430 THE DISEASES OF THE SEXUAL GLANDS 



methods came to a like result. It should further be noted that in pernicious 

 anemia Smith and Plesch found subnormal values [for the quantity of blood]. 



In connection with this subject it might be well to mention the altera- 

 tions in the water metabolism that are observed in chlorotics. v. Romberg, 

 v. Noorden and Rethers frequently observed in chlorotics a tendency to the 

 retention of water, while on the other hand we often see under the influence 

 of iron-therapy a rapid loss of weight with moderate polyuria. As has been 

 mentioned, products of decomposition of hemoglobin are not, in chlorosis, 

 eliminated in the urine. Therefore we cannot regard an increased destruc- 

 tion of the blood-coloring matter as a cause of the poverty in hemoglobin. 



Not at all rarely the thyroid gland shows a swelling. Giudiceandrea, 

 Archangeli and Bastianelli found it in half the cases. Handmann found it 

 in twenty-four times among forty-four cases, three times with distinct 

 Basedow's symptoms, v. Noorden and v. Jagil report an interesting case in 

 which the development of the anemia was associated with a swelling of the 

 thyroid gland and on a relapse led to an acute Basedow's that lasted for 

 several days. As the statements as to the involvement of the thyroid increase 

 in so astonishing a manner (since the time that attention has been directed to 

 the fact) , we must ask ourselves whether the pseudochlorosis described by 

 Fr. 11. Mitller does not stand in an intimate relation with true chlorosis. 

 v. Muller states that in regions where goiters are frequent, there are not 

 rarely found pale, readily fatigable, girls with abnormally irritable heart- 

 action, in which manifestation of Basedow's disease later became more 

 distinctly conspicuous. 



Finally I come to a description of the alterations of the genitalia, after 

 which I shall add some remarks as to the disease's pathogenesis. I shall 

 try to separate those changes that are due to an alteration of the glands of 

 generation and those to changes of the interstitial glands. 



Disturbances of development are found in the genitalia in chlorotics not 

 rarely. Deficient development of the external genitalia, deficiency in the 

 prominence of the mons Veneris, flat nates, small labia majora, while labia 

 minora and clitoris are uninvolved; eventually, narrow vagina, faulty develop- 

 ment of the uterus, breasts, etc., are sometimes observed. The statistical 

 reports of Stieda, and of H. W. Freund and v. Noorden show that a relatively 

 larger percentage of chlorotics have such developmental disturbances in more 

 or less pronounced manner. There are undoubtedly a not inappreciable num- 

 ber of chlorotics whose genitalia are developed normally. As especially note- 

 worthy I would emphasize that the hairiness of the genitalia, the mons Veneris, 

 and the axillae corresponds to the age of the individual and further that a 

 delayed closure of the epiphysial junctures and corresponding eunuchoid 

 dimensions of the body is not to be observed in chlorosis. Tandler states 

 on the contrary that he has observed very frequently in chlorotics a very 

 frequent premature epiphysial closure, and as a result of this, an especial 



