ner that the patient
can hardly fix a date to the earliest feeling of that languor which is
shortly to become extreme. The countenance gets pale, and white of the
eyes become pearly, the general frame flabby rather than wasted. The pulse
perhaps larger, but remarkably soft and compressible, and occasionally
with a slight jerk, especially under the slightest excitement. There is an
increasing indisposition to exertion, with an uncomfortable feeling of
faintness or breathlessness in attempting it; the heart is readily made to
palpitate; the whole surface of the body presents a blanched, smooth and
waxy appearance; the lips, gums and tongue seem bloodless, the flabbiness
of 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 dis