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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    without any definite discoverable cause. The onset, therefore, may be either abrupt or it may be gradual. In the cases reported here the gradual type is illustrated. In none of them was a distinct cause detect- able ; in each an old endocarditis was known to exist. The symptoms were few, but sufficiently marked to make it possible to establish a proper diagnosis. Autopsy was performed in two of them, and a demonstration of the suspected morbid lesions thus obtained. The features by which this form of endocarditis is recognized are the gradual development of irregular fever, for which no adequate expla- nation can be detected, and which is usually accompanied by excessive sweating, and ofttimes by chills. The patient’s general condition more and more assumes the appearance of a septic state. There may be en- largement of the spleen ; there may be purpuric eruption ; there may be diarrhea; albumin, blood, and even tube casts may appear in the urine ; sometimes the joints are swollen and red ; finally and conclu- sively, as was the case in two of the three here reported, embolism not infrequently supervenes. Of course, embolism does occur in cases of simple endocarditis, but where there is a general septic state with irregular fever and sweats the occurrence of embolism and infarction is sufficient to direct suspicion upon the endocardium as the primary focus from which the general infection and intoxication have taken origin. The course of cases of this description is exceedingly variable ; some- times they rapidly grow worse and worse and death may occur after but a few days or weeks; in others the duration is stretched over a period of months; and cases have been observed in which the final termination was delayed for over a year. In these prolonged forms there is constantly a considerable degree of variability of the symp- toms and, from time to time, such subsidence of the latter that there may seem to be an arrest or even recovery. Indeed, it is not impossi- ble, and cases have been reported to sustain this position, that the final outcome may be the restoration of the condition of the patient to that present before the attack began, or with but slight increase of the chronic valvular disease. From our present views regarding the pa- thology of acute endocarditis it would naturally be expected that border-line cases exist which, though presenting to an extent the clinical features of malignant endocarditis, are of sufficiently benign character eventually to terminate in recovery. In other words, these cases exemplify what was said above,—viz., that no sharp dividing line exists separating the simple from the malignant forms. Case I.—W. A., aged 25 years, was admitted to the University Hospital May 3, 1892. The patient was born in Poland. His father, mother, and three sisters were in good health. He had had small-pox when quite young and scarlet fever, but no other illness until six