252 DISEASES OF THE BLOOD 



Bunge advanced the idea that under normal conditions the only 

 form of iron that can be absorbed is that which is combined 

 with proteids, particularly nucleoproteids ; iron administered in 

 inorganic form, or as compounds with organic acids, he believed, 

 can all be recovered from the feces, and, therefore, is not 

 absorbed. He suggested that in chlorosis the iron taken with 

 the ordinary food is precipitated in the intestines by sulphides 

 or other products of intestinal putrefaction, and hence there 

 results a deficiency in the amount of iron absorbed and avail- 

 able for the manufacture of hemoglobin. The inorganic iron 

 given in chlorosis, Bunge believes, owes its efficiency to its 

 saturating all of these sulphides so that the nucleoproteid-iron 

 is not precipitated, and can, therefore, be absorbed. Many 

 objections have been raised to Bunge' s hypothesis, however, for 

 competent observers have failed to find any abnormal putrefac- 

 tion in chlorosis, and others have found that sulphide of iron 

 itself gives good results in the treatment of chlorosis, while 

 bismuth and other sulphur-binding substances are without 

 effect. Furthermore, Bunge' s contention that iron administered 

 in medicinal form is not absorbed seems to have been completely 

 disproved by several experimenters. 1 



As a consequence of all these conflicting data we are at 

 present completely in the dark as to the reason for that failure 

 to properly manufacture hemoglobin which seems to be at the 

 bottom of chlorosis. The hypothesis that iron and arsenic 

 favor recovery by stimulating the hemogenetic tissues, which is 

 urged by v. Noorden and others, is unsatisfactory in the 

 extreme, and explains nothing. There is absolutely no ques- 

 tion that administration of iron restores the composition of the 

 blood to normal, usually quite rapidly, and this seems to leave 

 as most probable the explanation that in some way an iron 

 starvation is the fundamental cause of chlorosis. However, as 

 Ewing says, any theory must be inadequate that fails to take 

 into account the age of puberty, the female sex, and the func- 

 tion of menstruation. 



PERNICIOUS ANEMIA 



In contrast to chlorosis many evidences of hematolysis may 

 be found in pernicious anemia, particularly the increased amounts 

 of iron in the liver, spleen, and kidneys ; hemoglobinemia and 

 hemoglobinuria ; increase in urobilin, and not infrequently icterus. 



1 Full review with bibliography by Abderhalden in his " Lehrbuch der 

 physiol. Chemie," 1906, pp. 408-430. For literature on treatment of chlorosis see 

 Komberg, Berl. klin. Woch., 1897 (34), 533. 



