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TERMINOLOGY. 509

problem of the etiology of the di^sea^^e in question and has been princi-
pally concerned in determining whether it is of constitutional origin or
of local origin, or of both. Of the more important recent writings on
the subject may be mentioned those of Drs. E. T. Darby, H. H. Bur-
chard, G. V. Black, M. L. lihein, E. L\ Kirk, James Truman, Junius
E. Cravens, Louis Jack, K. K. Andrews, and R. Ottolengui.
Terminology.—No disease in the whole domain of surgery has
received so many and such diverse names as the one under consideration.
Each succeeding title was an attempt at the production of a comprehen-
sive descriptive designation of the disease, but when it is recognized
that the essential nature of the pathological processes involved is, even
now, not fully made out, it is evident that the many names simply
represent as many diverse views and can therefore have no permanency,
nor do they, indeed, deserve any.
The following is a fairly complete list of the synonyms of the dis-
order : Suppuration eonjointe ; Pyorrhea inter-alveolo-dentaire ; Gingi-
vitis expulsiva Osteo-periostiti-alveolo-dentaire Pyorrhea alveolo
; ; ;
Cemento-periostitis ; Infectioso-alveolitis ; Pyorrhea alveolaris ; Calcic
inflammation ; Phagedenic pericementitis ; Riggs' disease ; Hemato-
genic calcic pericementitis ; Blennorrhea alveolaris ; Gouty pericemen-
titis.
Examining the foregoing list, from the pathological point of view, it
will be observed that there is a wide divergence of opinion as to the
conditions Avhicli should be included under the generic title of pyorrhea
alveolaris.
As the term is now understood, pyorrhea alveolaris includes all of
those cases of morbid action characterized by the following features :
A molecular necrosis of the retentive structures of the teeth (their liga-
ment, the pericementum), an atrophy of the alveolar walls, together
with a chronic hyperemia of the gum tissue which leads to limited
hypertropliy. After a variable period the teetli drop out, and the mor-
bid action ceases with their loss. An examination of the roots of the
teeth before or after their exfoliation usually exhibits deposits of cal-
culi upon their surfaces. The disease is generally though not always
attended by a flow^ of pus from the alveoli.
Clinically the cases in which these phenomena are observed may be
divided into two classes : First, those in which the disease process ap-
pears to begin at the gum margin. The second class, those in connec-
tion with which there is much controversy, begin at some portion of
the alveolus between the unbroken and apparently healthy gum margin
and the apex of the root, the l)ulp of the tooth being alive. These two
conditions are so clearly ditferentiated from one another that each re-
quires a separate description. Between these two classes, but intimately