Unusual Forms of Heart Disease

AM in general accord with Hutchison's "Don'ts for Diagnosticians," the first two of which read, "Don't be too clever" and "Don't diagnose rarities."Hutchison1 himself quoted Samuel Gee, who said, "Common things most commonly occur," and it may be em- phasized that many rare cardiac conditions perhaps could be all but forgotten, without loss, in day-to-day cardiologic practice.Un- usual manifestations of common diseases probably mislead the physician more often than do unusual diseases.Rare conditions tend to be the spice of practice, however, and constitute the substratum whereon one's probing wits are tested.To a certain extent, also, missing of the diagnosis of a rarity is the bote noir of the specialist.Moreover, in this era of rapid transportation, the patient who has sought diagnosis without success often travels far looking for special help.Thus, by force of numbers, a rarity becomes less an event in a large institution than in general practice.This fact is well known and is well exemplified in the discussions of con- sultants who participate in the "Weekly Clinicopathological Conferences" based on "Case Records of the Massachusetts General Hospital" and reported in The New England Journal of Medicine.Some readers of these reports, whose native language is other than English, must be perplexed by the high in- cidence of symptoms and signs which are From the Mayo Clinic and the Mayo Foundation, Rochester, Minn.The Mayo Foundation is a part of the Graduate School of the University of Minnesota.A paper given before the San Francisco Heart Association Postgraduate Symposium, October, 1953, with minor abridgments and editorial revisions for which the author acknowledges the help of Dr.