THE GENESIS OP CHLOROSIS 333 



disturbances of the sexual functions, a point which is important for the com- 

 prehension of the entire process. 



As factors which favor the outbreak of the affection we may mention 

 the changes in the food and in the mode of life, particularly the late going 

 to bed and the hard work (the climbing of many flights of stairs). Other 

 causes which play an important role are the hurry of life, psychical exaltation, 

 especially nostalgia, and finally reduced consumption of fresh air. 



Certainly, it is undeniable that the mere removal of a previously perfectly 

 "healthy young girl from the country to a large city is sufficient to produce the 

 entire symptom-complex of chlorosis, and that the same girl, if sent back to 

 her former country home, will lose every trace of the disease; for this reason 

 the author suggests the name " city chlorosis " for this variety of the affection. 



Besides these factors, organic diseases may lead to the development of 

 chlorosis. As an instance, we may mention " gastroptosis " with the digestive 

 disturbances that accompany it. Meinert, especially, has called the attention 

 of the profession to its frequent presence in chlorosis. 



Menstrual abnormalities, too, particularly profuse menstruation, certainly 

 predispose to chlorosis, as also probably does an attack of an acute infectious 

 disease. 



Reviewing at a glance all these predisposing factors, beginning with the 

 anatomical changes of the circulatory apparatus, then the unhygienic influ- 

 ences, and, finally, actual organic diseases, it is at once apparent that there 

 exists no specific factor nor' one single factor which is found as the cause in 

 all eases, but, on the contrary, taking into consideration the great variety of 

 predisposing causes, we have reason to believe that the points of minor resist- 

 ance that favor the outbreak of this peculiar disease are manifold. The 

 question arises which, in this large number of diversified and detrimental 

 influences, is the connecting link that may satisfactorily explain the genesis 

 and the true nature of the disease. 



THE GENESIS OF CHLOROSIS 



The views that have been expressed with regard to the development and 

 the true nature of this disease vary greatly. First, the theory is to be consid- 

 ered which treats of chlorosis as an essential blood disease, in which all 

 organic changes or symptoms on the part of the organs are of a secondary 

 nature, and the blood itself is the primary seat of the disease. This view 

 is no longer tenable on account of the numerous and exact blood examina- 

 tions that have been made in the last few decades, the results of which have 

 been mentioned above. According to our present knoivledge, a specific dis- 

 ease of the blood must of necessity be combined with changes of the blood 

 cells, and, as we have noted, there is absolutely no support for this view, since 

 the principal and most important morphological changes consist in a decrease 

 of the hemoglobin of the blood-corpuscles, while degenerative changes, as well 

 as characteristic pathological changes of the leukocytes, are entirely absent. 



The absence of pathological changes of the bone-marrow, as we have al- 

 ready stated, is against the view of a substantive blood disease, and another 



