Rokitansky's Law

ROKITANSKY'S LAW states that in mitral stenosis there is no pulmonary tuberculosis. Pathological-anatomical observations indeed show that this position, if not a law, is undoubtedly a rule with a very limited number of exceptions. R.z. should however not be understood to mean that tuberculosis of the lung in mitral stenosis does not occur in any form; the question concerns the absence of active progressive forms that fall under the concept of so-called consumption. In other words, tuberculosis of the lung in the indicated heart defect as a rule has an academic character, manifesting either in an isolated petrified focus or in indurative-rubbed fields of the apices. Explanations for the antagonism of these two diseases cannot yet be given. It is very probable that here two factors are of importance--local and general. The local (pulmonary) factor consists in that the congestive hyperemia that arises in the lungs in mitral stenosis creates unfavorable conditions for the development of the tuberculous process or upon its occurrence promotes the most rapid healing of it, as is indeed observed for example in the treatment by the method of Bier of various inflammatory processes. As a general factor, the constitutional moment may be advanced, since predisposition to tuberculosis and rheumatism (lying at the basis of the main mass of heart defects) is based on different anat.-physiol. and pathogenetic prerequisites. It is also interesting that the tuberculous bacteriemia noted in rheumatics as a rule does not find explanation in the existence of progressive tuberculous foci anywhere; the latter remain anatomically and clinically latent. In general therefore R.z. is based on correct observations.