CHLOROSIS 429 



tory gas exchange is usually slightly increased. The condition of nutrition 

 is as a rule not bad. Investigations as to the assimilation limits for carbohy- 

 drates gave an increase, or at least no decrease. After the ingestion of 150 

 gm. of grape-sugar, there never, in the experiments of v. Noorden and v. 

 Jagic, occurred glycosuria except in one case that at the same time showed 

 symptoms of Basedow's disease. Also Chatin came to the same result. It 

 should further be mentioned that not rarely chlorotics show a higher level of 

 their body temperature. 



In not very rare cases there are found pigmentations of the skin. 



The examination of the urine shows no abnormal constituents. Also 

 the products of destruction of hemoglobin are not eliminated in abnormal 

 amount. 



I now enter on a description of the blood findings; on account of the 

 poverty in hemoglobin there occurs in the severe cases a greenish-pale 

 facial color, that has given to the disease its name. There are, however, 

 numerous cases that on account of the reddening of the cheeks make a florid 

 impression. Here the disease is unmasked by a close examination of the 

 mucous membranes and careful examination of the blood. The chlorotic 

 blood-finding is characterized by a relatively very marked poverty of the 

 blood in hemoglobin and a relatively slight reduction of the erythrocyte 

 count. Hemoglobin amounts as low as 50 per cent, are very frequent, those 

 and as low as 30 per cent, not rare. When there is high-grade poverty of 

 the hemoglobin there is found more or less distinct poikilocytosis; and in 

 addition isolated nucleated erythrocytes. In the lighter forms the count of 

 the red blood cells is normal or only slightly reduced, only in the severe 

 forms do reductions as low as 60 per cent, occur. In the severe cases the 

 specific gravity of the blood is markedly reduced, while that of the serum is 

 essentially unaffected. With regard to the leucocytes there is a slight 

 relative mononucleosis. 



Recently, as was mentioned. at the beginning, Horowitz, has called at- 

 tention to the fact that in rare cases that otherwise show the symptom-com- 

 plex of chlorosis, the blood is found to be normal or nearly normal. Already 

 Laache had described such cases, also several statements have been made by 

 O. Naegeli and Grawitz, while lately Seller, Groag, Dubnikojf, and others have 

 described such cases. Handmann even found twenty-three cases with normal 

 blood findings among forty-four cases of chlorosis. 



It is furthermore very noteworthy that the investigations so far made as 

 to the quantity of blood in chlorosis have shown a plethora. While accord- 

 ing to the investigations of Smith the total amount of blood in normal in- 

 dividuals is about 5 per cent, of the total body weight, this author found in 

 chlorotics with 29-50 per cent, hemoglobin the blood amount to be 7.5 

 per cent, and 14.3 per cent. The lower the hemoglobin percentage, usually 

 that much larger the amount of blood. Plesch and Oerum using other 



