CHLOROSIS 



By E. GRAWITZ, Charlottenburg (Berlin) 



Among the numerous cases of anemia constantly coming under observa- 

 tion in the hospital, one group stands out prominently, which, in regard to the 

 origin as well as the symptomatology, and the entire course of the affection, 

 occupies a distinctive position, and, since the time of Hippocrates, has been 

 considered to indicate an impoverished condition of the blood. [As Stengel 

 has recently remarked, there seem to be fewer cases diagnosticated as chlorosis 

 in the clinics of the larger American cities than was the case some years ago. 

 Whether there are, in fact, fewer cases or whether better technic makes us 

 reject many that were supposedly, but not actually, chlorotic, I do not 

 know. — Ed.] 



SYMPTOMS 



This group consists almost exclusively of young girls and young women, 

 in whom the anemia betrays itself by a conspicuous pallor of the shin and the 

 mucous memlirane. [I have never seen in adolescent boys any cases of anemia 

 at all resembling those which in girls we call chlorosis, and those reported in 

 literature are mostly a good many years back and vaguely reported. — Ed.] 

 In many cases there is also a- decided yellowish tinge which may sometimes 

 verge upon green, and, as frequently happens in pathology, from this by no 

 means significant nor even very frequent green color, a term has originated 

 which has long encompassed the entire symptom-complex, and has become 

 current in the language of all countries ; namely, the designation " chlorosis " 

 (from ■x^opo'i, greenish). 



Besides this pale or pale yellow discoloration of the skin, there are in 

 many cases dark gray rings around the eyes; it is especially worthy of note 

 that there is no sign of loss of the subcutaneous adipose tissue; on the con- 

 trary, many of these patients have a plentiful layer of fat. 



It may be seen, therefore, that this form of anemia is not due to a general 

 cachexia, but occurs in well-nourished persons, a fact which is confirmed by 

 an examination of other organs. 



Besides the peculiar color of the skin, the majority of chlorotics show a 

 more or less pronounced edematous infiltration of this tissue, so that, for 

 instance, the lower eyelids often seem swollen, and imprints of the examining 

 fingers on the back and at the ankles of the patient are distinctly persistent. 



These signs lend to the patient a peculiar doughy appearance, which, at 

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