days, the bowels began to act, and soon acted once a day, She was all this time only taking beef tea (cold) and water as a drink, as I did not think that the claret agreed with her; she sometimes took a little bread and gravy, and once or twice tried a little fish, and also a small piece of mutton, but as any solid food that she took was vomited, she discontinued this. She improved gradually until July 21, the vomiting ceasing, and nausea only remaining, so that I expected to be able to take leave of her shortly, but on the 23rd a message came to me with a note from her mistress, stating that the vomiting had returned (in the night). I sent her Tartar emetic 6, and when I saw her on the following day found that she was better, but the bowels were relaxed (they had acted three times) and there was a good deal of rumbling in them. I gave her China 1; she improved, but still the vomiting continued, and she became so weak that I was obliged to give her champagne which she relished greatly, and did not vomit; she lived on it for three or four days, taking literally nothing else in the way of nourishment (she took about half a bottle a day). I tried to get her to take a little beef tea, but it always made her sick; after four or five days, however, she ceased to relish the champagne, but she was stronger, and began to take spoonfuls of beef tea, but still there was so much nausea that she took very little, so that I told her I should be obliged to give it to her by injection, as I could not let her get weaker than she already was if I could help it; this horrified her greatly, and she began to take more (about a teacupful each day) for a few days, and improved steadily. On August 6th there had been no vomiting; on the 9th also she was still free from it, but complained of a loss of power in her hands, so that she could scarcely do anything with them. All this time the patient had not been confined to bed, though obliged to lie on the bed the greater part of the day on account of excessive debility. I had been studying her case carefully and anxiously, looking over the medicines suggested by our repertories [after China 1 she took Podophyllum 1, and then again Lach. 6, as she never lost the excessive nausea, and there was still

the yellowish tint of the face and of the conjunctivæ, and the yellow mucus on the posterior part of the tongue]. I found that Plumbum was so strongly marked in correspondence to most of her symptoms that I referred to Pereira's Materia Medica, and found that her case corresponded exactly with his description of lead jaundice; she had the fœtor of the breath mentioned by Pereira as a symptom of lead poisoning so strongly that a fellow servant who slept in the same room with her told her mistress that she could scarcely endure it. The paralytic weakness of the arms, of which she now complained, is such a wellknown symptom of lead poisoning among painters, that I felt it must be a case of lead jaundice and therefore examined her gums; they showed the "blue line" along the alveolar border more plainly than I ever saw it in a hospital patient: that was proof positive. I therefore took home some of the drinking water furnished by a well in the house, and testing it with a solution of sulphuretted hydrogen, found that the water became of a distinctly brownish tint, showing the presence of lead. The water was of such remarkable purity in appearance that it was the last thing that one would have suspected, à priori, of being the cause of this illness. As the case was so grave I took, for satisfaction, a specimen of the water to Dr. Frankland, of the Royal College of Chemistry, who tested it, and stated in his report about it as under:

"ROYAL COLLEGE OF CHEMISTRY; "August 12th, 1873.

"MY DEAR SIR,-I have tested, qualitatively, the sample of water which you left with me, and find that it contains so much lead as to render it quite unfit for domestic use. "Believe me, yours very truly, (Signed)

"E. FRANKLAND.

"Dr. VON TUNZELMANN."

Dr. Frankland has since then determined the quantity of lead in the water of the well (as drawn from the pump of the adjoining house, which is supplied by the same well), about which he reports as under:

"14, LANCASTER GATE, HYDE PARK, W.;

"MY DEAR SIR,-The sample of water contains 1.547 grain of lead per

imperial gallon.

(Signed)

August 29th, 1873.

"Yours very truly,

"E. FRANKLAND.

"Dr. VON TUNZELMANN."

The use of this water was stopped, and I did not see the patient again, as she soon after this went to Brighton for six weeks for a change.

October 18th.-This patient has now returned from Brighton and is quite well, better (as might have been expected) than before her illness.

To return now to Case 1.-Having discovered lead in the water of a well in one house, I was naturally led to test the drinking water in the house where my patient with diplopia lives; I had not done so before, as I had never heard of well water having become impregnated with lead; and Dr. Frankland told me that although he has to examine specimens of water by the hundred he has never been consulted about contamination of well water with lead before. Lead was found in the water of this well nearly to the same amount as in the water of the other well, and this explained not only the diplopia, but also the excessive languor from which Miss A- had been suffering. Lachesis 6 was given, and the family going to the Lakes, I did not see my patient for six weeks.

