THE GENESIS OP CHLOROSIS 335 



of this disease was formerly supposed to be in the uterine sphere, although 

 there can be no doubt that in this morbid state many hysterical women have 

 perfectly normal sexual organs and functions, so that to-day no physician 

 seriously refers the symptom-complex of hysteria to the uterus. 



Another opinion which was firmly maintained by Clark and Nothnagel is 

 that in chlorotics, who almost invariably suffer from constipation, there is an 

 abnormal process of decomposition in the intestines, and from the resorption 

 of products of this the disease originates. 



This theory of autointoxication, however, cannot be considered to explain 

 the entire pathological picture; indeed it may be confidently asserted that 

 many chlorotics never suffer from constipation — neither before nor after the 

 onset of the disease. Nevertheless, I am under the impression that in some 

 cases of chlorosis, autointoxication from the intestines may have an auxiliary 

 deleterious effect, and I believe that various degenerative signs in the erythro- 

 cytes which do not conform to the ordinary blood-picture of chlorosis may 

 often be attributed to these auxiliary causes. 



Another theory as to the etiology of chlorosis has been proposed by Meinert, 

 who, as has been stated, lays special stress upon displacement and atony of the 

 stomach; this, in his opinion, develops a dragging of the abdominal sympa- 

 thetic, and is said to cause anemia, that is, chlorosis. 



In reviewing these theories, of which I have indicated only the most impor- 

 tant, it may be noted that they are alike unsatisfactory from the circumstance 

 that they do not conform to a uniform principle, active and pathologic in all 

 cases, iut, on the contrary, of all of them it may be said that the anatomical 

 or functional changes considered to be causative are in many cases certainly 

 not present. 



When we consider the characteristic symptoms which distinguish chlorosis 

 from other simple conditions, and reflect that such symptoms can be produced 

 by the nervous system exclusively, and remember, on the other hand, the pecul- 

 iar blood finding which shows a conspicuous accumulation of plasma in the 

 blood and a decrease of hemoglobin in the cells without a diminution in the 

 number of the cells, the conviction forces itself upon us that the characteristic 

 changes found in this form of anemia must be referred to the nervous system. 



In my opinion chlorosis depends more upon anomalies in the lymph- 

 formation than in the blood-formation ; abnormal amounts of fluid accumulate 

 in the tissues as well as in the chlorotic blood, as was shown in the description 

 of the symptomatology, and in chlorosis it appears as though the blood-vessels 

 were disturbed in their function, and the systematic exchange of fluid between 

 blood and tissue altered ; thus accumulations of fluid arise which, because of 

 disturbed secretory activity, are not excreted in sufficient amount, and in conse- 

 quence lead to stasis of the lymph. 



These disturbances in the circulation of the blood and lymph are, in my 

 opinion, to be referred to anomalies in function of the vasomotor nerves, to 

 which also we may refer the pallor and blushing that in chlorotics appear and 

 disappear so rapidly. Abnormalities in- the exchange of fluid between the 

 blood and the tissues of the body are especially dependent upon pathological 

 functioning of the vasomotor nervous system, as my former investigations 



