Green Sickness: A Historical Look at the 'Disease of Virgins'

Imagine that it’s 1554, and you’re the father of a young girl who is unwell. You write to a friend of yours, who is a physician, describing her symptoms, which include her being ‘pale, as if bloodless’. And this is the reply you get:

You complain bitterly to me […] that your firstborn daughter Anna, who is now of marriageable age, is desired in marriage by many suitors of unblemished virtue […]. Yet, because of the infirmity of your daughter, you are forced to refuse them. But this is less worrying for you than the fact that, until now, not one of the doctors has been able to explain the internal cause and essence of the disease, or indeed to prescribe treatment. […] I am quite astounded that your family doctors did not recognise the cause and nature of the disease. […] This disease does not have its own name, but as it is peculiar to virgins it may be designated ‘the disease of virgins’ […]. This disease often attacks virgins when, already ripe for a man, they have left behind their youth. […] Finally, as to whether your daughter who is sick with this disease ought to marry, and what the treatment for it should be…

The doctor continues, writing that the ancient Greek physician Hippocrates suggests that

virgins suffering from this disease [should] live with men as soon as possible, and have intercourse. If they conceive, they recover. […] I have never been mistaken in treatment, or been disappointed in my hopes. So, therefore, take courage, betroth your daughter. I myself will gladly be present at the wedding. Farewell.

— Johannes Lange, Medicinalium epistolarum miscellanea (1554), pp. 74-77.

So… the solution for this condition is sex, within a heterosexual marriage and, ideally, motherhood. Huh. Let’s talk about green sickness, or the ‘disease of virgins’.

I first came across recipes to treat green sickness years ago, and I always found it to be one of the most intriguing ‘diseases’ in the history of medicine. It tells us much about attitudes toward girls and women in the past, about how diseases can be created and shaped by culture, about how the body was imagined to work, and about how patriarchal values can be intertwined with medicine. So, stick with me; this might be a longer and kind of weird – there’s everything from Sappho to Shakespeare and Freud, but, in my defence, green sickness has a weird – and fascinating – history.

(This text owes much to Helen King’s book “The Disease of Virgins: Green Sickness, Chlorosis and the Problems of Puberty”, which I highly recommend you check out – full reference below.)

Diagnosing the Past…?

As you might have gathered from the letter that the doctor sent to the young girl’s worried father I mentioned, in the 16th century this condition was difficult to define. But let’s try. Here are the symptoms most commonly mentioned in contemporary sources, summoned up by the 17th-century physician Thomas Sydenham, the ‘English Hippocrates ’:

a bad colour of the face, and whole body
a swelling of the face, eyelids and ankles
heaviness of the whole body
a tension and lassitude of the legs and feet
difficult respiration
palpitation of the heart
pain in the head
feverish pulse
drowsiness
an unnatural longing for such things as are noxious, and unfit for food and,
a suppression of the menstrual discharge

This last symptom, lack of menstruation, or amenorrhoea , was crucial for understanding this condition. You’re probably thinking by now, what does a lack of periods, along with weakness, paleness, and dietary issues mean? If you’re a 21st-century physician, like Dr House, you might think of several possibilities for diagnosing Anna, and that’s because the list of symptoms linked to green sickness was like a big umbrella under which lots of different conditions could hide, such as:

dyspepsia
organic mitral disease
ulceration of the stomach
ulcerative endocarditis
tuberculosis
pernicious anaemia
lead poisoning
Bright’s disease
anorexia (nervosa)
myalgic encephalitis
irritable bowel syndrome
unsuspected pregnancy

This last one would explain tiredness and lack of menstruation, not to mention pica , or the urge to eat inedible things, such as charcoal or soil, which can sometimes happen during pregnancy. Plus, some doctors, such as the 18th-century Jean Astruc, described women who accidentally fell pregnant as using green sickness as a temporary excuse for not having their periods. Still, even though most of us today would associate not getting your period with being pregnant, this was not straightforward in the past – which is why I’m always so frustrated when, in period dramas, a princess or queen not having her ‘monthlies’ is taken by those around her as a sign that she’s expecting. Amenorrhoea , or a lack of periods, could be explained in lots of ways, from malnutrition to a blockage of some sort. Also, in premodern medicine, things we would today understand as symptoms, such as amenorrhoea, were often conflated with diseases, which makes things even more confusing. The vagueness and variety of symptoms leave us with a lot of uncertainty. What did girls suffering from this condition have?

The Faint, by Pietro Longhi (1744). Source: Wikimedia Commons.

