authority than Sibson, however, insists upon its frequent occurrence in acute rheumatism. [Footnote 68: _Barth. Hosp. Repts._, xiv. 228.] [Footnote 69: On this subject see Stokes, _Dis. Heart and Aorta_, pp. 423, 435, 502; Stark, _Archives générales de Méd._, 1866; DaCosta, _American Journal Med. Sci._, July, 1869; Hayden, _Dis. Heart and Aorta_, 1875; Balfour, _Clin. Lects. on Heart and Aorta_, 1876; Cuming, _Dublin Quart. Jour. Med. Sci._, May, 1869; Nixon, _ib._, June, 1873. I. A. Fothergill has seen several cases in which such mitral murmurs have followed sustained effort in boys, and have disappeared after a time: _The Heart and its Diseases_, 2d ed., 1879, p. 177.] [Footnote 70: Reynolds's _System. Med._, Eng. ed., vol. iv. 463.] [Footnote 71: See _Brit. Med. Jour._, i. 1883, 1053.] The anæmia which is so striking a symptom of rheumatic fever, especially when several joints are severely inflamed, coexists very frequently with a systolic basic murmur, which is most often louder over the pulmonary artery (in second left intercostal space and more or less to left of sternum) than over the aorta. The murmur may appear early in the disease, but sets in most frequently when the disease is subsiding. When thus appearing late in a case accompanied by endocarditis and pulmonary congestion, it is of favorable omen and indicates improvement in the thoracic affection. The growing opinion, however, respecting so-called anæmic murmurs is, that they depend chiefly upon regurgitation through the tricuspid orifice, although Dr. W. Russell refers them to pressure of a distended left auricle upon the pulmonary artery.[72] [Footnote 72: _Ib._, 1065.]