An account of the disease called Mill-Reek by the miners at Leadhills, in a letter from Mr James Wilson, Surgeon at Durrisdeer, to Alexander Monro. P.A.

In obedience to your desire, I send what I have observed concerning the disease, which the people at Leadhills call the mill-reek, and which all the inhabitants there are subject to; but it mostly seizes, and violently affects the men whose daily business is to melt down the lead. The melting-houses, where this is done, are called mills; because the bellows there are worked by water-mills.
In the slighter stage of this disease, an uneasiness and weight is found about the stomach, especially near the ‘cartilago enfiformis’; and sometimes it appears like a colic in the intestines. The spittal of the sick is sweet, and something of a bluish colour, resembling what one observes when he chews lead. The pulse is a little low; the skin is all over cold; and a clammy sweat frequently breaks out,-- The legs become feeble with a prickling numbness; and there is a debility and laziness in all the body, -- The appetite goes away, and they don’t digest what food they take,--Sometimes a diarrhoea makes a cure; but, if it continues too long, it is very hurtful, in this stadium the sick are yet able to go about and to work.
But, if these symptoms continue long, and spirituous liquors are drunk with an empty stomach, or after working lead; the disease comes to its second stage; in which, to the former complaints, are added a fixed pain in the stomach and guts, especially in the lower part of the abdomen, extending itself from the one os ilium to the other, The patients become very costive, with the sense of somewhat gnawing their intestines; and the pulse turns quick with heat on the skin, Giddiness, with vehement pain, seizes the head; which is succeeded by an insensibility and delirium, like madness of the worst kind; in so much that they tear their own flesh, and bite their hands; the extremities tremble, and are convulsed; at last they fall low, the pulse intermits at every 3rd or 4th stroke, and they die in a coma or apoplexy.

The reek or smoke rising from the melting lead, is believed to be the cause of this disease; because the melters, who are most exposed to the smoke which come out often full in their faces, are most subject to this disease, the mill-reek. The people here say they have seen birds, in a calm moist day, attempting to fly thro’ the smoke of such a chimney, fall down dead, cattle which pasture near to mills, are often killed; and therefore shepherds take great care to keep their sheep at a distance; which, if not by the smoke, must be hurt by the grass, which I often see made blue by the smoke falling on it. The other animals suffer from the water impregnated with the fumes, or with the lead washed in it.

The symptoms in them are very like to what men suffer. Dogs, in the last stage, lie either dull and stupid, or bite and snatch at every creature that comes near them: nay, they will gnaw and tear up ground on which they lie, after they cannot raise themselves on their legs.

The people of Leadhills are so averse to opening of dead bodies, that I could never prevail upon them to allow me to open any who died of this disease. But, in a dog who had it, I found sludge (the fine particles of lead which subside slowly in water, in which lead has been washed) lying on the inner coat of the stomach and intestines; and; in several parts, it was turned to a crust. The guts were much inflamed in some places, and in others a mortification was begun with holes thro’ them. His faeces were very hard; and, where they were of little quantity, the coats of the guts were thick, and the passage thro’ them less.

If proper medicines are given in the first stage of this disease, the patient generally recovers, --If it goes on till giddiness begins, the success is doubtful; and when the cure is delayed to be attempted a little longer, the disease almost constantly proves mortal.

If the work-people at Leadhills would use the following precautions, they might save themselves from this disease, at least would have it very mild.

  1. No man ought to go to work fasting; and he ought to take oily or fat food; the English mill-men on this account hold much better out than our countrymen. A glass of sweet oil pure, or mixed with a little aqua vitae, would be a good morning draught.
  2. Physic should be taken spring and harvest, and whenever any effects of the reek are felt.
  3. Ardent spirits ought to be drunk very sparingly; and ought never to be taken in time of work at the mill, or immediately after it. They increase and fix the bad effects of the leady smoke.
  4. No mill-man, when heated by work, ought to go into cold air; but to put on his clothes immediately, and return to his lodging, to change his working clothes for others, and cool gradually: by which he would prevent catching cold. In this article they are very careless.
  5. Immediately after coming from work, the aliment should be mostly liquid, as broths.
  6. Low and poor diet makes them more liable to be affected, and less able to under-go a cure: these workmen ought to feed on good meat.
  7. When their business can allow, they should go out of the reach of the reek, to breath an untainted air, and to take victuals free from lead. But I must caution the labourers at Leadhills not to take long journeys: they are more hurt by travelling one day than by working two.

The cure of this disease depends principally on cleansing the primae via: and therefore, after blooding such patients, if they are plethoric, I give them a vomit of emetic wine or tartar; which must be a dose double to what would vomit another person; otherwise it would have no effect, especially when the disease is violent or has continued long. My father, who has had long practice with such patients under the mill-reek, has always finely powdered vitrum antimonii ready; of which he gives half a drachm for a dose; and during its operation, warm water is to be drunk plentifully. If the vomit operates well, and purges briskly too, the patient is in a fair way of recovering; which a second , but a milder dose of ipecacuanna with some tartar emetic mixed, often makes complete: but, if the emetic neither vomits nor purges, the patient is generally worse for it; and a stronger dose should be given soon. If it vomits but does not purge, a cathartic of the antimonial kind, or of jallop and mercury, in greater than ordinary quantities, ought to be given: and during the time of purging by the emetic or cathartic medicine, the patient ought to drink warm broth plentifully. The vomits and purgatives ought to be repeated at proper intervals, till the uneasiness in the stomach and guts, from the disease, is gone. If these medicines over-do, an opiate may be given at night; but this is to be administered sparingly, least it bring or increase costiveness, which is the worst thing can befall the patient. At the same time, emollient, anodyne, and laxative clysters, are frequently to be injected for emptying the guts, if the purgatives do not their duty.

When blood or matter are passed with the faeces, the emetics and purgatives are to be abstained from, till, by healing, balsamic, but laxative clysters, and mild food, this appearance ceases.

When the belly is much swelled, emollient fomentations should be often applied to it; but, if the madness is begun, little else can be done, than to endeavour to keep the patient quiet during the little time he has to live.

Sometimes it happens, that, after the complaints of stomach and guts are gone, a prickling pain and feebleness remain in the legs, much like rheumatism; for which, friction with a coarse cloth or flesh-brush, is necessary. If that fails, ung. Nervinum with ol. Terebinth mixed, is to be rubbed on every night, before the fire; after which, the member is to be wrapped in flannel. If these pains are violent, or the feebleness resembles palsy; blisters ought to be applied to the skin under which large nerves are situated, and the medicines proper in a palsy are to be given.

Some are so wasted before the cure is completed, that they remain afterwards emanciated, weak, and as if they were heotic, with a giddiness in their head: and sometimes they chat to no purpose, or seem hypochondriac. In this condition, the patient should go to the country, to ride on horseback some miles every day; and, at the same time, should take bitters with bark and steel. If the giddiness continues, I have given with success, pilul. de myrrh. With a small proportion of camphor.