Well, and I’m sorry to disappoint you, but thinking like this just doesn’t work for a condition like green sickness. There are just too many issues. Firstly, were the girls diagnosed with the ‘disease of virgins’ even ill? If so, were they all suffering from the same condition? And was a 16th-century diagnosis of green sickness similar to a 19th-century case? Lastly, could we match these symptoms with a single condition today? And which one would it be? Even if we could ‘diagnose’ individual cases using contemporary categories, I don’t think we could ever do that with green sickness as a whole. Just like hysteria , we might end up with lots of different answers, from anorexia to depression, digestive or hormonal issues, not to mention plenty of cases in which the girls were actually healthy, if unconventional or unwilling to fulfil the role expected of them in some kind of way. I just don’t think there’s a simple, unique equivalent between modern medicine and what doctors in the past called ‘green sickness’, which makes it particularly intriguing.

Something often discussed by historians of medicine is the problem with retrospective diagnosis, especially when you don’t have human remains to test in a lab, or when a condition seems to be of the mind rather than of the body. It might be misleading to try to reconcile conflicting sources for the sake of supporting the hypothesis of a single disease. Green sickness wasn’t like tuberculosis in the sense that there wasn’t a defining moment in the lab when scientists ‘discovered’ the cause of the disease. And, although this condition had ancient precedent – remember Dr Lange mentioned Hippocrates in his letter – it was discussed by doctors from the mid-16th century to the beginning of the 20th century. Much like hysteria, it was a gendered disease that came and eventually, arguably, just disappeared. But why?

Well, different societies interpreted physiological bodily processes differently throughout history, and they have understood symptoms and defined ‘disease’ in different ways, too. Plus, in the 16th century , we’re at a time in which medicine was largely dependent on the classical tradition, with the citation of ancient writers kind of acting as a substitute for how we would use lab results today. Medicine was very much between the physiological and the cultural. Similar symptoms received different diagnoses depending on the gender and age of the patient and so medicine reinforced social expectations. So, to understand the ‘disease of the virgins’, I think we need to focus on human history, not biology. In terms of symptoms, what was considered characteristic of the disease of the virgins changed over time. The one constant element, though, was that it was connected with amenorrhoea, lack of menstruation, and that it was believed to affect almost exclusively teenage girls. It was a disease of girls undergoing puberty. But what was it?

So, what was ‘Green Sickness’?

Although you may have never heard of green sickness before, it’s probably fair to assume that, if you were living in 16th-century London, that wouldn’t be the case, even if you weren’t a doctor. If you went to the theatre to watch a play by Shakespeare who, as we know, was writing for a broad audience at the time, you might hear this line about effeminate boys:

There’s never none of these demure boys come to any proof; for thin drink doth so over-cool their blood, and making many fish-meals, that they fall into a kind of male green-sickness; and then, when they marry, they get wenches. They are generally fools and cowards.

— (Henry IV, Part 2, first performed around 1597)

There’s a lot going on here, but you can see how masculinity is pictured, in opposition to femininity. The allusion to eating fish for instance, which was usually considered a ‘cooling’ food, might make men closer to women, whose bodies were believed to be colder. (And if you’re interested in food in this period, I have a video about it, which I suggest you check out.) These boys are weak, feminine, and cowardly; green sickness is used to highlight all of this. The main reason for that is that, from the beginning, green sickness was a gendered disease; it was a disease of young girls at around the age of menarche , so when they started to menstruate. If we go back to the physician I mentioned in the beginning, Johannes Lange , and his description of the ‘disease of virgins’, it’s clear that the way he understood the female body was deeply shaped by classical medicine, by Galenic texts and Hippocratic writings, which stressed how important regular menstruation was for female health. Blood should ‘flow like that of a sacrificial victim’. Nice visual, isn’t it?

Quinta Essentia illustration showing the four humors in relation to the four elements and zodiacal signs (Wikimedia Commons)

Diagram of the four humours (Wellcome Collection)

Green sickness was understood within the context of the humoral theory – and I know, I mention this all the time, but it’s impossible not to! Ok so, and I know I’ve said this before, but just to recap, there were four humours , black and yellow bile, phlegm and blood, which were characterised as hot or cold, dry or moist. The condition was also deeply connected to hysteria , another gendered disease that would dominate medical discourse centuries later. In general, women were believed to be colder and moister than men; their blood was thought to be thicker than men’s. The four humours, if they were in excess, could accumulate and cause blockages within the body. This ‘humoral body’ was based on the idea that humours and fluids could transform into each other – menstrual blood would feed a foetus during pregnancy and it would become breastmilk to feed the baby after birth, for instance. For both Hippocrates and Galen , menstruation was central to female physiology; women needed to menstruate to be healthy. Except if they were too young or old or pregnant, obviously. By the time Dr Lange was writing to Anna’s father, most people would have thought of the female body as naturally plethoric , so as naturally having too much blood that, if there wasn’t a foetus, needed to periodically be expelled. This is why inducing menstruation became such a common medical practice. Female bodies were imagined as more ‘leaky’, with plethora or the abundance of blood being the natural state for women. That’s why they menstruated and men – usually – didn’t. (There were stories of menstruating men though, which I’ll probably explore another time.) But anyway. Not only was blood more plentiful in women, it was also thicker. And, in the Hippocratic text ‘On the disease of virgins’, which Dr Lange mentioned in his letter to Anna’s father, it was said that in adolescent girls, because their bodies were growing, there would be an even greater quantity of blood which needed to be expelled periodically. But the vessels might not be large enough or even open, so intervention would be needed for these bodies to work properly – either by doctors or a husband.

