Sources: Disturbances Of The Heart
Since we have learned that bacteria are probably at the bottom of
almost any endocarditis, the terms suggested under the
classification of endocarditis as "mild" and "malignant" really
represent a better understanding of this disease. They are not
separate entities, and a mild endocarditis may become an ulcerative
endocarditis with malignant symptoms. On the other hand, malignant
endocarditis may apparently develop de novo. Still, if the cause is
carefully sought there will generally be found a source of
infection, a septic process somewhere, possibly a gonorrhea, a
septic tonsil or even a pyorrhea alveolaris. Septic uterine
disturbances have long been known to be a source of this disease.
Meningitis, pneumonia, diphtheria, typhoid fever and rarely
rheumatism may all cause this severe form of endocarditis.
Ulcerative endocarditis was first described by Kirkes in 1851, was
later shown to be a distinctive type of endocarditis by Charcot and
Virchow, and finally was thoroughly described by Osler in 1885.
Ulcerative endocarditis was for a long time believed to be
inevitably fatal; it is now known that a small proportion of
patients with this disease recover. Children occasionally suffer
from it, but it is generally a disease of middle adult life. Chorea
may bear an apparent causal relation to it in rare instances.
Ulcerative endocarditis may develop on a mild endocarditis, with
disintegration of tissue and deep points of erosion, and there may
be little pockets of pus or little abscesses in the muscle tissue.
If such a process advances far, of course the prognosis is
absolutely dire. If the ulcerations, though formed, soon begin to
heal, especially in rheumatism, the prognosis may be good, as far as
the immediate future is concerned. If the process becomes septic, or
if there is a serious septic reason for the endocarditis, the
outlook is hopeless. This form of endocarditis is generally
accompanied by a bacteremia, and the causative germs may be
recovered from the blood. One of the most frequent is the