PHOSPHORUS. 
§ 299-] 
241 
may be seen by the naked eye twelve hours after the fatal dose. The 
liver is mostly large, but in a case 1 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. 
In the museum of the Royal College of Surgeons there is a prepara¬ 
tion (No. 2737) of the section of a liver derived from a case of phosphorus 
poisoning. 
A girl, aged 18, after two days’ illness, was admitted into Guy’s 
Hospital. She confessed to having eaten a piece of bread coated with 
phosphorus paste. She had great abdominal pain, and died on the 
seventh day after taking the phosphorus. A few hours before her death 
she was profoundly and suddenly collapsed. The liver weighed 66 ozs. 
The outlines of the hepatic lobules were very distinct, each central vein 
being surrounded by an opaque yellowish zone ; when fresh the hue was 
more uniform, and the section was yellowish-white in colour. A micro¬ 
scopical examination of the hepatic cells showed them laden with fat 
globules, especially in the central parts of the liver. 
The microscopic appearances are also characteristic. In a case of 
1 This case, from the similarity of the pathological appearances to those pro¬ 
duced by yellow atrophy, deserves fuller notice :—“ Frances A. Cowley, aged 20, on 
her own admission, took some rat-paste on Tuesday, June 19th. Death ensued 
eleven days later. The initial symptoms were not very marked. Nausea and 
vomiting continued with moderate severity for a few days and then ceased. There 
ensued a feeling of depression. Towards the end insensibility, icterus, and somewhat 
profuse metrorrhagia supervened. At the necropsy the skin and conjunctivse were 
observed of a bright yellow colour. There was no organic disease save of a recent 
nature, and entirely attributable to the action of the poison ingested. The stomach 
contained about three-quarters of a pint of dark claret-coloured fluid, consisting 
largely of blood derived from capillary haemorrhage from the mucous membrane. 
There was no solution of continuity of the mucous membrane, which showed traces 
of recent irritation. The whole surface presented a yellow icteric tint, except the 
summits of some of the rugae, which were of a bright pink colour. There was also 
faint wrinkling of the mucous membrane. The upper part of the small intestine was 
affected in much the same manner as the stomach. The large intestine contained a 
quantity of almost colourless faeces. The liver was shrunken, weighing only 26 ozs., 
and both on its outer and sectional surface exactly resembled the appearances pro¬ 
duced by acute yellow atrophy, except that there were greater congestion and inter¬ 
stitial haemorrhage in patches. The lobules of the liver were in many places unrecog¬ 
nisable ; in others they stood in bold relief as brilliant canary-yellow patches, standing 
in strong contrast to the deep dark red areas of congestion and extravasation. The 
gall-bladder contained about 2 drachms of thin greyish fluid, apparently all but devoid 
of bile. The urinary bladder was empty ; the kidneys were enlarged ; the cortex 
was very pale and bile-stained, of greater depth than natural, and of softer consistence. 
The spleen was not enlarged, nor was it in the least degree softened. In addition 
to the bleeding from the uterus noticed during life, there was capillary haemorrhage 
into the right lung and pleura, into the pericardium, and, as already mentioned, 
into the stomach. The brain was healthy.” 
16 
