Malignant Endocarditis during Pregnancy: with an Illustrative Case.*

Abstract

Malignant endocarditis, under which term I include all cases of severe acute endocarditis, whether attended by actual ulceration and loss of substance of the endocardium or not, is unfortunately only too well known in connection with the puerperal state. Puerperal infection is mentioned as a possible cause by all writers since the disease was identified, and a glance at the literature of the subject suffices to show how well founded this statement is. The disease itself is actually about three times as common in the male sex as in the female. But of forty-nine fatal cases occurring in the female, in the statistics of Kanthack and Kelynack, we find eight put down to puerperal infection? an average of rather more than 16 per cent. On the other hand, the occurrence of malignant endocarditis in pregnancy is a rarity. In his Goulstonian lectures on malignant endocarditis, Osier mentions four cases as having occurred in pregnancy. In addition to these, I have been able to find only two more cases, after an extensive, if not exhaustive, search through the literature. The mode of onset, the symptoms, and the course of malignant endocarditis are all so diverse that it is not possible to draw a clinical picture that will fit every case. Two types are in general recognised?the typhoid type, and the intermittent, septic or pysemic type. These again are subdivided into cardiac