, 5' 5; other
(including formation, sweeping, erecting outside, eic.i,
10'0.
U se of machines for pasting and attention to detail in the
application of exhaust in mixing and weighing lead compounds,
in trimming, wire brushing, filing of lugs and lead burning alone
will reduce it. The cause of poisoning in paints and colours;
'where the object is necessarily to reduce lead colours to the finest
state of division, is obvious; in coach building and in paints
used in other industries, to sand papering painted surfaces and,

9
10 some extent also, to lack of facilities for washing; in ship-

.building, to chipping and scraping off old lead paint (often: in
.confined spaces such as double bottoms, tanks, and bilges), and
occasionally from fumes given off in inserting red-hot rivets into
holes containing yam soaked in red lead and oil. The import.ance of distributing cases under the vague heading other industries
has led to tabulation of them in the five-year period 1910-14 in the
following way, which gives an easy key to the source of poisoning : (a) Tempering springs, 10; ,(b) other contact with molten
lead, 91; (c) metal sorting, 7; (d) handling lead, 12;
(e) shot making, 2 ; (j) other contact with metallic lead, 27 ;
(g) indiarubber, 26; (h) glass making, 3; (i) yarn dyed
in llellow chromate of lead, 32; (j) other lead compounds, 116; (k) other tinning, 7; (1) coopering, 4:
(m) other, 30 ; total, 367.
In tempering springs and other contact with molten lead the
cause is from dust in drossing ; in metal sorting and other contact
with metallic lead, from dust; in shot making, from friction in
'the grading and sifting operations; and in indiarubber, glass
making and other lead compounds and coopering from dust.
In the whole of these cases, therefore, not a, single one can be
said to be unassociated with dust or fume.
Means for prevention, apart from substitution of innocuous
materials, for those containing lead (as, for example, leadless or
low solubility fritted gla.zes for carbonate of lead in pottery, or
zinc oxide paint for white lead), are sufficiently indicated in the
Recommendations of the International Labour Organisation
already quoted. Meticulous attention to detail is needed in securing as perfect a locally applied system cif exhaust vetilation as
possible for the removal of fumes or dust,
SYMPTOMS AND DIAGNOSIS.

A blue line on the gums by itself indicates rather the presence
of lead than lead poisoning, but as a danger signal and as affording
confirmation of the exact etiology and other symptoms it is a
valuable sign. Presence of a marked blue line in a workman will
at once show that not only he himself, but all his fellow workers
in the particular process, must be running grave risk from fumes
or dust containing compounds of lead, that poisoning must have
occurred in the past and will certainly occur in the future, and
that if work has been continued for years under these conditions
constitutional effects on the circulatory and excretory system
must have gone far. In many instances such a line would be
lessened or removed by cleanliness of t]:16 teeth, without changing
conditions of exposure to the lead.
AnlXmia.-The first action of lead when absorbed into the
system is on the blood and circulatory system, diminishing the

10

number of red cells and the amount of hsomoglobin, and impairing the organs from whichfresh blood-cells are produced; Facial
pallor due to interference with the nerve supply of the blood
vessels is frequently noted. Among males anrsmia is comparatively rare, and its significance when associated with loss of subcutaneous fat particularly noticeable in the orbit and buccinatorregion in the face of a lead worker is consequently greater. In
lead workers, more particularly in men, there is sometimes.
developed a special type of anramia, with glistening cornea and
sclerotic, suggesting organic disease of the heart which, however,
does not necessarily co-exist.
Changes in the blood are often found in cases of incipient and
acute lead poisoning characterised by alteration in shape and
basophile staining of some of the red cells. Some authorities.
regard the finding of 100 basophile red cells per million as evidence
that lead absorption has passed into the stage of lead poisoning
after other causes normally giving rise to basophilia have been
excluded.

