Two Cases of Poisoning by Phosphorus
Authors: F. W. Willmore
Journal: BMJ (1878)

be mapped out; the impulse was indistinct; the sounds were natural the lungs were normal, except for slight emphysema.The abdomen was much distended, of spherical form, rising three or four inches above the level of the sternum, and measured forty-seven and a half inches in circumference at the umbilicus.Fluctuation was distinct * the super- ficial abdominal veins were somewhat distended.The liver dulness appeared to reach the lower border of the fourth rib, in the right mam- mary line.Neither liver nor spleen could be felt in the abdomen.There was slight pitting oni pressure over the legs.The urine was scanty, acid, of specific gravity 1,012, free from albumen.The tem. perature, pulse, and respiration were normal.The abdomen was directed to be bandaged with a wide flannel roller.She was ordered to take mistura rubra, one ounce, three times a-day.November I5th.The ascites was considerably diminished.The abdominal walls were quite flaccid and thin.The liver-dulness did niot extend two fingers-breadth in the right mammary line.The general .onditionwas improved.December 6th.The abdomen was greatly diminished in size; it was flaccid and pendulous.There was no distinct fluctuation wave now, but there was dulness in both flanks, whilst the summit of the abdomen was resonant.There was still slight pitting over the feet and legs.She was directed to continue the abdominal pressure.December 20th.The patient was now up ; the abdomen had not enlarged since she had left her bed.There was no oedema of the feet.She still had the kidney look observed on admission.For the last two months, she had passed, on an average, sixty-five ounces of urine daily, of pale colour, specific gravity varying between I,OIO and i,015, and, though repeatedly examined, it had never contained albumen.The patient was now allowed to go home and attend as an out-patient.Whilst she continued under observation there was no recurrence of the ascites.The only medicine she took throughout her residence in the hospital was the mistura rubra of the London Hospital Pharrnacopcria (burnt sugar and water).It will be seen that in the first case alluded to the ascites was very great, and the vital condition of the patient brought very low from mal. assimilation.The appearance of the leg, with the absence of any history of intemperance (the latter not a very valuable indication in the case of a woman, it is true), suggested the possibility of syphilis causing the disease of liver which gives rise to the ascites.Without adopting this view, I thought it right to give the patient the advantage of the doubt, and accordingly administered iodide of potassium until the patient was fully under its influence.The ascites certainly diminished during the time the patient was taking the drug, but the diminution continued, it will be observed, when it was replaced by some quinine and iron, given as a general tonic, and was, no doubt, due to the rest in bed.I cannot ascribe any specific action to the iodide of potassium, therefore, and the patient never subsequently had any symptoms suggestive even, of syphilis.Between March and May, it will be noticed, the patient made no progress.Her dropsy remained stationary.She passed at this time about forty ounces of urine daily.The idea suggested itself to me, as it had often previously,