AN.KMIA. 93 



the ears is on both sides, is rumblini; and low-pitched, and is often described as being 

 like curt -wheels in the distance. It is intensified by any mental effort, such as 

 thinking, or reading, or writing. There may be occasionally a little giddiness for a 

 minute or two, and things may seem as if they were going round and round. The 

 muscles are weak, and a diih'culty is experienced in making an y prolonged Of forcible 

 exertion. From the defective state of the circulation the fingers are often blue, and 

 the patient complains of * pins and needles." The patient is usually a little lethargic 

 and disinclined for exertion, and the relations between sleeping and waking are apt 

 to be upset. The appetite is probably poor, and it often happens that nothing but a 

 cup of tea with perhaps a little bit of bread-and-butter is taken after the early 

 dinner. At bed-time the patient is depressed for want of food, and probably passes 

 a sleepless, restless night. The next day the requisite rest is taken in the arm-chair. 

 or the patient has his " forty winks " oil the sofa, and so the thing goes on. The 

 sr.-retions are more or less disturbed, the urine is thick and forms a deposit on 

 cooling, and the bowels are sluggish, constipation sometimes alternating with 

 diarrhoea. The poorness of the health may give rise to great despondency. Anaemic 

 people often take on odd fancies and do odd things, and are very apt to get strange 

 notions into their heads. They often have specks before the eyes, or, perhaps, little 

 bright shining spots. Sometimes they see spectra, and sometimes their sight is 

 peculiarly affected so that they see only halves of things. They are very apt to 

 suiter from confusion of ideas, and feel stupid from noises in the street. Very 

 frequently in women there is some disturbance of the menstrual function, the 

 periods being scanty or altogether absent. Anaemia is said to be a common cause of 

 barremi'-- 



The conditions which may give rise to anaemia are very numerous. In the first 

 place it may have been caused by loss of blood, which may have arisen spontaneously 

 or as the result of accident. It matters little from what part of the body the blood 

 flows, the result is the same. For instance, a vessel may have been cut across by a 

 stal>, or the patient's nose may have been bleeding, or he or she may have been 

 spitting up blood from the lungs, or vomiting it from the stomach. In the case of 

 women the periods may have been excessive either in quantity or frequency, or there 

 may have been excessive bleeding at a confinement. The continuous loss of blood 

 from piles may give rise to anaemia. Then again, although there may be no loss i J 

 blood, there are other ways in which the strength may be exhausted. A woman 

 may continue to suckle her child long after her health has shown signs of giving 

 way, probably thinking that in this way she may succeed in warding off another 

 pregnancy with its attendant trouble and expenses. Anaemia is very readily 

 produced by the " whites," or any discharge of a similar nature. The result is the 

 same when the natural secretions are in excess, as for instance in chronic diarrhoea, 

 or in diabetes where very large quantities of water are passed. When there is no 

 i\ e discharge to account for the presence of anaemia, it may be found to depend 

 on a defective supply of food. It is not, so to speak, the expenditure which is in 

 s but the income which is deficient. It is to be feared that even in the middle 

 classes of society the number of people who from some reason or the other are unable 

 to obtain a proper supply of food is very great. Where the quantity is sufficient, 



