PHOSPHORUS-FATAL DOSE. 119 In the case of a girl, æt. 13, who died on the sixth day after taking phosphorus-paste beaten up with egg, there were the usual symptoms, with severe paroxysms of vomiting and pain. The matters first vomited were observed to be luminous in the dark. There were numerous ecchymosed patches in the cellular tissue of the skin of the abdomen over the rectus muscle; these were also seen on the chest and on the diaphragm. The stomach contained a dark-colored thick fluid, like altered blood; the coats were not inflamed; and the surface of the innner coat was covered with a brownish-colored mucus which had no odor of phosphorus. At the greater curvature the surface was dotted over with numerous small dark particles, consisting of coagula of altered blood adhering to the membrane, but easily removed from it. They had the appearance of effused coagula of blood, in petechial spots. The contents. of the stomach owed their color to these little masses of blood being disseminated through them. The duodenum contained a similar liquid. The intestines presented no abnormal appearance. The liver was in an advanced state of fatty degeneration. This condition of the liver has occurred so frequently in cases of phosphorus-poisoning that it may be regarded as one of the characteristic appearances. (Guy's Hosp. Rep., 1868, p. 242.) In a case recorded by Habershon (Med.-Chir. Trans., 1857, vol. 50, p. 87), in which a woman died on the fifth day, the symptoms and appearances were similar to those above described. The phosphorus was taken in the form of paste, and it is supposed in a dose of from three to four grains. There was much ecchymosis in patches in and about the cellular tissue of the abdomen and chest. There was fatty degeneration of the liver and kidneys. The stomach contained a large quantity of fluid, like soot and water, and was covered with a tenacious bloody mucus. There was some congestion in the mucous membrane, and there was much redness with ecchymosis in the small intestines. The fatty degeneration induced by phosphorus is usually most marked in the liver, though it may extend to the kidneys, the heart, the glands of the stomach, to the muscular tissue generally, and the arterioles and capillaries. The editor has seen considerable enlargement of the liver produced within forty-eight hours of the time at which the poison was administered. The liver is usually enlarged, doughy, anæmic, and of uniform yellow or yellowish-white color. The acini are distinct. Wagner describes an interlobular hypertrophy of the connective tissue. The hepatic cells are loaded with fat. The heart and muscles generally may be soft, yellow, and of defective tenacity. In place of transverse striæ, innumerable fatglobules and granules of fat are seen with the microscope. The glandular epithelial cells of the gastric follicles, and the cortex of the kidneys, may be filled with fat-globules. Occasionally the liver is of a deep yellow color, alternating with reddish patches, simulating acute yellow atrophy of the organ. The viscera and the flesh of animals recently poisoned by phosphorus have the peculiar odor of this substance, and if the case is recent they are luminous in the dark. (Galtier, Toxicol., vol. 1, p. 184.) In a case of a woman who died while taking phosphorus medicinally it was remarked that the whole of the organs were luminous; thus indicating the diffusion of this poison by absorption. (Casper's Wochenschr., 1846, pp. 115, 135.) Fatal dose. That phosphorus is a powerful poison is proved by two cases quoted by Christison. In one, death was caused by a grain and a half in twelve days; in the other, by two grains in about eight days. The smallest fatal dose met with is in a case quoted by Galtier. A woman, æt. 52, took in divided doses, in four days, rather less than one 120 AMORPHOUS PHOSPHORUS. grain of dissolved phosphorus. The largest does taken at once, i. e. on the fourth day, is stated to have been half a grain. Symptoms of pain and irritation appeared, and the patient died in three days. The gullet, stomach, and small intestines were found much inflamed. (Toxicol., vol. 1, p. 87.) When the phosphorus is dissolved in a liquid, or when it is finely divided, as in phosphorus-paste or in lucifer-matches, its action is then more powerful, as it is in a state well fitted for absorption. In general several days elapse before a case proves fatal. Orfila met with one which terminated fatally in four hours, and Habershon quotes a case which is said to have proved fatal in half an hour. (Med.Chir. Trans., 1767, vol. 50, p. 92.) This is the most rapid case on record. Chemical Analysis.