of poisoning by lead in its several forms have been completely verified, and we are now able to distinguish the effects of lead poisoning with, perhaps, more ease than almost any other form of disease.

The patient exposed to the influence of lead becomes of a sallow and anæmic aspect, his muscular development is diminished, and his mental capabilities are somewhat enfeebled; if colic come on, he experiences severe pain in the abdomen, at first moderate, but afterwards becoming intense and of a twisting and grinding character about the umbilicus; the abdomen is contracted, and the patient experiences relief by firmly compressing the abdomen with his hands, or even across a chair; the bowels are obstinately constipated, the abdomen is neither tender nor hot, but hard and contracted; nor is there generally any vomiting, but the patient writhes with the severity of the pain; the tongue may be clean or furred, the pulse is feeble, but not increased in frequency, and the urine is pale. After some hours the severity of the pain subsides, but may again return during the next night, or after taking food. The severe colic is sometimes accompanied by cerebral disturbance, but this is a rare occurrence, although severe cephalalgia or epilepsy may precede or follow colic, as another of the effects of the lead poisoning, as also paralysis of the extensor muscles of the forearm; or the colic may be associated with severe cramps and pains in the extremities; the constipation sometimes gives place to diarrhoea, but still the pain continues, or rather severe soreness, occasionally aggravated into intense suffering. On examining the gums we find along the edge a grey line, composed of minute particles of sulphuret of lead, from the mutual decomposition of the lead permeating the capillaries and the sulphocyanide of the saliva. This is itself a very distinctive sign of lead poisoning, and when the pain is unaccompanied by tenderness is sufficient to guide us to a correct diagnosis. It rarely occurs that lead colic alone terminates fatally, unless associated with other diseases or other conditions of lead poisoning. In a case to which I have referred in diseases of the stomach, lead colic was associated with chronic ulceration of the stomach, which led to perforation and fatal result. We sometimes find the paralysis of the hands or wrists, and epilepsy,

coincident with the colic; it is unusual to have paralysis of the ankles, but such a case I have seen.

The proximate cause of lead colic is not known, whether it arises from irregular peristaltic action, or paralysis of one part, and spasmodic contraction of another. In those cases which I have examined, and in others recorded, no abnormal appearance was found in the intestine. The manner in which the lead enters the system is, in some cases, very obscure, but generally it is sufficiently manifest. Drinking fluids from leaden vessels which are not covered with any protective carbonate, &c., and acid drinks, as cider, &c., from leaden vessels, are the common modes of its introduction; but lead colic is most frequently observed in plumbers, painters, type-founders, &c., men who are constantly employed in handling lead, and who breathe an atmosphere contaminated with minute particles of it. It appears probable that in the mixture and using of paints containing lead there is still greater liability to its absorption, the volatile oil containing minute particles of the metal, and thus its ready inhalation is effected. In many instances the want of proper cleanliness in washing the hands before taking food, and in changing the clothes, very much aggravates the liability to poisoning by lead. It is sometimes, however, difficult to ascertain how lead has entered the system. Dr. Addison mentions a publican who was thus poisoned by drinking in the morning, as his first draught, the ale which had remained in the leaden pipe during the night. Several instances have been known where lead was found in the snuff which the patient had been in the habit of taking. It has sometimes been produced by the medicinal use of acetate of lead; but Dr. Thompson has shown that there is less liabilility to this effect being produced when the lead is combined with opium, or given with dilute acetic acid.

The diagnosis of lead colic is sufficiently clear when ordinary caution is used, the lead line along the gums, with pain relieved by pressure, and the contracted abdomen, distinguish the disease; but, as before mentioned, it may be associated with chronic ulcer of the stomach, with hernia, &c., which obscure the diagnosis, and may lead to a fatal result.

In lead colic alone we may give, especially in the earlier attacks, a favorable prognosis.

Treatment. The indications of treatment appear to be sufficiently plain in this disease-to relieve the pain, to act on the bowels, and to remove lead from the system. For the relief of the pain, opium or chloroform is the best remedy, and may be administered freely; to act on the bowels, croton oil with opium, or calomel with opium, or castor oil and laudanum, or the sulphate of magnesia with compound infusion of roses and henbane may be used; or we may administer injections of castor oil or colocynth; warmth should be applied at the same time to the abdomen.

