PHOSPHORUS.
FACE.
►
Objective. ► Hippocratic
face, [Preceding death. -Hughes.] [25].
► His features had a sort of fixity,
which impressed upon his physiognomy a singular air of sadness, languor,
and wandering of mind (seventh day), [56].
► Countenance fixed and anxious, [232]. [750.]
► Expression, when aroused, that of
profound bewilderment (sixth day); the expression of bewilderment and
confusion which came over his face was frequently painful to behold
(tenth and eleventh days), [217]. ► Sleepy expression, with complete
consciousness (tenth day), [177]. ► Countenance peritonitic, [43]. ► Face
pinched (eighth day), [115]. ► Features contracted and the countenance
had an air of stupidity (fourth day), [165].
► *Face sunken, earthy; eyes deepseated,
hollow, surrounded by blue rings (after six, and seven
hours), [6]. ►
Falling in of the features (fourth day), [173].
► *Expression of general weakness,
[97]. ►
Countenance expressive of pain (fifth day), [161]. ► *Pale,
sickly expression, in the evening, [10]. [760.] ► *Pale sickly color of the face (after
eight days), [1]. ► Face pale, eyes sunken, surrounded by
blue rings (second day), [8]. ► Deathly pale, with cool skin and
suppressed pulse, only 20 (not followed by death), [173]. ► *Pale,
yellow face, [1]. ► Patient very pale, [214]. ►
Sudden remarkable paleness of the face, with chilliness, colic, and
headache (after twelve days), [1].
► *Face pale, earthy, sunken
(third day), [109]. ► Pale and thin, and has an anxious look, [104]. ►
Pale; features slightly changed (second day), [100]. ► *Face
pale, [13], [77]; (third day), [113], [114];
(after ten hours), [140], [157]. [770.]
► *Face pale, sunken, [203]. ►
Marked pallor of the face, [119]. ► *Icteric color of the face (fourth
day), [155]. ► *Yellow color of the face, [218]. ►
Face the color of old parchment (tenth and eleventh days), [217]. ►
Yellowish hue to the face, [125]. ► Alternating redness and paleness of the
face (fourth day), [114]. ► Redness of the face, [4]. ► Face
red and congested, [79]. ► Face very red, [149]. [780.]
► Face red and of an anxious
expression, [178]. ► Face greenish red (eighth day), [103]. ►
Face dark leaden-colored, not jaundiced (fifth and sixth days), [140]. ►
In the morning the face was red, in the afternoon the turgescence had
increased (second day); turgor of the face heightened, and in the
afternoon it had assumed a remarkable bluish-red color, from which,
however, the middle of the face was perfectly free; a colorless band of
about an inch in breath, extended from the highest point of the forehead
to the chin, and was sharply defined, giving the face a most peculiar
appearance (third day); the bluish-red color of the face had changed
into a perfectly cyanotic hue, the median line remaining free from all
color (fourth day), [101]. ► Flushing of face during fever, [52]. ►
Rush of blood to the face, with a feeling as if it were distended, in
the open air, disappearing in the house, [10].
► *Face swollen and œdematous,
[121]. ►
Much swelling of the face, [122]. ► *Puffiness of the face, [1]. ►
Face somewhat puffy (second day), [220].
[790.] ►
*Face pale, puffy, [159].
► Puffiness of the side of the face
upon which he has been lying, [4].
► Tension of the whole skin of the
face, [1]. ► Subjective. ►
Burning in the face, about the nose and upper lip, as from something
acrid, [1]. ►
Warmth creeps over the upper portion of the face with increased redness,
with obscuration of the eyes, [6].
► *Tearing pains in the face, [38a]. ►
Tearing in the bones of the face and temples, as if everything would be
torn out, constantly increasing till 8 P.M., [10]. ► Aching
in the facial bones, [1]. ► Cheek and Upper Jaw. ► Frequent livid flush over left cheek, [81]. ►
Excessive, almost bluish redness of the cheeks, without sensation of
heat, at 8 A.M., [8]. [800.] ► Cheeks red (third day), [142]. ►
Swelling of the right cheek, corresponding to three carious upper teeth
with expected necrosis of the jaw; after a few days, however, it had
entirely disappeared, [201]. ► Swelling of the cheek (third day); became
much larger, harder, and painful, and extended over the left side of the
throat (fourth day), [173]. ► Swelling of the cheek and gum without
pain, [1]. ►
Twitching of the muscles of the cheeks, [1].
