Relation of Portals of Entry to Subacute Bacterial Endocarditis

As part of an investigation in subacute bacterial endocarditis the records of 364 patients admitted to Mount Sinai Hospital in the past fourteen years (to October 1933) have been analyzed, with particular attention to the antecedent history and the manner of onset. Several interesting facts were noted which are reported here. The outstanding feature of the cases studied is the frequency with which the onset of subacute bacterial endocarditis is associated with an immediately preceding acute infection of the upper respiratory tract, tonsillitis or grip. This relationship has been noted by others. Libman,1in an article on the prognosis in subacute bacterial endocarditis, pointed out that the onset can occur with an attack of acute tonsillitis. He also wrote that "there is evidence which indicates that repetition of infection (in cases with recurrent attacks) may be due to an invasion from focal infections." In a subsequent article2he