PHOSPHORUS. 
§ 301-1 
243 
healthy, or a little congested only. The pancreas has also been found 
with its structure in part replaced by fatty elements. 
Of great significance are also the fatty changes in the general muscular 
system, and more especially in the heart. The muscular fibres of the 
heart quickly lose their transverse striae, which are replaced by drops 
of fat. Probably this change is the cause of the sudden death not 
infrequently met with in phosphorus poisoning. 
In the lungs, when the phosphorus is taken in substance, there is 
little “ naked-eye ” change, but Peris, 1 by manometric researches, has 
shown that the elasticity is always decreased. According to experiments 
on animals, when the vapour is breathed, the mucous membrane is red, 
congested, swollen, and has an acid reaction. 
In the nervous system no change has been remarked, save occasion¬ 
ally haemorrhagic points and extravasations. 
§ 301. Diagnostic Differences between Acute Yellow Atrophy of 
the Liver and Fatty Liver produced by Phosphorus. —0. Schultzen 
and 0. L. Piess have collected and compared ten cases of fatty liver 
from phosphorus poisoning, and four cases of acute yellow atrophy of 
the liver, and, according to them, the chief points of distinction are as 
follows :—In phosphorus poisoning the liver is large, doughy, equally 
yellow, and with the acini well marked ; while in acute yellow atrophy 
the liver is diminished in size, tough, leathery, and of a dirty yellow 
hue, the acini not being well mapped out. The “ phosphorus ” liver, 
again, presents the cells filled with large fat drops, or entirely replaced 
by them ; but in the “ atrophy ” liver the cells are replaced by a 
finely nucleated detritus and through newly formed cellular tissue. 
Yellow atrophy seems to be essentially an inflammation of the intra¬ 
lobular connective tissue, while in phosphorus poisoning the cells become 
gorged by an infiltration of fat, which presses upon the vessels and 
lessens the blood supply, and the liver, in consequence, may after a 
time waste. 
There is also a clinical distinction during life, not only in the lessening 
bulk of the liver in yellow atrophy, in opposition to the increase of size 
in the large phosphorus liver, but also in the composition of the renal 
secretion. In yellow atrophy the urine contains so much leucin and 
tyrosin, that the simple addition of acetic acid causes at once a precipitate. 
Schultzen and Eiess also found in the urine, in cases of yellow atrophy, 
oxymandelic acid (C 8 H 8 0 4 ), but in cases of phosphorus poisoning a nitro- 
genised acid, fusing at 184° to 185°. 
According to Maschka, grey-white, knotty, faecal masses are found in 
the intestines in yellow atrophy, but never in cases of phosphorus poison¬ 
ing. In the latter, it is more common to find a slight intestinal catarrh 
and fluid excreta. 
1 Deutsch. Archiv f. klin. Med., Bd. vi. lift. 1, 8. 1, 1809. 
