The History of Mitral Stenosis

The early observations on mitral stenosis were largely made in France and Britain, and in the past its clinical diagnosis was probably more discussed than that of any other form of valvular disease of the heart.As the study of morbid anatomy is much older than the practice of auscult- ation, the lesion of mitral stenosis was described more than a hundred and fifty years before its clinical recognition received the help of auscultation.Extreme constriction of the mitral orifice in a young man was recorded in 1668 by John Mayow (1640-1679), an Oxford physiologist contemporary with Richard Lower (1631-1691), whose Tractatus de corde appeared in 1669.The morbid change in a case was more fully reported in 1715 by another contemporary, Raymond de Vieussens (1641-1715) of Montpellier, with an illustration of the mitral valve, reproduced in Major's Classic Descriptions of Disease.Morgagni (1682-1771) also recorded the lesion in 1761, under the title " ossification of the mitral valve."PHYSICAL SIGNS In 1806 J. N. Corvisart (1755-1821), called by Andral " the Morgagni of France," and in 1819 his pupil R. H. T. Laennec (1781-1826) began the descrip- tion of the physical signs of mitral obstruction which, following Morgagni, they designated as ossification or calcification of the mitral valve.Corvisart gave an account of the rustling or thrill palpable over the heart as characteristic of the lesion and ascribed it to obstruction to the passage of the blood from the lungs and left auricle through the narrowed mitral orifice.Number cliv of his aphorisms, collected by his pupil Merat (1780-1851), but not published until 1929, is to the effect that on placing the hand over the precordia a thrill is felt, which resembles that experienced by the hand while stroking a cat.The aphorisms were translated into English in 1939 by McDonald.Laennec is sometimes referred to as the original describer of this sign probably because in 1819 he employed the term fremissement cataire; he, however, stated that Corvisart was the first to make this observation.