Chlorosis (from Gr. green), a disease characterized by pallor, with a greenish tint of the face. The disease has been called the "green sickness," and is known in past medical literature by a variety of synonymes. It affects chiefly girls at or near the period of puberty, and is generally connected with disorders of menstruation. This function in some cases is either arrested or performed insufficiently, and in some cases there is a marked loss of blood. Modern researches have shown that a constant and essential condition in cases of this disease is the morbid blood-change called anaemia, or impoverishment of the blood; the change consisting in a diminution of the red globules. Many of the symptoms in cases of chlorosis are doubtless attributable to this change in the blood; and some writers consider that the disease is, in fact, simply anaemia occurring especially in young girls, and often when the customary causes of impoverishment of the blood are wanting. The morbid complexion, which is more or less marked in different cases, is due chiefiv to anaemia. Other common symptoms are muscular debility, tendency to faintness or syncope, susceptibility to cold, impaired ability for mental effort, with depression and irritability of temper.
With these symptoms are often associated defective appetite, with sometimes a morbid craving for innutritions substances, such as chalk and slate; disturbance of digestion, manifested by a variety of symptoms; palpitation of the heart; pain in the side, especially the left side, attributable to intercostal neuralgia; neuralgic affections in other situations; consumption, leucorrhcea, and various other ailments. A constant sign, representing the blood-change, is the venous hum, called by French writers bruit de dialde (the word diable relating to the toy known as the humming top). This sign is a continuous humming sound, sometimes musical, heard through the stethoscope applied to the neck, especially on the right side, the head being turned as far as possible in a direction opposite to the side on which the stethoscope is applied, and the patient being either sitting or standing. The sound is caused by the movement of the current of blood in the veins of the neck. An abnormal sound, known as a bellows or blowing murmur, is usually heard when the stethoscope is applied over the aorta and pulmonary artery, just above the heart, also over the carotid and other arteries of considerable size.
These blood-murmurs are valuable to the physician as evidence of anaemia, and their disappearance serves to show that the anaemic con-' dition is removed. The causation of chlorosis is evidently connected with the evolution of the sexual system, but it is not easy in the existing state of our knowledge to give a pathological explanation of the connection. So far as the anaemic condition is concerned, in some cases this is produced and kept up by immoderate menstruation and insufficient alimentation. - In the medical treatment of chlorosis, the preparations of iron are especially to be relied upon. These are sometimes rapidly effective, but often to secure their full efficiency they must be continued for a long period. Tonic remedies to promote appetite and digestion are useful. Using proper reserve with reference to the risk of abuse, wine may be advised with advantage, and Burgundy wine is generally considered most appropriate. Malt liquors are sometimes taken with benefit. Hygienic measures, however, constitute an essential part of the treatment. These measures consist of out-of-door life, change of scene, mental recreation, and as nutritious alimentation as practicable. The affection is not in itself serious, nor does it involve a tendency to any grave disease.
Under judicious management the recovery of health may be confidently expected. - An essential element in chlorosis, as already stated, is anaemia, or impoverishment of the blood. The red globules, instead of being in the normal proportion of from 120 to 130 in 1,000 parts, may decrease to 70, GO, or even nearly to 20. The term anaemia is also employed to denote a deficiency of blood in any of the organs of the body; thus, cerebral anaemia means a deficiency of blood with-in the substance of the brain. In this sense of the term it is the opposite of hyperemia, or congestion. Ischaemia is a term lately introduced to express a local anaemia. Anaemia is of frequent occurrence, exclusive of cases of chlorosis, and much more frequent in women than in men. The relative proportion of the red globules to the other constituents of the blood in health is somewhat less in the former than in the latter; and besides there are several causes of anaemia peculiar to women, namely, child-bearing, lactation, and excessive menstruation. It is an effect of the loss of blood or haemorrhage in any situation, the explanation being that the red globules which are lost are not quickly renewed, their reproduction requiring more or less time.
A deficiency of alimentary supplies, inability of the stomach to retain food, and defective assimilation give rise to the anaemic condition; also profuse suppuration, or the formation of morbid products involving an undue expenditure of the blood constituents. Thus, anaemia is incident to such diseases as chronic pleurisy, albuminuria or Bright's disease, chronic dysentery, etc, which impoverish the blood. Again, certain diseases occasion anaemia by interfering with the production of red globules in modes not fully explicable with our present knowledge. Examples are the so-called malarial affections, lead poisoning, diphtheria, cirrhosis of the liver, etc. The effect of anaemia is to impair the functional ability of all the important organs of the body - in other words, to diminish vital power throughout the system. In the practice of medicine, it is very necessary to take cognizance of the anaemic condition as a pathological element which may either enter into, or be incidentally connected with, a great variety of diseases. The phenomena of anaemia are especially manifested in disorders of the nervous system.
Many of the affections of the nervous system which are distinguished as functional, belonging among the affections called the neuroses, are in a great measure caused and kept up by the anaemic condition; and the treatment of these affections, to be successful, must proceed from an appreciation of this connection. With reference to the treatment in cases of anaemia, it is of course of primary importance to determine its causes, and if possible to remove them. This is not practicable when the anaemia is incidental to such diseases as consumption, cancer, etc.; but it can be done when the anaemic condition depends on lactation, insufficient alimentation, and certain affections, as for example those due to malaria, which are under the control of medical art. Under all circumstances anaemia offers certain indications for remedies and other measures of treatment which relate directly to the impoverished state of the blood. These have been already stated in connection with chlorosis. If the condition has been produced by causes which are either temporary or removable, the success of treatment strikingly exemplifies the improvement in medical practice derived from the recently acquired knowledge of this morbid condition.