Arsenious trihydride, arseniuretted hydrogen.
1. HERING. [In his Guiding Symptoms, vol. ii, Dr. Hering has published the results of a proving of this gas, which he speaks of having made, with five associates, in 1847. The mode of experimentation is not mentioned. [ “My experiments with the ars. hydr. have shown that the millionth of this gas, taken by inhalation, caused a dangerous illness, lasting several weeks.” So Hering writes in Metcalf’s Homoeopathic Provings, p.22. He probably refers to the symptom of “F.K.”-EDS] Save in the case of himself and one other (“F. K.)” very scanty results seem to have been obtained; and even with those two no really characteristic effects appear which have not been observed in cases of poisoning. Accordingly, since arseniuretted hydrogen is unlikely to be used in practice save-as in Dr. Drysdale’s hands- for conditions such as cholera, answering to its toxic influence, we have thought it sufficient to give a few observations of poisoning by the gas, referring the student desirous of more minute to Dr. Hering’s work. -EDS.].
1. In 1815, Gehlen inhaled a small quantity. In 1 hours he was seized with continued vomiting, accompanied by shiverings and great weakness. The symptoms continued to increase till the 9th d., when death supervened amid intolerable sufferings. (ORFILA, op. cit., sub voce.) 2. Schindler, in 3 h. after inhaling half a cubic inch, became affected with giddiness on mounting stairs, and soon after experienced sensation of discomfort and pressure in renal region, augmenting rapidly, and extending over back up to shoulders, without, however, becoming severe. At same time, general shivering, pains in knee-joints, and coldness in extremities. On undressing about 10 p.m., shivering was so intense that he does not remember having had anything like it; at same time, severe pains came on in arms and elbows, similar to those in knees. The symptoms now increased in an alarming manner. Superior extremities up to middle of arms, lower up to knees, nose, eyebrows, were as dead, the feeling of the life left them; absence of pulse, but power of locomotion remained; then at short intervals violent and tearing pains supervened in region of stomach, and continuous spasmodic eructations with emissions of a considerable quantity of inodorous wind, without any relief from the abdominal pains, which caused the sufferer to groan. He soon after had two vomitings with such intense colic that he is unable to describe in words its violence. He then thought he was near dying, without hope of improvement. The vomitings consisted of a yellowish-green mucus, and were very bitter to taste. That of which he complained most was a violent pain in renal region, which was continuous, and accompanied with urging to urinate; urine was of dark colour. blackish red; it was quite pure blood, which formed clots in the vessel. At same time, patient felt burning heat in abdomen, with coldness of extremities. In a few h., his looks had quite changed: skin of whole body had become dark brown; eyes, with yellowish tinge, were downcast, sunken in the orbits and encircled with a large blue ring. Face was drawn, expressing pain. Patient hardly recognizable. Had no sleep that night. Before vomiting, he had taken a little tea; later on, some warm drinks to induce perspiration. These had the effect of bringing back to the dead parts the feelings of life, preceded by very severe tingling, especially at nose, which was seat of violent sneezing, and which was so painfully cold that it was necessary to apply warm linen to it. All these symptoms lasted with same intensity throughout next d.: urine was still like thick blood, but formed no more clots, although renal pains were just as violent. All the hair on the dead parts had become white as snow; the white eyebrows showed sharply on brown skin. Thirst was severe: patient drank much decoction of barley and other demulcents; he also took a solution of sulphate of magnesia with a few drops of tincture of opium. The next d. (3rd) abdominal pains continued intermittently, but less violent. Vomiting only once, less convulsive and less painful than before. Vomited matter consisted of mucus and bile. Renal pains less severe; urine clearer, though still bloody. Eructations had lessened, leaving patient often 1/4 h. peace, but very tiring hiccup had come on, which lasted continuously. Had emission of much flatulence, which brought on stool. Blister at pit of stomach drew blood of a dull red hue. Sleep was quite absent: patient was in such a state of mental excitement that he talked almost incessantly. Weakness considerable; he could, however, stand straight without help and walk a few steps. Had no longer fear of death, although those about him had little hope. On 4th d., same state, though slightly better. 5th d., colour of face was only darkish yellow. Distorted features, showing severe internal sufferings. Urine tinged with blood, colic round navel, recurring at long intervals; intermittent hiccup, lasting an hours; eructations less frequent; several stools. Diluents, mucilaginous drinks. 6th d., vague sensation, very trying, as if he had a stone in belly; patient said constantly that his belly had become like a stone. Sulphate of magnesia did not drive away this sensation nor the eructations. Soon patient wished for something solid, and ate a little rice with good appetite. Urine no longer bloody. 7th d., is better. Face has become white; appearance good. Eyebrows are beginning to get to natural dark colour. No more colic; eructations get less frequent. Has severe tingling in feet and hands, and transient dartings in arms and legs. Towards evening, back pains of first days return less violently, but almost unbearable. Great weakness; tendency to sleep, but sleep not calm, being broken at least noise. During next n. he had feeling of pressure and giddiness in head, with tearing sensation. Cold fomentations all night; pain ceased towards m. 8th d., is better. Slight pressure in abdomen; dorsal pains more violent in evening, unbearable during night; complains bitterly; relieved in sitting posture, but cannot remain so long, owing to weakness. Friction, application of heat is of no avail. All next d. violent pains. E., better after hot-milk fomentations. He goes to sleep, and next d. is decidedly better. From this moment, his state gets more and more bearable. Strength returns, appetite also, and sleep is refreshing; convalescence, however is slow, and he is only well again after 7 w. During third week, a fresh arsenical effect was noticed. The whole foreskin and glans became covered with purulent vesicles, which were followed by small circular and flattened ulcerations. The patient counted as many as sixty-five on the external part of the foreskin: they took 10 or 12 day to heal. There were no symptoms left of this serious case of poisoning, and the patient regained his former health. (L’Art Medical, xlviii, 323.)
