136 PHYSICAL EXPRESSION. 



found. In Case 10 cyanosis was more marked in 

 the feet than in the hands. As to the signs of the 

 presence of heart-disease, bruits were present in nine 

 cases ; hypertrophy, evidenced by forcible impulse, 

 distinct area of dulness, strong pulse, or proven by 

 autopsy, was present in seven cases ; irregularity of 

 action was present in three children. Clubbing of 

 the fingers in three cases was noticed. No symp- 

 toms dependent upon the heart-defect were noted 

 in six of the cases given. In six cases some kind 

 of evidence was obtainable as to causation. I 

 found no evidence of "maternal impression" as a 

 cause of congenital defects of the heart ; but there 

 was evidence against the family in four cases in 

 such particulars as to many deaths or several mis- 

 carriages preceding the birth of the patient. In 

 two cases there was no bruit, and in another case 

 the presence of a bruit was very doubtful. 



GROUP III. 



CASES OF CLEFT-PALATE. 



Case 12. Cleft-palate No heart-defect Head 

 small. 



Case 13.--Cleft-palate No heart-defect Head 

 small- Premature birth Marasmus. 



Remarks on Group III. Neither of these cases 

 presented any known coexisting deformity, but in 

 Case 1 a heart-defect accompanied cleft-palate. 

 Such a coincidence appears not improbable, and is 

 worth looking for 'in other cleft-palate patients as 

 a question affecting prognosis and the safety of 

 chloroform in operating, etc. 