In relation to the subsequent treatment, we should not be content with the subsidence of the colic, as long as the patient retains his sallow and anæmic aspect, and has a lead line along the gums. Iodide of potassium has been used, and it has been found that the urine contained lead during its administration; this I have often attempted, but unsuccessfully, to verify. Considerable benefit has been found in dropped hand from rubbing iodine ointment into the paralysed parts,* and still more by the use of electricity and galvanism locally applied. An insulated water bath has been recommended, the patient in the bath being connected with one pole, the sides of the bath with the other. The lead is stated to be removed from the body of the patient, and deposited upon the walls of the bath; but I have not seen electricity applied in this manner; the only opportunity in which I have known galvanism used in colic, to excite the bowels to action, was in the case associated with gastric ulcer; the existence of gastric ulcer was not known, and fatal peritonitis followed. Warm baths, perfect cleanliness, bracing air, and preparations of steel, after the removal of lead, are of great service; but a considerable time is required for the complete removal of the poison from the system.

The prophylactic treatment is an exceedingly important consideration to those employed in the use of lead. The importance of perfect cleanliness, of changing the clothes, of not partaking of the meals in the workshop, are now generally acknowledged, although they are not acted upon as their cogency demands.

A drink containing dilute sulphuric acid is mentioned by Dr. Watson, as having been used by Mr. Benson, in lead works, with very great advantage.

'Medical Times and Gazette,' May 1857.

CHAPTER XIII.

ON CONSTIPATION.

WASTE and repair are necessarily connected with the performance of every function of the human body; and the various excretory organs are the channels by which the materials of waste are separated as substances no longer of any benefit, and the retention of which becomes increasingly detrimental to the whole economy.

The large intestine may be looked upon as a very important excretory organ; and the removal of its contents is as necessary for the continuance of human life, as the separation of carbonic acid from the lungs in ordinary respiration.

The colon is well adapted for the purposes of excretion, and by its arrangement serves as a reservoir; and it thus allows an occasional, rather than a continuous, separation of its contents.

But in this periodical movement of the intestinal canal there is great difference; and the variation within the bounds of health is much greater than is usually supposed; with some, and perhaps by far the larger number, an action of the bowels takes place once every day, or it may be two or three times, although either may be the state of health; on the contrary, with others, it may be that every second or third day is the normal condition; and the usual period may be even extended to every fourth or seventh day. This variation must be borne in mind, otherwise, in the attempt to produce what is considered beneficial, an abnormal condition may be set up, and comfort and health lost in striving to bind all to the same universal law.

Much, however, may be acquired by habit; regularity may be attained; or inattention and want of care may induce a condition which will almost baffle subsequent exertions to eradicate. Premising that the healthy action of one is disease with another, we may define constipation to be a less frequent action from the bowels than is the healthy condition of each individual. Ordinary constipation arises from the insufficient contraction of the muscular coat of the intestine; the canal becomes more and more distended, and with each increase in the circumference of the tube greater power is required to force onward its contents. I have sometimes observed a colon so enlarged by distension and loss of power, with obstinate constipation, that it has measured as much as twelve to fifteen inches in circumference; the power required to propel the contents must have been enormous. And it appears probable that in this extreme distension, a state closely allied to paralysis of the muscular parieties is the result; sometimes, however, this gradual distension is the effect, rather than the cause of paralysis.

A second effect of constipation is that the lateral pouches of the colon formed by the circular and longitudinal bands of muscular fibre, become more aud more distended, and being thus filled out, their contents are removed from the central current, and become impacted, while the bowels act with some degree of regularity; these impacted fæces may frequently be felt as tumours through the abdominal walls, alarming the patient, but disappearing under judicious treatment.

Pouches of the colon sometimes become of considerable size, and generally the circular fibres of the canal surround them; but not unfrequently the circular fibres yield, and the mucous layer projects, covered only by the peritoneum, thus forming a mere elongated sac, filled with mucus, or more frequently with fæces. The orifices of these small sacs are bounded by the hypertrophied circular and longitudinal fibres, and their contents remain almost shut off from the intestinal canal. These pouches are the result of constipation, the muscular fibres become hypertrophied, but their efforts to propel onward the contents of the canal lead to these minute hernial protrusions.

I have most frequently observed pouches in connexion with the sigmoid flexure; but they, probably, occur at any part where