► Twitching in the left malar bone,
disappearing after rubbing, [10]. ► Pressive pain in the malar and maxillary
bones and teeth, especially on chewing, swallowing food, and on going
from a cold into a warm room, [1].
► Tearing in the malar bone, [10]. ►
Tension in the malar bones, as if they would be forcibly pressed towards
each other, disappearing on rubbing, [1].
► A stitch in the left cheek, [1]. [810.]
► Necrosis of the left upper jaw,
with hectic fever, sleeplessness, entire loss of appetite, [187]. ►
On the upper jaw of the right side there is likewise partial necrosis,
as the probe can be passed over a portion of bare bone. Considering the
extent of the disease, and the consequent drain to the system, he enjoys
tolerable health, [75]. ► At the end of three years her face began
to swell and she then left the business; the swelling gradually
increased, and she entered the hospital; several teeth were extracted,
with but little relief; she appears to have repeatedly left and returned
to the hospital, with the swelling continuing, until at last an abscess
formed in the superior maxillary bone, which left it carious, [65]. ►
Violent pain in right upper jaw, which was soon succeeded by swelling
and abscess of the gums; eight teeth in succession became rapidly
carious and were removed; this had some effect on the swelling, but it
soon increased again, extending to the cheek and part of the neck;
according to the patient’s account, the suppuration at the commencement
had a strong odor of Phosphorus. Pregnancy appeared to have proved
favorable to the disease, but on new examination, there was found to be
a necrosis of the superior maxilla, [63].
► About two years before her entrance
into the hospital, she began to have severe pain in the second molar
tooth of the left upper jaw. The tooth was carious and was removed, but
the wound always remained open, though the pain ceased. Seven months
before her entrance, there was swelling affecting the whole gum on that
side, and extending inwards to a considerable extent over the roof of
the mouth. Soon after this, there was a discharge of pus from the
alveolus of the tooth, and also from the left nostril, and this state of
things continued, the swelling not having diminished since the abscess
first broke. Soon after the tooth became affected, one of the others
became loose and painful, and was extracted. Meantime the left cheek had
become unnaturally full. Three months later the alveolar process was
found to be diseased, and all the remaining teeth of that maxilla were
extracted except the two incisors and the wisdom tooth. Several pieces
of dead bone were removed and the antrum was found to be in
communication with the mouth. Two months later, the jaw became again the
seat of pain, which in the course of a month became so great as to
prevent sleep. On entrance, there was much swelling, soreness, and pain
about the gum and roof of mouth. The middle incisor remained, but was
quite loose. The antrum was open, and there was a good deal of
semi-purulent offensive discharge, [93].
► Pain in the left upper jaw, with
swelling of the upper lip; the pain afterwards disappeared for awhile,
but the lip remained swollen; several abscesses formed in the mouth,
discharged matter between the teeth, and the patient had some of the
back teeth drawn and experienced relief from pain for a time, but
afterwards it considerably increased and the gum became swollen, so that
the mouth could scarcely be opened and the bone became denuded, [69]. ►
Gums began to soften and swell, violent pains in the teeth of the upper
jaw followed, with swelling extending over the whole cheek; the teeth
becoming carious, fell out, and a fetid suppuration proceeded from the
sockets; on examination, the bone was found largely diseased, [64]. ►
Lips. ► Upper lip swollen,
every morning, [1]. ► Eruption on the red of both lips, at
times with stitches, [1]. ► Deep crack in the middle of the lower lip,
[1]. [820.]
► Painful blisters as large as peas,
filled with lymph, on the inner surface of the lower lip, [2]. ► Painful
ulcer on the inner surface of the lower lip, [1]. ► *Lips
parched (fifth day), [161].
► Lips and face pale, [129]. ► Lips
very dark (eighth day), [115]. ► Dryness of the lips and palate, without
thirst, [10]. ► Lips blue, [13].
► Lips livid (seventh day), [56]. ►
Lips dry all day, [10]. ► Skin about both lips rough, [1]. [830.]
