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capable of setting up metastatic disease. This being so, the gonococcus must be regarded in the same light as the staphlyococcus and other pyæmia producing micro- organisms. Its presence in the lymphatic apparatus has been shown by COLUMBINI (Rif: Med: 1898) and MYSING (Inang Dissert. Kiel: 1900) and others, while its demonstration in the blood stream has been accomplished be several observers, notably WERTHEIM, THAYER and BLUMER, UNGER and PROSCHASKA.
Regarding, therefore, the gonococcus as one of the exciting agents of pyaemia, we find that just as in the case of other nicro-organisms, the gonococcus in the production of disease, shows preference for certain parts of the body, eg., the synorial membranes of joints, tendon sheaths, and the valvular apparatus of the heart.
The affection of the heart by the gonococcus has been a subject of much discussion, more particularly in regard to the frequency of its occurrence. Since its demonstration by LENHARTZ (Munch. Med. Woch. 1897), THAYER and BLumer (Berl. Klin. Woch. 1901) and UNGER (Berl. Klin. Woch. 1001), but few cases have been reported. Recently papers on this subject have been published by FINGER, LEYDEN, MICHALIS, CARAGEORGIADÉS and others amplifying the earlier investigations. In view of the small number of cases so far reported, I feel justified in putting my case on record and all the more so owing to the fact that the condition was only discovered post-mortem, in a perfectly fresh cadaver.
There is good reason to believe that the condition is one which is by no means rare. Its demonstration is difficult in many cases, but with the routine examination of the blood in all cases of Endocarditis ante-mortem as well as post- mortem, cases due to the gonococcus ought to be brought to light in greater abundance. There is also reason to believe that many cases due to the Micro- coccus Gororrhæ run a benign course.
ENDOCARDITIS.
No. SEX. AGE. SEAT OF DISEASE.
BACTERIOLOGY.
M. 1.
year.
Aortic valve with
extension for
Micrococcus lanceolatus.
2 F.
20
years.
inch along surface of endocardium.
Aortic valve pro-
cess limited
to valve.
3 M. 43
years.
Mitral valve on its auricular surface
with extension along the posterior wall of left amicle.
4 F.
38
Artico valve on its
years.
ventricular
1
aspect with
extension of the
process over the
endocardium.
Do.
Streptococcus pyogenes. and Micrococcu
lanceolatus,
Micrococcus Gonorrhoea.
REMARKS.
The affected region was studded with delicate excrescences which were greyish pink in colour and friable. Nu- merous petechiae were present over the left endocardium and generally over the visceral pericardium. No peri- carditis. Infarctions present is spleen and kidney.
There was evidence of old sclerotic changes in the valve affected. There was marked loss of substance. Con- siderable necrosis accompanied by the formation locally of secondary coagula. No Pericarditis but numerous petechiae were found over the left heart especially towards the base of the ventricle.
The process was warty or verrucose, the vegetations being recent, friable, pinkish in colour. An easily detectable evagulum was present over the inflammatory granulations. Acute fibrinous pneumonia was also present.
The affected valve was studded with delicate granulations, more particularly along the line of maximum contact where there had been the greatest friction. These granu- lations were pin head in size, extremely soft, greyish pink in colour and translucent. In some parts the proliferation of tissue was more extensive and covering this was a considerable amount of necrotic tissue admixed with blood coagulum. The valve tissue itself was con- siderably thickened owing to the great amount of round celled infiltration and the activity of the connective tissue. The endocardiuni surrounding the principal focus of disease was opaque and in some places slightly rough. Opaque patches with slight thickening were found scattered over the left endocardium with localised thickenings of the chorde tendineæ.
The other valves were normal. No pericarditis.
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