On the Elimination of Lead in Chronic Lead Poisoning
Authors: J. D. Mann
Journal: BMJ (1893)

THE sequence of events leading up to death in the case here ,related is the usual one in cases of acute peritonitis following rupture of the intestine, but there are one or two points of special interest in this case.About 11 P.M., on July 30th, 1892, J. G., a labourer, aged 46. was kicked in the lower part of the abdomen.He was for the moment apmewhat stunned, but almost immediately was able to get into grips with his assaflant, throwing him down and falling above him.He made little complaint for about twenty minutes, when he began to feel pain in the abdomen.He sat down, bending forwards with his hands pressed on the injuredpart, and said to his wife that he was "done for."About an hour afterwards he became sick and vomited, while the pain became intense, and spread over the whole abdomen.His wife poulticed him during the night, and next day called in Dr. C. S. Young, who saw him sixteen hours after he had been assaulted.He found him lying in bed, with his shoul- ders raised-and his knees drawn up.He had a pinched and anxious look; his pulse was rapid but notthready; the whole of the abdominal cavity was greatly distended and tympanitic, and very tender on palpation; there was no swelling or bruising of the penis or scrotum.About midnight, however, twenty-four hours after the assault, his wife noticed some swelling of his genitals.At 9.30 A.M. next day he insisted on getting out of bed to make water, and, with the assistance of his wife, he managed to walk to the kitchen sink for that purpose.He did not pass any water, but his wife noticed that the swelling of the scrotum and penis had in- creased enormously.While being assisted back to bed he fell down on 'the floor and died, thirty-five hours after the injury.I was asked by the Procurator Fiscal to make a post-mortem examination ,of the body, and did so along with Dr. Young thirty-four hours after death.We found no marks of bruising on the abdomen or any other part -of the body.There were several large bullae filled with bloody serum on both sides of the abdomen, probably the result of the poulticing, but the abdominal wall showed no discoloration from putrefactive changes.'The scrotum and penis were enormously enlarged, being three or four times their normal size, from emphysema of the cellular tissue.The same condition was also present over the upper part of both thighs, the front of the abdomen and chest, the neck and face, the shoulders, and supper part of both arms.There was no bruising of the muscles of the abdominal wall or rupture of the parietal peritoneum.The whole of the peritoneum covering the intestines was much Injected, and covered with flakes of soft recent lymph.The edges of the convolutions of the intes- tine were glued together.The abdominal cavity contained about 12 ounces of a thick grumous fluid, with a slightly fiscal odour.Three inches from the ileo-cecal valve on the free border of the ileum was a rup- ture, half an inch in length, horizontal in direction, with its edges everted and the mucous coat protruding.There was some ecchymosis of the serous cbat for about an inch on either side of this.The stomach, duo- denum, jejunum, and part of the ileum were distended, and the rest of the intestine was collapsed.There weresome'solid fwces in the descend- ing colon and rectum; the bowel was otherwise quite normal.The blad- der contained 2 or 3 ounces of urine.The left Internal abdominal ring was patent ; the opening leading into the sac of an inguinal hernia, which admitted the whole of the index finger; the sac was, however, empty.The rest of the body was normal.