Charles D. F. (Charles Douglas Fergusson) Phillips.

Materia medica and therapeutics, inorganic substances; (Volume 2) online

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with this action on the liver, partly with similar action on the intestinal
glands (British Medical Journal, ii., 1878). Heubel attributes the icteric
condition frequent in plumbism to contraction of the bile-ducts (muscular



LEAD. 257

fibres). During an attack of colic, all the secretions are diminished ex-
cept that of the skin (Alderson: " Lumleian Lectures," 1852, Lancet).

Modes of Chronic Lead-poisoning. Of the different workers in lead,
oxide of lead, or " white lead" (carbonate), those who grind it in factories
are most liable to suffer, though less so now that the powder is ground
with water (Taylor); but house-painters and coach-painters, plumbers,
pewterers, and compositors, makers of certain white glazed cards, hat
pressers, bleachers of Brussels lace, and glazers of pottery, are often af-
fected. Severe symptoms have sometimes arisen from sleeping in a new-
ly-painted room, or from breathing the sm.oke of burning painted wood.
Among exceptional and little suspected causes of plumbism, are the hand-
ling of vulcanized rubber and black horse-hair colored by lead sulphide,
the use of hair washes, dyes, and cosmetics containing lead salts, breath-
ing dust from "American cloth" whitened with lead salts, and in the
process of making yellow cord fusees (chromate of lead). Poisonous
symptoms have followed in an infant after the application of strong lead
lotions to the mother's nipples, and in children from yellow confectionery
(chromate); the chewing of "tea lead" (in which tea is wrapt), the using
of snuff that had been wrapped in similar " foil," the use of soda water
from lead "syphons" (British Medical Journal, 1874-75) (free tartaric
acid is said to help in this case) bathing in water impregnated from a
leaden pipe, the drinking of wine from bottles which had been cleansed
with shot have all caused plumbism.

Two curious epidemics have occurred one at Taunton, another in
France from flour ground .between millstones that had been mended
with lead (British MedicaUournal, 1877; Medical Times, i., 1878), and
even the handling of lead machines, as in ice-cream making, or cameo
polishing, or cleaning " beer engines " or brass handles (as engineers do),
has induced colic.

There is some reason to think that the " dry colic," or enteric neural-
gia, of tropical countries is connected with lead. Gubler gives instruc-
tive instances of its development from the use of lead cosmetics in Creoles
(Medical Record, 1876), and it is said to have become more common since
steam-boats have been more used ! (Medical Record, 1876). Mialhe and
other French physicians also speak of lead colic being frequent on ship-
board, and connect it with the action of a saline atmosphere on lead en-
gines, etc.

But excepting the trades first mentioned, the most frequent source of
lead-poisoning is the use of drinking-water impregnated with the metal
or some of its compounds. Bad symptoms have resulted from so small
an amount as -fa gr. per gallon, and 1 gr. per gallon is a surely dangerous
dose. It is to be noted that the freer the water from saline ingredients,
the more readily it takes up a soluble carbonate formed on the metal pipe
or cistern. Its formation and solubility are also favored by much organic
VOL. II. 17



258 MATERIA MED JO A AND THERAPEUTICS.

impurity, free access of oxygen, a little nitric acid (as may happen after
thunder-showers), or the presence of a second metal (iron as well as lead).
Carbonic acid in pure water also favors solubility, although in certain cir-
cumstances it may act differently. Lime and other saline constituents
will, on the other hand, if present in the water, lessen liability to contam-
ination by forming insoluble coatings on the metal: otherwise, no doubt,
plumbism would be still more common than it is.

Idiosyncrasy. There is a great difference in the susceptibility of
different individuals to the poisonous action of lead as may be verified
in any large factory and it is comparable to what has been noticed with
arsenical wall-papers, etc. One attack of colic strongly predisposes to
another, which may follow after a long interval from comparatively
slight cause thus, a man who had suffered as a house-painter, turned
game-keeper, and got an attack long afterward from stirring shot in
water with his hands (British Medical Journal, i., 1877).

