Recognition of the Causative Agent of “Phossy Jaw” and “Fragile Femur” in Fumes Arising from White Phosphorus

Hinshaw, William B.; Quin, Louis D.

doi:10.1080/10426507.2015.1071818

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…In combination with ammonia, it could produce nitrogen‐containing bisphosphonate or, with common amino acids, amino bisphosphonates. Through the circulatory system, these elements were absorbed in the bony matrix; by daily exposure, this absorption resulted in chronic poisoning that negatively affected people's health (Hinshaw & Quin, ; Marx, ).…”

Section: Resultsmentioning

confidence: 99%

Health and safety issues in the Victorian workplace: An example of mandibular phosphorus necrosis from Gloucester, UK

Valoriani

Eliopoulos

Irish

et al. 2019

Intl J of Osteoarchaeology

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Working conditions in factories during the Industrial Era in Great Britain have been linked to numerous occupational diseases. In this paper, the authors present a case study from Victorian Gloucester, where skeletal remains of a young male recovered from the Southgate Street 3/89 excavation exhibit osteonecrosis on the left mandibular ramus, a condition known as "phossy jaw." The case is examined in terms of macroscopic characteristics, distribution and severity of lesions, and differential diagnosis.The lesions consist of extensive bone necrosis with periosteal reaction and subperiosteal new bone formation that affects the left side of the mandible. Conditions that may have produced similar changes were considered and include various forms of neoplasms, actinomycosis, and taphonomic alterations. However, these are rejected as they are not supported by the lesion characteristics.Additional supportive evidence for the case of phosphorus necrosis is offered by the historical context: In the 19th century, Gloucester was one of the main centres for match manufacture, and it is well known that individuals who were directly exposed to phosphorus fumes developed a condition known as "phossy jaw."The potential contribution of the current analysis in our understanding of working conditions in Victorian Gloucester is evaluated.

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Section: Resultsmentioning

confidence: 99%

Health and safety issues in the Victorian workplace: An example of mandibular phosphorus necrosis from Gloucester, UK

Valoriani

Eliopoulos

Irish

et al. 2019

Intl J of Osteoarchaeology

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“…Analogous to the hypophosphatasia victims, who were exposed internally to excess pyrophosphoric acid, these workers were exposed to an external source of the same molecule, since the fresh smoke from burning white phosphorus has been shown [59] to consist largely of the two substances shown by Fleisch [48] to have antiresorptive properties: pyrophosphoric acid and mixed polyphosphates. The details of this interesting analogy have been presented [60] elsewhere.…”

Section: Establishing a Meaningful Definition Of Causationmentioning

confidence: 99%

The Causation of “Bisphosphonate-Associated” Atypical Femur Fractures

Hinshaw¹

2020

BJSTR

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The last decades of the 20 th century saw the development of intense research programs directed toward the reduction of low-trauma fracture risk by the use of preventative medications. It is not the intention here to recite the history of these efforts, as these have been amply described elsewhere. After the turn of the century, it became apparent that the introduction of the bisphosphonate medications for the purpose was associated with a number of unfortunate consequences. Among these number the appearance of unanticipated necrosis of the mandible and/or maxilla and similarly unanticipated (or almost unanticipated) spontaneous fractures of the subtrochanteric femur. There followed a vigorous response by the medical community to these cataclysmic events. This response was exemplified by the convening, after a number of years of case-reports multiplying in the literature, by the American Society of Bone and Mineral Research, of select groups of concerned physicians and scientists tasked with evaluating the origins of these problems.At no time did these so-called Task Forces acknowledge clearly and unambiguously that the preponderance of evidence was consistent with the cause of these dramatic effects being the associated use of the bisphosphonate drugs. The purpose of this opinion paper is to show that the problem of assigning causation, a conundrum which has resulted in contrary opinions of many eminent philosophers, has indeed been convincingly elucidated in a manner that has received acceptance and recognition in the field of applied medicine, and furthermore, to show the application of this technique to the question of the causation of the effects "associated" with the bisphosphonates, with particular reference to the femur fractures mentioned above.

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“…A third analogy can be found in the history of phosphorus chemistry. In the mid-19 th to early 20 th centuries, mid-femoral fractures occurring with no trauma were observed in factory conditions where there was exposure to smoke and fumes from accidental white phosphorus fires [97,98]. This smoke contains a significant amount of pyrophosphate [97,98].…”

Section: Causality Of Bisphosphonate-related Fracturesmentioning

confidence: 99%

Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

Hinshaw¹,

Schneider²

2017

BJMMR

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Recognition of the Causative Agent of “Phossy Jaw” and “Fragile Femur” in Fumes Arising from White Phosphorus

Cited by 7 publications

References 31 publications

Health and safety issues in the Victorian workplace: An example of mandibular phosphorus necrosis from Gloucester, UK

Health and safety issues in the Victorian workplace: An example of mandibular phosphorus necrosis from Gloucester, UK

The Causation of “Bisphosphonate-Associated” Atypical Femur Fractures

Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

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