Causation

Chronic lead poisoning is common among all artisans or mechanics who work much with lead in any form, but especially white lead. Plumbers and house painters are therefore particularly subject to it. It may also be acquired by eating improperly tinned or badly soldered canned food, although such cases are usually acute. It is sometimes caused by using drinking water which has passed through new lead pipes. When present in the strength of only one one-hundredth of a grain to the gallon it may cause palsy.

The cheap ale, or "four ale," as it is called, sold in London to the lowest classes, is sometimes kept in contact with pewter pipes until it contains toxic quantities of lead.

Lead is sometimes contained in poisonous amount in beer or wine which has been contaminated by the metal during its careless manufacture. Some persons are exceedingly susceptible to lead, and cases are recorded of poisoning from the medical use of a few doses of lead and opium pills, and also from that of cosmetics containing white lead.

Dietetic Treatment

Chronic lead poisoning is nearly always accompanied by constipation, and it is highly important to overcome this difficulty by such foods as will keep the bowels actively open. Fresh fruits and coarse cereals (such as oatmeal, cornmeal, wheaten grits, Graham bread), and molasses are recommended, with such other foods and regulations as are given under the heading of the Treatment of Constipation (p. 582).

Water should be drunk in large quantity, not only to increase the digestive secretions and keep the faeces moist, but to act as a diluent and aid in washing out the poison.

Lemonade, acidulated with dilute sulphuric acid, fifteen drops to the tumblerful, or with a similar dose of aromatic sulphuric acid, is much in vogue as a prophylactic beverage, for it forms an insoluble lead sulphate from the more soluble carbonate or other salts of lead which may have reached the stomach by being taken with food or drink. This insoluble salt is not absorbed, and hence poisoning may be averted.

Men employed in the manufacture of white lead or other preparations of lead believe that drinking milk freely as a beverage is prophylactic against poisoning, but it is doubtful whether it acts otherwise than as a good diuretic.

Lead colic is sometimes benefited by lavage.

Dietetic Complications Arising From Associated Diseases

There are certain diseases and conditions which are not infrequently associated in the same individual, the dietetic treatment of each of which may be directly opposed to that of the other. Such, for example, are: Diabetes and chronic Bright's disease, the former requiring chiefly meat, the latter none; extreme leanness and chronic gastric catarrh, the former condition requiring fats, starches, and sugars, the latter prohibiting them; obesity and chronic albuminuria, the former requiring animal food, the latter none (unless it be milk); acute rheumatism and extreme anaemia, the former requiring no solid animal food, the latter demanding it; intestinal dyspepsia and gallstones, the former benefited by a meat diet and no starches or vegetables, the latter doing better with opposite diet; ascites and chronic albuminuria, where the quantity of fluid ingested as well as the diet may present very opposite requirements.

When such complications arise it is possible to compromise for a time upon a milk diet, this being the most natural food, and one which, on the whole, is capable of more universal adaptation than any other. In other cases, as, for example, in the first instance mentioned above - of diabetes accompanied by severe Bright's disease - one must be governed by the patient's general condition, the gain or loss of body weight, the strength of pulse and muscle tone being the important guides for one or other system of dieting. The lesser evil, whichever it may be, must naturally give way to the greater, and a generous mixed diet may sometimes be found to serve the patient better than one too much restricted by theoretical considerations.

No subject taxes the skill and ingenuity of the dietist more severely than the treatment of such complications, when ordinary rules appear most contradictory.