► Numbness of the right side of the
upper lip and of the tip of the tongue (first day), [42b]. ► Heat
in the lips, that were denuded of epithelium (after seven hours), [140]. ►
Burning, like fire, of both lips, [10].
► Burning pain on the red of the
lower lip, with white blisters on its inner surface, with burning pain
(after eleven days), [1]. ► Burning stitches on the margin of the
upper lip, while sitting, [10]. ► Chin. ►
Gradually a red swelling appeared on the under part of the chin; at
first it was the size of a four penny piece, and quickly enlarged until
it extended over the face as far as the eyes; except upon the chin,
however, the swelling remained pale and doughy; upon the original
swelling of the chin there was found a group of pustules of the size of
hempseed and larger, which, after discharging their thin turbid
contents, formed an ulcer the size off a six pence; at the same time the
parts beneath became disorganized into a thin, slightly discolored
offensive purulent mass. A disagreeable smell also emanated from the
mouth; the gums and teeth, particularly the front teeth of both jaws,
became loose from salivation, which set in at the same time, and the
child, from the commencement of the affection, complained much of
toothache and headache. Within eight days the ulcer had destroyed the
soft parts, even to the bone; after the use of remedies for ten days,
three thin pieces of bone, the size of a bean, detached themselves from
the surface of the lower jaw at the chin, and on the following days
other small very thin fragments of bone were observed upon the lint;
upon this the sanious discharge was arrested; the surface of the ulcer
became clearer and began to discharge a thin pus, and to form
granulations; three weeks after the exfoliation, the ulcer was
cicatrized, [74]. ► Suffered much from violent toothache,
accompanied with considerable swelling of the right side of the face; he
had a double tooth extracted, but without relief; the affection
progressed so quickly that in a short time he ceased to be able to
follow his employment; one tooth after another dropped out; he became so
weak that he was unable to work; a swelling of the size of an egg formed
below the right orbit, which in a fortnight burst, discharging a large
quantity of white pus; he continued to get worse, all the teeth having
fallen out, the gums of the lower jaw retracted, and he now presents the
following appearance. The right cheek is considerably swollen; at the
right angle of the lower jaw exists an opening, discharging laudable
pus, through which the probe can be passed a couple of inches along bare
bone, two inches anterior to this there is another aperture likewise
leading to dead bone; on opening the mouth, the whole of the lower jaw,
as far as the ascending rami and down to the reflection of the mucous
membrane on the cheek, is quite dead, denuded, and of a leaden-grayish
color, [75]. ►
Closure of the jaws so that she could not separate the teeth, [1]. ►
Trismus, [148]. ► Glandular swelling of the articulation of
the lower jaw, [4]. [840.] ►
Inferior maxillary bone completely denuded of soft parts, and its
surface grayish, rough, rugous, and covered with a fetid suppuration.
After remaining a month, she left the hospital, and died soon after, [62]. ►
Out of eighty-eight cases reported, in thirty-two the upper jaw, in
thirty-eight the lower jaw, and in ten both jaws were affected, [87]. ►
Necrosis of the inferior jaw with all the ordinary symptoms, with
removal of the jaw and recovery, [183].
► Necrosis of the jaw, with
œdematous swelling of the face and neck, [189].
► Necrosis, preceded by great pains,
in the lower jaw, [188]. ► Necrosis of the jaw, during the progress
of which the patient was attacked with the most violent erysipelas,
which threatened her life, [186]. ► Seized with toothache, and swelling on
the right side of the lower jaw; to relieve it the gums were lanced,
and, finally, the tooth extracted; after this the pain ceased, but the
swelling gradually increased, until a spontaneous opening formed on the
under side of the jaw, with a discharge of pus, which has continued
since; she remained in the factory until one week previous to her
admission into the hospital. Upon examination after her admission, the
inferior maxilla was found necrosed on the right side, and partially on
the left; the jaw was painful, and that side of the face swollen; the
discharge was at times profuse, and apart of it took place through the
buccal cavity, rendering it very annoying; her appetite was good, but
mastication difficult and painful; the necrosis gradually extended, but
her general health continued good, [98].
