Blood of ehlorotic patients examined for micro-organisms, and in ten or twelve cases either the streptococcus albus or the staphylococcus albus found. the former being the more abundant, and— in rarer instances—the bacillus coli. Lemoine (Le Progres Nov. 17, '94).
Thrombi may form in the cerebral sinuses and cervical veins, though usu ally they occur in the femoral vein. They necesarily cause death ; the two recorded instances of thrombi in the jugular vein ended in recovery. Infection the cause. Bonrdillon (Jour. de MM. et de Chin Prat., Sept. 10, '92).
Enlargement of the spleen observed in twenty-one out of fifty-six cases of chlo rosis. Inasmuch as a "ffetal state" of the spleen, marrow, and other luemato poietic organs has been described as char acteristic of chlorosis, this observation is interesting. F. Chvostek ( (Allgemeine med. Central-Zeitung. July 22, '92).
Study of thirty-one cases: Chlorosis is, in the great majority of eases, the re sult of malnutrition, dependent upon the consmnption of an insufficient amount or of an unsuitable quality of proteid; in most cases a great diminution of the nitrogenous excreta of the urine found, While a common symptom of clilorosis is a perversion of the appetite to the excessive consumption of starches and sugars. The siiperiority of such prepara tions as ferra tin over the inorganic forms of iron slig.gests that there is value in he proteid material which they contmin.
Simon (Amer. Jour. of Med. Sciences, Apr., '97).
Chlorosis is due to a transient inca pacity of the blood-forming organs oc curring during puberty, or to an hypo plasia of those organs, manifesting itself more or less throughout life, and occa sionally resulting in the hypoplasia of the vessels described by Virchow. This weakness of the blood-forming apparatus . manifests itself in the production of less valuable erythrocytes, deficient in limo globin and altered in form. Hofmann (Miinehener med. Woch., July 1S, '99).
Prognosis.—The prognosis of uncom plicated chlorosis is invariably good, the response to appropriate treatment being prompt and decided. It should be borne in mind, however, that inter current disease of any kind is apt to be unusually severe. This is especially
true with reference to febrile disorders, which occasion great and rapid consump tion of the blood-corpuscles in healthy persons. As a matter of course, the powers of resistance to such affections are much reduced in those whose blood is already impoverished. In forming a prognosis the tendency of the disease to relapse should not be forgotten. This is especially marked in those cases in which the development of the vascular and re productive systems is imperfect; in other words, in those in whom the tendency to anmmia is congenital. Predictions of permanent cure after a single course of treatment should, therefore, be made with great reserve or, better still, should not be made at all.
Pathology.—Virchow endeavored to place chlorosis upon a distinct anatomi cal basis by the demonstration that, in fatal cases, there is often found an im perfect development of the aorta and arterial system generally. He has found the aorta of a full-grown woman so small as barely to admit the little finger, whereas, normally, it should admit the thumb, and, with this condition of the lumen of the vessel, its coats were found to be much thinner than normal. Ile regards this condition of the vessels as congenital, and the importance of the observation depends upon the fact that the blood-vessels and the blood-cor puscles are both derived from the same embryonic layer,—the mesoblast,—an imperfect development of the one nec essarily entailing the same condition of the other. There is little doubt that Virchow's observation is true with ref erence to some of the cases, especially those that run a fatal course. A con dition of imperfect development of the vascular system might, doubtless, give rise to grave disturbances of nutrition eventually ending in death; but alio rosis is not a fatal disease, the great ma jority of cases under appropriate treat ment terminating in recovery, and with reference to them there is no proof that such a stunted condition of the blood vessels is present.