DISEASES OF CHILDREN, CONTINUED
Mastitis or Inflammation of the Breasts in Infancy—Mastitis in Young Girls—Let Your Ears Alone— Never Box a Child's Ears—Do Not Pick the Ears—Earache—Inflammation of the Ear—Acute Otitis—Swollen Glands—Acute Adenitis—Swollen Glands in the Groin—Boils—Hives— Nettle Rash—Prickly Heat—Ringworm in the Scalp— Eczema—Poor Blood—Simple Anemia—Chlorosis—Severe Anemia—Pernicious Anemia
MASTITIS, OR INFLAMMATION OF THE BREASTS IN INFANCY
There are a few drops of a milky secretion in the breasts of infants when born. Occasionally the amount will be in excess of the normal quantity, and the breasts, around the nipple, may be swollen and slightly inflamed. Should this condition persist, it may be relieved by painting the parts with the tincture of belladonna. Under no circumstances should the breasts be manipulated or rubbed, as this is very apt to cause an inflammatory condition, and to result in mastitis.
Mastitis begins, as a rule, during the second week of life. The breast becomes red, swollen, painful, and shows inflammatory changes. It may terminate without the formation of an abscess, or it may go on to suppuration. The child becomes extremely restless and irritable, it is disinclined to nurse, and suffers from loss of sleep and nourishment. It is possible for such a condition, in the female, to injure the breast to the extent of arresting its development and to render it useless in the future. If the suppuration is extensive the process may terminate fatally.
Mastitis in infants is caused by unnecessary interference and manipulation and by want of cleanliness. When it occurs the parts should be kept absolutely clean and should not be handled in any way. Ichthyol 25 per cent., Zinc Oxide Ointment, enough to make one ounce, spread upon old, clean, soft linen, and laid over the parts and changed every six hours, is an excellent healing application. A piece of oiled silk may be put outside the linen to prevent the ointment staining the clothing, and over this a layer of absorbent cotton and a binder, applied without pressure.
If an abscess develops in spite of treatment, it must be freely opened and freely drained, and the general health of the patient supported by regular nourishment and tonics.
Mastitis in Young Girls.—Pain and swelling of the breasts are sometimes complained of by girls between the twelfth and fifteenth years, though it may occur at an earlier or later date. If left alone the condition will invariably subside without treatment. Should bacteria find an entrance through the nipple at this time, an abscess may result. The whole breast is involved and it will be exceedingly painful and much swollen. There may be moderate fever, headache, and a pronounced feeling of indisposition. These patients should be given a laxative,—citrate of magnesia, or Pluto Water, and kept on a very light diet. An ice-bag should be kept constantly at the breast during the day, and a moist dressing of 1:5000 bichloride of mercury during the night.
It may take a week before recovery takes place.
LET YOUR EARS ALONE
Never Box a Child's Ears.—A single blow may make a child deaf; repeated blows on their ears will certainly injure children's hearing.
Thomas A. Edison, our greatest inventor, was made deaf when a lad by a surly brakeman, who soundly boxed his ears for some trivial or fancied offense.
Boxing a child's ears is but one of a great many things you should never do to the ears. In fact, there are far more things you should not do to safeguard the hearing, than there are things you can do to benefit your ears.
Do Not Pick the Ears.—Do not put cotton in the ears unless ordered to do so by a reputable physician. Do not syringe the ears without the doctor's orders. Put no poultices in the ears. Do not put drops of any kind in the ears unless prescribed by a doctor. Above all, do not use the advertised ear cures, as most of them are harmful. Never blow into a child's ear, never douche the nose without the doctor's orders, as this may wash germs into the tubes leading to the ears and bring about a serious condition.
Riding in tunnels, especially in tunnels under water where the air pressure varies, has, through some recent investigation, been found to be injurious to the ears of a great many people.
Conductors and other trainmen who run through many tunnels are apt to have ear trouble, as are the men who work underground a great depth where they are in motion, such as miners running underground trains.
If you have an earache that continues for any length of time, take no chances, but consult a physician. And remember to care for the throat and nose, as ill conditions in those places result in ear troubles. Do not blow your nose too hard; it merely injures the inner sides of the ear drums. Adenoids in children frequently bring about a bad ear trouble. Even seasickness is due in a great measure to ear disturbances.
