The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1889, ©1888
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Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    produced by tlic fatty changes in tlie new grovctli ; finally, portions of the muscnlar tissue disappear by absorption. In the gummy form circumscribed tumors of small size appear, preferably in the ventricles where the muscular wall is thickest. The surrounding tissue is the seat of diffuse myocarditis ; the walls of the heart thicken ; its cavities enlarge ; its muscular ]io\ver is impaired. The valves usually escape—a sign of diagnostic imj)ortancc. The endocardium and pericardium may both be involved. These heart- lesions are rarely detected during life. Lancereaux diagnosticated a case which got well under the use of iodide of potassium. The course of the disease is long, its beginning insidious. The possibility of ul- ceration of a gumma into one of the heart-cavities, and subsequent embolic obstruction of vessels at a distance, has been pointed out by Lancereaux.* Grenouiller.f drawing deductions from twenty-four col- lated cases, believes that myocarditis, commencing as a small gumma and ending in fibrous sclerosis, is the commoner form, dilfnse intersti- tial myocarditis less usual. Gumma was found in eighteen of the twenty-four cases once in the first year, but averaging ten years after infection. The left ventricular wall was its most common scat. There are no positive pathognomonic symptoms during life by which this malady may be detected. Heart-disease was sometimes suspected. About two thirds of the cases terminated in sudden death. S. Smith I reports gumma of heart in left ventricle of an apparently healthy woman, leading to sudden death. Teisser * has a recent case. Si/mpto7ns are : increase of size in the heart, eufeeblement and irregularity of its action, palpitation, finally asystole ; sometimes pros- cordial pain and distress, a little dyspnoea, some turgescence of the vessels of the neck, sometimes slight oedema of the lower extremities, rarely any valvular murmur. Diagnosis.—A syphilitic history, the coincidence of other tertiary phenomena, the usual absence of evidence of valvular lesion, are the main features of a differential diagnosis. Sudden death is the most common termination, but, if treatment be commenced before the muscular tissue of the heart has been materially altered, there is every reason to believe that a cure may be effected. Treatment is that of late syphilis. Lancereaux believes there may be an amyloid change in the mus- cular structure of the heart. Syphilitic Arteritis.—Heubner's || admirable monograph first se- riously aroused the profession to the importance and extent of the * Archiv. G6n., July, 1873. f Cardiac Syphilis, TbJsse de Paris, 1878. X Syphiloma of heart, Lancet, February 16, 1878, p. 240. * Ann. de Derm, et de Syph., second ser., t. iii, No. 6. D Die lenetische Erkrankung der Ilirnartcrien, Leipsic, 1874.