LEAD ( SHISHA)

As with other metals the soluble compounds of lead are more

poisonous than lead itself, except, when lead in the volatile state lead may
obtain access to the body by inhalation, by ingestion or by absorption.
From the skin or mucus surface. The primary effect of lead is to cause
spasms of the capillaries and arterioles. The toxic effects result from
fixation or lead in certain tissue such as brain and peripheral nervous
system.

Sources of Lead :
The principle salt’s of lead which produce toxic effects are the acetole
( Sugar of lead or salt of sotum) the oxide ( litharge Mudrsang) converted in
to the oleate in the form of diachylon the carbonate or white lead ( safeda),
the Tetroxide or the red lead ( Vermillion sindur) the yellow chrome or the
chromate of lead and tetraethyl lead.

Symptom , signs , treatment and postmortem appearances of acute

lead poisoning :
Acute lead poisoning is rare symptom are similar to those of acute
arsenical or mercurial poisoning , except that diarrhea is replace by
constipation and the stool is blackened and offensive . The Principle
manifestation are gastrointestinal or central nervous system disturbances.

Symptoms and Signs

i) The symptoms consist of metallic a strigent taste , dry throat,
thirst , nausea, and vomiting with colic like pains in abdomen,
relived by pressure.
 ii) They may be purging but more usually constipation
iii) The faces are offensive and black owing to the formation of lead
sulphide and the urine is suppressed.
iv) When the case is protracted the patient may suffer from cramps in
the legs and arthralgia.
v) Headache drowsiness and paralysis of the limb may be
observed.Finally , collapse precedes death Acute cases may
survive and develop the symptoms of chronic poisoning.

In poisoning by tetraethyl lead gastric symptoms are absent or slight

cerebral symptoms the so called lead encephalopathy. Predominate it is
characterized by headache, sleeplessness, tremors of the eyes, mouth and
fingers. sometimes paralysis or loss of vision, hallucnations, excitement ,
delirium or apathy, and convulsions. The patient suffer permanent mental
changes of insanity.

Fatal Dose : The fatal dose of absorbed lead has been estimated to be 0.5
gram. Fatal dose of lead acetate is about 20 grams and lead carbonate
about 4 grams. A drop or two of pure tetraethyl lead may cause serious
symptoms.

Fatal Period : Death may occur on the second or third day. Acute poisoning
is rare and may be followed chronic poisoning.

Treatment :
The stomach should be washed out with 1% of magnesium of sodium
suphate followed by ample washing with plain water to remove the lead
sulphate formed. Morphine and atropinc help to relived painful colic. The
bowel should be cleared at regular intervals to get rid of excreted lead
calcium favours the desposition of lead in the skeleton. A diet rich in milk
and administration of calcium salt and vitamin D are helpful. Calcium
versenate (EDTA) and penicillamine are useful antidotes peritoneal or ,
haemodiolysis may be necessary. The rest of the treatment is symptomatic.
If commercial tetraethyl lead is spilled on the skin, washing the area
with kerosene within fifteen minutes after contact will remove the poison
quantitatively. When gasoline containing tetraethyl lead is swallowed the
treatment is the same as that for gasoline.

Postmortem appearances :
These are chifly of gastroenteritiss. The gastric mucosa is congested.
They may be eroded patches. The large intestine may contain black
coloured faeces.

Account of chronic lead poisoning (Plumbism saturnishm or saturine

poisoning)
Lead poisoning is nearly always of the chronic type. It is encountered in
various industries. E.g Through ingestion in typesetting, plumbing, battery
work, and glazing pottery, through inhalation in the manufacture of white
lead, smelling. From Pain in oxyacetylene ship breaking, diamond cutting
file making , turning car welding and polishing and through ingestion and
inhalation in painting coach building lacquering, Thinning , viterou,s
enameling and colour and dye manufacture and use home chronic lead
poisoning may occur from use of dye manufacture and use of “ghee”
(butter) stored in tins or taking food cooked in tinned vessels . Formely , it
used to occur from drinking water supplied through lead pipes.
 Chronic poisoning may also result from the mobilization od lead
already stored in the body tissues, Especially the bones.
E.g. In acidosis and symptoms of acute and chronic poisoning may develop ,
even years after the original absorption of lead.