If you have a running ear, attend to it at once by visiting a doctor. So serious is this that life insurance companies will not insure people in that condition.
Earache.—When a child complains of earache its ear should be examined. In nearly every case of earache it is necessary to treat the throat, as this is, as a rule, the seat of the trouble. An antiseptic gargle of equal parts of Borolyptol and warm water is an excellent mixture. It should be used freely every two hours. Children suffering from earache should be kept indoors. If the examination should show that it is not necessary to lance the ear drum, some local measure may be adopted to allay the pain. Putting the child in bed with the head resting on a hot-water bottle may be all that will be necessary. The following procedure may be carried out, but only after a physician has made an examination and according to his directions: A hot water douche, given by means of a douche bag, is quite effective. The water should be 110° F.; the bag should be held about two feet above the level of the child's head, and the irrigating point should not be pushed into the ear, but held so that the water will find its own way into the ear.
When the earache does not respond to the above methods the ear should be closely watched and examined at intervals so that it may be opened at the right moment. This is very essential because, if it is neglected, the pus may find its way into the mastoid cells and set up the dangerous disease, mastoiditis. This disease may cause abscess of the brain and death. The moment a child develops fever in the course of an earache the ear should be examined and opened at once, if found necessary.
Inflammation of the Ear. Acute Otitis.—Inflammation of the ear seldom occurs in childhood, unless as a complication, or as a result of some infectious disease. Any disease which affects the throat in any way may be the cause of the inflammation of the ear. Such diseases are, "cold in the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles, scarlet fever. It is much more common in children than in adults. The younger the child, the more liable it is to develop ear trouble when suffering from any of the above diseases. The presence of adenoids favors the development of ear complications.
Symptoms.—There is one symptom present in all cases of inflammation of the ear; that is, fever. Pain may or may not be present; it is present in a majority of the cases. Children with inflammation of the ear are exceedingly restless and do not sleep long at a time nor do they sleep soundly.
Treatment.—The treatment is to open the drum membrane, at the right time, which of course will always be done by a physician who has had some experience in this work.
After Treatment.—The after treatment consists of washing or syringing the ear every three hours with eight or twelve ounces of a 1:10,000 solution of corrosive sublimate. This will be kept up for four days; then the intervals between the washing will be extended to five hours, and kept up until the drum membrane closes. If the corrosive sublimate solution should cause any eruption around the ear, a normal salt solution (see page [ 627]) may be used in the same way, and in the same quantity as above. A running ear will run for from three to six weeks. It may heal up at any time after ten days. If the discharge should suddenly stop and the fever rise, it indicates that the opening has become plugged or healed too quickly. In either case it will have to be opened again. As soon as the ear begins running again the symptoms will disappear. After syringing the ear it should be dried thoroughly with pieces of sterile absorbent cotton.
The best syringe to use for washing out the ear is a one-ounce hard-rubber ear syringe with a soft rubber tip. An ordinary douche bag will do if a syringe of the above character cannot be obtained. The douche bag should not be held higher than two feet above the patient's head. The double-current ear irrigator is an excellent device for this purpose. The child should be on its back on a table. Its arms should be fastened down by its side. A basin can be placed under its ear and the irrigating done without causing any pain or discomfort.
Any child addicted to disease of the ear should be closely watched and examined for tuberculosis. Scrofula may accompany this condition. These children need careful attention in every little detail, they need good nourishment, fresh air night and day, and they should not be pushed at school. During the winter they should be protected from "catching colds;" it is a good plan to put them on a cod-liver-oil mixture for the entire cold season. During the summer they should have a radical change of climate.
SUMMARY:
1st. Inflammation of the ear is frequently a complication of or follows some other disease which affects the throat.
2nd. If a child with one of these diseases becomes restless, sleepless and feverish, be on the look-out for ear trouble.
3rd. The ear must be lanced immediately when necessary.
4th. The after treatment is very important, because the hearing of the child depends upon it.
SWOLLEN GLANDS. ACUTE ADENITIS
Swollen glands in infancy and childhood are usually seen below and behind the ear, less frequently in the groin. Their cause is, as a rule, local disturbance in the mouth or throat, as decayed teeth, enlarged tonsils, cold in the head, catarrh, adenoids, or some form of infection of the mouth, or throat, or scalp. They occasionally accompany scarlet fever, diphtheria, measles, and influenza. They seldom suppurate.
