Temperature. - Owing to capillary expansion, the superficial temperature is at first slightly raised, being subsequently diminished. Evaporation and radiation, arising from profuse diaphoresis, contribute to thermal reduction.

Eye. - In chronic poisoning from phosphorus, hemorrhages and patches of degeneration in the retina are sometimes visible; the ophthalmoscopic picture resembling the retinitis of albuminuria.

Under medicinal doses no special effects upon the eye are reported, although, as has been stated, the vapor of phosphorus is highly irritant to the conjunctivae.

Uterus. - The action of phosphorus tends to increase the menstrual flow.

Untoward Action. - Small doses produce in some individuals severe gastric disturbance, and in rare cases diarrhea, tenesmus, and jaundice. The fatty degeneration of the retinal capillaries, just mentioned - such as results from chronic intoxication affecting workers in match-factories - is an untoward manifestation to be guarded against by every available means.

Poisoning. - The effects of a fatal dose of phosphorus are not immediate. Indeed, as shown by Kionka, large doses of phosphorus may be ingested without any poisonous symptoms, but if the drug is finely divided poisonous symptoms occur. In some patients a rapid onset, thirty minutes to four hours, has been observed. Nausea, vomiting, heart weakness and coma are rapidly followed by death. This type of poisoning is occasionally observed from the use of certain abortion pills sold usually by the Chinese. In the majority of instances the protracted gastro-enteric form of poisoning occurs.

In these forms the acute symptoms subside, and the hope is raised that the patient will recover, but after a lapse of several hours or even two to three days, the symptoms of the acute stage may recur. There is great weakness, accompanied in a large majority of cases by vomiting. Abdominal pains follow, the symptoms becoming more acute, mucus and bile being present in the dejecta, which for a while retain the odor and luminosity of phosphorus. With the cessation of vomiting pain is abated, although it may extend over the entire abdominal region and even be attended with paroxysms.

The foregoing symptoms are accompanied by pronounced anorexia, thirst and fever, a thickly coated or whitish tongue, burning in the throat, and often signs of collapse. The temperature at first may be high; it subsequently sinks below the normal. After thirty-six hours or more jaundice sets in. The liver is usually swollen, and tender to pressure. The urine is diminished, becoming charged with albumin and urates, and even bloody, containing among other ingredients biliary acids and coloring-matter. In fatal cases urea is almost wholly wanting. The stools may be normal, but the general condition is usually marked by diarrhea or constipation and flatulence. Hemorrhage often occurs, wounds bleeding profusely, and as the severity of the symptoms increases delirium ensues, or coma terminating in convulsions.

Serious nervous manifestations are frequently preceded by restlessness, insomnia, headache, and vertigo. In some delirious conditions wild, erotic states of the mind are the precursors of convulsive or comatose symptoms. Somnolence is not uncommon, with partial spasms and contraction or paresis of the voluntary muscles.

In cases of acute poisoning the duration of the malady varies greatly, death occurring at times within a few days, or, again, being deferred for a few weeks. As a rule, recovery is retarded, the elimination of the drug requiring time, 1 1/2 grains (0.1 Gm.) are given as the lethal dose; 3/4 grain (0.05 Gm.) has proved fatal, and 1/4 grain has given severe symptoms.

Postmortem examination shows that the liver, heart, kidneys, muscles, capillaries, and arterioles are implicated in the general effects of the poisoning, and are undergoing fatty degeneration.

The symptoms of chronic poisoning are in some respects especially marked, inhalation of phosphorus-fumes frequently resulting in pronounced conditions of necrosis, particularly of the lower maxillary, although it has been maintained that this feature of the poisoning is contingent upon denuded surfaces of bone, disintegration or softening of tissues, caries of the teeth, or communicating wounds. Very rarely the palate and frontal bones are similarly attacked.

Treatment of Poisoning. - Emetics and purgatives are from the first necessary. Copper sulphate is the most efficient emetic as well as the best chemical antidote. Hydrated magnesia, charcoal, and lime water have been suggested, yet their action is tardy, and a more efficient antidote is desirable. Several chemical and physiological agents have been employed to counteract the effects of the drug, among them old acid (oxygenated) oil of turpentine and potassium permanganate in a 1/3 per cent. solution, opium being used as a stimulant to the heart and the circulatory system. Cathartics, such as castor oil, or other oily menstrua, are to be avoided. Some toxicologists teach the contrary doctrine.

As prophylactic measures for the protection of workmen against phosphor-necrosis, masks covering mouth and nose have been found serviceable, as well as inhalation of the vapor of turpentine, obtained by suspending a small bottle of the fluid at the neck. The teeth should be kept constantly in good condition, since caries favors the tendency to necrosis.

Therapeutics. - Phosphorus is not used externally, but internally it is a tonic, especially of the nervous and osseous systems, stimulating protoplasmic activity. According to Gubler, however, "phosphorus is a rapid stimulant, but it acts by causing waste, and not by increasing power; it impoverishes, and does not enrich; it momentarily galvanizes, as it were, the torpid functions, but is incapable of renewing a dilapidated constitution or even a nervous system exhausted by chronic disease."