328 CHLOROSIS 



condition of the blood has been properly designated "polyplasmia," that is, 

 an increase of the total amount of plasma in contrast with other changes of 

 the blood, such as are found, for instance, in chronic circulatory disturbances 

 in consequence of heart or lung diseases, in which the volume of the blood 

 cells exceeds by far that of the plasma, and in which, therefore, a condition 

 of " oUgoplasmia " is present. [The researches of Haldane and Smith re- 

 garding the total volume of the blood in chlorosis as measured by capacity 

 to absorb CO gas point to the same polyplasmia referred to by G-rawitz. — Ed.] 

 All these changes must be carefully considered, as they point the way to 

 a more thorough understanding of the pathologic process in chlorosis, as we 

 shall see later. However, the circumstances in all cases are by no means so 

 simple and so distinctly pronounced that we are able to make the diagnosis 

 of chlorosis from the blood changes alone. We must emphasize explicitly 

 that in general practice the blood examination can only confirm the diagnosis; 

 the disease itself can only be diagnosticated by talcing into consideration all the 

 previously described symptoms. 



In conclusion let us review the entire symptomatology of chlorosis, and 

 compare it with that of simple anemia, for example — to choose the simplest 

 form — post-hemorrhagic anemia, such as develops after repeated hemorrhages 

 from the stomach or the uterus. 



In simple anemia we find general pallor, extension of the cardiac dulness, 

 systolic murmurs and also venous murmurs as in chlorotics; in addition the 

 signs of anemia of the brain are found, specks before the eyes, vertigo and 

 syncope. On the other hand, if there are no complications, the entire group 

 of nervous symptortis are lacking in simple anemia, especially anomalies in 

 the psychical sphere and of the appetite; in spite of the increased frequency 

 of the pulse, as the result of anemia, the troublesome cardiac palpitations are 

 absent, as are also the symptoms referable to the sensory sphere and the 

 vasomotor tissue which give to chlorotics their peculiar puffy appearance. 



The changes in the blood, too, are essentially different, for in simple anemia 

 following hemorrhage we always find a considerable reduction in the number 

 of cells, while the amount of hemoglobin in the individual cell is only slightly 

 or not at all decreased. [This is true immediately after the bleeding. Later, 

 the amount of hemoglobin becomes relatively diminished, and the blood may 

 simulate closely the conditions found in chlorosis. — Ed.] On the other hand, 

 the serum in these anemias always shows a more or less considerable diminu- 

 tion in the percentage of albumin, so that these two main factors, the blood 

 cells and the blood serum, are entirely different from those of chlorosis. 

 Moreover, in anemias following severe hemorrhage we find nucleated red 

 corpuscles and an increase in the number of leukocytes. [Post-hemorrhagic 

 leukocytosis is a curiously inconstant phenomenon. As a rule it occurs, not 

 immediately after the hemorrhage, but some days later, and its duration is 

 very variable. Unless frequent examinations are made the wave of increase 

 is often missed altogether. 



The same is true of the " shower " of normoblasts which usually occurs 

 .after hemorrhage, but may be very brief.' — Ed.] 