Symptoms.—A swelling is noticed just below the angle of the jaw; it does not grow rapidly. There is a slight temperature and the child is more or less irritable. If the patient is an infant, the fever may be quite high and there may be considerable prostration. The trouble lasts from four to eight weeks.
Treatment.—An ice-bag constantly applied is the best treatment. This not only relieves pain, but it prevents the possibility of the gland breaking down and suppurating. It is sometimes difficult to keep an ice-bag on an infant, in which case cold compresses should be applied. These are made by taking several layers of old linen or cheese cloth and laying them on ice. They should be applied frequently to the swollen gland. The following ointment may be applied, though the ice-bag is the better and more certain treatment: Ichthyol 25 per cent., Adeps Lanae one ounce. This is applied on cloth and renewed every six hours.
This ointment is black and stains the clothing. For that reason it is advised to use oiled silk over the cloth to avoid staining the pillow or clothing.
Children suffering from adenitis should use a spray of Dobell's solution in the nose and throat three or four times daily. If the cause of the swollen glands is known, treatment for its cure should be promptly instituted.
In the event of pus forming the gland must be opened and drained.
Swollen glands in the groin of a child are caused most frequently by some inflammatory condition of the privates, which should be discovered and treated.
BOILS
In some delicate children and in some children who do not seem to be delicate, repeated crops of boils may appear from time to time.
It is necessary to open them as soon as pus is present. They should be pressed out and a gauze dressing, wet with a saturated solution of boric acid, bound over them. The dressing should be kept moist.
I have in a number of instances successfully rid a child of the tendency to boils by the use of the following formula, which I can recommend highly as one of the best tonics I have ever used in the treatment of delicate and poorly nourished children: Tinct. Nux Vomica 4 drops, Acid Phosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make a two-ounce mixture and give to children over four years of age one teaspoonful after each meal; to younger children, one-half teaspoonful after each meal.
It is necessary in these cases to keep the bowels open daily.
HIVES. NETTLE-RASH
Cause.—Contact with different plants, bites of insects, irritation from clothing, use of certain drugs. Certain articles of food, such as tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause hives.
Dentition during warm weather and the presence of worms and chronic malarial poisoning have been known to cause hives.
It is most frequently caused, however, in childhood by some disturbance in the stomach or bowels.
It causes severe itching and loss of sleep and as a result of these the general health suffers.
Treatment.—If caused by any external irritant, remove it. If it is caused by any special article of diet, prohibit its use. If no cause is apparent, give the child one tablespoonful of castor oil, and put it on the mildest diet possible of soups, broths, and dried stale bread. Give no milk. Use the following treatment on the erupted parts: Menthol, ten grains in one ounce of cold cream. Keep the bowels open.
It is sometimes necessary to advise a change of air before complete cure results.
PRICKLY HEAT
This is a very common complaint in children during the summer months. It is so common that it is well known and easily recognized. It consists of a bright red eruption, composed of little papules, close together.
The rash comes out quickly, so much so that mothers may be surprised and frightened by observing an angry looking rash on their baby some morning when none was there the night before. It most frequently appears upon the neck, back, chest, and forehead. It is exceedingly itchy and a child may scratch itself and cause extensive harm. Eczema, of a very obstinate type, frequently results from scratching.
The rash of prickly heat is easily diagnosed from other rashes because it is accompanied by no other symptom, such as fever, which would suggest a more serious disease. The rash of prickly heat resembles the rash of scarlet fever more than any other rash, but it is quickly noted that when a child has scarlet fever it has every symptom of being profoundly sick, while prickly heat has no symptom other than the itch and discomfort. It is caused by overfeeding, being overclothed, and sweating in hot weather.
Treatment.—Steps should be taken to prevent prickly heat in an infant. Use light, seasonable clothing, bathe frequently, and use plenty of good toilet powder. When the child actually has an attack, open its bowels freely with citrate of magnesia, and give some sweet spirits of niter, according to age. Protect the skin from the irritating underwear by interposing a soft piece of linen. In order to reduce the inflammation and cure the condition apply equal parts of starch and boric acid powder freely. Keep the patient on a light fluid diet. The bran bath is advisable if the little patient is addicted to these skin eruptions.
