Three cases of chlorosis charaeterized by the precence in the mine of a pe culiar "ehromop-en--a colorless sub stance which becomes converted into a pigment of oxidation. It is manifested by the urine becoming- a rose-red color on the addition of nitrous-nitrie acid; i.e.. pure nitric acid to which a small quantity of the common yellow acid of commerce been added. Chromogen is a derivative of skatol, and. therefore. derived from ffecal absorption. In all cases there was marked constipation. tbe relief of which by large enemata consti tuted the ba-is of his treatment. Res toration to health coincided with disap pearance of the urinary chromogem George Herschell (Practitioner, May, '93).
Chlorosis is of intestinal origin. Dim inution of urobilin in the urine an huportant sign. A toxic body found in the urine, -the exact nature of which it has been as yet impossible to determine," but which is believed to be largely ac countable for the nervous phenomena of ehlorosis. F. Forchheimer (Therap. Gaz., Nov. 13, '93).
Another exciting cause of chlorosis is cold. Prof. Augusto Murri, of Bologna, has published an elaborate paper on the influence of cold in the etiology of chlo rosis. He gives the notes of three cases, in which the symptoms of the disease were limited to the cold months of the year, disappearing in summer and re curring at the onset of the succeeding winter, and he states that others pre cisely similar have come under his ob servation. He, therefore, styles them "winter chlorosis," or chlorosis It is well known that chlorotic patients are often affected unfavorably by such exposure to cold as is well borne by the healthy, and this Murri believes to be due to an instability of the vasomotor system on the part of the former. In fact, he regards chlorosis as a vasomotor neurosis, the blood-changres in the dis ease being induced by cold, nervous shock, or long-continued irritation from the genital organs or elsewhere.
Meinert, of Dresden, claims to have demonstrated a displacement of the stomach (gastroptosis) in sixty consec utive cases of chlorosis. Fifteen per cent. of the cases were complicated with right movable kidney and in one case both kidneys were movable. The gas troptosis is secondary to enteroptosis and this, in turn, to the pressure of the corset; so that, according to Meinert, it is to this article of female apparel that chlorosis is due. After the cure of a case of chlorosis, its anatomical sub stratum, the visceral displacement, re mains, and hence the notorious tendency of the affection to relapse.
No one doubts the evil effect of tight lacing, and all will admit that in a per son predisposed by inheritance or wise to chlorosis the development of the disease may be accelerated by tion of the thoracic base and consequent displacement of viscera.
Chlurotic subjects often present a high position of the diaphragm. The liver dullness begins at the upper edge of the fourth or the lower edge of the third rib. The heart-dullness is sometimes found to extend either to the right or to the left. This enlargement of the area of the heart dullness is probably due ill but a, few eases to dilatation. Frequently it is of a certainty due to the elevated position of the diaphragm, in consequence of the diminished volume of the lungs. F. Miiller (Berl. klin. Woch., Sept. 23, '93).
In a series of 29 eases dilatation of stomach without retention found in 8 eases; dilatation of stomach with re tention found in 6 cases; flatulent dys pepsia in 14 cases. Chlorotie patients are more concerned with the pale color, breathlessness, swelling of the feet, and palpitation than with gastric disturb ances. In 17 eases, however, dyspepsia preceded the ehlorosis; in 2 eases both appeared simultaneously. and in the re mainder the relation could not be deter mined. Mongour (Archives Clin. de Bordeaux, Nov., '96).
As to Meinert's contention that chlo rosis is produced by the gastroptosis brought about by the pressure of tbe corset: It may be possible to define the outline of the stomach in eases of con siderable gastroptosis where the upper curvature lies below the liver and. the abdominal walls are lax; but in young subjeets. such as chlorotie girls. the chlo rotie walls are not lax. In a large num ber of chloroties, who wore corsets, to map out the lesser curvature of the stomach was found impossible. It is usual. however, in such cases to find the greater curvature extending lower down than usual; this is possibly due to an abnormal distensibility of the stomach: a condition occurring as a result of chlo rosis. Leo (Dent. med. Woch., Mar. 19, '96).
There are those who regard chlorosis as an infectious disease. Chief among them is Clement, of the Hotel-Dieu, Paris, who bases his opinion of its in fectious nature on the enlargement of the spleen, which he has found in thir teen cases; on the frequency of fever, the occasional complication of phleg masia dolens, and the epidemic rence of the affection. The hypothesis is well argued, but the facts upon which it is based are questionable.