Diseases of the chest and the principles of physical diagnosis . lls 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 A
Diseases of the chest and the principles of physical diagnosis . lls 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 no particular from degenerative changes due to otherIt is not generally appreciated, however, that the heart may be causes. Yjq, 392.—Gumma of the left ventricle. {Specimen from the Pennsylvania Hospital.) affected early in the infection and that at this time the evidences of severecardiac weakness may be present. Brooks found that dyspnea was themost common symptom in the early cases. Precordial pain and tender-ness are also common and in some instances anginal attacks are ^ also has directed attention to the cardiac sj^mptoms arisingin early syphihs. He found that dilatation of the right heart was com-mon and that a functional or accidental murmur at the apex was present1 Munch, med. Woch., 1897, xliv; Deid. Klin. Med., 1900, Ixix, 58, 264. 692 DISEASES OF THE PERICARDIUM, HEART, AND AORTA in 40 per cent, of his cases. The murmur is soft and blowing in character,becomes more evident on exercise and is occasionally transmitted towardthe axilla. In addition, alterations in the cardiac rhythm are almost uni-versally
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