Towards a history of infective endocarditis

Infective endocarditis is a serious heart disease which is sometimes very difficult to diagnose and treat despite the progress made over the last few decades.The complex nature of the pathophysiological mechanisms involved in this disease is reflected in the countless number of scientific studies still being done on it.1At the end of the eighteenth century and during the first half of the nineteenth century, the anatomo-clinical method facilitated the gradual establishment of correlations between a lesion discerned during autopsy and symptoms observed in the live patient.It then became a question of bringing together what were, until then, separate individual observations.The very term "endocarditis", referring to an individual tissue and an inflammatory process, goes back to early-nineteenth-century clinicians such as Broussais and Bouillaud, before the germ theory and the birth of bacteriology.However, it was very difficult for doctors of that period to define endocarditis in a simple, unequivocal manner.There was not always a clear relationship between the ideas which late historians have supposed fed each other; the arguments were confusing, tortuous, circular, and dead-end.In his discussion of syphilis, Ludwik Fleck correctly pointed out that disease is a constructed, ever-changing phenomenon which constantly integrates new information and concepts.2Thus, the term "endocarditis" continued to be used for a disease which underwent endless development throughout the nineteenth century.There was also modification of the aetiological links between anatomical abnormalities, clinical symptoms and observations during autopsy.The pathology of the disease was regularly reformulated and its definition varied from period to period and from country to country.The germ theory and the use of the microscope changed the view and concept of the disease at the end of the century.But, even if an instrument suddenly enhances the power of the senses, the knowledge thus acquired needs to be interpreted by human beings.The fact of being able to "see" minute granulations hitherto invisible is not enough immediately to transform these granulations into an analytical tool.The perception of the disease as a relatively coherent whole with aetiological symptoms, led, *Alain Contrepois, INSERM U158 (Universite Ren6 in the field of infectious pathology.In particular, it Descartes, Paris V), H6pital Necker-Enfants assists in the collection of important data on the Malades, 75015 Paris, France.distribution of antibiotics in the infected tissue (the I am indebted to Patrice Pincll for his guidance in inner membrane of the heart and, in particular, the heart valves), on the local activity of the antibiotics ChristieseanhSnding for thneirarh ulicomnt ond on the micro-organisms responsible for the infection Christiane Sinding for their helpful comments on as well as on bacterial adhesion to the endocardium.earlier versions of this paper.The support of the 2Ludwik Fleck, Genesis and development ofa Institut Beecham (Nanterre, France) for part of this scientific fact, eds T J Trenn and R K Metton, work is gratefully acknowledged.