Calic.-The digestive symptoms often associated with plumbism
include habitual constipation and attacks of colic.
Cases are
reported, however, not infrequently where the colic is accompanied
by diarrhoea or by constipation alternating witlrdiarrhcea. The
chief points associated with lead colic are (1) the intermittent
character; (2) the relation of the colic mainly to the lower part
of the abdomen; (3) slowing of the pulse; and (4) the relief'
afforded by firm pressure of the abdomen.
Colic accounts for
fully 75 per cent. of the notifications. .
Arthralgia-,-The pain which may accompany any of the forms'
of lead poisoning does not usually follow the course of the nerve
trunks, but is localised near the large joints (lead arthralgia)
generally the knee, elbow, or shoulder. The condition is probably myalgic in character.
Nervous System.-Attacks of vertigo or persistent headache an'
significant in persons exposed to lead poisoning, and so too are
tremor and numbness or impairment of muscular action..
The most serious menace to life in acute lead poisoning arises
from cerebral manifestations known generally as encephalopathy,
a term which includes convulsions, delirium, coma, amaurosis,
insanity, etc. Epileptiform seizures are most commonly met with
in young women, and may appear in them after a short term of
work in lead. Occurrence of this severe form of lead poisoning
-now rare-s-oalls for the fullest inquiry, with a view to remedying defects in the processes of manufacture. Post-mortem minute
hromorrhages in the substance of the brain have been found. The
existence of hysterical symptoms previous to the onset of the
seizures has been noticed, and as a prodromal symptom it should,
therefore, arouse grave suspicion. The difficulty of distinguishing ordinary epileptic seizures from attacks of true lead encephalopathy raises the question whether persons who are the subjects

11

of idiopathic epilepsy can be suitably employed in lead processes.
Associated sometimes with epileptiform seizures is neuro-retinitis
which may pass on to optic atrophy.
Persistent headache is a late and grave symptom, not to be
confused with the transient headache associated with colic.
Mental symptoms may be grouped as (1) toxsemic, with sensory
disturbance which tend rapidly to improve on removal from exposure; (2) hallucinations of sight and hearing, more chronic
in nature, which may be permanent; (3) those resembling general
paralysis with tremors, increased knee jerks, inco-ordination,
accompanied by listlessness amounting to dementia, but which
tend to get well.
Pamlysis.-The most, frequent, pronounced nervous symptom
of lead poisoning is the well-known " dropped wrist.," due to
paralysis of the extensors of the fingers and wrist; that is, the
muscles supplied by the musculo-spiral nerve (except the supinator
longus, which has an additional nerve supply and is, moreover,
more a flexor than an extensor muscle).
Although paralysis affects chiefly the extensor muscles of the
wrist and fingers other groups of muscles become involved, more
especially the deltoid and biceps, those of the thenar and hypothenar eminences as in file cutters as a result of overstrain.
The degree of strain to which particular muscles are put seems
to influence the direction and extent of the paralysia,

Interstitial Nephritis.-Direct inflammation of the vessel walls,
resulting in obliterative arteritis, arterio-sclerosis and degeneration and exudation in the kidney, lung' and liver, are due to
degenerative changes either in the intima or the middle coats of the
finer vessels. Inthe kidney such vessel changes are the precursors
of disease, and albumen is found in the urine, but the quantity
is rarely very large. Only incidental allusion need be made to
the later stages of chronic plumbism where sclerotic changes
have taken place in the kidneys and blood vessels, so that the
symptoms and dangers always associated with chronic interstitial'
nephritis are present. Cerebral hrsmorrhage at a comparatively
early age is a frequent cause of death in lead workers.
Gout.-Investiga,tion by Goadby* suggests that the condition of
gout in painters is to a, great extent attributable to turpentine.

PERIODIC MEDICAL EXAMINATION.

In tIle periodic medical examination of lead workers, the surgeon
should remember his objects are (1) to prevent lead poisoning and
minimise lead absorption, and (2) to obtain information for the
occupier of the relative danger of one process and another with a
,~ Lead Poisoning and Lead Absorption, by Legge and Goadby (Edward
Arnold, London), 1912.

