Cardiovascular Syphilis Research Articles

INCIDENCE OF DISABLING DISEASES

To the Editor: —The article on diseases of the aged by Drs. Medalia and White inThe Journal, Aug. 16, 1952, page 1433, presented one conclusion that is subject to reevaluation. The emphasis of the study was on the heart and cardiovascular-renal system; however, the conclusion that active tuberculosis was rare, occurring in only 117 autopsies, 9.3%, is certainly misleading. If one translates this percentage, with due caution, into the population serviced by the two hospitals, and to similar population groups in this country, the serious implications to physicians and the public health must become evident. It would be of interest to know how many of these patients were known to have active tuberculosis before their final hospital admission. Tuberculosis in the older age groups is acknowledged to have become a major facet in tuberculosis control. The use of the word rare was perhaps colored by interest. Certainly cardiovascular syphilis

The natural history of syphilitic heart disease.

Article1 October 1952THE NATURAL HISTORY OF SYPHILITIC HEART DISEASEBENTON M. MONTGOMERY, M.D., R. MAXWELL ANDERSON, M.D., JOHN A. BOONE, M.D., F.A.C.P.BENTON M. MONTGOMERY, M.D.Search for more papers by this author, R. MAXWELL ANDERSON, M.D.Search for more papers by this author, JOHN A. BOONE, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-37-4-689 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe unusually high incidence of syphilitic infection among the Negro population of Charleston, S. C., and its environs affords an excellent opportunity to study the disease in its many manifestations. Our experience has suggested to us that some of the current teaching concerning syphilitic cardiovascular disease may be on less firm ground than, for example, in rheumatic heart disease. In order to evaluate more objectively a number of features of syphilitic involvement of the cardiovascular system, the authors have reviewed a large amount of autopsy material and attempted to relate it to the clinical course of the patient before death....Bibliography1. Moore RA: A textbook of pathology, 1944, W. B. Saunders & Co., Philadelphia, p. 410. Google Scholar2. CarterBaker EPBM: Certain aspects of syphilitic cardiac disease, Johns Hopkins Hospital Bulletin 48: 315, 1931. Google Scholar3. Moore JE: The modern treatment of syphilis, 2nd Ed., 1941, C. C Thomas, Springfield, Ill., p. 290. Google Scholar4. ColeVsiltonMooreO'LearyStokesWileParranVonderlehr HNLJJEPAJHUJTRA: Cooperative clinical studies in the treatment of syphilis; cardiovascular syphilis, Arch. Int. Med. 57: 893, 1936. CrossrefGoogle Scholar5. Blumgart HL: The detection and treatment of cardiovascular syphilis, New England J. Med. 223: 443, 1940. CrossrefGoogle Scholar6. BraunsteinTownsend ALSR: Bacterial endocarditis superimposed on syphilitic aortic valvulitis, Arch. Int. Med. 65: 957, 1940. CrossrefGoogle Scholar7. WrightZeek JPM: Bacterial endocarditis superimposed on syphilitic aortic valvulitis, Am. Heart J. 19: 587, 1940. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Charleston, South Carolina*Received for publication January 26, 1952.Presented at the Southeastern Regional Meeting of the American College of Physicians, Charleston, S. C., January 27, 1951.From the Departments of Medicine and Pathology, Medical College of South Carolina. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe epidemiology of cardiac failureErkrankungen des EndokardThe surgical correction of aortic insufficiency by circumclusionTRENDS IN CARDIOVASCULAR SYPHILIS*ALFREDS RIMSA, M.D., GEORGE C. GRIFFITH, M.D., F.A.C.P.Observations on Penicillin Therapy in Cardiovascular SyphilisFurther Progress in Venereology 1 October 1952Volume 37, Issue 4Page: 689-696KeywordsAutopsyCardiovascular diseasesCardiovascular therapyInfectious diseases ePublished: 1 December 2008 Issue Published: 1 October 1952 PDF downloadLoading ...

