C. W. M. Poynter 



HISTORICAL 



Investigators, as well as clinicians, have been interested in car- 

 diac malformations ever since they were first reported. Their 

 relationship to other anomalies was early recognized and in 1671 

 Stenson reported a defect of the inter-ventricular septum asso- 

 ciated with cleft-palate. Since that time a great many different 

 types of anomaly have been found in association. Rokitansky 

 collected twenty-four defective hearts, a third of which cases had 

 other developmental irregularities. It is impossible to regard the 

 presence of the other anomalies as a mere coincidence, yet there 

 is no constant specific type association. 



Senac (1749) saw in congenital cardiac disease only a weak- 

 ening of the formative influence, while Meckel (1812) pointed 

 out the resemblance of certain of these hearts to those of lower 

 animals, explaining them as reversions ; he classified them as am- 

 phibian, reptilian, etc., and, although bis theory has never been 

 generally accepted, his insistence that arrest of development was 

 the primary cause of these anomalies pointed the way to embryo- 

 logical study which has formed the basis of all m'odern attempts 

 at scientific classification and explanation. Lee (1880) saw in 

 single and associated anomalies the result of baneful influences 

 acting during the early weeks of pregnancy sometimes selecting 

 one part and sometimes another. 



Kreysig (1817) offered the suggestion that foetal endocarditis 

 was responsible for congenital cardiac disease. This theory has 

 been very widely accepted, particularly by pathologists. It has 

 been considered as affecting not only the early developing heart 

 but the fully formed heart as well. With a better understanding 

 of heart development, the modern tendency is to explain the ma- 

 jority of cardiac irregularities as due to arrest of development 

 caused perhaps by a variety of factors. There still remains a 

 certain proportion of cases in which it is impossible to say that 

 foetal endocarditis has not been present and has not disturbed the 

 normal course of development ; however, the presence of thick- 

 ened tissues does not necessarily prove that a defect is due to an 

 inflammatory process. The final discussion of these cases must 



