Phosphorus Necrosis of the Jaw: A Present-day Study: With Clinical and Biochemical Studies

Abstract

A historical note on the aetiology of phossy jaw shows that present-day knowledge is little greater than it was a century ago. The varied clinical course of the disease is described together with a report of 10 classical cases not previously reported. Six cases, not amounting to true necrosis but in which healing after dental extraction was delayed, are described, and mention is made of the noticeable differences in the oral state and appearances of tartar of healthy workmen exposed to phosphorus compared with healthy workmen not exposed. But no systematic differences of any kind were found in the incidence of general infections, fractures of bones, haematological findings, and biochemical studies of blood and urine in two groups of healthy men most exposed and least exposed to phosphorus in the same factory. An intensive study in hospital of a case of classical necrosis showed no departure from normal, except delayed healing following bone biopsy from the iliac crest, and a reversed polymorphonuclear/lymphocyte ratio. In the discussion the time of onset of necrosis after first exposure to phosphorus, clinical and radiological diagnosis, the organisms present, personal susceptibility, the appearance of the sequestra, and regeneration of bone are considered. An up-to-date note on prevention of the disease is given, although this has met with only partial success. Some persons are highly susceptible and, whilst complete protection is impossible in the light of our present knowledge, early diagnosis and modern treatment have robbed the disease of its terrible manifestations of Victorian times and turned it into a minor, although often uncomfortable complaint, with little or no resulting disability. Phossy jaw, or phosphorus necrosis of the jaw, has been described as the most terrible of the industrial diseases, and, indeed, its fearsome ap-pearance in Victorian times with a reported 20% mortality in Europe was the sharpest spur to international industrial legislation. It has often been said that the Berne Convention, forbidding the use of white (yellow) phosphorus in the match industry, which Great Britain ratified in 1906, is the supreme example of how legislation can wipe out an industrial disease. But a little reflection will question the truth of this, for other industrial diseases cannot similarly be legislated out of existence and in fact phossy Consultants to the Group. tDeceased October 1961.