File:Principles and practice of physical diagnosis (1911) (14578489657).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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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 Tessier. Theassociation of mitral stenosis with cholelithiasis, which occurs inabout one-fifth of all cases of this type of valvular disease,according to Brockbank, has never been satisfactorily explained.
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Stenotic mitralorifice Fig. 173.—Mitral stenosis (Jefferson Hospital Laboratories). The structural changes in mitral obstruction implicate mainly thevalve leaflets, their tendinous and muscular attachments, and thebasal ring of the orifice (Figs. 172 and 173). Of the valve defects,the two most distinctive types are known as Corrigans button-holemitral and the so-called funnel-shaped stenosis, of which theformer is the commoner in adults and the latter, in children. In thebutton-hole variety of obstruction the valve segments are fused, re-tracted, and greatly thickened, with the result that the mitral orifice is DISEASES OF THE CARDIOVASCULAR SYSTEM 417 converted into a mere narrow slit or a somewhat crescentic perforation;in the funnel-shaped stenosis the leaflets are intimately welded to-gether, and, by sclerotic shortening of the chordae tendineae, pulleddown into the cavity of the left ventricle in the form of a conic structurethe large orifice of which points toward the auricle.

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