Heart Block in Osteitis Deformans.

The simian figure of the country gentleman from the north of England, who was Sir James Paget's first reported case (1877) of osteitis deformans, hobbles still through all accounts of this disease: he exemplifies most of the known complications. Paget himself learnt little more from the twenty-two other cases he saw (1882, 1889), and since then a forest of at least 700 articles, covering over 2000 cases, has added little wholly new to the original description. The basic problem of the xtiology still eludes us. Schmorl (1926, 1930, 1932) has shown the disease to be less rare than Paget thought, and with many others (Higbee and Ellis, 1911; Knaggs, 1926; and Jaffe, 1933, the chief) has extended our knowledge of the morbid anatomy. Da Costa et al. (1915) questioned, and Koller (1946) seems to have refuted, Paget's denial of all hereditary element. Packard et al. (1901) and Knaggs (1926) questioned, but Coley and Sharpe (1931) established beyond question, Paget's claim of a relationship to bone sarcoma. Of perhaps more fundamental importance are the demonstrations, by methods not available to Paget, of the high blood phosphatase by Kay (1930) and of the extraordinarily high blood flow through affected bones by Edholm, Howarth, and McMichael (1945). The interest in the vascular relations of the disease following the latter work encourages us to report two cases of a complication that has so far been overlooked. In both cases calcification of the interventricular septum, consequent we believe upon the Paget's disease, interrupted the bundle of His and produced heart block. This seems to be no coincidence: a recent series (Windholz and Grayson, 1947) of 12 cases of heart block (in all of which septal calcification was demonstrated radiologically) included 2 cases of Paget's disease.