CHRONIC POISONING may result from exposure to phosphorus-fumes in match and other factories or from the long continued use of large doses of the drug. The most common symptoms of chronic poisoning by phosphorus are fatigue, abdominal pains, anorexia, dyspepsia, diarrhoea, sometimes obstinate constipa tion, intermittent headache, more or less cough, and necrosis of the lower jaw, if the teeth are carious, attended by swell ing and distension of the gums with pus (see JAWS, DISEASES or). The com plexion becomes sallow. The skin may be the seat of an eruption. The hair falls out. There is an increase of phos phates in the urine.
Treatment of Poisoning by Phosphorus. —The researches of E. Q. Thornton, of Philadelphia (Ther. Gaz., Jan., '93), have developed the fact that the use of sulphate of copper as an antidote is dangerous, and that the best anti dotes are the permanganate of potash and hydrogen peroxide, which act chem ically by oxidizing the phosphorus and thus destroying its poisonous character. Thornton prefers potassium ate because peroxide of hydrogen is too slow in its action. The permanganate is used in a to a 1-per-cent. solution by mouth, or a 1 to 1000 solution may be used to wash out the stomach. A pint of this latter solution has been used with success half an hour after the poison was taken.
Permanganate of potassium is the best antidote for phosphorus. Adminis tration of the potassium salt advised be fore the phosphorus becomes absorbed, since vomiting will generally prevent the chemical reaction. The antidote must be well diluted (0.5- to 1-per-cent. solution). and must be given in excess. from the fact that a large portion of the permanganate is reduced by the organic substances of the stomach. E. Q. Thorn ton (Then Gaz., Jan., '93).
At clinic of von Jakseh, in Prague, from March, 1894, to March, 1895, twelve cases of phosphorus poisoning were observed which were treated ac cording to the suggestion of Antal.
In the first place, the stomach was washed out with a large quantity (fifty or more quarts) of S-per-cent. solution of permanganate of potassium, and finally one quart of a 'A-per-cent. solu tion was introduced into the stomach and left there. In addition, on the same day infusion of senna was given as a purgative, and on the following days large doses of bicarbonate of sodium were given, and also old oil of turpen tine. 5 drops three times daily.
Five patients died; in fact, all but one, who received 3 grains or more of phosphorus. Fr. Lanz (Ther. Gaz., Nov. 15, '95).
Pota AS111111 permanganate has been proposed as an antidote for these poi sons, the effect depending upon the pow erful oxidizing action of the salt. Since large doses of potassium salts are toxic, the remedy cannot always be used in sufficient quantity, and for this reason sodium permanganate substituted. Ex
periments with animals show this to be as effective as the potassium salt, and applicable without danger in larger doses. lu cases of poisoning by phos phorus irrigation of the stomach with 0.2-per-cent. solution. leaving a pint of the solution in the stomach, advised. Schreiber (Apoth. Zeit.; Alienist and Neurol., July, 1901).
Oils must be avoided in all cases, as phosphorus dissolves in them and thus absorption is favored. The value of old turpentine (French turpentine) should not be forgotten, used preferably after an emetic (cupric sulphate, 3 grains well diluted, repeated every five minutes until vomiting occurs).
The administration of magnesia or sulphate of magnesia is desirable, to empty the bowels and promote elimina tion. Further treatment will be directed by the symptoms present; stimulants and anodynes are usually indicated.
In chronic poisoning immediate with drawal from the infected atmosphere is demanded. The teeth and gums of those working in the presence of phos phorus-fumes should be carefully looked after, and kept in good order.
T h erap eutic s.—Certain precautions should be taken during the period of medication by phosphorus. Frequent observation of the patient is not only desirable, but necessary, for the prompt detection and relief of the first symp toms of overeffect; phosphorus should never be given long in large doses; phos phorus is not indicated in diseases at tended by acute or inflammatory lesions; phosphorus should never be given in substance, but in the form of an alco holic or oily solution. Phosphorus is chiefly indicated in malnutrition of nerve and bone.
Attention called to the different forms of phosphorus which are to be used in the treatment of various diseases. The hypophosphites arc useful in wasting dis eases, such as phthisis. Phosphorus it self, in oily solution, or the phosphide of zinc, seems to be most suitable in neuralgia and nervous disorders. and the acid salts in various gastric disorders. Joseph Eiehberg (Gaillard's Med. Jour., July, 'S9).
In administering phosphorus the ac tion of the remedy upon the digestive organs should be carefully watched. Jenches (Boston Med. and Slug. Jour., Nov. 2S, '9.3).
Substances phosphorus (glycerophosphates, lecithins, phos phoric acid) fix phosphorus in the or ganism and stimulate multiplication of cellular elements: i.e., the enlargement and division of nuclei and changes in multiplication. They produce a general dynamogenic action. Phosphoric acid is anti-alkaline, antiseptic, and assists di gestion. A. Martinet (La Prcsse Med., No. 44, 1901).