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If this chronic endocarditis develops with a general arteriosclerosis, the wine inflammation soon occurs in the aorta, and, following the endarteritis in the aorta, atheromatous deposits may also occur there. Chronic endocarditis of the walls of the heart, not in immediate continuity with endocarditis of the valves, is perhaps not liable to occur, except with myocarditis.
It bears certain analogies to Raynaud's disease in that spasm of the vessels plays a part in determining the local death. The main arteries are narrowed by hyperplastic endarteritis followed by thrombosis, and similar changes are found in the veins.
In the smaller arteries there is more or less uniform thickening of the tunica intima from proliferation of the endothelium and increase in the connective tissue in the elastic lamina a form of obliterative endarteritis. The narrowing of the vessels may be sufficient to determine gangrene in the extremities.
Sooner or later, in most instances of this disease, whether hypertension, chronic endarteritis or interstitial nephritis or any combination of these conditions is most in evidence, the heart will hypertrophy.
If it occurs later in life it generally is associated with aortic narrowing, and is a part of the general endarteritis and perhaps atheroma of the aorta. Sometimes it is caused by strenuous exertion apparently rupturing the valve. This form of valvular disease frequently ends in sudden death. On the other hand, it is astonishing how active a person may be with this really terrible cardiac defect.
The virus of syphilis exerts a special influence upon the Blood Vessels, exciting a proliferation of the endothelial lining which results in narrowing of their lumen, endarteritis, and a perivascular infiltration in the form of accumulations of plasma cells around the vessels and in the lymphatics that accompany them.
When an obliterative endarteritis is threatening a leg with anemic gangrene, or when one lies too long in the same position on a hard bed, there is threatening injury from local anemia, and as a result there is acute pain, but when the obliterative endarteritis threatens anemia of the brain, or when an embolism or thrombosis has produced anemia of the brain, there may be no accompanying pain.
The inflammation associated with syphilis results in thickening of the tunica intima, whereby the lumen of the vessel becomes narrowed, or even obliterated endarteritis obliterans. The middle coat usually escapes, but the tunica externa is generally thickened. These changes cause serious interference with the nutrition of the parts supplied by the affected arteries.
Less frequently the trabecular framework is added to by the formation of new bone, resulting in a remarkable degree of sclerosis, and if, following upon this, there is caseation of the tubercle and death of the affected portion of bone, there results a sequestrum often of considerable size and characteristic shape, which, because of the sclerosis and surrounding endarteritis, is exceedingly slow in separating.
Reference is here made to the chronic inflammations of the synovial membrane of joints, of tendon sheaths and of bursæ chronic synovitis, teno-synovitis and bursitis; of the fibrous tissues of joints chronic forms of arthritis; of the blood vessels chronic forms of endarteritis and of phlebitis and of the peripheral nerves neuritis.
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