If large quantities of hydrocyanic acid have been inhaled, death ensues very quickly. The person affected falls down suddenly, breathes with difficulty, the pulse soon becomes imperceptible, and after a more or less long stage of deep unconsciousness (coma) life becomes extinct.
In slight cases of poisoning the patient feels a sensation of irritation in the throat, giddiness, sickness, and difficulty in breathing; occasionally such disturbances persist for some time.
Some writers have described symptoms in workers manipulating prussic acid and cyanides, which they believe to be due to chronic prussic acid poisoning. Complaint is made of oppression of the chest, throat irritation, giddiness, difficulty in breathing, palpitation, hebetude, exhaustion, and nausea and vomiting; in certain instances the attack, aggravated by exhaustion and weakness, culminates in death. It is a question whether such poisonings are chronic in the true sense of the word. In view of the mode of action of hydrocyanic acid, such cases of sickness should rather be accounted acute or sub-acute poisonings through repeated action of small quantities of the poison.
It may be mentioned that in persons working with alkaline cyanides (especially in electro-plating) skin affections occasionally occur; these are traceable to the caustic effect of alkaline cyanides.
Treatment by oxygen inhalation with simultaneous artificial respiration holds out most prospect of success. This holds good for acute poisoning by the other poisons belonging to this group. Besides this, saline injections and bleeding are recommended, and also the administration of an infusion of sodium thiosulphate solution.
GROUP: ARSENIURETTED HYDROGEN AND CARBONIC OXIDE (BLOOD POISONS)
Included in this group, as in the former one, are substances chemically very different from each other, but of which the action is especially on the blood. Besides this common effect, these substances also produce various other effects, such as local irritation, effect on the nervous system, &c. The industrial blood poisons, which according to their chemical constitution are classed among the aliphatic and the aromatic series of organic compounds, will, for the sake of clearness, be discussed in the following chapters.
ARSENIURETTED HYDROGEN
Acute arseniuretted hydrogen poisoning, produced by inhalation of relatively very small quantities of arseniuretted hydrogen gas (AsH₃) is in most cases industrial in origin. The absorption of an amount corresponding to about 0·01 mg. arsenic suffices to produce severe poisoning symptoms. The poisonous effect results chiefly from action upon the red blood corpuscles, which are dissolved (hæmolysis). Arseniuretted hydrogen is therefore a genuine blood poison. The effect upon the blood, if not immediately fatal to life, is to cause the dissolved blood-colouring matter to pass into the tissues where, though some is deposited, most goes to, and acts injuriously on, the organs, especially the liver, spleen, and kidneys. In cases running at once a fatal course, the impoverishment of the blood caused by the lack of colouring matter necessary to internal respiration produces tissue suffocation, which is therefore the primary cause of death. In cases not immediately fatal, the injury to the functions of the organs alluded to (for instance, cessation of the functions of the kidneys, &c.) may lead to death secondarily.
Symptoms of the disease appear often only some time after the poisoning has set in, and begin with general malaise, sickness, collapse, fainting fits, and difficulty of breathing; after some hours the characteristic signs follow—the urine becomes dark red to black, containing quantities of blood colouring matter and dissolved constituents of the blood, and later also bile colouring matter, so that a coppery jaundice comes on if the illness is prolonged. The region of the liver, spleen, and kidneys is painful. Severe cases often end fatally during the first stage of the illness, more rarely later, with increased difficulty of breathing; sometimes death occurs after a preceding comatose stage marked by convulsions and delirium. In slighter poisoning cases the symptoms abate in a few days and recovery follows.