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.

    5/8 (page 5)
    Old scars were found in the spleen and kidneys, and in the right kidney also recent infarction. Cask II.—J. H., aged 19 years, was admitted to the University Hospital March 27, 1893. His family history furnished no important data. The notes on admission to the hospital read,—Previous history : He had measles at 5 years of age, after which he was healthy until he was 12 years old, when he got a severe cold from working in the wet as a plumber’s boy. This ended in an attack of rheumatism in his knees and ankles, and kept him in bed eight days. About a week after this he noticed a bulging of his left chest over the precordial region. He had never noticed this before, and there was no pain in that region. About six months later, while lifting something, he struck his chest and suffered considerably from this, so much that he consulted a doctor, who first told him he had heart-trouble. He had grippe three years ago, and after it for a short time had shortness of breath and palpitation on any exertion. About four months later he had severe epistaxis, which lasted six hours and required plugging of his nares for three days. After this he was in a hospital for two weeks, and at this time his feet were swollen and sore and weak. Following this and until last October he has been fairly comfortable. The presejit ilhiess began last October with another attack of rheumatism, which lasted nearly six weeks (three weeks in bed). Ever since then he has had occasional slight attacks of rheumatic pain and continual headache and shortness of breath. Phosphenes appear before his eyes, and when he lies down he hears his heart-beats. It sounds like running and dropping water to him. He has an occasional sharp pain over the heart, but not very often or severe. Physical examination showed a marked bulging over the precordia, with a very extensive apex-beat; practically the whole chest wall anteriorly pulsated with each heart-beat. On auscultation there was found a distinct, loud, systolic murmur at the apex, transmitted into the axilla. At the aortic interspace there was a slight systolic murmur, but it was difficult to determine whether this was transmitted or whether it was followed by a diastolic murmur. The patient’s temperature was normal; the pulse varied from the normal to 100 ; the respirations from 20 to 30 or occasionally as many as 40 in a minute. There was slight cough. The patient remained in the hospital about three weeks, during which time his condition was never bad, and he was repeatedly used for class demonstration. He left in very good condition. On July 14 he returned to the hospital, complaining of increased pain over the region of the heart and epigastrium, and he had decided dyspnea. The temperature when he was admitted was ioi° P\ ; the