This section is from the "A Practical Treatise On Materia Medica And Therapeutics" book, by Roberts Bartholow. Also available from Amazon: A Practical Treatise On Materia Medica And Therapeutics
Phosphore, Fr.; Phosphor, Ger. A translucent, nearly colorless solid, resembling wax, without taste, but having a peculiar smell. Its specific gravity is 1·8.
Phosphorated oil. Prepared by dissolving phosphorus in ether and almond-oil. One part of phosphorus to 100 parts of the menstruum. Dose, τηi—τηv.
Phosphorus pills. Each pill contains about 1/100 grain. Phosphorus is dissolved in chloroform, and then mixed with powdered althea and acacia, glycerin, and water. The pills are coated with balsam of tolu.
Spirit of phosphorus. Prepared by dissolving phosphorus in absolute alcohol—1·2 grammes of phosphorus and sufficient alcohol to make up to 1,000 c. c. This alcoholic solution is utilized in preparing the elixir of phosphorus.
Elixir of phosphorus. Prepared by mixing the spirit of phosphorus 210 c. c. with glycerin 550 c. c. and a sufficient quantity of aromatic elixir (U. S. P.) to make up to 1,000 c. c.
Each cubic centimeter of elixir of phosphorus represents about one fourth milligramme, 0·0025 grain, of phosphorus.
Pills of phosphorus may be extemporaneously made by mixing the bisulphide of carbon solution with some inert powder. The evaporation of the bisulphide leaves the phosphorus in a finely-divided state intimately incorporated with the powder.
Zinc phosphide. Dose, one twentieth to one tenth of a grain. It is best administered in pill-form made with conserve of roses.
Oils and fats favor the absorption of phosphorus, and should never, therefore, be employed in cases of poisoning by this agent. Arsenic, and in a feeble degree sulphur, are synergistic.
The chief chemical antidotes to phosphorus are hydrated magnesia, lime-water, powdered charcoal, and sulphate of copper. To this list must be added turpentine of a certain kind. Phosphorus is now frequently taken in the form of matches, the particles of which do not readily dissolve in the stomach and intestinal juices. When pure phosphorus, in the sticks or cylinders in which it occurs in commerce, is swallowed, large masses may remain imbedded in the folds of mucous membrane, or, escaping solution, descend with the other contents of the canal. Considerable time may thus elapse from the ingestion of the poison until its action begins. Emetics, therefore, assume a high degree of importance, and the most serviceable emetic is sulphate of copper, which is at the same time a chemical antidote (Eulenburg and Guttmann). Bamberger has shown that phosphorus reduces sulphate of copper to the metallic state, the first step in the process being the formation of phosphide of copper, and that the masses of phosphorus are surrounded by a layer of copper, preventing its evaporation. He therefore advises that an emetic dose of sulphate of copper be first administered. Emesis may be facilitated by giving hydrated magnesia, diffused in a quantity of tepid water. As catharsis is next in importance, the bowels should be thoroughly evacuated. After the emetic dose of sulphate of copper has acted efficiently, this antidote should be given in small doses as frequently as possible—about one twelfth of a grain every twenty minutes. As the irritability of the stomach may prevent sufficient retention of the sulphate, the carbonate of copper has been proposed as a substitute, although Eulenburg and Landois, in their experiments on animals, have been unable, by the exhibition of the latter, to prevent death in cases of phosphorus-poisoning.
Before the action of potassium permanganate was ascertained, tur-pentine was the most important antidote. Letheby was the first to note that the vapor of turpentine prevented the toxic action of the vapor of phosphorus, and that workmen employed in the match-factory at Stafford, who were protected by vials of turpentine worn about the neck, escaped necrosis of the maxillary bones and other deleterious effects. Dr. P. C. Andant next published cases indicating the antidotal power of turpentine, and M. Personne submitted the subject to experimental demonstration and confirmed the observations of Andant. As turpentine destroys the luminosity in the dark and arrests the escape of the vapor of phosphorus, M. Personne infers that it acts similarly as an antidote, that is, prevents the combustion of phosphorus in the blood and the consequent consumption of the oxygen. The author has collected forty-six cases of poisoning by phosphorus, in which turpentine was employed as the antidote, and of this number but four were unsuccessful (Kohler, Sorbets, Laboulbene, Schimpff, Lichten-stein, Rommeleare, Berthold, etc.). Rectified oil of turpentine is not antidotal. The acid French oil is the preparation which has been used with success. The experiments of Vetter on animals fully confirm the results of clinical experience, for he found that, while the rectified oil of turpentine had no effect, the crude, acid, French turpentine was very efficient as an antidote. The action of the crude turpentine is a process of oxidation and combination by which phosphorus is converted into phosphoro-terebinthinic acid—a spermaceti-like substance, without poisonous or irritating qualities, which is eliminated by the kidneys, the urine having a camphoraceous instead of the violet odor due to turpentine itself. Although the crude French oil is to be preferred, it is probable that our common oil of turpentine, exposed to the air, will develop antidotal power, by absorbing and ozonizing oxygen. The vapor of turpentine acts in the same manner on the vapor of phosphorus. Permanganate of potassium has lately been proved to have complete antidotal power. To accomplish this result, the antidote must be administered before absorption has taken place. The stomach should be evacuated with copper sulphate in solution, and then the stomach should be irrigated with a solution of the permanganate.
To sum up: In the treatment of poisoning by phosphorus, in any of the forms in which it is introduced into the stomach, an emetic of sulphate of copper should be promptly employed, and the bowels should be moved by hydrated magnesia. When the stomach is emptied, small doses of sulphate of copper may be administered, and turpentine given; or a solution of permanganate of potassium may be used. To counteract the cardiac and general systemic depression, opium will become necessary. If phosphorus has entered the blood despite the use of the appropriate antidotes, and much injury to its corpuscular elements has resulted, transfusion can be employed with considerable confidence, since Jürgensen has succeeded in several instances in saving life by this expedient. Direct transfusion of human blood, with or without previous withdrawal of some portion of the damaged blood, is the proper procedure.