Phossy jaw, formally known as phosphorus necrosis of the jaw, was an

occupational disease An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalen ...

affecting those who worked with white phosphorus (also known as ''yellow phosphorus'') without proper safeguards. It was most commonly seen in workers in the

match A match is a tool for starting a fire. Typically, matches are made of small wooden sticks or stiff paper. One end is coated with a material that can be ignited by friction generated by striking the match against a suitable surface. Wooden mat ...

stick industry in the 19th and early 20th centuries. It was caused by white phosphorus vapor, which destroys the bones of the jaw. Modern

occupational hygiene Occupational hygiene (United States: industrial hygiene (IH)) is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from hazards at work that may result in injury, illness, or affect the well being of work ...

practices have since eliminated the working conditions that caused this disease.

Symptoms

Those with phossy jaw would usually begin suffering painful

toothache Toothache, also known as dental pain,Segen JC. (2002). ''McGraw-Hill Concise Dictionary of Modern Medicine''. The McGraw-Hill Companies. is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the t ...

s and swelling of the

gums The gums or gingiva (plural: ''gingivae'') consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health. Structure The gums are part of the soft tissue li ...

. The pain was characterized as "persistent yet progressive ... spreading to neighboring teeth and jawbone". Over time, pus formation developed penetrating the oral mucosa with the formation of

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

, tooth loss, and recurrent

abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends ...

es. Further progression led to the formation of sequestrum (dead bone that has separated from living bone) after three months and

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated diges ...

of the jaw within six months. The distinguishing feature of this disease was the eventual separation of the

sequestrum A sequestrum (plural: sequestra) is a piece of dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication (sequela) of osteomyelitis. The pathological process is as follows: * infection in ...

which was described as porous and light in weight. The lower jaw was more commonly affected than the upper jaw. Affected bones glowed a greenish-white colour in the dark. The condition also affected the brain, provoking seizures in some chronic cases.

Treatment

Treatments included topical antimicrobials, conservative

debridement Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy. I ...

of sequestra and surgery. Surgical removal of the afflicted jaw bones could save the patient; otherwise, death from organ failure would follow. The disease was extremely painful and disfiguring to the patient, with dying bone tissue rotting away accompanied by a foul-smelling

discharge Discharge may refer to Expel or let go * Discharge, the act of firing a gun * Discharge, or termination of employment, the end of an employee's duration with an employer * Military discharge, the release of a member of the armed forces from ser ...

. Removal of the jaw bone also had serious effects on patients' ability to eat, leading to further health concerns including

malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...

Diagnostic imaging

The clinical features appear first, pain in the teeth and jaw, abscesses, etc. as described above. Once the clinical changes occur, and the problem is made known, a doctor or dentist could see changes in the jaw bones through radiographs or X-rays. The sequestra, the part or parts of the bone that dies and breaks off are light in terms of weight and yellow to brown in color. Thus phossy jaw can be clearly demarcated from similar entities by radiographs. In radiographs, the sequestra present as a typical worm-eaten appearance similar to a pumice stone. Sequestra appear

osteoporotic Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...

and decalcified. Separation of the dead bone from the surrounding bone appears clearly demarcated in the radiographs.

History

Discovery

The first case of phossy jaw was diagnosed by Friedrich Wilhelm Lorinser, a doctor of Vienna in 1839. The patient was a female Viennese matchstick maker who had been exposed to the phosphorus vapors over a five-year period. He named the disease "Phosphorimus chronicus". In 1844, Lorinser reported 22 cases of phossy jaw, and established the toxic effects of white phosphorus in matchsticks.

International and national legislation and public organisations

Europe

The Grand Duchy of Finland, part of the Russian Empire, in 1872, was the first country to place an absolute ban on the manufacture, use, and sale of white phosphorus in matches, followed by Denmark in 1874 and France in 1897. In Great Britain, a ban on white phosphorus matches became effective on January 1, 1910. The international association for labor legislation, an international conference, met at Berne, Switzerland, in 1906 and pledged to prohibit the manufacture, importation, and sale of white phosphorus matches. This treaty was signed by Finland, Denmark, France, Switzerland, Luxemburg, Italy, the Netherlands, and Germany, in what is considered as the first international attempt to ban an industrial product.

