The Vegetations On The Valves above referred to undergo different metamorphoses, as we have already seen, and as will be made more apparent in the sequel. We will here specially notice:

1. Their Gradual Diminution And Final Disappearance

According to numerous highly interesting analogies, it would appear that these conditions depend on an actual waste of the fibrinous coagulum. They undoubtedly occur very commonly, and from a comparison of the frequent or almost invariable appearance of very numerous and extensive vegetations on the valves in recent endocarditis, and their insignificant character and occasional absence in obsolete cases, it appears evident that in the course of time, they become considerably diminished, and at length entirely disappear.

2. Ossification And Calcification

Ossification And Calcification of these vegetations are metamorphoses, which, although of frequent occurrence, have not hitherto been duly considered. They constitute a special form of valvular ossification, which has never yet been duly considered.

f. The secondary Coagulation of Blood in the capillary system, together with its metamorphosis, which presents a highly important indication of the endocarditic process,1 has also been disregarded by observers. It indicates the most important phenomenon manifested during endocarditis, namely, the formation of a product on the free surface of the endocardium and its absorption into the mass of the blood, and consequently shows the equal importance of endocarditis and inflammation of the vessels (namely, of the veins), while it moreover tends to elucidate the symptoms of disease during life. It is more constant than in phlebitis, inasmuch as, from the absorption of the inflammatory product, no coagulum can be formed in the heart of a similar nature to those which occur in the veins, and hence there can be no immunity afforded against a poisoning of the whole mass of the blood. This process probably, on this account, constitutes an important means of diagnosing between obsolete endocarditis and a form of hypertrophy of the endocardium, and more especially of the valves, which is induced by depositions from the blood; but this subject we will presently consider more at large.

It is of common occurrence in the spleen and kidneys, but is seldom found in the lungs, excepting in the very rare cases of endocarditis of the right side of the heart. The secondary processes which result from endocarditis depositing a purulent exudation, and terminating in suppuration, are less limited to these organs of haematosis, and manifest themselves as metastases in the subcutaneous cellular tissue, in the mucous membranes, etc.

The process commonly called Phlebitis (but more appropriately termed Angioitis capillaris) consists, as far as we know, like that observed in a larger vessel (namely, a vein), in a coagulation of the blood in the capillaries, and a metamorphosis of the coagulated fibrin, varying in accordance with the quality of the absorbed product. Since endocarditis, in ordinary cases, yields no deleterious product (pus or ichor), the metamorphosis consists in a conversion of the fibrinous coagulum into a fibroid mass, with obliteration of the vessels, and so great a degree of obsolescence of the affected tissue of the diseased organ, that the whole resembles a cellulo-fibrous callus which shrivels to a callous, whitish or black cicatrix, containing pigment. It is not improbable that the process may terminate in resolution, or, in other words, in the solution of the coagulum, and thus leave no trace of its existence. In the very rare cases in which endocarditis deposits a purulent product, the coagulum in the capillaries becomes decomposed into a fluid, which is more or less purulent, according to its elementary composition, while there is consecutive fusion of the walls of the vessels and the diseased tissue, the result of which is the formation of an abscess, or so-called purulent metastasis. This form of endocarditis may result in a true process of exudation in the serous and synovial membranes, and even in the parenchyma, in consequence of the diseased condition of th blood induced by the morbid product.

1 Oesterr. med. Jahrbücher, B. _xix. St. 3.