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506 PYORRHEA ALVEOLA RIS.

tion. The gouty and rlicumatie pn^scntcd tlie disease most frecjiiently,
though its presence in those suti'eriug from diabetes and albuminuria
was extremely common. The deposition of tartar on the roots of the
teeth, which might at first glance be regarded as playing an imj)ortant
l)art in the causation of the disease, Magitot considered as accidental
and not to be looked upon as a causative agent. With reference to the
efficacy of any treatment, however, he advised the removal of the tartar
as an indispensable preliminary. The points of diagnosis differentiating
between this condition and the former, that of gingivitis, however
severe, were also clearly recognized and noted.
Following Magitot's able paper was one by Serran in 1880, in which
the author took exception to certain of Magitot's views, as well as to the
term by which the latter proposed to designate the disease. He recog-
nized, however, that the disease was most common in middle life and
occurred principally among the gouty, the diabetic, and the albuminuric.
He believed that the primary manifestation was a local congestion of
the gums, followed by an exudation into the peridental membrane which
destroyed its vitality and led to the formation of pus and all the other
symptoms and pathological conditions characteristic of the disease. A
commission composed of MM. Depres, Delens, and Magitot was ap-
pointed by the Societe de Chirurgie to consider the statements of Dr.
Serran. In this report' they denied the f/inf/ival origin of the dis-
ease, and stated their belief that the periosteal membrane and the
cementum were the primary anatomical seat of the lesion ; that the
succession of morbid phenomena completely precluded the idea of an
initial gingivitis ; that the disease begins without any trace of conges-
tion of the gums ; that after its formation the pus burrows toward the
gingival border, which it detaches—without, however, for a time de-
stroying its normal aspect ; that only after considerable augmentation
of the flow of pus and the loosening of the teeth do the gums become
implicated ; that the disease has nothing in common with the hypothesis
of a gingival malady, and that it is most frequently a manifestation of
a general state, or a diathesis.
These were the views entertained and published by French surgeons
on the nature of " pyorrhea alveolaris " about the period when the
disease began to receive consideration from American dentists. Though
pyorrhea alveolaris had long been recognized in the United States and
various observations regarding its pathology and treatment had been
published, it was not until Dr. John W. Riggs, in October, 1875, read
a paper before the American Academy of Dental Surgery, entitled
" Suppurative Inflammation of the Gums and Absorption of the Gums
and Alveolar Processes," that the disease began to attract the attention
^ Bulletins et Memoires de la Societe de Chirurgie, tome vi. p. 411.