Also, with all this circulation happening inside the body, if there was a blockage, humours might use any other available route. There was also the risk of fluids travelling around the body in the wrong direction, which was what Dr Lange thought was happening to his friend’s teenage daughter, Anna. If menstrual blood was retained or blocked, that could have serious consequences for the body, from being poisoned by the inside by noxious vapours to becoming ‘masculinised’. So, in the 1550s, the symptoms of green sickness were believed to be caused by retained or blocked periods. But why would that happen? Well, the idea was that if this blood was excessively thick (‘crassus’) and sticky (‘glutinosus’) in young girls, it might get stuck in the channels around the womb if they were too thin or even closed. According to some doctors, such as Jean Varandal, this might happen because of excessive dieting. He wrote that, because girls knew that paleness was considered attractive, they tried to make themselves prettier by essentially starving themselves. Another 16th-century physician, William Bullein, wrote that girls who ‘would fayne be fayre’, so who would like to be pretty, would eat foods that dried up their blood and made them pale. So, an inappropriate diet would make the blood thick and slow, and explain the problem. Of course, this laid the blame on girls being vain and frivolous.

Other writers believed that the issue could be caused by the stomach, the womb itself, or the liver. And this is where it gets tricky to define green sickness. It’s possible that people first understood it as a form of jaundice, green jaundice, and so as a blood condition. But doctors weren’t sure whether the lack of menstruation was what caused green sickness or if having green sickness made your periods stop. To make things even more complicated, there was much overlap with digestive problems too. Still, the main problem was amenorrhoea and what that meant.

The 17th-century midwife Jane Sharp explained how menstrual suppression in women was different than in girls: ‘Maids, they presently fall into the Green sickness by it [amenorrhoea]’, whereas women would vomit, don’t want to eat or eat unnatural foods, which hints at pregnancy. So, regardless of changing symptoms, causes, explanations and names for this condition, the main thing that remained constant and defined green sickness was this: it was the lack of menstruation in adolescent girls. This was how doctors understood it, even two centuries after that first letter I started the text with. John Maubrey wrote in 1724 of ‘the Virgin-Disease, commonly called the Green-Sickness’ as the only one of the ‘Indispositions of Life, which can properly be accounted peculiar to Virgins’.

Portrait of a Girl (Anonymous, 1600-1620). Wikimedia Commons.

So, although people had written about symptoms such as amenorrhoea for centuries, green sickness as such was a condition that roughly existed from the mid-16th century to the 1920s or 30s, when it was described as a blood disorder, hypochromic anaemia. It was called by many different names, and doctors were never in complete agreement about symptoms, causes, or treatments, which varied as medical theories changed. Some doctors didn’t even believe it was a thing. The 19th-century Newcastle physician Andrew Fogo called it an ‘imaginary disease’. Still, for those girls diagnosed with it, for centuries, the consequences of this label could be very real.

Why ‘Green’?

Here we get to one of the main questions about this condition – why the colour green? The very idea of green skin makes the whole thing sound unbelievable, and it made many people doubt green sickness even existed. Although there were exceptions, a physician writing in the 80s – yes, 1980s – said

I am convinced that chlorosis did exist, for I have seen a chlorotic woman […] her face was green, its colour accentuated by flaming red hair

— (William Crosby, Journal of the American Medical Association, 1987).

But this was not how most people would have thought of green sickness throughout its history. As I mentioned, the term ‘green sickness’ already existed in vernacular texts before the famous letter that Dr Lange wrote to Anna’s father. It was his idea of the condition that arguably shaped it into a puberty-related, gendered disease. The ‘disease of virgins’, morbus virgineus, was one of the names for a group of symptoms, which were sometimes also called ‘white fever’, ‘green sickness’ and, later, in the 17th century, chlorosis , from the Greek chloros, a sort of greenish yellow or yellowish green. By the 19th century, it was also called hypochromic anaemia – so, again, much of the focus was on colour. In 1619, when Dr Varandal first used the term ‘chlorosis ’, this is how he described it: ‘the disease of virgins, which we, from Hippocrates , call Chlorosis , which is a type of cachexia accompanied by a certain bad colour from white, more or less to green’.

