Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . if the eroded surface is notat once covered by the deposit of fibrin from the blood, a consid-erable loss of substance may take place. This is far more common,however, in the malignant form, although it has been observed insimple endocarditis complicating rheumatism. More commonlythe eroded surface, necrotic from the action of bacteria, is at oncecovered by a deposit of fibrin from the blood. This fibrin forms afirm warty mass of a yellowish
Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . if the eroded surface is notat once covered by the deposit of fibrin from the blood, a consid-erable loss of substance may take place. This is far more common,however, in the malignant form, although it has been observed insimple endocarditis complicating rheumatism. More commonlythe eroded surface, necrotic from the action of bacteria, is at oncecovered by a deposit of fibrin from the blood. This fibrin forms afirm warty mass of a yellowish or reddish colour, which rises abovethe surface of the membrane, and hence has received the name ACUTE ENDOCARDITIS 147 of vegetation. The name is, however, Dot very appropriate, aa theSO-called vegetation is in its format inn and composition a throm-bus, and may contain all the elements of a thrombus, fibrin, redand white blood-corpuscles, and blood-platelets. By the time that the vegetation has reached such a size as to benoticeable to the unaided eye, the process of repair has begunat its base. This is accomplished by the ingrowth of young con-. Fig. 26.—Malignant Veerucose Endocarditis of Mitral in collection of Dr. Gustav Futterer. nective-tissue cells and the formation of a granulation tissuewhich finally replaces the entire mass of adherent fibrin, and intime becomes covered by the endothelium from the neighbouring 148 DISEASES OF THE IIEART membrane. The growth can now be more properly termed a vege-tation, as it is essentially an outgrowth from the subjacent tissue,and some authors limit the term to this form. The accumulationof fibrin over such an affected area may be very large, but theaverage vegetation is about 3 millimetres in length. When of theirregular form described, the endocarditis is spoken of as thewarty or verrucose variety (Figs. 24-27). The vegetation may be large and polypoid in shape or longand string-like, attached at one end so as
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