The child must take plenty of nitrogenous food, and if, as sometimes happens, the appetite is poor, with a special dislike to meat, his fancies must be consulted in every way possible. Often a child will eat a small bird, as a lark or a snipe, when he turns with disgust from beef and mutton. Pounded underdone meat spread upon bread and butter will often be taken, or the meat may be diffused through a meat jelly. Eggs, milk, and fish are all of service, and a moderate quantity of farinaceous food may be allowed ; but the child must be prevented from taking starchy matters to the exclusion of more nutritious articles of diet. When the appetite is poor, it may be often improved by taking three times a day a drop or two drops of the dilute hydrocyanic acid (P. B.) with five grains of bicarbonate of soda in infusion of orange peel. The draught can be • sweetened with spirits of chloroform, and should be taken an hour before meals.
Iron is only to be resorted to as an addition to the more general meas ures for restoring nutrition and improving digestive power, and it must not be given until the disorder of the gastric functions has been attended to. Iron acts far more energetically when it is combined with aperients. Often, indeed, until the bowels have been well relieved by appropriate purgation the remedy seems to be perfectly inert. Not seldom, after giv ing an iron mixture perseveringly for a length of time without any sign of improvement, I have noticed an immediate alteration for the better when the chalybeate has been exchanged for a morning and evening dose of the compound senna mixture of the British Pharmacopoeia. The form in which the iron is given is of little importance. The close should always be as large a one as the child can bear without discomfort ; and if the digestion be in good order, the acid preparations are to be preferred as a rule to the alkaline salts. Still, if there be any remains of catarrh of the stomach, the ammonio-citrate should be given with an alkali. Most children bear the sulphate of iron well. For a child of six years old, five grains of the dried salt may be given in a teaspoonful of glycerine three times a clay directly after food. This dose may seem rather a large one, but it is rare to find any signs of irritation produced by the medicine, and the tonic effect upon the system is usually rapid and decided. The perchloride is also a good form for administration of the remedy. Twenty to thirty dropS, well di luted with water and sweetened with glycerine, may be taken after each meal. These preparations are far more useful than the various iron syrups which are commonly. preferred. I have seen many a case of anmmia aris ing from gastric catarrh prolonged by the use of these syrups, which promote acidity and flatulence and encourage the excessive secretion of mucus.
In some children almost all forms of iron seem to act as direct irritants to the stomach, inducing indigestion and peevishness of temper and caus ing wakefulness at night. In these cases the dialysed iron is the best form in which the remedy can be administered. Pure chalybeate waters
are also of service if the child can be induced to take them. Their value is, no doubt, enhanced by the fresh country air and exercise by which the change to a chalybeate spring is usually accompanied.
Under the use of iron the red corpuscles increase in size and the pro portion of hmmoglobin is therefore largely augmented. The improvement is announced by a healthier tint in the complexion, an improvement in the appetite, and, if the child had been previously listless and dull, by greater freedom and sprightliness in his movements.
Arsenic is another remedy of great value in improving the condition of the blood. Children bear arsenic well. The drug, unless given in very large quantities, is rarely a cause of gastric irritation. In fact, as is well known, arsenic in small closes is a valuable sedative to the digestive organs and often arrests vomiting. As a tonic the remedy should be given to a child of six years old in the dose of three or four minims of Fowler's solu tion directly after food. When the digestion is greatly impaired by re peated attacks of gastric catarrh the effect of this medication is often very striking. The arsenic may be usefully combined with a drop or two of the tincture of nux vomica. Another remedy from which good results have been obtained is phosphorus. This powerful drug may be safely given to a child of six years old in doses of to of a grain. I have, however, no personal experience of its value.
Cod-liver oil is of service as an additional food, and in combination with iron wine is a favourite remedy in all forms of anemia in young sub jects. The alcohol of the vinum ferri is no doubt a valuable therapeutic agent. Alcoholic stimulants taken with food help to promote digestion, and in many pallid, weakly children have great virtue in aiding the return to health. Sound claret, or the St. Raphael tannin wine, diluted with an equal proportion of water, is usually taken readily by the child, and is a sensible help to other treatment.
Cold-water packing is said to be useful in improving the condition of the blood. Drs. M. P. Jacoby and V. White have reported a series of cases in which anemia was treated by the regular application of the cold pack followed by massage. The patient was enveloped in a cold wet sheet, this was covered by a drier sheet, and over all six blankets were laid and carefully tucked in. After the lapse of an hour the coverings were re moved and the skin and muscles were vigorously shampooed. This plan of treatment was combined with rest and careful feeding, and was attended by very good results. It might be employed with advantage in the case of weakly, pallid children in whom anorexia is a marked feature, for one of its most pronounced effects was found to be an immediate improvement in the appetite. The induction of sleepiness by the pack and massage is usually an indication that the patient is benefiting by the treatment.