GENERAL DISORDERS OF NUTRITION. 



upon which the blood itself depends for its redness, and the tissues 

 through which it circulates for their tints, is reduced one-half, or one- 

 third, or even lower. The exceptions to this rule, namely, the occa- 

 sional instances of chlorosis in which the cheeks retain their redness, 

 are easy of explanation, when we come to know that the color of the 

 blood is but one of the causes upon which the tint of the cheek de- 

 pends ; another consisting in the filling and distention of the capil- 

 laries. Just as there are persons whose cheeks are pale, in spite of 

 the deep hue of their blood, because their capillaries are inadequately 

 filled, so there are other chlorotic persons who, notwithstanding that 

 their blood is pale, always have red cheeks, because their capillaries 

 are filled to bursting, and are varicose. The transient flush observed 

 in almost all chlorotic persons when excited or heated, and to which 

 we shall refer hereafter, is also to be ascribed to a momentary disten- 

 tion of the capillaries with blood. 



The fat in the subcutaneous areolar tissue of chlorotic persons is 

 often normal in amount, and is sometimes even in a state of exuberant 

 development. This condition furnishes an important distinctive mark 

 between chlorosis and the chronic anaemia which often manifests itself 

 hi latent consumption, and in other concealed disorders which affect 

 the quality of the blood. In a symptomatic ansemia or hydraemia of 

 this kind, which is frequently confounded with chlorosis, the subcutane- 

 ous fat soon vanishes as the color of the skin fades. CEdematous 

 effusion into the subcutaneous cellular tissue is rare in this disease. 

 Hence a moderate paleness of the surface, accompanied by oedema of 

 the feet, warrants the suspicion of hydraemia and not of chlorosis ; and 

 conversely, when the lips, cheeks, and ears are white as wax, and yet 

 there is no sign of oedema, it is probable that the serum of the blood 

 retains its normal composition, and that the case is a pure oligocythae- 

 mia and not a hydraemia. 



Chlorosis is always accompanied by more or less shortness of 

 breath, owing to a diminution in the number, sometimes amounting 

 to one-half or more, of the bodies which take up oxygen, and give out 

 carbonic acid. The normal number of respiratory acts is insufficient to 

 supply oxygen to the lungs in quantity adequate to the wants of the 

 system. Every bodily effort, by increasing the consumption of tissue, 

 and augmenting the production of carbonic acid, aggravates the dysp- 

 noea, and multiplies the patient's breathings to a distressing degree. 

 Hence patients with pronounced chlorosis scarcely ever fail to com- 

 plain that they " get out of breath " when they walk fast, or mount 

 the stairs. The diminution in the interchange of gases, and especially 

 the impediment to oxygenation of the blood, also accounts for a second 

 series of symptoms peculiar to chlorosis. The strength of the muscles, 



