428 THE DISEASES OF THE SEXUAL GLANDS 



of the chlorotic symptom-complex is associated with an approximately normal 

 blood condition, upholds the view that the blood-changes in chlorosis con- 

 stitute only a symptom and not the essence itself of the disease; he points 

 to the frequency of thyroid glandular swelling and believes the cause to be 

 a disturbance in the reciprocal action of the ductless glandular system. 

 Kottman observes that there is a deficient iron-assimilation on account of a 

 weakening of the internal secretion of the ovaries. Finally we mention the 

 theory of Charrin and Villemin that chlorosis is a menstrual autointoxication. 

 Villemin assumes in addition that the internal secretion of the corpus luteum 

 possesses hemolytic properties. 



Symptomatology. Chlorosis is a disease that inclines very much toward 

 relapses. The first attack of chlorosis usually occurs between the fourteenth 

 and twentieth years of life. Cases of so-called tardive chlorosis (Hayem, 

 Rieder) are extraordinarily rare. Lately also cases of infantile chlorosis have 

 been described (Rist, Hutinel, Stoltzner, et al.~). Because of the uncertain con- 

 nection with these cases with true chlorosis, v. Noordenproposed for these cases 

 the name chlorotoid. Also the connections of the extraordinarily rare cases 

 of conditions similar to chlorosis occurring in the male sex (for example, 

 the cases of Formanoli, Ferrari, Byrom Bramwell) are contested by most of 

 the later authors, v. Noorden and v. Jagic believe that in such cases we are 

 dealing with sexual neurasthenics who are insufficiently nourished. A great 

 role in chlorosis is played by heredity. Often many sicknesses are found in 

 the family of the patient. In rare cases there is observed in the same family 

 simultaneous occurrence of chlorosis and of prepubertal eunuchoidism 

 (Tandler, v. Noorden; confer also Observation LI) . 



Chlorosis usually sets in with a series of subjective complaints; attention 

 is attracted to the color of the face. These symptoms consist in ready 

 fatigability, cardiac palpitations on slight bodily exertions, slight dyspnea, 

 headache, sensations of cold especially tendency to cold hands and feet 

 eventually seeing black, flickers before the eyes, ear noises, vertigo, fainting- 

 spells, pressure in the gastric region, nausea, etc. 



Examination of the heart often shows in advanced cases slight broaden- 

 ing, soft systolic murmurs, the known humming-top murmur over the jugular, 

 furthermore in a great number of cases acceleration of the pulse, great ex- 

 citability of the cardiac activity and of the vasomotors. Further is found 

 a marked laxity of the arteries (crural double tone). According to the 

 investigations of Bihler and v. Noorden there is always a reduction of 

 blood-pressure. 



Breathing is mostly somewhat accelerated and superficial, with high 

 position of the diaphragm. 



As far as the digestive tract is concerned, should be mentioned that there 

 is frequently a slight degree of hyperacidity. According to v. Noorden, 

 constipation is not much more frequent than in normal girls. The respira- 



