CHLOROSIS. 803 



favor the occurrence of chlorosis at the time of puberty ; for, al- 

 though it is not improbable that the development of this affection is 

 often encouraged by a want of fresh air and exercise, by improper 

 nourishment, mental excitement, improper reading, masturbation, or 

 by a generally unhealthy mode of life, yet the disease arises often 

 enough under conditions precisely the opposite of these, in girls who 

 work all day in the open air, who are well fed, do not read novels, and 

 are not addicted to any secret vice. I may add that, according to my 

 observation, obstinate chlorosis attacks all young girls without excep- 

 tion, in whom the menses have appeared in the twelfth or thirteenth 

 year, and before the development of the breasts and pubes. 



Far more rarely chlorosis oligaemia without assignable cause 

 appears in children and in pregnant women, and sometimes even in 

 males. The number of instances of chlorosis in this class is very 

 limited. 



ANATOMICAL APPEARANCES. The lesions characteristic of chloro- 

 sis lie mainly in the blood, which, with Virchow, we may regard as a 

 tissue consisting of cells with a liquid intercellular substance. As has 

 been said already, this intercellular substance, the serum, does not 

 present any constant anomaly. Its composition generally is normal ; 

 more rarely there is a diminution of its albumen. In other cases, again, 

 the amount of albumen of the blood-serum seems to be increased, so 

 that, besides the oligocythaemia, there is hyperalbuminosis. In the first 

 two instances, the whole volume of the blood is probably reduced, 

 while in the latter the possibility cannot be denied that, in spite of 

 the diminished number of the blood-corpuscles, the absolute bulk of 

 the blood is augmented, adding a serous plethora to the oligocythsemia. 



In pronounced chlorosis, the disease in the red-blood corpuscles 

 may be so great that a thousand parts of blood may contain but sixty 

 or forty parts of dried blood-cells, instead of the normal average of one 

 hundred and thirty parts. Upon the autopsy of a chlorotic person, 

 who has died of intercurrent disease, the viscera are all found to be 

 remarkably pale. In some cases, the signs of simple fatty degenera- 

 tion are found in the tunica intima of the great vessels. 1 



SYMPTOMS AND COURSE. The most striking symptom of chlorosis 

 consists in the pallor of the skin and visible mucous membranes. When 

 the skin contains but little pigment, as is the case in blondes, the sur- 

 face of the body is of a pure white ; while, when the pigmentation is 

 intense, as in black-haired persons, it is more of a dirty-gray or yel- 

 lowish hue. The pallor is often most distinctly pronounced upon the 

 ears, while in the mucous membranes the loss of color is most remark- 

 able in the conjunctiva and the gums. The reason for this blanching 

 of the complexion is manifest. The number of red-blood corpuscles 



