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.).
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.