ACUTE POISONING may occur from an overdose of any preparation of unoxi dized phosphorus, or from swallowing phosphorus paste used for destroying vermin, or from chewing the tops of lucifer matches. Red phosphorus, an allotropic form made by heating (464° to 482° F.) phosphorus for fifty hours in an atmosphere which is unable to act upon it chemically, is not poisonous, and has replaced to a large extent the yellow variety in the manufacture of matches. In acute poisoning the rapid ity with which the symptoms appear varies. Generally in from one to eight or ten hours the peculiar, disagree able taste of phosphorus is noticed in the mouth and the breath is heavily laden with its odor. An intense warmth in the oesophagus, stomach, and bowels develops gradually into a violent, burn ing pain, which extends all over the ab domen. Eructations having a garlicky odor, followed by nausea, vomiting, and purging now follow. The vomited mat ters at first consist of food and later of mucus, bile, and, perhaps, blood; the color of the vomited matter is usually dark, the odor of phosphorus is present, and it with the dejeeta may be luminous in the dark, owing to the presence of phosphorus. The pupils are dilated, the abdomen distended, the extremities cold, the pulse weak, and the thirst intense. Constipation is sometimes present in stead of purging. Very soon the liver increases in size and is the seat of pain and tenderness. After twenty-four or
forty-eight hours the symptoms abate and symptoms of acute yellow atrophy of the liver develop. Jaundice appears, first in the conjunctivae, and then ex tends over the whole body. Vomiting and pain now return, "coffee-ground" matter is vomited, showing the presence of altered blood. The bowels are now confined, or, if moved, the stools are clay-colored, showing the absence of bile. Bile is also absent from the vomited matter. The urine is often retained. Nervous symptoms develop — muscular twitching, headache, vertigo, delirium, and convulsions, or coma—and death en sues. If the patient survive the acute stage, he generally dies of general fatty degeneration of the internal organs. Recovery is rare.
The smallest doses of phosphorus known to have destroyed life were 1 '/, grains in a man, grain in a woman, and grain in a child. Death in cases of acute poisoning usually takes place within three to six days. In one re corded case death occurred in half an hour. Chronic cases may last for months or even years.
In acute phosphorus poisoning death is probably due to the toxic action of certain products of cellular metabolism, which the liver and kidneys are unable to eliminate on account of the profound changes that have taken place in them. Lo Monaco and Trambusti (Lo Speri., p. 26, '94).