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By F. H. Pritchard, M.D. , Weaver's Corners, Ohio


This drug occupies an important place in the treatment of chronic nephritis; but what form of the disease is it capable of causing pathogenically?

Kobert (Lehrbuch der Intoxikationen, p. 421, Stuttgart, 1893), that master of toxicology, states that in cases of poisoning, in the last few days of the patient's disease, which usually is a matter of five to eight days, his entire appearance is essentially altered. His whole body is decidedly icteric, and many portions of the skin, especially that of the  back, are covered with petechiae. The urine, in case anuria does not set in, presents large numbers of casts, especially of the granular variety, with fat globules, cell detritus, red blood-corpuscles, leucin, and tyrosin, undoubted signs of fatty degeneration. This fatty degeneration is one of the most characteristic actions of this powerful drug upon the organism.

As Lenzmann (Ueber einige den Arzt interessierende Nierengifle und die durch dieselben hervorgebrachten Veraenderungen der Nieren. Festschrift zur Feier des 50 jaehrigen Jubilaeums des Ver. d. Aerzte des Reg. - Bez. Duesseldorf, p. 159) says, it is very probable that an inflammatory irritation precedes this fatty degeneration, for if death occur very rapidly, only hyperaemia and swelling of the kidneys are found.

Ribbert (Nephritis und Albuminurie) has found in rabbits, after administration of small doses of phosphorus, as an incipient stage of fatty degeneration, a characteristic glomerulo-nephritis, with swelling and desquamation of the epithelium of the glomeruli.

At any rate, after good-sized doses, the kidneys present a picture which is stated by Lenzmann to be macroscopically that of acute scarlatinal nephritis. The cortex is increased in size, soft in consistency, and the color varies from whitish to yellow.

Microscopically the epithelia are discovered either to be partly lying in the lumen of the urinary caniculi, or partly adherent to their walls, and chiefly having undergone fatty degeneration. 

 The urine is usually scanty, contains albumin and bile-pigments ; the quantity of urea is subnormal.
 L.W.  Faglund (Om fosforfoergiftningar I Finland, Festskrift fran pathologisk-anatomiska institutet, Helsingsfors, 1890), also found, in poisoning by phosphorus, the kidneys showing the uriniferous tubes with epithelium undergoing cloudy  swelling or distinct fatty degeneration, and containing numerous small drops of oil.


 In both men and animals the administration of very small doses of phosphorus for months gives rise to an actual cirrhosis of the liver with ictreus, as well as to a cirrhotic state of the kidneys, which is not to be distinguished from true contracted kidney. - (Wegener, Aufrecht, Koenig, etc., cited by Kobert, I. c.).


 This is an indication that the remedy might be found homoeopathic to biliary hypertrophic cirrhosis of the liver (Hanot's disease), which is sometimes followed by cirrhosis after a preliminary hypertrophic stage.

This pathological picture would lead one to regard phosphorus as indicated, homoeopathically, in amyloid degeneration of the kidneys, post-scarlatinal nephritis, especially the less severe cases, if it be indicated, though chronic parenchymatous nephritis would appear to correspond more especially to its pathological results, and above all, in the form of the disease which is known as the large white kidney of Wilk's, in which the organ is enlarged, the surface white, with the stellate veins injected and the capsule thin.

Osler (The Principles and Practice of Medicine, p. 747) thus describes the organ pathologico-anatomically: "On section the cortex is swollen and yellowish-white in color, and often presents opaque areas. The pyramids may be deeply congested. On microscopial examination it is seen that the epithelium is granular and fatty, and the tubules of the cortex are distended, and contain tube-casts. Hyaline changes are also present in the epithelial cells. The glomeruli are large, the capsules thickened, the capillaries show hyaline changes, and the epithelium of the tuft and of the capsule is extensively altered. The interstitial tissue is everywhere increased, though not to an extreme degree".

He describes a second variety, the the small white kidney, which may either result from increase in the connective tissue and the subsequent shrinkage, or occur as a primary independent form. The capsule is thickened and the surface is rough and granular. On section the resistance is greatly increased, the cortex is reduced, and presents numerous opaque, white, or whitish-yellow foci, consisting of accumulations of fatty epithelium in the convoluted tubules. This combination of contracted kidney with areas of marked fatty degeneration has given the name of small, granular, fatty kidney to this form. The interstitial changes are marked, many of the glomeruli are destroyed, the degeneration of the epithelium in the convoluted tubules is wide-spread, and the arteries are greatly thickened.

A third variety as described by him, and where phosphorus would be indicated, is chronic haemorrhagic nephritis, in which the the organs are greatly enlarged, yellowish-white in color, and in the cortex are many brownish-red areas, due to haemorrhage in and about the tubes.