DERMATOLOGY AND SYPHILOLOGY—PENICILLIN TREATEMENT OF CARDIOVASCULAR SYPHILS

Evaluation of Treatment Among the still unsolved problems in the evaluation of penicillin therapy are: (1) uncertain criteria of diagnosis, clinical and post-mortem, of uncomplicated syphilitic aortitis; (2) influence of race and sex; (3) prophylactic effect; (4) amount of treatment adequate in early syphilis to prevent the development of cardiovascular complications. Furthermore, insufficient time has elapsed to determine the efficiency of penicillin in the management of cardiovascular syphilis. Evaluation of the effect of penicillin therapy on prognosis is also difficult because we do not know whether or not cardiovascular syphilis is changing with the passage of time, so that we are now seeing a different type of this phase of syphilis. The simultaneous occurrence in patients of cardiovascular and other forms of late syphilis, such as neurosyphilis, may alter the picture of therapeutic efficacy, besides increasing the potential reactivity of the patient to a particular treatment system or drug. Other variable factors involved are: the presence of diabetes mellitus; hypertension; degree of arteriosclerosis; renal function.

Further observations on penicillin-treated cardiovascular syphilis.

One hundred and eleven cases of cardiovascular syphilis were treated with penicillin and, of these, 13 were in congestive heart failure, eight suffered from angina pectoris, and three had a history of coronary occlusion. Except for mild fever in a few instances therapeutic shock was not observed in any of the patients and therapeutic paradox, although sought for, was also not observed. There is evidence to suggest that penicillin has a favorable influence upon cardiovascular syphilis; angina pectoris and congestive heart failure do not contraindicate the use of penicillin in cardiovascular syphilis.

The specific treatment of syphilitic aortitis.

Penicillin has made the specific treatment of cardiovascular syphilis easy to give and easy to take and has all but abolished dangerous treatment reactions. Just as the curative therapy of acute syphilis with penicillin is simple and feasible, so is the prophylactic treatment of cardiovascular syphilis in individuals with latent syphilis and uncomplicated syphilitic aortitis simple and feasible. In spite of the fact that the effectiveness of such treatment has not been conclusively established, the prospects seem bright that the incidence of cardiovascular syphilis will decrease sharply in the immediate future. Cardiovascular syphilis may be treated, with or without preliminary bismuth and iodide "preparation," by the administration of 4.8 to 6 million units of penicillin in a period of 8 to 10 days. Larger doses and longer periods of treatment have been employed. Experience thus far does not indicate that penicillin therapy of established complications of syphilitic aortitis will be any more successful than was therapy of the pre-penicillin era.

Jarisch-Herxheimer reaction following penicillin therapy in case of syphilitic aortitis.

Penicillin has been widely employed in the therapy of cardiovascular syphilis during the past five years, and yet the occurrence of serious Jarisch-Herxheimer reactions remains controversial. Dolkart and Schwemlein 1 report two cases in which anginal episodes occurred in the course of penicillin treatment of cardiovascular syphilis. One occurred after 20,000 units had been administered in two doses of 10,000 units each in two days, the other on the fourth day after the administration of 700,000 units. The first case was complicated by rheumatic heart disease, and the second had had previous bouts of precordial pain. Use of penicillin was discontinued in both, but the assumption that these symptoms were produced by Jarisch-Herxheimer reactions due to penicillin is a tenuous one. Diefenbach 2 reports a case of fatal Jarisch-Herxheimer reaction with sudden aneurysmal dilatation of the arch and descending aorta and consequent complete left bronchial occlusion in a Negro man,

Observations on treatment of cardiovascular system syphilis with aqueous penicillin G.

THE USEFULNESS of penicillin in the treatment of cardiovascular syphilis is being evaluated by various groups. Several reports 1 of investigations using different schedules and employing varying total doses show that penicillin in various vehicles rarely causes reactions necessitating cessation of treatment in this group of patients. A few articles show important follow-up observations over extended periods, the longest being 1,243 days. 2 Caution against starting any treatment with penicillin before heavy metals have been used is emphasized by some authors 3 and disregarded by others. Some fatalities as well as instances of anginal and precordial pain concomitant with penicillin therapy in cardiovascular syphilis have been reported 4 and undoubtedly have led to hesitation in the use of the drug in similar cases. In January 1947 we started treating patients having syphilitic heart disease with aqueous penicillin G intramuscularly, using a gradually increasing dosage schedule to see whether this manner of administration of penicillin would prevent the buga

Penicillin treatment of patients with cardiovascular syphilis in congestive failure.

