The external application of lead solutions and ointments sometimes produces unpleasant effects, such as discoloration of the skin. In the mucous membrane lead rarely excites symptoms of poisoning, a single case being reported where lead water compresses were applied to the eye. Gastric pains have occurred after repeated applications of such compresses to a contused shoulder, the pains ceasing with their withdrawal and reappearing with a renewal of the treatment. Colic and paralysis of the member have followed washing of a large ulcer of the leg with lead water, these symptoms disappearing upon a withdrawal of the drug. In still another case a sweetish, styptic taste in the mouth and stiffness of the neck resulted from the external use of the solution.

Poisoning. - Acute poisoning from therapeutic doses is, fortunately, rare, the acetate - the form generally given - producing emesis, thus preventing toxic effects of the drug.

The first symptom of poisoning is a sweetish, metallic taste, soon followed by nausea and vomiting of a white, milky fluid containing curdy material - the result of a combination of the excess of lead with the hydrochloric acid of the gastric juice, and the formation of lead chloride. Constipation and subsequent diarrhea usually occur, with black passages, the discoloration being caused by the sulphide of lead formed in the intestinal canal. There is severe, persistent pain in the abdominal muscles, which are rigid and contracted, while a retraction of the abdominal walls is clearly perceptible. There are great thirst, and possibly cramps in the calves of the legs, neuralgic pains, muscular twitchings, vertigo, stupor, anesthesia, and paralysis. Tenesmus is present, and the face is pale and the lips vivid. As a rule, the liver is retracted and often diminished in size. The pulse is rapid and tense at first, becoming weak, compressible, and slow. 2 ounces (60.0 Gm.) of the acetate have caused death in three days.

Treatment of Poisoning. - Evacuation of the stomach is imperative, the process being more or less assisted by the emetic property of the drug. Some sulphate should be administered in order to form an insoluble lead compound. Epsom and Glauber's salts are the best antidotes, since they are readily soluble and easily obtained; acting, moreover, as purges, they empty the intestinal canal. Opium will serve to relieve pain and irritation, while to maintain bodily temperature hot applications can be used on the feet and abdomen.

Chronic Poisoning. - Chronic plumbism arises from a number of causes. The train of untoward symptoms is occasioned by long-continued medicinal use of lead preparations. Very frequent sources of poisoning are: drinking water conveyed in lead pipes, and foods colored with chrome yellow and those contained in cans soldered with lead. It is especially liable to occur among painters (colica pictonum), manufacturers of lead salts, color-grinders, and typesetters and founders. Hair dyes and cosmetics frequently cause lead-poisoning. Other sources are articles wrapped in tinfoil, cheap camp outfits, forks, plates and spoons, some glazed earthenwares.

The symptoms develop with comparative uniformity, affecting chiefly the (1) intestines, (2) blood, (3) kidneys, and (4) nervous system. (1) The intestinal symptoms are those of local irritation, anorexia, constipation, dark feces, occasional diarrheal attacks, mouth tastes bad, smells badly, dark discoloration about the teeth (so-called lead line), particularly in those who do not keep the mouth clean. Colic usually develops after a short time - it often precedes a diarrheal attack. The intestinal spasms are exceedingly severe and come on with great suddenness.

(2) From the beginning there is an increasing grade of anemia. The red blood-cells degenerate, are pigmented, and the blood-making organs are also involved. The leucocytes may be increased or diminished. Pallor may become extreme.

(3) The kidneys almost invariably show granular degenerative changes. The urine is usually increased in amount, is of low specific gravity, usually contains albumin, granular and hyaline casts. The nephritis, originally parenchymatous in type, may become diffuse.

(4) The nervous symptoms are very variable. There is usually very early with the anemia and nephritis a persistent headache. The peripheral motor nerves are also affected and a multiple neuritis develops with extensive extensor paralysis. There is drop-wrist, drop-toe, etc. Usually bilateral, it may be unilateral. Pronation of the hand is possible, as the supinator longus is usually not involved in the paralysis. Sensory involvement is also possible. Anesthesiae, paresthesiae, sometimes neuralgic pains, occur. Arthralgias (gout-like) are not uncommon results of interference with the functions of the trophic nerves. Occasionally the nervous structures of the retina (amblyopia) are involved, either as a result of the albuminuria or as a direct poisoning by the lead. The brain itself may become affected. Acute delirious states may be induced, or there may be hallucinations with mental confusion and dementia and convulsive seizures of an epileptiform nature.

