Nuclear segmentations occur frequently, especially in the nuclear red blood cells, but also in the white cells, and they can be well seen in the Zeiss chamber in a blood diluted with a 1 per cent. acetic acid. In making dry preparations, they are generally crushed.
The following table contains the proportionate figures of 2 eases. In the first case (Fig. 21) the blood picture improved considerably by clinic treatment; death ensued later during home treatment, probably from bronchopneumonia: the second case was completely cured in the Children's Asylum of the City of Berlin (Finkelstein); the child made splendid progress, but died later of whooping-cough and pneumonia.
Course and mild cases the anemia, soon improves under proper treatment; in severe cases, especially if external injurious influences cannot be removed, it persists for months and may result in death, generally in consequence of complications, usually of broncho pneumonia. nld cases of infantile anaemia should also be taken seriously, because the transition to severe forms is never impos sible, and at all events under insufficient treatment a long-continued debility may remain behind. On the other hand, even in severe cases the prognosis need never be pessimistic, as even the gravest blood conditions may undergo a surprising improvement under appro priate treatment.
The diagnosis itself offers no difficulties. The differentiation from pernicious anvemia is possible through the enlargement of the spleen and the increase of leucocytes, while in pernicious anemia the leucocytes de crease. Sometimes, however, the differential diagnosis from leuke mia is by no means simple. For splenic anemia speaks (1) the number of leucocytes, which seldom exceed 50,000; (2) the practically sustained percentage during the first year of the various kinds of leucocytes in spite of the presence of myelocytes, with a possible slight preponderance of lymphocytes; (3) the considerable changes in the red blood corpus cles, especially the enormous quantity of nucleated red corpuscles. The comparatively small size of the liver (von Jaksch) is not quite a reliable sign. Doubts may exist particularly if a polynuclear leucocytosis com plicates the antenna, because in that case the blood picture sometimes resembles myeloid leuktemia.
The best prophylaxis is nat urally nourishment from the mother's breast. Artificial nutrition should be made as rational as possible. It is not proven that a particular food, such as buttermilk, specially fa vors the development of severe anaunias, but any such food had better not be continued too long. The same refers to the feeding with steri
lized preparations. Of importance is proper regard for light and air, even in winter.
first step in the treatment is to correct errors in diet and to remove intestinal disturbances. Of importance in many cases is feeding with mixed diet, such as a few teaspoonfuls of spinach, mashed carrots, mashed potatoes, asparagus tips, artichokes, cauliflower, fruit juice (preferably raw), also meat juice, broth, and the exclusion of oversterilized or pasteurized foods. The appetite is stimulated by the administration of bitters (tr. comp. or tr. rhei 8-10 12 drops in sugar water three times daily) or a mixture of pepsin and hydrochloric acid (1: 2:100). Great care should be taken under any circumstances to provide good light and air. Children of poor parents are now best cared for in children's hospitals. If the weather conditions are favorable, infants are allowed to lie in the open air or on verandas. Children living in cities are highly benefited by removal to a dry, sunny spot in the country; a great improvement is rapidly produced in the case of poor children by sending them to the garden colonies of larger cities; better still may be the effect of a mild sea climate, or southern climates in winter. Of great importance is the care of the skin; it should be rubbed with flannels and spirits of calamus several times every day, while every other clay a warm chamomile bath or one prepared with a decoction of calamus should be given. Washing with cold water should be avoided. At the same time direct medicinal treatment may also be tried. Rachitic children are given phosphorated codliver oil to improve the anaemia (phosphori 0.02, ol. jec. aselli ad. 100.0, one teaspoonful in the morning after the first meal, in all about three bottles), which is a suitable combination and apparently quite efficacious. Of iron prepa rations the following are suitable for infants: liquor ferri alb., S-10-15 drops three times a day; ferri last. 0.03-0.05 Gm. gr.) three times a day; ferri pyrophosph. c. ammon. citrico, 0.05-0.1 Gm. gr.) in mixture three times a day, but iron may also be dispensed with. Arsenic is sometimes not borne well; in some cases, however, the use of greatly diluted solution (sol. Fo•leri gtt. 2, water 50.0 Gm. (14 drams),4-5 tea spoonfuls a day, for a child of 2 years) has been followed by remarkable improvement. lleubner recommends a teaspoonful of fresh bone mar row three times a day, stirred up with egg or spread on bread; d'Orlandi recommends 25 Gm. (7 drams) daily of fresh spleen juice.