SYNEBGISTS. The depressing influence of lead upon the circulation is
assisted by digitalis, ergot, veratrum, prolonged cold, etc.; its astringent
action by metallic salts of copper and zinc particularly. The other metals,
especially mercury, antimony, and copper, have a similar effect in lessen-
ing nutrition.

ANTAGONISTS AND iNCOMPATiBLEs. Sulphate and carbonate of lime,
carbonic acid, acids mineral and vegetable, alkalies, iodide of potassium,
opiam, albuminous solutions, and most vegetable astringents are chemi-
cally incompatible, and most of these may be used in the treatment of-
lead-poisoning. In acute cases, when the *drug has been taken by the
mouth, emetics or the stomach-pump should be used, and sulphate of soda
or magnesia given in milk or mucilage. In chronic cases, alkaline iodide
should be given internally, and sulphur baths should be used, containing
about 7 oz. of sulphuret of potassium. During half an hour of bathing,
frictions should be employed, and soap should be freely used afterward
(Eulenburg). Electricity should be applied to the affected muscles
faradaism if it causes contraction, if not, the continuous current three or
four times weekly for about a quarter of an hour, whether it induces con-
traction or no: in curable cases it will ultimately do so. Purgatives
should be freely given. Fatty food is said to antagonize the develop-
ment of plumbism in lead-workers, and a long prevalent colic in large
lead-works at Birmingham was stopped by the free use of a " treacle
beer," containing sulphuric acid (Lancet, i., I860). Washing the hands
before eating, etc., is important, and washing with petroleum is said to be
prophylactic (British Medical Journal, ii., 1877).

Pilocarpin and amyl nitrite antagonize the increased arterial tension
which occurs in chronic cases (v. p. 256).

THERAPEUTICAL ACTION (EXTEENAL). Disinfectant Power. A. solu-
tion of lead nitrate (Ledoyen's disinfectant) has been in use for many



LEAD. 259

years, and acts by decomposing sulphuretted hydrogen, but has no other
good effect; it is comparatively expensive, and its black precipitate is
sometimes objectionable: Dr. Goolden has, however, recently recom-
mended as applicable to many cases, solution of chloride of lead, although
it also can act only on sulphuretted hydrogen. He prepares it by dis-
solving $ dr. of powdered nitrate of lead in one pint of boiling water, and
mixing this with 2 dr. of common salt in 2 gallons of water. The pre-
cipitate which falls is in part carbonate of lime, in part carbonate of lead,
and the clear supernatant fluid is a saturated solution of lead chloride.
This quickly removes the smell of foul drains, ship-holds, etc., and cloths
wrung out of it, and placed about a room, neutralize organic emanations,
e.g., from crowded assemblies, fetid suppuration, etc. It was used with
much advantage on board the Thunderer after a gun-explosion (Lancet,
ii., 1875, ii., 1876 ; British Medical Journal, ii., 1876, p. 323).

Inflamed Surfaces. A solution of subacetate of lead is still, perhaps,
the most frequently used of all remedies in the external inflammatory
conditions for which it was introduced by Goulard, of Montpelier, more
than 100 years ago.

In erysipelas it proves cooling and astringent, and a good formula for
its use is that given by Christison, Murchison, and others (Medical Times,
i., 1867, p. 523), viz., 4 gr. each of lead acetate and of powdered opium
in an ounce of warm water. The meconate of lead is formed, and pre-
cipitates, but gives an effective therapeutical result; a more elegant form
combines the lead salt with acetic acid and acetate of morphia. Dr.
Lawson speaks well of a solution of acetate, 10 to 20 gr. in \ oz. each of
plain water and lime-water, for all kinds of burns, wounds, and ulcers
(Lancet, ii., 1875). Mr. Freer, from much practical experience, recom-
mends the carbonate of lead with linseed oil (white paint) in preference
to the acetate, or indeed to any other application; it has the advantage
over nitrate of silver of being painless, and it often relieves very quickly
(Lancet, i., 1859). It is good not only in erysipelas, but in burns, car-
buncles, eczemas, etc., since it excludes air and exerts a sedative effect
it may be applied with a feather, and a fresh coat put on every two hours
or so, and left to peel off in a few days. A more elegant mode of using
the carbonate is with glycerin, 1 dr. to 4 gr. of the powder, and 1 oz. of
cerate; this is useful for erythema.

