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138 Scurvy in the Gwms.
tional and local causes, and may be termed complicated. The
treatment of the former is local, but the cure of the latter
requires both constitutional and local treatment.
These species have not been sufficiently distinguished by
dental authors ; therefore, they generally lay to much stress
for ninety cases in the hundred
upon constitutional causes ;
have little to do with the constitution, as far as the causes of
the disease are concerned, these being mostly local, as neglect,
tartar, dead roots, &c.
Scurvy in the gums attacks persons of all ages and condi-
tions,* though most frequently the hearty and robust, after the
age of puberty. Old persons, who have been so lucky as
not to have lost their teeth by decay, generally lose them by
this disease, if they lose them at all; their teeth dropping out
perfectly sound. It generally first attacks the incisores of the
lower jaw, and the molares of the upper, because tartar is most
apt to collect about these teeth, from the proximity of them to
the salivary ducts. The disease gradually extends to the
periosteum and sockets of the teeth, causing their gradual ab-
sorption, and deposition of bony matter takes place at the bot-
tom of the sockets, which gradually protrudes the teeth, till at
length they drop out one after another, pefectly sound, till the
patient is rendered edentiless.

* " Persons of robust constitutions are much more liable to this affec-
tion of the gums, than those of delicate habits ; and it shows itself in its
worst forms oftener after the age of thirty, than at an earlier period.
The teeth of such persons are generally perfecly sound, or very little
affected wnh caries, though I have occasionally met with exceptions to
this observation.
"The lower classes are particularly subject to this affection; and not
even those country people who enjoy uninterrupted good health, and the
influence of the most salubrious atmosphere, and who have originally
the most beautiful and healthy teeth, are altogether free from its attacks.
"This disease seems to be confined to no particular climate, and is
more or less prevalent in every part of the world : I have observed the
inhabitants of the most apposite countries, the Russians, the Germans,
the French, the Italians, the Spaniards, the Portuguese, the English, the
Africans, the East and the West Indians, and the inhabitants of the
United States, to be all more or less liable to iL"—Koecker, pages 272
and 273.