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ETIOLOGY OF PHAGEDENIC PERICEMENTITIS. 977

It may here be said that cases occur in which the usual types are
variously combined, and Avhich cannot very certainly be assigned to
either one or the other class. These will generally be old chronic
cases of calcic inflammation which have been in progress for many
years, and in which the gum tissues have been brought to so low a
state of vitality that they no longer resist the encroachments of the
ordinary micro-organisms of the mouth and are continually invaded
by them. In these cases some wide pockets may be seen by the side
of the roots of the teeth, but there is a more general Avasting of the
tissues and a more dilapidated appearance of the whole apparatus of
mastication. In this class of cases it is common to see nearly all of the
teeth loose — perhaps very loose—at one time, none, or very few, having
been lost, all being held by the thickening of the tissues of the apical
space. This state of things is characteristic of the last stages of general
calcic inflammation of the peridental membrane and gums, and is sel-
dom or never seen in the phagedenic variety.
Another point should not be overlooked. It sometimes happens that
a case of alveolar abscess simulates the form of phagedenic pericemen-
titis so closely as to cause a mistake in diagnosis. In this case an
abscess occurs at the root of a tooth from the previous death of the
pulp and consequent apical pericementitis, and the pus, instead of being
discharged by any of the more usual routes, eats its way along the side
of the root and is discharged at the margin of the gum. In this process
the peridental membrane is destroyed over one side, or a portion of the
side, of the root, forming a narrow pocket in some cases very much
resembling the very deep pockets of phagedenic pericementitis. If in
such cases it is remembered that when pockets of such magnitude are
formed by the disease in question there are very sure to be other points
of attack in the neighborhood, it will do much to clear up the diagnosis.
The absence of these should always rouse a suspicion that the case may
be one of alveolar abscess and lead the inquiry in that direction.
Of the ETIOLOGY of phagedenic pericementitis we have no very defi-
nite information. It seems most probable that the disease is caused and
maintained by the presence of some peculiar fungus or form of micro-
organism and that it is infectious. Some years ago I thought I had
detected a form of fungus that stood in a causative relation to it, but
further study has placed the matter in such doubt that I prefer to con-
sider it as not proven. Others have also pointed out a seeming causa-
tive connection of certain forms of micro-organisms with the disease.
Dr. Arkoevy of Buda-Pesth says : ^ *' There constantly occurs a cer-
tain fungus-formation which I find in close connection with the wasting
of the alveoli and gingival margin, as well as the subsequent loosening
of the teeth ; it is quite different from leptothrix buccalis, although it is
in developmental relation with it." Dr. Arkoevy seems to think that
the fungus stands in causative relation to the disease. Dr. Joseph Islai,
of the same place, has also studied this fungus, and expressed a similar
conviction. Dr. Adolf Witzel of Essen, Germany, describes the disease
as " infectious alveolitis " and considers it to be primarily of the alveolar
borders. He says : ^ " We have, in fact, to deal neither with an ulceration
'International Medical Congress, London. '^British Journal, 1882.
Vol. I.—62