JenniferReiling, Editorial Assistant
SEPTEMBER 2, 1899
Janeway notices the various phenomena of heart disease, among them the spontaneous disappearance or outgrowing by the patient of mitral insufficiency. He also notices the disappearance of the murmur of this condition in Graves' disease, the two conditions apparently being sometimes antagonistic. In his experience in private practice recovery is the rule in Graves' disease. Mitral stenosis is a disorder more often overlooked, and he has observed it in a number of cases occurring after violent exercise in high altitudes. He thinks that in about one-third of the cases one can make a probable diagnosis by listening at the back of the chest below the angle of the scapula, where a murmur is heard, though not so marked as in front. He also calls attention to the substitution of the mitral systolic murmur for the presystolic as the heart compensation is markedly disturbed. Ulcerative or infectious endocarditis is another condition of which he speaks at some length, and he points out the difficulties of diagnosis. The most difficult of the acute cases to recognize are those where there is no heart murmur and where the lesion is on the right side and the secondary effects are more particularly in the lungs. In the former cases, by paying attention to the petechiæ, especially if combined with irregular nervous phenomena, we may be able to make a correct diagnosis. In the latter the difficulty is in determining which is primary, the lung or the heart trouble.
Heart Disease. JAMA. 1999;282(21):1990I. doi:10.1001/jama.282.21.1990I-JJY90039-2-1
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