GENERAL DISORDERS OF NUTRITION. 



lying behind the sternoclavicular articulation is attached upon all 

 sides, so that it cannot collapse, like other veins, when the stream of 

 blood is reduced in volume. When the jet of blood which enters 

 this large space is too small, it can only fill it by forming an eddy. 

 This whirling current throws the walls of the veins into sonorous 

 vibration. If the neck be turned to one side so as to compress the 

 jugular of the opposite side between the omohyoid muscle and the 

 cervical fascia, the bruit de diable becomes audible in the majority 

 even of full-blooded, healthy persons. When the sound is perceptible 

 without such a turning of the neck, it may always be inferred that the 

 patient's blood is impoverished and that his veins are scantily filled. 

 The excessive nervous irritability arising from inadequate oxygenation 

 of the blood also involves the vasomotor nerves ; whence the sudden 

 flushing and paling of chlorotic persons. 



Besides the cardialgia already alluded to, other serious disorders 

 of the digestive system arise in chlorosis, which, unless watched with 

 patience and attention, might give rise to dangerous mistakes. The 

 appetite is nearly always diminished ; after eating, there is a sense of 

 pressure and fulness in the epigastrium, with acid eructations and otner 

 symptoms of dyspepsia, which, in most patients, depend on " atonic 

 weakness of digestion " (Vol. I.), and generally disappear as the state 

 of the blood improves. Affections such as these are not dangerous, 

 and nearly always get well under proper treatment ; unfortunately, 

 however, the chronic ulcer of the stomach is also a very common occur- 

 rence in chlorosis, and often develops undetected. In treatment of a 

 chlorotic patient, it must never be forgotten that the cardialgia and 

 dyspepsia may be dependent upon this grave lesion of the stomach, 

 and all suitable means must be invoked to aid us to a correct diagnosis. 

 Neglect of such precautions may terminate in an unexpected and tragic 

 denouement by haematemesis, or even by perforation. 



The urine of a chlorotic patient, unless there be intercurrent fever, 

 is remarkably limpid and light. The lowness of its specific gravity is 

 probably owing to the small amount of urea which it contains, and its 

 light color to a deficience in coloring matter. Reduction in the supply of 

 oxygen sufficiently accounts for the decrease in the destructive assimi- 

 lation, and consequently for the diminution of the urea in the urine. 

 We know but little regarding the formation of its coloring matter, but 

 it can scarcely be doubted that it is derived from that of the blood ; 

 hence, when the number of the blood-corpuscles, which contain the 

 red matter, is diminished, it is not surprising, cfeteris paribus, that the 

 coloring of the urine should decrease. 



The sexual function nearly always suffers derangement, generally 

 vn the form of amenorrhcea, more rarely in the form of excessive men- 



