the solid increases, the appetite fails, extreme languor and faintness supervene, breathlessness and palpitation are produced by the most trifling exertion, or emotion; some slight oedema (swelling) is probably perceived about the ankles; the debility becomes extreme.  The patient can no longer rise from the bed; the mind occasionally wanders; he falls into a prostrate and half torpid state and at length expires; nevertheless, to the very last, and after a sickness of several months’ duration, the bulkiness of the general frame and the obesity (fat) often present a most striking contrast to the failure and exhaustion observable in every other respect.  The disease is usually fatal.

Treatment.—­The patient should remain in bed and should use a light nourishing diet, taking food in small amounts and at stated intervals.  Rest in bed is essential.  Dr. Osler treated a case in the following way:  I usually begin with three minims (drops) of Fowler’s solution of arsenic three times a day and increase the dose to five drops at the end of the first week; to ten at the end of the second week; to fifteen at the end of the third week, and if necessary go up to twenty or twenty-five.  Symptoms of an overdose are rare; vomiting and diarrhea occur.  Then the medicine must be discontinued for a few days.

Secondary anemia.  Causes.—­Hemorrhage form (bleeding). (a) Rapid bleeding from the rupture of an aneurism, from a blow, or eating into the blood vessels by an ulcer. (b) Slow bleeding as from nose-bleed, flow from the womb, piles or in “bleeders” people who bleed readily.

2.  Inanition form.—­Not nourished because of interference in taking food or assimilating food, from cancer of the gullet, or disease of the stomach.

3.  Toxic poison cases; from acute and chronic diseases, such as typhoid fever, tuberculosis, rheumatism, syphilis, malaria, nephritis; or chronic lead poisoning, mercury, arsenic, and copper poisoning.

Symptoms.—­There is pallor, dizziness, headache, palpitation and dyspnoea, difficult breathing on exertion; there is weakness, tendency to fainting, poor appetite, dyspepsia and constipation.  The red blood cells are diminished, also the haemoglobin.  Death may occur from a single hemorrhage.

[252 Mothers’ remedies]

Treatment.—­Remove the cause and rest.  Good fresh air, good easily digested food.  The bowels must be kept regular.  Iron and arsenic are good remedies if necessary.  It is not possible to give special directions.  A person in this condition needs a good physician.  There is no time to waste.  Iron and arsenic are good remedies, but they must be used intelligently and in proper doses.  Blaud’s pill is good in some cases.  It contains iron.  Also Fowler’s solution of arsenic.

Leukaemia.—­An affection characterized by persistent increase in the white blood corpuscles, associated with changes, either alone or together, in the spleen, lymphatic glands and bone-marrow.