The vapor of phosphorus is highly irritating to the conjunctiva and to the broncho-pulmonary mucous membrane. If caries of the teeth exist, necrosis of the maxillary bones may be induced by the vapor; but it is doubtful whether, as has been affirmed, such necrosis may occur when the teeth are perfectly sound. There is an obvious distinction between the local effects of the vapor of phosphorus and the disease of the osseous system, the result of the constitutional impression of this agent.

In ordinary medicinal doses, phosphorus gives rise to a sense of warmth at the epigastrium, but, if the dose be large, decided heat and even burning are experienced, and tenderness of the epigastrium remains. Prolonged administration of full doses will excite considerable gastric disturbance, and a catarrhal state of the mucous membrane. In the process of the oxidation of phosphorus, hydrogen is evolved, which in its nascent state readily combines with a portion of phosphorus, forming phosphide of hydrogen, eructations of which constitute one of the disagreeable features in the administration of this remedy. The action of the heart becomes more frequent, and the cutaneous circulation, especially, more rapid; the body temperature rises somewhat; the mental activity and the muscular power increase; the menstrual flow grows more abundant, and in males aphrodisiac effects are experienced, and the urine and sweat are more abundantly excreted. Phosphorus in small quantity promotes constructive metamorphosis, increases the activity of the vegetative organs, and is a natural excitant of the functions of animal life; it enters largely into the formation of tissues, and is a necessary element in the phosphorized fat which holds an important position in the composition of the cerebral matter. The administration of phosphorus increases the excretion of urinary phosphates.

The effects of phosphorus in toxic doses have been elaborately studied, both in fatal cases of poisoning, occurring in man, and by experiments on animals. The form in which it is swallowed affects the rate at which the action occurs. If taken in solution in oil, in ether, or in the paste used as a vermin-destroyer, the toxic symptoms appear more promptly than if match-heads or ordinary phosphorus has been swallowed. An interval of varying duration elapses from the ingestion of the poison until disturbance of the stomach ensues. This interval— one to three hours—is occupied by the solution and oxidation of the phosphorus. Then epigastric uneasiness, nausea, and vomiting, come on; first, the contents of the stomach, and then mucus and bilious matters being ejected. The vomiting, accompanied by considerable epigastric pain and tenderness, persists usually for several days, when it assumes a special character, owing to the presence of the so-called "coffee-grounds," or "black-vomit." At first the vomited matters have a distinct odor of phosphorus, and appear phosphorescent in the dark. After several days of vomiting these symptoms disappear, and there may then be more or less haematemesis, as well as coffee-grounds, due to erosions of the mucous membrane (Wolfe). The condition of the intestines varies with the presence or absence of phosphorus in their contents. The stools may be simply pasty and grayish from the absence of bile, or they may contain mucus and blood, and appear phosphorescent in the dark. Accordingly, as they may or may not be irritated, will the symptoms be those of constipation, diarrhoea, or dysentery. The very characteristic but not invariable symptom—jaundice —appears on the second to the fifth day after the reception of the poison. It is absent in one fourth of the cases, and may be absent, also, when there is considerable fatty degeneration of the liver (Wolfe, Alter). It presents the usual appearance of jaundice as it occurs in acute yellow atrophy. It does not attain the maximum at once, but it appears first as some yellowness of the conjunctiva, the urine also becoming dark and loaded with urates, at the same time.

The chemical changes which phosphorus undergoes in the stomach, and the combinations by which it enters the blood, are as yet not fully 11 explicable. That some phosphoric acid and phosphide of hydrogen are formed is certain. That the oil or fat in the stomach will dissolve some portion of the phosphorus, and thus facilitate its diffusion as phosphorus into the blood, is highly probable (Husemann and Marmé). Phosphorus is also slightly soluble in water at about 100° Fahr., and in organic fluids, as the bile, to a greater extent (Hartmann). As in the oxidation of phosphorus, phosphorous and phosphoric acids, and phosphide of hydrogen, are products, it is certain that these exert a poisonous influence to a greater or less extent in the stomach (Lecor-ché). A portion of the agent taken undoubtedly enters the blood as phosphorus, and the subsequent changes in tissue-metamorphosis are due to its presence in the blood, where it has been detected by Bamberger and others. With the entrance of the poison into the blood the action of the heart increases, and the temperature rises, the fever having a remittent type (Mannkopff). Toward the end, however, the function of haematosis and of tissue-metamorphosis are so depressed that the body-heat declines below normal. In other cases there is no fever at all, or it appears near the end. Very great weakness of the heart's action has usually been observed, and the pulse has been much accelerated, although in some instances it became very slow, descending as low as 40. The damage done to the blood is shown in the haemorrhages which take place from the various mucous surfaces—from the nose, stomach, intestines, kidneys, uterus (menorrhagia and me- trorrhagia)—and into the areolar tissue, in the form of petechia3 and ecchymoses. A haemorrhagic diathesis develops, so that the bleeding from a simple wound, a leech-bite, etc., may become uncontrollable.