So we get the idea that the colour green covers varying degrees of paleness, and doesn’t necessarily mean a literal, Wicked Witch of the West, green. And a pale skin colour was, among other things, associated with love sickness – another fascinating condition which deserves its own text. This might sound surprising to our modern imagination – we tend to associate redness, flushed cheeks and blushing, with passion. But this connection between love and paleness was centuries-old. In Ovid ’s Art of Love (1.729), it is said that lovers become pale and that paleness is the most appropriate colour for a lover. Sappho also wrote how, when overcome with love, the poet was ‘turning more chloros [pale/greenish?] than grass’ (‘chlorotera de poias emmi’, Sappho 31, lines 13-14). By the 16th century , Shakespeare would write that ‘Green indeed is the colour of lovers’ (Love’s Labour’s Lost, c. 1595). But people would have understood ‘green’, just like ‘chloros’ as referring to paleness, and pale women in particular could be described as being particularly lustful.

And this was not only something that learned people would think. Just look at this passage in a popular ballad:

A handsome buxom lass/ lay panting on her bed./ She look’t as green as grass/ and mournfully she said/ Unless I have some lusty/ lad to ease me of my pain/ I cannot live/ I sigh and grieve/ My life I now disdain.

— ‘A remedy for the green sickness’ (ca. 1683)

But, of course, the colour green is also associated with inexperience, with youth, and this is important when thinking of the ‘disease of virgins’. In Robert Greene’s romance, Mamillia, her father realised that the young woman was

marrigeable, knowing by skill and experience, that the grasse being ready for the sieth [scythe], would wither if it were not cut; and the apples being rype, for want [lack] of plucking would rotte on the tree; that his daughter being at the age of twentie yeeres, would either fall into the green sickness for want of a husband, or els if she scaped that disease, incurre a farther inconvenience [illegitimate pregnancy]

— Mamillia. A mirrour or looking-glasse for the ladies of Englande (1583)

What did Mamillia’s father do? Well, he found her a husband, mirroring Dr Lange’s recommendation to Anna’s father in the beginning. (And I’ll explore this ‘treatment’ a little bit more later). But both Dr Lange and Mamillia’s father describe the girls as ‘ripe’ for marriage, so you can see this parallel between young women and nature. Again, this was not new either. Centuries earlier, the nun and altogether incredibly talented Hildegaard von Bingen (1098-1179) had written that menstruation hinted at ‘greenness’, at a young woman’s flowering:

As a tree, from its greeness, brings forth blossoms and leaves and bears fruit, so too woman, from the greenness of the rivulets of menstrual blood, brings forth blossoms and leaves in the fruit of her womb

Not everyone thought this pale-green colour to be attractive, though. Dr Maubray actually described it as the ugly pale colour of languishing Virgins (‘foedus seu pallidus Virginum color’). But the connection between greenness and nature is what should be highlighted here. In the 18th century, the French philosopher Jean-Jacques Rousseau described female puberty as the ‘springtime’ of a woman’s life. In his book Emile, the character Sophie is passive, while Emile is active; she is weak, while he is strong. She is weak, delicate, and timid. This image of femininity included Sophie falling into melancholy as she dreams of a lover. So, again, a young woman being ‘ripe’ for marriage but left unpicked, like a flower in a meadow.

Speaking of flowers, periods were often called the ‘flowers’ – I actually wrote a piece about this language.. The English midwife Jane Sharp also wrote how the flowers, menstruation, preceded the fruit, the baby, so you can see how all these layers of meaning are connected. She also wrote that puberty was a time when young girls would ‘grow almost mad with love’; for her, green sickness was ‘more common in maids of ripe years when they are in love and desirous to keep company with a man’ so, young women, like Mamillia, Sophie, or Anna, who were ‘ripe’ for marriage, i.e., sex.

So, the green or pale colour, which had likely come from other conditions, such as white fever, love sickness and jaundice, picked up new meanings through time, from the idea that paleness was connected to lust and love to the idea of sexual inexperience and the emergence of sexuality during adolescence. But who were the young women diagnosed with this condition?

Who Were the ‘Chlorotic’ Girls?

According to a 19th-century doctor, Frederick Hollick, patients suffering from green sickness were

‘delicate and interesting, stricken by a disease from which they deeply suffer, but which often leaves their beauty untouched, or even heightens its attractions, they excite the liveliest emotions of pity and the most ardent desire to render them assistance’

Another one, Lawson Tait, described the condition as ‘the anaemia of good-looking girls’, common among those ‘with a pretty pink and white complexion’. Yet another doctor, Byrom Bramwell, wrote how

‘In blondes, the complexion often has a beautiful rosy-red tint […] patients suffering from chlorosis flush readily; their skin is usually thin and delicate; the temporary tinting of the skin which results from the flushing is very becoming, for many of the girls who are affected with chlorosis are very pretty’.

