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1、ArticleHistorical documentation of leadtoxicity prior to the 20th centuryin English literatureME Jonasson1and R Afshari2,3AbstractLead is a heavy metal that remains a persistent environmental toxin.Although there have been a substantialnumber of reviews published on the health effects of lead,these
2、reviews have predominantly focused on recentpublications and rarely look at older,more historical articles.Old documents on lead can provide useful insightin establishing the historical context of lead usage and its modes of toxicity.The objective of this review is toexplore historical understanding
3、s and uses of lead prior to the 20th century.One hundred eighty-eight Englishlanguage articles that were published before the year 1900 were included in this review.Major themes inhistorical documentation of lead toxicology include leads use in medical treatments,symptoms of lead poison-ing,treatmen
4、ts for lead poisoning,occupational lead poisonings,and lead contamination in food and drinkingwater.The results of this review indicate that leads usage was widespread throughout the 19th century,and itstoxic properties were well-known.Common symptoms of lead poisoning and suggested treatments werei
5、dentified during this time period.This review provides important insight into the knowledge and uses of leadbefore the 20th century and can serve as a resource for researchers looking at the history of lead.KeywordsLead,poisonings,history,reviewIntroductionLead is a toxic metal that remains an occup
6、ational andenvironmental hazard throughout the world.1Leadoften enters the body through ingestion of lead-contaminated dust and inhalation of lead particlesproduced from the combustion of lead-containingmaterials.1The major sources of lead exposureinclude leaded gasoline,piped drinking water,cera-mi
7、c glazes,soldering from canned foods,lead-basedpaints,and traditional medicines.2Lead accumulatesthroughout the body in blood,soft tissues(includingthe brain,renal cortex,and spleen),and bone.2Leadstoxic effects are cumulative and affect multiple bodysystems.1Some of the impacts of high-level leadex
8、posure include damage to nervous system function,hemoglobin synthesis,and kidney function.1,3Lowlevels of lead exposure are particularly a concern forits neurotoxic effects among children.4,5Children areparticularly susceptible to the effects of lead,due tohigh levels of hand-to-mouth activity and h
9、igher ratesof lead absorption compared to adults.2Althoughhealth organizations like the American Centre forDisease Control and Prevention have establishedguidelines for safe levels of lead exposure,evidencesuggests that there is no safe level of lead.1,2,4Thehealth effects of lead are irreversible.1
10、The burden of disease from lead exposure remainshigh,particularly for low-and middle-income coun-tries(LMICs).1Although lead is rarely perceived as aproblem in high-income countries,the recent watercontamination in Flint,Michigan,demonstrates thatlead remains a topical issue in public health.681Simo
11、n Fraser University,Burnaby,Canada2BC Centre for Disease Control,Vancouver,Canada3Occupational and Environmental Health Division,School ofPopulation and Public Health,University of British Columbia,Vancouver,CanadaCorresponding author:R Afshari,BC Centre for Disease Control,655 West 12thAvenue,Vanco
12、uver,Canada V5Z 4R4.Email:Reza.Afsharibccdc.caHuman and Experimental Toxicology114The Author(s)2017Reprints and permission:sagepub.co.uk/journalsPermissions.navDOI:10.1177/ on noncommunicable diseases,including lead poisoning,have received less attentionthan communicable diseases.Historical accounts
13、 oflead are most often associated with chronic lead poi-soning and saturnine gout in Ancient Rome,whichhas been controversially attributed to the fall of theRoman Empire.9Historical literature on lead is usefulfor understanding past occupational and environmen-tal routes of exposures as well as clin
14、ical symptoms,treatments,and applications of lead.The objective ofthis article is to explore the medical history of leadand to understand the views and perceptions of leadprior to the 20th century.Reviews on lead often focuson more recent literature and do not have a targetedfocus on documents prior
15、 to the 20th century.Although some articles have been written looking atthe history of lead,these articles have not extensivelyexplored the available literature nor characterized his-torical understandings of lead.This review is usefulfor researchers looking to explore the state of knowl-edge on lea
16、d prior to the 20th century as well as leadscommon uses.MethodsA narrative review was conducted to explore the his-torical literature on lead.Articles were identifiedusing PubMed and through the Simon Fraser Univer-sity(SFU)library database.The SFU database con-tains several historical databases and
17、 journalsproviding access to journal articles preceding the20th century.Articles included in this narrativereview were limited to English language articles pre-ceding the 20th century.Subject terms searched were“lead toxicity,”“lead poisoning,”“occupational leadpoisoning,”“lead acetate,”“red lead,”a
18、nd“whitelead”.Additional articles were also identified throughscreening the references of articles included in thisreview.Articles were included in the review if theyhad a primary focus on lead poisoning or the use oflead.There were 188 articles identified that fit theinclusion criteria and were inc
