Syphilis of the Cardio-Vascular System.

For every patient with syphilitic disease of.the cardio-vascular system, there are twenty with heart disease of some other etiology. It is therefore a much less common cause of heart disease than acute rheumatism and arteriosclerosis, although the latter do not as a rule so quickly cause serious disability. Among the factors that determine whether or not a syphilitic shall develop later cardiac complications are thi thoroughness with which the initial infection is treated, the degree of physical stress entailed by the occupation, and the social status of the individual. Men are more likely than women to suffer cardio-vascular sequele, particularly in the poorer sections of the community where treatment in the active stages of the infection is likely to be less complete, and in whom laborious and unhygienic conditions of lIfe are likely to prevail. When the cardio-vascular system becomes involved it is usual for the first symptoms to appear about twenty years or more after the primary stage. There are wide variations, but in the great bulk of cases the diagnosis will be made between the ages of forty-five and sixty-five. Although syphilis accounts for a surprisingly small fraction of unselected heart disease, it is a factor the existence of which it is of the greatest importance to determine. The decision that heart disease is due to chronic lesions in the lungs, or to childhood rheumatism, helps little as far as alleviation of the symptoms or cure of the condition is concerned. On the other hand, the discovery of syphilitic aortitis in a relatively early stage may be of considerable importance to the patient, since it is probable that by active treatment the onset of serious symptoms may be delayed and the expectation of life materially prolonged. At the same time, a syphilitic atiology may be one of the most difficult to determine. In the first place, the ethical and social factors which are inseparable from infection of this kind frequently render the patient's history wilfully inaccurate. But not only may known syphilitic infection be denied, the patient may have been infected and be yet unaware of it. Needless to say, an admisson of gonococcal infection suggests the likelihood of co-existent syphilis. It is obvious that in many cases the conjunction of a history of syphilitic infection twenty years previously, with aortic reflux and a positive Wassermann reaction lead swiftly to an unquestionable diagnosis. On the other hand, with …