Memorandum to Dr. Thompson, September 19, 1925

COPY TREASURY DEPARTMENT Bureau of The Public Health Service Washington September 19,1925. MEMORANDUM FOR DR. THOMPSON: With reference to your letter of September 18th, just received requesting information regarding necrosis of the jaw. I am sorry to state that it is impossible for me to take the time to go into this thoroughly. There is so mach written about it, and it has so many angles that one could almost write a volume about it alone. I am leaving in an hour for an inspection trip through the West, and the best I am able to do is to send you some of the best books we have, with a notation on the outside cover as to where the information may be found. With reference to the question as to which race is most fre- quently affected, I am sorry to say it is impossible for me to give this information. However, I believe that in the near future this section will be able to compile some data along this line, as within the next month we will have a dental officer placed at Ellis Island, and it is hoped that while performing his other duties there he may be able to compile considerable information regarding certain diseases of the various races, which I am sure has never been written up before. Necrosis of the bone is death of the bone en masse, and occurs under widely different conditions, and of course in any part of the body where there is bony tissue. Inflamation first invoives the periosteum, and then extends to the bony tissue itself. This, of course, establishes an osteitis. It is possible that the inflam- mation can begin within the bone, as in the case of an osteomyelitis in a long bone, or as an abscess in the alveolar bony structure or maxillary bones. When inflammation such as this starts, it spreads to the periosteum at a later date. At the time of the inflammation, an exudate is thrown out which becomes coagulated and renders the central portion of the swelling harder than the surrounding tissues, which are also swollen. In the hard central portion of this area, there is a stoppage of the circulation. Thenever this stoppage of the circulation is widespread and long continued, and especially where it involvos the bone, there is nearly always death of that part of the bone which is in- voived. This cannot be thrown off immediately, but remains attached to the living bone for a time until the activity of the healthy bone makes a permanent line of demarkation. This is followed by a contraction of the healthy bone close around the dead portion, by which it is finally loosened. This dead portioniwhich is thus exfoliated is called a sequestrup. Then the dead portion may be removed, sometimes in pieces, and sometimes in one single piece. Usually there are no after-results, and healing takes place readily after this sequestrum is removed. In cases where teeth are lost with the alveolar process, the latter is never reformed, and often this makes quite a deformity in the mouth where large pieces of bone and teeth are lost from necrosis. Etiology. Necrosis of the jaw bone, I believe, is most frequently caused by death of the pulp and the formation of an alveolar abscess. It may result as an injury such as a blow or a kick - anything that could cause a fracture. It could be caused from arsenical poisoning, in giving treatments with arsenic, and last but not least by any means, syphllis should be mentioned as a cause of necrosis. I wish I could go into this further for you, but I hope that with what I have written above and what you can find in the books which I am sending OV you will be able to help Dr. Bean in this matter. C.T. Messner Dental Surgeon (R)