Examination of t.be eyes of a ease of chlorosis. while the blood showed that the red corpuscles were as low as 300,000, the whites 2500, and the haemoglobin re duced to 24 per cent., nucleated red rorpuseles being present. The pupils were of the same size. The irides re sponded equally to light-stimulus. There was a marked tremor of the orbicularis musele of the right eye. The fields of vision. a.s well as could be taken, were redueed concentricall.s% The eye-grounds were about the same on each side. There WILS a disposition to laemorrhages into the retina that were characteristic of both the Quincke and the Horner types. The disc was pallid. The retina was somewhat (edematous in the 7111.0-111aC11 reg,ion. The larger hremorrhages. \Odell. as a rule, were deeply seated be neath the fibre-layer of the retina, pre sented both white and grayish centres. and, as slimvn the figure, one envel oped a portion of the lower temporal vein. :More careful study made it ap parent that a few of the white areas in the hremorrhages were dne to leneo cytie aggregation, though the bulk of them were dependent upon tissue-de generation. (See rolored plate, Pig. II.) Charles A. Oliver (Trans. Amer. Ophth. Soc., '97).
Etiology.—Th e chief predisposing causes of chlorosis are to be found in sex, age, and constitution. The forces emanating from these sources come to a focus, so to speak, in a case of chlorosis and that which brings them to a focus in the advent of puberty. The principal of these predisposing causes is, I be lieve, a congenital tendency to anmmia. Some years ago, while examining the blood of the new-born at the Maternity Hospital, I discovered an infant whose red blood-corpuscles numbered only 3,625,000 per cubic millimetre, the nor mal average being at least 5;000,000. Now, this child which, by the way, was a female, might, under proper treatment, thrive until the age of puberty, when the demands made upon the blood by the evolution of the sexual system would, in all probability, give rise to well-marked chlorosis. The chief predisposing causes of chlorosis are, I repeat (1) sex, the vast majority of cases occurring in females; (2) age, the decade between fourteen and twenty-four furnishing most of the cases; (3) constitution, either inherited or acquired.
True elllorosis. when not traceable to external injury or to a primary disease, is a disorder of development, like any other sue]: disorder or sign of physical degeneracy. It is very frequently asso elated with infantile types of structure in the adult patient, especially ill-devel oped pelvis, labia, uterns. pudendal hair, and breasts. Stieda (Zeit. f. Gebiirtsh. it. Glyniik., I1. 32, II. 1, '05).
Chlorosis is the result. not the cause, of amenorrha,e: a menstrual autointoxi eation. Immediately before the period the toxieity of the serum is at a maxi mum. Wet-uurses who menstruate dur ing lactation apt, during the days preceding the show of blood, to cause their sucklings to sufTer from diarrlicea and cutaneous eruptions. Such women themselves often have herpes and fever. Menstruation is a, true excretory process: a purging of waste-products. Charrin
(NU41..Mod., ;fan. 11, '96).
Chlorosis looked upon as the symptom of a general neurosis, in which many other symptoms arise through the anmnie blood. Altered composition of the blood ascribed to a morbid function of the vasomotor nerves, which gives rise to polyplasmia, lymph-congestion, and im perfect development of red blood-cor puscles. That ehlorosis is essentially a disease of puberty may be explained by the fact that, at the time of development of the female sexual organs, the vaso motor nerves are especially disposed to disease, just as, in still earlier periods, the motor functions are prone to affec tion, as in chorea. E. Grawitz (Fort schritte der Med., Berlin, No. 3, '98).
The family history of 36 cases of chlo rosis studied during the last five years to ascertain the connection between chlorosis and tuberculosis. In 1800 Jolly concluded from an examination of 54 cases that in the majority of in s7tances a personal or family history of scrofula or tuberculosis was to be found. Tbe 36 cases now recorded, however, show that tuberculosis has not any more influence in the causation of chlo ro.sis than have other pathological states. The influence of hereditary tu berculosis is only exerted by enfeebling the stock. Leclerc and Levet (Lyon Me'd., Aug. 4, 1901).
—The exciting causes of chlorosis are those of amemia in general, such as insufficient food, light, air, and exercise; overwork, either phys ical or mental; anxiety, grief, and nerv ous excitement in general. There is another exciting cause on which great stress was laid by the late Sir Andrew Clark and which, therefore, deserves to be considered at some length. The cause to which I refer is constipation, and Clark regarded it of such paramount tance that he used the term fiEcal anwmia as a synonym of chlorosis. This theory of Clark is based upon certain signs and symptoms that are commonly encount ered in chorosis. Chief among them are digestive disturbances. The tongue is generally heavily coated at the base, large, flabby, and with its sides indented with the teeth. The breath is disagree able and sometimes, according to Clark, has a distinctly fiecal odor. The bowels are either confined or inadequately re lieved, and the ft-eces consist of scybalous masses imbedded in mucus swarming with bacteria. Pain in the side, most marked on the left, is a common symp tom, and is believed by Clark to have its seat either in the hepatic or splenic flexure of the colon. This view of the nature of the pain in the side is corrob orated by the fact that it may be relieved bylarge enemata of warm water. Accord ing to the authority just named, it is a common thing for young girls to neglect the calls of nature, so far as the bowels are concerned. The kuces accumulate, and, by their decomposition, ptomaines and leucomaines are generated, absorbed, and, by their poisonous action, produce the multiform symptoms of chlorosis. A treatment based upon the theory that chlorosis is due to fiecal retention is sometimes eminently successful, and will be referred to later in detail.