2ÔQ 



of a lesion of the endothelium of the heart. It is hard to say 

 why in these infections this endothelium suffers. HERXHEIMER 8) 

 is of opinion that the bacteria by their impetus are pressed into 

 the endothelium, of course this is no explanation. Chemotaxis is 

 more probable. We are quite used to this explanation for the 

 localisation of f. i. rheuma in the joints. Possibly too the 

 endothelium of the heartvalves has by taking up a more 

 mechanical function lost its resistance against bacteria. This 

 view is supported by clinical observation that a heart with an 

 old valvular defect, which probably has caused the endothelial 

 layer to be of inferior quality, always at once contracts endo- 

 carditis when a slight infection occurs. 



A parallel case is given in phlegmasia alba dolens. There 

 too we have a locally interior endothelium in the venae of the 

 pelvis, partly by overstretching, partly by pressure. An infection 

 occurs, and the local endothelium suffers from the absorbed 

 bacteria, which it cannot resist. 



When the endothelium at several places is unable to resist 

 the absorbed bacteria, it becomes the cause of the haemorrhages 

 which we know from the description of septicaemia. Rheumatoid 

 haemorrhages into the skin may be explained accordingly. So 

 we can without any constraint explain most symptoms of septi- 

 caemia in the light of endothelial lesions: changes in the heart, 

 haemorrhages, thromboses, emboli. Even the changes in the 

 joints might with some effort be brought under the s«a.ui€ view. 



Clinically therefore we have sufficient reason to consider 

 serious "bloodinfections" (we think here especially of the ordinary 

 strepto- and staphylococcus-septicaemia) as lesions of the endo- 

 thelium. The pathology of these conditions entirely favours 

 this opinion. HERXHEIMER 8) mentions changes in the vascular 

 walls in infectious and toxical conditions, and calls it fatty 

 degeneration. SAVAGNONE 9) found anatomical lesions of the 

 vascular wall after injections of the nucleoproteid prepared from 

 Malta-fever-bacteria after LuSTIG's method, and these serve 

 him as an explanation for the typical haemorrhages in this 

 affection. PRUDDEN and HODENPIJL 10) after intravenous injec- 

 tions of tuberclebaccilli found changes in the endothelium of the lungs 

 and the liver ; later on swellings were formed which correspon- 

 ded with tubercles. It is interesting to note that HEIM, from 



