CHLOROSIS 251 



The decrease in hemoglobin is demonstrable chemically as 

 well as microscopically, Becquerel and Rodier 1 having found 

 the amount of iron in the total blood decreased in direct pro- 

 portion to the apparent decrease in hemoglobin, which frequently 

 falls to 30-40 per cent., and may drop to 20 per cent, or possibly 

 less. Alkalinity, as determined by titration, is diminished in 

 some cases, but generally remains nearly normal. The cor- 

 puscles are said to contain a larger proportion of water than 

 normal, independent of the proportion of water present in the 

 serum. Limbeck found their isotonitity (i. e., the strength of 

 NaCl necessary to prevent hemolysis) very low about 0.380.4 

 per cent. NaCl. 



Very few changes seem to occur in the organs of the body ; 

 the usual tendency to lay on fat, and the occurrence of fatty 

 degeneration observed commonly in anemias, may be exhibited, 

 and are correlated with Erben's observation of an increased fat 

 content in the blood ; but these changes are often absent. The 

 hypoplasia of the aorta, upon which Virchow laid so much 

 stress, is now considered to be of little or no significance. 

 Thrombosis is a not infrequent complication of chlorosis, 2 and 

 is probably favored by the increased fibrin-content of the blood 

 and the tendency to fatty changes in the vessel-walls. 



Studies of nitrogenous metabolism by Vannini 3 showed practi- 

 cally no alterations except a slight retention of nitrogen. 



Etiology. As to the etiology of chlorosis, chemical find- 

 ings indicate some possibilities and negative others, but decide 

 nothing. That chlorosis does not depend upon a hemolytic poi- 

 son is well established by the following facts : there is no free 

 hemoglobin in the blood plasma, and even less iron in the serum 

 ash than normal ; lecithin and cholesterin, important products 

 of disintegration of erythrocytes, are both decreased in the 

 serum ; hematogenous icterus does not occur, and the amount 

 of pigments in the urine and feces is decreased. 



Apparently, therefore, hematogenesis is at fault, particularly 

 the formation of hemoglobin, since this is more deficient than is 

 the total number of red corpuscles. The rapid improvement 

 in the condition that follows the administration of iron would 

 seem to indicate that a deficient supply of iron is the cause of 

 chlorosis, but numerous objections exist to this hypothesis. 



^or literature see Krehl, " Pathologische Physiologic," 1904, p. 137; 

 Swing, " Clinical Pathology of the Blood," 1901, p. 167; Kossler, Cent. f. inn. 

 Med., 1897 (18), 657. 



2 See Schweitzer, Virchow's Arch., 1898 (152), 337, and Leichtenstern, 

 Munch, med. Woch., 1899 (46), 1603. 



3 Virchow's Arch., 1904 (176), 375. 



