CHLOROSIS (Gr. , green), is a diseased condition which first manifests itself almost exclusively in females at the time of puberty or in the early years after its establish ment. If it occurs later it is probably the re currence of an earlier attack. The manifest symptoms are a characteristic pallor which often shows a greenish-yellow tint and gives the disease its name, chlorosis or °green-sick ness"; lassitude, tendency to fatigue, to head ache and vertigo; loss of appetite and anoma lies of appetite, digestive disturbance; some times dilatation of the heart and anemic heart murmurs; dyspncea; slight rise in temperature; disturbance of the menstrual function and other hysterical manifestations. The red cor puscles of the blood are but slightly reduced but there is insufficiency of hemoglobin. There is evidence to show that the haemoglobin is not reduced but diluted by the marked increase in blood plasma.
The disease has come to be recognized as due to a disturbance of the secretory function of the sexual glands. As such it is variously explained. It has been thought that there is a deficiency of the hormone substances secreted by the ovary into the general circulation and therefore an interference with blood formation and likewise with the formation of the bone marrow. But the alteration of the blood is not always present in chlorosis nor is there evi dence of insufficiency of the bone marrow. These features separate chlorosis from anemia as does also its different response to iron. An other theory is that of intoxication produced in the blood through disturbance of the ova rian activity. When ovulation first takes place at puberty and at each subsequent menstruation there is a new formation of interstitial cells in the ovarian (Graafian) follicles and an ac cumulation of hpoids produced by these cells, upon which sexual characteristics depend. Anything which disturbs the normal relativity between the number of lipoids produced and the number utilized in the process of matura tion produces an increase of these in the ovary and in the blood, with resulting intoxication of the organism. This produces the symptoms of
chlorosis, the insufficiency of hemoglobin, car diac, vasomotor, respiratory and other disturb ances already noted. The follicular disturbance affects directly the menstrual function, causing amennorhea, and the uterine issue. The action of iron has been found to be inhibitory to the ovarian lipoid secretion, hence its value, accord ing to this theory of chlorosis, in this disease.
The presence frequently of hysterical symp toms as well as response to certain environ mental elements in treatment point to a psychi cal etiology also for chlorosis. That portion of the nervous system which controls the activity of the endocrinous glands (glands of inner secretion) is no less than the voluntary nervous centres at the service of the psychical attempt to adapt to environment the attitude of the patient toward the world. The disease occurs at the period when psychical and physi cal activity are stimulated to new adjustments which are made often with much difficulty. Stimulation and inhibition of psychical im pulses are not well adjusted. The chlorosis, therefore, is one mode of expression of in ability to adapt individual wishes to the de mands of development in the social environ ment, which at this period of stress comes to definite expression and may manifest itself again at further strenuous periods. Psy chotherapy should therefore also be con sidered in treatment. Consult Falta, The Ductless Glandular Diseases); Pende, 'Endo crinologia) ;Jelliffe and White, 'Diseases of the Nervous System' (2 vols., ed. 1917),