The relationship of chlorosis to anaemia is not exactly clear, but it has this in common with it - that the number of red corpuscles is diminished, and that those which are visible are mostly small, some are shrivelled and irregular, and all are pale-colored; the serum is in excess: in causation, also, it is allied, as it occurs often in young girls obliged to live in close, ill-ventilated rooms or workshops, and it has also, sometimes, seemed directly due to the hemorrhage of the first menstruation (Wade).

As an entirely primary disease it seldom occurs in any but unmarried women, and chiefly from thirteen to twenty-four years of age; if it occur later in life, it is usually traced to frequent confinements coming rapidly one after another, and especially if the women nurse their children. It is connected with deranged menstruation and certain sexual causes which we are at present unable to distinguish accurately: it occurs either before the menses have appeared, or after symptoms of disordered menstruation have continued for some months; dysmenorrhoea and leucorrhoea are fre-quent precursors of it. It is often hereditary; the children of tuberculous parents and delicate women with irritable nervous systems are the most susceptible to it: sometimes, in exceptional cases, menstruation is too frequent and profuse. The patient is subject to most of the symptoms already described under anaemia, especially dyspnoea, palpitation, headache, giddiness, and dyspepsia: the face is oedematous and pallid, with a greenish hue; the condition lasts longer than ordinary anaemia, and relapses are still more liable to occur.

The cure of this affection is often readily accomplished with suitable diet, pure air, exercise, healthy mental occupation, and a steady course of iron, which latter is almost a specific in all simple cases. It was formerly thought that the metal acted by supplying some deficiency in the blood, or at least by directly increasing the number of corpuscles. Behier considered that it was always indicated when he found, on microscopical examination, that the red globules were reduced to a proportion of 80 per 1,000, and to some extent this is a guide. General improvement will usually occur pari passu with an increase in their number toward the normal amount, but it must be understood that the action of iron is not simply a mechanical or chemical one. Claude Bernard has shown by analysis that the metal, as such, is not always deficient in amount in chloro-tic blood, and Hayem has shown that the number of corpuscles is not always diminished before, nor increased after the use of iron; on the other hand, the latter observer has clearly shown that the size, and color, and "vital character" of the corpuscles are remarkably improved by it. It acts, therefore, as a stimulus in some manner peculiar to itself, or, as others have expressed it, it has a "dynamic or vital influence" which chemistry alone will not explain (Trousseau, etc.; see also Physiological Action).

With regard to the preparation that is most suitable, we may refer to the observations of M. Coste. He made trial of different forms in 118 cases, fifty-five being of chlorosis, and he concluded that the choice of any particular one was not in itself important, if irritation of the stomach did not result - every preparation that did not irritate produced the good effects of iron; the reduced metal, taken at meal times in small quantities, proved on the whole the most satisfactory form, and the experiments of Quevenne, and the observations of Chomel, Trousseau, and others, are to the same effect. Sydenham obtained remarkable success with iron filings and iron wine, and, as a rule, we may say that the simpler the form used the better, and chemical theories as to solubility, etc., do not guide as to the therapeutical result. The ferrum redactum, the oxides and proto-salts, especially the carbonate, are certainly to be preferred in the earlier stages of chlorosis, unless the occurrence of mucous or other discharges indicate a necessity for astringents: sometimes the metal itself causes unpleasant eructation, and the oxides are liable to adulteration, and hence the recently precipitated carbonate, which is not astringent or irritant, is preferred by many, and in the form of mist. ferri comp., or Griffith's mixture, has had great repute in the treatment of anaemic amenorrhoea. The "Pilules de Blaud" contain carbonate of potash and sulphate of iron, and have for many years retained a high reputation in the treatment of chlorosis, especially on the Continent (Niemeyer): his original memoir, recording thirty successful cases, is republished by Bayle, and will repay perusal (Biblio. de Therapeutique Journal, iv., 1837). I have but little personal experience of the value of the hydrated oxide, or "dialysed iron," which seems pure and non-irritant; the doubts expressed about it seem to be mainly theoretical (Bouchardat: Bulletin, January, 1878; Medical Times, 1878; British Medical Journal, ii., 1878). I have had excellent results from a protochloride, and sometimes the citrate with ammonia will be borne better than any other. Dometz specially recommends an albuminate (see Preparations), and in the anaemia so common in Japan, and traceable to intestinal catarrh, found it better borne than any other form. I have seldom seen the astringent forms, when given in a right dose, and at a proper time, produce any injurious effect on a weak or irritable stomach; indeed, in many such cases I have found them particularly suitable, and we need not be deterred from their use by fear of irritating effects: astringent preparations, such as the perchloride and sulphate, should be used in cases of "menorrhagic chlorosis," for it is found practically better to treat the anaemia in such cases than to omit iron for fear of increasing hemorrhage (Trousseau). This applies especially to cases where the discharge is profuse and frequent, but pale and imperfectly coagulating; but, even when it is florid in character, iron may be ordered with advantage, if due attention be first given to such symptoms as hepatic congestion and constipation. Astringent preparations are also useful if there be a tendency to palpitation, general relaxation, or undue discharges of any kind, and also when impairment of nerve-power is a marked symptom. Aloes is often added to reduced iron or iron carbonate, in phlegmatic subjects, and sulphate of magnesia to medicines containing iron sulphate, especially if the patient be plethoric; sometimes small doses of belladonna will regulate the bowels, preventing constipation better than either of these aperients. In all cases, success will depend not upon giving a large quantity of the medicine, but upon securing its due assimilation; for this purpose, air and exercise are important, and fatty food certainly aids the digestion of iron (Nasse: British Medical Journal, ii., 1877). Jeannel found that an oleo-stearate of iron, prepared with the sulphate and white soap, was very well borne: nitro-hydrochloric acid baths also favor the absorption of iron (Chambers: Medical Times, i., 1862).

It is important in all cases to continue the remedy sufficiently long, and not to omit it on the first symptoms of improvement; permanent benefit can seldom be expected under five or six months.

In cases where iron had not been given properly, and when it afterward failed to produce due effect, I have found great advantage from arsenic alone, or in conjunction with iron. Manganese has also been recommended (Petrequin).