-Yellow phosphorus is a solid of waxy consistency, having a peculiar odor, and a taste resembling garlic. It is the odor and taste which prevent it from being criminally employed as a poison, and render it easy of detection in articles of food. It evolves a white vapor in daylight, and a faint bluish luminosity in the dark. It melts and takes fire at a temperature of 112° F., burning with a bright yellow flame, and producing white, opaque, acid vapors. It is not soluble in water, but it is dissolved by alcohol, ether, chloroform, and oils; and especially by disulphide of carbon. The smell which phosphorus imparts to solids and liquids is characteristic. When it has been taken in a solid form the particles may sometimes be separated as a sediment, by washing the contents of the stomach with water. These may be melted under water into one mass, either by plunging the tube containing them into hot water or by pouring hot water upon them in a glass. If a portion of the organic liquid is evaporated to dryness in the dark, the particles of phosphorus will be easily recognized by their luminosity as well as by their combustion when the surface on which the material is spread is heated. Owing to its great solubility in disulphide of carbon, phosphorus may be separated from many organic matters by digestion with this liquid. It is thus procured from flour and phosphorus-paste, or from the residue of the contents of the stomach after washing and decantation. On the spontaneous evaporation of the disulphide, decanted from the organic liquid or solid, the phosphorus may be procured in small globules or beads. These ignite when touched with a hot wire, and burn with the bright flame of phosphorus. Its vapor blackens nitrate of silver. If the phosphorus is in a state of solution or in too small a quantity to be dissolved out of the material by disulphide of carbon, its presence may be indicated by distilling the liquid containing it in the dark. The vapor appears luminous as it is condensed in a glass condensing-tube. So delicate is this process of distillation, which was first suggested by Mitscherlich, that in one experiment with the head of a single lucifer-match the luminosity appeared for half an hour in the condensing-tube. Absolute darkness is required for the success of this experiment. When taken in the form of matches, portions of sulphur, vermilion, or Prussian blue may be found in the sediment. The substance known under the name of red or amorphous phosphorus is not possessed of poisonous properties. This fact, long since announced by Liebig, has been confirmed by experiments, which, however, need revision. It has been given to animals in doses of thirty grains without causing symptoms of poisoning. In 1860 a woman, æt. 26, swallowed the composition scraped from a number of lucifer-matches made with amorphous phosphorus. She suffered no inconvenience. She procured other matches of common phosphorus, took a decoction of them in coffee, and died from the effects. Amorphous phosphorus is easily recognized by its red color and infusibility at the temperature of boiling water. When a mixture containing it is heated to about 500° F., it burns like common phosphorus, and yields similar products. It is insoluble in all liquids, and by its insolubility in disulphide of carbon it is distinguished and separated from common phosphorus. It has neither color nor taste, and is not luminous in the dark. [IODINE. Symptoms. From experiments on animals, as well as from observations of its effects on man, iodine has a strong local action as an irritant on the stomach and bowels. In large doses, it occasions a burning heat in the throat, severe pain in the abdomen, with vomiting and purging, the vomited matters having the peculiar odor of iodine, and being of a yellow color, except when any farinaceous food has been taken, in which case they are blue, or even black. The fecal matters may also contain free iodine if the poison has been taken in the solid state. Besides these symptoms, there is a great thirst, with anxiety, headache, giddiness, trembling, and convulsive movements of the limbs, and fainting, these last symptoms indicating that the poison has become absorbed. When taken for some time in small doses, it gives rise to salivation, vomiting, purging, pain in the stomach, and cramps; the pulse becomes small and frequent; there is a general wasting of the body, and it has been observed that, in this form of chronic poisoning, certain glands are liable to become affected and diminished by absorption -the breasts in the female, and the testicles in the male. Iodine produces these secondary effects (iodism), whether it is taken internally or applied externally. A woman swallowed by mistake one drachm of iodine dissolved in an ounce of alcohol. When seen soon afterwards, she complained of a violent pain in the throat or stomach, followed by retching and slight vomiting; the pulse was rapid and full, the eyes prominent and suffused. Vomiting, promoted by diluents, brought no relief to the symptoms. She became much depressed, and