3. B-, et. 22, employed in a manufactory of chemicals busied himself with experiments relating to the colouring matter of aniline. In one of these experiments, he produced a pretty large quantity of arsen. hydrogen, which mixed with the air of the laboratory (it was 7 a.m.) About 1 h. afterwards, B-felt a rather severe headache which obliged him to open the window for a short time. He afterwards went on with his work for about 2 h. At 10:30, he took a meal without noticing anything particular. An h. after, headache increased; pains began at epigastrium, and then vomiting of food came on. Patient had himself carried to the hospital. On the way he vomited food three times. On arrival, these were his symptoms: Pale face, bloodless lips, difficulty of walking, very intense frontal headache, severe spontaneous pain in lumbar region; feeling of tightness at base of chest, quickened breathing; no cough, no rales on auscultation, normal resonance; keen thirst; no abdominal pain per se, or on pressure. Cold extremities. No disturbance of sensorium. Treatment: Mustard plasters; frictions with balsam of Fioraventi; hot-water bottles; diuretic wine; ordinary decoction containing 16 grms. per litre of acetate of ammonia; purgative enema. In about 1/2 h. patient becomes warm, a slight moisture covers whole body; breathing gets easier. Patient still complains, however, of bruised feeling generally, and especially of lumbar pains. Motor power seems unaltered. Pulse 110, pretty full and regular. Liver painful to palpation. Towards 5, patient passes two fetid and abundant stools; some time after, emission without pain of about 220 grms. of red urine, in which not a single globule of blood is found on microscopical examination. Greenish vomiting brought on by slightest quantity of drink. Towards 10:30, headache more severe, and face has more animated expression; injected conjunctive. Pulse strong and quick. Embarrassed speech, answers slowly. After being bled to extent of 500 grms., an almost immediate amelioration followed. Headache decreases, as also lumbar pain. Breathing 20, pulse 95. Vomiting, however, continues, and no drink can be retained. At 1 a.m. M. Piorry was called, and found him in this state: Face reddened, skin hot, pulse 100, regular, pretty full; intellect clear, answers rational. Vomiting has ceased. M. Piorry prescribes drink in large quantities and repeated injections into rectum. A fresh purgative enema at about 3, then a bath. Patient feels a little better after it, though still they tired. Next day face is of an earthy yellow, skin dry, pulse 104; tongue dry, great thirst; stupid look; there is posterior pulmonary congestion; patient has not urinated. 3rd d., patient is in a state of drowsiness and apathy; conjunctive are again injected; urine notably diminished in quantity, and still reddish. 5th day, after a seeming amelioration of short duration, general state gets much worse. Urine suppressed again; tongue and lips covered with a fuliginous coating; skin is of bronze colour; pulse becomes imperceptible, breathing faster and embarrassed; intellect gives way. Death took place that e. Autopsy revealed only congestion of liver, without alteration of hepatic cells, softening of spleen, and enlargement of kidneys with very marked injection of the whole organ, especially in tubular substance, and granular state of cells of both divisions. (OLLIVIER, Gaz. des Hopitaux, 1863.)
