The above remarks are applicable to lead-poisoning in general. Particular forms of it require special modifications of treatment. In the form of colic, it is necessary to relieve the pain, and overcome the obsti-nate constipation. For this purpose, the preparations of opium are to be employed in connection with purgatives, of which calomel, croton oil, castor oil, and sulphate of magnesia are perhaps the best. The last-mentioned remedy has the additional advantage of converting the poisonous preparation of lead in the bowels into the sulphate. The purgatives may be aided by cathartic enemata. Tobacco cataplasms, and chloroform over the abdomen, have been recommended for the purpose of relieving pain and relaxing spasm; and the latter remedy has been used internally* with the same view. The mercurial impression has been considered as antidotal to the saturnine, and calomel with a view to salivation has been considerably used; but it is seldom necessary. Alum often acts most happily in the disease, sometimes speedily relieving all the symptoms, when the opiate and purgative plans have failed. It may be employed conjointly with them from the beginning of the treatment. It has been supposed to operate chemically, either upon the poison remaining in the bowels, or on that contained in the tissue of their coats, by converting the compound of lead into a sulphate; but, were this its mode of action, the same effects should be obtained from diluted sulphuric acid or Epsom salt, which have not been found to answer as well in practice. As the insensibility of the bowels to purgative influence is probably owing to a partial condition of paralysis, the use of strychnia is indicated in obstinate cases.

In the paralytic cases, besides the use of the antidotal measures above referred to, and especially iodide of potassium and sulphuretted baths, recourse may be had to strychnia, electricity, and the application of blisters; and the mercurial impression may be tried, should other measures fail. When neuralgic pains complicate the palsy, opiates or other anodynes may be conjoined with the antidote.

In the cerebral cases, whether convulsive, comatose, or delirious, general and local bleeding, cold to the head, sinapisms or blisters to the extremities, and purgation have been generally deemed advisable; and, should the state of the circulation call for these remedies, they should undoubtedly be employed. But there is reason to believe that these phenomena, sometimes at least, depend upon a direct impression made by the lead upon the cerebral centres, analogous to that upon the bowels and the external muscles; and, as this is rather of a depressing than excitant character, it may be a question, whether opiates and other cerebral stimulants may not prove more effectual than depletory measures. In a fatal case, with violent delirium, spasmodic rigidity of the muscles, and convulsions, ending in coma, in which the depletory and revulsive measures were employed with no effect, no sign could be discovered after death of inflammation or active congestion of the brain or its membranes. {Arch. Gen., 4e ser., xxvii. 71.) In such a case, if attended with an unexcited state of the pulse, and paleness of the face, I should be disposed to try the plan referred to, of course in conjunction with the proper antidotal measures.

Prevention. In relation to preventive measures, the best rule is to guard, by extreme care, against the introduction of the poison Into the system. For this purpose, the cautions should be observed to keep the hands and surface of the body clean, and, as far as possible, to avoid swallowing any of the poison whether in food, drink, or mixed with the saliva. It cannot be kept from the lungs when the air inspired is impregnated with it; but much may be done for self-protection by preventing this impregnation, and by avoiding the inhalation of the poisoned atmosphere. Thus, in the manufacture of white lead, it has been found that the disease is less prevalent since the introduction of grinding the salt under water, than when it was powdered dry, and thus caused to fill the air with its fine particles. The habitual use of sulphuric acid, diluted so as to form an agreeable drink, has been recommended as a preventive to those who are necessarily exposed. But it is evident that the acid can act only on the portion of the poison swallowed; and, as the sulphate has been shown not to be altogether innocuous, it cannot be a complete safeguard even against this; while the steady use of a substance so active as sulphuric acid cannot itself be without its inconveniences.*

4. Therapeutic Application

The therapeutic indications to be fulfilled by the preparations of lead, based upon their astringent and sedative properties, are mainly to arrest hemorrhage and morbibly increased secretions, and to reduce inflammation. But it will be most convenient to consider the remedial uses of the metal, under the head of its several preparations, and especially under that of the acetate, which is the only one much employed internally.