Pneumonia, malignant endocarditis of tricuspid valve / by F.G. Finley.

  • Finley, Frederick Gault, 1861-1940.
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: Pneumonia, malignant endocarditis of tricuspid valve / by F.G. Finley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    8 as cherries, forming a cluster and ha%dng a general appearance analogous to condylomata round an orifice. The tricuspid orifice though somewhat obstructed by these vegetations, was neither dilated nor stenosed, the other orifices were of normal size. The mitral valve was very slightly thickened, but free from vegetations. None of the heart cavities wei’e dilated. The character of the vegetations was pecu- liar. They were white, rounded and very firmly attached to the valve and had not led to destruction or perforation, their appearance being rather that of mural thrombi in the heart than usual vegetation. This made it appear as if the peculiar lesions in this case resulted from an antecedent rie'ht heart thrombosis. The auricular surface of the tri- o cuspid was the part effected; the auricle itself being free except for a small thrombosis the size of a pea about one-half inch above the ring. Microscopical examination showed large numbers of large lancet shaped diplococci staining by Grams’ method about twice the size of the pneumococcus, also a number of short coccus chains of four elements staining by Gram. The diplococci grew on blood serum and gave an abundant greyish growth; injections of the cultures into mice failed to kill them. It was suggested by Dr. Finley that they might be involution forms of the pneumococcus which had lost virulence during the chronic course of the case. The spleen and kidneys showed extreme cloudy swelling, but neither .showed emboli. On the other hand in the small branches of the pulmonary artery of both lungs, there were several areas of necro- sis and softening surrounded by areas of pneumonia. In other parts of the lungs partly decolourised infarcts existed surrounded by pneu- monic areas. Near the root of the lung were firm areas of interstitial pneumonia, the lung process showing different dates or recurrences of infection. The cultures from the lungs showed pneumococci, staphy- lococci, auris and streptococci; The thrombi in the lung arteries had the same white rounded appearance as the cardiac vegetations. On the entry of the patient the case presented the typical picture of acute lobar pneumonia of a moderately severe type. It was not until the 11th day, when the rigor took place, that a complication was suspected, and after the second rigor I was strongly inclined to regard the condition as one of malignant endocarditis. This seemed to be the only explanation for the septic condition of the patient, and the preceding pneumonia also supported this supposition. The marked and early prostration was a striking feature and was a strong point in favour of this opinion. The spleen, which was of normal size on admission, was first noticed to be enlarged on the 30th and was in accord with a septic condition.