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February 1, 1919


JAMA. 1919;72(5):327-328. doi:10.1001/jama.1919.02610050009004

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Mitral regurgitation, which has been assumed to be the easiest of all valvular diseases to recognize, is, in my experience, the most difficult. It is essential that one define mitral regurgitation on a pathologic basis. Mitral valvular disease in this sense is assumed to consist pathologically of a true valvulitis.

The presence of a systolic murmur at the apex, transmitted to the axilla, has quite generally been regarded as evidence of mitral valvular disease. It is my opinion that entirely too much emphasis has been laid on the presence of a systolic murmur. The large number of adventitious sounds heard in examining recruits has been a matter of surprise. Deviations of the cardiac mechanism from the presumed normal are almost the rule. Systolic, apical or basic murmurs are heard in at least 50 per cent, of all men examined, especially immediately after exercise. The intensity of these apical murmurs varies

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