Document K62JZMxwjvYR0J37xBjLpGjjK

~3- -o <--*O" oc <r : < V) T Vl> 3 <x for it. For this salary he has not to work eight hours a day for six days in the week, but every day in the year, and even every hour in the daylie is bound to be ready to take up his heavy burden. Other men have, with Sundays and public holidays, about two months in the year for rest and recreation ; for the unfortunate lodge doctor there is no provision for a holiday annual or otherwise. The inevitable break down in health which must follow such a service makes it dear at any price. We feel that we are right in advising men against selling themselves into such slavery ; for 'There is a tide in the affairs of men, Which taken at the flood leads on to fortune ; Omitted, all the voyage of their life Is bound in shallows and miseries." A PLEA FOR PAINTED RAILINGS AND PAINTED WALLS OF ROOMS AS THE SOURCE OF LEAD POISONING AMONGST QUEENSLAND CHILDREN. By J. Lockhart Gibson. M.D. (Edin.), M.R.C.S. Eng.}, Brisbane, Hon. Ophthalmic Surgeon, Brisbane Hospital for Sick Children. I h a v e had recently under my care four fresh cases of the very definite condition which I T_*'--), described* as "ocular neuritis, Simula ting basal meningitis--plumbism." The appearance of so many cases at the same time, all of them fairly severe ones, though fortunately not of very long standing, and all of them cases which, in my- opinion, would have suffered from permanent blindness unless removed from their surroundings, and possibly also unless treated, again called my attention to the question of source. Although efforts to discover the source of the lead poisoning have hitherto been unsuc cessful it has been apparent to those of us interested in the question that the source o' the lead is available to almost all Queensland children who live in towns, and certainly- to all the children of an affected family, even although one only showed symptoms of poisoning. Wej- explained the fact that one member of a family is often selected and the others are apparently unaffected, by the fair assumption that the lead was injected in very- small Quantities only, and that only children idiosyncratic to lead showed symptoms of poisoning. We pointed out, however, that often other children of a household showed a * A. J f . t 7 ., 1897, p ag e 479. t A . Jeft'eris T u rn e r, A. M. G, , 15P7 p ag e 475; J . L o c k h a rt G ibson, ibid. blue line on the gums, indicating the presence of lead circulating in the blood, but not in sufficient quantity to cause the distinctive poisonous symptoms. I t is known th at lead when it gains entrance to the body is very slowly excreted by the kidneys, and in some undoubted cases of lead, poisoning the Government Analyst has failed to find it in the urine, while finding it in other cases exhibiting absolutely identical symp toms. This lent colour to the belief that defective excretion in some children was a reason for their selection as those showing poisonous symptoms. I hope to-night to furnish a better explanation than idiosyn crasy for the selection in a family of victims to lead, and also to get rid of the idea th at only small quantities are ingested. Shortly, I am able, I believe, and advance a very strong plea for painted walls and railings as the source of the lead, and for the biting of finger nails or sucking of fingers , as in a m ajority of cases, the means of conveyance of the lead to the patient. My own personal experience is now, of course, confined to the cases exhibit ing eye symptoms unaccompanied by other paralytic symptoms; but I am quite satisfied that except in isolated cases the source of the poison is the same in all Queensland children affected. It is possible that some of you have long recognised paint as a source. To my shame, I cannot remember to have done so, and I cannot remember to have ever heard it discussed as a source, or even seriously stated to be one. Mr. Henderson, the Government Analyst, says that he suggested it, but that the idea was pooh-poohed. The four cases, all in young children, all ex hibiting the same ocular signs, hardly even differing in degree, have recovered so com pletely and so quickly th at although I showed three of them at last meeting, in onlvone was there remains of a previously intense double optic neuritis, and in only two was there a very slight remains of paresis of an external rectus which had been paralysed. I was able to show the elder brother of one case who, while not presenting any of the paralytic symptoms of lead poisoning,showsapeculiarly ' distinct blue line in the gum completely surrounding one of his posterior molars. The clinical picture presented by these cases is a very definite one, and one which I have not seen described in its entirety except in my own paper. The symptoms are sudden onset, with