330 CHLOROSIS 



blood changes, i. e., decrease in the amount of hemoglobin, but which in all 

 likelihood brings with it another pathological condition of the blood which 

 we must designate as oligcemia vera, i. e., a decrease in the total mass of 

 the blood. 



Such persons with lessened capacity of the heart and of the vessels and 

 probably of a lessened total quantity of blood, may, provided they do not 

 over-exert themselves, appear to be quite healthy; and, as a matter of fact, 

 we are very frequently surprised to find this state of affairs in a well developed 

 form at the autopsy of persons in whom we could not suspect an anomaly of 

 the vascular system. 



In itself it is quite unlikely that hypoplasia of the vascular system is capa- 

 ble of producing chlorosis. It can at most be looked upon as a predisposing 

 factor; aside from this it certainly plays an important role in those chlorotics 

 who show an abnormal tendency to relapses, characterized by very slight 

 inclination to improvement, so that such cases have also been designated as 

 " habitual " and " persistent " chlorosis. 



At the present time it may be maintained with certainty, that the severe 

 anatomical changes of the vascular system are not characteristic, nor are they 

 even the specific anatomical foundation of chlorosis. In our further discus- 

 sion, we shall have to consider their effect as factors in prognosis and treat- 

 ment. 



Similar hypoplastic changes have also been found in the genital organs, 

 and these changes have also been considered to bear a causal relation to 

 chlorosis. Yet here we may hold the same view as in the hypoplasia of the 

 vascular system, that, these anomalies are to be looked upon only as predis- 

 posing factors, and that they cannot be regarded as an explanation of the 

 entire symptom-complex, especially of the blood changes. 



All other changes, such as degeneration of the heart muscle, parenchyma- 

 tous inflammation of the kidneys, and other anatomical alterations, are to be 

 considered as secondary. Hence it must be admitted that at the present time 

 a definite anatomical cause of this disease is absolutely unknown. 



FREQUENCY OF CHLOROSIS WITH REGARD TO 

 SEX, AGE AND LOCALITY 



It has been noticed for many years that chlorosis affects preferably the 

 female sex. There are, however, undoubtedly cases of genuine chlorosis in- 

 young men, all the symptoms of the disease most distinctly presenting them- 

 selves, in the blood as well as in the other organs. As Wunderlich has 

 observed, the symptom-complex is noted usually in young men of poor 

 physique and of sedentary occupation — tailor-apprentices, office clerks, etc. 

 [See Editorial Note II on p. 320.— Ed.J We do not as yet Imow whether or 

 not the abpve mentioned changes in the heart and vascular system are already 

 existent in these cases and predispose to the outbreak of the disease. 



The age at which chlorosis appears in the great majority of cases is that 

 of puberty, from the twelfth or fourteenth year to the twentieth. [From 

 eighteen to twenty-three is, in my experience, the period in which the great 



