From bullets to poison: tales of toxic lead and what makes it so lethal (2024)

Bullets are dangerous. This may seem like stating the obvious. Of course bullets fired into a body at high velocity are dangerous. But, it turns out that there are other ways that bullets can cause harm, through lead poisoning.

In shootings, there are more immediate concerns than the toxic effects of the bullet. That bullets contain lead is also no surprise but it is only recently that a study has looked into bullets as a possible cause of lead poisoning.

The chances of surviving being shot have improved remarkably in recent years thanks to advances in emergency medical treatment. Once the threat to life has passed, removing the bullet or fragments might cause further damage so in many cases things are best left as they are. In the United States there are annually estimated 115,000 firearms incidents with an approximate 70% chance of survival. There are likely to be thousands of people walking around with lead fragments from bullets inside them.

Lead is the most intensely studied environmental poison and with good reason. The element and its compounds are highly toxic. The metal has been known and used for thousands of years. The effects on human health have also been well-known, if not properly understood, since at least the 4th century BC. The Romans in particular had a great many uses for lead from pipes to a food additive.

The only natural sweetener available to the Romans was honey so they found a way to make an artificial sweetener. Lead pans were used to boil the fruit mash left over from crushing grapes for wine. The acid in the fruit mash corroded the pans to form lead acetate, known for centuries as sugar of lead because of its sweet taste. The resulting sweetened fruit mash, called “sapa”, was then used to flavour wine.

Wealthy Romans may have been slowly poisoned by their wine consumption but this would have taken time and the symptoms may have been too subtle to notice. It would have been difficult to make the connection to sapa and lead. But evidence of lead’s toxicity could be found elsewhere.

Roman prostitutes are said to have eaten spoonfuls of sapa as a means of contraception, it also caused abortions as well as giving the women desirable pale complexions. However, these affects may have been seen as a positive advantage rather than evidence of damage to the body. Still, more evidence was available from Hippocrates who described a case of terrible attacks of stomach cramps in a lead miner. All of these health problems were a direct result of high levels of lead in the body.

No one seems to have paid much heed to poor Roman health resulting from exposure to lead, and the metal, and many of its compounds, continued to be used extensively. From Renaissance times to the 19th century, faces were plastered with white lead make-up to give the appearance of a fashionable pale complexion. Queen Elizabeth I made the practice hugely popular but paid the price with the loss of her teeth and hair. The white cosmetic, called ceruse, corroded the skin, caused the shakes, and in the cases of Kitty Fisher and Maria duch*ess of Coventry, it killed.

When the lethal effects of lead became apparent it was even used as a method of murder. In 1882 Louisa Taylor obtained sugar of lead from a doctor to treat a fictitious skin complaint. Instead, Taylor used the “medicine” to slowly poison 82-year-old Mrs Tregillis whose teeth turned “black as coal” and gums blue – a classic symptom of heavy metal poisoning. Her vomit was black and burned her throat.

Tregillis’s suffering was very prolonged, though it did mean she was able to testify against her murderer while still alive and lying in her death bed. She pointed to Taylor and stated she had seen her pour a white powder into her medicine. After Tregillis died, Taylor was convicted of murder and hanged at Maidstone prison.

Lead’s devastating effects on the body are a result of interactions with enzymes. Any enzyme can be potentially affected but in particular lead disrupts the function of an enzyme (δ-aminolevulinic acid dehydratase) involved in the production of haem for haemoglobin in red blood cells. With less haemoglobin the blood is less red, resulting in a pale complexion. Also, the material normally being converted by the enzyme is now floating around in higher concentrations than normal. These haem precursors can weaken the walls of blood vessels in the brain causing fluid to accumulate. The results can be anything from headaches and sleeplessness to hallucinations, depression, fits and coma. Children are particularly susceptible to the effects of lead and exposure in infancy can result in permanent low IQ levels and behavioural problems due to damage to the brain.

The symptoms don’t stop there either. Lead is also likely to damage nerves leading to numbness and general feelings of weakness. Lead harms reproduction, causing miscarriages and babies with low birth weight. It also affects the kidneys as the organ attempts to remove it from the blood. It is often kidney failure that kills in cases of severe lead poisoning.

The severity of the symptoms depends on the level of exposure. But, unlike other toxic substances that have a minimum threshold below which the body can manage without cause for concern, no safe level has been identified for lead.

As the damaging effects of lead have become undeniable, measures have been introduced to lessen our exposure to the element. We have made considerable progress since the days of ceruse make-up and lead-tainted sapa added to wine. Lead paints are no longer on sale and lead compounds are not added to petrol. Although lead can never be completely eradicated from our lives it is slowly being removed wherever possible. Elevated levels of lead in your environment should be a genuine cause for concern as the people of Flint Michigan well know.

Where does this leave our survivors of firearms incidents with lead still within their body? Although fewer than 100 cases of lead poisoning from bullet fragments have been reported, cases are likely to be underreported. Symptoms can be mild and non-specific. Unless a patient is potentially exposed to lead through their occupation, they are unlikely to have their blood lead levels tested. The suggestion is greater counselling for those living with bullet fragments stressing the importance of testing. Greater awareness of the potential problems may help diagnosis and therefore treatment. It might also prompt the question of retained bullet fragments when patients present elevated blood lead levels that can’t otherwise be explained.