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meant an enforced lack of air, exercise and ultra-violet radiation during the best intervals
of the day, that was bound to lower metabolism and impair vitality in the long run till
anaemia became but a particular symptom of a generally impoverished state ot health.
The cause of confinement was not always ignorance but might be domestic difficulties
(e.g., inability to put the child out of doors, in rooms) or mistaken zeal as to a child's
actual needs in the matter of rest during the day.
As a matter of clinical interest, if not in illumination of this question of causes,
the association of anaemia with certain other clinical conditions was observed.
Ancemia and functional heart murmurs. Twenty per cent of the anaemic children
showed heart murmurs at one or other examination, as compared with 16 per cent of
the total cases examined. Of these murmurs 80 per cent were mitral murmurs. An
additional 4.6 per cent of the anaemic children showed a modification of the first sound
at the apex but not a murmur. Two cases only showed modification of cardiac rhythm.
The incidence of heart symptoms to some extent ran parallel with the degree of anaemia
shown, in that 25 per cent of the moderate or definite anaemia cases exhibited murmurs,
as compared with 18 per cent only of the slight cases. The severe cases were too few
to allow of similar comparisons. In 8 out of 209 anaemic cases re-examined at a later
date, a murmur had supervened, i.e., in an additional 4 per cent, and in 4 of these
rheumatic symptoms also were found.
Ancemia and rheumatism. Six slight and 1 moderate case of anaemia showed
symptoms that might be indicative of early rheumatism. This is a case incidence of
1.4 per cent as compared with 2.3 per cent for the total cases examined. The figures
are too small to allow of any deduction.
Ancemia with septic tonsils. Two hundred and thirty-six of the anaemic children
showed definite tonsillar enlargement and in 57 cases tonsillectomy was recommended.
T he standard adopted at the clinic in regard to the need for operation is a very conservative
one. These figures compare with the general group of cases as follows:—
Tonsils, or Tonsils and
Adenoids, found to be Operation
enlarged. recommended.
Anaemic cases 50 per cent 12 per cent
Total cases 41 per cent 5 per cent
These figures would appear to indicate some association of anaemia with enlarged
tonsils and a definite association with the septic case requiring operation, since amongst
these children the operation rate is more than double that among the general group of
children examined. This finding would tend to corroborate what has been suggested
by other workers regarding the secondary and general effects of tonsillar infection.
Ancemia and pallor. The relation of these symptoms, commonly considered by
the lay public as interchangeable terms, is interesting. 10.8 per cent of the anaemic
cases showed facial pallor. The same symptom was noted in 7 per cent of the general