CHLOROSIS 433 



maturity and chlorosis, observed by Hastings Gijford, does not seem so in- 

 explicable. The author had observed this case between the second and 

 the eighteenth years. Menstruation began at the age of thirteen months and 

 from then on came at irregular intervals up to the eighth year of life, after 

 which it was regular. With the menstruation at the thirteenth month oc- 

 curred also a rapid growth ; at three and one-half years of age the child was 

 already 146 cm. tall and weighed 41)^ kg. X-ray plates of the hand showed 

 a development that corresponded to that of an eight-year-old girl; the sexual 

 development was that of a thirteen- to fourteen-year-old child. The intelli- 

 gence had remained somewhat behind. From the sixth to the twelfth year 

 the girl was always under treatment for recurring chlorosis. From then on 

 recovery set in. 



We have further seen that in the premenstrual period the activity of the 

 ductless glands is increased, so that there is hence in chlorosis either an in- 

 crease in the activity of the ductless glands, or, in those whose activity 

 comes most in demand, an exhaustion. Very significant in this respect 

 seems to me the behavior of the thyroid gland. I refer to findings described 

 under symptomatology and the frequency of slight symptoms of Basedow's 

 disease. From this standpoint it is indeed intelligible that a newer attack 

 of chlorosis, that perhaps takes place with the maturation of a follicle, leads, 

 when a corresponding disposition is present, to temporary symptoms of 

 Basedow's disease (see the cases of v. Noorden and v. JagiX). 



A second ductless gland whose activity seems to me to be very significant 

 is the chromaffin tissue. We have seen that under normal conditions there 

 occurs in the premenstrual period an increase of blood-pressure, and we have 

 expressed the opinion that impulses proceed from the ripening follicle that 

 increase the activity of the chromaffin tissue and raise the vascular tonus. 



Plainly this organ can become relatively rapidly exhausted, the ex- 

 haustion leading to an influencing of the vasomotor system in the sense 

 of an irritable weakness. The laxity of the arteries as well as the low blood- 

 pressure belongs to the constant symptoms of chlorosis. We may indeed go 

 further and try to explain the blood alterations, at least in part, from this 

 point of view. Heightened tonus of the vessels leads to hyperglobulia 

 through transudation of the plasma into the tissue. (I refer to the dis- 

 cussions on the subject of tetany, and those concerning the significance of 

 the chromaffin tissue for the regulation and distribution of blood-pressure.) 

 It is therefore to be expected that on decreased vascular tonus there will be 

 an increase in the amount of the blood; as the blood becomes thereby poorer 

 in erythrocytes, it is to be assumed that erythrocytes that are then poorer 

 in hemoglobin are given off to the blood paths. Just these conditions ob- 

 tain in chlorosis, increased amount of blood, slightly reduced erythrocyte 

 count, more markedly reduced amount of hemoglobin. In a group of 

 cases the functional breadth of the bone marrow may fully suffice for this 

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