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Green sickness: Hippocrates, Galen and the origins of the “disease of virgins”

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Abstract

This article argues that the publication in 1554 of Johannes Lange's description of what he called the “disease of virgins,” later identified as green sickness or chlorosis, should be linked not to epidemiological or social factors but instead to a stage in the reception of Hippocratic medicine. The restoration to the Western tradition of the Hippocratic textOn the diseases of virgins occurred in 1525, with the publication of Calvus's Latin translation of the Hippocratic corpus. Features of green sickness can best be understood by investigating how this newly available text was read within a Galenic model of the female body, influenced by choices made in the translation from Greek to Latin.

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References

  1. See for example K. Figlio, “Chlorosis and chronic disease in nineteenth-century Britain: The social constitution of somatic illness in a capitalist society,”Social History 3 (1978), 167–97; I.S.L. Loudon, “Chlorosis, anaemia and anorexia nervosa,”British Medical Journal 281 (1980), 1669–1675; J. Starobinski, “Chlorosis—the ‘green sickness’,”Psychological Medicine 11 (1981), 459–68; A. Clair Siddall, “Chlorosis: Etiology reconsidered,”Bulletin of the History of Medicine 56 (1982), 254–60; J. J. Brumberg, “Chlorotic girls, 1870–1920: A historical perspective on female adolescence,”Child Development 53 (1982), 1468–77; I. S. L. Loudon, “The diseases called chlorosis,”Psychological Medicine 14 (1984), 27–36.

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  2. Siddall, “Chlorosis,” 254.

  3. Artistic and literary aspects are discussed by Loudon, “Chlorosis, anaemia and anorexia nervosa,” 1669; cf. R. E. McFarland, “The rhetoric of medicine: Lord Herbert's and Thomas Carew's poems of green-sickness,”Journal of the History of Medicine 30 (1975), 250–8. L. Dixon,Perilous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine, Ithaca and London, 1995, reproduces a large number of images of sick maidens, mostly from seventeenth-century Holland, several of which are associated by title or by content with green sickness. However, the author chooses to merge green sickness, love sickness, hysteria, nymphomania and many other categories which sources contemporary with their alleged prevalence chose to distinguish. By glossing over attempts to separate them, and instead seeing them all as different labels for a single condition, “a mysterious universal ailment of many names that has afflicted women throughout history” (240), Dixon fails to understand the rich range of ways in which medicine has historically claimed to hold the keys to the health of women of all ages and social classes. Her book is also littered with a series of serious factual errors. A. Hansen, “Die Chlorose im Altertum,”Sudhoffs Archiv für Geschichte der Medizin 24 (1931), 175–84, discusses the absence of chlorosis not only from ancient medical literature, but also from ancient poetry and art, believing that anything adversely affecting the marriage prospects of young girls would have been the subject of “long and lively discussion” by their mothers and would thereby have entered non-medical literature (182). This may be somewhat fanciful, but the point remains that a full history of chlorosis would need to take account of changes in the visual representations of the condition. G. de Baillou,De virginum et mulierum morbis, Paris 1643, 58 describes the role of “ignorant and complaining mothers” who are shocked by the speed with which their afflicted daughters appear to be wasting away.

  4. Luis Mercado,De mulierum affectionibus, Venice 1587, 215; cf. J. Varandal,De morbis et affectibus mulierum, Lyons 1619, preface, on the many pale and disfigured virgins of his own day as a result of cachexia, the “pale colours” and the “foedi colores:… quibus plerasque virginum nostrarum hodie deturpari conspicimus.” All quotations are given with page numbers from the 1620 edition of Varandal.

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  6. The subtitle of Ernest Lloyd Jones,Chlorosis: the special anaemia of young women, London 1897.

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  8. In the nineteenth and early twentieth centuries there was considerable debate over whether male chlorosis was possible; writers such as Samuel Fox (Observations on the disorder of the general health of females called Chlorosis: Shewing the true cause to be entirely independent of peculiartities of sex, London 1839, preface), who regarded chlorosis as a liver disorder, argued that it also appeared in “young and delicate” men. Summaries of the debate are given by R. C. Cabot in W. Osler and T. McCrae (edd.),Modern Medicine: Its Theory and Practice, Philadelphia 1908, 641. When the English translation of K. von Noorden'sChlorosis appeared in P. Ehrlich, A. Lazarus, K. von Noorden and F. Pinkus,Diseases of the Blood, Philadelphia and London 1905, 339–536, the editor, A. S. Stengel, felt it necessary to correct von Noorden's statement that only females could contract the condition (339). On late chlorosis, see A. S. Stengel in: T. L. Stedman (ed.),Twentieth Century Practice vol. 7:Diseases of the Respiratory Organs and Blood, and Functional Sexual Disorders, London 1896, 351 and R. P. Hudson, “The biography of a disease: Lessons from chlorosis,”Bulletin of the History of Medicine 51 (1977), 452.

  9. Stengel, inTwentieth Century Practice, 343, suggests that even the hair may become “light coloured in spots.”

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  12. Loudon, “Chlorosis, anaemia and anorexia nervosa,” 1672. Simon Forman (1552–1611) uses the term “grene” for “newly delivered of a child” in the notes he made of his medical practice from 1597 onwards; see B. H. Traister, “‘Matrix and the pain thereof’: a sixteenth-century gynaecological essay,”Medical History 35 (1911), 441.

