ENDOCARDIAL EXCRESCENCES. 405 



degeneration taking place both at the surface and deep 

 beneath it. The process generally pursues its course so 

 latently that no disturbance is perceptible during life, 

 nor are we able, in the present state of our knowledge, 

 to name any very obvious anatomical change as being 

 the subsequent result of it. On the other hand, what 

 we call endocarditis, what can be demonstrated to arise 

 in the course of rheumatism, and may indubitably ap- 

 pear as a sort of equivalent to the rheumatism of the 

 peripheral parts, begins with a swelling of the deceased 

 spot itself. There is, namely, no exudation, but the 

 cellular elements take up a greater quantity of material, 

 and the spot becomes uneven and rugged. Then we 

 see, when the process runs its course somewhat slowly, 



FIG. 119 



either that an excrescence, a condyloma arises, or that 

 the swelling assumes a more mammillated form, and af- 

 terwards becomes the seat of a calcification which may 

 produce real bone. If the process runs a more acute 

 course, the result is either fatty degeneration or soften- 

 ing. The latter gives rise to the ulcerative forms, in 

 which the valves crumble to pieces, drop off, and em- 

 Fig. 119. Condylomatous excrescences of the mitral valve; simple, granular 

 swellings (granulations) and larger prominences (vegetations), some villous, others 

 branched and putting forth secondary buds ; in all elastic fibres running upwards. 

 70 diameters. 



