File:Diseases of the chest and the principles of physical diagnosis (1920) (14780604645).jpg

Identifier: diseasesofchestp1920norr (find matches)
Title: Diseases of the chest and the principles of physical diagnosis
Year: 1920 (1920s)
Authors: Norris, George William, 1875-1965 Landis, Henry R. M. (Henry Robert Murray), 1872-1937, joint author Krumbhaar, E. B. (Edward Bell), 1882-1966
Subjects: Chest Diagnosis Thoracic Diseases Diagnosis
Publisher: Philadelphia, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ellular fibrosis and finally necrosis. Brooks urges theimportance of bearing in mind the character of the lesion and the factthat it may manifest itself during the so-called secondary period. Vigor-ously treated, such lesions may be recovered from without permanent ^ Trans. Assoc. Am. Phys., 1914. 2 International Clinics, Twenty-fifth Series, vol. i, 1915. ^ Loc. cit. * Trans. Assoc. Am. Phys., 1898. 44 . ■ • 690 DISEASES OF THE PERICARDIUM, HEART, AND AORTA damage being done to the heart. Neglected, there may eventually resultareas of fibrosis or the formation of gummata. The late cardiac changes due to syphilis are fairly common. In ananalysis of the cardiac lesions found in 50 consecutive cases of syphilisBrooks found that the changes in the heart muscle were by far the mostcommon. Fatty degeneration was found in 44; fibroid changes occurredin 4 and in 5 there were fibroid changes and fatty degeneration. Gum-mata were present in 5 of the 50 cases. Mracek,i among 60 cases, found
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Fig. 391.—The nodular gummatous mass obliterates the undefended space ol tlie inter-ventricular septum, and entirely fills that part of the septum through which the auriculo-ventricular bundle runs. (Specimen from the Pennsylvania Hospital.) gummata in 10. In common with degenerative changes due to othercauses syphilitic involvement may include or be limited to the speciaUzedfibers, known as the auriculo-ventricular bundle. There are now onrecord a number of cases of the Adams-Stokes syndrome in which thebundle of His was the site of a gummatous infiltration. An excellentexample of this is shown in Fig. 391. The lesions are chiefly encountered1 Arch. f. Dermatol, und Syph., 1893, xxv, p. 279. DISEASES OF THE MYOCARDIUM 691 in the ventricles, are generally multiple and, as a rule, are sharply definedand encapsulated (see Fig. 392j. Absorption of the gumma may befollowed bv cardiac fibrosis or aneurism. Symptoms.—The symptoms of the late cardiac manifestations ofsyphilis differ in n

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