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August 1938


Author Affiliations


From the Department of Internal Medicine, St. Louis University School of Medicine.

Arch Intern Med (Chic). 1938;62(2):247-270. doi:10.1001/archinte.1938.00180130068005

I. REPRODUCTION OF THE DISEASE BY MEANS OF INTRAVENOUSLY INJECTED STREPTOCOCCI  The fact that the treatment of bacterial endocarditis remains unsuccessful emphasizes the difficulty involved in understanding this disease. The utter failure to treat the disease successfully with such immunologic agents as serums and vaccines indicates also that the factors at work within the animal body are distinctive and for the most part unidentified. In a general way, two facts seem to be established by clinical studies: first, the patient who acquires bacterial endocarditis has invariably suffered previous injury to the tissues of the valves, and, second, bacterial endocarditis is established by the implantation in or on this injured valve of bacteria, usually nonhemolytic streptococci, which gain access to the blood stream through the medium of a local infection such as pharyngitis or otitis media. In some instances it is not known that previous injury to a valve existed. It