336 CHLOROSIS 



have taught me. I believe, therefore, that in this direction, i. e., in some 

 neurosis of the vasomotors, we must search for the explanation of the peculiar 

 blood findings of chlorosis, for hereby the polyplasmia of the blood and of 

 the tissues may readily be explained, and it is also perfectly comprehensible 

 that from a general accumulation of fluid in the tissues, particularly in the 

 bone-marrow, the supply of hemoglobin to the erythrocytes should be deficient. 



Chlorosis, therefore, I consider to he a neurosis, which appears in young 

 adolescents, not exclusively, but usually, in girls and women; its development 

 being favored by various preceding, predisposing causes. The anemic compo- 

 sition of the Mood is simply one symptom of this neurosis, even though it is 

 the most invariable and most prominent symptom. The origin of the anemia 

 may be also referred to a faulty function of the nerves, as also are all other 

 nervous symptoms which characterize chlorosis. 



The symptomatology, as well as the views regarding the etiologic factors, 

 and also the therapeutic results which are to be later described, in my judg- 

 ment exclude a specific organic disease of the blood, as well as the idea of an 

 anemia dependent on the formerly mentioned functional and anatomical 

 anomalies; on the contrary, I believe chlorosis to be a link in a chain of neu- 

 roses particularly prevalent in females, and to represent a peculiar form of the 

 general hysteric symptom-complex. 



DIAGNOSIS 



In regard to the diagnosis of chlorosis, it must first be emphasized that 

 the Hood finding alone is not decisive in the recognition of chlorosis, as the 

 blood condition above described occurs not only in chlorosis, but is occasion- 

 ally found in other anemias, and therefore cannot be looked upon as typical 

 or pathognomonic. In this disease, as well as in other anemias, the blood 

 finding may be utilized to confirm the diagnosis after a previous general ex- 

 amination of the organs, but, on the other hand, the diagnosis cannot be made 

 from the blood condition and the organic changes be, then made to conform to 

 this finding. 



The diagnosis in well-developed cases may be readily made when the dis- 

 ease occurs in young, puify-looking girls, with a yellowish-green color of the 

 skin, who present the manifold symptoms and anomalies on the part of vari- 

 ous organs which have been described. There are, however, some difficulties 

 here which not infrequently lead to error, and are therefore of importance in 

 practice. 



It must be emphatically pointed out that it is a mistake to male a diagnosis 

 of chlorosis, without further consideration, when young girls showing general 

 pallor come under treatment; on the contrary, this peculiar disease must be 

 distmguished from the usual forms of anemia, and here we may consider par- 

 ticularly the anemia which is the result of internal hemorrhages, for example, 

 from the menses, or hemorrhage due to gastric ulcer which, under some cir- 

 cumstances, may produce even more serious changes in the composition of the 

 blood than chlorosis, but which, for obviou'S reasons, and chiefly from a thera- 

 peutic standpoint, must be differentiated from chlorosis. 



