Licence: In copyright
Credit: Two cases of acute endocarditis / by John Cowan [and others]. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![By JOHN COWAN, A. M. KENNEDY, A. E. PATERSON, AND JOHN H. TEACHER. With Plates 2 and 3 In a recent number of this Journal,^ two of us reported a case of partial heart-block, occurring during an attack of acute rheumatism and persisting for a fortnight; and we suggested that the condition might be due to the involve- ment of the a.~v. bundle in one of those little inflammatory lesions which are so frequently present in the myocardium in the acute infections. The favourable issue of our case precluded confirmation of our theory, but we have again met with cases where it seemed probable that the a.-v. bundle or node was implicated in the way which we had suggested, and in two of them we were able to secure a microscopic examination of the parts. Our first case was a man aged 26 years, who was admitted into hospital on June 5, 1909, complaining of weakness and of breathlessness on exertion of some months' duration. He stated that he had not been in good health since an attack of enteric fever in 1903 for which he was in hospital in Japan for about three months. He never regained his former health, and his feet were often swollen at night, but he was able to work as a clerk until July, 1908, when he was thrown out of employment by the failure of his firm. He stayed at home in fairly comfortable circumstances until he procured a new situation on February 19, 1909. In the early part of February he had caught cold and he was feeling ' run down ' when he commenced his new work. This entailed a daily walk of four miles, and he felt exhausted at night, and also during the day when walking uphill, but though he steadily became weaker he continued at his post until six weeks before admission, when he was compelled to go to bed. His cough, accompanied by a slight mucoid spit, persisted from February until May. He had frequent attacks of shivering at night after getting home ; they were fairly severe, and lasted for fifteen to twenty minutes, and he felt hot after he got into bed, and often sweated profusely in the early morning. About a fortnight before admission his right forearm and elbow became sore to the touch and on movement, and this continued for a few days. Four days before admission the left hip and ankle became painful, and this still persisted. His family history was good. He had always been healthy prior to 1903, but he admitted on cross-examination that he had suffered from arrowina: pains and an attack of tonsillitis in boyhood. He had also had an attack of gonorrhoea early in 1903. On admission he was found to be a thin, pale, badlj' nourished man, with flabby muscles and little subcutaneous fat. The left hip and ankle were painful and tender, and there was a small [Q. J. M., Oct., igio.] ' 1910, iii. 115. D 2](https://iiif.wellcomecollection.org/image/b21465861_0003.jp2/full/800%2C/0/default.jpg)
