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material around the organisms, which tends to stain with the ordinary dyes and is of a mucinous nature.

Biological Characters.—An äerobic, non-liquefying coccus; nonmobile. No spores formed.

Gelatin.-Does not grow at room temperature; grows slowly at 37° C.

Agar Plates, 37.5° C.-Flat spreading colonies, dentate edge, surface granular; microscopically, surface colonies, irregular dentate edge, brown to brownish-black, surface granular, marmorated (veined). Deep colonies, irregular, moruloid, brown.

Agar Streak, 37 5° C.-Two days: raised viscous shining streak, edge defined, wavy. The whole mass may be wound up upon the platinum needle and is extremely viscous.

Potato, 37-5° C.-Slight flat grey viscous growth confined to area of inoculation.

Blood Serum, 37.5° C.-Similar to agar; no liquefaction.
Litmus Milk, 37-5° C.—No change.

Broth, 37-5° C.-General turbidity with well marked pellicle and flocculi floating in fluid and deposit.

Peptone Water, 37.5°C.-H,S formed. Glucose, dextrin, starch, lactose, acid in three days. No nitrite and no indol ; gas evolved with nitrate media.

Glucose formate media, 37.5° C.—No growth anäerobically, but development when air is admitted

DISEASES OF THE MOUTH WITH UNDETERMINED

BACTERIOLOGY.

Ulcerative Stomatitis.- Nothing is at present known of this condition as far as its bacteriology is concerned. It occurs with many diseases associated with fever and it appears to spread from the gum margins; particularly is this the case in the mouths of those already suffering from marginal inflammation and pyorrhea alveolaris. Many of the mouth organisms are increased in numbers in the condition, especially the spirilla, and I can confirm Bernheim's? observations that these organisms are constantly present in the disease. Ulcerative stomatitis also occurs in an epidemic form,

"Semainc Medicale, 1897, p. 252.

and it has been suggested that it is related to the “ foot and mouth disease ” of cattle.

Foot and mouth. disease has been investigated by Löffler and Trosch, who found that the cause was present in the vesicles and the mouth secretions. Moreover it required several filtrations through porcelain filters to remove the active agent, which so far is invisible to the most powerful microscopes. The lymph filtered once is still capable of producing the disease when inoculated into animals.

Aphthous Stomatitis is also without bacteriological investigation.

Gangrenous Stomatitis.—Petruschy has found diphtheria bacilli together with pseudodiphtheria bacilli in two cases, which were cured with injection of diphtheria antitoxine. The condition occurs as a sequela of various fevers.

Mycosis of Tonsil and Mouth.—Occasionally large patches of a white numular nature are formed upon the tonsil and buccal mucous membrane. Sometimes these nodular masses are composed almost entirely of sarcinæ, at other times they are found to consist of tangled masses of threads (Leptothrix ?) and various other bacteria ; yeasts are also frequently present, sometimes to the extent of a false membrane. I have met with two such cases.

Epidemic Parotitis.—Laverant and Mercay” and Walsh have found diplococci resembling staphylococcus albus in cases of mumps : the injection produced transitory orchitis in rabbits and dogs, with occasional parotitis. The matter requires confirmation.

Suppurative Parotitis occurs occasionally associated with intestinal growth and gastric ulcer. In one case which came under my own observation staphylococcus aureus was present in pure culture, in another staphylococcus albus and a bacillus forming long threads which died out before its biology could be determined.

"Osler, “ Princ. of Medicine," p. 442.
2 Cent. für Bakt., Bd. xxiii., 371.

3 Deut. med. Wochenschr., 1898, 600. 4 Comp. rend. Soc. Biol., 1893. 5 Cent. für Bakt., xxi., 68.

175

CHAPTER XI.
Pyorrhoea Alveolaris.

CHRONIC suppurative periodontitis, caries alveolaris specifica, Rigg's disease, periostitis alveolo-dentalis, &c., &c., are among the terms applied by various authors to the chronic inflammatory condition of the gum margins and peridontal membrane leading to wasting of the alveolus and loss of the teeth. A coverslip preparation made from the pus found in the pockets around the teeth of chronic suppurative periodontitis shows a large number and variety of morphological forms so varied and changeable that there is considerable difficulty in tabulating them. Cocci as a rule are prosent in only small numbers in coverslip specimens, but in the usual culture media cocci invariably develop, even when plate cultivations are made from the mouth direct the majority of the colonies appearing belong to the genus cocci. Anyone who has been engaged for any length of time on the study of mouth bacteria cannot fail to have been struck with the difficulty of recovering in pure culture the organisms seen to be present in the pus of pyorrhea. The staphylococcus viscosus described in the chapter on caries is frequently present, and from its constant presence in dento-alveolar abscesses may have some share in the pus formation. Most of the morphological forms met with develop for a period on maltose-agar, but it is well nigh hopeless to obtain pure cultures by the ordinary process of plating.

