304 DISTURBANCES OF CIRCULATION 



and in the total blood, although somewhat increased in the red cells. 

 Cholesterol is decreased in both serum and corpuscles. In the ash, 

 phosphoric acid, potassium, and iron are decreased, while calcium and 

 magnesium are both increased. An apparent increase in socUum chlo- 

 ride exists, but it is only apparent, being the result of the increase in 

 the proportion of plasma m the blood. The total amount of plasma 

 is greatly increased (polyplasmia) . 



The decrease in hemoglobin is demonstrable chemically' as well as 

 microscopically, Becquerel and Rodier^^ having found the amount of 

 iron in the total blood decreased in direct proportion to the apparent 

 decrease in hemoglobin, which frequently falls to 30-40 per cent., and 

 may drop to 20 per cent., or possibly less. Alkalinity', as determined 

 by titration, is diminished in some cases, but generally remains nearly 

 normal. The corpuscles are said to contain a larger proportion of 

 water than normal, independent of the proportion of water present 

 in the serum. Limbeck found their isotonicity (J. e., the strength of 

 NaCl necessary to prevent hemolysis) very low — -about 0.38-0.4 per 

 cent. NaCl. 



Very few changes seem to occur in the organs of the body; the 

 usual tendency to lay on fat, and the occurrence of fatty degeneration 

 observed commonly in anemias, may be exhibited, and are correlated 

 with Erben's observation of an increased fat content in the blood; 

 but these changes are often absent. The hypoplasia of the aorta, 

 upon which Virchow laid so much stress, is now considered to be of 

 little or no significance. Thrombosis is a not infrequent complication 

 of chlorosis,^^ and is probably favored by the increased platelet and 

 fibrin-content of the blood and the tendency to fatty changes in the 

 vessel-walls. 



Studies of nitrogenous metabolism bj' Vannini^^ showed practically 

 no alterations except a slight retention of nitrogen. 



Etiology. — As to the etiology of chlorosis, chemical findings indi- 

 cate some possibilities and negative others, but decide nothing. That 

 chlorosis does not depend upon a hemolytic poison is well established 

 by the following facts: there is no free hemoglobin in the blood plasma, 

 and even less iron in the serum ash than normal; lecithin and choles- 

 terol, important products of disintegration of erythrocytes, are both 

 decreased in the serum; hematogenous icterus does not occur, and 

 the amount of pigments in the urine and feces is decreased. 



Apparently, therefore, hematogenesis is at fault, particularly the 

 formation of hemoglobin, since this is more deficient than is the total 



*' For literature see Krehl, "Basis of Symptoms," 191G, j). 100; Ewing, "Clin- 

 ical Pathology of the Blood," 1901. p. 167; Kossler, Cent. f. inn. Med., 1897 (18), 

 657. 



" See Schweitzer, Virchow's Arch., 1898 (152), 337, and Leichtonstern, Miinch. 

 med. Woch., 1899 (46), 1603. 



•i* Virchow's Arch., 1904 (176), 375. 