19、luded in this review.ResultsLead in the ancient world(second century B.C.E.to seventh century C.E.)Nicander(Floruit(fl.)second century B.C.E.)hasbeen credited as writing the earliest recorded accountof lead poisoning during the second century B.C.E.10Dioscorides(circa(c.)40 to(c.)90 C.E.)alsodescrib
20、ed a case of lead poisoning in the first centuryC.E.11Pliny wrote about the dangers of red lead andlead acetate.12Celsus(c.25 B.C.E to c.50 C.E.)alsoidentified lead as a poison and proposed an antidoteconsisting of walnut juice combined with wine.13Galen(130 to c.210 C.E.)previously stated that wate
21、rtransported to Rome through lead pipes was not suit-able for consumption.14Galen also recommended thatrain water should be used in the preparation of med-icines,as opposed to water brought through leadpipes.14Vitruvius(c.80 to c.15 B.C.E.)wrote aboutthe health implications of using water collected
22、fromlead pipes.14Aetius(c.390 to 454 C.E.)also wroteabout the dangers of collecting rain water from roofs,as roof tiles were often covered with lead.14BothVitruvius and Pliny(23 to 79 C.E.)identified that thefumes from lead mining were poisonous;Vitruviusgoes further to state that water near mines w
23、as alsofound to be harmful.12,15Pliny describes how the lin-ing of copper pots with lead prevents the leaching ofcopper into food.3Marcus Cato(234 to 149 B.C.E.)and Columella(4 to c.70 C.E.)also promoted the useof lead and lead-lined vessels.16,17Pliny,MarcusCato,and Columella all endorsed the boili
24、ng downof grape syrup in lead vessels as part of wineproduction.12,16,17The addition of lead as a sweetenerto wine was described by Pliny.12Pliny also describedthat heavy consumption of lead-sweeten wine couldresult in paralysis in the hands.11Similarly,Diodorus(90 to 30 B.C.E.)described these wines
25、 as capable ofleading to pain in the nerves.18Paul of Aegina(c.625to c.690 C.E.)described an epidemic of lead poison-ing that occurred in Ancient Rome during the seventhcentury C.E.19Herodotus(c.484 to c.425 B.C.E.)describes that lead was used in the bridges ofBabylon,and Diodorus Siculus mentions t
26、hat leadwas incorporated into the Hanging Gardens ofBabylon.17,20Another ancient practice with lead com-monly seen in Ancient Greece and Anatolia was apractice where molten lead was mixed with water andthe forms and shapes produced would be examined topredict the future.21,22These practices were oft
27、enconducted indoors with minimal ventilation.Occupational exposures to lead in the 18th and19th centuriesThe National Observer reported that cases of lead poi-soning were occurring in white lead factories andstated that the cases were due to workers not followingthe proper health and safety protocol
28、s.23White lead2Human and Experimental Toxicology XX(X)factories were a common source of occupational leadpoisoning.2427Painters who worked with white leadwere also susceptible to lead poisoning.28White leadhasalsobeenusedforjointsincabinetsandwoodwork,making it a source of poisoning among carpenters
29、.29Smith reported lead poisoning among a group ofweavers in a cotton-mill,working with a dye thatcontained lead dichromate.30Symptoms includedjaundice and a blue line on the gums.30Investigationinto the poisonings led to a stronger regulation in theprocess of dying the yarns and the use of personalp
30、rotective equipment among mill workers,ultimatelyending all cases of lead poisoning.30Hodge looked at lead exposure and the impacts oflead poisoning among workers on a pottery.31Hodgenoticed the dangers of lead exposure,particularlyamong workers whose job was to dip pottery into thelead glaze.31Murp
31、hy also reported several cases oflead poisoning among pottery workers.32Additionalarticles also identified lead poisoning as commonamong pottery workers.3338Working in glass staining was another occupationwhere lead poisoning was identified.33Glass cuttingand glass polishing are also occupational so
32、urces oflead exposure.39An 1889 article reported a case of lead poisoningin a florist who would bite off the ends of tinfoil usedto wrap bouquets of flowers.40The tinfoil used wasfound to be up to 80%lead(22).Plumbers were alsocommonly poisoned from lead.26Webb examinedthe increased instances in lea
33、d poisoning amongminers in Derbyshire.41Workers involved in producing and finishing brasshave also been identified as having symptoms of leadpoisoning when the process included lead.42Ormrod identified that in rare cases,lead poisoningwas identified in manufacturers of steel.43Ormrodidentified that
34、the source of this poisoning was likelythat certain ores used for steel contain higher concen-trations of lead,and that lead vapors from the smelt-ing process were the route of entry among workers.43A suitcase maker who worked with a black glazedcloth showed symptoms of lead poisoning.44Tests onthe
35、material ultimately identified that the cloth wasthe source of lead.Lead poisoning through drinking water in the18th and 19th centuriesIn 1889,an outbreak of lead poisoning occurred inSheffield,United Kingdom,that was ultimatelyattributed to the use of lead pipes and the presenceof dissolved lead in
36、 drinking water.45,46The entranceof lead into the waterways was associated withincreased instances of sterility and spontaneousabortion.43In 1890,a series of reports on the Shef-field outbreak was published in BMJ.4750Thesereports examined who in the Sheffield populationwas impacted by lead poisonin
37、g and suggested mea-sures to treat the contaminated water.4750Chalk wasultimately added to treat the lead-contaminatedwaters of Sheffield.51Another article cited a case of lead poisoningamong a family in Philadelphia;the source of the leadwas identified as lead pipes connected to hot waterapparatus.
