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Am J Dis Child. 1913;VI(2):87-92. doi:10.1001/archpedi.1913.04100320024003.
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Case:  R. Z., aged 2 1/4 years, under observation at the Presbyterian Hospital, N. Y.; accident when 1 year old; died; autopsy.A puny, undersized child was brought to the out-patient department of the University and Bellevue Hospital Medical College, the parents hoping that she might be strengthened, her color improved, her bronchitis cured. She was announced to me among the material for clinic as "congenital heart disease." She was not cyanotic. I put my hand over her chest and felt the purring thrill. I presumed it to be a case of congenital heart in which there was no cyanosis, an exception to the rule. On further examination it was noticed that the murmur, though loud and purring, was heard all over the chest, and was not of maximum intensity over the left space and costo-sternal junction. The maximum was rather over the belly of the left ventricle. The physical


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