Malignant endocarditis / by William Pepper and Alfred Stengel.

Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: Malignant endocarditis / by William Pepper and Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    MALIGNANT ENDOCARDITIS. By William Pepper, M.D., LL.D., Professor of the Theory and Practice of Medicine and of Clinical Medicine in the University of Pennsylvania, AND Alfred Stengee, M.D., Instructor in Clinical Medicine in the University of Pennsylvania. The following cases are illustrative of that form of endocardial inflammation which it seems best to speak of under the title given above. After the masterly studies of Bouillaud and Kreisig, making the recognition of acute inflammation of the endocardium possible, there was recognized but one form of endocarditis, though, of course, the appearances of the lesion were known to vary. Kirkes, however, in 1851, first pointed out the existence of a variety, differing from that most commonly observed, and which has since been variously known as ulcerative, mycotic, necrotic, diphtheritic, and malignant endocar- ditis. The last name is preferable because it expresses very well the essential features by which this form of endocarditis differs from the ordinary simple or benign. The careful pathologic and bacteriologic work of recent years has shown that there is no sharp dividing line by which the benign cases can be separated from the malignant; and the coincident increase in our knowledge of the clinical features of these important diseases has similarly shown that in this direction also there is no separating line. Those terms which are based upon supposed anatomical differences fall short of satisfaction ; and particularly must we set aside the name ulcerative, which is, perhaps, the most commonly used, in that it indicates but one form, or manifestation, under which malignant endocarditis may present itself. It is improper, for the same reason to speak of necrotic or diphtheritic endocarditis and the etiologic term mycotic must fall, since micro-organisms have been found in cases which are unquestionably of the simple or benign type. The following cases are of particular interest in illustrating a clin- ical type of malignant endocarditis which is more common than is usu- ally supposed, the form to which German authors have given the name chronic recurrent endocarditis. It is a form in which an acute process becomes engrafted upon an old disease of the valves. It may result, as does primary malignant endocarditis, from infection in the course of pneumonia, diphtheria, scarlet fever, small-pox, or other diseases of a similar nature ; but it may also occur in an insidious manner and