The intellect may remain unimpaired, but usually there are restlessness, with coma, sometimes noisy delirium, anaesthesia of the extremities, paresis of the members, and, near the end, convulsions (Hermann).

The poison entering the blood is eliminated chiefly by the kidneys. The changes occurring in the urine are of especial interest. No departure from the normal occurs until the alterations in the composition of the blood, and the general steatosis, prepare the way. The urine is diminished in amount, contains albumen, blood, and sometimes fibrinous casts. When jaundice comes on, its appearance is first announced by the presence of bile-pigments and acids. Urea almost entirely disappears toward the fatal termination; leucin and tyrosin are occasionally present, and a peptone-like substance; but the peculiarity most distinctive is the large quantity of paralactic acid, especially in the fatal cases (Schultzen and Riess).

The duration of the cases of phosphorus-poisoning is by no means uniform. Although the rule is that symptoms do not follow immediately on the entrance of the poison into the stomach, there are cases in which pain, nausea, and vomiting do occur almost immediately, and the most formidable symptoms come on promptly. One case is reported in which death occurred within nine hours, and numerous cases have terminated in death at the expiration of forty-eight to seventy-two hours. But usually the cases are less acute, and death does not occur before the end of the first, second, or third week. It is important to bear in mind that death may take place unexpectedly, before the most severe symptoms manifest themselves (Naunyn); and that the absence of decided gastric disturbance does not necessarily indicate a mild case. When recovery takes place, the improvement is slow, and the duration more or less protracted. In cases observed by Schultzen, the swelling of the liver could be distinguished at the expiration of four weeks, although the jaundice and the haemorrhages had disappeared.

The changes induced by phosphorus are eminently characteristic. In the stomach are found erosions of variable extent, often absent; fatty degeneration of the epithelium; and a gastro-adenitis, first described by Virchow, and confirmed by subsequent observers, notably by Bernhardt, whence the membrane has a swollen, grayish, or yellowish color. The same state of the mucous membrane may exist in the intestine as well. The liver is much enlarged as a rule, but may be atrophied. In five of the sixteen cases studied by Wolfe the liver was atrophied, but this is probably a more advanced change, and is, therefore, encountered in the most protracted cases. The color of the liver is usually a pale yellow, or it may present a deep yellow, the acini appearing enlarged and distinct. The increased size of the organ, and the change in its appearance, are due to fatty degeneration of the hepatic cells and epithelium (Mannkopff); but, according to some other authorities, an interstitial hepatitis is also set up, which is especially well marked in chronic phosphorus-poisoning. The jaundice, it is agreed generally, is due to resorption of the bile, swelling of the bile-ducts and of the orifice of the ductus communis preventing the entrance of the bile into the intestine. The presence of bile-pigments and acids in the urine supports this view, but it has also been maintained that the jaundice is haematogenic from dissolution of the blood.

The changes in the composition of the blood are numerous and important: it is fluid, non-coagulable, its corpuscles altered in form, and it contains much fat (Méhu). There are numerous ecchymoses, especially under the peri- and endo-cardium (noted in thirteen out of sixteen cases by Wolfe), under the capsule of the liver, and in other situations. Besides the alterations in the blood, the occurrence of ecchymoses is favored by fatty degeneration of the small blood-vessels and capillaries (Klebs). The heart is also the seat of an acute fatty degeneration, and its tissue is soft and easily torn. The spleen is enlarged, and the kidneys are also enlarged and fatty, the renal epithelium being crowded with oil-drops Not every case exhibits the wide-spread changes above described. If death occur in a short time, within nine hours, as has been noted, not sufficient time will have elapsed to allow of universal steatosis. There may, indeed, be no characteristic morbid appearances under such circumstances. In other cases, the changes may be limited to the liver.

Chronic poisoning by phosphorus presents some interesting features. It occurs in those who are exposed to the vapor, in workmen engaged in phosphorus-factories, and especially in the workers in match-factories. Irritation of the bronchial mucous membrane, and to a less extent of the gastro-intestinal, takes place, with the attendant symptoms of cough, loss of appetite, indigestion, constipation, failure of nutrition, etc. The most important change is that occurring in the maxilla, more especially in the inferior maxilla, which is both more severely and more frequently diseased. The lower jaw has been repeatedly removed for this phosphorus necrosis, which begins in carious teeth, develops into a periostitis, and ends in death of the bone. The alveolar process only, or a part or the whole of the bone, may be cast off. Phosphorus increases the production of osseous tissue; the spongy tissue is thickened, and the compact is rendered more dense. Extensive osteophytic formations take place in animals fed on it, and the marrow cavity of long bones may be much encroached on, even closed, by the deposit of new osseous material (Wegner).