(GREEN SICKNESS)
An anemia characterized by great reduction in the amount of hemoglobin.
It most frequently occurs in adolescent girls. It seems to be
associated with neurotic manifestations and menstrual irregularities.
=Etiology.=—Its cause is not well understood. Poor hygienic conditions
may be a factor, but it is a condition found in all stations of
life. The age and sex have led to investigation as to probability of
lack of an ovarian internal secretion. The reports of workers are
contradictory. The name of the condition is derived from the color of
the skin, which usually ranges from a pale greenish tint to a slight
pallor. Occasionally there is localized vasodilation of the cheeks
giving brilliant color. Constipation accompanied by copremia seems to
be either a causative factor or result. In many cases it appears to act
in the dual role. Fixation of the middle and lower ribs accompanied by
osteopathic lesions from the mid to the lower dorsal spine seem to be
constant findings. The costal fixation leads to lessened respiratory
excursion and resulting diminished oxygenation.
=Diagnosis.=—Chlorosis may be suspected from the color of the skin,
perverted appetite, wandering neuralgias, heart palpitation, edematous
infiltration, and shallow type respiration, but the diagnosis is not to
be made without the aid of the blood count. The striking part of the
blood picture is the great reduction in amount of hemoglobin carried by
each erythrocyte. There is usually some reduction in the erythrocyte
percentage but not in proportion to the decrease in color index.
There are usually many pessary-shaped and shadow erythrocytes. These
are of all sizes, but seldom is the condition of such gravity as to
cause more than an occasional nucleated red cell, and when found
are most likely to be normoblasts. The staining reaction is of wide
limits. Cells of all degrees of relative alkalinity are found and often
there is a wide variation of staining reaction in the same cell. The
number of erythrocytes is usually slightly decreased but not in the
proportion that the hemoglobin percentage is, so that the color index
is therefore strikingly low. Probably, the average color index for a
typical case of chlorosis is 50, with an erythrocyte count of 4,000,000
and a hemoglobin of 40 per cent (Dare.) This drop in color index in
chlorosis is far out of proportion to the clinical symptoms which would
be expected from a similar reduction resulting from the ordinary causes
of secondary anemia. The blood plasma is increased and the specific
gravity is lowered, sometimes reduced from 1.055 to about 1.030.
=Treatment.=—The treatment of any malady in which the etiology may
be apparently of widely different natures will naturally rationally
vary with the apparent cause. If there is copremia, which seems to be
a definite causative factor, this should be at once corrected. These
patients form the cathartic habit readily, so physical and dietary
methods of returning the digestive motility to normal should logically
be given first trial. If it is a matter of lessened metabolism as
a result of insufficient exercise, or blood oxygenation, outdoor
gymnastics and breathing exercises may incite the stimulus to normal
erythrocyte hemoglobinization. The diet should be of such nature as
to furnish material both for erythrocyte formation and iron in form
for ready absorption by them. The organic iron compounds of animal
hemoglobin and vegetable chlorophyl are our most common and cheapest as
well as most effective sources.
The medical treatment of chlorosis is based on the empiric use of
inorganic iron. “The exact method in which iron exerts a favorable
influence upon chlorosis still remains unsettled. It is difficult to
understand why iron salts in the food which are sufficient for all
ordinary needs, are insufficient in chlorosis. It seems most probable
that iron cures chlorosis by acting as a stimulant to the =blood
forming organs=” (Beifeld, The Basis of Symptoms.)
Clinically, osteopaths are daily obtaining rationally the necessary
stimulus to the blood forming organs by removing all impedance from
these organs caused by vertebral and costal lesions and by obtaining
better digestive and respiratory hygiene.
=Prognosis.=—Recovery is to be expected and its rate will depend upon
the thoroughness of the osteopathic work and the patient’s ability to
respond to the stimulus. The blood may show chlorotic relapses with
concomitant symptoms if in later life secondary anemia develops from
hemorrhage, hook-worm infection, or other causes.