air, food, and exercise, and who present a peculiar yellowish-green complexion; and (b) the fatal type of anæmia, in which there are waxy pallor and bloodless lips and such great languor and increasing weakness that the patient takes to bed.

Symptoms. Besides paleness of the skin and mucous membrane of the lip inside of the mouth and pearly bluish whiteness of the whites of the eyes, there is the peculiar greenish-yellow complexion of the anæmia of young women; while in the more grave forms the skin has often a waxen or even yellowish hue, and there may be brown pigmentation about the ankles. Among the more frequent results of anæmia are fluttering of the heart and short breath on slight exertion; languor and fatigue after slight mental or physical work; poor appetite and disturbed digestion, with constipation; headache, dizziness, and fainting, with the appearance of spots before the eyes and blurring of the sight. In the severe cases of anæmia there is excessive weakness. Puffiness of the face and ankles is sometimes seen.

The skill of a physician will be required to rule out such conditions as disease of the heart or kidneys, or nervous exhaustion associated with paleness, in which the symptoms are somewhat similar. The outlook is usually favorable in the anæmias secondary to other diseases, which can be remedied, and also in the form of "green disease" peculiar to young women. The treatment consists in a general way in following an

outdoor life, especially in high altitudes; in eating good, nourishing food, particularly the red meats, milk, eggs, and green vegetables; and in the use of iron in the form of Blaud's pills. Two of the five-grain Blaud's pills may be taken three times daily, after meals. Arsenic is valuable, notably in the more severe cases, but should be taken only under a physician's directions.

CHAPTER II

The Stomach and Bowels

Indigestion - Jaundice - Biliousness Dyspepsia — Vomiting — Diarrhea-Cholera Infantum-Dysentery-Cholera Morbus

-Cholera-Constipation-Worms.

ACUTE INDIGESTION.-Acute indigestion is really a catarrhal inflammation of the lining mucous membrane of the stomach, with swelling and redness such as is seen in a bad sore throat; sometimes there is also an acute catarrh of the first part of the bowels (see p. 477). This condition is caused by food which is indigestible or has begun to decompose, in which condition it is favorable to the growth of disease germs, particularly in hot weather. The excessive use of alcohol, overeating, fatigue, and violent emotion may also cause it.

Symptoms. At first there is a feeling of weight, fullness, and discomfort just below the breastbone. Sometimes there is actual pain, but this is usually not violent. The mouth is dry, the tongue is coated, and thirst is usually present. Nausea and vomiting are the most characteristic symptoms, together with tenderness on pressure over the stomach. pelled, and then mucus and bile.

The food is first ex

After vomiting has

occurred the patient begins to improve; but the tongue remains coated, the breath is disagreeable, there is an unpleasant taste, and some discomfort in the stomach for several days. Fever is absent or slight in mild cases, but sometimes the temperature rises suddenly to 102° or 103° F., and there are chills, headache, dizziness, and dullness. This condition is spoken of as gastric fever. Formerly, what were in reality mild cases of typhoid fever were called cases of "gastric fever." In typhoid fever the temperature rises slowly during a week, becoming higher each day, instead of suddenly appearing at its highest in the course of one day, as is seen in catarrh of the stomach. The communicable diseases, such as influenza, and the eruptive disorders, such as scarlet fever, frequently come on like indigestion, but in four days a diagnosis will be made without doubt. Mild cases of acute indigestion last only twentyfour hours; severer cases for two or three days. There is always more or less languor. The bowels are commonly constipated, although diarrhea may be present. Cold sores are often troublesome.

Treatment. It is advisable to empty the stomach and bowels and be rid of the offending contents. One or two teaspoonfuls of castor oil should be given to babies or children, and five grains of calomel, followed in six or eight hours by a tablespoonful of Epsom salts or a Seidlitz powder in a glass of water, are appropriate remedies for adults. If there is much pain and discomfort in the stomach and vomiting does not come on

(before using the cathartic) it is wise to empty the stomach. The patient should drink a pint of tepid water containing a teaspoonful or more of common salt, and then tickle the back of the throat with the finger to cause vomiting.

Children may receive a teaspoonful of sirup of ipecac. Rest of the stomach is the next necessity, that is, fasting; this is very essential. If vomiting persists after the stomach is empty of food, little pieces of cracked ice held in the mouth, or a tablespoonful of ice-cold soda water at frequent intervals, will give relief. No solid food should be eaten for two days. Strained rice or barley gruel may be taken during this time, and on the third day gruels, soups, and a soft egg. Medicine is not otherwise necessary. The cathartic at the onset of the disorder is as essential if there be diarrhea as when there is constipation.

JAUNDICE.-There are many causes of jaundice, but the commonest form, described here, is due to an attack of acute indigestion or catarrh of the stomach and first part of the bowel. As a result of this catarrhal inflammation, the lining mucous membrane of the intestine becomes swollen, and in this way obstructs the opening of the tube (common bile duct), which conveys bile from the liver into the bowels. The opening of this bile duct in the intestine is about three or four inches below the point where the stomach ends and the bowel begins. Not only is the bile duct closed by swelling of the mucous membrane about its