12

view to adoption of remedial measures.
That examination is
useless which merely records entries in a book without following
them up. Special attention should be paid to new workers because
development of signs in them constitutes the surest guide to
defects in the processes of manufacture. The surgeon! can examine
the outstretched hands by placing the tip of the forefinger: of his
own in the outstretched hand of the worker and the ball of the
thumb on the extreme tip of each finger gently pulling it down,
noting the spring present in the muscles. This test is probably the
most delicate there is for detection of early extensor paralysis.
Sometimes the strength of the wrists and fingers of all the workers
is rapidly estimated by the surgeon placing his palms on the
dorsum of the patient's outstretched hands, and seeing whether
the patient can be prevented from lifting them without flexing
the wrists or finger joints. The test detects (1) paralysis which
has been recovered from; (2) commencing partial paralysis; and
(3) weakness of muscular power, especially in those who have
worked in lead for a number of years. This weakness appears
to be an effect of lead upon the muscular tissue or dependent
on debility the result of lead absorption, and independent of nerve
implication. The condition often remains unaltered for years, or
undergoes alteration, being at times absent for months together.
Somewhere about 2 milligrammes (or 0'002 gramme of lead) is
the lowest daily dose which, inhaled as fume or dust, may, in
the course of years set up chronic plumbism. Probably if the
air breathed contains less than 5 milligrammes per 10 cubic
metres of air, cases of encephalopathy would never, and cases of
colic very rarely, occur. And this is a quite practical figure to
keep the dust down to in any process amenable to exhaust ventilation.

N O'l'IFICATION,

SUSPENSION , WARNING.

If in the course of the examination the Surgeon meets with a
notifiable case of lead poisoning, he should notify it on Form
303;
If, however, the Surgeon is the Certifying Surgeon
for the District, the notification is not required: he should proceed at once with investigation and report on Form 190).

The necessity for notification does not arise until lead poisoning
is diagnosed, and, in general, not unless the symptoms are of
such a nature as to require abstention from work, but in deciding
the question of suspension or fitness for work in lead, other considerations come in. Liability to injurious effects may be indicated by present or past attacks of lead poisoning, by tendency
to hysteria and epilepsy, by marked ansemia (not necessarily due
to lead), by existence of extensive oral sepsis, by mental weakness, by careless personal habits, such as want of attention to
cleanliness of hands and teeth or of clothing, or biting of nails,
or taking food in prohibited places (or with unwashed hands,
after working in lead), or neglect of other precautions prescribed

13
by Regulations. Unsuitable subjects for processes in which there
is risk of exposure to dust and fumes of lead compounds are those
who have suffered from malaria or any condition which has
brought about blood destruction and ex-soldiers who have
Indirectly, shortsightedness predisposes to
been gassed.
danger, by causing undue proximity to the work. In women the
question of pregnancy has to be borne in mind. Tt is illegal for
a woman to be employed in any factory or workshop within
four weeks after confinement, and where the work is such as to
involve the grave additional risk of plumbism a longer interval
beconles necessary.
Some degree of immunity may be inferred from protracted employment in lead 'without recent manifestations of the more
serious forms of plumbism, especially in processes amenable to
exhaust ventilation locally applied for the removal of dust. Each
case, therefore, requires to be considered on its merits.
Where the diagnosis of acute plumbism is dearly established
there should be no hesitation in ordering suspension from ordinary
employment, and advising transference on recovery, if possible,
to other processes not exposing to risk. Whether the predisposing cause in such instances be natural susceptibility or merely
careless habits, the unfitness for work in lead is equally obvious.
The duration of suspension from work rests with the discretion
of the Surgeon. In general, it may be said that a temporary suspension should suffice in cases of slight and transient attack, but
repeated or grave attacks call for prolonged exclusion from work
in lead, and usually for discontinuing it altogether.
In every case before work is resumed a certificate permitting
this should be entered in the Health R e g i s t e r . '
Short of suspension, conditions are nlet with which call for a
caution to the workers, and careful observation on the part. of the
Surgeon. Special attention should be directed at each examination to those who have been allowed to resume work in lead processes after an attack of plumbism; to those who present equivocal
symptoms in any way suggesting plumbism; to those who have
even a trace of a blue line; and to women workers who are
pregnant.
In such cases the question of transfer to non-lead
processes should be considered.
The value of the periodic examination in impressing upon the
workpeople the importance of habits of cleanliness, and of attention to the prescribed Regulations, cannot be too strongly insisted
upon. A cautionary leaflet (Form 406) is supplied on application,
for distribution among persons commencing employment in lead
processes.
If any difficulty, or apparent breach of Regulations is met with,
the District Inspector should be informed.
REGULATIONS.

The following codes of Regulations, applying to lead industries.
require examination of certain employees, either by .the Certifying
Surgeon or by a specially appointed practitioner who may be the

14

Certifying Surgeon. Sometimes the occupier may wish the
Surgeon to extend his examination to employees in other processes than those which the Regulations specifically mention.
Copies of the Regulations are supplied to Surgeons concerned.
Medical Examinations.
Codes.
Periodical.

