CHLOROSIS 427 



Treatment. Up to the present, the treatment, as far as tumors were 

 demonstrable, has been surgical operation. In many cases, as is shown in 

 the above reports, the results were remarkable. Whether X-ray, radium 

 irradiations, or mesothorium irradiations have been tried as yet in certain 

 cases, I do not know. Also in cases without demonstrable tumors it is 

 conceivable that injections of thorium X or actinium X might induce an 

 inhibition of the abnormal sexual glandular development and thus influence 

 the premature development of the organism. 



IV. CHLOROSIS 



The circumstance that the beginning of chlorosis always falls at the time 

 of puberty or during the time of maturation of the female organism following 

 puberty, together with the circumstance that in chlorosis, disturbances in 

 the genital sphere are found almost regularly, shows that this disease, at 

 least to a certain extent, belongs in the chapter on the sexual glands. Opin- 

 ions are at variance in regard to the nature of the functional disturbances. 

 Therefore I avoid placing chlorosis in one of the divisions of hypogenitalism 

 or hypergenitalism and give it a position by itself. 



Historical. Virchow on the ground of pathologico-anatomical findings 

 assumed a congenital deficient development of the vascular system. Im- 

 memann supposed a weakness of the blood-forming organs that is in part 

 congenital and associated with the hypoplasia of the vascular system, and 

 in part acquired and temporary, The disease begins in puberty because 

 at this time especial demands are made in blood-forming apparatus, v. 

 Bunge places in the center of the pathogenesis a disturbance in the iron 

 metabolism. The maternal organism gives to the child organism a very 

 great amount of iron. This is stored up not during pregnancy but already 

 at the time of puberty, whereby there occurs a poverty of the blood in hemo- 

 globin. Zander regards the cause of chlorosis as a disturbance of the absorp- 

 tion of iron, other authors as chronic constipation, and as gastroptosis through 

 the wearing of tight corsets, etc. . Basing his views on the theory of Immer- 

 mann, v. Noorden for the first time explains a disturbance of the activity of 

 the ductless glands as essential for the coming into existence of chlorosis. 

 According to v. Noorden chlorosis depends on an in part congenital, in part 

 acquired, weakness of the blood-forming organs, in consequence of which 

 there occurs in the period of sexual ripening disturbances in the blood- 

 formation proceeding from the female sexual organs. Normally impulses 

 flow from the female sexual glands to the blood-forming organs. Loss or 

 weakening of the internal secretion of the ovaries leads to chlorosis. 



Grawitz sees the cause of chlorosis in a disturbance of the relation of liquid 

 interchange between blood and tissues. This depends on deficient function 

 of the vasomotors. He therefore regards chlorosis as a neurosis. 



Very recently, Morowitz, on the ground of observations in which the rest 



