304 DISTURBANCES OF CIIiCULATIOX 



hy the following facts : there is no free hemoglobin in the blood 

 plasma, and even less iron in the serum ash than normal ; lecithin and 

 cholesterol, 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 

 number of red corpuscles. The rapid improvement in the condition 

 that follows the administration of iron would seem to indicate that a 

 deficient supply of iron is the cause of chlorosis, but numerous ob- 

 jections exist to this hypothesis. Bunge advanced the idea that under 

 normal conditions the only form of iron that can be absorbed is that 

 which is combined with proteins, particularly nucleoproteins ; iron ad- 

 ministered in inorganic form, or as compounds with organic acids, 

 he believed, can all be recovered from the feces, and, therefore, is not 

 absorbed. He suggested that in chlorosis the iron taken with the 

 ordinary food is precipitated in the intestines by sulphides or other 

 products of intestinal putrefaction, and hence there results a de- 

 ficiency in the amount of iron absorbed and available for the manu- 

 facture of hemoglobin. The inorganic iron given in chlorosis, Bunge 

 believes, owes its efficiency to its saturating all of these sulphides so 

 that the nucleoprotein-iron is not precipitated, and can, therefore, be 

 absorbed. ]\Iany objections have been raised to Bunge 's hypothesis, 

 however, for competent observers have failed to find any abnormal 

 putrefaction in chlorosis, and others have found that sulphide of iron 

 itself gives good results in the treatment of chlorosis, while bismuth 

 and other sulphur-binding substances are without effect. Further- 

 more, Bunge 's contention that iron administered in medicinal form is 

 not absorbed seems to have been completely disproved by several ex- 

 perimenters.^** 



As a consequence of all these conflicting data we are at present 

 completely in the dark as to the reason for that failure properly to 

 manufacture hemoglobin which seems to be at the bottom of chlorosis. 

 The hypothesis that iron and arsenic favor recoveiy by stimulating 

 the hemogenetic tissues, which is urged by v. Noorden and others, is 

 unsatisfactory in the extreme, and explains nothing. There is abso- 

 lutely no question tluit administration of iron restores the composi- 

 tion of the blood to normal, usually quite rapidly, and this seems to 

 leave as most probable the explanation that in some way an iron 

 starvation is the fundamental cause of cldorosis. However, as Ewing 

 says, any theory must be inadequate that fails to take into account the 

 age of puberty, tlie female sex, and tlio function of menstruation. 



40 Full review witli biljliofjiapliv bv E. Clever, Krpebiiisse Phvsiol.. 1005 (.5), 

 698; Meinertz, Cent, riiysiol. u. Path". StolTwedi., lOOT (2), 652." 



