§ 292. Blood takes up far more phosphine than water. Dybskowsky found that putting the coefficient of solubility of phosphine in pure water at ·1122 at 15°, the coefficient for venous blood was ·13, and for arterial 26·73; hence the richer the blood is in oxygen the more phosphine is absorbed. It seems probable that the poisonous gas reacts on the oxyhæmoglobin of the blood, and phosphorous acid is formed. This is supported by the fact that a watery extract of such blood reduces silver nitrate, and has been also found feebly acid. The dark blood obtained from animals poisoned by phosphine, when examined spectroscopically, has been found to exhibit a band in the violet.
§ 293. Post-mortem Appearances.—There are a few perfectly well authenticated cases showing that phosphorus may cause death, and yet no lesion be discovered afterwards. Thus, Tardieu[303] cites a case in which a woman, aged 45, poisoned herself with phosphorus, and died suddenly the seventh day afterwards. Dr. Mascarel examined the viscera with the greatest care, but could discover absolutely no abnormal conditions; the only symptoms during life were vomiting, and afterwards a little indigestion. It may, however, be remarked that the microscope does not seem to have been employed, and that probably a close examination of the heart would have revealed some alteration of its ultimate structure. The case quoted, by Taylor[304] may also be mentioned, in which a child was caught in the act of sucking phosphorus matches, and died ten days afterwards in convulsions. None of the ordinary post-mortem signs of poisoning by phosphorus were met with, but the intestines were reddened throughout, and there were no less than ten invaginations; but the case is altogether a doubtful one, and no phosphorus may actually have been taken. It is very difficult to give in a limited space anything like a full picture of the different lesions found after death from phosphorus, for they vary according as to whether the death is speedy or prolonged, whether the phosphorus has been taken as a finely-divided solid, or in the form of vapour, &c. It may, however, be shortly said, that the most common changes are fatty infiltration of the liver and kidneys, fatty degeneration of the heart, enlargement of the liver, ecchymoses in the serous membranes, in the muscular, in the fatty, and in the mucous tissues. When death occurs before jaundice supervenes, there may be little in the aspect of the corpse to raise a suspicion of poison; but if intense jaundice has existed during life, the yellow staining of the skin, and it may be, spots of purpura, will suggest to the experienced pathologist the possibility of phosphorus poisoning. In the mouth and throat there will seldom be anything abnormal. In one or two cases of rapid death among infants, some traces of the matches which had been sucked were found clinging to the gums. The stomach may be healthy, but the most common appearance is a swelling of the mucous membrane and superficial erosions. Virchow,[305] who was the first to call attention to this peculiar grey swelling of the intestinal mucous membrane under the name of gastritis glandularis or gastradenitis, shows that it is due to a fatty degeneration of the epithelial cells, and that it is by no means peculiar to phosphorus poisoning. The swelling may be seen in properly-prepared sections to have its essential seat in the glands of the mucous membrane; the glands are enlarged, their openings filled with large cells, and each single cell is finely granular. Little centres of hæmorrhage, often microscopically small, are seen, and may be the centres of small inflammations; their usual situation is on the summit of the rugæ. Very similar changes are witnessed after death from septicæmia, pyæmia, diphtheria, and other diseases. The softening of the stomach, gangrene, and deep erosions, recorded by the earlier authors, have not been observed of late years, and probably were due to post-mortem changes, and not to processes during life. The same changes are to be seen in the intestines, and there are numerous extravasations in the peritoneum.
[303] L’Empoisonnement, p. 520.
[304] Poisons, 3rd ed., p. 276.
[305] Virchow’s Archiv. f. path. Anat., Bd. 31, Hft. 3, 399.
The liver shows of all the organs the most characteristic signs; a more or less advanced fatty infiltration of its structure takes place, which was first described as caused by phosphorus by Hauff in 1860.[306] It is the most constant pathological evidence both in man and animal, and seems to occur at a very early period, Munk and Leyden having found a fatty degeneration in the liver far advanced in twenty-four hours[307] after poisoning. In rats and mice poisoned with paste, I have found this evident to the naked eye twelve hours after the fatal dose. The liver is mostly large, but in a case[308] recorded in the Lancet, July 14, 1888, the liver was shrunken; it has a pale yellow (or sometimes an intense yellow) colour; on section the cut surface presents a mottled appearance; the serous envelopes, especially along the course of the vessels, exhibit extravasations of blood. The liver itself is more deficient in blood than in the normal condition, and the more bloodless it is, the greater the fatty infiltration.