gratifying an unnatural craving for such things as earth, mud, lime— what is called pica or geophagy. The stools sometimes, though rarely, have a reddish-brown tinge from admixture of half-digested blood. Sometimes they may contain small flakes of bloodtinged mucus. Pure blood is rarely passed; and an extensive hæmorrhage, unless there be concurrent colitis, is still more rare, although, post mortem, considerable quantities of blood may be found in the small intestine. Fever of an irregular, intermitting, or even of a subcontinued type is common. On the other hand, the temperature may be constantly subnormal. Or these conditions may alternate. After a longer or shorter time, symptoms of profound anæmia gradually disclose themselves. The mucous surfaces and the skin become pallid, the face is puffy, and the feet and ankles are swollen. All the subjective symptoms of a definite anæmia now become more and more apparent; there are lassitude, breathlessness, palpitations, tinnitus, vertigo, dimness of sight, mental apathy and depression, liability to syncope, etc. The circulation is irritable, and hæmic bruits can be heard over the heart and larger blood-vessels. Ophthalmoscopical examination may reveal retinal hæmorrhages.
From some of these symptoms, were it not that with the advancing anæmia there is no loss of weight, one might be led to suspect the possibility of tuberculous or cancerous disease, or of Bright's disease. So far from losing weight, the patient may appear quite plump and, though hæmocytometric estimates testify to a slow and steady fall in the corpuscular richness of the blood until the lowest limit compatible with life is reached, there is no true poikilocytosis as in idiopathic pernicious anæmia, no excessive leucocytosis as in leucocythæmia, and not necessarily any enlargement of lymphatic glands, liver, or spleen. There is generally a marked eosinophilia. The depression in the hæmoglobin value of the corpuscles is considerably greater than the fall in their numbers.
The rate of progress is very different in different cases. In some a high degree of anæmia may be attained, and even a fatal issue ensue within a few
