OBJECTIVE EVIDENCE OF THE STATE OF ACQUIRED VALVE LESIONS OBTAINED WITHOUT TRAUMA BEFORE AND AFTER SURGERY * t

OBJECTIVE criteria of the results of therapy permitted the development of effective management for tuberculosis, pernicious anemia, diabetes and prostatic cancer, while false hopes had been aroused by enthusiasts or quacks whose claims for cures of consumption or cancer were based on the sense of well-being in their patients, with no objective evidence of control of the disease. For physicians familiar with the contrasting histories of effective management and bogus cures, it was disturbing to note the emphasis on how well patients felt after mitral valvotomy, and the absence of objective evi-dence of change in cardiac function in most reported series of patients. In congenital heart disease, when shunts are closed during open-heart surgery, there is no more question of the effectiveness of the procedure than there would be about removal of an appendix. But when valvular insuf-ficiency or a stenotic lesion is attacked, or a ligature is put around a patent ductus, it obviously is wise to obtain objective evidence of the resulting change in the circulation to decide whether treatment has been curative