Conjunctivitis. Warm lead lotions, with or without opium, are very
serviceable in ordinary catarrhal cases, but it is important they should
not be ordered if the corneal surface be abraded, or else an opaque white
deposit may be left.

Eczema. In cases of moist discharging eczema, lead lotions are often
soothing and sometimes curative; a combination of the liquor plumbi 1
oz., with glycerin - oz., and cherry-laurel water 3^- oz., is very good for
subacute cases, but may require. dilution. Mr. B. Squire gives the pref-



260 MATERIA MEDIC A AND THERAPEUTICS.

erence to a glycerole of subacetate of lead, in the preparation of which
glycerin is used instead of the water of the officinal liquor (Medical
Times, i., 1876): 1 part of this in 4 of glycerin or of vaseline is a useful
strength. Equal parts of the liquor plumbi and glycerin have given me
as good results in chronic eczematous conditions, and more especially in
mentagra. In some cases, the iodide of lead ointment will be found use-
ful.

Wounds. Mr. Hutchinson has strongly recommended the continuous
use of lead lotions in operative surgery. Within about six hours of any
serious amputation he applies over and near the part, compresses soaked
in a lotion containing oz. of liquor plumbi, and 1 oz. of spirit of wine,
in a pint of water, and kept constantly moistened every half-hour for
several days and nights. This constant attention is essential to success,
and is the only troublesome part of the treatment, which seems to prevent
inflammation, to have some antiseptic power, and certainly to promote
union by first intention no poisonous symptoms have been observed
from it (Lancet, i., 1875). Zeissl advocated a similar dressing for bubo,
after observing the unfavorable results of routine treatment by incision,
etc., as carried out in certain German hospitals; he kept the surface con-
stantly covered with linen soaked in solution of basic acetate of lead, and
found that inflammation and suppuration were much controlled, and con-
valescence hastened (Medical Times, i., 1872, p. 521).

Onychia. Powdered nitrate of lead I have found a remarkably good
resource in cases of onychia, and it has quickly benefited when ordinary
treatment had failed (Marsh, MacCormac, Scott, etc., British Medical
Journal, i., 1874). Professor Perizzi was the first to draw attention to
this.

Sore Nipples. Dr. Fordyce Barker speaks highly of the nitrate of
lead (10 to 15 gr. in the ounce of glycerin) as an application to sore nip-
ples (Medical Times, ii., 1873, p. 503).

Enlarged Glands, etc. The ointment of lead iodide is often useful in
chronic adenitis and splenic enlargements, also in chronic synovitis.

Leiicorrhcea, etc. In cases of purulent and muco-purulent discharge
from the vagina, the urethra, the ear, etc., lead lotion is very useful, and
may be used at any stage, since, if sufficiently dilute, it does not irritate,
like alum and some other astringents. If, however, improvement is not
obtained from weak dilutions, the full strength should be tried, and zinc
sulphate may be added in the proportion of 1 or 2 gr. to the ounce of
lead lotion.

THERAPEUTICAL ACTION (INTERNAL). Hemorrhage. The acetate of
lead has decided power over many forms of internal hemorrhage, and is
still in frequent use, though not so much so as formerly. Dr. Elliotson
often prescribed it in 2 to 3-gr. doses; Dr. Stokes says "nothing can be
more striking than its power to arrest the discharge in chronic bronchial



LEAD. 261

hemorrhage," and I have more than once verified this. Dr. C. J. B. Wil-
liams recommended 3 gr. with opium every hour or half-hour in cases of
haemoptysis, taking care to give a daily dose of purgative salts (Lancet,
i., 1862). In the hemorrhage of enteric fever, acetate of lead is often
valuable.

