File:Principles and practice of physical diagnosis (1911) (14741948196).jpg

Identifier: principlespracti1911daco (find matches)
Title: Principles and practice of physical diagnosis
Year: 1911 (1910s)
Authors: Da Costa, John C., jr., 1871-
Subjects: Diagnosis Diagnosis
Publisher: Philadelphia and London : W.B. Saunders Company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ee p. 367.) MITRAL STENOSIS Clinical Pathology.—Rheumatic endocarditis is unquestionablythe most important factor of this variety of valvular disease, whichordinarily depends upon an insidious and progressive valvulitis,arising, in childhood, in connection with vague arthritic symptoms,and being first recognized during the second or third decade of DISEASES OF THE CARDIOVASCULAR SYSTEM 415 life in those who, as young children, suffered from growing painsand other atypical manifestations of subacute or masked rheumatism.Less frequently mitral stenosis is traceable to an acute attack ofrheumatic fever attended by well-defined endocarditis, and veryexceptionally the lesion is to be regarded as congenital, being due insuch instances either to fetal endocarditis or to developmental defect.Chorea is also a prominent cause of mitral valvulitis and narrowing,and the valvular irritation consequent to anemia and chlorosis, aswell as the undue stress upon the mitral leaflets imposed by attacks
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Fig. 172.—Mitral stenosis (Jefferson Hospital Laboratories). of pertussis, may excite fibroid constriction of the mitral orifice.Pure mitral stenosis is a disease of children and young adults, ratherthan of advanced life, and is much commoner in females than in males,the former fact being generally attributed to the prevalence of rheu-matism in the young, and the latter to the susceptibility of girlsto rheumatism, chorea, and anemia. Persons of middle or advancedage occasionally acquire mitral stenosis of a sclerotic type, underwhich circumstances the lesion is but part of a general arterio-sclerosis, and is commonly associated with chronic renal disease, 4i6 PHYSICAL DIAGNOSIS gout, or syphilis. Rokitanskys theory that mitral stenosis andpulmonary tuberculosis are antagonistic is generally regarded astenable. The view that tuberculosis is an exciting cause of mitralobstruction, especially of those types characterized by slow develop-ment and progress, is supported by Potain and by

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