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PHOSPHORUS                                                        487

Fatal Dose.  The smallest fatal dose recorded for an adult is one-eighth V
of a grain, but one to two grains may be regarded as an ordinary fatal dose.
An infant of five weeks is reported to have died from sucking the head of a
single lucifer match containing about one-fiftieth of a grain of phosphorus.3
Recovery has followed the doses of four and six grains of phosphorus.

Fatal Period.  Death occurs in four to ten hours if it is due to collapse ;
otherwise it usually takes place in from two to seven days, but may be
delayed for two or three weeks. Death occurs in nine to ten hours in poison-
ing by organic phosphorus compounds.

Treatment  The stomach should be washed out with a solution" of
potassium permanganate of the strength of about 10 to 15 grains to one pint
of water. ^Potassium permanganate acts as a chemical antidote, oxidizing
phosphorus, forming harmless compounds, phosphoric acid and phosphates,
and itself changing to manganese dioxide. Large doses of charcoal should
afterwards be administered.

The stomach can also be washed out with warm, water until the smell of
phosphorus disappears, and then with magnesia suspended in water or with
milk of magnesia. Two to three grain-doses of copper^iilphate may be given
every five minutes until free emesis is produced. It acts as an antidote, as
it combines with phosphorus and forms an insoluble, harmless salt, phos- '
phide of copper. Oilsjand, fats must n^er be given, for they dissolve
phosphorus and promote its absorption. Purgatives, especially magnesium
sulphate, should be given to evacuate the bowels. Moi^hine may be given
hypodermically to relieve pain. Dextrose and alkaline drinks may be given
to protect the liver and normal saline may be administered intravenously to
combat shock. Atropine may be administered subcutaneously at short
intervals in poisoning by organic phosphorus compounds.

Post-mortem Appearances.  Peteehial haemorrhages are commonly found
under the skin, which is usually yellow. 1 On opening the cavities of the l
body the smell of garlic may be observed, but this is not possible in India
owing to the rapid occurrence of putrefactive changes. \ The mucous mem-
branes of the stomach and intestines are yellowish or greyish-white in colour,
and are softened, thickened, inflamed and corroded, or completely destroyed
in patches exhibiting even perforations. Their contents may be garlicky in
odour and luminous in the dark.

The liver presents the most characteristic appearances. It is very much
enlarged, but may be normal in size or contracted. It is doughy in consist-
ence, uniformly yellow, easily friable, and contains many nsemorrhagic spots
in its substance. There is fatty degeneration of the liver cells. In acute
yellow atrophy the liver is smaller in size, greasy, leathery and of a dirty
yellow colour. Its capsule is wrinkled. The liver-cells are mostly necrosed,
and contain crystals of leucin and tyrosin.

The heart and kidneys show signs of fatty degeneration. The blood is
fluid and disorganized, the colouring matter of the haemoglobin being dis-
solved in the liquor sanguines.

Chronic Poisoning.  This form of poisoning, although rare in these days,
may occur among persons exposed to the white fumes resulting from
oxidation of white phosphorus in factories.

The symptoms are a sallow complexion, lassitude, pain in tiie               ,

nausea, vomiting,  diarrhoea, jaundice,  bronchitis, pain in the JoSSfe '' anS/y
emaciation; but the chief characteristic symptoms are caries bit ^               ' '

and necrosis of Ib&jaws, especially the lower Jaw,   It is

3.   Luff, Forew. Jfe^ VeL I, p. KL