In an obstinate case of hcematuria (renal), after failure of tannin,
iron, and other remedies, grain doses of lead acetate, with gr. of opium,
given every six hours, soon arrested all bleeding; a blue line appeared
on the gums within a week of this treatment (Gull: Lancet, i., 1866).
In uterine hemorrhage, acetate of lead with opium is often suitable. Dr.
Dewees used it largely in plethoric menorrhagia and in hemorrhage oc-
curring during pregnancy.

Dr. Workman has written to advocate a novel prescription, which
theory would scarcely seem to justify, though the practice is said to be
advantageous; he gives the acetate in to 1 dr. doses without any
opium; this causes diarrho3a, but no other bad symptoms, and produces,
he says, the best results in haemoptysis and also in uterine hemorrhage,
and causes contraction of the uterus (Medical Record, 1878).

Phthisis Chronic Bronchitis. At one time, acetate of lead was
thought valuable in consumption, and it may relieve some of the symp-
toms, such as profuse sweating, expectoration, and diarrhoaa, but the
cases said to be cured by it were probably of chronic bronchitis, with ex-
cessive secretion. M. Beau has, however, written comparatively lately
to advocate again the advantages of lead treatment in phthisis, recom-
mending the carbonate in gradually increasing doses (Lancet, ii., 1861).
He founded his practice upon some cases of phthisis which recovered
after working in lead-factories, and concludes that a moderate degree of
lead-poisoning is antagonistic to the malady but such an opinion is not
generally accepted. I need scarcely say that other physicians condemn
the use of lead salts in phthisis "as worse than useless" (Medical Times,
i., 1860, p. 435). The truth probably lies between the two extremes, but
a decided objection to any continued use of the drug is its impairment of
appetite.

Pneumonia. Under the use of lead acetate, a good proportion of
success in the treatment of pneumonia has been reported by Brandes,
Strohl, Leudet, and others (British Medical Journal, i., 1863).

Aneurism. Since the observations of Dupuytren, who reported three
cases of aortic aneurism relieved by lead acetate (together with small
bleedings and i;est), this remedy has been tried by many physicians. Dr.
Owen Rees reported a case of acute popliteal aneurism (Lancet, i., 1805),
with thin walls, and no coagula in the sac, which did not improve under
pressure, and was thought incurable without operation; on October 29th,
3 gr. of acetate with opium were ordered thrice daily, the diet was not
restricted, nor rest enforced: on November 1st, there was a slight blue



262 MATERIA MEDICA AND THERAPEUTICS.

line on the gums: on November 5th, the dose was increased to 5 gr., and
this was continued for twenty-six days, when the remedy was stopped on
account of colic: aneurismal pulsation had ceased. On December 31st
the man was at work, and on January 17th reported cured. This rather
striking instance I have not found supported by the results of others,
though Dr. A. Clark reports a case of thoracic aneurism in which 2 gr.
of acetate with opium were given thrice daily for two months, and the
patient got better; he was kept constantly at rest (Medical Times, ii.,
1867, p. 566). Stille remarks that the sacculated form of aneurism can
only be cured by coagulation of blood in the sac, and in so far as acetate
of lead promotes this, it assists a cure, but in the fusiform aneurism, with
symmetrical distension, no mere astringent can exert a salutary power.
Bellingham objects to the use of lead in any case, and Mr. T. Holmes,
who has known aneurism develop during the course of a lead colic, as-
serts that the acetate is of no real value in the treatment of the malady
(Lancet, i., 1872). Dr. Bristowe points out that it may help to quiet the
circulation, but cannot really coagulate blood within the vessels, other-
wise its administration would lead to danger from thrombosis or embo-
lism. From a general review of the evidence at present before us, I
should conclude that although individual cases of apparent benefit may
be cited, as a rule very little can be expected in aneurism from the use of
lead.

Diarrhoea Dysentery. Stille has collected a large amount of evi-
dence, American and foreign, in favor of lead acetate as a remedv in
many forms of these disorders. Graves and others have recommended it
in cholera. It certainly exerts a powerfully astringent effect, but should
not be used without due regard to the elimination of irritating material
by previous purgation if necessary. In some cases of obstinate diarrhosa
among the ill-fed children of the poor, I have found it exceedingly useful.

