340 CHLOROSIS 



tainty to-day that there is no specific in the treatment of chlorosis, and that 

 even iron, which Felix Niemeyer declared in his time to be a specific, cannot 

 be looked upon as such nor infallible. 



On the contrary, experience proves that some chlorotics, who have shown 

 no appreciable improvement under a plentiful iron treatment because their 

 general hygienic surroundings were unchanged, are restored to health in a 

 short time if they — as is frequently the case, for example, with the previously 

 mentioned domestics — are sent from their usual sphere of activity to the 

 country where fresh air and generally favorabla hygienic conditions exert a 

 curative influence upon them without a drug therapy of any kind whatsoever. 



In keeping with my view that chlorosis is a neurosis in which the blood 

 alteration is not the essential part of the disease, but usually forms the most 

 constant symptom, I have for some time attempted to influence this disease 

 without administering drugs that have a specific action upon the blood com- 

 position, and particularly without the employment of iron preparations, but 

 purely by the same dietetic and hydrotherapeutic measures which are em- 

 ployed in other neuroses, especially in hysteria. With this antinervous regime 

 I have completely cured a number of chlorotics in alout the same time as with 

 the -ordinary iron therapy, yet it is true that some individual cases were favor- 

 ably affected after an iron therapy had been instituted. 



It is evident, at all events, that under hospital treatment with good nurs- 

 ing and proper nutrition, the use of sweat baths at the beginning, friction 

 with light massage later, and the internal administration of some nervines 

 such as bromide or valerian, but without any iron medication, the same favor- 

 able results can be obtained as are observed in girls who regain their health by 

 being sent back to their country homes. 



This therapeutic experience strengthens my belief in the view that chloro- 

 sis is a peculiar neurosis going hand in hand with a damage in hemoglobin 

 formation, and, to my surprise, I recently found that Sydenham in his excel- 

 lent " Lectures upon Hysteria," which even to-day are well worth reading, 

 particularly emphasizes this, that chlorosis is curable by the same remedies 

 .which are effective in hysteria. 



In spite of these experiences, I do not by any means intend to deny the 

 value of iron treatment in chlorosis. This has been demonstrated in prac- 

 tice, time and again, by numerous examples; I generally advise the adminis- 

 tration of iron in the treatment of chlorosis. I merely wish to point out that 

 in these cases iron is not to be looked upon as a specific, that we must not 

 commit the error of thinking that enough is done when we prescribe a good 

 iron preparation for a chlorotic girl, but that the main point in treatment 

 undoubtedly consists in good nursing and diet. 



The treatment of chlorosis is best begun by ordering complete rest in bed, 

 a laxative to relieve the coprostasis, and something to stimulate the appetite. 

 It is well at the start to ascertain by an examination of the gastric contents 

 the state of the secretory and motor functions of the stomach; for, in some 

 cases, as has been stated, hydrochloric acid is in excess, while in others it is 

 diminished, and in still other eases atony of the gastric walls exists which 

 prevents the timely expulsion of the ingesta. All of these morbid changes 



