SUBACUTE BACTERIAL ENDOCARDITIS: ACTIVE CASES WITHOUT BACTEREMIA*

FOR several years I have been interested in the group of patients with active bacterial endocarditis without bacteremia during life. These cases are not infrequent, and since organisms can be isolated from the vegetations post mortem, it is a matter of some interest to gather more information re-garding the nature of the local lesion in the valves and the mechanism con-cerned with the absence of bacteremia. The relative incidence of these so-called " bacteria free " f * cases varies in the experience of different observers. In the last 54 cases of endocarditis which came to necropsy at the Boston City Hospital,! the blood cultures and the heart's blood cultures at postmortem examination were negative in 13 or 24 per cent of the cases. In all of these the organisms were cultured from the vegetations and found by microscopic examination of the heart valves. Other observers report that in anywhere from 15 to 25 per cent of the cases which are observed, bacteremia cannot be shown to be present. At this time, I present a summary of 15 cases which I have observe