CHLOROSIS. — From Gr., x2.(..)po; greenish yellow.
Definition.—An affection of the blood characterized mainly by a reduction of the percentage of hEemoglobin and a greenish hue of the skin.
By a slight stretch of the imagination the skin of a person of dark complexion suffering from clalorosis might be called greenish yellow; but chlorosis is very common in Sweden, where the inhabi tants are, as a rule, of a very fair com plexion; so that the very name of the disease is, to a certain extent, a mis nomer. It has, however, the sanction of ancient usages, and it would be hard to find another to which greater objections could not be raised.
Symptoms.—In investigating the clin ical history of a disease which is practi cally confined to the female sex our first inquiries are naturally directed to the organs of reproduction. We find that chlorosis makes its appearance at or about the time of establishment of men struation, and the behavior of this func tion in cases of the disease in question is twofold: It may be either premature or long delayed. Niemeyer states that he has never known the menses to ap pear between twelve and thirteen years of age in a girl with undeveloped breasts without the supervention of chlorosis. A premature appearance of the menses is, therefore, one of the important events in the clinical history of chlorosis. In such cases, menstruation may appear but once, the discharge being followed by amenorrhcea and chlorosis. In the other class of cases the menses do not appear at the usual time; the breasts and uterus remain undeveloped, while, at the same time, a decided degree of chlorosis makes its appearance. The exact relation be tween the amenorrhcea and the blood change is not understood, although it is probable that, in cases of amenorrhcea with a properly-developed genital sys tem, the suppression of menstruation is secondary to the blood-change, whereas in those cases with an undeveloped state of the uterus and its appendages the re lation is not so clear. The other toms of chlorosis are secondary to the blood-change and include the various manifestations of ancemia in general.
Analysis of 232 cases, showing that im perfect evolution of menstruation, as evi denced by scantiness of the flow and ir regularity of the periods, is as regular a feature of chlorosis as the imperfect evo lution of the red corpuscles of the blood.
These constants were not related to each other as cause and effect, but were inde pendent one of the other. the same time there is a close relationship between them, whereby the reproduction and de velopment of the red corpuscles of the blood are governed by, or formed part of, the menstrual cycle; and both are influenced by a greater rhythmic action which determined the time and activity of development, growth, and reproduc tion. W. Stephenson (Brit. "..1.ied. Jour., Mar. 16, '89).
Tt is in this disease that the inorganic cardiac murmurs are so frequently heard, especially over the base of the heart, i.e., over the points of the origin of the aorta and pulmonary artery.
In 205 cases, 11.5 had cardiac bruits. Of these, 56 were audible at the base, 13 at the apex, 24 at base and apex, and 22 at base, apex, and back. The last group were always accompanied by distinct dilatation of the ventricle and strong im pulse; they were the first to disappear under treatment: a fact WI1101 show.s that they are present in the more ad vanced cases. In 2 of the 22 cases the murmur persisted after seven and nine months, respectively. These remain as permanent mitral regurgitations. Barr (Amer. Jour. Med. Sciences. Oct.. '91).
Many of the bruits supposed to be in tracardiao really due to the action of the heart against the hings. Potain (L'Union .M(81., Dec. 23. 30, '90).
The bruit dr dirtble and venous limns eldorosis. The former occurred in 51.4 per cent. of personal cases: a proportion which is low, inasmuch as the litemo globinorneter, which detects the disease in the absence of pallor and other visible signs. Wf1.9 11SNI. As to venons hums, none found in 49.4 per cent. of 180 cases; on the right side only in 33.3; on the left side in 9.1, and on both sides in 11.1 per cent. Of 27 eases in which relapses occurred, 66 per cent. have venous hums: a fact which may prove of some use in prognosis. The bruits usually disap peared when the hasuoglobin showed some increase. Richardson (Lancet, June 27, '91).