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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    months before, when he had a severe attack of rheumatism with impli- cation of the joints, sore throat, and considerable fever. The course of this attack was very irregular ; one joint after another being in- volved at intervals of a few days or weeks. He denies a specific history entirely ; has never been a hard drinker ; does not use tobacco. But his occupation—that of a coal-miner—exposed him to cold and damp- ness, and was doubtless the immediate cause of the rheumatic attack. Immediately following the latter, he began to have uncomfortable feel- ings about his heart with, sometimes, severe palpitations. There never was any edema of the feet or hands. The note made on the day of his admission reads : The patient is pallid ; has decidedly club-shaped fingers, which he says have been present since childhood. The apex-beat is displaced outward an inch beyond the mammary line, is forcible and somewhat irregular. On auscultation there is found at the apex a presystolic followed by a sharp systolic murmur, the systolic being transmitted to the axilla. At the aortic region there is a loud diastolic murmur. The patient is somewhat short of breath, but examination of his lung reveals no ab- normal physical sign. The temperature is normal; the pulse somewhat collapsing. During the first few days after admission, he complained of vague pains in the muscles and joints, and at the end of the first week there was a sharp rise of temperature. After this time, and until his death, September 5, there was at no time normal temperature, the range being from 990 to 103° F., higher in the evening than in the morning. The daily excursions averaged about 20 to 2^° F., and were sometimes as great as 40 F. He continued to complain of vague rheumatic pain, of headaches, and of excessive sweating now and then. The heart- action continued excitable and dyspnea was constantly present, increas- ing and decreasing with the temperature, though out of proportion to the latter. The range of the respiratory curve was from 20 to 40 in- spirations per minute ; and shortly before the termination the number reached 50. There was little change in the patient’s condition from day to day, but his strength gradually decreased; his color grew more and more pallid; and the heart-action less vigorous. In the latter end of August, there began to be mild delirium in the evening and he complained that other patients were talking about his approaching death, and generally he grew more and more suspicious and irrational. Physical examination revealed a little dulness at the base of the lungs posteriorly and there were a few soft rales. This increased towards the end. He died, on September 5, of heart-failure. The diagnosis in this case was attended with some difficulty at first. At his entrance to the wards, and for a week thereafter, there