CHLOROSIS 431 



short leggedness and also a certain prematurity, as shown by other sexual 

 characters. 



As far as the function of the generative glands is concerned, almost all 

 the statements are concerned with menstruation, while, as is intelligible, 

 ovulation evades observation. Disturbances of menstruation are relatively 

 very common. I here quote some examples from the statistics. According 

 to Stieda only seven chlorotics among twenty- three had menstruated regularly. 

 According to Otten, among four hundred forty-eight cases there were only 

 one hundred eighty-six who had menstruated regularly before and during 

 Ihe illness. In the first edition of v. N Garden's monograph, 60.7 per cent, of 

 one hundred seventy- three cases showed weakness of menstruation. In the 

 newer statistics of v. Noorden and v. Jagil that embraces two hundred 

 fifty cases this figure was raised even to 77.2 per cent., and twenty-six of the 

 cases had not menstruated before the onset of chlorosis. There are, how- 

 ever, cases with entirely normal menstruation, and furthermore cases with 

 abnormally strong menstrual hemorrhage. Trousseau has described such 

 cases as menorrhagic chlorosis. In such cases the ovaries were found to 

 be enlarged and there was a great abundance of follicles, v. Noorden and 

 v. Jagic on the basis of their compilation came to the conclusion that in 

 chlorosis menstruation shows no characteristic behavior. 



Pathogenesis. If we now survey what I have just said as to the re- 

 lation of the sexual glands and the primary and secondary sexual characters, 

 we find it hard to accept the theory that chlorosis is a functional disturbance 

 of the interstitial glands, especially if we compare it with those manifesta- 

 tions which are described in the rare cases of female eunuchoidism. There 

 is indeed no doubt that in chlorosis there occurs an enfeebled development 

 of the primary and secondary sexual characters, but in such cases this is 

 mostly only of a slight grade, and just the essential symptoms of failure 

 (deficient hairiness, delayed epiphysial closure) are absent practically al- 

 ways; indeed on the contrary, according to Tandler, as has been mentioned, 

 the development points to a degree of prematurity. Also animal experi- 

 mentations have as yet failed to furnish any support for the assumption of 

 a diminished activity of the interstitial glands. According to the investi- 

 gations of Monaro and of Breuer and v. Seiller the extirpation of the ovaries 

 in young dogs in a state of development indeed leads to a temporary com- 

 mensurate sinking of the amount of hemoglobin and count of erythrocytes, 

 never, however, to the blood picture observed in chlorosis. If I here use the 

 methods that I employed in the exposition of the tests of the sexual glands 

 for separating the symptoms that depend on the functional failure of the 

 interstitial glands from those to the functional failure of the generative glands, 

 I may suppose a slight strengthening of the function of the interstitial glands; 

 it is, however, a priori improbable that these stand in the mid-point of 

 the pathogenesis. I believe that there is applicable an hypothesis that at 