Ok then. Nothing like when the male gaze and the medical gaze overlap. You can easily see here how green sickness – as well as many other conditions, from hysteria to tuberculosis – was eroticised, not to say sexualised, especially in the 19th century. Doctors like Armand Trousseau would even write how ‘the erotic instincts are more developed in chlorotic than in other women’. The same would be said about hysterics . And just like hysteria , green sickness was gendered as a female disease. But, and again the same happened to hysteria , the way the condition was understood shifted through time. In the case of green sickness, the focus roughly changed from the stomach and intestines to the womb and the liver. If it wasn’t a womb-related disorder, that opened up discussions in the 19th century about whether men could suffer from green sickness. There is a lot of medical misogyny here, too. Women were considered ‘weaker’ than men, and so, ‘delicate and feeble’ men, like the ones described by Shakespeare in a satyric way I mentioned earlier, could potentially be ‘chlorotic ’.

Still, most people would have described the typical patient suffering from green sickness as a young woman, usually in her teens. Probably because of her youth and inexperience, this green sickness patient would be, besides pretty, described as passive and weak, evoking sympathy, sure, but also as someone controllable, someone her family and doctor could manage. Doctors like Sir Andrew Clark would describe them as ‘for the most part gentle and inoffensive’. This is very different from how hysterics or nymphomaniacs were depicted in this period. As older, more experienced women, they were usually perceived to be manipulative. There was also an idea that chlorotic girls weren’t to blame for their suffering, even if they were sometimes accused of succumbing to their vanity and making things worse. For some, like Dr Campbell, writing in the 1920s, green sickness was ‘an exaggeration of a physiological change occurring in all girls rather than a disease sui generis’. So, it could happen to any girl going through adolescence.

The Magdalen, by Bernardino Luini (c. 1525). Source: Public Domain.

Puberty had been considered a turbulent age for centuries. But, for many doctors in the 19th century, the onset of menstruation had become connected with desire, with both the young women becoming desirable to men, and starting to experience desire themselves. Dr Ambroise Rue would describe menarche , the onset of menstruation, as something that ‘gives to this young beauty, no matter how sad or languid, the freshness and sparkle which mark the dawn of her life’.

As for symptoms, because the list was vague, ever-changing, and constantly expanding, there were times, such as the Victorian era , in which virtually any young woman could be diagnosed as suffering from green sickness, just as an older woman might be perceived as suffering from hysteria. And, just like with hysteria, many of the symptoms could be said to be learned behaviours. Girls could model their behaviour after friends and family, but they could also learn the expected behaviours from the popular press, not to mention doctors themselves. I’m not saying they were ‘faking’ or ‘pretending’; but we do know that doctors can shape how a condition is perceived. Of course, others had physiological symptoms and, a few decades later, they might have been diagnosed with anaemia or a gastric ulcer. But we should be careful not to write off green sickness altogether. A statement like Karl Guggeinheim’s ‘The once-prevalent disease known as chlorosis is now generally believed to be hypochromic anaemia’ sounds to me accurate yet incomplete at the same time.

That’s the thing that makes conditions like green sickness so interesting, but also so tricky. They encapsulated but also obscured many other things that might be happening to someone, from the physiological to the psychological. Still, although there was much overlap between medical categories, and the way people understood diseases was always changing, an 18th-century doctor like Bienville summed up the emotional and physical changes behind green sickness, defining the typical patient like this:

‘This disorder frequently surprises the younger part of the sex [girls], at a marriageable age, when their hearts, premature in love, have warmly pleaded in favour of some youth, for whom they feel a desperate passion, the gratification of which is opposed by insurmountable obstacles’.

This is why, similarly to hysteria , novels and love poems were believed to contribute to the condition, as they stimulated female desire, they made young women’s imaginations run wild. And it was precisely this overlap between emotional and physiological conditions, based on what to us are clearly outdated ways of understanding both the body and the mind – not to mention gender and sexuality – that made many doctors think that this was a dangerous time in a girl’s life, when she’s ready or ‘ripe’ for marriage but still unmarried. So, the ‘natural’ remedy, with gigantic air quotes here, was, of course, marriage.

Patriarchy and Medicine: Getting Married as a ‘Cure’…?

In Romeo and Juliet, Romeo says: ‘Her vestal livery is but sick and green,/And none but fools do wear it. Cast it off.’ He’s evocating the imagery of greenness and virginity and, quite bluntly, saying that Juliet should be rid of it, with his help, naturally. But Romeo isn’t the only one in the play to worry about this. At the beginning of the play, Juliet’s father, Lord Capulet, is eager to marry her off to Paris. When she refuses, he says ‘Out, you green-sickness carrion!’, among other insults. He is frustrated with her, sure, but we can also assume that he might be worried about her health.