or without preliminary colic, vomiting, or malaise, and with or without retracted head and acute pains in the hack of : He states that the oxide of zinc which forms the neck, of paralysis or paresis of one or both upon and covers insides of galvanized iron external recti, accompaned. by optic neuritis ! tanks is so porous th at it does not prevent the or choked disc, so intense that any medical j contained water from coming into contact man at all acquainted with the appearance . with the metallic zinc underlying it. of a normal disc would recognise it at once. | In weighing evidence in favour of any The swelling and consequent advancement ! source we must bear in mind that it is some of the disc in all cases most distinct, and even source available to a majority of Queensland the surrounding retina often swollen and children, except the very poorest, who live advanced. I called the condition ocular neu in towns. Paint occurred to me as a possible ritis, because no case of the many I have seen l source. I took it as a hypothesis and have has the optic neuritis existed without para i endeavoured to get facts to prove the hypo lysis of an external ocular muscle; in only one thesis correct. In this there has been no case where one muscle only was paralysed element of taking the cart before the horse, was it other than an external rectus. In very but perhaps more apparent than real. I t severe cases the other external ocular muscles will be convenient to state the evidence in are paralysed. These have been cases of support of my hypothesis in as tabulated a some standing, and have resulted in blindness. form as its nature will admit. The* cases, excepting the very severe ones 1. A majority, probably all the children with pain in the neck muscles and retracted we have observed affected with lead poisoning, head, are often hardly unwell, and have no have lived in houses whose rooms have been temperature. As a rule the internal squint j painted, or at least whose verandah railings disappears before the optic. neuritis. The i have been painted. All four children under squint is always recovered from, even when : discussion have done so. The children of the retro-bulbar neuritis results in atrophy ; school age who may not have had much op and blindness. The cases do not die if re portunity of contact with painted walls and moved soon enough from their homes. The railings at home have opportunity at our oldest of the four cases admitted to the Chil- j public school buildings. dren's Hospital in January is eight years, the 2. Two conditions of painted surfaces youngest two years. In the urine of the two j would be more than usually liable to induce of the four, E.M., aged eight, and E.B., aged j poisoning, viz., (a) freshly painted or a t two. the Government Analyst found lead ! least, sticky surfaces; \b) painted surfaces *4 milligrammes per litre in one and -32 milli- j which have either been exposed to the sun and grammes per litre in the other. A second ' air, and whose paint has lost its oil and be sample of E.B .'s urine sent to the Analyst i come a dry easily detachable powder, or when recovery was nearly complete yielded j which though not exposed have lost some of only a trace. 1 milligramme of lead per litre of their oil and gloss, and which when nibbed urine. The two other cases gave no lead in yield a powdery substance to the touch and the urine submitted to the Analyst. I am possibly distribute it to the dust, of rooms. of opinion that the Government Analyst has Dust, of course, is capable of being both proved that the water from galvanized iron swallowed and inhaled. A greater danger, tanks may be excluded as a source of the however, is adhesion of the paint either by poison, and that abundant observations have nature of its stickiness or by nature of its proved that the presence of metallic zinc in powdery character, and fingers and nails by the water precipitates any lead which may which it is carried to the mouths of children, get into the tank. The fact that the Analyst especially in the case of those who bite their was able to find lead in three specimens of nails, suck their fingers, or eat with unwashed tank water prior to my former paper is cap hands. A further danger worthy of con able of explanation. It appears that neither sideration is absorption of the very soluble lead carbonate nor zinc carbonate is soluble lead salts contained in paint through the skin in pure water, carbonic acid must be present, of children's hands and feet. The sweat but it always is present in natural waters. moistened skin in summer would render this Only the presence of metallic zinc in the tank method of absorption more likely. We must deposits lead from its solution, the equa remember that arsenic poisoning has been tion being, according to