PATHOLOGICAL ANATOMY 329 



PATHOLOGICAL ANATOMY 



The anatomical lesions of this disease have by no means been determined 

 with certainty. The great difficulty in making positive statements regarding 

 organic changes in chlorosis lies in the fact that in uncomplicated chlorosis 

 fatal cases are exceedingly rare, and we are consequently dependent upon the 

 scant observations obtained when chlorotics have perished from an intercur- 

 rent disease, and in these cases we are compelled to decide which among the 

 organic changes are to be referred to chlorosis and which are to be attributed 

 to the affection causing the fatal issue. 



In these cases, changes in the hematopoietic apparatus of chlorotics, that 

 is, in the marrow of the long, tubular bones, which might be held responsible 

 for the origin of the blood changes, are as yet not understood. The author 

 himself examined thoroughly the tibiee of two chlorotic girls, and was unable 

 to find any disease changes, macroscopically or microscopically, in the distri- 

 bution of the red and fat marrows. 



Best known are the changes in the circulatory apparatus, presented by 

 Virchow as the anatomical foundation of chlorosis, and which for a long 

 time were interpreted in this sense by clinicians. According to Virchow, we 

 are dealing in these cases with a defective development of the heart and of 

 the large arterial vessels, with a hypoplasia or dwarfed state in which the 

 changes in the vessels become manifest by abnormal narrowing, thinness, and 

 elasticity of the arteries, and also by irregular ramifications of the vessels. 



This hypoplasia of the heart and vascular system, as Virchow teaches, 

 favors the assumption of a predisposition, either congenital or acquired in early 

 youth, which, as a rule, causes actual disturbances having pathological im- 

 portance only at puberty, and that chlorosis itself, though incurable, may, by 

 proper treatment, particularly by dietetic measures, be hept in a state of 

 latency. 



These hypoplasias of the heart and valvular system subsequently became 

 matters of great importance, and the narrow, thin-walled and enormously 

 elastic aorta has briefly been designated " aorta chlorotica," without at all 

 explaining how a diminished amount of hemoglobin in the blood can result 

 from narrowness of the vascular system, secondly, why the chlorotic symp- 

 tom-complex can in many cases be so readily and permanently overcome, and, 

 finally, the important question why men who, according to Virchow, also 

 frequently suffer from hypoplasia of the heart and of the arteries, are so 

 rarely attacked by chlorosis. In regard to this latter point particularly, i. e., 

 the rare occurrence of chlorosis in men, it is remarkable that Virchow disre- 

 garded this in his hypothesis, in spite of frequent anatomically recognizable 

 changes in the vascular system. 



As a matter of fact, in many chlorotics, hypoplasia of the heart and of 

 the vessels certainly plays an important role, but only in so far as it represents 

 an irreparable and, therefore, very unfavorable complication of chlorosis; for 

 in this condition we are dealing with a faulty structure of the vascular system 

 v/hich is acquired in early youth, which cannot of itself lead to chlorotic 