I started this text with a father worried about his daughter asking his friend, a physician, for advice. Essentially, Anna’s father had two questions: what was wrong with her, and should she get married? The doctor’s reply covered both. Yes, she should marry, and that would cure her condition. But why? Well, I talked a little bit about how young women suffering from green sickness were perceived as full of desire, emotionally ready for sex which, of course, for them to be ‘respectable’ meant sex within the context of a heterosexual marriage. But that’s not the whole story. Remember how I mentioned that young female bodies were believed to struggle when menstruation started, because the blood was too slow or thick, and the vessels around the womb were too thin? Well, traditionally, doctors had recommended that sexual activity was the main way to ‘correct’ all this, as intercourse enlarged or opened the vessels of the womb and encouraged the blood to move around. So, the cure for the disease of virgins was essentially to stop being a virgin.

Regardless of how much medical sense this makes which, admittedly, is not a lot, let’s stop and think about this sudden preoccupation with virginity. For centuries, virginity had been praised within Christianity, not to mention in antiquity, for both men and women, with saints and prophets being lauded for their virginity. Just think of the Virgin Mary. But, in the mid-16th century , when Dr Lange was writing to his friend and recommending that Anna get married, Protestantism was spreading in Europe, with its priests who could and should marry and have their families, as opposed to the celibate Catholic priests. The way virginity was understood was shifting and, while it was still important for a young woman to remain a virgin until she married, staying in a prolonged or permanent state of virginity was not something most Protestant preachers advocated. I know I’m generalising here, but Protestantism in its many iterations tended to favour marriage and motherhood as the ultimate Christian path for women, and that would shape how green sickness was perceived, too.

A family, in the Whole Book of Psalms (1563). Source: Wikimedia Commons.

There’s another factor at play here, though: the typical age when young girls would get their first period, which varied greatly through time. But it’s probably fair to say that in antiquity and the medieval period , most young women would menstruate later than their Victorian counterparts, due to a mix of socio-economic reasons, including the Industrial Revolution, with the main one being improved diet. By the 19th century, the gap between menarche and marriage had widened, and adolescence or ‘youth’ had become a longer phase. So this was a potentially dangerous time, with the onset of sexuality. Of course, this is an oversimplification, and things weren’t the same for a girl working in a factory and a wealthy one. Victorian and Edwardian working-class girls would move much quicker from childhood to adulthood; they had to, as they started to work early, not to mention taking care of their families. But, for wealthier girls, such as the ones mentioned by many of these doctors, this limbo, this in-between stage, could be much longer. And it was still believed that this was a time in which the body was full of heat produced by the humours and, therefore, lust. This created a lot of anxiety for these girls’ families. So, if menarche usually happened when girls were between 14 and 17 years old, marriage should ideally happen when these young women were around 20. Or else. In his letter to Anna’s father, centuries earlier, Dr Lange is essentially describing the physical issues that can arise from young women remaining unmarried, following the Hippocratic tradition.

It’s important to say that marriage wasn’t the only treatment suggested for green sickness. In Aristotle’s Masterpiece , a very popular 17th-century sex manual, which is neither by Aristotle nor a masterpiece, it was advised that, if marriage wasn’t possible, blood-letting would help, ideally from the ankle. This followed Galenic theories and would encourage the blood to move downwards in the body, and so stimulate menstruation. Plus it would get rid of the excess of blood and help balance everything out. Sometimes using leeches on the labia was advised, which makes me wince. This was consistent with how amenorrhoea had been treated for centuries, and this advice changed little. Besides blood-letting, emmenagogues were suggested, so remedies to induce menstruation by stimulating uterine contractions and voiding the womb. (There’s a lot of overlap between these remedies and abortifacients, so formulas to provoke an abortion, but this is something that I’ll talk about another time.) Anyway, besides remedies meant to induce menstruation, patients were also prescribed mithridatum, as a theriac, an antidote for poisons. If the blood is trapped within the body, and poisoning it from the inside, that would make sense. Other, easier cures would include onions, which according to Dr Bullein, ‘bringe good couler to the face, and helpe the grene sickness’. Characterised as a hot and dry food, in terms of its humoral qualities, onions would thin thick fluids in the body, such as period blood, and so, could help. You could also follow this recipe, from the book Health ’s Improvement:

‘Stamp 1 handful Rue, 2 Red Sage, strain juice, add to 1 pt hot honey, spoonful Pepper. Stir. Give 1 spoonful and half, blood warm, morning and evening. Plus to eat, 4 or 5 times daily, 5 or 7 ‘Raisins of the Sunne’.

