THE CIRCULATORY SYSTEM. 



441 



Syphilitic Myocarditis is ac- 

 companied by the growth of con- 

 nective tissue or granulation tis- 

 sue in the wall of the heart 

 between the muscle fibres. The 

 pericardium and endocardium 

 may also be thickened, and peri- 

 cardial adhesions may be formed. 

 Gummata of the heart are of rare 

 occurrence. 1 



ENDOCARDITIS. 



The endocardium is a connec- 

 tive-tissue membrane containing 

 but few blood-vessels which lines 

 the cavities of the heart and 

 forms its valves. Its inner sur- 

 face is covered with a layer of 

 endothelial cells. The connec- 

 tive-tissue cells and basement 

 substance are principally con- 

 cerned in the inflammatory proc- 

 esses. The new tissue thus pro- 

 duced is prone to degeneration and calcification. 



FIG. 237. ULCERATIVE ENDOCARDITIS. 



The valve and adjacent portion of the heart wall are 

 ulcerated, and a ragged clot has formed upon the rough- 

 ened surfaces. 



The roughening of 



FIG. 238. MASSES OF BACTERIA IN VEGETATION ON THE HEART VALVE IN INFECTIVE (MALIGNANT) 



ENDOCARDITIS. 



the endocardium due to the inflammation often leads to the formation 

 of fibrin on the affected surface. 



'See Loomu, Aim. Jour. Med. Sciences, vol. ex., p. 389, 1895, bibliography. Also 

 Adler, Trans. Assn. Am. Pliys., vol. xiii., p. 73, 1898, bibliography. 



