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GOUTY PERICEMENTITIS. 531

times daily, may be sulxtituted. A valuable adjunet to the medicinal
treatment is the free use of alkaline waters, which assist in the elimi-
nation of waste products, though it is probable that the good effects
attributed to these are largely due to the quantity of liquid consumed.
The Saratoga, Vichy, alkaline waters of Wisconsin, the ]Marienbad,
Carlsbad, Apollinaris, etc. have all been found efficacious. Should
the patient be very dyspeptic, as is frequently the case, remedies
directed to the digestive viscera are of course indicated. If anemia be
a concomitant, iron and quinin Avill be necessary. A combination
which has been found of great value in improving the quality of the
blood is one of iron and a salt of potassium. Bland's pill, consisting
of these two ingredients, is a desirable form for administration ; one
three times a day will be sufficient.
There is in addition one factor which may be regarded as therapeutic
or at least prophylactic, and which is deserving of more than a passing
notice, viz. the exercise of great care in the avoidance of injuries to the
pericemental membrane, wherever there is a possibility of the presence
of the unfortunate diathesis.
However ingenious our interpretation of pathological conditions
may be, and however plausible our deductions may appear, the ultimate
test of their value will be the readiness with which they yield to and
disappear under approjiriate treatment.
If pyorrhea alveolaris be a manifestation of the gouty diathesis, and
the symptoms and pathological conditions which characterize it be ex-
cited and maintained by the deposit and pressure of uric acid and its
salts, it should be in general terms amenable to the therapeutic measures
which have been efficacious in the treatment of all other forms of gout
in other portions of the body. It must be borne in mind, however, that
though a case be cured for a period of six months, or even a year, this
does not preclude a relapse should the patient return to an improper
diet or irregular mode of life. It is hardly necessary to say that this
is true of all diathetic diseases. In individuals predisposed to uric acid
accumulations, a new mode of life is to be instituted and followed with
extreme care for a long period of time.
The conclusions entertained may be represented in a condensed form
in the following postulates :
(1) Pyorrhea alveolaris of constitutional origin—which is its most
— primarily begins as a
destructive and unyielding form local inflam-
matory disorder in tissues on the side of the root near the apical ex-
tremity, and secondarily advances in the very large majority of cases
toward the gingival borders.
(2) The cause of this inflammation, or gingivitis and pericementitis,
is the plasma exudation from the bloodvessels, freighted with salts