PHOSPHORUS. 
233 
§ 287.] 
become swollen and painful; but in a considerable number of cases the 
symptoms are not at once apparent, but are delayed from one to six 
hours—rarely longer. The person’s breath may be phosphorescent 
before he feels in any way affected, and he may go about his business 
and perform a number of acts requiring both time and mental integrity. 
Pain in the stomach (which, in some of the cases, takes the form of 
violent cramp and vomiting) succeeds ; the matters vomited may shine 
in the dark, and are often tinged with blood. Diarrhoea is sometimes 
present, sometimes absent; sleeplessness for the first night or two is 
very common. The pulse is variable, sometimes frequent, sometimes 
slow ; the temperature in the morning is usually from 36-0° to 36-5°, in 
the evening 37° to 38°. 
The next symptom is jaundice, as was observed in the following 
23 cases :—In 1 within twenty-four hours, in 3 within thirty-six hours, 
in 3 within two days, in 11 within three days, in 1 within four days, 
in 1 within five days, in 1 within nine days, in 1 within eighteen 
days, and in 1 within twenty-seven days ; s© that in about 78 per 
cent, jaundice occurred before the end of the third day. Out of 26 
cases, in which the patients lived long enough for the occurrence of 
jaundice, in 3 (or 11 per cent.) it was entirely absent. In 132 cases 
recorded by Lewin, Meischner, and Heisler, jaundice occurred in 65, 
or about 49 per cent. ; but it must be remembered that in many of 
these cases the individual died before it had time to develop. The 
jaundice having thoroughly pronounced itself, the system may be con¬ 
sidered as not only under the influence of the toxic action of phosphorus, 
but as suffering in addition from all the accidents incidental to the 
retention of the biliary secretion in the blood ; nor is there from this 
point any special difference between phosphorus poisoning and certain 
affections of the liver—such, for example, as acute yellow atrophy. There 
are retention of urine, sleeplessness, headache, frequent vomiting, painful 
and often involuntary evacuations from the bowels, and occasionally skin 
affections, such as urticaria or erythema. The case terminates either by 
acute delirium with fever, followed by fatal coma, or, in a few instances, 
coma comes on, and the patient passes to death in sleep without delirium. 
In this common form there is in a few cases, at the end of from twenty- 
four to thirty hours, a remission of the symptoms, and a non-medical 
observer might imagine that the patient was about to recover without 
further discomfort; but then jaundice supervenes, and the course is as 
described. Infants often do not live long enough for the jaundiced 
stage to develop, but die within twenty-four hours, the chief symptoms 
being vomiting and convulsions. 
§ 287. Haemorrhagic Form. —The symptoms set in as just detailed, 
and jaundice appears, but accompanied by a new and terrible train of 
events — viz. great effusion of blood. In some cases the blood has been 
