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GOUTY PERICEMENTITIS. 519

tory of one of these disorders. Careful investigation by several other
observers has brought to light similar testimony, particularly within
the past three years (Kirk, Darby, Burchard, Jack, and others).
It had been noted by succeeding generations of practitioners that the
therapeutic resources (local) of dentistry were insufficient to eitlier check
or cure the disease condition. All local means of treatment having
been exhausted and shown to be of little or no avail, there was a natural
inquiry into the exact nature of the predisposing and exciting causes of
the malady, so that the therapeusis might be placed upon a rational basis.
No purely local causes having been found sufficient to account for
the dental condition, all constitutional states which were known to
affect tlie teeth or their alveoli were examined and compared with the
phenomena of the dental disorder. While it was and is found that
several constitutional conditions do predispose to pyorrhea alveolaris, a
flow of pus from a tooth socket, and most of these conditic^ns may be
included under the heading of diseases of sub-oxidation, none of them
was found to cause a disease having the precise clinical phenomena
noted in connection with the one under discussion. By a process of
exclusion, and tiually by direct clinical and experimental evidence, the
field of inquiry was narrowed down to the conditions which clinical
medicine has included under the heading of the disorders of the gouty
diathesis.
In order to clearly comprehend the connection of the general condi-
tion with tlie local disease it is necessary to examine the essential, the
intimate, nature of gout and its manifold manifestations. Much con-
fusion has arisen in the discussion of this subject due to the lack of
agreement of observers as to what constitutes gout, many apparently as-
suming that gout is necessarily and inseparably connected with an acute
attack affecting the metatarso-phalangeal articulation (the great toe).
Pathology of the Constitutional Morbid Condition.—Pvorrhea
alveolaris regarded as a local manifestation of the gouty diathesis is
the result of a deposition of uratic salts in the pericemental mem-
brane : these, acting as a local irritant, excite a specific inflammation
;
while, as in other manifestations, the deposition of the gouty material
is determined by an abnormal condition of the membrane, a condition
of impaired vitality, the result of some mechanical or other irritation,
which predisposes it to the infiltration.
As no special manifestation of the gouty diathesis can be intelligently
understood without reference to its constitutional relations, it will not be
out of place to briefly consider the phenomena presented by— (1) The
gouty diathesis as a constitutional malady (2) The special manifesta-
;
tion here under consideration as a moleculai: necrosis of the perice-
mental membrane, or pyorrhea alveolaris.