Congestive failure has been considered a relative contraindication to antisyphilitic therapy in cardiovascular syphilis since the arsphenamine era, when severe reactions were reported following administration of this vasculotoxic drug. After having observed no severe reactions to penicillin in a series of patients with cardiovascular syphilis, it was decided to administer the antibiotic as initial therapy for individuals in congestive failure. This report summarizes observations on twelve such patients. There were no severe reactions during the course of treatment in the entire group. Digitalis and other measures to restore compensation were used concomitantly with penicillin. All the patients were improved upon completion of therapy. Case histories of 2 patients who died two months after treatment, are given. The significance of observations on the entire group is discussed.

THE JARISCH-HERXHEIMER PHENOMENON IN LATE SYPHILIS

Since the introduction of arsphenamine the Jarisch-Herxheimer reaction has been a much debated, frequently maligned and little understood phenomenon. In early syphilis, the reaction is characterized by fever with or without an intensification of accompanying visible lesions, the complete reaction occurring within the first twenty-four hours following the administration of an actively antitreponemal agent. In late syphilis fever also occurs, but the clinical manifestations are more varied both in symptoms and in severity depending, probably in large part, on the anatomic site of the lesion(s) and perhaps, on the numbers of Treponema pallidum present. With the advent of penicillin, attention has been refocused on the Jarisch-Herxheimer phenomenon, and alarming, although not fatal, reactions presumably of this type have been reported in neurosyphilis, 1 in cardiovascular syphilis 2 and in syphilitic primary optic atrophy. 3 The purpose of the present report is to record fatalities in 2 patients with late syphilis

TREATMENT OF CARDIOVASCULAR SYPHILIS

Excerpt INTRODUCTION Cardiovascular syphilis is frequently a problem to the internist. Ten to 15 per cent of cases of recognized cardiovascular disease, Blumgart1has estimated, are due to syphilis....

THE EARLY DEVELOPMENT OF SYPHILITIC AORTITIS

Case Reports1 November 1947THE EARLY DEVELOPMENT OF SYPHILITIC AORTITISFRANK S. HOUSER, M.D., EDWARD M. KLINE, M.D., F.A.C.P.FRANK S. HOUSER, M.D.Search for more papers by this author, EDWARD M. KLINE, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-27-5-827 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe clinical diagnosis of aortitis is usually made late in the course of syphilitic infection. Although the literature contains references to its early development, it is not generally appreciated that the condition may sometimes be found within a short time after the primary infection. In the case to be reported symptoms appeared 10 months after infection and death from heart failure occurred 22 months later.CASE REPORTA colored male, aged 41 years, was seen in the Out-Patient Department October 25, 1944, complaining of dyspnea and orthopnea since August, 1943.The past history is irrelevant except for the following important...Bibliography1. BROOKS H: The heart in syphilis, Am. Jr. Med. Sci., 1913, cxlvi, 513. CrossrefGoogle Scholar2. BLACKFORDSMITH LMC: Syphilitic aortic insufficiency in negroes, Am. Jr. Syph., Gonor. and Ven. Dis., 1938, xxii, 146. Google Scholar3. REID W: Specific aortitis, Boston Med. and Surg. Jr., 1920, clxxxiii, 67 and 105. CrossrefGoogle Scholar4. SANFORD SP: An unusual case of aortic aneurysm, Ann. Int. Med., 1945, xxii, 599. Google Scholar5. COLEUSILTON HNLJ: Coöperative clinical studies in the treatment of syphilis: cardiovascular syphilis, Arch. Int. Med., 1936, lvii, 910. CrossrefGoogle Scholar6. STOKESBEERMANINGRAHAM JHHNR: Modern clinical syphilology, 1945, 3rd ed., W. B. Saunders Co., Philadelphia, p. 897. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Received for publication January 25, 1946.From the Medical Service, St. Luke's Hospital, Cleveland, Ohio. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySecondary syphilis presenting with aortitis and coronary ostial occlusionErkrankungen der thorakalen Aorta (außer Fehlbildungen) 1 November 1947Volume 27, Issue 5Page: 827-829KeywordsDyspneaHeart failureMedical servicesOutpatients Issue Published: 1 November 1947 PDF downloadLoading ...

