A side benefit of white phosphorus is that white phosphorus smoke is toxic and readily penetrates protective mask filters. Phosphorus smokes are generated by a variety of munitions. Some of these munitions such as the MA25 (155-mm round) may, on explosion, distribute particles of incompletely oxidized white phosphorus.
These weapons are particularly nasty because white phosphorus continues to burn until it disappears. If service members are hit by pieces of white phosphorus, it could burn right down to the bone. Remove quickly all clothing affected by phosphorus to prevent phosphorus burning through to skin. If this is impossible, plunge skin or clothing affected by phosphorus in cold water or moisten strongly to extinguish or prevent fire. Then immediately remove affected clothing and rinse affected skin areas with cold sodium bicarbonate solution or with cold water. Moisten skin and remove visible phosphorus (preferably under water) with squared object (knife-back etc.) or tweezers. Do not touch phosphorus with fingers! Throw removed phosphorus or clothing affected by phosphorus into water or allow to bum in suitable location.
Cover phosphorus burns with moist dressing and keep moist to prevent renewed inflammation. It is neccessary to dress white phosphorus-injured patients with saline-soaked dressings to prevent reignition of the phosphorus by contact with the air. Systemic toxicity may occur if therapy is not administered. Therapy consists of topical use of a bicarbonate solution to neutralize phosphoric acids and mechanical removal and debridement of particles.
A Wood’s lamp in a darkened room may help to identify remaining luminescent particles. The early signs of systemic intoxication by phosphorus are abdominal pain, jaundice, and a garlic odor of the breath; prolonged intake may cause anemia, as well as cachexia and necrosis of bone, involving typically the maxilla and mandible (phossy jaw).
The presenting complaints of overexposed workers may be toothache and excessive salivation. There may be a dull red appearance of the oral mucosa. One or more teeth may loosen, with subsequent pain and swelling of the jaw; healing may be delayed following dental procedures such as extractions; with necrosis of bone, a sequestrum may develop with sinus tract formation. In a series of 10 cases, the shortest period of exposure to phosphorus fume (concentrations not measured) that led to bone necrosis was 10 months (two cases), and the longest period of exposure was 18 years.
White phosphorus fume causes severe eye irritation with blepharospasm, photophobia, and lacrimation; the solid in the eye produces severe injury. Phosphorus burns on the skin are deep and painful; a firm eschar is produced and is surrounded by vesiculation. Signs and symptoms include irritation of the eyes and the respiratory tract; abdominal pain, nausea, and jaundice; anemia, cachexia, pain, and loosening of teeth, excessive salivation, and pain and swelling of the jaw; skin and eye burns. Phossy jaw must be differentiated from other forms of osteomyelitis. With phossy jaw, a sequestrum forms in the bone and is released from weeks to months later; the sequestra are light in weight, yellow to brown, osteoporotic, and decalcified, whereas sequestra from acute staphylococcal osteomyelitis are sharp, white spicules of bone, dense and well calcified. In acute staphylococcal osteomyelitis, the radiographic picture changes rapidly and closely follows the clinical course, but with phossy jaw the diagnosis sometimes is clinically obvious before radiological changes are discernible. It is good dental practice to take routine X-ray films of jaws, but experience indicates that necrosis can occur in the absence of any pathology that is visible on the roentgenogram.
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