Licence: In copyright
Credit: Sudden death / by Herbert French. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![progressive lesion that sets in between 35 and 45 years of age in males who work hard, and it is apt to advance even in spite of the adminis- tration of iodide of potassium and mercury. Syphilitic aortic regurgitation, therefore, is much : more likely to cause sudden death than is aortic regurgitation due to a former rheumatic I endocarditis, other things being equal. One must remember, however, that upon the top of what was a simple rheumatic endocarditis, followed by a scarring of the valve, there may I develop an acute fungating endocarditis, which iis accompanied by an ulcerating process that 1 often eats a hole through the valve, and thus ] produces so sudden an increase in the degree of I regurgitation that sudden death results. I need (scarcely remind you that there may be a similar I rupture of the valve when the disease is due to I atheroma, as Dr. Lauriston Shaw has recently I told you in his clinical lecture on that subject. I have now to consider two much rarer con- iditions, namely, rupture of the heart and ruptui’e (of the aorta. They both come under one heading iin a way, because they ai-e both most liable to (Occur in syphilitic patients. Whereas you may Iknow that an aortic regurgitation patient has 1 heart disease, and he may be under your care I for years before he suddenly dies, you cannot (diagnose, as far as I am aware, the man who is 1 going to have rupture of the heart, because ■ death from this cause usually comes on in an (apparently healthy person. It is the kind of (case that is medico-legally important, because tthe disaster is likely to occur in a man who is (engaged in some work, such as going up a ladder 'with a hod of bricks on his shoulder ; the weak ^spot in the heart may rupture and the man may [fall down and break his neck, the medico-legal](https://iiif.wellcomecollection.org/image/b22425019_0015.jp2/full/800%2C/0/default.jpg)