United States

Phossy jaw was publicized by the American Association for Labor Legislation, whose secretary, John B. Andrews, began investigating the disease in 1909 and found more than 100 cases. This report was published in the ''Bulletin of the Bureau of Labor''. The White Phosphorus Match Act of 1912, signed by President

William Howard Taft William Howard Taft (September 15, 1857March 8, 1930) was the 27th president of the United States (1909–1913) and the tenth chief justice of the United States (1921–1930), the only person to have held both offices. Taft was elected pr ...

on April 9, 1912, required manufacturers who used white phosphorus to register with district collectors of internal revenue and to file periodic notices and returns; levied a tax of two cents per hundred matches; and required makers of white-phosphorus matches to affix

revenue stamp A revenue stamp, tax stamp, duty stamp or fiscal stamp is a (usually) adhesive label used to designate collected taxes or fees on documents, tobacco, alcoholic drinks, drugs and medicines, playing cards, hunting licenses, firearm registration ...

s to the matchboxes.

Asia

Russia placed a heavy tax on white phosphorus matches in 1892 which was doubled in 1905. By 1906 the production of white phosphorus matches had been reduced to one match in every fifty. India and Japan banned the use of white phosphorus in 1919 after the United States, followed by China's ban on white phosphorus usage in match production in 1925.

Match industry

White phosphorus was the active ingredient of most matches from the 1840s to the 1910s. Concern over phossy jaw contributed to the London matchgirls strike of 1888, and although this strike did not end the use of white phosphorus,

William Booth William Booth (10 April 182920 August 1912) was an English Methodist preacher who, along with his wife, Catherine, founded the Salvation Army and became its first " General" (1878–1912). His 1890 book In Darkest England and The Way Out o ...

and

The Salvation Army The Salvation Army (TSA) is a Protestant church and an international charitable organisation headquartered in London, England. The organisation reports a worldwide membership of over 1.7million, comprising soldiers, officers and adherents col ...

opened a match-making factory in 1891 which used the much safer, though more expensive,

red phosphorus Elemental phosphorus can exist in several allotropes, the most common of which are white and red solids. Solid violet and black allotropes are also known. Gaseous phosphorus exists as diphosphorus and atomic phosphorus. White phosphorus Whit ...

.Fact and fiction about Salvation Army history
salvationarmy.org.au The Salvation Army also campaigned with local retailers to get them to sell only red phosphorus matches. However, it was not until the use of white phosphorus was prohibited by the international

Berne Convention The Berne Convention for the Protection of Literary and Artistic Works, usually known as the Berne Convention, was an international assembly held in 1886 in the Swiss city of Bern by ten European countries with the goal to agree on a set of leg ...

in 1906, and these provisions were implemented in national laws over the next few years, that industrial use ceased.Phossy jaw
Rootsweb.com. Retrieved on 2018-04-12.

Mechanism of action of white phosphorus

In phossy jaw patients, the forensic evidence suggested the conversion of yellow phosphorus to potent amino bisphosphonates by natural chemical reactions in the human body. Yellow phosphorus has a simple chemistry; when combined with H₂O and molecules from respiration and some amino acids such as lysine, bisphosphonates result.

Links to bisphosphonates

A related condition, bisphosphonate-associated osteonecrosis of the jaw (BON), has been described as a side-effect of amino-bisphosphonates, a class of phosphorus-based drugs that inhibit bone resorption and are used widely for treating

osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...

, bone disease in

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

and some other conditions. BON, sometimes called "bis-phossy jaw", is primarily associated with the use of

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

bisphosphonates in the treatment of cancer. The percentage incidence of BON from this use is approximately 1000 times higher than the incidence of BON caused by the use of oral bisphosphonates.

References

{{DEFAULTSORT:Phossy Jaw Phosphorus Occupational diseases Osteonecrosis