Hey, Dr Bernard here. This case was recorded in October 1841. It was published in a book in 1908.
Humans react to chemicals the same way today, as they did back then.
Parts of I’ve adapted for today, but I’ve preserved as much of the original
description as possible. The poisoning still happens today, in a working space
that didn’t exist in the 1800s, all of which, I will tell you about later in this video.
A Scientist Inhaled 3 Liters of Gas he made in a balloon. This Is what happened to his kidneys.
MB is a 31 year old man, presenting to the emergency room with a pain between his legs.
He tells the admitting nurse that over the last four hours,
he kept emptying his stomach into the laboratory sink. At first,
it was forcefully projectile, but as the time continued, it became green in color.
MB was a scientist writing a book about chemicals.
He had a good career and a good reputation as a teacher.
MB loved to make jokes in the lab. Science is supposed to be fun, he thought. He would make
gases from chemical reactions and inhale them. This would change his voice for a short amount
of time. All of his students found this hilarious. His voice could become high,
his voice could become low. He found this effect funny. And
he kept thinking of new ways to inhale different gases, to “find his voice.”
One day, MB mixed some metal shavings with sulfuric acid. He collected the resulting hydrogen
gas in a ballon, knowing that it would make his voice an exceptionally high pitch, and because
this gas is light, it would just make its way out of his lungs, and it’ll be no problem he thought.
Immediately after inhaling what was supposed to be hydrogen gas in the balloon,
MB felt light like a feather. His voice was high pitched and he could hear the resonance
ring throughout his skull as he felt like he was floating around in the air. Looking at the ballon,
he saw there was enough for one more, as he breathed it in, and he felt on top of the
world. He was seized with giddiness and his vision felt lightweight, as it started turning dark. But
then he started to notice that he was shivering and shaking. At first it was subtle, but then he
noticed that his legs started to hurt. The pain got worse and worse as he could start to feel his
heart beating in his feet, as his hands started tingling and going numb. He went into the bathroom
and noticed that his urine could only trickle out, and what did come out was a deep red color.
As the hours passed, contents from MB’s stomach kept coming up. It was projectile
before it became green and it brought him down to the floor. He struggled to call for 911,
and he’s brought to the emergency room where we are now.
At examination, the medical team noticed that MB’s skin felt cold to the touch, his heart rate was
high and his stomach contents that came up were green, maybe a little yellow. When he could talk,
his voice seemed weak. His face and the whites of his eyes were also a greenish-yellow color
meaning he’s jaundiced. The color comes from a chemical called bilirubin something
that makes feces brown and is produced from breaking down red blood cells in the liver,
all of this meaning that there could be some liver damage happening to MB. He told them
about the hydrogen gas that he inhaled before this happened, but he was unsure if it really was the
gas causing all these problems because hydrogen doesn’t just do something like this.
As the night continued, the team noted that every hour,
on the hour, MB would have a stomach movement come up out his mouth. They noticed that his
urine was still red. But as the hours passed, they noticed t hat MB stops urinating. He seems
bloated. His face and his belly are swollen as if he’s retaining the fluid that should be urine.
A blood test finds that MB has anemia. An- meaning without and -emia meaning presence of
blood. Something called hemoglobin was low in his blood, which is the protein that carries
oxygen throughout the body. Without oxygen going to vital parts like the brain,
bad things can start to happen. But examining his red urine,
they find that what’s making it red is huge amounts of hemoglobin.
Clearly, something is happening to his liver if he appears jaundiced.
And if he had hemoglobinuria before he completely stopped making urine altogether,
then it means something happened to his kidneys too, but why? MB inhaled what should have been
hydrogen gas. Typically you don’t get sick like this just by breathing that in, but
everything started to go wrong after that particular moment. If he inhaled something,
then why are bad things happening to his liver and kidneys and not his lungs?
In the lungs, the oxygen from the air, is exchanged for carbon dioxide from the blood.