THE PROGNOSIS OF SYPHILITIC AORTIC INSUFFICIENCY

Article1 October 1947THE PROGNOSIS OF SYPHILITIC AORTIC INSUFFICIENCYGEORGE G. READER, BRUNO J. ROMEO, BRUCE WEBSTER, WALSH MCDERMOTTGEORGE G. READERSearch for more papers by this author, BRUNO J. ROMEOSearch for more papers by this author, BRUCE WEBSTERSearch for more papers by this author, WALSH MCDERMOTTSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-27-4-584 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe course of syphilitic aortic insufficiency is generally believed to be rapidly progressive.1, 2, 3, 4, 5, 6 Death from cardiac failure is said to occur 12 to 36 months after the discovery of the lesion,7 although Grant8 in a study of 1,000 cardiac patients showed that the 10-year case fatality rate of syphilis of the aortic valve is only 64 per cent. It has been reported that antisyphilitic therapy doubles the life expectancy in this disease.3In a previous study from this clinic9of a large group of patients with aortic valvular syphilis, it was observed that current prognostic...Bibliography1. WHITE PD: Heart disease, 1944, The Macmillan Company, New York, p. 384. Google Scholar2. LEVINE SA: Clinical heart disease, 1946, W. B. Saunders Company, Philadelphia, p. 155. Google Scholar3. MOORE JE: The modern treatment of syphilis, 1944, Charles C. Thomas Company, Baltimore, p. 284. Google Scholar4. YATER WM: Fundamentals of internal medicine, 1940, Appleton-Century, New York, p. 28. Google Scholar5. LAMBTURNER ARKB: Nelson's loose-leaf medicine, 1932, Thomas Nelson and Sons, New York, p. 394A. Google Scholar6. TICE F: Tice's Practice of medicine, 1944, Prior Company, Hagerstown, Maryland, p. 300. Google Scholar7. WHITE PD: Cecil's Textbook of medicine, 1943, W. B. Saunders Company, Philadelphia, p. 1092. Google Scholar8. GRANT RT: After histories for ten years of a thousand men suffering from heart disease. A study in prognosis, Heart, 1931-33, xvi, 276. Google Scholar9. MCDERMOTTTOMPSETTWEBSTER WRB: Syphilitic aortic insufficiency: The asymptomatic phase, Am. Jr. Med. Sci., 1942, cciii, 202. CrossrefGoogle Scholar10. FARROPPENHEIMERSAGER LBSRV: The circulation time in various clinical conditions using sodium dehydrocholate, Am. Heart Jr., 1933, viii, 766. Google Scholar11. GOLDBERG SJ: The use of calcium gluconate as a circulation time test, Am. Jr. Med. Sci., 1936, cxcii, 36. CrossrefGoogle Scholar12. UNGELEIDERCLARK HECP: A study of the transverse diameter of the heart silhouette with prediction table based on the teleroentgenogram, Am. Heart Jr., 1939, xvii, 92. CrossrefGoogle Scholar13. KAMPMEIER R: Essentials of syphilology, 1944, J. B. Lippincott Company, Philadelphia, p. 319. Google Scholar14. PADGETMOORE PJE: The results of treatment in cardiovascular syphilis, Am. Heart Jr., 1935, x, 1017. CrossrefGoogle Scholar15. CHRISTIAN HA: Osler's Principles and practice of medicine, 1944, Appleton-Century, New York, p. 414. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication February 21, 1947.From the Department of Medicine, Cornell University Medical College and The New York Hospital.The work described in this paper was done under a grant-in-aid from the U. S. Public Health Service and the Barbara Whitney Henry Research Fund. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAcquired Lesions of the Aortic ValveErworbene Vitien der AortenklappeNatural History of Aortic RegurgitationCase 31-1967Die koronare Blutversorgung bei den Klappeninsuffizienzen des linken HerzensSYPHILITIC AORTIC INCOMPETENCEObservations on Penicillin Therapy in Cardiovascular SyphilisA clinical study of one hundred cases of severe aortic insufficiencyCardiovascular Syphilis: A CLINICAL STUDY OF 578 CASESPenicillin Treatment of Cardiovascular SyphilisTreatment of Cardiovascular SyphilisSYPHILITIC HEART DISEASE IN THE AGED*FREDERIC D. ZEMAN, M.D., F.A.C.P., SIDNEY STORCH, M.D.Penicillin Treatment of Patients with Cardiovascular Syphilis in Congestive FailurePenicillin therapy of cardiovascular syphilisSyphilis 1 October 1947Volume 27, Issue 4Page: 584-595KeywordsAortic valveHeart failureHeart rateHospital medicineLife expectancyMedical servicesResearch fundingSyphilis ePublished: 1 December 2008 Issue Published: 1 October 1947 PDF downloadLoading ...