PREPARATIONS AND DOSE. Plumbi acetas : dose, to 3 gr. or
more. Pihda plumbi cum opio : dose, 4 to 8 gr. (1 gr. of opium in 8 gr.
of the pill mass). Plumbi iodidum : dose, to 1 gr. Suppositoria
plumbi composita: (1 gr. of opium and 3 gr. of acetate in each). The
following are for external use only: Plumbi oxidum; Etnplastrum plum-
bi (diachylon); Emplastrum plumbi iodidi; Unguentum plumbi acetatis;
Liquor plumbi subacetatis (Goulard extract); Liquor plumbi subacetatis
dilutus (Goulard water) ; Unguentum plumbi subacetatis comp. (contains
camphor, wax, and oil better made with vaseline) ; Plumbi carbonas ;
Unguentum plumbi carbonatis ; Plumbi nitras.

[PREPARATIONS, U. S. P. Plumbi acetas ; Ceratum plumbi acetatis :
solution of subacetate of lead 2 fluid ounces, white wax 4 troy-
ounces, olive-oil 8 troyounces, camphor 30 gr. ; Linimentum plumbi
subacetatis : olive-oil 3 troyounces, solution of subacetate of lead 2 troy-
ounces; Liquor plumbi subacetatis ; Liquor plumbi subacetatis dilutus ;



POTASSIUM. 263

Suppositoria plumbi : acetate of lead 36 gr., oil of theobroma 324 gr. ;
make 12 suppositories; Suppositoria plumbi et opii : acetate of lead 36
gr., extract of opium 6 gr., oil of theobroma 318 gr. ; make 12 supposi-
tories; Plumbi car bonas; Unguentum plumb i carbonatis (60 gr. in 1 oz.);
Plumbi lodidum; Unguentum plumbi iodidi (60 gr. in 1 oz.); Plumbi
nitras / Plumbi oxidum Emplastrum plumbi.]



POTASSIUM KALIUM, K,=39.

This metal has not been found native, but its various compounds are
very widely diffused. The nitrate occurs in various soils, and the chloride
in mines, the tartrate in the juice of the grape and other fruit, and carbo-
nates and chlorides are found in the ashes of all woods and plants; chloride
of potassium abounds especially in the seeds of leguminosas (Berthier).
From vegetables this salt passes into the animal organism, and hence the
milk and the urine of herbivora contain much more of it than the same
secretions of carnivora: the blood-globules and the contractile substance
of muscle contain a comparatively large proportion of it.

CHARACTERS. The metal itself is soft and silvery white, so light (sp.
gr. .865) that it floats on water, and with such affinity for oxygen that it
abstracts that gas from the water, thus setting free hydrogen which ig-
nites and burns with a violet purple flame, characteristic of the presence
of potassium. Some liquid devoid of oxygen like benzine is therefore
required for keeping the metal; if exposed to the air it rapidly oxidizes
to potash.

COMPOUNDS OF POTASH.
Potassii iodidum (v. vol. i., p. 59). Potassii bromidum (v. vol. i., p. 97).

LIQUOR POTASS^ SOLUTION OF POTASH, KHO,=56.

PREPARATION". By adding slaked lime to a boiling solution of about
twice its weight of carbonate of potash; carbonate of lime subsides, and
the clear solution of potash is transferred by means of a syphon to a bot-
tle, which should be of green glass.

K a CO 3 + CaH 2 O 2 = 2KHO + CaCO 3 .

(The solution would corrode wool or other organic niters, and would dis-
solve lead in white glass.)

CHARACTERS AND TESTS. A colorless liquid of acrid taste, and
strongly alkaline reaction; sp. gr. 1.058; contains nearly 6 per cent, of
caustic potash, or 27 gr. in the fl. oz. ; it feels soapy when rubbed between
the fingers, on account of its solvent action on the cuticle; it corrodes



264 MATERIA MEDICA AND THERAPEUTICS.

animal and vegetable substances, and forms soluble soaps with oily and
fatty bodies. It is liable to contain carbonate of potash, lime, sulphates,
chlorides and alumina. The best general test for potash salts in solution
is perchloride of platinum, which precipitates a yellow double chloride.



