CHLOROSIS Chlorosis is an anaemia which attacks almost exclusively the female sex in the period of development and in the decade following; its origin may, however, frequently be traced to early childhood.
Nature and varying theories have been advanced on the nature and etiology of this affection. One mistaken idea was that it owed its existence to a disturbed resorption of iron (Zander), to an intoxication from the intestine (Duclos), perhaps in consequence of the usually prevailing constipation; Grawitz attributed the cause to a primary disturbance in the formation of lymph, rendering the blood watery and swelling up the red cells; von Noorden considered a distur bance of the inner secretions of the sexual organs the cause of the func tional weakness of the blood-making organs; Rosenbach and Meinert hold that the corset impedes respiration, displaces the abdominal or gans, and thus leads to nervous and functional disturbances. Virchow pointed to a constitutional cause. In individuals who have shown signs of chlorosis during life, he found hypoplasia of the vascular system (stenosis of the aorta, thinness of its walls, anomalies of the vessels). Even if all cases of chlorosis do not present these grave irreparable changes, the origin of the affection is nevertheless probably attributable to a constitutional weakness in the majority of cases. This view is sup ported by the distinct heredity of the affection. This weakness may lead to disturbed blood formation during the period of development, and then only in the female, such disturbance being characterized by the fact that the cells do not sufficiently assimilate the iron. The fact of its occurring principally in the female has its analogy in the occur rence of Basedow's disease at the same period. This fact also supports the opinion of von Noorden who looks upon the affection as a distur bance of the internal secretion of the sexual organs.
Its occurrence may be favored by all such factors as may be regarded as causes of secondary analnia: insufficient food supply, vitiated air of school rooms, and—in no small degree—the objectionable distribution of school time, excessive study, insufficient recreation and sleep; in older children mental excitement through homesickness, worry, anxiety, ambition and improper literature. Excessive masturbation is probably much more to be regarded as a sign of a debilitated constitution than as a cause of injurious effects.
Symptoms.—The blood changes in chlorosis are characterized by the fact that the ha'moglobin is disproportionately decreased to a much higher extent than the number of red blood corpuscles (Duncan). According to Graeber 7 cases out of 2S had more than 5,000,000 red cor puscles, 13 cases 4 to 5 millions. A reduction of the red corpuscles by one fifth corresponds to a sinking of the hemoglobin by one half. For this reason the red corpuscles look pale and arc of unequal size. In severe eases poikilocytes and normoblasts may finally make their ap pearance. The white blood corpuscles are, according to reliable authors, on the whole, normal, so far as their number and proportion are con cerned. The specific gravity sinks about in the same proportion as the percentage of It should he remarked, however, that the blood changes do not in all cases keep step with the clinical symptoms; sometimes it is a matter for surprise to find the palest complexion asso ciated with quite a sufficient percentage of haqiloglobin, or even no blood changes at all, in spite of pronounced clinical symptoms.
Nervous troubles are the dominating factor of the disease picture. In the foreground stands lassitude. In mental or bodily exertions there may be flickering before the eyes, paroxysms of vertigo and spells of fainting. The feebleness often stands in no proportion to the blood changes, sometimes it is only pronounced in the morning hours, while even greater exertions can be borne in the evening. Anomalies of disposition, inclination to ponder over things, sensitiveness, are of frequent occurrence. There may be pain in the epigastrium and in the sides probably owing to muscular weakness; palpitation of the heart occurs in paroxysms as in true tachycardia. Disturbances of the vascu lar innervation are also frequent, such as changes of the complexion, cyanotic extremities, continuous tormenting feeling of chills, tendency to chilblains in winter. Headache, too, which occurs partly as a contin uous dull pressure and partly as paroxysmal migraine, may to a certain extent be based on disturbances of vascular innervation. is frequently caused by visibly unskilful and far too flat respiration. Complaints about digestion, pains in the stomach, anorexia, constipa tion, always play an important. role; less frequent are peculiar cravings (pica) as for instance for eating chalk, coffee beans and soured food.