RINGWORM OF THE SCALP
Children of all ages are liable to "catch" ringworm of the scalp. It particularly affects those who are untidy, dirty, and badly cared for, though any child is apt to get it while attending the public schools.
If a mother discovers scaly patches in the scalp, with loss of hair, ringworm should be immediately suspected. It is not, however, always easy to diagnose the condition, especially if the case is a mild one. If it is a severe attack, there is, as a rule, quite a little inflammation, and this may render the condition obscure for some time. The disease may be mistaken for dandruff, but dandruff covers a large area of the scalp, while ringworm is limited and sharply defined. Dandruff may cause a loss of hair; if it does, the hairs come out clean, while in ringworm they break off near the scalp.
Treatment.—Ringworm is always curable, provided the patient is watched and treatment carried out thoroughly. It is always absolutely necessary to treat the condition, because it will not get better of itself, and the longer it is permitted to last, the worse it gets, and the more difficult it is to cure. If treatment is begun at once, it may take two months to cure it. If the case has lasted for some time, or if it has been neglected and not treated thoroughly, it will take from six months to one year to cure it. These facts are stated so that parents may not become discouraged.
The first thing to do is to cut the hair as close to the scalp as possible, wherever the ringworm is, and for about an inch outside, and all around it. The entire scalp should be thoroughly washed three times a week. The scales should be kept soft by the use of carbolic soap.
The hair should not be brushed at all, because brushing the hair may spread the disease to other parts of the scalp. Every child with ringworm of the scalp should wear a cap of muslin or one lined with paper, so that others may not be infected. These caps can be burned when dirty and new ones made. One of the best remedies to apply to the affected area is the following: Bichloride of mercury, 2 grains; olive oil, 2 teaspoonfuls; kerosene, 2 teaspoonfuls. This is rubbed in every day until the parts are sore and tender. It is a good plan to apply this mixture to the entire scalp every fourth day, to guard against other parts becoming infected. It is not necessary to rub it in when using it where there is no ringworm.
When the scalp becomes sore from the application it can be stopped for a day or two, or until better; then begin again and repeat the treatment right along. If the kerosene in the above mixture is objected to, a very good mixture is bichloride of mercury, 2 grains, and tincture of iodine, 1 ounce. This may be rubbed vigorously enough to produce a rash. If the disease shows a tendency to spread under this treatment it is best to apply the latter mixture to the entire scalp.
Ringworm on any other part of the body is effectually treated by applying tincture of iodine. It should be painted on every day until the skin begins to peel, when the ringworm will disappear with the skin.
ECZEMA
Eczema is the most important skin disease of babyhood. It is probably the most frequent skin disease of infancy. Any baby may develop eczema. There are, however, some babies who seem to be very susceptible to it. The reason of this susceptibility seems to be due to the natural tenderness, or delicacy, of the skin. These children, because of the extreme sensitiveness of the skin, develop an eczema from a very slight degree of external irritation, or a trifling disturbance of digestion. Children of rheumatic or gouty parents are more liable to be victims of eczema than are others. Eczema of the face is quite common in children who are apparently healthy and fat. It does not seem to matter whether they are breast-fed or bottle-fed. The following conditions may be regarded as contributory to eczema:
Exposure to winds; cold, dry air; heat; the use of hard water or strong soaps; lack of cleanliness, and the irritation of clothing. It frequently accompanies chronic constipation, indigestion, and other conditions of the intestinal canal; overfeeding; too early or too excessive use of starchy foods.
Eczema of the Face:—Eczema Rubrum.—This is the most frequent form. It affects the cheeks, scalp, forehead, and sometimes the ears and the neck. It begins on the cheeks as small red papules. These join together and form a mass of moist, exuding crusts. They dry in time and may be so thick as to form a mask on the face. The skin may be much swollen. When the crusts are removed the face looks red and angry and bleeds easily. It is exceedingly itchy. It causes restlessness, loss of sleep, and it may affect the appetite, though, as a rule, the health remains good. Eczema of the face is exceedingly chronic; it improves from time to time, but it is cured with great difficulty only.
Infants suffering with eczema of the face begin to improve about the middle of the second year and may be entirely cured about this time. The reason of this is the greater amount of exercise the child is getting at this period. If the disease continues longer it is because of the unnecessary amount of fat that the child has.
