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March 24, 2017
Infective Endocarditis Emanuel Fredrik Winge

Emanuel Fredrik Winge (1827-1894)

[Mycosis endocardii.] Norsk Mag. Laegevid. (Forh. Norske med. Sels-kab), 1869,23,78-82

Emanuel Fredrik Winge
Portrait of Emanuel Fredrik Winge
Portrait of Emanuel Fredrik Winge


Emanuel Fredrik Hagbarth Winge was a physician from Norway. He studied under Virchow in 1857. He first suggested that endocarditis was due to microbial infection in 1869.

Winge described the case of a 42 year-old male who presented with a toe injury which became infected with the development of a local abscess. Subsequently the patient had fever, chills, sweating, dyspnea and delirium. He died a few days later from the symptoms of "blood poisoning".

At autopsy, aortic and tricuspid valves were covered with cauliflower-like vegetations which contained pus.  Areas of hemorrhagic infarcts were noted in the spleen, kidneys and lungs.

He then summarized his thoughts that pyemia [septicemia] could lead to the infection of cardiac valves:

"The ulcerative endocarditis can be found with pyemia is a known fact, if it occurs with an infection such as the present infection one could regard it as a secondary phenomenon and put it in the class of metastatic processes."

He also reported in this work three cases of "primary ulcerative endocarditis":

"...all died with the picture of typhoid [septicemia] and at autopsy fresh endocarditis was found with a large number of miliary abscesses and hemorrhages in the serous membranes, skin, wall of the heart, kidneys, etc."

Regarding the first case, his analysis of microscopic examination of the cardiac valve vegetations was:

"The further study of the lesions on the heart valves gave  an unexpected result...It was demonstrated that the thrombi produced by the lesions of the endocarditis for the most part were not composed of fibrin of the components of the blood, but of a parasitic vegetation. They appeared under the microscope, at first glance as a mesh of fine threads of fibrin with a finely granular mass of detritus, but on close inspection the threads were found to be fine cross striations, and on greater magnification...they were seen to be composed of short, rod-shaped or round bodies, they were partly branched, also the grains of the short rods had the appearance of small bacteria, while the threads appeared like the mycelium of leptothrix. The same structure was found in the emboli in the arteries of the kidney as well as in the small foci in the heart, with the exception of blood and detritus there were the same threads and grains, with the exception that these could be shown to lie in the great vessels."

Winge was convinced of the accuracy of his microscopic findings and in the conclusion of his article remarked:

"In the present case there can be no basis for confusion, I must say for certain...that this is not a postmortem artifact."

Winge's publication was extremely important as he suggested the role of these "parasitic particles" that could enter the body through the skin with the potential risk of dissemination through the blood circulation with secondary localization on cardiac valves. Winge proposed this disorder to be named "Mycosis endocardii".

REFERENCES

Major RH. Classic descriptions of disease. 3rd ed. Springfield Ill, CC Thomas,1945


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