This would mix abortifacient herbs and red ingredients, and red is symbolic here, as we’re thinking of menstruation. Besides remedies for inducing menstruation, the midwife Jane Sharp recommended changes in diet, with ‘cooling’ foods being prioritised and exercise. Of course, many doctors recommended housework as a particularly apt form of exercise. Who would have thought, right. Later, the infamous ‘rest cure’ could be prescribed, which was also used for hysteria and about which I’ll speak more another time. Surgery was sometimes performed, though that was rare, as families weren’t thrilled at the prospects of their daughters ‘losing their virginity’ at the surgical removal of the hymen. Steel or iron powder or steel pills had also been used since the 17th century, but by the 19th century, the most famous ones were Dr William’s Pink Pills for Pale People and ‘young girls fading away’. At the same time, hydropathy, or water treatments were becoming more popular, so girls would be wrapped up in sweating blankets, to make the pores expel toxins, and wet sheets, which doesn’t sound pleasant at all. And, when electricity came along, it was also used to treat green sickness during its peak, around the last decades of the 19th century. Often, many of these treatments would be used in combination. Of course, looking back, we can see that at best, most of these treatments would have been ineffective and, at worst, they could cause real harm. Just the idea of leeches… anyway. Still, ceasing to be a virgin through marriage remained the main ‘treatment’ for the condition.

So, you have doctors encouraging marriage as close as possible to the onset of menstruation, saying that going from girlhood to womanhood was basically beneficial to your health. If female puberty and sexuality were issues to be solved, early marriage could even be a sort of profilatic measure to young women in general, besides a ‘treatment’ for green sickness. Essentially, doctors were acting here, whether consciously or not, as a tool of patriarchal socialisation, in a society in which regulating and controlling young women’s sexuality and bodies was considered important. Marriage was the most socially acceptable way for a young woman’s body, a virgin’s body, to be put under male control. Once married, these young women’s sexuality would be socially and religiously sanctioned. It would be ‘normal’, ‘healthy’, acceptable and accepted. So, when marriage is suggested as the ‘easiest’ way to cure green sickness, this should really give us pause.

Final Thoughts

Let’s get back to Anna, the girl Dr Lange diagnosed by letter and which some people say may never have existed. Regardless of her real story, for centuries her case served as the prototype of green sickness; it added a narrative to the doctor’s own interpretation of Hippocratic and Galenic theories and codified the ‘disease of virgins’. Green sickness is kind of unique in terms of the history of medicine, because it started and finished in precise moments in time, from Lange’s mid-16th century description of it as the ‘disease of virgins’ to its disappearance in the 1920s, which has been explained in different ways, from improved diet to the development of blood testing. Maybe it just stopped being a useful term. Arguably, with the rise of laboratory testing and a deeper understanding of disease, green sickness just disappeared as there was nothing else that hadn’t been classified as a different condition. It was kind of defined out of existence as other diseases were better understood. From a social perspective, it’s perhaps no coincidence that its disappearance coincided with a change in women’s roles in society, especially with the First World War, including their entry into the institutionalised medical profession.

So, rather than asking what it was, it’s perhaps more useful to ask what was green sickness for? What were the implications of being seen as suffering from it? Why were these symptoms connected to young girls around the time they started menstruating? There are many possible explanations here depending on time and place, from the 16th and 17th centuries’ rise of Protestantism making marriage and motherhood even more the ‘proper’ path for girls, to the peak of green sickness in the 19th century and the concerns around women being educated and social anxieties around longer periods between the onset of menstruation and marriage. But this was also a time in which the dangers of female sexuality were discussed by many and nymphomania and hysteria, both gendered diseases, were the focus of many doctors. In terms of the history of ideas or intellectual history, we could probably say that, with its connection to classical thought, the rise of green sickness went hand in hand with the rediscovery of Greek medical texts in the Renaissance , and its decline in the early 20th century corresponded to a time in which this tradition at last lost its influence over medical thought.

In terms of science and technology, experimenting with blood had been happening for centuries, but it really intensified and became much more sophisticated in the 19th century. And so, by the end of the century, green sickness kind of ‘became’ hypochromic anaemia, from a physiological perspective – but that doesn’t mean we should just explain away the ‘disease of virgins’ as an archaic way of talking about iron-deficiency anaemia which, by the way, can affect people of all ages and of any sex. As I mentioned at the beginning, throughout its history green sickness covered many different conditions and was constantly being reshaped. But, with the shift to anaemia, some of the moral policing behind the condition was diminished, even if the management and control of the patient remained central to most therapies. Leaving the body aside and thinking of the mind, we could argue that, later, with Freud’s writings about hysteria , the behavioural and emotional aspects of green sickness faded away, too, as fewer and fewer young women were diagnosed with it. But we should be mindful that, even if hypochromic anaemia became the prevalent diagnosis, scientific blood testing and medicine could serve to enforce patriarchal gender roles. For example, in England, in 1923, the Report of the Board of Education actually mentioned lower haemoglobin levels in girls (which is something normal) as a reason why they shouldn’t have the same access to education as boys. So, although there was a new understanding about blood, the ideas behind green sickness and women in general were slow to change, with lab results reinforcing social and gender norms.

