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These last two groups include the majority of cases. The
groups of symptoms are nearly always in combination, varying
in degree with the activity or type of case.

This classification follows that of Dr. R. Miller. It appears
the most useful, as in it a place is found for all cases irrespective
of situation, or character of symptoms. Grouping of Rheumatic
cases, in spite of the ever increasing advance in diagnostic
methods, still remains a matter of difficulty and one requiring
considerable experience in all the diseases of childhood.
Perhaps the earliest signs and those which in particular led
to the diagnosis of a case as mild and potential were "growing
pains" in highly strung children, in associaton with slight irregularities
of cardiac sounds or rhythm.
Where these signs were present in a case, who also showed
some cardiac dilatation accompanied bv breathlessness on
exertion, the diagnosis became more certain and passed into the
definite and quiescent group.
In these cases anaemia was frequently present, being recorded
in 36 cases out of a total of 99 definite cases.
Malnutrition was frequently noted, and an expression of
nervous tension completed a clinical picture whose only counterpart
may be seen in children the subjects of glandular, mesenteric,
or other forms of tuberculosis. The mistake of diagnosing
some of these rheumatic cases as tuberculous must be constantly
guarded against.
The definite and active group comprised cases of frank
Rheumatic carditis, as shown by well marked physical signs with
a history, or the presence of rheumatic fever or chorea.
Some cases of organic heart disease, whose origin could not
be otherwise accounted for, were placed in this group.
4.—Rheumatic manifestations.