POTASSA CAU8T1CA CAUSTIC POTASH HYDRATE OF POTASH
POTASS1C HYDRATE, KHO,=56.

PREPARATION. By rapidly evaporating the liquor to dryness in a
clean silver or iron vessel, then fusing and pouring into suitable moulds.

CHARACTERS AND TESTS. Occurs in hard fibrous pencils, which should
be white, but are often bluish in color; of peculiar nauseous odor, and
acrid taste. It has a strong affinity for water and carbonic acid, and
readily deliquesces if exposed to the air: is soluble also in alcohol. Heat
is evolved during its solution in water.



POTASSES CARBONAS CARBONATE OF POTASH, K 2 CO 3 ,=138.

PREPARATION. From the ashes of plants which consist of a soluble
carbonate, and insoluble salts of lime, silica, etc. The carbonate is dis-
solved out by frequent washing with water, which is then evaporated,
and the residue fused to a brown stony mass the crude potashes of com-
merce (black potash). This is purified by calcination in a furnace, the
dull white residue being termed " pearl-ash," and this again is further
purified by solution in a small quantity of water, filtering, and evaporat-
ing to dryness. The carbonate may also be obtained by heating to red-
ness the bicarbonate.

CHARACTERS AND TESTS. Occurs in small white opaque crystalline
grains, having strong alkaline taste and reaction; it is distinguished from
the bicarbonate and from sodium salts by its great affinity for water, for
on exposure it soon deliquesces into a thick liquid.



POTASS^ BIG ARBON AS BICARBONATE OF POTASH, KHCO 3 ,=100.

PREPARATION. By passing carbonic acid gas through a strong solu-
tion of carbonate of potash; the stream of gas should be disengaged
slowly but continuously for a week: crystals of bicarbonate are gradually
deposited.

K,CO 3 + H S O + CO,, = 2KHCO 3 .

CHARACTERS AND TESTS. These crystals are large, transparent, color-
less, rhombic prisms, which are not deliquescent and not caustic; they
are soluble in four parts of cold, and less than their own weight of boil-
ing water, insoluble in alcohol: nearly neutral to test paper.



POTASSIUM. 265



POTASS^ AC ETAS ACETATE OF POTASH, KC 3 H 3 O S , =98.

PREPARATION. By neutralizing acetic acid with carbonate of potash;
the acetic takes the place of carbonic acid, which is liberated with effer-
vescence.

K.CO, + 2HC,H S 0, = 2KC,H 3 S + H,O + CO 2 .

The liquid is evaporated, and the salt dried, melted, and crystallized.

CHARACTERS AND TESTS. Occurs in white, smooth, glistening, and
generally long pieces, which are soft, fibrous in texture, and unctuous to
the touch: neutral in reaction, very deliquescent, and soluble in alcohol,
as well as in water.



POT ASS j CITRAS CITRATE OF POTASH, K 3 C 6 H 6 O 7 ,=306.

PREPARATION. By neutralizing carbonate of potash with citric acid;
a reaction similar to the last-mentioned occurs, but this acid being triba-
sic, requires three equivalents of carbonate for saturation.

3K 1 CO i +2H,C.H 6 O 1 =2K 1 C e H.O T +3H a O+3CO s .

CHARACTERS AND TESTS. Citrate of potash is a white, granular, crys-
talline powder, deliquescent, soluble in water, insoluble in alcohol. It is
charred by hot sulphuric acid, and its solution gives a precipitate with
chloride of calcium Tanly when boiled a test which distinguishes it from
tartrate of potash.

POTASS^! TARTRAS TARTRATE OF POTASH, K 2 C 4 H,O<,,=226.

PREPARATION. By boiling the acid tartrate with carbonate of potash
and water, when an equivalent of hydrogen in the acid salt is replaced by
one of potassium, and carbonic acid given off.

2KHC 4 H 4 6 + K,C0 3 = 2K 3 C 4 H 4 O 6 + H,O + CO,.



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 32 of 40)