334 CHLOROSIS 



point must be particularly emphasized to which Becquerel and Eodier, the 

 celebrated investigators in the realm of hematology, called attention about the 

 middle of the last century, namely, that the changes in the Mood of chlorotics 

 do not correspond with the severity of the clinical picture; on the contrary, 

 particularly at the onset of the disease, when all of the other symptoms are 

 conspicuously developed, the blood changes are comparatively slight, and only 

 increase upon prolongation of the malady. This late deterioration of the 

 blood, according to our present knowledge, must be referred partly to an 

 insufficient ingestion of food, in some cases also to accompanying symptoms; 

 for example, to profuse menses, sometimes perhaps to autointoxication from 

 the intestines. Therefore, the assumption that in chlorosis the hlood itself 

 is the tissue primarily diseased cannot he maintained. 



The development of chlorosis has been also attributed to disturbances in 

 the sexual functions; for, as previously remarked, too slight or too profuse 

 menses are observed in most cases of chlorosis, and Trousseau actually refers 

 to menorrhagic chlorosis. 



Anatomical anomalies of the sexual organs, which not infrequently appear 

 as hypoplasia of these organs, have, as we found to be the ease in the circula- 

 tory apparatus, been looked upon as responsible for the development of the 

 disease. Nevertheless, these changes cannot all be looked upon as special 

 causes of chlorosis, but, at most, in many cases as predisposing causes. In 

 the majority of instances, however, they are certainly secondary conditions 

 in the chlorotic pathological picture. 



That these anomalies have no general importance in the genesis of chlorosis 

 may be seen clearly from the fact that in numerous chlorotics neither abnor- 

 malities nor functional anomalies of the sexual organs can, at any period of 

 the disease, ie discovered. 



In accordance with modern pathological views, an attempt has lately been 

 made to attribute to the sexual organs the development of chlorosis in another 

 sense. It has been assumed that from these organs (as we know positively in 

 the case of the thyreoid gland) besides their well-known specific function, 

 still another internal secretory activity proceeds, by means of which materials 

 reach the circulation, and that this activity bears a certain relation to the 

 hematopoietic function. 



This view is based mainly upon the fact that chlorosis is prone to appear 

 in that period of life in which the sexual organs mature. Yet it is indicative 

 of the uncertainty of these views that, while v. Noorden assumes that there is 

 an absence of the internal secretion in chlorotics, and that as the result of 

 this the material reaching the blood is insufficient to stimulate blood forma- 

 tion, in opposition to this Lloyd Jones holds the opinion that at the time of 

 sexual maturity internal secretions enter the hlood in superfluous amounts, 

 and in some complicated manner bring about its chlorotic composition. 



These modern views according to which chlorosis is attributed to the hypo- 

 thetical functional disturbances of the generative organs appear to me as 

 untenable as the earlier ones which were based upon anatomic and well-known 

 functional disturbances. I believe these views of chlorosis to be just as partial 

 as those concerning hysteria, in which the name at once shows that the origin 