► Two years ago he began to be
troubled with carious teeth: the three molars on the left side of the
lower jaw became so painful that he was obliged to masticate on the
right side exclusively. Afterwards the teeth on the right side pained
him, and he was forced to employ the left ones again. Two months ago he
took cold, and after a few days, he found a swelling about the left side
of the lower jaw, accompanied with pains in the bone, extending to
different parts of the head and face. He had three teeth extracted,
which were rotted away at their crowns, but their fangs were entire. At
the time of his admission, the three remaining incisors were quite
loose; entire gum on left side swollen and spongy; fetid pus escaping on
the slightest pressure, from the previous site of the extracted teeth; a
probe passed into these openings strikes on bare bone; over these parts
there was considerable exterior swelling; pulse quick and feeble;
general strength impaired; face puffy and very pallid; sleep disturbed
by pain in the jaws and general articular pains. The pain and swelling
increased on the right half of the face, speedily bringing it into the
same condition as the half first affected. The ulceration of the gum
over the diseased alveoli advanced; and as the several openings became
confluent, the alveolar margin of the bone became exposed. The soft
parts rapidly retracted from the surface of the bone, and the denudation
became every day more complete, and its exposure was attended with a
copious and most fetid suppuration. From then until now the only
difference that has occurred has consisted in the gradually advancing
isolation of the bone, [82]. ► Began to suffer with toothache in the
right side of lower jaw; this lasted for some time, and was followed
soon by a hard lump upon the outside of the jaw; the pain continued to
increase and the swelling to enlarge until an abscess formed in the
submaxillary region, and burst, and discharged a large quantity of
purulent matter. Upon introducing a probe into the discharging orifice,
I found that it led directly to the jaw, which was deprived of its
periosteum and in a necrosed condition; there was, however, no
indication that exfoliation had taken place from any part of the jaw,
but, on the contrary, the whole bone was firm and solid. At this time
the disease seemed to extended only from the right lower canine tooth to
the angle of the same side of the jaw. Later he presented himself in a
condition much worse than before, now from weakness and exhaustion he
had been forced to give up his occupation. All the teeth upon the right
side of the jaw have loosened and fallen out; besides several openings
upon the outside of the face, that were freely discharging pus, there
were two or three inside of the mouth, from which there issued a large
quantity also, and which led directly to the diseased bone. The disease
now seemed to involve the whole of the right side of the lower jaw,
without there being made the least attempt, seemingly, by the periosteum
to replace the dead bone with a new casing of osseous deposit such as
usually forms in ordinary cases of necrosis; nor was there any
disposition to exfoliate or to form a sequestrum, but on the contrary
the whole jaw was as firm and solid as at the time when it was first
examined. His constitution had now become seriously affected, as he was
much emaciated and weakened by the great drain of pus that was
constantly poured forth from the diseased parts. Later, in the mouth can
be felt and easily seen the denuded jaw for an extent of two inches. His
breath smells very offensively. The disease now extends from the right
temporal-maxillary articulation to the left lower canine tooth. He
cannot eat solid food, though his appetite is tolerably good, [104]. ►
During the last half year she had occasionally suffered from toothache
on the right side of the lower jaw. In a few months it became more
severe and ceased to be limited to the carious teeth, and extended
through the whole jaw, over the cheek, and even to the temporal region
and the neck. At the same time considerable febrile disturbance, with
occasional rigors, supervened, accompanied by swelling of gums and cheek
with erysipelatous redness of the latter. On admittance, the examination
showed the right cheek much swollen, and very tense towards the eye, the
mouth, the chin, and neck; the tenderness most considerable in the
vicinity of the lower jaw. Pain deepseated, throbbing, piercing,
concentrated at the angle of the jaw, and radiating thence over the
adjacent soft parts. Extreme tenderness on pressure. The gums of the
diseased side of the jaw much swollen, tense, darkened, and tender; the
mucous membrane of the cheek equally so; between the angle of the jaw
and first molar, fetid pus of a phlegmonous character oozed out on
pressure. The first and fourth molars on the right side of the lower jaw
were carious, the other molars deficient. The swelling of the gums
increased, became more tense, extended to the soft palate; dysphagia and
salivation supervened, and the jaw became almost immovable. Suppuration
increased, pus laudable, but fetid. During the second week, the four
incisors and one molar became loosened, suppuration ichorous and rusty,
gums softened and livid, formation of sinuses on the external and
internal surface, through which the probe reached the bone, which
appeared in part rough, in part smooth. In the progress of the disease,
increased retraction of gums from the alveolar surface, fresh abscesses,
increased discoloration, and burrowing sinuses, so that the entire jaw
was exposed to the probe, both externally and internally. The bone
appeared almost entirely detached from the soft parts, floating in an
excessively sanious fluid, [81]. [850.] ►
The disease appeared to commence by a swelling in that part of the jaw
whence a tooth had been extracted two years before; the swelling
continued to extend until the entire bone became affected. He said that
he had suffered great pain through the entire jaw, and that his nights
had been sleepless. He looked very ill, was much emaciated, and he
presented a curious appearance of the mouth, which was pursed up into a
round aperture in consequence of the protrusion forward of the enlarged
jaw. There were two fistulous openings, one on each side of the upper
part of the neck; and a probe introduced struck the angle of the jaw,
which was quite dead. I examined the mouth and found the jaw quite dead.