On first
employment,
within

Health
Register.

REGULA'fIONS-

Heading of yarn (dyed with I
lead)
I
Vitreous enamelling of metal I
~
(Quarterly."
Form 605.
and glass ...
I
Tinning of metal hollow- '1
ware, &c. ...
)
Electric accumulators: manu- I
faeture
I
Paints and colours: manuForm 605.
facture
( Monthly.
Lead smelting and manufacture of red lead, orange
lead, flaked litharge
)
Pottery: manufacture and } Monthly:']
Form 655.
One week.]
decoration ...
Compounds of lead: manuWeekly."
Form 605.
facture __..:..:..:..._--'.:...:..:..:...~:..:..:.-'J
"Or such other intervals as may be prescribed by the Chief Inspector of
Factories.
t For certain kinds of employment (not entailing exposure to lead) yearly,
and for others half-yearly, examinations are required.
For" permission to work" in certain non-lead processes.

I

t

t

The precise duties devolving on the Surgeon are set out in each
code, and may include(a) Attendance at the works at appointed times to be
arranged with the occupier and made known to the
employees concerned. Alteration by the Surgeon of
the appointed time should, whenever possible, be made
known beforehand.
(b) Examination at those times of all employees presented
for the purpose. (The arrangements for examination
should be such as to secure adequate privacy, e.g., the
exclusive use of a room.' If this be wanting, the
attention of the occupier should be directed to the
matter, and, failing compliance, the District
Inspector should be informed.)
(c) Entry of the results of each examination in the prescribed'
Health Register provided by the occupier and kept at
the works; showing the fitness or nnfitness of each
employee for employment in the dangerous processes,
and formally suspending where necessary any
employee from such employment.

15
{d)

Special examination of individual employees, on their
application, with entries as above. Any certificate (01
suspension, or allowing resumption of work after suspension) granted upon such an examination should be
notified at once to the occupier and entered in the
Health Register on the Surgeon's next visit to the
works.

Health Reqister,
The object of the Health Register is to keep a record intelli:gible, not only to the occupier and Inspector, but also to the
'workers.
Entries on a uniform system are desirable, and
Surgeons, therefore, are asked to make them as below.
They
should indicate degrees of deviation from normal health, and distinguish (by use of rnimerals) those attributable (or possibly
attributable, in whole or part) to work in lead, from those not so
.attributable, for which latter letters should be used. The con-clusion is perhaps best expressed as t, il, and so on.
'The numerals should be taken to mean : Passed without comment (no observed effect of lead)
Blue ~ne (or indication thereof).
Lead ansemia or other impairment of health.
Suspension or transfer, by reason of impairment of health
from effects of work in lead.
Except in the case of a worker whose exposure to lead is only
,recent, rena! disease should always be indicated by a numeral.
Letters should hear the following meaning :-A. No comment (i.e., fair general health).
B., c.
Increasing degrees of impairment of general health.
(Pregnancy, if without suspension, should be entered
as c.)
D. Suspension or transfer, for reasons other than impairment
of health from effects of work in lead.
x. Carelessness, or neglect of precautions, N unsuitability
for work in lead. (Suspensions for such reasons
should be marked DX.)
1.
'2.
3.
4.

Occasionally use of a Health Register on the card system is
'preferred and no objection can be raised to this provided the
-entries to be made are a facsimile of those in Forms 605 and 655.
The importance of the conclusions to be drawn from the notifi-cations and reports upon them received from year to year, calls
for careful examination and tabulation of these cases, for which
purpose it is necessary that precise information as to occupation
(including of course not merely the manufacture carried on, but
the particular work done by the patient), probable causation of
plumbism, and symptoms and degree of severity of the attack,
.should be given by the Certifying Surgeon in his report.

16
~Jvery effort is being made by the Home Office, by the exerciseof powers under the Factory Acts and Regulations, and by investigation of the conditions of manufacture, to reduce as far as.
possible the danger of lead poisoning in those industries in which
it occurs. For this purpose it is necessary that all cases of
plumbism in factories and workshops should be. reported, and
that full and prompt enquiry should be made into the circumstances of each case.

The duties under section 8 of the Workmen.'s Compensation
Act, 1906, devolving on Certifying and Appointed Surgeol1i3 in
connection with lead poisoning, are outside the province of the
Factory Department.
Factory Department,
Home Office.