Symptoms and Signs :

Although chronic poisoning correctly describes prolonged exposures,
manifestation often are acute
The main symptoms and signs are facial pallor, anemia with punctate
basophilia, lead line colic and constipation.
Paralysis , encephalopathy, renovascular, manifestation, reproductive
system manifestations and general symptoms

Facial Pallor :
The facial pallor particularly about the mouth is one of the earliest
and most consistent sign , it is supposed to be due to vasospasm.

Anaemia with punctate basophiliar –

The blood shows hypochronic anaemia associated with
polychromasia punctate basophilla, reticulocytosis, poikilocytosis an
increase in mononuclear cells and decrease in polymorphonuclear cells,
Punctuate basophilia means the presence of many dark blue colored
pinhead like spots in cytoplasm of red blood cells. These are stained with
basic dyes and hence the name . The condition is due to toxic action of lead
on porphyrin metabolism porphyrins are excreted in the urine, the amount
being as much as 500 micrograms per day
Lead Line :
This is a stipped bluish black line due to subepithelial disposition of
lead sulphide granules on the gums of the junction with the teeth (no on the
teeth) It is seen on the gums of carious teeth. Especially noticeable on the
upper jaw. Its colour is due to the action of hydrogen sulphde liberated by
micro-organisms from decomposing protein food around carious teeth in
the presence of circulating lead .A somewhat similar line may be seen in
cases of mercury, copper , bismuth, iron and silver poisoning.

Colic and Constipation :

The colic generally affects intestines, ureters, uterus, and blood
vessels. It Is relived by pressure on the abdomen. It is a late manifestation
but constitutes an acute symptom of chronic plumbism obstinate
constipation is associated with it.

Paralysis :
This is usually a late manifestation , seen in less than 10 percent of
cases onset may be gradual or sudden. there is commonly paralysis of
extensor muscles or writst. but peroneal muscles or other muscles groups
may also be affected.
Encephalopathy :
Lead encephalopathy, is some form or the other is said to be present in
every case of plumbism but is more common in poisoning by tetraethyl
lead . It is common in children and is characterized by recurrent
convulsions and progressive mental deterioration optic ultrophy may
occur.
Renovascular Manifestation :
Vascular contriction results in hypertension and arteriolar,
degeneration, arteriosclerotic nephritis may occur.

Reproductive System manifestation :

Menstrual disorder such as dysmenorrhea, amenorrhoea are
common. Toxic ction on the irophoblastic epithelim and tonic contraction
of the uterus result either in a dead foetus or abortion .

General Symptoms :
These consiste of general weakness, anorexia, dyspepsia metallic
taste in the mouth, foul, breath headache, vertigo , irritability drowsiness
and arthralgia.

Diagnosis :
Clinically this may be suspected from colic, punctuate basophilia and
a bluish black line on the gums. Palsy or encephalopathy may be
contributory more than 200. Punctuate basophilia cells per cmm is is
diagnostic and so also the presence f 0.25 mg of lead per liter of urine lead
interferes with the enzyme system concerned with the synthesis of haem
resulting in exertion

Treatment :
The aim is to remove the source of exposure and then exceretion of
the stored lead. EDTA combines with lead, promotes its mobilization and
urinatory excretion in an inactive form and affords rapid control of the
signs and symptoms of poisoning including those of lead encephalopathy.
Other symptoms are treatment on general lines. If lead paralysis has
developed massage to the affected muscles is helpful.

Postmortem Appearances :
In chronic forms, the findings confirm the clinical feature already
described bone marrow shows hyperplasia of erythro blasts and
leucoblasts with decrease in fat cells. A long bone, teeth, hair and nails
should be preserved in case analysis become describe

Comment on Medico legal Aspects of Lead Poisoning

Acute poisoning is rare , lead used for homicidal purposes lead
poisoning is usually accidental, it may occur in children from eating pain on
cribs, or beds or toys subacute or chronic lead poisoning may be caused by
the contamination of food or drink. Apart from industrial poisoning
accidental chronic poisoning has occurred from the use of lead monoxide
as a remedy for syphilis by quacks, rarely from the continue use of
vermillion by married Hindu womento the scap and form the use of
diachylon paste to procedure abortion. Sometime lead poisoning may occur
from lead missiles embedded in the tissues due to gunshot injury red lead
is occasionally used as cattle poison either alone or mind with white
arsenic.