PENICILLIN IN CARDIOVASCULAR SYPHILIS

A FULL evaluation of the results of penicillin therapy in cardiovascular syphilis will require observations on treated patients over a period of many years. At present, it is possible to analyze only the early reactions to administration of penicillin. In early syphilis 1 and in neurosyphilis 2 the Jarisch-Herxheimer reaction (therapeutic shock) is a frequent immediate effect of penicillin therapy. This phenomenon is of potential importance in cardiovascular syphilis because of the theoretic possibility of the occlusion of the coronary orifices or of the rupture of an aneurysm. Moore 1a has advised that in the treatment of cardiovascular syphilis with penicillin extreme caution should be exercised to avoid therapeutic shock within the first few days of treatment. This warning is based on 4 cases reported in the literature. Dolkhart and Schwemlein 3 described 2 cases in which injection of penicillin was discontinued because of severe angina, which they attributed to

Treatment of cardiovascular syphilis with penicillin: Russek, H. I., Cutler, J. C., Fromer, S. A., and Zohman, B. L.: Ann. Int. Med. 25:957 (Dec.), 1946

Treatment of cardiovascular syphilis with penicillin: Russek, H. I., Cutler, J. C., Fromer, S. A., and Zohman, B. L.: Ann. Int. Med. 25:957 (Dec.), 1946

TREATMENT OF CARDIOVASCULAR SYPHILIS WITH PENICILLIN

Article1 December 1946TREATMENT OF CARDIOVASCULAR SYPHILIS WITH PENICILLINHENRY I. RUSSEK, M.D., F.A.C.P., JOHN C. CUTLER, M.D., STEPHEN A. FROMER, M.D., BURTON L. ZOHMAN, M.D., F.A.C.P.HENRY I. RUSSEK, M.D., F.A.C.P.Search for more papers by this author, JOHN C. CUTLER, M.D.Search for more papers by this author, STEPHEN A. FROMER, M.D.Search for more papers by this author, BURTON L. ZOHMAN, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-25-6-957 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMost authorities agree that specific therapy in cardiovascular syphilis favorably influences the course of the disease and increases life expectancy.1 According to Scott2 "any medication that tends to allay the process in the aorta and thus prevent its spread to the aortic orifice or retard the development of aneurysm, may add years to the patient's life." Moore and his associates,3 using preparatory heavy metals to avoid the possibility of Herxheimer reaction, followed by conservative arsenotherapy, have reported striking effects on the mortality rate and the average duration of life in this form of the disease.The demonstration by Mahoney, Arnold...Bibliography1. WHITE PD: Heart disease, 1944, ed. 3, The MacMillan Company, New York, p. 385. Google Scholar2 SCOTT RW: in Oxford Medicine, The Oxford University Press, New York, 1942, p. 508. Google Scholar3. MOOREDANGLADESREISINGER JEJHJC: Treatment of cardiovascular syphilis: Results obtained in fifty-three patients with aortic aneurysm and in 112 with aortic regurgitation, Arch. Int. Med., 1932, xlix, 879. PADGET, P., MOORE J. E.: The results of treatment in cardiovascular syphilis: A report of three years' additional observation, Am. Heart Jr., 1935, x, 1017. CrossrefGoogle Scholar4. MAHONEYARNOLDHARRIS JFDCA: Penicillin treatment of early syphilis: A preliminary report, Ven. Dis. Inform., 1943, xxiv, 355. Google Scholar5. WILE UJ: News from the centers, Bull. Rapid Treatment Centers, 1945, ii, 12. Google Scholar6. DOLKARTSCHWEMLEIN REGX: The treatment of cardiovascular syphilis with penicillin, Jr. Am. Med. Assoc., 1945, cxxix, 515. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication April 27, 1946.From the Cardiovascular Research Division and Venereal Disease Research Laboratory of the U. S. Marine Hospital, Staten Island, New York.Published with the permission of the Surgeon General, U. S. Public Health Service, Washington, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byKrankheiten der GefäßeCardiovascular Syphilis: A CLINICAL STUDY OF 578 CASESPenicillin Treatment of Cardiovascular SyphilisThe Specific Treatment of Syphilitic AortitisPenicillin Treatment of Patients with Cardiovascular Syphilis in Congestive FailureZweite wissenschaftliche SitzungPenicillin therapy of cardiovascular syphilisFatal Jarish-Herxheimer Reaction with Sudden Aneurysmal Dilatation and Complete Bronchial Occlusion Following Penicillin TherapySyphilis 1 December 1946Volume 25, Issue 6Page: 957-959KeywordsCardiovascular therapyDeath ratesHeavy metalsLife expectancyMedical servicesPenicillinResearch laboratoriesSexually transmitted diseasesSurgeonsSyphilis Issue Published: 1 December 1946 PDF downloadLoading ...

