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BRITISH MEDICAL JOURNAL a heart murmur at this stage the blood was examined for sulphhaemoglobin and methaemoglobin, with negative results. However, a systolic murmur was again heard at the age of 10 weeks, and soon after a precordial thrill also developed and the. child became increasingly dyspnoeic. E.C.G. was within normal limits except for the presence of slight left axis deviation and a suggestion of left ventricular hypertrophy in the precordial leads. Radiological examination of the chest showed some widening of the upper mediastinum with a slightly globular heart shadow. The lung fields were clear. The diarrhoea, which had persisted throughout, now became profuse, and death occurred from uncontrollable dehydration at the age of 13 weeks.At the post-mortem examination a bilocular heart was found with the aorta and pulmonary artery arising in the correct relationship from the common ventricle. The aortic arch was right-sided and the pulmonary artery was hypoplastic. On each side a superior vena cava and two pulmonary veins entered the common auricle. Each lung possessed three lobes. There was a complete absence of spleen and splenic tissue. The stomach was represented by a thick-walled widening of the gut embedded in the liver. The pancreas consisted of a small round mass of tissue. COMMENTIn such cases as this the diagnosis of splenic agenesis might be suspected during life from the unusual blood picture and the presence of cyanotic heart disease.

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