Harm is also done by the well-meant efforts to improve the anaemic looking child by attempts at over-feeding with plentiful and rich food. A weakened digestion and insufficient secretion of gastric and intestinal juices, together with diminished muscular exertion, does not require an abundance of eggs and meat. Even milk taken in large quantities may do harm, if the desire for albuminous foods is indicated by an improved appetite. The giving of wine had also best he omitted, for this beverage does not supply the constituents which are lacking in anaemic blood. Although red wine, on account of its supposed contents of iron, is often warmly endorsed for this purpose, it fails to accomplish the object sought.
The manner of life of a child, although carried out under what are apparently the most favourable circumstances, exerts a harmful effect on the development of its body in more cases than is generally supposed. First of all must be mentioned the influence of the school, the confinement in poorly ventilated school-rooms, and the development of the mental, at the expense of the bodily, functions ; insufficient exercise in the open air contributes to the neglect of the latter, especially if a portion of the time after school-hours is given up to music or other accomplishments. The effects of life in large cities and the demands of present-day society also exert their harmful influ ences. Children and young people do not get enough sleep, and a lack of sleep is as distinctly harmful as insufficient nourishment. Early school hours rob the children of the large cities, where a timely retirement is often prevented by a multitude of circumstances, of a considerable portion of the refreshing morning-sleep. No words need be wasted in doing more than allude to the baneful effects of social amusements which extend into the early morning-hours, and of the exertion attendant upon (lancing in hot and close rooms. Happily, the love of outdoor sports partially counter balances this tendency, but these should be indulged in with the thought uppermost in mind that the abuse of muscular activity, especially in the undeveloped body, may do a great deal of damage, and in certain grades of anaemia must be entirely avoided.
The symptoms of anaemic persons are due to the fact that the poorly con stituted blood cannot sufficiently nourish the various organs. Cp to a cer tain point this is made up by more active circulation and deeper respira tions ; that is to say, both the lungs and the heart are compelled to work harder and faster in order to supply the body with the necessary quantity of oxygen. When this can no longer be kept up, those organs which are most in need of constant and appropriate nourishment—the heart, muscles, and brain—are the first to exhibit an inherent weakness. In anemic and
chlorotic individuals the breathing is, therefore, more rapid, and the pulsa tion faster than in healthy persons. The former often complain of a sudden respiratory embarrassment which is looked upon as asthma ; excitement or exertion, especially rapid walking or going upstairs, " takes their breath away," and they become afflicted Nvit h palpitation. The muscles, as is shown by their bright red colour, contain a large amount of the blood-colouring matter, the haemoglobin, and even during quiet they require large quantities of oxygen. Naturally enough, this demand for oxygen and hemoglobin is quickly increased \Then these muscles are thrown into a state of activity ; and if the blood is deficient in these constituents, the other organs, particu larly the brain and skin, will suffer, because their allotment is drawn away to supply the muscles. As a result, the patients are seen to grow pale at almost every exertion, and they complain of headaches, vertigo, and flickering before the eves.
When the blood supply is insufficient even for moderate bodily move ments, there soon ensues a feeling of fatigue, and sometimes this is accom panied by severe and obstinate muscular pains. These are especially marked in the calves of the legs and in the back, and this fact should be borne in mind in chiding anemic persons for the stooping posture which they usually assume. In the course of time the muscles of the chest and the abdomen also become sensitive, and the patients complain of constant, or transient, deep-seated pain, often in the early morning, in various localities, especially between the ribs and in the pit of the stomach, also of difficult respiration and abdominal cramps. On account of the sensitiveness of the abdominal muscles, the pains are increased at every meal time, often to such an extent that the patients will forego their food rather than endure the discomfort. The abdominal distress is sometimes mistakenly attributed to disease of the internal organs, such as the liver and stomach ; and the pain in the chest to affections of the pleura, the lung, or the heart ; sometimes it is difficult even for the physician to make a definite diagnosis. Attacks of pain in anemic persons, which are usually designated as neuralgic, are often. as a matter of fact, nothing but muscular pains, although, on account of the sensitiveness of the nervous system, nervous pains do occur. persons are readily tired, exhibit a feeling of languor, and arc usually chilly, although they are subject to congestion of the blood in various regions. They are often troubled by toothache and headache, very irritable, easily excited, and either have difficulty in falling asleep or else are constantly drowsy. In the latter case prolonged sleep is most essential.