The organisms seen on direct examination may be tabulated as follows:

(1) Cocci-generally in diplococci and massed around the epithelial cells in clumps.

(2) Thick bacilli generally jointed and often showing consider-' able irregularity in their staining characters.

(3) Thick bacilli with pointed ends and somewhat of the shape of a bean pod; they frequently show a division in the centre and appear as two elongated triangles with the bases opposed.

(4) Various fine bacilli 0.5 u and under in width often exhibiting an irregular banded marking, especially well marked in the larger threads, which may be of great length.

(5) Spirilla, spirochæte, and comma-shaped bacilli, all showing marked motility in the hanging drop.

(6) Various yeast forms, sometimes with a partially developed mycelium.

(7) Streptothrix threads, generally showing well marked clubs (see fig. 67).

(8) Masses of bacilli associated with the threads, some jointed in chains, others free and often massed in clumps. Some of them exhibit polar-staining.

From pus containing all the above forms only the cocci develop with any degree of certainty when cultivated on artificial media.

In broth cultures the threads (4) may be obtained in impure culture, but I have only once succeeded in obtaining a pure culture, and even then the organisms died out before the proper cultural reactions could be ascertained.

It is obviously impossible therefore to say at present exactly which of the above organisms is especially related to the disease, or if the various morphological forms cited are only the various phases of one or two schizomycetes, or if the various forms are related to some higher class of organism. Until careful cultural experiments have resulted in a proper determination of these organisms the matter cannot be definitely decided.

Various observers have from time to time investigated the bacteria associated with pyorrhæa alveolaris, and of these Galippe and Miller deserve notice.

Galippe (1889) isolated two organisms which produced general abscess formation when injected into animals. With one the abscesses were frequently met with in the bones and were occasionally associated with spontaneous fracture, the site of the fracture being surrounded with a well defined area of suppuration. The second organism produced intermuscular abscesses. These organisms were however not properly described, and it is impossible to determine anything concerning them.

Miller conducted a series of cultural and inoculation experiments on the subject and came to only negative results. He cultivated a number of bacteria upon gelatin and agar from a large series of pyorrhæa cases, but was unable to satisfy himself that any par

ticular organism isolated was the one chiefly concerned in the process. He made however several valuable observations, particularly the infrequency with which the common pus cocci were present. Thus in forty-three cases of pyorrhoea examined staphylococcus aureus was met with three times and staphylococcus albus twice.

Netter likewise found the pus cocci present in about 10 per cent. of the cases examined, and my own cultivation experiments confirm those of Miller and Netter, as in one hundred and fifty cases of marginal suppuration examined exactly 10 per cent. (15 cases in all) gave cultures of the staphylococcus aureus and albus.

So far my own experiments are very much in a line with those of Miller; I have isolated a large number of different bacteria, some of them pathogenic for animals, just as were a number of those obtained by Miller, but so far no organism appears with sufficient frequency to associate it especially with the disease. The results of some inoculation experiments, however, throw some additional light upon the subject. Animals (guinea-pigs) succumbed when inoculated with the filtrate of old broth cultivations, made from the mouth direct, and containing the fine threads referred to above, and moreover giving off a considerable fæcal smell. No organisms were found in the tissues at the post mortem, and it seems reasonable to suppose therefore that the animal died from a toxæmia, especially as there were evidences in the hæmorrhagic condition of the suprarenal capsules that such was the case.

Such a circumstance appears to point to a toxic element in pyorrhea, and we may call to mind the curious shining atrophic appearance of the gums in cases of long standing. What appears therefore to be a reasonable supposition is that the particular bacteria concerned in the process produce some sort of toxine which so alters the vitality of the tissues surrounding the teeth that any and every mouth organism may assist in the continuation of the process. One of the cultures inoculated was from the mouth of a man suffering from various nervous symptoms, including wasting and loss of power in the legs, which cleared up on attention to mouth hygiene."

Many of the bacteria found in the pus are pathogenic when injected into animals. Thus ten guinea-pigs and five rabbits injected

" Trans. Odonto. Soc., April, 1902.

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