332 CHLOROSIS 



As already remarked, although the whole complex of symptoms in chlorosis 

 cannot be explained by these anatomical changes, yet they surely form pre- 

 disposing factors, and moreover, as we shall observe later, chlorosis is undoubt- 

 edly more severe in these abnormally organized girls than in those with a 

 normal circulatory system. 



Still more injurious is the pernicious habit of allowing, young girls to wear 

 iiglitly laced corsets which compress the lower parts of the thorax, hinder 

 respiration and the circulation of the blood, and unquestionably, besides pro- 

 ducing the well-known changes in the liver, lead to alteration of position, 

 and prevent the motility, of the stomach. [That tight lacing has any definite 

 relation to chlorosis is, I think, quite unproved, though many writers refer 

 to it.— Ed.] 



Other injurious causes are to be found in the nutrition; these consist of 

 disturbances of digestion with a loss of appetite for wholesome food; instead 

 of nourishing the young girl with milk and other easily digested and nutri- 

 tious food, she is allowed to feed upon dainties. 



Among the lower classes, unhygienic conditions of living are frequently 

 at fault; growing up in damp, badly ventilated rooms into which the rays 

 of the sun rarely penetrate, eating insuiKciently and of indigestible food, are 

 conditions potent as predisposing causes of chlorosis. [It has still to be 

 shown, I think, that bad hygiene can or does produce any type of anemia. 

 It is natural to expect that anemia would result from such conditions, but I 

 have never seen any good reason to believe that it does. — Ed.] 



In all classes, premature indulgence in alcohol must be considered; this is 

 often permitted children through mistaken dietetic principles, but conduces 

 to the undermining of the health at an early age. 



To these faults in training psychical factors are added, such as the prema- 

 ture awakening of sensuality by exciting literature, exaggerated novels and 

 the like, from which ideas of love develop entirely too early and, in many 

 cases, not only exert an unwholesome influence upon the psychical nature, 

 but upon the whole physical condition. 



A peculiar predisposition favoring the development of chlorosis may be 

 observed daily in the life of a large city. This is manifested in young servant 

 girls, who, as a rule to-day, come from the country or from small towns to 

 the large cities in quest of higher wages, and often, after a brief residence, 

 suffer from well-developed chlorosis. This contingent of young girls forms 

 a large proportion of our hospital patients, and it is interesting to inquire 

 into their history. Usually we find that these girls, on the average from 

 eighteen to twenty-two years of age, were while at home always well, strong, 

 and able to work, as may also be inferred from their " service books." After 

 arrival in the large city, a very brief period sometimes elapses before they 

 become ill and show the fully developed symptom-complex of chlorosis. 



The author has taken special interest in these cases, and after careful 

 mvestigation has found that two to four weelcs are often sufficient to transform 

 a healthy and rolust-looMng girl into a patient with pronounced symptoms 

 of chlorosis. It is worthy of note that these patients manifest no anomalies 

 of the stomach or intestines except, perhaps, transitory constipation, nor any 



