434 THE DISEASES OF THE SEXUAL GLANDS 



regulation, in another group it soon, according to this view, becomes ex- 

 hausted, the exhaustion leading to poverty in hemoglobin. In addition 

 to this it is possible that direct impulses go from the follicular apparatus 

 to the bone-marrow and on increased activity of the former favor the ex- 

 haustion of the latter. As according to this hypothesis we are dealing only 

 with an exhaustion due to the large demands, it is intelligible why in the 

 autopsies on cases of chlorosis the bone-marrow was found to be normal 

 (Birch-Hirschfield, Grawitz). Perhaps other symptoms of chlorosis point 

 to a lessened valuation of the chromaffin tissue, signs such as slight mono- 

 nucleosis, the not rare pigmentation, and indirectly the high carbohydrate 

 tolerance, which up to the present have been observed by all investigators. 

 The investigations as to the blood sugar have not as yet been made. At 

 all events it would not be unintelligible why chlorosis develops just in in- 

 dividuals with hypoplasia of the vascular system, which, as is known, is asso- 

 ciated with hypoplasia of the chromaffin tissue; the corroboration of our 

 views would be an instance of the penetrating vision of the past-master, 

 Virchow. 



This hypothesis seems to me also to explain why chlorosis is found al- 

 most exclusively in the female sex. If we were to assume the insufficiency 

 of the interstitial glands, it would be indeed unintelligible why in eunuch- 

 oidism, in which the symptoms of insufficiency are so conspicuous, we meet 

 with no chlorosis. The interstitial glands have the same function in both 

 cases; the follicular apparatus is something specific for woman. The revo- 

 lutions that take place in the female at the time of maturity are different 

 from those that occur in man and are much more powerful. 



The experimental basis for this view is yet to be laid. Whether the im- 

 plantation into young animals of ovaries taken in marked ovulation will be 

 able to produce a picture similar to chlorosis, is at all events questionable ; 

 just as castration, which according to the view set forth would bring the 

 chlorosis to a standstill in a short time, is impracticable. We must, however, 

 consider whether a very cautious X-ray irradiation of the ovaries would 

 not act favorably on the chlorotic process. 1 Perhaps this view furnishes the 

 key for the solution of the problem of iron therapy. As is known, iron has 

 an almost specific action in chlorosis, while in the other anemic processes it 

 mostly fails. Morawitz has concluded that the iron does not act principally 

 on the bone marrow, but somewhere else in the body. From the stand- 



1 1 would here call attention to the later views as to the cause of uterine hemorrhages. Pankow 

 pointed out that metritis and chronic endometritis could not be the cause of the profuse men- 

 strual hemorrhages. The chronic inflammation may very well be associated with profuse bleed- 

 ing, but it does not condition it. Pankow seeks the cause rather in a different functional size of 

 the ovaries conditioned by "disturbances in the reciprocal relations of the ductless glands to 

 each other." Perhaps the assumption of a deficient or increased ovulation would suffice, as the 

 climacteric hemorrhages have been favorably influenced by X-ray irradiation (Doderlein), 

 which restricts the process of ovulation. 