died on the following day. There was no examination of the body. (Prov. Jour., June 30, 1847, p. 356.) For a case of recovery after half a drachm had been taken, see Med. Times and Gaz., 1861, II., p. 669. Iodine is rarely used as poison. In 1864 an attempt was made by a woman to poison a fellow-servant by mixing tincture of iodine with food in a plate. The remarkable discoloration of the farinaceous food which it produced led to suspicion and prevented any ill effects from following. Iodine gives a blue, green, or dark color to the most organic liquids, and imparts to them a peculiar odor. It stains the skin and other organic substances yellow, the color being removed by an alkali. When in strong solution, it is corrosive, and destroys the parts which it touches; in this state it has been maliciously employed for throwing on the person. Appearances. As this is an irritant as well as a corrosive poison, the lining membrane of the gullet, stomach, and intestines is found inflamed and excoriated. In one instance the mucous membrane near the pylorus was corroded, and detached in a space of two or three inches. Analysis. The odor is in general sufficient to identify it. This may be concealed by alkalies or alkaline substances. When heated, it sublimes as a purple vapor. The addition of a cold solution of starch produces a blue color, but many substances prevent this reaction. It is very soluble in disulphide of carbon, forming a rich pink solution. The sulphide has the property of removing it from water or organic liquids in which it is dissolved. It may thus be separated for chemical examination, by decanting the watery liquid from the sulphide, which, on evaporation, leaves the iodine in crystals. Chloroform, a good solvent of iodine, may be substituted for the sulphide.] ARSENIC ACUTE POISONING. 123 METALLIC IRRITANTS. CHAPTER XI. APTER ARSENIC.-ARSENIOUS ACID. SYMPTOMS.-CHRONIC POISONING.-APPEARANCES White Arsenic.-Arsenious Acid.-This substance, when freshly prepared by sublimation, exists in the form of vitreous or glassy arsenic in semi-transparent white masses, which gradually become opaque on exposure to air and light. More commonly it is met with in commerce as the white arsenic or arsenic of shops, in the form of a white powder, not unlike flour in appearance, but visibly crystalline when examined with a lens. It is almost tasteless, and hence may be readily introduced unperceived, and in large quantites, into most ordinary articles of food and drink. It is sparingly soluble in cold water, a wineglassful of which will dissolve a fatal dose; but it is much more soluble in many other liquids. Arsenic, as it is sold to the public in small quantities, is required to be mixed either with 1-16th part of its weight of soot, which gives to it a grayish color, or with 1-32d part of its weight of indigo, and then it is blue. Sometimes, in place of indigo, ultramarine is improperly employed as a coloring. When ultramarine is used, the article is decolorized by all acid liquids, and by the gastric juice. Symptoms of Acute Poisoning.-The symptoms produced by this poison vary according to the form and dose in which it has been administered. The time at which they usually come on is generally in from half an hour to an hour after the poison has been swallowed; but they may appear earlier or much later. In a case in which sixty grains of white arsenic had been taken on an empty stomach, no symptoms appeared for two hours; in another, that occurred to Lachèse, in which a large dose was taken, there were no symptoms for seven hours. (Ann. d'Hyg., 1837, vol. 1, p. 344. See also Med. Chir. Rev., 1854, p. 294.) And in a third their appearance was protracted for ten hours. [Dr. Wood cites a case where a drachm had been swallowed, and the symptoms of poisoning were delayed for sixteen hours. (U. S. Dispensatory, 1865, p. 26.)] The maximum period yet known is eighteen hours. (Seidel.) In all cases in which arsenic enters the system from without, as by its application to the skin, or to ulcerated or diseased surfaces, the symptoms are rarely manifested until after the lapse of some hours or even days. The person first experiences a feeling of sinking or faintness, depression, nausea followed by sickness, with an intense burning pain in the region of the stomach, usually but not invariably increased by pressure. The pain in the abdomen becomes more and more severe; and there is violent vomiting of a brown turbid matter, mixed with mucus, and sometimes streaked with blood. These symptoms are followed by purging, which is more or less violent, and this generaily accompained by severe cramps in the calves of the legs. At the trial of Mrs. Maybrick (Reg. v. Florence Maybrick, Liverpool Sum. Ass., 1889) the absence of cramps in the calves and tenderness at the pit of the stomach was asserted to negative the con |