Isolation of virulent treponema pallidum from human aorta thirty-two hours after death from cardiovascular syphilis

Virulent Treponema pallidum was isolated from the aortic tissue of a patient who died of syphilitic aortitis with aortic regurgitation. The aortic tissue was transferred into the rabbit thirty-two hours after the death of the patient. Viable Treponema pallidum was also isolated from the juxta-articular nodules, but not from the circulating blood nor from the mitral valve tissue. The patient died twenty-five years after acquiring syphilis, without ever receiving specific antisyphilitic treatment.

THE TREATMENT OF CARDIOVASCULAR SYPHILIS WITH PENICILLIN

Several reports 1 have appeared dealing with the use of the penicillin salts in the treatment of early syphilis, benign late, early and late congenital syphilis and neurosyphilis since the original report of Mahoney, Arnold and Harris 2 in June 1943. Thus far there have been no available reports concerning the use of penicillin in cardiovascular syphilis. Recently we have had occasion to study the effect of penicillin therapy on 2 patients with syphilitic aortitis and were forced to discontinue therapy in both because of the untoward effects noted. The present report seems in order because of the widespread interest in and the increasing usage of penicillin in the therapy of syphilis. REPORT OF CASES Case 1. —R. C, a white man aged 56, came under our observation in December 1941, at which time he was admitted to the hospital because of cough and dyspnea associated with the

MYOCARDITIS IN CHILDREN

With the exception of myocarditis in rheumatic heart disease and myocardial degeneration associated with diphtheria, myocardial disease in children has received scant attention. The meager literature on the subject of myocarditis reveals a wide divergence of opinion. Some authors maintain that myocarditis in children is rare except in association with rheumatic fever and diphtheria¹; other authors state that, though rare as a primary disease it is common as a secondary disorder in acute infectious diseases.²Still others believe that the most important lesion in connection with carditis is myocarditis.³Gibson⁴recently stressed that from the standpoint of causation the majority of cardiac ailments fall into four groups: congenital anomalies of the heart, rheumatic heart disease, cardiovascular syphilis and degenerative lesions. Mention was also made of acute and subacute bacterial endocarditis. It is interesting that rheumatic heart disease was referred to as such but that myocarditis as

Cardiovascular syphilis: An approach to early clinical recognition and Early treatment: Dressler, M., and Silverman, M.: Ann. Int. Med. 19: 224, 1943

Cardiovascular syphilis: An approach to early clinical recognition and Early treatment: Dressler, M., and Silverman, M.: Ann. Int. Med. 19: 224, 1943

Cardiovascular syphilis: An approach to early clinical recognition and early treatment: Dressler, M., and Silverman, M.: Ann. Int. Med. 19: 224, 1943

Cardiovascular syphilis: An approach to early clinical recognition and early treatment: Dressler, M., and Silverman, M.: Ann. Int. Med. 19: 224, 1943