326 CHLOROSIS 



hemogloUn. Therefore, we designate this peculiar form of anemia in chloro- 

 sis as an " oligochromemia," that is, a deficiency in the. hemoglobin of the 

 Uood. This symptom forms one of the most important characteristics of the 

 blood of chlorotics, and is only seldom found so pronounced in the other 

 anemias. [In my experience " chlorotic blood " — excessively low color-index 

 —is not at all uncommon in other forms of anemia, e. g., in " splenic anemia," 

 malarial anemia, cancerous anemia, post-hemorrhagic anemia, etc. Chlorotic 

 blood is in no way peculiar. — Ed.] 



If attention be directed to the cells of the Hood themselves, we find the 

 view corroborated, even on examination of the unstained preparation; each 

 individual red cell has sustained a considerable loss in its hemoglobin. The 

 majority of these cells appear strikingly pale, and absorb stains very imper- 

 fectly, a sign that the quantity of coloring hemoglobin in the cells has been 

 considerably reduced. 



Morphologically we find striking differences in the size of the red blood 

 cells. Many of them appear remarkably large {macro cytes) and at the same 

 time quite pale, without a distinctly pronounced central umbilication — as 

 though swollen. These large, pale discs have been designated, quite appro- 

 priately, " chlorotic " blood-corpuscles. Still other cells, on the contrary, are 

 distinguished by their diminutive size (microcytes) . [Finnish observers have 

 proved that the average diameter of the red corpuscles in chlorosis is often 

 diminished. The cells grow smaller as the disease is aggravated, and return 

 gradually to their normal size in convalescence. — Ed.] 



The stained cells show very distinctly the anomaly designated polychro- 

 matophilia; that is, they partially take up the basic stains instead of acid 

 stains; and, therefore, the stained preparation has a peculiar appearance 

 characterized by the fact that many large cells, very faintly stained erythro- 

 cytes, alternate with many small intensely stained cells, and with cells showing 

 polychromatophilia. 



On the other hand, genuine phenomena of degeneration, such as poikilo- 

 cytosis and gi-anular " degeneration" (the presence in the red cells of numer- 

 ous, very small, basophilic granules), do not belong to the blood picture of 

 chlorosis, but occur only in very far advanced cases of this kind when decided 

 disturbances of nutrition are present, or complications which lead to cachexia; 

 as, for instance, habitual constipation with increased intestinal decomposition. 



In the same manner, nucleated red blood cells are not, as a rule, present 

 in chlorosis, but occur only in the extreme grades of the disease when intense 

 irritation of the hematopoietic organs, i. e., of the bone-marrow, has taken 

 place. 



The condition of the leukocytes in chlorosis is not uniform. It may be 

 stated positively that these cells do not show any characteristic change in this 

 disease. Very often their number is increased ; especially during those stages 

 of the disease in which regenerative processes in blood production are mani- 

 fested by other signs as well as, for instance, by the appearance of nucleated 

 erythrocytes. 



In the experience of the author, no new cell forms appear in this variety 

 of leukocytosis; but we have rather to deal with an increase in number of 



