Cocaine and Al Capone
To the Editor:
As the medical consultant for Laurence Bergreen's biography of Al Capone, I would like to respond to Robert Sabbag's comments (Letters, Sept. 18), which are somewhat misleading.
The controversy centers on the etiology of a perforation of the nasal septum described by Dr. Raymond M. Ritchey during an examination of Capone at the Federal prison on Alcatraz on June 4, 1938. Capone was known to have acquired syphilis some time before the examination and demonstrated physical and behavioral signs of general paresis due to neurosyphilis.
Perforation of the nasal septum is a common feature of late congenital syphilis. It is an uncommon feature of late acquired syphilis. The perforation of the septum is the end result of syphilitic osteochondritis and is a rather intense inflammatory response, with formation of a gumma that eventually breaks down and leaves a hole in the septum surrounded by inflammatory margins. It involves the bones and cartilage of the rest of the nose, the soft palate, the hard palate or the skull sinuses. X-ray plates of Capone's sinuses revealed no evidence of disease.
As the medical consultant for Laurence Bergreen's biography of Al Capone, I would like to respond to Robert Sabbag's comments (Letters, Sept. 18), which are somewhat misleading.
The controversy centers on the etiology of a perforation of the nasal septum described by Dr. Raymond M. Ritchey during an examination of Capone at the Federal prison on Alcatraz on June 4, 1938. Capone was known to have acquired syphilis some time before the examination and demonstrated physical and behavioral signs of general paresis due to neurosyphilis.
Perforation of the nasal septum is a common feature of late congenital syphilis. It is an uncommon feature of late acquired syphilis. The perforation of the septum is the end result of syphilitic osteochondritis and is a rather intense inflammatory response, with formation of a gumma that eventually breaks down and leaves a hole in the septum surrounded by inflammatory margins. It involves the bones and cartilage of the rest of the nose, the soft palate, the hard palate or the skull sinuses. X-ray plates of Capone's sinuses revealed no evidence of disease.
Septal perforation due to cocaine results from topical, local vasoconstrictive action of cocaine, which shuts down the blood supply to areas of the nasal septum that the drug touches. Since cartilage does not regenerate, the perforation does not heal. The inflammatory response is much less intense (ischemicnecrosis), and the condition in my experience is largely asymptomatic.
The description of Capone's nasal septum by the examining physician, the normal sinus X-rays, plus the lack of clinical problems associated with the finding, strongly suggest occasional cocaine use as the most logical etiology. JACK SHAPIRO, M.D. West Bloomfield, Mich.
The description of Capone's nasal septum by the examining physician, the normal sinus X-rays, plus the lack of clinical problems associated with the finding, strongly suggest occasional cocaine use as the most logical etiology. JACK SHAPIRO, M.D. West Bloomfield, Mich.
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