SYMPTOMS 323 



The respiratory apparatus in chlorotics shows few deviations from the 

 normal. A symptom noticeable in many of the patients is an accelerated res- 

 piration rate, which is to be explained, like the acceleration of the heart's 

 action, by a relative deficiency of the blood in oxygen. This, however, is not 

 characteristic of chlorosis, but is also met with in other affections accompanied 

 by deficiency in hemoglobin. 



Much more numerous are the symptoms on the part of the digestive appa- 

 ratus. First of all, as an almost invariable symptom, there is found anorexia 

 and repugnance for certain hinds of food, for instance, meat; and, on the 

 other hand, and this is a characteristic symptom of the disease, a morbid desire 

 for food difficult to digest or wliolly indigestible. Thus, many of these patients 

 have an especial liking for sour foods, vinegar, pickled products, etc., and 

 furthermore, for lime, chalk, slate pencils and the like ; longings which remind 

 one forcibly of similar cravings in pregnancy. 



Atony of the muscular wall of the stomach is often found, which not infre- 

 quently leads to dilatation and displacements of this organ. Still, I cannot 

 coincide in the opinion of Meinert, who considers gastroptosis, that is, the 

 pathological descent of the fundus of the stomach, a constant symptom of 

 chlorosis, and even makes it responsible for the origin of the whole disease. 



As a matter of fact, there is often found in young girls a displacement of 

 the stomach from its normal limits, the result of tight lacing and the wearing 

 of corsets ; and, as general weakness of the muscles exists on account of the 

 anemia, conditions are very favorable for the development of gastroptosis and 

 dilatation in consequence of the stagnation of food and tight lacing. 



In many eases the secretory activity of the stomach is quite normal; in 

 others an excessive production of hydrochloric acid is met with; and in still 

 others acidity is decreased. These, however, are facts that must be ascer- 

 tained iy direct examination of the gastric contents, and should never be 

 guessed at from the subjective complaints, as, for instance, from the inclina- 

 tion to eat chalk. 



The activity of the intestines is usually disturbed, and constipation is 

 one of the commonest symptoms; indeed, as will be seen later, theories 

 have been developed which ascribe the origin of the whole disease to this 

 phenomenon. 



Concerning the metabolism of chlorotics, exact researches have been made, 

 especially by v. Noorden and his pupils, from which it is ascertained that in 

 these patients no especially increased waste of albumin occurs, that the absorp- 

 tion of oxygen is within normal limits, and that the excretion of urea shows 

 no noteworthy change. 



The body temperature is neither increased nor diminished. The appear- 

 ance of fever is probably to be explained for the most part by the presence of 

 complications. Slight transitory rises of temperature without demonstrable 

 organic changes occur in some cases ; but we must consider the close relation- 

 ship between chlorosis and hysteria — a fact which we shall consider frequently 

 later on — in which fever of like character also is noted, and has thus far not 

 been satisfactorily explained. 



In chlorotics the sexual functions are disturbed in various ways ; and here 



