Mitral Stenosis Without Rheumatic Fever in North China

Ever since the etiologic relationship between rheumatic fever and stenosis of the mitral valve was established half a century ago by Hayden,1Fagge,2and Duckworth,3these two conditions have been closely associated in the minds of European and American students of heart disease. It is interesting to discover, therefore, that in North China, where typical rheumatic fever is almost unknown, mitral stenosis is the most common heart lesion, and its incidence is comparable to that in western countries. Table 1 shows the prevalence of mitral stenosis in our records as compared with those of St. Bartholomew's Hospital, London, for 1913, and of the Johns Hopkins Hospital, Baltimore, for 1914. In contrast to this, Table 2 shows the relative incidence of rheumatic fever and infectious arthritis in the same hospitals. This paper deals with thirty-nine cases of mitral stenosis occurring in Chinese patients. These include all of the definitely diagnosed cases