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524 PVORRIIEA A L VKOLA RIS.

The supposition that pyorrhea alveolaris iis a local expression of the
general tliatliesis has been converted into an actuality by the demonstra-
tion of the presence of uric acid and its allied salts in the incrustation
found on the roots of the exfoliated teetli. The eheniical analyses made
by Prof. Ernest ('ongdon of the Drexel Institute have demonstrated
the j)resence of these salts beyond (juestion.' All of the established
tests for uric acid were emjjloyed and in all instances crystals of uric
acid, sodium urate, and calcium phos])hate were detected. In several
instances sodium urates were most abundant. The constant presence
of these salts on the surfaces of the roots— the presence of which is
ascertained by proper analyses and aided vision—taken in connection
with the fiict of the coexistence of gouty disorders in other tissues justi-
fies the belief that the form of pyorrhea alveolaris here described is a
gouty inflammation.
The derivation of the salts from the blood, the abundance of the
calcium salts present, and the primary hwation of the inflammatory pro-
cess suggested to the writer the term hematogenic calcic pericementitis,
though it is admitted that the single epithet gotdy 'pericementitis would
be sufficiently explanatory and descriptive. The succession of patho-
logical states is readily explained and justified by the uratic deposit.
The formation of pus is preceded by a lowering of the vitality and solu-
tion of the pericemental tissues. This having been accomplished, the
disintegrating peridental membrane affords a favorable nidus for the
entrance and development of micro-organisms, which can be effected
either by the route of the circulation or by lesions around the gum
margins which give opportunity for direct infection from the oral fluids.
When organisms once gain access to the devitalized tissue they mul-
tiply with great rapidity, and in so doing increase the disintegration and
solution of the pericemental membrane with the formation of pus. The
specific bacteria which have been demonstrated to be present in the pus
are the usual forms—the staphylococcus pyogenes aureus, citreus, and
albns—which though capable of producing pus are not pathogenic in the
sense that they are the causative agents of the pericementitis with the
formation of an abscess. The purulent fluid burrows in the line of
least resistance, which in the majority of cases is toward the gum mar-
gin, whence it is discharged into the mouth, the fistulous tract thus
established constituting the well-known pyorrheal pocket.
By the continued irritation of the uratic deposition and the co-opera-
tion of micro-organisms, the inflammatory process extends until the
membrane is destroyed to such an extent that it is no longer capable
of nourishing and supporting the teeth.
The absorption of the alveolar process is in accordance with the laws
^ See Infeiifialional Dental Journal, 1894, vol. xv. p. 1.