Venous hums disappear after bleeding cases of chlorosis; hence the cause of these is a plethora, due to hypoplastic blood-vessels. Schubert (Wiener med. Woch., Nay 2, '91).
Careful examination of the heart in 22 eases of chlorosis gives the following conclusions: In 22 cases of chlorosis, in which no other cause for an alteration of the heart was present, 20 showed an en largement of the relative heart-dullness, which in a few eases was very marked. This increase should be due only to an increase in the size of the heart. The symptoms during and after the chlorosis allow us to assume that the heart was dilated and hypertrophied. In some cases the enlargement subsided after the symptoms of chlorosis ceased; more fre quently the heart remained enlarged for some time after, and sloNvly attained normal size. The causes of the dilatation and hypertrophy culminate in those of the chlorosis itself. in chlorosis there is a diminution of the functional power of the heart; the normal circulation offers such a, heart unusual difficulty, and in consequence it becomes dilated and hypertrophied. In chlorosis there is a convincing example of a transitory hypertrophy. The pathogenesis of the cardiac hypertrophy in chlorosis indicates the importance of congenital or acquired power in the development of any hyper trophy of the heart. Gautier (Deutsches Archly f. klin. Med., B. 62, H. 1 and 2, '99).
The most striking symptom is the sallow hue of the skin and pale, almost white, color of lips and palpebral con junctiva. This pallid complexion dif fers from that of the so-called wasting diseases, ,such as cancer and plithisis, in not being attended with emaciation. In fact, the adipose tissue is not only re tained, but persons affected with chlo rosis are apt to put on flesh, or, rather, fat. This is explained by the fact that, owing to the greatly reduced amount of hmmoglobin, the processes of oxidation in the body are carried on very feebly.
The other principal symptoms of chlo rosis are lassitude and indisposition to exertion, loss of appetite, and other di gestive disturbances, and constipation.
The dyspepsia of chlorosis due, as Hayein first pointed out, to lack of hy drochloric acid. Liegeois (Revue INIed. de l'Est, Sept. 15, '91); Labat (Gaz. de Dec. 30, '90); ChCbron (L'Union 316(1., Dec. 9, '90).
Dyspepsia in chlorosis. Seventy eases of chlorosis examined; an excess of pep sin found in 36, a decrease in 2S; an excess of hydrochloric acid in 6, and normal gastric juice in 2. In boys and girls at the age of adolescence there is commonly some dyspepsia from "hyper pepsia," and the advent of chlorosis makes this prominent. Hayem (La Sem. .11CA., Nov. 4, '91).
Examinations of the gastric juice of chlorotic patients. Conclusions: 1. The amount of HCI in the gastric juice is not diminished in cases of chlorosis; on the contrary, there is a state of hyperacidity in 95 per cent. of the cases. 2. The dys peptic disorders of chlorosis are neither due to a deficiency of HCI nor to motor insufficiency of the stomach. 3. The in discriminate employment of hydrochloric acid in eases of chlorosis is to be con demned. 4. The theories which refer either the origin of ehlorosis or its chronic character to a state of gastric subacidity al e untenable. K. Osswald (Minch. med. Woch., .1nly 3, 10, '94).
Among the ehloroses due to autointoxi cation is one which clinical and thera pentical observation explains as a thy roid autointoxieation. Clinically it is characterized by the usual symptoms of chlorosis, to which are added cedema similar to that of myxcederna, hyper trophy of the thyroid gland, and the signs of a commencing exoplithalmic goitre. Therapeutically this chlorosis disappears under treatment by iodothy rin. The iodothyrin was administered in tablets of 4 grains each, of which from three to five were taken per day, the amount being gradually increased for a considerable period, and then decreased. Jenlain (Med. News, Apr. S, '99).
Nervous symptoms, such as hyper cesthesia, neuralgia, and hysteria are not uncommon. The urine is pale, of low specific gravity, and deficient in urea.