I could distinguish every part of the bone except the condyles, which
were imbedded in soft tissue. There was a large quantity of fetid
discharge around the bone, but the principal part came from the vicinity
of the condyles. The outside of the cheeks about the masseteric regions
was much thickened. The teeth were all gone, and the appearance of the
jaw was that from an edentulated cranium, [124].
► Toothache in the left lower jaw,
formation of an ulcer on the side of the middle back tooth with violent
pains; as the ulcer opened a piece of bone was discharged; at last the
cheek became swollen and erysipelatous and
abscesses formed, which discharged much matter; the necrosis
of the bone progressed until the whole half of the lower jaw had to be
removed, [70]. ► A carious molar of the right side of the
lower jaw was extracted; from this time (seven months since) the
peculiar Phosphorus necrosis may be said to have fairly begun, and it
progressed rapidly, for the subject of it was compelled to give up the
charge of his department about a fortnight after the tooth was drawn.
The face was very much deformed by indurated swelling, which was
particularly conspicuous on the right side and about the chin; three
fistulous openings, surrounded by flabby granulations, were upon the
right side of the neck; from these fetid pus exuded freely; a horribly
offensive odor came from the mouth, and saliva and pus were constantly
dribbling out; the gums were spongy on the margin, but partook of the
general induration at the sides; four sound but loose teeth occupied the
right alveolar cavities; the upper jaw seemed healthy; the patient could
not part the two jaws sufficiently to introduce a finger with facility;
a probe detected necrosed bone both on examination in the mouth and
through the sinuses; the examinations gave excessive pain; a portion of
the left lower jaw only seemed clear of the disease; the symphysis was
completely involved, [152]. ► The disease seems first to attack the gum
of diseased teeth; it usually makes its appearance in a year or a year
and a half after beginning work in the factory; it is still questionable
whether the disease is due to Phosphorus, Phosphoric acid, or to the
ozone generated by the Phosphorus, or even whether it may not be due to
general chronic Phosphorus poisoning. The lower
jaw was affected in nine cases out of ten, the upper jaw in
one case; the disease very seldom spread from the upper jaw to the bones
of the face. The first symptom was tensive pain in the teeth, then
looseness of the teeth and discharge of matter between the gum and
teeth; if now the teeth be drawn the swelling and pain increase and
involve the whole half of the jaw; usually the disease progresses slowly
and irregularly, with transient periods of improvement; the soft parts
covering the jaws, cheeks, sides of the mouth, become swollen and
intolerably painful; one tooth after another becomes loose, and every
pressure upon the gum causes discharge of pus; the pus often is
discharged through the cheek externally. The skin of the margin of the
lower jaw becomes red, soft, loosens, and at last infiltrated; from this
infiltration there follows a discharge of matter that seems to come from
the alveolar process; wherever the opening is probed denuded bone is
found; at the same time it is found that the periosteum that has been
loosened from the bone has a new deposit of bone on its inner surface,
so that the sound passes between two surfaces of bone, one consisting of
old bone, the other of new growth; the denuded bone decays in various
directions and is gradually discharged with the matter. ► After two or three years these necrosed
pieces of bone separate from the whole extent of the jaw. ► With this the patient suffers from fever,
at times violent, considerable emaciation; nutrition is very much
disturbed on account of the difficulty of swallowing, and the digestion
suffers on account of the mixture of offensive matter with the food;
sleep at night is possible only by means of increasing doses of Morphia,
and the patient gradually sinks with hectic and exhaustion. During the prostration tuberculosis frequent develops;
at times also lobular pneumonia, terminating in gangrene of the lung and
pyohæmia, [180]. ► The Phosphorus disease of the jaw
consists in the first stage of an inflammatory swelling of the gum and
soft parts of the mouth, extending over the face and neck, associated
with the development of masses of osteophyte of varying extent and
thickness about the jaw; in the second stage the teeth become black, the
gum recedes, the osteophytes suppurate, and the jaw becomes denuded,
rough, and blackish or grayish-green, and the teeth fall out; this stage
is associated with the most violent pain in the face and head,
disturbance of digestion, sleeplessness, fever, salivation, fistulous
burrowing of the matter in the muscles and integuments of the face,
which became erysipelatous, followed by exfoliation of the bone, and
sometimes by extension of the necrosis to all the bones of the skull,
and death with hectic fever, [87].
