METALLOIDS 585 



resembling poisoning from phosphorus. Mushroom poisoning (which see) 

 is an example of such toxicosis, and, of other diseases, acute yellow atrophy of 

 the liver. 



What symptoms are produced by poisoning with sticks of phosphorus? 

 A few hours after the ingestion of the poison, nausea and a tendency to vomit, 

 more rarely actual vomiting, appears; the patient is uncommonly restless; 

 jaundice, which may occur upon the first or the second day after the poison- 

 ing, indicates the severity of the intoxication. Usually we see decided enlarge- 

 ment of the liver, which may even appear a few hours after the poisoning. 

 The evidences of the hemorrhagic diathesis and fever are added to this, and 

 in a few days the patient succumbs from his suffering. In the majority of 

 cases of poisoning with phosphorus it is fatty degeneration of the heart which 

 causes death. The later jaundice appears, the more favorable the prognosis; 

 a good appetite, or even a sensation of hunger, is a favorable sign in the course 

 of phosphorus toxicosis. In the severe cases the urine contains: Biliary col- 

 oring matter and albumin; not rarely, if large amounts of grape sugar be 

 administered to the patient, sugar is also present ; that is, an alimentary glyco- 

 suria arises, a symptom which, according to my experience, is intimately con- 

 nected with the changes produced in the liver by this toxicosis. 



What is the best treatment for phosphorus poisoning? I know of but 

 one reliable remedy : Thorough gastric lavage performed at once. The earlier 

 and the more actively this is carried out the more certain the result; never- 

 theless, even cases in which enormous amounts, up to 0.7 gram, of phos- 

 phorus have been taken may terminate in recovery, as is shown by a case of 

 my own. I also use sulphate of copper, solutions of old oil of turpentine, 

 hydrogen peroxid, and potassium permanganate, and I must admit that these 

 agents produce certain favorable effects, but, as a sovereign remedy in the 

 treatment of poisoning from phosphorus, they do not equal gastric lavage, in 

 which 30 to 40 liters of water may be used, and this should be continued until 

 the fluid no longer has the faintest smell of phosphorus. The chemical proof of 

 phosphorus in the vomited material or in the feces is very easy : Two pieces of 

 filter paper are moistened, one with a solution of nitrate of silver, the other 

 with a solution of lead acetate; both are then dipped in the material to be 

 tested. If the silver nitrate portion, owing to the reduction of salt of silver, 

 shows a black discoloration, this proves that phosphorus is present. When 

 the lead portion becomes black the result is uncertain, for then the reaction 

 may have been brought about by hydrogen sulphid, and this is particularly 

 prone to occur if the feces are examined. If the test is positive, i. e., if the 

 lead portion is not blackened, certain proof is furnished that poisoning by 

 phosphorus is present. I must remark here that a positive result in the test 

 of the feces always renders the prognosis unfavorable, for this reaction shows 

 that the phosphorus has passed through the entire intestine, and so has in all 

 probability been taken up into the organism. In such cases we must endeavor 

 to eliminate the phosphorus from the intestine as rapidly as possible, the best 

 means being by the administration of an infusion of senna. Much that is 

 interesting regarding phosphorus poisoning might still be mentioned, such as 

 the relations between poisoning by phosphorus and acute yellow atrophy of 



