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The management of subacute bacterial endocarditis superimposed on rheumatic heart disease in the immediate pre-penicillin era: the case of Pasquale Imperato.
[acute rheumatic fever]
Subacute
bacterial
endocarditis
(
SBE
)
was
invariably
a
fatal
disease
in
the
pre-penicillin
era
.
The
availability
of
sulfonamide
antibiotics
beginning
in
the
mid-
1930
s
raised
hopes
that
they
would
be
effective
in
SBE
.
Unfortunately
,
except
in
rare
instances
,
they
were
not
.
This
paper
reviews
the
clinical
experience
with
sulfonamides
in
the
pre-penicillin
period
in
treating
patients
with
SBE
.
It
presents
in
detail
the
case
of
Pasquale
Imperato
,
who
died
from
the
disease
at
the
age
of
72
years
on
30
November
1942
.
In
so
doing
,
it
focuses
on
the
medical
management
measures
then
available
to
treat
patients
with
SBE
and
on
the
inevitable
course
of
the
illness
once
it
began
.
Also
discussed
is
the
relationship
of
acute
rheumatic
fever
and
its
sequela
,
rheumatic
heart
disease
,
to
predisposing
people
to
SBE
and
possible
genetic
factors
.
The
well-known
case
of
Alfred
S
.
Reinhart
,
a
Harvard
Medical
School
student
who
died
from
SBE
in
1931
and
who
kept
a
detailed
chronicle
of
his
disease
,
is
also
discussed
and
contrasted
with
Pasquale
Imperato
's
case
.
Diseases
Validation
Diseases presenting
"bacterial endocarditis"
symptom
acute rheumatic fever
pyomyositis
This symptom has already been validated
