Poisoning by this substance is more common in France than in England. In England, the deaths due to this poison are more frequently the result of accident, from the incautious use of phosphorus paste for the destruction of vermin. These pastes generally contain from 3 to 4 per cent. of phosphorus. Children have also been poisoned by sucking the heads of lucifer matches. In one case, that of a child, death followed from sucking about forty matches. It has most frequently been employed as a means of suicide, but seldom for the purpose of homicide. One case, however, occurred at the Bodmin Assizes in 1857. Kopf relates a case of a young woman, aged twenty-four, who died on the fourth day after swallowing the heads of six packets of lucifers (Allg. Wien. Med. Ztg., No. 47, 1819; Schmidt, vol. cv. p. 296). The size of the packets is not stated. In this case the bowels were confined, and the post-mortem revealed only the redness of inflammation in the stomach and bowels. Death has followed inunction of phosphorus paste.
General Characters.—There are two kinds—ordinary waxy, crystalline phosphorus, and a peculiar form known as red allotropic or amorphous phosphorus, prepared by heating waxy phosphorus to a temperature of 240° C., in an atmosphere free from oxygen. The ordinary yellow phosphorus is poisonous, the red or amorphous non-poisonous. As found in the shops, phosphorus is preserved in water in the form of translucent white or slightly yellow-coloured cylinders. It is sparingly soluble in oil, alcohol, and other hydrocarbons, but greatly so in bisulphide of carbon. White vapours are given off when it is exposed to the air, these consisting of phosphorus and phosphoric acids.
Symptoms.—Phosphorus acts as an irritant poison, but some days may elapse after the poison is taken before the injurious effects become apparent. The symptoms occur in three stages.
First stage: The patient complains of a garlic-like taste in the mouth, peculiar to poisoning by this substance. This is followed by a burning sensation in the throat, accompanied with severe pain in the stomach, and intense thirst. The belly becomes swollen, and there is vomiting, in some cases, of blood from the stomach, which may continue till death. The vomited matters are of a dark green or black colour, with an odour of garlic, and sometimes appearing phosphorescent in the dark. This condition may also be observed in the motions passed. There is intense thirst. The pulse is feeble, the countenance anxious, and the surface of the body bathed in a cold sweat. In males, priapism is not infrequent. The nervous and muscular debility is intense, and the patient may die in a state of collapse or during a fit of convulsions.
Second stage: This is a stage of intermission of the symptoms which may last for three days or more, the patient seems as if going to recover, and only suffers from general malaise. A case is recorded where the intermission lasted nine weeks. In cases proceeding to a fatal termination the intermission is followed by the third stage.
Third stage: Jaundice is the most notable symptom and rapidly increases; the liver becomes much enlarged and the abdomen distended; epigastric pain is severe and there is vomiting of grumous black material consisting of altered blood; purging may be present and the motions contain blood. There is a marked tendency for hæmorrhages to occur from the mucous membranes and subcutaneously, producing purpuric spots. The urine is diminished, high coloured, contains bile pigments, albumen, blood, and casts. There are great prostration, a quick weak pulse, sleeplessness, coldness of the surface, gradually increasing weakness, apathy, convulsions, and coma, followed by death about the fifth or sixth day.
The liver may diminish in size before death. It is rare for recovery to take place after enlargement of the liver and jaundice have supervened. It is by no means always easy to diagnose acute yellow atrophy of the liver or malignant jaundice from phosphorus poisoning. In phosphorus poisoning, the early symptoms, those of acute gastritis, are more severe, are developed more rapidly, and run their course more quickly than in acute atrophy, and there is a marked interval between these and the appearance of the jaundice; in acute yellow atrophy this interval is wanting, and from the beginning, on the contrary, there are gradual malaise, slight gastric catarrh, and jaundice. The jaundice and suffering, together with the increased action of the heart in phosphorus poisoning, are wanting in malignant jaundice, but the cerebral symptoms are more marked in the latter than in the former. Acute yellow atrophy most frequently occurs in women, especially during pregnancy. In acute atrophy leucin and tyrosin are present in the urine; in phosphorus poisoning they may occur, but generally in the urine voided just before death.
Chronic poisoning, accompanied with all the symptoms just mentioned, may result from the action of the vapour on those engaged in the manufacture of phosphorus or of lucifer matches. In persons thus employed, necrosis of the jaws and caries of the teeth are not of infrequent occurrence. The lower jaw is more commonly affected. Mr. Lyons states that this form of necrosis cannot attack persons who have perfectly sound teeth, but only those whose teeth are carious (St. Bartholomew‘s Hospital Report, vol. xii.).
Post-mortem Appearances.—Those of acute irritant poisoning, including extensive destruction of the coats of the stomach, by softening, ulceration, and perforation, terminating in gangrene. The stomach may contain a quantity of white vapour, having a strong smell of garlic. This white vapour has been noticed to pass from the vagina and anus of those poisoned by phosphorus. The blood appears to be thoroughly disorganised; the blood-cells are colourless and transparent, their colouring matter being dissolved in the uncoagulated liquor sanguinis; hæmorrhages may be present beneath the serous membranes and in the pleural and pericardial cavities, and thromboses are frequently present, due to a tendency for the blood-cells to agglutinate. In a case recorded in the British Medical Journal, 1873, fatty degeneration of the liver and kidneys was found a week after the poison was taken. In phosphorus poisoning, the liver is enlarged, of a dull appearance, doughy, uniformly yellow, with the acini well marked; in acute atrophy, the liver is diminished in size, greasy on the surface, leathery, of a dirty yellow colour, with traces only of the obliterated acini. In the former, also, the hepatic cells are either filled with oil globules or entirely replaced by them; in the latter, the cells are filled with a fine granular detritus, and their structure replaced by newly-formed connective tissue. Putrefaction rapidly supervenes on death. Hæmorrhages may be found on the surface of the brain and spinal cord, and the grey matter of the cortex and basal ganglia rose-pink in colour. Fatty changes have been found in the walls of the capillaries and the large cortical cells.
Chemical Analysis.—The smell of phosphorus is characteristic, as is also its luminosity when exposed in the dark. The following process, suggested by Mitscherlich, may be adopted for its detection: