324 CHLOROSIS 



again the attempt has been made to refer the development of the disease to 

 these disturbances. 



Menstruation in chlorotic girls is delayed, or if it has already appeared it 

 becomes scanty or ceases when the chlorosis develops. In contrast to this, other 

 ehlorotics suffer from remarkably profuse menstruation, whieh sometimes may 

 be normal for a few months ; at the same time, there is considerable suffering 

 at the onset, such as headache, general nausea, indisposition, pain in the abdo- 

 men, etc. 



In opposition, however, to the opinion that the menstrual anomalies are 

 the actual cause of the disease, it must be maintained that many ehlorotics 

 menstruate in a perfectly normal manner until the onset of the disease, so 

 that, logically, these anomalies which develop during the course of the chloro- 

 sis must undoubtedly be considered as secondary conditions. Leukorrhea is 

 also very frequent in ehlorotics. 



The symptoms referable to the nervous system are numerous, and here 

 we must differentiate two groups, one of which may be easily recognized as 

 solely a consequence of the anemic condition of the Mood, while the other has 

 an independent character and is specially significant. To the first group belong 

 vertigo, specks lief ore the eyes, syncope, which can be easily explained as due 

 to a deficient supply of blood to the brain, all the more so as the symptoms 

 ameliorate when the patients are kept in a recumbent posture, so that the 

 access of blood to the brain is facilitated, while they become most prominent 

 as soon as the patients assume the erect position or attempt to walk. These 

 symptoms of anemia of the brain, resulting from unsatisfactory circulation 

 of the blood — at the same time poor in oxygen — become manifest in a similar 

 manner also in other forms of anemia. 



In the second group (nervous symptoms independent of anemia) belong 

 especially psychical anomalies, which manifest themselves by a change in the 

 disposition, and a dislike for mental and physical exertion ; on the other hand, 

 when it is specially interesting to the patient, she can endure a considerable 

 amount of exertion, as, for instance, in dancing, as has been previously men- 

 tioned. [Insomnia at night and a heavy sleepy condition in the daytime are 

 often seen in chlorosis, but some patients sleep excessively. — Ed. J 



As regards sensibility, we often find anesthesia of different parts of the 

 skin as well as of the mucous membranes, for example, of the pharynx; in 

 other cases there is hyperesthesia, and especially neuralgic phenomena in the 

 distribution of different nerves. Intercostal neuralgia is quite common, and, 

 if it occur on the left side, is often incorrectly referred to the spleen as the 

 so-called " splenalgia," of which the patients complain. 



Motor disturbances, also, are often accompanying symptoms. Paresis of 

 the various muscles of the larynx and also of those of the extremities is often 

 found. 



The condition of the reflexes varies; they are frequently normal, some- 

 times diminished, in other cases exaggerated. 



Moreover, disturbances of the sympathetic system manifesting themselves 

 by an abnormal innervation of the blood-vessels are very important. Thus 

 we may observe in these patients an abnormal facility for blushing followed 