Bonino (Primi Studi di Materia Medica, p. 276, Turin, 1893) claims phosphorus to be indicated in amoyloid kidney as well as in chronic nephritis with fatty degeneration of the the kidneys, together with a similar state of the heart and liver.

Dr. J. H. Freer (North Amer. Jour. Homoeopathy, Oct., 1890), reports the case of an elderly lady, whom he had previously treated for acute nephritis with uraemic convulsions, and who consulted him on account of irregular heart's action. Especially after fatigue would her heart become embarrassed in its action, and she would have a sensation of suffocation, attended with and followed by irregular and tumultuous action of the heart. A microsopical examination of the urine revealed nothing abnormal except an abundance of oil globules. Phosphorus was prescribed on the strength of their presence alone, and it relieved the cardiac symptoms.

Dr. Oscar Hansen, of Copenhagen, in a paper read before the International Homoeopathic Congress at Atlantic City (North Amer. Jour. Homoeopathy, September, 1891), on the homoeopthic treatment of Bright's disease, regarded phosphorus as one of the most important remedies. It is indicated when the disease is secondary to suppuration, and especially caries (amyloid kidney). When pneumonia complicates it is our best remedy. The characteristic symptoms are: lassitude in the whole body, hands and feet icy, sleepiness. The fatigue is greatest in the morning. Heat in the body without thirst, particularly in the evening; indisposed to work, giddiness, forgetfulness, heavy headache, particularly in the forehead; oedema of the upper eyelids, mist before the eyes, complexion pale, yellowish-gray; sickly oedema of the face; want of appetite; pressure and burning of the stomach; diarrhoea without pain, but weakening and light in color. Frequent passing of water at night, but of a small quantity at a time. The urine is watery and light-colored. Serous expectoration from the lungs is an important sign for phosphorus; fear and anxiety, asthma. Oedema about the ankles. If there is a tuberculous base to the affection, phosphorus is important; likewise when there is weakening of the heart-muscle. If during the disease diarrhoea occur without pain, phosphorus is to be commended with china.

Haematuria has frequently been reported cured by this remedy. Burt (Physiological Materia Medica, p. 710, Chicago, 1883) states that it has made many brilliant cures of haematuria, with much pain in the renal region, especially after sexual excesses. The pathological state, both of the blood and of the blood vessels themselves, produced by this drug favours haemorrhages, from all parts, into the mucous membranes, from the orifices, into the organs and even beneath the skin, in the form of petechiae. The blood is profoundly affected, becoming very dark, losing its power of coagulation and apparently suffering in its corpuscular elements, for ecchymoses are almost universal,  and haematine crystals are occasionally found in the viscera. "In the case of Concato the white corpuscles were observed to be increased in number and the red to be diminished in size and altered in form" (Dr. H. C. Wood, Therapeutics Materia Medica and Toxicology, Philadelphia, 1874). Dr. Burt cites Arnold, of Heidelberg, to the effect that numerous experiments upon animals have confirmed the observations made in phosphorus poisoning, in man, that the blood was dark, even black, and of a fluid consistency. The blood-disks become smaller, they decreased in consistency and circumference and assumed different forms. They change their forms in many ways, especially in their passage through narrow vessels and in their proportion to each other. One might say almost that the drug acts as a dissolvent upon the blood-disks. This action touches the blood-cell membrane more than the nucleus. Greater lustre, a less granular appearance, irregular and less distinctly defined outlines are the most conspicuous alterations.

According to Lunz, cited by Kobert (l.c. , p. 424), the blood-vessels of all the organs undergo not only a microscopic fatty degeneration, but also a physical alteration, i.e. , their elasticity decreases, and indeed to greater degree than in  lead poisoning. This, together with the changes in the blood, is of importance in understanding the haemorrhages seen with poisoning by this remedy.

H.C.  Wood (l.c. ,p. 92) dwells upon the important changes in the urine. Very commonly it is scanty, albuminous and sometimes contains sugar. As was first pointed out by Munk and Leyden (Die acute Phosphorvergiftung,Berlin, 1865), after ters, are always to be found in the urine. Not infrequently a cloudy sediment, consisting in part of epithelial cells, often lows, but may precede the icterus. A remarkable and seemingly constant constituent of the urine is sacro-lactic acid (H. C. Wood).
Hahnemann (cited by Burt) gives as indications for phosphorus a urine depositing either a white and cloudy sediment or it may contain one that is red and sandy.

Hering claims the remedy to be indicated in glycosuria with phthisis.

Source | The Hahnemannian monthly 1897

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Really excellent contribution, thank you very much!

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