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(8) There was some proof that lack of air and exercise, referable to unwise management,
may have intervened in some cases.
(9) There was found to be some clinical association between anxmia and facial
pallor, functional heart conditions and septic tonsils, but there was nothing
to suggest that anxmia in itself predisposed to or was a concomitant of
early rheumatism.
(10) In a majority of the cases re-inspected (60 per cent) the anxmic symptoms
improved after a period of 12 months under simple dietetic and hygienic
measures, but the improvement was not universal and in some cases other
symptoms supervened.
(11) In view of the lack of other positive evidence as to the cause of anxmia, the
hazard is made that it may be related to questions of diet that are not,
however, open, in an inquiry of this sort, to close correlation and control.
Observations are made with regard to deficiency in protein and mineral elements
and certain vitamins, and suggestions are offered for certain lines of improvement
of diet in these directions.
B. Heart Cases.
The total number of cases showing cardiac signs or symptoms out of 1,622 children
examined was 339 or 20 per cent. Compared with the total number of examinations
the percentage of defects is not nearly so high since certain children only showed a
defect after several examinations. Every clinical condition is recorded that came
under attention at examination.
(1) Nature of cardiac symptoms.
(a) Of these 339 children, 75 per cent showed cardiac murmurs, 249 of which were
presumed functional or temporary, and 8 were presumed congenital heart disease, i.e.,
16 per cent of the total children examined showed heart murmurs. Of those considered
to be functional cases, 192 showed apical murmurs, 25 basal murmurs and 32 a
combination of apical and basal murmurs. The murmurs were recorded as soft in
quality in 226 of the 249 cases and loud in 23. In 12 of the latter cases a loud murmur
at the apex was accompanied by a murmur audible at the base. In 2 cases only was
the presence of a diastolic murmur detected.
(b) Modification of sounds. In 78 cases a modification of the first sound at the
apex was noted without any accompanying murmur. In 3 of these cases a murmur
was found at a subsequent examination but the majority were cases not seen a second
time.
(c) Disturbance of rhythm. Simple modification of rhythm in the torm of
re-duplication of sounds, shortened diastole, increase of pulse rate, frequent extra
systoles or other minor deviations were noted without other cardiac signs in 12 of the
total cases. Of these, 7 were re-inspected after an interval and the rhythmic irregularity
was found to have disappeared in 4, was still present in 1, and in 2 had given place to
more definite cardiac disturbances, namely, apical and basal murmurs in 1 case and in