TREATMENT 341 



in the stomach must be relieved by a rational treatment before we proceed 

 ■with a special therapy ; and, as a rule, it is comparatively easy to correct these 

 anomalies of secretion. 



The diet in the beginning must consist of easily digested food, of which 

 milk is of the greatest importance, and only in very stout girls is it necessary 

 to limit or entirely withhold this, the best nutritive measure. Easily digested 

 vegetables, especially the green vegetables, such as spinach, which, by the way, 

 contains a small amount of iron, green peas and beans, mashed potatoes, and 

 rice are particularly advisable. Later on, finely scraped raw beef or scraped 

 ham may be allowed, while the use of eggs, at least in large amounts, is not 

 recommended on account of the intestinal decomposition which readily ensues. 

 Very frequently at the onset of treatment it is necessary to remove the 

 edematous swellings which appear in the face, giving the patient a peculiar 

 puffy appearance; these are also seen in the ankles and elsewhere. For this 

 purpose, venesection has lately been employed again, as it was by many physi- 

 cians at the beginning of the preceding century, though even then, when 

 venesection was in vogue, experienced physicians such as Becquerel and Eodier, 

 on the basis of their exact blood investigations, cautioned the profession against 

 the indiscriminate employment of venesection in chlorosis. To-day, with our 

 knowledge of the more minute constituents of the blood in chlorosis, vene- 

 section cannot be loohed upon as a justifiable therapeutic measure; for the , 

 plethora, i. e., the excessive accumulation of fluid in the blood, the removal 

 of which was attempted by the exponents of the venesection therapy, is rather 

 increased by the loss of blood and by the consequent inflow of lymph, and in 

 my opinion the only favorable result of venesection is the reactive outbreak of 

 sweat to which these physicians attached great weight. 



This effect of the outbreak of sweat upon the fluid accumulated in the 

 blood and in the tissues can, in my opinion, be brought about more effectively 

 and with less danger by a simple sweat bath. In puffy chlorotics, during the 

 first period of the treatment, I employ hot baths followed by sweating two or 

 three times a tveek, and I find that the subjective difficulties as well as the 

 objective findings are always favorably influenced thereby. 



Massage, too, is effective, particularly as long as the patients remain in 

 bed; it acts very favorably in stimulating the circulation and the entire 

 metabolism. 



Iron therapy, as already mentioned, forms an essential adjuvant in the 

 treatment of chlorosis, although to-day we no longer hold the old opinion that 

 iron is directly utilized in the formation of hemoglobin in the bod}', but it is 

 to be looked upon mainly as a stimulant for the hematopoietic organs. That 

 iron actually reaches the fluids of the body by absorption, a point that has been 

 questioned even very recently, has lately iaeen positively proven chiefly by 

 the investigations of Quincke. 



The number of iron preparations at our disposal for therapeutic purposes 

 is exceedingly large. Besides the inorganic compounds of iron such as ferrum 

 oxydatum, ferrum sulphuricum, ferrum citricum, ferrum carbonicum, ferrum 

 chloratum, and ferrum sesquichloratum, we possess countless newer prepara- 

 tions which contain iron in albumin combinations, and to these lately have 