Mr. Henderson, as proved to occur by absorption of powdered follows:-- arsenic through the skin. In considering Pb CO:iX CO-+Zn=Zn CO:, XCO;+Pb. lead detachable from walls of rooms and from verandah and other railings, as a possible j The child, E.B., aged two years, had not, cause of le..d-poisoning, we have a very com of course, been to school. The source of the plete parallel in the at one time pretty poison was to be looked for, therefore, in his common and well recognised poisoning by own house or surroundings. He had lived arsenic from the powder distributed to rooms up to the time of admission to the hospital in by green wall-papers. a house which has remained unoccupied 3. To ascertain whether the powdery sub stance so easily detachable from painted sur faces which have been exposed to the weather was or was not composed largely of lead, I supplied the Government Analyst with two pieces of calico, each about a foot square, whcli had been rubbed against such verandah railings. I asked him, 1st--How much lead is present, on one piece of calico.? 2nd--Ts the lead on the other piece in an easily soluble form ? Answers :--1st--The total lead on one of the pieces of calico was 0-3 grammes, equivalent to 0-375 grammes of white lead. It probably existed in the form of the very soluble hydrated carbonate. 2nd--Eighteen square inches from the centre of the other piece of calico were soaked in distilled water i , since his father left it in the end of January. I obtained leave to visit this house, and in vited Mr. Henderson to accompany me, which he was kind enough to do. Our object was to obtain evidence as to whether lead was to be found in the dust of theroom chiefly occupied by the boy, and whether the walls of the room yielded powder of lead, which was easily detachable. The house was com pletely painted throughout, and had evidently been painted for fully three years. The verandah floors were all painted as well as the railings, and there was painted lattice work around part of the verandah. The house, in fact, formed a simple lead trap, provided the paint was detachable and evidence could be obtained of its conveyance to the patient. for 24 hours. This treatment dissolved prac The paint in the room, and indeed in all the tically the whole of the lead. No attempt rooms, was in good condition, having a polish was made to keep carbonic acid out of the on it on walls and ceiling. The floor of the distilled water, as it is^present in all natural room was painted for a breadth of some two waters. feet at its margin. The verandah floor was 4. The child, E.M., whose brother shows so marked a blue line on his gums, but no paralytic symptoms, lived until December 5th in a house whose rooms were not painted, and whose verandahs and verandah railings had been so long unpainted that the child's mother says there was really no paint on them. They moved to their present house on Decem ber 5th. The child became ill on December 14th, or between that and December ISth. with colic or vomiting. A squint was noticed at about the new year, and double vision, of which I shall have more to say at another time, as it was monocular. She was brought to the Children's Hospital on January 7th. The house they moved into had been painted recently, and they were its first occupants, and the smell of new paint was very distinct. Tlie walls were sticky. The smell has now disappeared, and there is no longer stickiness. I t will be freely admitted that walls still sticky with paint would contaminate the completely painted, and here the paint was dried and powdery on the surface. Pieces of calico cloth, 9 in. x 4 in., were used for rubbing the ceilings, wallsof the room, painted floor margin, and verandah floor. They were rubbed firmly on the painted surfaces ; Mr. Henderson says, vigorously. There was not much dust in the room, which had evidently been well cleaned out before the house was vacated. Samples of dust were carefully brushed off ledges into watch-glasses with a camel's-hair brush, to avoid dislodging the paint. Analysis of calico cloths and of the dust samples gave the following result:-- 1st.--From the cloth rubbed on the ceiling whose paint was very glossy and showed no signs of wear and tear, no lead was obtained. 2nd.--From the cloths rubbed on the walls where the painted surface showed signs of wear and tear, 2 milligrammes of lead car bonate were obtained. hands of a child very readily, and that the 3rd.--A similar quantity of lead carbonate likelihood of such hands being carried to the was obtained from the cloth rubbed on the mouth would be very great. YVhen explaining painted floor margin. this idea to the mother she said, " And those 4th.--From the cloth rubbed on the veran are the only two of my children who bite their dah floor 12 milligrammes of lead were ob nails'' tained. I 5th.