j 84 SUPPURATION AND ALLIED CONDITIONS. 



Some conditions produced by the pyogenic organisms 

 demand special mention on account of their clinical import- 

 ance, namely, ulcerative endocarditis, acute suppurative 

 periostitis and osteomyelitis, and erysipelas. 



Ulcerative Endocarditis. This condition has been 

 proved to be a bacterial infection of the valves of the 

 heart, and may be produced by various organisms, chiefly 

 pyogenic. Of these the staphylococci and streptococci 

 are most frequently found. In some cases of ulcera- 

 tive endocarditis following pneumonia, the pneumococcus 

 (Fraenkel's) is present ; in others pyogenic cocci, especially 

 streptococci. Other organisms have been cultivated from 

 different cases of the disease, and some of these have 

 received special names ; for example, the diplococcus 

 endocarditidis encapsulatus, bacillus endocarditidis griseus 

 (Weichselbaum), and others. In some cases the bacillus 

 coli communis has been found, and occasionally in endo- 

 carditis following typhoid the typhoid bacillus has been 

 described as the organism present, but further observations 

 on this point are desirable. The gonococcus also has been 

 shown to affect the heart valves (p. 198), though this is a 

 very rare occurrence. Tubercle nodules on the heart valves 

 have been found in a few cases of acute tuberculosis, though 

 no vegetative or ulcerative condition is produced. 



In some cases, though we believe not often, the organ- 

 isms may attack healthy valves, producing a primary ulcera- 

 tive endocarditis, but more frequently the valves have been 

 the seat of previous endocarditis, secondary ulcerative endo- 

 carditis being thus produced. In both conditions the 

 affection of the valves usually occurs in the course of sup- 

 purative or inflammatory conditions elsewhere, e.g., in 

 osteomyelitis, in septic inflammations of the urinary pas- 

 sages, in pyaemia and septicaemia, in the course of or 

 following infective fevers, and not very infrequently as a 

 sequel to acute pneumonia. Not infrequently, especially 

 when the valves have been previously diseased, the source 

 of the infection is quite obscure. It is evident that as the 

 vegetations are composed for the most part of unorganised 