October 18th. This patient has just returned from her trip to the north, her eyes are now quite well; she is only reminded of her former trouble by an occasional sluggishness of adaptation in them.

CASE 3. Rheumatism, Palpitation, &c.-The mother of this young lady, subject to rheumatic pains (muscular) for some years (they have lived in this house for sixteen years), has also latterly suffered a good deal from palpitation, with such a distressing craving for air, especially at night, that during the warm weather she was obliged to keep both the door and window of her bedroom open, becoming in consequence deaf from getting a cold in her ears. (This

case makes a very good proving of lead, giving some of the less frequently observed symptoms.) Different medicines were prescribed for this palpitation, but no medicine continued to afford relief long; Lachesis 5 relieved her considerably at last; after taking it for a few days she complained of vague symptoms of indigestion, and Nux vom. 3 was given by day, the Lachesis being still continued at night, and she improved considerably.

Aug. 14th.-Was sent for this day on account of considerable aching pain in the back (lumbar region, with lassitude, and the secretion of a large quantity of watery urine, on the surface of which a pellicle had been observed, after standing (the same had been noticed about a year previously and occasionally since then). I had not then tested the water of the well, but did so the same day and found lead in it, as before said. The pellicle which formed on the urine passed by this patient, on examination the next day (a small specimen having been obtained), was found to be of pearly whiteness (it looked exactly like spermaceti), with a distinct metallic lustre; it left a greasy mark on the paper in which it had been wrapped, i. e. fatty matter mixed with lead, in some form. This fact is of extreme importance as showing how the kidneys excrete this mineral poison. A specimen of the urine was examined the next day; colour natural; reaction acid, but not strongly so; spec. grav. 1022; no albumen; on standing for an hour, deposits a light flaky sediment (one fourth), showing under the microscope only a few granules (mucous), and a solitary cell of renal epithelium, containing several fatty globules. I could not find another, but even this one suggests that the lead was excreted as an oleo-stearate of lead, inclosed in cells which, becoming detached, convey their contents into the bladder, retaining their vitality sufficiently long not to burst till after micturition has taken place; then chemical action coming into play, the lead is precipitated (as a sulphide*) and the fatty acids, rising to the surface, on account of their lightness, become solidified on the cooling

* Galena, the native sulphide of lead, has all the appearance of a metal; it is not unlike platinum, being somewhat darker than lead (in its pure state).

of the urine from 98° (the temperature of the body) to the temperature of the atmosphere (at that time about 70°), possibly becoming lime salts at the same time that the lead becomes a sulphide; the precipitated lead adhering to them. In private practice one cannot get a specimen of this nature in sufficient quantity for satisfactory examination, but if any of my colleagues who are hospital physicians should meet with a similar case, this pellicle might be collected in sufficient quantity to be examined by an analytical chemist. This was evidently an attack of renal congestion, a pathogenetic effect of the lead taken, for several years, in the drinking water, and an effort of the system to rid itself of the poison. Arsenicum 6 was prescribed, and it relieved the back somewhat, but I advised the lady not to take it except the distress should be excessive, as it was better not to interfere with the process of elimination.

The water of the well, I need hardly say, was not used after it had been found to contain lead. The lady went to the Lakes after this, so that I did not see her again for six weeks. She took Cantharis 6 with her, in case the pain in the back (lumbar region), with its concomitant symptoms of great languor and malaise, should be such as to require relief.

Oct. 18th.-Mrs A- is very much better, but still not quite free from pain in the back; the quantity of urine excreted is also still such as to be inconvenient at night.

The weakness of the arms is still felt at times, but not enough to require a course of Iodide of Potassium to dissolve the remaining lead out of the system.

CASE 4. Anasarca and Paralysis. In the adjoining house to the one where the case of lead-jaundice occurred, I was requested, in February of this year (1873), to prescribe for the housekeeper, who had swollen ankles; they had been in that state for three or four weeks; she had a sallow complexion; she complained of nausea, but otherwise appeared in good health. The anasarca extended about halfway up the legs. The urine was examined, but nothing abnormal was found in it—it was quite free from albumen. Arsenicum 6 was prescribed, and in about two months the