Treatment.—Eczema is a notoriously tedious disease. There is very little tendency for it to improve, if left to itself. The age, the severity, and just how much you can rely upon the mother, or nurse, faithfully to carry out directions—upon these its cure depends. At best, the treatment may have to be carried out for months. If the eczema is accompanied with constipation and indigestion in infancy, very little can be done with the eczema until these conditions are removed.
There exists in the minds of the laity, and in some physicians also, an idea that it is wrong, or dangerous, to cure, or "dry up," an eczema. It is never dangerous, but highly desirable, to cure an eczema, whenever possible. It is always wise, because it is always necessary, to get the child in perfect condition before you treat the eczema. Cure the constipation, or indigestion, or cold, or whatever is the matter with the child; then treat the eczema. This is the only plan that offers any success. It is not a simple matter to find out why a nursing child is having indigestion. The most minute care must be exercised to find out the element in the milk that is causing the eczema. It would, however, be foolish, and a waste of time, to apply pastes, etc., to an eczema of the face, while the real cause that produced it was still in existence. It will frequently be found necessary to change the food entirely. Strict attention to the bowels is essential, both in infants and in older children. Sometimes to cure the constipation means an immediate cure of the eczema.
If the child is anemic, poorly nourished, and flabby, tonics are advisable. Cod liver oil is of use in quite a number of these cases. Eczematous children should not be taken out when the weather is very cold or when there are high winds. They should not be washed with plain water, or with castile soap and water. When washing is necessary, do it with milk and water, to which one teaspoonful of borax is added. The clothing must not be too heavy.
In eczema of the face, the child must either wear a mask or heavy woolen gloves, so that he will not scratch the parts. Frequently these fail, and it will be necessary to restrain the child from scratching the face by the use of some mechanical device. A piece of strong pasteboard bandaged on the elbows, so as to prevent the child from bending them, is all that is necessary. If the child cannot bend the elbows he cannot scratch his face, yet he has the free use of his hands.
The use of external remedies is imperative, as frequently the cause is mostly external, and in other cases it must be used in addition to the general treatment. Before external treatment is instituted, the crusts should be softened by applying olive oil to them for twenty-four hours, after which they can be removed with soap and water. If there is much inflammation, or if the face looks angry, a very good application is Lassar's paste.
Later, when the inflammation has subsided and the itching is severe, a mixture of tar ointment, 3 teaspoonfuls; zinc oxide, 1-1/2 teaspoonfuls; rose water ointment, 6 teaspoonfuls has proved to be one of the very best.
When the eczema on the face is of the weeping, or moist, variety, the application of bassorin paste gives splendid results.
When an external remedy is applied to any eczematous surface it is necessary to apply it on a cloth. Simply to smear it on will do no good.
In the treatment of eczema, when the children are breast-fed, it is well to remember that the real cause of the eczema may be in the mother. If the mother is constipated, or if her diet is too liberal, if she is drinking beer, or an excess of coffee, or is not taking exercise, the eczema may be caused by one or other or all of these.
For eczema of the scalp the remedy to use is white-precipitate ointment, 1 part; vaseline, 4 parts. Mix together and apply.
POOR BLOOD. SIMPLE ANEMIA
Causes.—There is what may be termed an unnatural tendency toward poor blood during infancy and childhood. The explanation of this anomalous condition is, that the tax or strain put upon the blood to provide for the growth of the child is severe, and is in addition to the great demands made upon it in the exercise of its regular duties. We must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up.
It is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. Any disease may leave a child with temporarily poor blood. The conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. It is not fully appreciated how seriously these conditions can affect the health of growing children. There is one condition that every mother should be warned against, namely, the possibility of unduly prolonging breast-feeding. Children should be weaned at the end of the tenth month. By prolonging the breast-feeding a mother can undermine the vitality and strength of her baby and so impoverish its blood as to invite disease. A bottle-fed baby should be put upon a mixed diet at the same time. To continue feeding a child exclusively on milk for a year or two after weaning, simply because "it will not take anything else," is criminal. Any woman guilty of such stupidity should never have become a mother. Once again it must be emphasized that every child must have an abundance of fresh air, must not be confined in close, hot, unsanitary rooms, and must have a daily, satisfactory movement of the bowels to be a healthy child with good blood in its body.
