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the other mitral murmur plus cyanosis. In 15 further cases disturbances of rhythm
were found accompanying other cardiac signs or the general conditions considered in
this inquiry, namely, pallor, anaemia or rheumatism. The rhythmic disturbances
noted occurred in the following order of frequency:— re-duplication of sounds, 9;
short diastole, 9; increased pulse rate, 7; extra systoles, 1; simple arrhythmia, 1.
Care was taken to exclude simple nervousness in the cases noted as having an increase
of pulse rate, and in each confirmatory examination was made.
(d) Other cardiac conditions. Increased cardiac action (as apart from simple
increase of rate) was noted in 3 cases; each of these also showed symptoms ol rheumatism
and showed or subsequently developed a murmur. Apical thrill was noted in 3 only
of the total cases and each of these cases showed also some degree of dilatation and 2
of the 3, pains suggestive of rheumatism. In none of these cases, however, was a murmur
audible at the apex at the time of the examination. A thrill, on the other hand, was
searched for in all cases showing apical murmur, but was not found. Seven cases
showed displacement of the apex beat, of which one was without other signs ; 2 showed
rheumatic symptoms plus apical thrill (as already noted); 1 showed tachycardia plus
mitral murmur; 1 a mitral murmur preceding the dilatation; 1 antecedent anaemia,
subsequently developing a murmur with the dilatation, and 1 anaemia plus apical thrill
without other symptoms. Four only of the total cases showed cyanosis, of which 3
were, or had been, cases of Pink disease, and 3 had murmurs of a marked character.
Two of these were considered possibly to be cases of congenital trouble. No case
amongst the group marked functional complained of dyspnoea. In 5 of the cases
whose only cardiac disturbance was a disturbance of rhythm or cardiac dilatation,
anaemia was noted, in 2 pallor and in 7 rheumatism. There was no particular
association of the severer degrees of anaemia with cardiac symptoms as compared with
the lesser degrees of that condition.

(3) Association with ancemia and rickets. The co-existence of anaemia and cardiac
symptoms is discussed in the first part of this report. Eighty-seven of the pure heart
cases showed definite signs of rickets. This equals a percentage of 40. Minor signs
of rachitis were present in an additional 46, equalling a further 21 per cent. Therefore,
as in the case of anaemia, rickets is appreciably commoner among the cases showing
cardiac abnormality than among the general run of children examined. The finding
is a rational one since the poor muscle tone that is part of the rachitic disease must be
liable to affect the heart as it is other muscles of the body and produce functional
symptoms relative to that impairment pending general recovery of tone.