On the other hand, I have now notes of a series of cases

(14) which I have had under care for chlorosis. They were
apparently cured or relieved, or for some reason they ceased
for a time to attend the hospital for treatment. After a lapse
of time, varying from three months to a year, they all on
their reappearance presented not only symptoms of chlorosis,
but in addition the diagnostic symptoms (including haemate-
mesis and melaena) of gastric ulcer, and required active
treatment for this latter condition.
To me, therefore, it would appear that we must come to
one of two conclusions, viz., either that there is a pre-ulcera-
tive stage in the disease known as gastric ulcer, when all the
symptoms of chlorosis are present ; or, that cases of chlorosis
which are allowed to become chronic, terminate in a climax
which is gastric ulcer. Nor is the evidence in favour of my
contention confined to the symptomatology and pathology of
the two conditions.
We have confirmation in the results of our treatment. Let
us take chlorosis first. I take it that no physician with large
practice begins to treat chlorosis with iron preparations,
right away. If he does, my experience tells me that his
treatment will not be successful, even though the ferruginous
medicine be continued for many weeks.
