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GANGRENOUS TOOTH-PULPS AS CENTERS OF INFECTION. 293

How often cases of tliis nature occur may be seen from the
fact that a pupil of muie, who is making a study of this ques-
tion, was able to secure the history of no less than twenty-one
cases which had come under the notice of two hospital directors
within the last tive years.
Even leavino; these extreme cases recorded above out of
account, we tiud often enough caries and necrosis of the alveolar
abscess or of the maxilla itself, chronic pyaemia, large abscesses
opening upon the outside, etc., as the consequences of an infected
tooth. The course of even the simplest form of alveolar abscess,
from the beginning of the pericementitis to the formation of the
abscess and the discharge of the pus, is often accompanied by
very disagreeable symptoms,—intense pain, swelling, high fever,
complete debility, etc. However, the symptoms of alveolar
abscesses are too well known to make a further explanation of
them necessary in this place.
As regards the etiology of alveolar abscess, we have adopted
the universally accepted view that it is caused by bacteria.
There can hardly be a doubt of this, particularly as the most
careful investigations have proved that suppuration can arise
without micro-organisms only in exceptional cases.
Black made the attempt to produce suppuration at the apex
of the root by mechanical irritation, and for this purpose several
times passed a sterilized steel wire through the foramen of a per-
fectly disinfected root-canal, but succeeded in causing only a
slight temporarv inflammation.
According to Arkovy,'*^ Eothmann,^*^ and others, an infection
of the dental pulp may occur while it is still protected by a per-
fectly liealtliy layer of dentine, or, in other words, has not yet
been reached by the softening of the dentine. Under such cir-
cumstances Arkovy repeatedly observed the distinct phenomena
of pulpitis, and drew therefrom the conclusion that acute pulpitis
must be referred to a much earlier stage of dental decay and ot
dental infections in general than heretofore supposed. The
microscopical examination revealed numerous micrococci in the
connective tissue at the base of the odontoblast layer, on the
nerves, etc. (Fig. 118). Comparative examinations of intact
pulps revealed no invasion of micro-organisms. On the strength