If inhaled gas from the lungs goes directly into the blood, and MB noticed blood in his
urine before he presented to the emergency room, then it means that gas may have done
something to his blood. That “bad blood” could have flown into his kidneys and become his urine,
and this gives the medical team some clues as to what’s happening.
As the days pass, MB’s vomiting episodes become less frequent. His jaundice disappeared. It
looked like he was getting better. But then doctors noticed that he was bloated like he
was holding on to water. They noticed that he hadn’t urinated for several days now.
When they inserted a catheter in to his bladder to drain it hoping there’d be a bunch of urine
in there, they find that it’s completely empty. MB’s kidneys have completely stopped
working. But he didn’t appear to have anything wrong with his brain. He could respond to
commands, he could hold conversation, he knew where he was, but as the fifth day of being
in the hospital continued, he started to become drowsy, and tired. There could be something wrong
with his brain, but that’s not likely given he could speak, and move. But all of that could mean
that not enough oxygen might be getting to his brain for some reason, bringing
us back to his anemia, his hemoglobinuria, and the idea of gas exchange in the lungs.
Analysis of the metal shavings and the sulfuric acid that MB used to create the hydrogen gas
that he packed into his lungs finds substantial contamination of the element arsenic. If the
mixture reacted to form gas, then it means that the “hydrogen” MB thought he inhaled,
was arsine. This toxic gas exchanged in his lungs and started pushing into his blood. It started
spreading everywhere all throughout his body, and this explains everything happening to him.
Air that we breathe in is not mostly oxygen, it’s almost 80% nitrogen. On the periodic table,
nitrogen is a light element, it’s one of the most abundant elements in living beings,
it’s mostly a gas on earth, but when it’s combined with hydrogen, it becomes ammonia. In a column,
known as a group, on the table, elements have similar features. They’re not exactly the same
because as you go down the column, elements get heavier. They become more unstable, meaning they
could be more reactive. If Nitrogen and hydrogen make up ammonia, then phosphorous, which is also
abundant in the body can combine with hydrogen and make Phosphine, which is a poison gas that
can cause spontaneous human combustion when in the body. This also means arsenic can combine with
hydrogen to make Arsine, which is what MB inhaled when he produced the gas in his balloon from
contaminated reagents. These chemical properties don’t tell us directly how and why bad things
happen when someone inhales arsine gas. It’s not immediately obvious and experiments haven’t
given us a better idea at the moment. But we do know WHAT happens, because it’s happening to MB.
In the blood cells, arsine weakens the globin chains holding down heme.
We know this because this only happens to regular hemoglobin that’s found in
all healthy humans. It doesn’t happen to hemoglobin exposed to carbon monoxide,
the chemical known to bind stronger to hemoglobin than oxygen and can cause someone to suffocate
when it’s present. Arsine strips out the heme in regular hemoglobin of a red blood cell,
and sends the heme to float around in the body and this is one part of where the problems come from.
Heme contains iron. The form of iron that arsine strips out is reactive. It can cause damage to
all different parts of the body. One of the places in the body that can’t handle this reactive iron
is the kidneys. The heme lodges into the tubules and this pigment causes oxidative damage
necrosis as the tissue dies. In MB, this is what happened to him because he started urinating a red
color. It explains his anemia because the hemoglobin was getting cut out by arsine. And it
explains the hemoglobin in the urine before his kidneys completely stopped working
and he no longer made any urine for days while he was in the hospital.
The idea of poison arsenic goes back to ancient times. It was used as a pesticide,
and the Romans knew it as the King of Poisons, it was a poison of Kings because it was an
untraceable way to get rid of someone. English sources say that the French at one point
knew arsenic as the Powder of Inheritance, where it was used in untraceable deaths of
the elderly. “I totally have no idea what happened to them, they just got sick from
the food!” would be brought up to insurers, and wealth and an estate would be passed on.