► Necrosis of the jaw; the disease
begins as toothache, involving one or more teeth in the upper or lower
jaw; the disease spreads to the jawbone, which increases in volume and
becomes painful to pressure; afterwards the soft parts become swollen,
especially the gums and cheeks, in the latter erysipelatous inflammation
develops, even extending over the whole side of the face and down on to
the neck; the patients have fever, yellow color of the skin, especially
of the face, loss of appetite, thirst, irregular stools; the pain at
last extends to the ear and temple, with increased secretion of saliva.
Various teeth become loose, and between them there is a discharge of
offensive matter, that collects in various parts of the jaw under the
gum or under the skin externally, and gradually makes its way into the
mouth or through the skin, usually by a number of circuitous channels.
The teeth fall out, the jaw becomes denuded, and the necrosis either
becomes circumscribed or involves the whole jaw, [72]. ►
Diseases of the gums and maxillary bones, terminating in necrosis and
sometimes in death, were not uncommon; the complaints only appeared
after a sojourn in the factory for at least two years, and in
individuals habitually exposed to the fumes; all the workmen whom he had
observed had decayed teeth before the disease commenced, not
unfrequently before commencing the manufacture; many other workmen with
sound teeth have preserved them in the midst of phosphoric vapors, a
fact which induces him to believe that carious teeth constitute a
predisposing cause of the disease, [67].
► The disorder at first resembled
ordinary toothache, attended however, with swelling of the face; as the
severity of the symptoms increased she became a patient at the Royal
Infirmary, but derived little benefit from the treatment; six months
later all the teeth on the right side of the lower jaw fell out, or were
removed without difficulty, before the jaw was removed, and on the left
side as far as the second bicuspid, all the teeth were sound. There is a
great deal of new callus thrown out in the situation of the old bone, so
much so that there will be scarcely any disfigurement from the loss of
the jaw, a little from the loss of the teeth; she can close her jaw and
chew her meat and bread well; the bone and teeth of the upper jaw are in
a perfectly healthy state, and she now enjoys excellent health, [86]. ►
Scrofulous subjects are most affected, and in them the disease is most
fatal; almost all the girls employed have the gums more or less
affected, and at their junction with the teeth a red ulcerated line,
like that produced by mercurial salivation, is apparent. When the
individual is robust and the necrosis is confined to a small portion of
the bone, exfoliation takes place and a gradual cure follows, but where
there exists any tendency to scrofula, phthisis becomes developed, and
the patient sinks under the combination, [68].
► Sharp pain and difficulty when
masticating, in the middle of the left jaw (first day), [173]. [860.]
► Pressure, drawing, and tearing in
the lower jaw, extending towards the chin, [10]. ►
Jerking in the lower law, almost like toothache, [1]. ► Violent
drawing in the lower jaw, [1]. ► Tearing in the right lower jaw, extending
from the mental foramen backward (first day), [42b]. ►
Tearing in the maxillary bones, in the evening, while lying down,
disappearing on eating and moving the jaw, [1]. ► A
violent stitch in the middle of the left lower jaw, extending deeply
through the cheek and eye, to the forehead, [10].® 2000
Article