. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. se of the Heart.—Etiology.—The etiology has beenconsidered in the section on Endocarditis. Frequency.—Of 521 of my cases of clu-onic valvular disease, thelesions were distributed as follows: Mitral insufficiency , . ... Mitral steiiosis . , , Mitral insufficiency and stenosis ..... Aortic stenosis . Aortic regurgitation . ... Aortic stenosis and insufficiency . , . , . Endocardial and pericardial disease .... Combined lesions of mitral and aortic valves ... From this table it will be seen
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. se of the Heart.—Etiology.—The etiology has beenconsidered in the section on Endocarditis. Frequency.—Of 521 of my cases of clu-onic valvular disease, thelesions were distributed as follows: Mitral insufficiency , . ... Mitral steiiosis . , , Mitral insufficiency and stenosis ..... Aortic stenosis . Aortic regurgitation . ... Aortic stenosis and insufficiency . , . , . Endocardial and pericardial disease .... Combined lesions of mitral and aortic valves ... From this table it will be seen that clinically the rarest of lesionsis a pure mitral stenosis. As a rule the greatest majority of these casesis combined with some regurgitation. The most frequent lesion isthat of mitral regi:irgitation and next in frequency that of a combinedstenosis or insufficiency as the mitral value. Causation.—By far the greatest number of valvular lesions in infancyand childhood excepting those of congenital origin are caused byrheumatism. 225 cases 6 176 27 15 t 32 32 8 DISEASES OF THE HEART 683. Mitral stenosis, at first pure ami simple, is in a vast majority of in-stances caused by rheumatism in early childhood, though the markedand pronounced lesion may not be diagnosed before the tenth to thetwelfth year of life. It then becomes combined with the regurgitantlesion at the same valve. The murmur at first is just an audiblepresystolic, becomes rougher later on, and in the final stages the pre-systolic is heard to be replaced by a so-called diastolic murmur. Themitral regurgitant murmur is the most common met with in infancyand childhood, and may be combined with the presystolic or diastolicmitral. The aortic lesions at the valves with their accompanying murmursare not uncommon in childhood, they are met with in older childrenand are the direct result of valvulitis of a rheumatic nature. Theaortic lesion once established is,I think, the one least likely toremain stationary as
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