Cardio-Vascular Syphilis.

The incidence of syphilitic cardio-vascular disease is small in comparison with heart disease resulting from acute rheumatism and arterio-sclerosis; and of all patients suffering from cardiac disease less than one in twenty is found to be suffering from disease due to syphilis. Autopsies on syphilitic subjects have shown the aorta to be diseased in half the cases examined and recent observations suggest that the incidence of such changes has increased, despite the introduction of the arsenical preparations. Infection with syphilis having occurred, numerous factors appear to determine the occurrence of clinical heart disease due to this cause. The initial treatment may be faulty, the social status of the patient may result in neglect of treatment owing to indifference or inability to undergo a long course of treatment. The majority of victims are males and this suggests that heavy manual labour may be conducive to the production of vascular changes in infected subjects. The symptoms of cardiac disease arise some twenty or more years after the primary infection, although sometimes symptoms may arise within five years. The condition is commonly diagnosed between the ages of forty and sixty. Pathology. Brown and Pearce(' have shown by experiments on rabbits that the duration of a syphilitic lesion is inversely proportional to the intensity and extent of the local reaction, and the latter determine the clinical manifestations of the disease (which may explain the frequency with which a history of the primary infection in man cannot be obtained). The spirochaetes lodge in the perivascular lymph spaces and excite a typical reaction, consisting of an accumulation of lymphocytes and plasma cells. The endothelial lining of the capillaries swells, resulting in narrowing or obstruction of the lumen. Proliferation of fibroblasts occurs and when healing sets in there may be considerable fibrosis. The gross changes found in the aorta result from this syphilitic reaction. Endarteritis of the vasa vasorum of the adventitia and media of the aorta produces lymphocytic infiltration with consequent destruction of the elastic lamina, producing a replacement of the elastic fibres by fibrous tissue, which yields under pressure within the aorta and leads to fusiform or saccular dilatation and the formation of aneurysms. Syphilitic aortitis usually commences about one inch above the aortic valves, it may extend to the aortic ring causing dilatation of the aortic orifice and incompetence of the valves. The cusps of the valves may be normal, but often become sclerosed …