cuiJtuosL^ 303 



facture of hemoglobin than in cither a destruction or a deficient 

 formation of red corpuscles. Er])cn's '- analyses of chlorotic blood 

 showed that the total amount of protein is decreased, chiefly because 

 of the deficiency of hemoglobin; the relation of serum globulins and 

 serum albumins is unchanged, wliile tlie proportion of fi])rinogen is 

 increased. There is much more fatty substance than normal in both 

 the serum and the erythrocytes, but the lecithin is decreased both 

 in the serum and in the total blood, although somewhat increased in 

 the red cells. Cholesterol is decreased in both serum and corpuscles. 

 In the asli, pliosphoric acid, potassium, and iron are decreased, w-hile 

 calcium and magnesium are both increased. An apparent increase in 

 sodium chloride exists, but it is only apparent, being the result of 

 the increase in the proportion of plasma in the blood. The total 

 amount of plasma is greatly increased (polyplasmia). 



The decrease in hemoglobin is demonstrable chemically as well as 

 microscopicall}', 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 30^0 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 

 rionnal. 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 isotanicity {i. e., the strength of 

 NaCl necessary to prevent hemolysis) veiy 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 degenera- 

 tion observed commonly in anemias, may be exhibited, and are cor- 

 related 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 com- 

 plication 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 mctaholism by Yannini *° 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 



*2Zeit. klin. ^led., 1002 (47), 302. See also Frohmaier. Folia Hematol., 1015 

 (20), 115: Boumer and Burger, Zeit. exp. Path.. 1013 (13), 351. 



*3 For literature see Krehl, "Basis of Symptoms," lOlfl, p. 106; Ewing, "Clinical 

 Pathology- of the Blood," 1001. p. 167: Kossler, Cent. f. inn. Med., 1807 (18), 657. 



** See Schweitzer. Vircliow's Arch., 1898 (152), 337, and Lcichtenstern, Miinch. 

 med. Woch., 1809 (46), 1603. 



*5Virchow's Arch., 1004 (176), 375. 



