Bleeding from the nose and gums is not rare in anomie children ; and in hospital patients petechim are common in the skin as the result of flea bites. From this cause the bodies of poor children are often speckled all over with little extravasations of blood.
Pain across the forehead, or sometimes at the back of the head, is often complained of. In infants more serious symptoms may be met with as a consequence of of the brain. The child lies with a pale shrunken face, eyelids only partially closed, and fontanelle depressed. His extrem ities feel cold, and a thermometer in the rectum registers a temperature below the normal level. Soon the infant sinks into a state of semi-stupor, and unless aroused by energetic stimulation will probably die. Impover ishment of blood and prostration so profound are apt to be complicated by thrombosis of the cerebral sinuses or collapse of the lung.
The duration of a case of ordinary simple ammnia varies according to the measures which may be taken to remove the cause or causes which are impeding the supply of nutritive material to the blood. If the cause can be removed, and the child be afterwards fed with judgment and placed under good sanitary conditions, recovery usually follows very quickly.
In idiopathic anxmia all the preceding symptoms may be noted. In this form of the disease the anaemia is more profound. The skin is of the colour of ivory and the mucous membranes seem perfectly bloodless. Optic neuritis may occur with haemorrhage into the retina. Epistaxis is common, and vomiting may be frequent and distressing. The child becomes exces sively feeble, and has irregular attacks of pyrexia in which the temperature rises to 103° or 104°. Towards the end of the disease, however, elevation of temperature ceases to be noticed ; indeed, the bodily heat usually falls to a subnormal level. The blood has the characters already described.
Diagnosis.—In every case of anaemia it is important with regard prognosis and treatment that we should exclude serious organic ani diathetic disease. The diagnosis of the many conditions which induce impoverishment of the blood is treated of under their several headings. It may be only stated generally that if the cause lie elsewhere than in some obvious derangement of the digestion, we should institute very searching inquiry into the family and special history of the patient, particularly with regard to diathetic tendencies, and should make careful examination of the various organs.
Idiopathic anaemia may be distinguished by the profound deterioration of the blood without increase in the white corpuscles ; the absence of dis coverable cause for the pallor and weaknesS ; and the attacks of irregular pyrexia. Leucocythemia is characterised by increase in the proportion of white corpuscles, and by enlargement of the spleen or lymphatic glands.
anaemia the prognosis depends very much upon the primary disease, if any such can be discovered. If the poorness of blood be the sequel of some previous acute illness, or other cause which has ceased to prevail, the patient usually responds well to treatment and quickly recovers under ordinary restorative measures. In cases of idio pathic anaemia, when the prostration is great, the pallor extreme, and the temperature high, the child's prospects are very unfavourable.
must be treated according to the cause which has produced it. Impaired nutrition and a pallid face form in themselves no necessary indication for the employment of chalybeate remedies. The commonest cause of anaemia in the child, as has already been stated, is gastrointestinal derangement. In such a case iron has no power to im prove the condition of the blood until the hindrance to digestion has been removed. In anemic infants the dietary must be reconstructed upon the principles recommended elsewhere (see Infantile Atrophy). In older children if, as often happens, the patient be suffering from repeated attacks of gastric catarrh more or less severe, the digestive disturbance must receive careful treatment, and measures must be adopted to lessen the child's susceptibility to changes of temperature and to protect his sensi tive body from the cold (see Gastric Catarrh). In all cases plenty of fresh air should be prescribed. The parents should be warned of the necessity of thorough ventilation of nurseries and sleeping-rooms, and the child must be sent out as much as possible into the open air. It is important, hovf ever, not to force the patient to take exercise when his feeble powers will not admit of his deriving benefit from muscular activity. If his weakness be great, the child should go out only in a carriage ; and when in-doors care should be taken that his wearied muscles are allowed a sufficiency of needful rest. As he mends, however, he should be urged more and more to exert himself, and in severe cases a desire for exercise is a valuable sign of improvement.