338 CHLOROSIS 



tions which have a beneficial influence upon metabolism in general and upon 

 the nervous system. 



The cases which run an unfavorable course, particularly those forms of 

 the malady which are looked upon as habitual, i. e., those not completely dis- 

 appearing, are unquestionably often complicated by anatomical abnormalities 

 such as have been described ; for instance, by an abnormal smallness and nar- 

 rowness of the heart and vascular system, and, probably, by an unfavorable 

 predisposition of the hematopoietic apparatus, and a diminution in the amount 

 of blood. In these cases we are not dealing with pure chlorosis, but with a 

 complicated anemia due to anatomical and chlorotic changes, and in many 

 of these instances Virchow's opinion must be regarded as correct; namely, 

 that the chlorotic symptoms may be suppressed by suitable therapy, but the 

 disease can never be entirely cured. 



It is important to note that these very persons whose vascular system is 

 imperfectly developed offer very slight resistance to other morlific and dam- 

 aging influences, i. e., that they are usually predisposed to catarrhal affections 

 of the various organs, and that they are more subject to severe acute infectious 

 diseases, as, for example, pneumonia, etc., than persons with a normally devel- 

 oped vascular system. This fact explains the previously mentioned anatomical 

 anomalies found at the autopsy of anemic young girls. 



Quite as obstinate as these mixed forms of oligemia and chlorosis due to 

 anatomical changes are the forms of the affection in early youth due to such 

 errors in bringing up as have been described — insufficient nutrition, deficient 

 stimulation of the circulation, and undue irritation of the nervous system — 

 so that these children from their earliest years have never, in fact, had a hale, 

 hearty, rosy-cheeked appearance, and have never shown the normal mental and 

 physical vigor and sprightliness characteristic of a well-developed child that 

 has received proper bringing up under good management. 



We meet such girls chiefly in private practice among the better classes; 

 almost from infancy they are markedly languid, at school they are less capable 

 of application, and are easily fatigued; on the other hand, as they grow, they 

 develop a special liking for belles-lettres or for books which excite the imagi- 

 nation, and show but slight inclination to exert their physical powers. It is 

 therefore quite possible that in these girls, on account of insufficient muscular 

 exercise and stimulation, an undeveloped condition of the heart and vascular 

 system is induced, so that in some of them pure chlorotic symptoms no longer 

 appear, but mixed forms of general anemia (oligemia) and chlorosis. 



It is interesting to observe these girls when they reach puberty, marry, and 

 attain a riper maturity. We usually find that the chlorotic symptoms, i. e., 

 the puffy appearance and the numerous irregularities on the part of the vari- 

 ous organs, especially of the vascular system, disappear. Nevertheless, these 

 women remain pale, are inactive, easily irritated, and form a large proportion 

 of the widely distributed group of hysterics, so that, upon accurate investiga- 

 tion of the history of most hysterics, the report is obtained that in early youth 

 thgy had been anemic. 



This fact bears further testimony, in my opinion, to the close relationship 

 of chlorosis and hysteria. Indeed it may be observed in various realms of 