--Dust. (a) From top of mould ing above the door Weight of dust. Lead Carbonate found. 2 grammes 1'5 m. gram. fingers very decidedly, and calico cloths rubbed upon them only less decidedly. 6. Upon learning from the mother of E.M. (-i) Top of fatflight fac ing side verandah (c) Top of door facing front verandah .. (d) Top piece of Vene tian blind .. (e) Top of skirting near door and side verdah 25 grammes 25 grammes 32 grammes 2 grammes Nil 0*2in. gram. Nil Nil that the only two of her children who showed marked signs of the presence of lead in their systems bit their nails, I made further en quiries to see whether other cases did so also. 1 found that the two other girls who, with E.M. and E.B., were the immediate cause of the present enquiry,-also bit their nails badly; also that another inmate of the hospital Avery important observation on the house was the following :--The day was a very warm, oppressive one. My hands were moist with sweat, and I noticed touching the walls with my fingers always brought off A stain of paint, and that it came off much more notice ably on my fingers than upon the calico cloths. This can be demonstrated by anyone on moist painted surfaces that have been painted for any length of time. suSering from the arm and leg form of lead palsy, sucked her thumb. I then asked the resident surgeon, Dr. Lucy Gullett, to com municate with the parents of a number of undoubted lead cases and ask if they bit their nails. She obtained ten answers to twelve post cards, and of these eight bit their nails or sucked their fingers. Two were said to do neither. Several colleagues who have been kindly making enquiries from their lead patients have found that a large majority bite The child, E.B., aged two years, who lived their nails or suck their fingers. in this house, does not bite his nails nor suck The ready adhesion of paint to my sweat- his fingers, but he spent his days with bare moistened fingers made me ask Dr. Gullett feet on the painted verandah floor, whose to look up thehospital records for some years, painted surface was so powdery and easily and ascertain whether cases of lead poisoning detachable. His father tells me also that he ; were more frequent in summer than in winter. was very fond of standing grasping the j I thought it likely that an affirmative answer verandah railings and placing his face against i would favour the conclusion that paint is the and his nose through them. Their paint was ; source It was found that from 1898 to 1903. powdery and easily detachable. The child is i viz., six years, 85 cases of lead poisoning had in the habit of putting everything into his j been treated as in-patients at the hospital; mouth, and he may have sucked the verandah that of these, 42 were admitted during the railings. No doubt his hands were often on months of December, January and February, the floor as well as on the rails, and no doubt our hottest, months ; that 28 were admitted also he carried them sometimes to his mouth. during October November, March and April ; I t is possible that some poison may have been and that 16 only were admitted during the absorbed from the verandah floor through five cooler months. the skin of his feet or through that portion of In a house to which I had been taken by the skin occupied in sitting. Dr. Salter, who had been much interested in It will be seen, therefore, that there is an the lead question, but whom I have not quite intermediate state of painted walls and rail converted to my view, it seemed to me that ings where the danger of lead being distri valuable evidence was obtained of the method buted from them to occupants of a house is by which poisoning occurs. White painted comparatively non-existent, viz., the stage be railings and a white painted gate, from which tween the stickiness of comparatively new the paint was readily detachable as powder, paint and the powdery or semi-powderv con separated a small garden from the street. dition of old paint. While the paint, after The sitting-room and back verandah were ceasing to be sticky has remained glossy, the painted; there was a very narrow painted danger of lead contamination of hands would verandah passage having some sharp turns be expected to be very small, and the state in it leading to some back verandah stairs; of the ceiling in E.B.'s room confirms this at each corner the paint showed marked signs view. The walls of the same room, which of rubbing at the height where the children's showed more exposure to wear and tear, and hands would come into contact with it when which had to some extent though not very j going smartly downstairs. One of the markedly lost their gloss, contaminated my , affected children in this household sucked her thumb. She has had repeated attacks A CONTRIBUTION TO