Treatment of Poisoning. - Removal of the poison is the first indication. The sulphates are given for their chemical and purgative effects, yet in chronic plumbism the hepatic purgatives - calomel, gamboge, jalap, etc. - are often preferable. Opium and morphine relieve pain and spasms, being claimed by some authorities as specifics in lead-poisoning. Sulphuric acid lemonade and plenty of milk have been found beneficial. Potassium iodide in 10-grain doses, three times daily, has an eliminative effect. Lead may be detected in the urine after giving iodides. This test should always be applied in suspected cases. The cerebral symptoms may be alleviated by a diaphoretic, such as pilocarpin or an alcohol sweat.

In progressive paralysis, strychnine is widely employed. Faradization of the muscles, if they respond, or otherwise galvanization, should be used to increase muscular force and prevent atrophy.

Therapeutics. - Externally and Locally. - Acetate being the typical lead salt, its action will be first considered. It acts as a sedative as well as an astringent in acute inflammations, such as eczema (not chronic), impetigo, lichen, and erythema; but it must not be used stronger than 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of water.

It is of service as an injection in gonorrhea, leucorrhea, gleet, and otorrhea. In combination with opium it makes a good topical application for hemorrhoids. As a gargle it is of some value, and is also serviceable in orchitis, synovitis, and paronychia.

Internally. - Its most important use is in checking hemorrhages, in which use it is associated with opium, although it is chemically incompatible with that drug. It is of service in hemorrhage in typhoid fever, yellow fever, hemoptysis, and gastric ulcer.

Morbid discharges, such as the night-sweats and diarrhea of phthisis and the diarrhea of typhoid, dysentery, cholera infantum, secretions in bronchorrhea, and serous diarrhea, are effectually checked by the acetate of lead and opium, which diminishes the pain, griping, and tenesmus attending the respective affections. By far its most frequent use, however, is in serous diarrheas, the drug acting very quickly and efficiently, and being both sedative and astringent.

Given in chronic gastritis with pain, lead acetate affords marked relief.

Liquor Plumbi Subacetatis. - This preparation is used extensively for bruises, sprains, acute eczema, and as an application in ecthyma, erysipelas, and all kinds of inflammations; it should be well diluted. It also relieves the itching of urticaria, pruritus pu-dendi, and eczema.

A felon may sometimes be aborted, particularly if not deep, by saturating bread-crumbs with Goulard's solution, making a poultice, and placing it over the finger.

Plumbi Iodide. - Used very little. It acts beneficially when employed as an ointment applied to enlarged lymphatic glands and spleen; also for psoriasis and chronic eczema.

Plumbi Oxidum. - Hebryre commends an application of equal parts of lead plaster and linseed oil for sweating of the feet. It is chiefly used in the preparation of diachylon or lead plaster, emplas-trum saponis and emplastrum resinae being also prepared with the oxide.

Plumbi Nitras. - Used with good results in onychia and also in the manufacture of Ledoyne's disinfectant. It is an excellent remedy for fissured nipples, care being taken to wash the nipple before suckling. It destroys the fetid odor arising from gangrenous sores and offensive discharges from the ears, nostrils, rectum, and vagina.

Administration. - Locally a watery solution of lead acetate, 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc), is used. Powdered opium can be added, 1 dram to the pint of water. Applied to mucous membranes or used as an injection, 2 grains (0.12 Gm.) to 1 ounce (30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 grains (0.32 Gm.) of zinc sulphate in 1 ounce (30.0 Cc.) of water - rose water, for instance - proves a most efficient application. Suppositories for hemorrhoids may contain 1 grain (0.06 Gm.) of opium to 3-5 grains (0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opiolead acetate 3 grains (0.19 Gm.), opium 1 grain (0.06 Gm.) - is mostly used internally, one pill being taken every three hours. In dysentery and cholera infantum an enema containing 5 grains (0.32 Gm.) of lead acetate to 1 grain (0.06 Gm.) of opium, or 1/2 grain (0.03 Gm.) of morphine to 1 ounce (30.0 Cc.) of Water, gives excellent results.

Should there be any abrasion of the skin, lead subacetate must not be used, as it prevents healing by constringing the edges of the wound.

Solution of subacetate of lead is most frequently used in union with opium, forming the well-known L. and L., or lead-water-and-laudanum, solution. It is also used in conjunction with glycerin, 1 ounce of each, or as Goulard's cerate, consisting of 20 parts Goulard's extract to 80 parts camphor cerate.

For ulcers, fissured nipples, and epithelioma lead nitrate is used, chiefly in the powdered form. In the nose, ears, vagina, and rectum a douche (2-5 grains (0. 12-0.32 Gm.) to 1 ounce (30.0 Cc.) of water) is used. A solution of 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of glycerin or brandy is a very good application for sore nipples.