4. Four Italians were engaged in the manufacture of balloons filled with hydrogen, and for this they used an apparatus with very badly closing stoppers. July 16th, 1877, after having worked in a small room for 5 h., they all four in evening became very weak, and had trembling of limbs, vertigo, headache, nausea, and vomiting. Next m. there was added to this hemoglobinuria and jaundice. They were taken to Altona, where they were admitted to hospital on 18th in m. Diagnosis of poisoning with arsen. hydrogen was soon fixed upon, by the aid of chemical analysis of zinc employed in manufacture of hydrogen. We cannot here reproduce the separate cases of the four patients; suffice it to relate the general symptoms, and the autopsy of one of them who died. Violent vomitings were the first of the serious symptoms, which manifested themselves in a few hours, and lasted more or less time. Anxiety increased progressively, as also the feeling of a serious illness. The rapid annihilation of numbers of red globules of blood by the inhaled gas, and the consequent retention of carbonic acid, were made manifest by progressive dyspnoea and mortal anguish. Breathing anxious, rapid, groaning. Respiration 40 per minute; on 3rd day pulse increased from 100 to 130; there was dysuria and hematuria. Arsenic was found in urine; evacuation by kidneys of disorganized blood-cells lasted only 3 d. in those who recovered; it lasted 10 d. in the one who died; it was accompanied by an abundant desquamation of the epithelium of the renal tubuli, and by a small proportion of albumen and hemoglobuline in the urine. There was also a little intestinal hemorrhage. Colour of skin changed with the changes in the blood; it was at first of a deep yellow, pseudo-jaundiced, later of a greyish yellow, then cadaverous; there was at same time violent itching; all the patients had increased of biliary secretion. The abundant vomited matters were strongly green in colour; stools were largely composed of bile; spleen and liver were diminished in size at first, later hypertrophied; temperature raised in evening; uric acid found in urine during convalescence. First three patients left hospital 11th, 15th, and 19th d. respectively. The last died July 26th, without previous drowsiness, from anemia which showed itself during last days by a systolic murmur at apex; from retention of poison in body through stoppage of urinary secretion; from fatty degeneration also and paralysis of heart. Towards the end there was mortal anguish with violent pain in region of liver, coldness of extremities, and urticaria. Autopsy: corpse greenish yellow; urticaria still recognizable on skin of abdomen. It is discoloured, and has several cadaverous spots. Rigidity of corpse very marked. Colour of muscles normal. Blood of large vessels of neck is thin, liquid, and of dirty cherry colour. In the two pleura some tablespoonfuls of serous fluid, slightly sanguinolent. Same fluid in pericardium, 50 to 60 grms. Heart very soft; muscle of a pale red colour. In right ventricle, a little clear and liquid blood. L. one empty. Blackish blood in small quantity in right auricle; some fibrinous clots adhering to orifice of vena cava; a little blood and fibrine in left auricle; endocardium pale, valves normal, acting well. Edema of mucous membrane of epiglottis, and especially of ary-epiglottic ligaments. Frothy liquid in trachea, same in bronchi. Lungs slate coloured, pretty numerous red ecchymoses under pleura, especially behind inferior lobes. Lung tissue gorged with blood, but permeable to air throughout. A little fluid blood in pulmonary vessels. Spleen large, 16 centimeters long, 10 broad; surface coloured like dark lilac. Little blood oozes on incision. corpuscles of Malpighi are early visible to naked eye. Size of liver normal; of a pale brown colour; several small subserous ecchymoses; in cutting into vessels a little liquid blood flows out. Gall-bladder is gorged with a liquid as thick as tar, of a dark green colour. Kidneys are of normal size. On incision they show a dark colour; they contain relatively a good deal of thin blood, which is of a dull red. Capsules are adherent; pelves are of a dirty red colour. On cutting into pyramids, the naked eye perceives red and detached stripes. On microscopical examination, the greater part of tubuli of pyramids and of cortical substance are gorged with red blood- corpuscles, which is not the case with the glomeruli. Stomach empty; mucous membrane of a black slate colour, covered with a greenish-brown mucus. Exterior surface of intestines likewise slate coloured. In interior, a deal of liquid mucus, viscid, strongly coloured with bile. Mucous membrane of colon swollen, of a dirty reddish brown, strongly hyperemic, as well as that of small intestine, especially near the ileo-cecal valve. mesenteric glands tumefied, of a bluish red on section. In great venous trunks of abdomen there is a little reddish and dirty blood. Brain appears normal; vessels of membranes are full as usual. Cerebral substance shows edema, and some pale dots of blood. the plexuses are pale; ventricles are empty. ( L’Art Medical, loc. cit.) [Dr. IMBERT-GOURBEYRE, writer of the article in L’Art Medical to which we are indebted for so much of the foregoing, adds three other cases of poisoning in this number, and five more in that for November in the same year (1879). They add nothing to the picture presented in the foregoing narratives. Dr. Imbert- Gourbeyre finds the differentiation between poisoning by arseniuretted hydrogen and that by arsenic itself to reside in the simultaneous appearance, in the former, of vomitings, lumbar pains, hematuria, and jaundice (of which the two latter are the most important), and the absence of cramps. The symptoms are slower in supervening, and the patient is acutely ill for a much longer time before death or recovery. He shows that while all the other forms in which arsenic has been taken display similar toxic effects, those of arseniuretted hydrogen have so many points of distinction that they must be separately classed. -EDS.]
5. A pupil of mine for a long time breathed arsen. hydr. in his private experiments, and in works where he superintended gildings and silvering by galvanism, in which zinc is extensively used. It brought on a peculiar kind of epilepsy, much like that described by Christison, which has latterly been gradually increasing, and his intellect, which was once one of the brightest, is now reduced nearly to fatuity. (SHERMAN, in Prov. Medorrhinum and Surg. Journ., 1844, p.1.).
Experiments on animals
1. Hitherto, as in Naunym’s experiments (Reichart and Dubois’ Archiv, 1868), no icterus could be induced in animals by ars. hydrogen. Stadelmann, by conducting experiments in a different manner, succeeded in setting up this condition in nine out of eighteen canine, and in a certain proportion of feline, subjects. With rabbits he also was unsuccessful. (Arch. f. Exp. Path., xvi, 221.).