murmurs can be made and the child spared needless restriction and invalidism. Second, cases of rheumatic heart disease can be kept under observation and guidance so that relapses may be recognized and treatment instituted as soon as possible (this applies particularly to relapses of carditis unassociated with arthritis or chorea) and the child advised regarding education and subsequent employment. Third, cases of congenital heart disease can be diagnosed as accurately as possible and the parents and school authorities advised as to any necessary restriction and about education and subsequent employment. Further, the possibility of corrective surgery can be assessed. For general practitioners and school medical officers the clinics afford readily available advice and help in the management and care of the children. For paediatricians or cardiologists in charge of such clinics a vast field is opened up for observational research on the natural history of congenital and rheumatic heart disease. These clinics also provide many fascinating diagnostic problems and are of great value in undergraduate and postgraduate teaching, since they bring together so many and such varied cardiac physical signs. Finally, the analysis of the cases referred to the clinic gives information as to the incidence of the various types of heart disease occurring in the community served. Some reports giving information of this nature about such clinics have appeared in North America (e.g., Robinson, Aggeler and Daniloff, 1948; Keith, 1951), but we have traced only one from the British Isles, that of Price (1949), who described a clinic in a semi-urban area during its first 18 months. It was therefore considered that a report from a clinic in an urban area might provide material of interest, the value of which would be enhanced by a follow-up survey of several years' duration. The clinic in Bristol was started in 1927 by Dr. Carey Coombs to provide a service for the School Medical Department, and has been continued since. It would have been interesting to review the part the clinic has played over the 25 years of its existence, but there were insuperable difficulties. First, it must be admitted that the accuracy of diagnosis in both rheumatic and congenital heart disease has been increased in recent years, in part because of the cumulative experience from cardiac clinics. Thus, it has been shown clearly that many murmurs, even when occurring in children with a history of 'rheumatism', are in fact 'innocent' or 'functional' murmurs. Second, as a result of the intensive study of congenital heart disease over the past two decades, a fairly firm diagnosis can now be made, in the majority of cases, on a clinical basis. For these two general reasons comparisons over a period of 20 years or more are not valid. A third, and local, reason is that some of the Bristol records were lost as the result of enemy action in the war. For these various reasons, and to permit of a reasonable period of observation, only the cases referred to the clinic between 1943 and 1948 have been studied. Essentially the clinic serves the Bristol City area, and patients living outside Bristol have been excluded from this study. The large majority of children who attended were referred from Bristol school clinics. The school population was 38,500 in 1943 rising to 48,700 in 1948.* In addition, some younger children were referred from pre-school clinics, and this group included a large proportion