Etiology.--This disease develops among lead-workers--or workers in lead mines, paint factories, white-lead factories, and institutions where face-powders are put up. Such poisoning may also develop among makers of wallpaper, paperhangers, drinkers of soft drinks that are charged through lead pipes, and those who eat food put up in lead-foil. The poison gains entrance into the system through the lungs, digestive organs, and skin. I have had a great many patients who had been poisoned from the use of cosmetics containing lead.

   Symptoms.--These patients usually show more or less anemia. The most pronounced symptoms are those of wrist drop or lead paralysis. In well-developed cases of lead poisoning there is a blue line on the gums, which often leads to the diagnosis when otherwise the physician would be in doubt. By lifting the lip and exposing the gum, there is an eighth of an inch just above the teeth that is bluish, while the rest of the gum is of a normal appearance.

   Lead colic is the most common symptom of chrome lead poisoning. It is preceded by symptoms of gastric fever, beginning with indigestion and vomiting,

   Treatinent.--Pressure on the abdomen has a tendency to relieve the colic. In severe cases physicians usually resort to morphine, hypodermically applied; but a hot bath, continued from thirty to forty minutes, and sometimes longer, will bring on relaxation and give relief. Before the patient is subjected to the bath, an enema should be administered; and if the bowels do not move, then another should be given after the hot bath. So long as the cause is not removed there can be no cure. 'The patient will have to be content with palliation--with being relieved whenever the attack comes on. Those who are working in lead will have to go out of the business, if they want to get full relief and cure. Those who work in lead should be careful to keep their hands very clean. Before eating, the hands should be cleansed with water and soap, and the nails cleaned with a knife. Every means should be adopted to keep the lead from being taken in with the food. People who have developed much poisoning should think more of their health than of their work, and get into another calling. Some people are more susceptible than others to this influence. Those who eat in such a way as to bring on an acid state of the fluids will be more susceptible than normal people to this and mercurial poisoning; in fact, there will be more of it absorbed into the system. A properly balanced bill-of-fare will be about as good a preventive as can be had. Much fruit and uncooked vegetables should be eaten daily. Salad--such as those made by combining lettuce, tomatoes, and cucumbers with a small bit of onion, dressed with salt, oil, and lemon juice--should be eaten with every dinner. One meal a day should be of fruit. The dinner should be meat, a combination salad, and vegetables. Bread should not be eaten more than once a day.

   Acute poisoning by arsenic is brought about by taking rough-on-rats, Paris green, and sometimes arsenous acid. People who desire to commit suicide sometimes persuade the drug store to sell them arsenic for killing rats, but instead they take it themselves,. If they knew how much suffering the poison would bring them, they would probably seek an easier route out of the world.

   Arsenic is used with other drugs for the cure of syphilis. Arsenic poisoning, to a greater or less extent, will be found following the treatment that is being given to all these people who have a positive test returning from the laboratory. The worst case of arsenic poisoning that I have seen in the last twenty years was a case of arsenical dermatitis. I do not see how a more severe poisoning could end otherwise than in death. This woman had a very narrow escape. She took her arsenic in the form of 606. If such severity can be developed in a few cases of using arsenic to correct cases, why should there not be many cases of skin troubles that will be treated for anything except arsenical poisoning. I insist that doctors are creating more disease than there would otherwise be if the materia medica had been fed to the fishes as Dr. Holmes suggested many years ago.

   Symptoms.-The chief symptoms are vomiting, with pain, cramps, colic, diarrhea with a great deal of bearing down pain. In those who recover, paralysis is liable to follow.

   Treatment.--In acute poisoning the treatment should be just about the same as it is for any poison taken into the stomach; namely, the stomach should be emptied as soon as possible, so as to get all out that has not been absorbed. This may be done by using an emetic. The best plan, however, would be to use a stomach-pump. Milk and the white of egg should be given very freely after the pump has done what it can in clearing out the stomach.

   Where Fowler's solution, or any solution of arsenic, has been taken, dialyzed iron, in doses from six to eight drams, may be used as an antidote, causing the arsenic to form an insoluble compound, after which the stomach-pump should be used. Of course, the work should be done very rapidly. The iron should be swallowed as quickly as possible, and then the pump used.

   Chronic poisoning by arsenic is brought on in many ways. Arsenic is used in the coloring of wall-paper, and the paperhangers are frequently poisoned by inhaling the arsenic which dusts off the wall-paper; besides, more or less of it is taken into the mouth from the hands, and from the mouth into the stomach. In chronic arsenic poisoning patients lose their hair, dropsy develops, and many die of heart disease and dropsical accumulation. Arsenical paralysis is developed in some cases.

   Ptomaine poisoning may be developed from taking into the system food that is in a state of decomposition, or it may be produced by taking wholesome food into the system in too large quantities. Ptomaine poisoning, then, may be exogenous or endogenous. The exogenous is taken in, while the endogenous is developed within. Sometimes the poison is due to errors in food combinations. This style of poisoning comes from taking into the system animal food that is undergoing putrefaction,

   Sausage, blood-pudding, etc., more than other meats are inclined to create ptomaine poisoning. Imported sausage has been known to create death after lying in the bowels for one week after it had been eaten.