But while the ancient world knew arsenic as a poison, it also knew it as a medicine. In
Han Dynasty China 2000 years ago, a published book titled the Shennong Bencao Jing 神農本草經 is
an ancient pharmacopoeia, still available in print today. It recorded the use of an
arsenic compound to treat jaundice, ulcers, parasitic infections and malignant growths.
What’s poison becomes medicine, and what’s old becomes new again, bringing us to today. In 1971,
in Harbin city in the north of China, the local government caught wind of an
herbalist dispensing cancer treatments. They sent an official to inspect
what exactly these treatments were and they discovered it was a mix of toad extract,
mercuric oxide, and arsenic trioxide. This mixture was tested in a particular blood cancer called
Acute Promyelocytic Leukemia. Promyelocyte being a young, immature type of blood cell. Leuk from
Greek Leukos meaning white referring to the kind of blood cell and -emia meaning presence in blood.
Immature white blood cell presence in blood. This appears in the body as a cancer. Arsenic trioxide
was used to achieve complete remission in 21 out of 32 patients with this particular blood cancer,
published in Chinese medical literature in 1992 with study rational deriving from a fusion of
traditional and modern medical ideas. The idea of arsenic as a treatment for Acute
Promyelocytic Leukemia crossed over from China to one of the largest cancer centers in the United
States, Memorial Sloan Kettering. And published in English literature in 1998, 11 of 12 patients with
Acute Promyelocytic Leukemia were in remission after treatment containing, Arsenic Trioxide.
Today, we see this in the news. American Football player playing for the Houston Texans was recently
diagnosed with Acute Promyelocytic Leukemia, his treatment may contain therapeutic arsenic as
it is a standard of care. Semiconductor manufacturing to make computer chips relies
on a step that needs ion implantation, where a gas is used to implant a metal on the wafer,
and it’s here where arsenic is deposited on chips through the use of Arsine gas,
as it’s used today. This is an occupational hazard for people working in this space
that happens today, in a workspace that didn’t exist in the 1800s, bringing us back to MB.
On his 6th day in the hospital, MB passed 7 stools that were likely a watery consistency
consistent with arsenic poisoning. The medical team found that he did make some urine,
but all of it was red. As the day passed, he became weak and bloated as the sun started set.
Arsine gas was discovered in 1775. The first recorded case of poisoning was in 1815 in Germany,
where the chemist accidentally exposed himself to the gas. These accidents would happen around the
time the hot air balloon was invented, because to inflate the balloon with hydrogen gas,
sulfuric acid was mixed with iron, and because both would be contaminated with
arsenic, people exposed would suffer illness and be found not alive days later, just like MB.
At autopsy, doctors tested MB’s body fluids. They found the same concentration of arsenic that was
found in the sulfuric acid, and the metal shavings that he used to make the gas that he inhaled.
The test that doctors used to find the arsenic in MB is the same test that put a
stop to the French calling arsenic the powder of inheritance, because it’s easily provable
once the arsenic can be detected. But as sophisticated as doctors were at the time
to detect arsenic after the fact, they didn’t know how to treat arsine gas poisoning back then.
Today, we can try to stop the kidney damage from arsine by exchange transfusion. This will take
out the patient’s broken blood, and replace it with donor blood that doesn’t have arsenic
in it. Today, Sulfuric acid doesn’t, shouldn’t, have arsenic contamination in it, iron still does
sometimes. In everyday life, regular people aren’t typically going to come into abundant contact with
arsenic and arsine gas. General rule of thumb in line with MB’s case, if you don’t need to put
it in your lungs, don’t put it in your lungs. If recognized early and if the arsine exposure wasn’t
too much, patients can come out OK. For MB, given that he was alive 6 more days in the hospital
after he accidentally inhaled that 3 liters of Arsine gas, he could have been saved if his case
happened today, but they didn’t know how or have the tools to do so back then on October 23, 1841.
Thanks so much for watching. Take care of yourself and be well.