Studies in cardiac pathology . be carefully excluded before drawing definite conclusions. The fact that mitral obstruction is not rarely associated withcongenital malformations naturally suggests a common cause,such as syphilis, alcoholism, tuberculosis in the parents, and Lezary* have recently collected 15 cases in which, inaddition to mitral stenosis, such lesions as syndactjdia, ectopictesticles, harelip, sternal malformations, imbecility, were is quite possible, however, that such cases are coincidences,or the result of an intrauterine infection, since the symptoms of
Studies in cardiac pathology . be carefully excluded before drawing definite conclusions. The fact that mitral obstruction is not rarely associated withcongenital malformations naturally suggests a common cause,such as syphilis, alcoholism, tuberculosis in the parents, and Lezary* have recently collected 15 cases in which, inaddition to mitral stenosis, such lesions as syndactjdia, ectopictesticles, harelip, sternal malformations, imbecility, were is quite possible, however, that such cases are coincidences,or the result of an intrauterine infection, since the symptoms ofmitral stenosis rarely manifest themselves before the twelfthyear (Poynton). A mitral heredity has been dwelt upon byHirtz.^ Peck: Annals of Surgery, July, Elsberg: Jour. Exper. Med., 1899, p. 479. Cabot states that out of 48 cases discovered at. autopsy at the Massachusetts GeneralHospital were overlooked clinically. * Heitz and Lezary: Arch. d. Mai. du Cccur, 190S, i, p. 701.^Hirtz: Presse Med., Sept. 19, Tic. 24.—Stenosis of the Aortic, Mitral, and Tricuspid Valves. The aortic leaflets are fused together and the orifice is greatly reduced in caliber. Themitral orifice consists of a mere .slit, of crescentic outline—buttonhole type. The tricuspidorifice is also contracted. (Specimen from the Philadelphia Hospital.) 80 STUDIES IN CARDIAC PATHOLOGY MITRAL INSUFFICIENCY Pathogenesis.—The mitral valves may fail to prevent back-ward leakage owing to organic disease or to atonicity of the mus-cular sphincter, upon the integrity of which the proper functiona-tion of the valve so largely depends. This atonicity of the sphinc-ter in turn may result from muscular degeneration or from purelyfunctional causes. The conditions necessary to produce a func-tional lesion are diminished muscular tonicity and an overworkedventricle. When mitral insufficiency results from organic causes,it is not infrequently associated with some obstruction. Thevalves may be fused, retr
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