Cover of "The disease of virgins" by Helen King — Cover of “The disease of virgins” by Helen King

There are some diseases, like tuberculosis, in which there’s an ‘eureka’ moment in the lab. When doctors understand its causes, symptoms, and possible treatments. And there are others, like green sickness, which are a loose collection of symptoms, which change through time, which get mixed up with other conditions, both physical and psychological. In modern terms, green sickness embraced a wide range of conditions and symptoms, from digestive and hormonal disturbances to undesirable behaviour or emotional states. The variety of symptoms and the vague definition of green sickness, with the overlap with other conditions, and the focus of doctors shifting from the stomach, to the womb, to the liver and the blood, meant that this label, confusing as it was, was highly flexible and adaptable and that led to its longevity. With ideas about the body and technology changing, green sickness was adapted to fit with these new ways of thinking. Arguably, the one thing that remained constant throughout its history was the focus on female puberty and virginity. Young women were infantilised by society but, once they were ‘ripe’ for marriage, it was advisable that they should marry quickly, shifting from the control of their families – especially their fathers – to that of their husbands. Doctors argued that this was for their health, of course, and I’m sure many of them did genuinely believe so, without malice. But we know our perceptions are shaped by the culture we live in, and doctors are no exception. For instance, the idea that the condition was made worse by young women spending time together, such as in boarding schools, highlights the unease at girls forming social networks and potentially being out of male control. Arguably, these anxieties about female puberty and sexuality – not to mention female agency and education – were at the basis of how green sickness, in its many forms, was constructed. Codified as a disease, diagnosis would be followed by treatment, managed by doctors with marriage and ideally motherhood ‘curing’ the patient.

There’s much more that could be said about the ‘disease of virgins’, but in this article I tried to focus on the role green sickness played throughout time in how the female body was understood and how young women’s sexuality was regulated. (By the way, there are lots of references and reading recommendations below, but if you were to read just one book, the one by Helen King, is probably the best overview that there is of green sickness.) Anyway, as a social phenomenon, a disease doesn’t exist until people agree it does – which often coincides with it being named. Whether intentionally or not, medical writings created a ‘natural’, medical reason why women were better off in the home as wives and mothers, excluded from the public sphere. By defining the roles women should play in society, medicine also cautioned them of what the consequences of going against their ‘natural’ place would be. And this is why I’m so fascinated with the history of medicine. Although we like to think of medicine as ‘scientific’ and ‘objective’, there is much overlap between the medical and the social; medicine can and has been used to legitimise cultural norms and strict gender roles. So, if you managed to stick with me through the weird and frankly disturbing history of green sickness, I salute you! Thank you, and see you next time!

References:

Anon., Aristotle’s Masterpiece (1694).

Jean Astruc, A Treatise on all the Diseases incident to Women (1743).

D. T. de Bienville, *Nymphomania, or a Dissertation Concerning the Furor Uterinus (*1775).

Byrom Bramwell, Anaemia and Some of the Diseases of the Blood-Forming Organs and Ductless Glands (1899).

William Bullein, A Newe Booke Entituled the Gouernment of Healthe (1558).

J. M. H. Campbell, ‘Chlorosis: A Study of the Guy’s Hospital Cases During the Last Thirty Years’, Guy’s Hospital Reports 73, pp. 247-97.

Andrew Clark, ‘Observations on the Anaemia or Chlorosis of Girls, Occurring More Commonly Between the Advent of Menstruation and the Consummation of Womanhood’, Proceedings of the Medical Society of London, 11, pp. 55-66 (1887).

Andrew Fogo, Observations on the Opinions of Ancient and Modern Physicians, Including those of the Late Dr Cullen on Amenorrhea, or Green-Sickness (1803).

Robert Greene, Mamillia. A mirrour or looking-glasse for the ladies of Englande (1583).

Hippocrates, Hippocratis Coi Medicorum Omnium longe…, trans. by Marco Fabio Calvi (1525).

Frederick Hollick, the Diseases of Women: Their Causes and Cure Familiarly Explained with Practical Hints for their Prevention and for the Preservation of Female Health (1852).

Johannes Lange, Medicinalium epistolarum miscellanea (1554).

William Langham, The Garden of Health (1597).

John Maubrey, The Female Physician, Containing All the Diseases Incident to that Sex (1724).

Luis Mercado, De mulierum affectionibus (1579).

Ambroise Rue, ‘Essai sur la première menstruation, précédé de quelques considerations sur la chlorose’, Paris Medical Faculty (1819).

Jane Sharp, The Midwives Book, or the Whole Art of Midwifry Discovered (1671).

Thomas Sydenham, The Entire Works (1753).

Lawson Tait, Diseases of Women and Abdominal Surgery, vol. 1 (1889).

John Tanner, The Hidden Treasures of the Art of Physick (1659).

Armand Trousseau, Lectures on Clinical Medicine, vol. 5 (1872).

Jean Varandal, De morbis et affectibus mulierum (1619).