THE STUDY OF of lead poisoning, occurring always in the NEOPLASMS. summer months- By Arthur Styles Yallack, M.B , Ch.M. (Syd.), The point most emphasised regarding treat Bowral, N.S.W. ment in my last paper was removal of the cases from their homes. I have been accus Of all the problems which confront medical tomed to put those who have eye symptoms, science a t the present day, probably none and who come under my care in bed, to inject has excited a more general interest, either pilocarpin daily for six weeks to the extent amongst the medical profession or amongst of causing diaphoresis, and to give iodide of : the general public, than th at presented by the potash. The pilocarpin I have given in the causation of cancer. The am ount of re hope of relieving tension in the optic nerve search work done in recent years in this sheath, and I should be disinclined to dis connection has been enormous, and in many continue its-use. Still, I am convinced that countries patient and competent workers removal of the cases from their homes to the have expended much time and labour in hospital is more important than anything. attem pting to throw some light upon the The fact that arms and legs are affected in matter. But, though the results of their some cases, and that ocular neuritis occurs activity have been both interesting and in others, and that seldom or never are the valuable, we seem to be as far off as ever from two conditions coincident, shows that different arriving at any general consensus of opinion. parts of the peripheral nervous system are Speaking broadly, the various hypotheses susceptible in different children, and makes which have been brought forward to account one hesitate to exclude personal susceptibility for the origin of malignant growths divide or idiosyncrasy from playing a part in deter themselves into two groups, viz., the para mining the victims to lead in any special sitic and the developmental. The former family. Still, if my contention to-night be regards the excessive cell growth as stimu correct, the children have an abundant supply i lated by irritation of the cells due to some of lead available, and do not require to be I living parasite introduced from without ; idiosyncratic to it. the latter regards the process as due to some Although not averse to leading a crusade intrinsic perversion of the reproductive against the semi-vandalism of covering the function of the cells themselves. prettily grained pine linings of our houses Of late the mind of our profession seems to with paint, I am glad to think th at the ap be obsessed by parasites. We live in the age parent fact th at most of the cases bite their of microbes. The only explanation of any nails or suck their fingers will give us help in morbid phenomenon which appears to us in at least preventing the frequently recurring any way complete or satisfactory is th a t p ro -. attacks which the ordinary lead cases get, and vided by the discovery of a living causa will enable us also to educate the public in causans. Indeed, it is only natural th a t this the matter of prevention of primary attacks. should be so. I t is not long ago since the I have until now been in the habit of saying etiology of tubercle or malaria was as obscure to patients' parents, " You had better avoid as that of gout or epilepsy. Unquestionably, tank water for drinking purposes " ; but I do bacteriology has done far more to place our not know the source of the lead--I only know art upon a scientific basis than, any factor that lead is the cause of the affection. I which has operated within recent years. Is shall henceforth, unless I am offered a better it any wonder, then, th a t the pathological explanation, blame paint. dove, after hovering long over the troubled ' Read before the Q ueensland B randt of the sea of ignorance and doubt, longs to find a B ritis h M edical A sso ciatio n .') secure resting-place for her foot upon the back of a bacillus or the pseudopodium of a proto- A Hospital Portrait Gallery. Brisbane.-- Some years ago, while medical superintendent of the hospital, Dr. E. Sandford Jackson set himself to collect photographs of persons who were identified with the early history of the institution, and he has lately pre zoon ? I t appears to me th at this bias has at times had the effect of narrowing our con ceptions of disease in general. Wc focus our gaze to the twelfth-inch oil immersion, when sented the result of this collection, together with a number of groups marking the growth of the nursing staff, to the committee, in the hope that these may form the nucleus of a substantial collection in the future. by putting away the microscope and stepping back a few yards we might get a much more comprehensive and enlightening view. Per haps in no field of observation and research