NOTES ON THE TREATMENT OF SUBACUTE BACTERIAL ENDOCARDITIS ENCOUNTERED IN 88 CASES AT THE MASSACHUSETTS GENERAL HOSPITAL DURING THE SIX YEAR PERIOD 1939 TO 1944 (INCLUSIVE)

Abstract

An analysis is presented of a series of 88 clearcut and 4 probable cases of subacute bacterial endocarditis treated at the Massachusetts General Hospital from Jan., 1939, to Sept., 1944, inclusive. Five (6.5%) of; 77 sulfonamide-treated patients who were followed up recovered and quite possibly a 6th case (Case 6), and if 2 other patients who had valvular lesions, fever, embolic phenomena, and at least 1 positive culture are included, 6 (7.8%) or 7 (8.9%) of 79 re-covered. The opinion that the milder the infection and the earlier the treatment is instituted, the better the prognosis, is only partially confirmed. The transient antipyretic effect of sulfonamides, especially sulfapyridine, was noted. 52 (68.8%) of the 77 sulfonamide-treated cases showed a definite partial or complete loss of fever within 1-3 days after treatment was instituted, the response lasting from 2 to 12 days. Sulfapyridine appeared to have a greater antipyretic effect than other sulfonamides. 17 cases of the sulfonamide series received heparin in the course of treatment; 11 for 5 days or less, 1 for 7 days, and 5 for 10-23 days. 3 of the 5 recovered cases had received heparin and 2 others had not. 5 more recent cases were given dicou-marin, without effect. Since Jan., 1944, 9 cases of subacute bacterial endocarditis have been treated with large doses of penicillin. 6 of these 9 cases (67%) have shown a definite control (perhaps a cure) of their subacute bacterial endocarditis by "massive" doses of penicillin; 2 of these 6 cases, however, developed other serious complications, namely rheumatic fever and congestive heart failure respec- tively. Important complications of subacute bacterial endocarditis that tend to be too little emphasized are cerebral embolism, acute rheumatic infection, and congestive failure, alone or in combination. At the present time these 3 conditions, are on occasion serious drawbacks to complete recovery, even in the cases that seem to be reacting well to massive penicillin therapy.