The treatment of arseniuretted hydrogen poisoning is similar to that adopted in the case of all other blood poisonings: in addition, if possible, direct transfusion of blood from the artery of the giver into the vein of the receiver, liquid nourishment, saline injections, and, above all, prolonged oxygen inhalation.
CARBONIC OXIDE (CO)
Carbonic oxide (CO) is a colourless, odourless gas which frequently causes both acute and, it is said, chronic industrial poisoning.
Carbonic oxide is a very poisonous gas; even as little as 0·5 per thousand in the atmosphere breathed has a poisonous effect; about 2-3 per thousand can be dangerous to life.
Its poisonous effect results from its power of combining with the blood-colouring matter or hæmoglobin to form carboxy-hæmoglobin; the affinity of carbonic oxide for the hæmoglobin of the blood is more than 200 times greater than that of oxygen, so that, however small the amount of carbonic oxide in the air, it is inevitably absorbed by the blood and retained. The blood so altered, assumes a cherry-red colour, is unable to effect the necessary exchange of gases for internal respiration, and in consequence of the lack of oxygen suffocation ensues.
Without doubt, however, carbonic oxide has also an immediate effect upon the central nervous system (first excitation, followed quickly by paralysis). It is maintained also that besides the action upon the hæmoglobin it favours coagulation of the blood through the disintegration of the blood corpuscles. The last-mentioned action is thought to account for the sequelæ of carbonic oxide poisoning, but they can also naturally be accounted for by the direct effect of the poison.
Onset of symptoms is very sudden if a large quantity of pure carbonic oxide is inhaled. The affected person immediately falls down unconscious and succumbs after drawing a few breaths with difficulty.
In less acute cases the illness begins with premonitory symptoms, generally headache, sickness, giddiness, sleepiness, though in cases of fairly rapid absorption these are absent, and are naturally absent also when the poisoning creeps upon the affected persons while asleep, as occasionally happens in cabins, &c., in factories. If the poisoning continues, increasing mental dulness, accompanied by nausea and vomiting, leads sometimes to a short stage of seemingly drunken excitement, which preludes deep unconsciousness during which there is often a convulsive stage, followed by complete loss both of sensation and of reflex action; the breathing becomes shallow and intermittent, the pulse small and irregular, and finally death ensues. Occasionally in the stage of unconsciousness, death is hastened by entrance of vomited matter into the respiratory passages. Bright red patches are seen on the body after death.
If persons affected by severe carbonic oxide poisoning are withdrawn from the poisonous atmosphere after having reached the stage of unconsciousness, they may recover, but often with difficulty; not infrequently—in spite of suitable treatment—death occurs some considerable time later from the symptoms described above. Still, in many cases, under the influence of right treatment, gradual recovery has been brought about, even after long unconsciousness accompanied by repeated convulsions. In the rescued the symptoms described as characteristic of the first stage often continue for at least a day. Further, they are liable to a number of serious after effects, such as severe inflammation of the lungs due to infection by the entrance of vomited matter into the air passages, skin affections (rashes), and especially severe nervous and mental affections. Frequently these develop from centres of softening in the brain or from inflammation of the peripheral nerves (neuritis); occasionally the poisoning may really only be the predisposing cause for the outbreak of an existing psychical disease. It is not our task to enumerate all the extremely varied disturbances which are observed after carbonic acid gas poisoning. Neuralgias and paralyses have been described as associated with the peripheral nerve symptoms over areas supplied by different nerves; various forms of diseases of the brain and spinal cord (poliomyelitis, paralysis, sclerosis, &c.); and finally a series of psychoses (neurasthenia, melancholia, mania, &c.), occasionally passing into dementia and imbecility. Glycosuria (sugar in the urine) has also been noted as a sequela.
Chronic carbonic oxide poisoning, arising from continued inhalation of small quantities of the gas, sets in usually with symptoms similar to those of acute carbonic oxide poisoning; if the worker continues exposed to danger, severe symptoms may arise which point to marked alteration of the blood and later also of the digestion and bodily functions. Under certain circumstances severe nervous and mental affections are said to occur similar to those which we have mentioned as sequelæ of acute carbonic oxide poisoning (convulsions, disturbances of mental activity, symptoms which resemble progressive muscular atrophy, &c.).