Green Sickness, or chlorosis, was a mysterious ailment predominantly recognized between the 17th and 19th centuries, almost exclusively affecting adolescent girls and young women. The name “chlorosis” derives from the Greek word chloros, meaning pale green or greenish-yellow, reflecting the unusual complexion of those afflicted. This historical malady was often misunderstood and intertwined with the social and moral expectations of the time.
The Historical Perception and Classic Symptoms
Historically, Green Sickness was frequently referred to as morbus virgineus, or the “disease of virgins,” highlighting its perceived connection to sexual maturation and unmarried status. Physicians often linked the ailment to melancholy, emotional distress, or thwarted romantic aspirations, reflecting a time when accurate physiological understanding was lacking.
The defining symptom was characteristic pallor, sometimes presenting as a subtle, sickly greenish-yellow tint to the skin. This unusual complexion was accompanied by profound physical complaints, including extreme fatigue and listlessness, even with minor exertion. Patients also exhibited shortness of breath and heart palpitations, even at rest. A particularly unusual symptom was pica, an intense craving for non-food items such as chalk, slate pencils, earth, or candle wax.
The Underlying Medical Reality: Chlorosis and Iron Deficiency
While its historical interpretation was often romanticized or moralized, the underlying medical reality of chlorosis is now understood as a case of severe microcytic, hypochromic anemia. This condition arises from a significant deficiency of iron, which is necessary to form hemoglobin, the protein in red blood cells responsible for transporting oxygen throughout the body. When iron levels are too low, the red blood cells produced are smaller (microcytic) and paler (hypochromic), reducing the blood’s capacity to carry oxygen.
The resulting lack of sufficient oxygen delivery to tissues explains the classic symptoms of fatigue, listlessness, and shortness of breath. The pale or greenish skin tone was simply a visual effect of the reduced amount of oxygen-rich hemoglobin circulating near the skin’s surface. The unusual craving of pica is also recognized as a common symptom of severe iron-deficiency anemia.
The condition disproportionately affected young women due to several overlapping physiological and social factors. Rapid growth during adolescence increases the body’s iron requirements substantially, and the onset of menstruation introduces monthly blood loss, which further depletes iron stores. Additionally, the diets of young women, particularly in the 19th century, were often restrictive due to poverty, working-class demands, or aesthetic standards that favored a pale appearance. Green Sickness largely faded from medical literature in the 1920s and 1930s, primarily because of improved nutrition and a greater availability of iron-rich foods in the general population.
Traditional Treatments and Modern Management
Historically, treatments for Green Sickness were varied, sometimes reflecting the psychological theories of the time. Because the condition was often perceived as a result of emotional blockage, one common, unscientific remedy suggested was marriage, believed to correct emotional or reproductive “stagnation.” Less effective interventions included purges or bloodletting, which actually worsened the patient’s anemic state.
Some traditional remedies were accidentally effective because they contained the necessary mineral. As early as the 17th century, physicians like Thomas Sydenham prescribed “ferruginous preparations,” or iron-containing compounds. These remedies included “chalybeate” waters from natural springs rich in dissolved iron salts, and various iron filings mixed with wine or other liquids.
Modern management of the condition, now recognized as iron-deficiency anemia, is highly targeted and effective. The primary treatment involves the administration of oral iron supplements, such as ferrous sulfate, which efficiently replenishes the body’s iron stores. This is combined with dietary counseling to encourage the consumption of iron-rich foods and Vitamin C, which aids in iron absorption. The shift in therapeutic approach reflects the triumph of physiological understanding over historical misinterpretation.