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is so frequently associated with anæmic conditions that Biernacki has argued that such conditions really constitute the primary and fundamental cause of hysteria (Neurologisches Centralblatt, March, 1898). And, centuries before Biernacki, Sydenham had stated his belief that poverty of the blood is the chief cause of hysteria.

      It would be some confirmation of this position if we could believe that chlorosis, like hysteria, is in some degree a congenital condition. This was the view of Virchow, who regarded chlorosis as essentially dependent on a congenital hyoplasia of the arterial system. Stieda, on the basis of an elaborate study of twenty-three cases, has endeavored to prove that chlorosis is due to a congenital defect of development (Zeitschrift für Geburtshülfe und Gynäkologie, vol. xxxii, Part I, 1895). His facts tend to prove that in chlorosis there are signs of general ill-development, and that, in particular, there is imperfect development of the breasts and sexual organs, with a tendency to contracted pelvis. Charrin, again, regards utero-ovarian inadequacy as at least one of the factors of chlorosis. Chlorosis, in its extreme form, may thus be regarded as a disorder of development, a sign of physical degeneracy. Even if not strictly a cause, a congenital condition may, as Stockman believes (British Medical Journal, December 14, 1895), be a predisposing influence.

      However it may be in extreme cases, there is very considerable evidence to indicate that the ordinary anæmia of young women may be due to a storing up of iron in the system, and is so far normal, being a preparation for the function of reproduction. Some observations of Bunge's seem to throw much light on the real cause of what may be termed physiological chlorosis. He found by a series of experiments on animals of different ages that young animals contain a much greater amount of iron in their tissues than adult animals; that, for instance, the body of a rabbit an hour after birth contains more than four times as much iron as that of a rabbit two and a half months old. It thus appears probable that at the period of puberty, and later, there is a storage of iron in the system preparatory to the exercise of the maternal functions. It is precisely between the ages of fifteen and twenty-three, as Stockman found by an analysis of his own cases (British Medical Journal, December 14, 1895), that the majority of cases occur; there was, indeed, he found, no case in which the first onset was later than the age of twenty-three. A similar result is revealed by the charts of Lloyd Jones, which cover a vastly greater number of cases.

      We owe to Lloyd Jones an important contribution to the knowledge of chlorosis in its physiological or normal relationships. He has shown that chlorosis is but the exaggeration of a condition that is normal at puberty (and, in many women, at each menstrual period), and which, there is good reason to believe, even has a favorable influence on fertility. He found that light-complexioned persons are more fertile than the dark-complexioned, and that at the same time the blood of the latter is of less specific gravity, containing less hæmoglobin. Lloyd Jones also reached the generalization that girls who have had chlorosis are often remarkably pretty, so that the tendency to chlorosis is associated with all the sexual and reproductive aptitudes that make a woman attractive to a man. His conclusion is that the normal condition of which chlorosis is the extreme and pathological condition, is a preparation for motherhood (E. Lloyd Jones, "Chlorosis: The Special Anæmia of Young Women," 1897; also numerous reports to the British Medical Association, published in the British Medical Journal. There was an interesting discussion of the theories of chlorosis at the Moscow International Medical Congress, in 1898; see proceedings of the congress, volume in, section v, pp. 224 et seq.).

      We may thus, perhaps, understand why it is that hysteria and anæmia are often combined, and why they are both most frequently found in adolescent young women who have yet had no sexual experiences. Chlorosis is a physical phenomenon; hysteria, largely a psychic phenomenon; yet, both alike may, to some extent at least, be regarded as sexual aptitude showing itself in extreme and pathological forms.

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