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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    was neither fever nor any other indication of general intoxication ; but simply dyspnea and the ordinary indications of lacking compensation in chronic valvular disease. At the end of the week, however, fever set in, and the man became evidently more ill. In the mean time he had been in bed, there had been nothing to induce the infection of the valves that afterwards became so clearly evident. There was, how- ever, some complaint of pain in the joints and members, that not un- naturally suggested recurrence of rheumatism, though at no time did any of the joints exhibit evidences of active inflammation. Not, there- fore, until time had made it clear that these articular manifestations were too slight to justify the belief in their being the cause of the patient’s general state was it recognized that some underlying cause existed which had thus far eluded discovery. Physical examination did not furnish any data upon which an opinion could be founded ; for the valvular murmurs continued exactly the same as they had been; and the other organs seemed entirely healthy. Meantime, however, the continuous septic state of the patient persisted ; the heart-power grew weaker and weaker, and thus the conclusion was forced upon us that the underlying lesion was a malignant endocarditis. This may have been of rheumatic origin, or in some way dependent upon the exposure his occupation necessitated, but the subsequent rheumatoid articular pains, which persisted throughout the entire duration of the case, were more likely of the nature of the joint-pains that not infre- quently associate themselves with septic conditions of various kinds. The duration of the case, four months, was remarkable, but, as has been before noted, much more protracted cases are recorded. Autopsy.—(Only the points of interest in relation with the cardiac condition are extracted.) The pericardial sac contained 400 cubic centimetres of clear serous fluid. There were a few old and some recent fibrinous adhesions binding the two layers of the pericardium to each other. The heart was very greatly distended and weighed 770 grammes. The hydrostatic test showed the aortic leaflets to be incompetent. The left ventricle was greatly hypertrophied and dilated. The mitral valve segments were markedly thickened and the orifice narrowed. On the ventricular face of the anterior mitral leaflet there was a large ulcer covering it almost completely and extending upward to the aortic valve. Two of the segments of the latter were more or less completely de- stroyed, leaving jagged stumps. There was deep ulceration in one of the sinuses of Valsalva. The auricular surface of the mitral valve was not involved. Several of the chordae tendineae of the left ventricle were destroyed by ulceration, but there was no involvement of the right side of the heart. There was, therefore, old valvular thickening affecting the aortic and mitral leaflets, and recent malignant endocar- ditis of the same valves and of the neural endocardium.