   Several years ago I was called to see a young girl, about nine years of age, who was dying when I got to her bedside. 'The symptoms were very strange; in fact, she passed out so rapidly that I could not have a very definite opinion in regard to her condition. I got no clue pointing to food poisoning of any kind, but I diagnosed the case as ptomaine poisoning. One week after, her sister, two years older, died under the same circumstances, within twenty-four hours of the appearance of her first symptoms, which were similar to those of the sister who had died previously.

   A year or more after the two deaths I learned that just before the illness of the first girl the family had eaten more or less of imported sausage, and that no more had been taken after that time; showing that in one case death came almost immediately after eating the meat, and in the other case the sausage required a week to develop the poisoning that produced death.

   Any fresh meat, if not well taken care of, and allowed to become tainted, may poison, unless cooking has been so thorough as to kill the putrefaction. The period of incubation--or, in other words, the period required from the time of eating the poison meat until it develops its symptoms--ranges very widely.

   We often hear of wholesale poisoning at church suppers, where a hundred or more people are poisoned in one night; showing that this poisoning comes on very rapidly, as a rule.

   The symptoms usually start with a feeling of languor, perhaps headache, aching all over, and vomiting, Sometimes there are griping pains in the bowels, and at other times there is a real cholera morbus. Sometimes there will be trembling almost equal to the ague. In many cases there are precordial oppression, difficult breathing, and a feeling of faintness.

   During the summer there are quite a good many attacks of poisoning from ice cream. Nausea and vomiting, preceded by a chill, and sometimes diarrhea, are the prominent symptoms.

   Treatment.--There is but one way to treat any kind of poisoning, and that is to clear out the bowels with large enemas. If the stomach is not already emptied by vomiting, it should be emptied with the stomach-pump, or by giving copious drinks of salt water. No food should be taken until the symptoms have entirely disappeared, even if that requires one or more weeks. Feeding during ptomaine poisoning has a tendency to prolong the disease; in fact, food eaten takes on decomposition very rapidly . Under such circumstances, fermentation is imparted to all fresh intake of food, so that the patient continues to poison himself.

   Many cases of chronic ptomaine poisoning are treated for something else. Where too much food has been eaten--twice as much perhaps as the amount for which there is digestive capacity--decomposition starts up, with symptoms of diarrhea, pain in the bowels, and vomiting. Then, if feeding is begun as soon as the patient is relieved, the symptoms may lead off into chronic gastro-intestinal disease, which may break down the constitution to such an extent that the patient will die in a year or two. Other cases may be fed so soon after being relieved that there will be a relapse and death will follow. I remember one case where a patient was thrown into a desperate illness by eating calves' brains. When I was called to see her, she was delirious, with a temperature of 107° F. I had the nurse wash her bowels out thoroughly, and in about twenty-four hours she came out from under the influence of the coma into which she had settled after six hours of delirium, She wanted something to eat. I had instructed the nurse not to give her anything at all; but the sick woman was so insistent that the nurse yielded and gave milk--two quarts during the night and the following forenoon. The poisoning was renewed by the milk taking on decomposition; the patient had a relapse, which swept her out of existence within twenty-four hours.

   Definition.--This is a condition brought on by exposure to excessive heat of those who are enervated from sensual indulgence. Those who are brought down with so-called sunstroke are almost invariably sick beforehand. The inebriate is very liable to meet with this trouble in excessively hot weather. Those who are badly toxemic are also apt to come down with excessive heat. Real sunstroke is not a disease that will take hold of a normal and healthy person. Some authorities divide sunstroke into two classes: heat exhaustion and sunstroke. There is quite a difference. Heat exhaustion may come to those who are quite well, when exposed for a long time to very hot rooms. Stokers and men who feed furnaces are very liable to be brought down with heat exhaustion. But those who are brought down with sunstroke are sick, and often their resistance is so very low that they will go down under the effect of heat which the average person will not consider excessive. The large cities afford quite a number of examples of both heat exhaustion and sunstroke every year.

   Symptoms.--The victim falls into a state of prostration, and may die within an hour, the principal symptoms being those of heart failure, difficult breathing, and a comatose state. Some writers describe fatal cases that occur almost instantaneously. Victims fall as if shot down. The more common forms present pain in the forehead, dizziness, and a feeling of difficult breathing, with nausea and vomiting. In some cases there are diarrhea and frequent urination. If dyspepsia has helped the hot weather to bring on the condition, the breath will usually show it. There will be an alcoholic odor to the breath. Of course, sunstroke should not be mistaken for an alcoholic drunk; for patients will rally and get over the drunk, whereas, if they are neglected when the condition is that of heat exhaustion, they may die. The heat exhaustion must be differentiated from uremic coma and morphine narcotism.

   Treatment.--Get the patient to a comfortable place where he can rest and not be annoyed. The head should be bathed with hot water, while someone is fanning with a good strong fan. The rest of the body may be sponged with cool water. I would not use ice-water, because this leaves the patient very uncomfortable. If two or three people will volunteer to do the work of fanning, the patient will be benefited more by the hot sponge-baths given under the hand fanning; or an electric fan may be used. The sponging should be with hot water, and the entire body should be gone over as rapidly as possible--repeated and repeated. Evaporation will be so rapid that the excessive heat of the body will be carried away much faster and more safely than where patients are bathed in ice-water. When the patient rallies, he may take orange juice and water, half and half, or hot milk and hot water, half and half. If convulsions occur, they must be controlled with chloroform. Each case must be treated according to its requirements.