38、52An article reported that conducting waterthrough lead pipes was a dangerous source of leadpoisoning,and that lining lead pipes with tin couldactually enhance its toxicity.53Several articles citedconcern about the entrance of lead within the waterof pipes.5460Collyns reported on a family whoexperie
39、nced lead poisoning through their wellwater.61Additional articles identified lead poisoningfrom drinking water.62Kirker looked at the ability offermentation by-products to breakdown lead in thewaters of Sheffield,and that the breakdown of leadvaried with the seasons.63Lead contamination in food sour
40、ces in the 18thand 19th centuriesIn 1878,a confectioner was charged with coloringcandies with chromate of lead.64Contamination ofconfectionaries by lead was commonly found.65Anewspaper article from Toronto reported that a popu-lar soda water being sold was actually carbonated lakewater that containe
41、d dissolved lead.66An 1879 articleidentified that cayenne pepper was often contami-nated with red lead.67An 1869 report cited cases oflead poisoning from flour,originating from a millerwho cast lead in his millstone to repair cracks andfurrows.68Lead was reported to be used in dairies,particularly i
42、n the use of lead-lined vessels.69Leadcontamination was a problem in the distillation ofrum and in wine production where it was used as asweetener.14,59,69Lead has been cited to easily mixwith oily foods including butter and lard.59Cider winewas particularly seen as being a source of lead poison-ing
43、 as lead was commonly used as a sweetener.14,59The washtubs that were used for making cider werealso a source of lead if they contained white leadpaint.70Another case of lead poisoning was identifiedJonasson and Afshari3by a patient who drank cider directly through leadpiping.71One article explored
44、a claim that lead acet-ate could be used to precipitate hops bitters in beer.72In 1883,Hoffman repeated the classical recipes forboiling down grape syrup and was able to extract 237mg of lead per liter of syrup.73An 1874 article repro-duced experiments claiming that aerated water con-tained trace am
45、ounts of lead.74Murrell investigatedtinned meats as a source of lead poisoning but wasunable to find any supporting evidence.75Norrisexplored cases of lead poisoning among individualswho consumed flour prepared by a miller who acci-dently added lead to the flour rather than alum.76One strange case o
46、f lead poisoning occurred from achemist who confused black pepper for a combina-tion of stannic oxide and lead,thus poisoning hisfood.71Gorham looked at the presence of lead acet-ate in vinegars.77A report from 1789 highlights the use of lead inkitchen utensils and earthenware containers,whichmay le
47、ad to the introduction of lead into the diet.78The author of this article also states that foods thatare oily and high in fat are the best treatment forchronic lead poisoning,and that the daily use ofbutter and oil should be used by painters and leadworkers.78Other articles identified lead poisoning
48、from earthenware jars due to the storage of acidicfoods dissolving the glaze.79Other sources of lead poisoning in the 18th and19th centuriesAn article from 1793 describes how many cosmeticsmay contain lead,as the recipes for these cosmeticsoften remain secret.80An 1877 article reported thatsome manu
49、facturers of silk thread soak their thread inlead acetate,leading to a heavier(and therefore moreexpensive)fabric that releases lead vapors.81Symptoms of lead poisoningIn 1840,Henry Burton(17991849 C.E.)describedthe dark blue line along the gum line as a symptomof lead poisoning.82This symptom was s
50、ubse-quently referred to as Burton line.Fagge exploredthe physiological origins of Burton line.83Otherarticles have also identified Burton line as a symp-tom of lead poisoning.66,84,85Saturnine gout has been identified as commonlyoccurring among individuals who are chronicallypoisoned by lead.86Some