Memorandum to Dr. Thompson, September 19, 1925

COPY TREASURY DEPARTMENT Buroau of The Public Health Service Washington September 19,1925. MENCRANDUM 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 mo to talce the time to go into this thoroughly. There is so much 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 em 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- quontly affected, I am sorry to say it is impossible for me to give this information. However, I bolieve 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 dontal officer placed at Ellis Imland, 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 beon written up before. Necrosis of the bone is death of the bone en masse, and occurs undor widely different conditions, and of course in any part of the body where there is bony tissue. Inflamation first invokves the periosteu, and then extends to the bony tissue itsoli. This, of courso, 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 inflamation such as this starts, it spreads to the periosteum at a later date. At the time of the inflamration, an exulate is thrown out which becomes coagulated and renders the contral portion of the swelling harder than the surrounding tissues, which are also swollen. In the hard contral portion of this area, there is a stoupage of the circulation. Whenever this stoppage of the circulation is widespread and long continued, and especially where it involves the bone, there is nearly always death of that part of the bone which is in° vokvod. This cannot be thrown off innediately, 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 pertion.which 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 takos place readily after this sequestrum is removed. In cases where teeth are lost with the alveolar process, the latter is never reformed, and ofton this makes quite a deformity in the mouth where large pieces of bone and teeth are lost from necrosis. Etiology. Necrosis of the jew 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 enuse a fracture. It co' be caused from arsenical poisoning, in giving treatments with arsenic, and last but least by any means, syphllis should be mentioned as a cause of necrosis. I wish I could 20 into this further for you, but I ho with what I have written above and what you can find in the boolcs which I an ser you will be able to holp Dr. Bean in this matter. C.T. Messner Dental Surgeon (R)