The fact that Streptococcus viridans, usually a nonpathogenic organism regularly residing as a saprophyte in the teeth, tonsils, vagina and other organs, can be the cause of fatally terminating endocarditis was discovered by Schottmueller.1 This author was the first to demonstrate that in order to cause endocarditis this organism must implant itself on a previously diseased or congenitally deformed valve, the order of frequency in case of a diseased valve being a rheumatic valve, more rarely a syphilitic valve and still more rarely an arteriosclerotic valve. When Schottmueller recognized that this form of endocarditis, which he still believes can be caused only by Str. viridans, almost always has a protracted course, he named it "endocarditis lenta."
Libman2 and his associates, notably Celler,3 working in this country, have found, however, that similar pathologic changes in a chronically diseased valve, giving rise to a like clinical course, can be
HELD IW, GOLDBLOOM AA. ACUTE STREPTOCOCCUS VIRIDANS ENDOCARDITIS: REPORT OF FOUR CASES, WITH AUTOPSY OBSERVATIONS IN TWO. Arch Intern Med (Chic). 1934;53(4):508–526. doi:10.1001/archinte.1934.00160100030002
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