Chronic arsenical poisoning is caused by gradual absorption through the respiratory or digestive tracts of small quantities of the oxidic arsenic compounds either in solution or as dust or fumes.
The disease usually begins with digestive derangement which shows itself in more or less severe gastric and intestinal catarrh (loss of appetite, vomiting and diarrhœa); sometimes there are severe affections of the respiratory tract,—pharyngeal and bronchial catarrhs; often the illness is accompanied by skin affections of various kinds, rashes, pustular eczema, loosening of the nails, abscesses, dark pigmentation of particular parts of the skin, and other symptoms. The nervous symptoms vary much according to the severity of the disease; first of all, deafness and feeling of pins and needles, or loss of sensation (paræsthesia and anæsthesia) of the extremities. Further, rheumatic joint pains, weakness of the extremities and characteristic symptoms of paralysis occur, with accompanying atrophy of the muscles, and gradual loss of energy leading to total incapacity for work. Severe cases end in general exhaustion and loss of strength, with signs of severe injury to the central nervous system, such as epileptic fits, mental hebetude, &c.
PHOSPHORUS
Phosphorus (P) is polymorphic; red (amorphous) phosphorus is innocuous, while white or yellow is poisonous. Phosphorus at various stages of oxidation is little if at all poisonous. White phosphorus is volatile and fumes in the air—the fumes consisting of phosphorus, phosphoric and phosphorous acids.
Chronic industrial phosphorus poisoning is produced by continued inhalation of the fumes of white phosphorus resulting in inflammation of the periosteum of the bone, with which necrosis and formation of new bone are associated. It attacks especially the lower jawbone (ossifying periostitis). The inflammation begins with increased flow of saliva, painful swelling of the gums, which, as it increases, brings about the death of the jawbone (necrosis, phosphorus necrosis). This becomes covered again with newly formed bone substance from the periosteum. The process ends with the formation of a fistula (a passage filled with pus), which discharges outwards, and through which the dead bone (sequestrum) is eventually cast off. Occasionally the process attacks the upper jaw, rarely other bones.
With these characteristic symptoms of phosphorus necrosis, derangement of nutrition together with anæmia, indigestion and bronchial catarrh, may be associated. Further, a general brittleness of the bones (fragilitas ossium) is observed with the result that the long bones of the leg or arm sometimes break at relatively small exertion of force; such cases from Bohemia came lately under my notice.
Some authorities regard caries of the teeth as the pre-disposing cause of phosphorus necrosis; according to this view the carious teeth constitute the means of entrance for the poison. Opposed to this so-called ‘local’ theory is the view that chronic phosphorus poisoning is a ‘general’ one. The truth may lie midway. On the one hand phosphorus necrosis probably arises partly from the general poisonous action of the phosphorus, and on the other from local inflammation which leads to the occurrence of local symptoms. The general symptoms of chronic phosphorus poisoning described above support this view, especially the effect observed on the bones of the skeleton. This view is also strengthened by the fact that workmen with perfectly sound teeth, who had been exposed to phosphorus fumes for many years, were attacked by necrosis only when traumatic inflammation produced by chance injury was set up.
The treatment of phosphorus necrosis is surgical. Formerly the treatment recommended was to wait for formation of new bone and exfoliation of the dead bone (expectant treatment); the necrosed portions of bone were then extracted through the fistula. Recently early operative interference has succeeded in preserving the periosteum which enabled the new bone to form.
Phosphoretted Hydrogen
Industrial poisoning by gaseous phosphoretted hydrogen (PH₃) calls for attention in connection with the preparation and employment of calcium carbide (acetylene) and also of ferro-silicon.