Symptoms.—Children suffering from poor blood are flabby, constipated, hungry, weak specimens of childhood. They are under weight, complain of headache, pains, disturbed sleep, are nervous and irritable. They tire quickly, are short of breath, and may have a tendency to faint easily. The hands and feet are cold, the pulse is small and irregular. They may have attacks of nose-bleeding and of bed-wetting.
Chlorosis.—Chlorosis is that form of anemia, of poor blood, which occurs in young girls about the time their sickness begins. It is most frequently seen between the fourteenth and seventeenth years, and more often in blondes than in brunettes. The cause is not known. It is thought to be due to constipation. Any occupation which is deleterious to health has a distinct influence on the condition. Employment in factories, confinement in badly ventilated rooms, bad or insufficient food, great grief, care, or a bad fright, mental strain, overstudy, may all produce, or contribute to the production of chlorosis.
Symptoms.—The symptoms of chlorosis resemble those of simple anemia. Children suffering from anemia are pale; girls with chlorosis have a peculiar greenish yellow tint in the skin. They are short of breath, they have vertigo, palpitation, disturbances of digestion, constipation, cold hands and feet, and scanty or arrested monthly periods. They have various nervous disturbances, such as headache, pains in various parts of the body, neuralgia, especially over the eyes, hysterical attacks, and sometimes cholera. Ulcer of the stomach is sometimes seen in this condition.
The disease lasts for a year or longer; it frequently lasts a number of years. Relapses are frequent.
By permission of Henry H. Goddard
"A Misfortune at Birth"
Warren is feeble-minded. His family said it was due to "a serious fall of the mother."
[A] "The family history is, however, exceedingly interesting.
"The paternal grandfather, whom we have called Nick, was of good family, although he himself was totally different from the rest. He was weak in every way, and to be considered feeble-minded. He married into a family that was much lower socially than his own, although we have no proof that it was a defective family. The children of this couple were all mentally defective and low-grade, morally as well as intellectually.
"Warren's father, Jake, a thoroughly disgraceful character, married Sal, a woman somewhat older than he.
"The immorality of this family beggars description. A girl named Moll was fifteen years old when Jake brought her into his home: his wife, Sal, was so feeble-minded that she allowed the illicit relations between these two. Moll's child was born in the hospital after the mother had been sent away from one Home because of her horrible syphilitic condition—from which she finally died.
"Our boy Warren's sister Liz with whom the father lived in incestuous relations, was also allowed to live illicitly with a man who worked for her father. She was so simple that she talked openly about her relations with her father and with this man. When a child was to be born the man married her.
"This is not all, but enough: and sufficient to show what feeble-mindedness leads to when it takes the direction of sexual abuses."
[A],"Feeble-mindedness: Its Causes and Consequences," Goddard, The Macmillan Company.
Severe Anemia: Pernicious Anemia.—This is the most severe form of anemia, or the condition in which we have the poorest blood. While this condition frequently results in death the others rarely ever do. This condition is not common in childhood.
Symptoms.—There is intense weakness and prostration. The skin is very pale, the mucous membranes are bluish white. The breath is markedly short and there is often dropsy of the limbs and feet. Fever is often present and quite high. The disease lasts a number of months; the patient often feels better for a time, then relapses into a more serious condition than before.
TREATMENT OF THE VARIOUS FORMS OF ANEMIA
Simple Anemia.—Find the cause and stop it. In infancy special attention should be given to diet and hygiene, giving the child plenty of fresh air, and a change of air to the country or seashore if necessary. The general treatment is more important than any benefit that may be derived from drugs. The rules laid down in the articles on "Malnutrition" must be closely followed in these children.
Chlorosis.—In this form of anemia, or poor blood, it is best to give iron. Change of air and change of scene are of special importance in these cases and will frequently cure. The general condition of course must not be overlooked. The diet, exercise, bowels, habits, should receive careful attention. Iron should be continued for a number of months after all traces of the anemia have disappeared.
Pernicious Anemia.—For this condition arsenic is the one remedy needful. In all conditions of poor blood the most careful attention should be given to the general health. Colds must be guarded against. The patients should never get their feet or their clothes wet. Muscular exercise, because of the weak condition of the heart, should be moderate, and only given on the advice of a physician. It is frequently necessary to stop all forms of exercise and in many instances we get the best results by directing complete rest in bed for a considerable part of the day or for all day if the case demands it.