CHLOROSIS. 805 



which, to be vigorous, calls for a supply of well-oxygenated blood, is 

 greatly reduced. The patient is easily fatigued, and complains of a 

 sense of weight in his limbs, and not unfrequently (pseudo-rheumatic) 

 muscular pains are induced by the slightest effort, such as only are felt 

 by healthy folk after unusual and excessive exertion. Important as it 

 is to the normal function of the muscles that a free supply of well- 

 oxygenated blood should circulate within them, this is equally essen- 

 tial to the proper action of the nerves. In treating of the neuroses, 

 in almost every instance, we have referred to the state cf the blood in 

 chlorosis as an important point in their etiology. Hence, neuralgia is 

 extremely common among chlorotic patients, that of the trigeminus 

 being especially frequent among the peripheral neuralgias, while in 

 the internal organs cardialgia is more common. Anaesthesia, convul- 

 sions, and palsy, are rarer, and are seldom observed excepting when (as 

 sometimes happens) hysteria develops during the disease. There are 

 nearly always signs of hysteria in chlorosis, which consist of general 

 bodily and mental hyperaesthesia, a troubled, irritable temper, a dis- 

 position to weep, perverted appetite (for instance, a craving for coffee- 

 beans, slate-pencils, etc.). 



The organs of circulation present numerous deviations from the 

 normal. The patients nearly all complain of palpitation. I have 

 already declared that this symptom is not altogether due to an aug- 

 mented or accelerated action of the heart, being also in some degree 

 dependent upon a general hyperaesthesia, whereby the impulse of that 

 organ is rendered distressingly perceptible, whereas it is not felt at 

 all by most persons, even when its beat is enormously intensified by 

 hypertrophy (Vol. I.). Upon auscultation of the chest, over the heart 

 and great vessels, we hear the blowing sounds so often alluded to, 

 and which are known as " blood murmurs," to distinguish them from 

 the morbid murmurs depending upon alteration of the structure of the 

 heart. This name is inappropriate, however, as the sounds are not 

 caused directly by the altered condition of the blood. They most 

 probably arise from an abnormal tension of the valves and arterial 

 walls. 



tfar more frequently, upon listening over the jugular vein, a pecu- 

 liar humming, singing murmur is heard, known as the "Nonnen- 

 gerausch," or " bruit de diable." The name is derived from the sound 

 of the humming-top, called " Brummkreisel " in North Germany, and 

 "Nonne" (nun) in other places; while in France it is called the 

 ' diable." The sound is more intense upon the right side than upor, 

 the left, and subsides when the patient assumes a horizontal attitude 

 or draws a forced breath. The mode of origin of the " bruit de diable " 

 seems to be as follows : The lower part of the internal jugular veins 