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  16. Hudson, “Biography,” 452–5 points out that the magnesium salts often prescribed to counteract another supposed symptom of chlorosis, namely constipation, would have prevented the iron given to nineteenth-century chlorosis patients from having any beneficial effect.

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  20. R. James,A Medical Dictionary (3 vols), London 1743, s.v. “chlorosis”; Lettsom,Boarding-schools, 17; Hudson, “Biography,” 457; Loudon, “Diseases called chlorosis,” 31.

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  22. Stengel,Twentieth Century Practice, 330–1.

  23. Hudson, “Biography,” 448.

  24. Varandal,De morbis mulierum, 1: “quem vulgus pallidos colores sive foedos, icterum album, febrem amatoriam, morbum virgineum appellant, nos ex Hipp. chlorosin quae est species cachexiae.”

  25. Homer,Iliad 7. 479; M.S. Cyrino,In Pandora's Jar: Lovesickness in early Greek poetry, Lanham, Maryland 1995, 164 n. 69.

  26. Onchloros in ancient Greek literature, see E. Irwin,Colour Terms in Greek Poetry, Toronto 1974, 31–78; for the Sappho usage, “greener than grass,” M. Marcovich, “Sappho fr. 31: anxiety attack or love declaration?”Classical Quarterly 22 (1972), 25–6 argues that the reference here too is to fear, while J. McIntosh Snyder, “Public occasion and private passion in the lyrics of Sappho of Lesbos,” in: S. B. Pomeroy (ed.),Women's History and Ancient History, Chapel Hill, 1991, 1–19 picks up Irwin's suggestion that the primary referent forchloros is “youth and life”; for Renaissance readership, J. Haig Gaisser,Catullus and his Renaissance Readers, Oxford 1993, 163. On love-sickness see Cyrino,Pandora's Jar, D. A. Beecher and M. Ciavolella (edd.),Jacques Ferrand; A Treatise on Lovesickness, Syracuse, NY 1990 (Ferrand's use of Sappho is discussed on p. 41) and M. F. Wack,Lovesickness in the Middle Ages: The Viaticum and its Commentaries, Philadelphia 1990.

  27. Ovid,Ars amatoria 1.729; use ofpalleat.

  28. Shakespeare,Love's Labour's Lost (c. 1595), I.ii.281; Beecher and Ciavolella,Ferrand, 119 on the appropriate colour being a “greenish yellow tint of the skin.”

  29. William Bullein,A newe Boke of Phisicke called ye Government of Health, London 1559, 124 refers to onions helping “the grene sickness”; the section on pepper on 217 mentions” greene sicknes” as a possible consequence of eating too much of this substance, while on 228 a discussion of the uses of Mithridatum recommends it “for women whiche have a newe disease peraccidentes called the greene sicknes.” These references considerably predate the date of 1608 proposed for the first vernacular reference to green sickness by Sawyer,Patients, Healers, and Disease, 490–1 and n. 42 and followed by Loudon, “Diseases called chlorosis,” 29.

  30. Bullein'sBulwarke of Defence; The Booke of Simples, London, 1562, includes a section on the use of onions: “They doe make thyn the Bloude… [they] bee hoat in the thyrd degree, but they warme and cleanse the Stomacke, brynge good Colour to the face, and then they muste be good for the neewe Greene Sycknesse.”

  31. J. Lange,Epistulae medicinales, Basle, 1554 (second and extended edition, 1560), popularised through J. Schenck von Grafenburg,Observationum medicarum, rararum, novarum, admirabilium, et monstrosarum libri, Frankfurt, 1600, IV case 256; the fourth book, on the reproductive organs of both sexes, was first published separately in 1596.

  32. V. Fossel, “Aus den medizinischen Briefen des pfalzgräflichen Leibarztes Johannes Lange (1485–1565),”Sudhoffs Archiv für Geschichte der Medizin 7 (1914), 238–52; V. Nutton, “John Caius und Johannes Lange: medizinischer Humanismus zur Zeit Vesals”,NTM—Schriftenreihe für Geschichte der Naturwissenschaften, Technik und Medizin 21 (1984), 84;idem, “Humanist surgery,” in: A. Wear, R. K. French and I. M. Lonie (edd.),The Medical Renaissance of the Sixteenth Century, Cambridge 1985, 94.

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  33. This can be seen by comparingEpistula 1.21 and the Calvus translation of the HippocraticOn the diseases of virgins.

  34. For the reading habits of another sixteenth-century humanist, who appears to have read several books simultaneously, see L. Jardine and A. Grafton, “Studied for action': How Gabriel Harvey read his Livy,”Past and Present 100 (1990), 30–78.

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  35. M. Ullmann,Die Medizin im Islam=Handbuch der Orientalistik, I. Abt., Ergänzungsband VI, 1. Abschnitt, Leiden 1970, 32; F. Sezgin,Geschichte des arabischen Schrifttums, Band 3, Leiden 1970, 40–1 no. 17 and 45 no.3, argued thatDiseases of women was translated into Arabic. In “Zwei spätantike Kommentare zu der hippokratischen Schrift “De morbis muliebribus',” Medizinhistorisches Journal 12 (1977), 245–262, Ullmann instead suggested that references toDiseases of women in Arabic authors derive not from direct knowledge of the texts themselves but from lists of Hippocratic works given in the order in which Galen recommended they should be studied: he concluded, “Das Buch ist—so darf mit Sicherheit gesagt werden—nicht ins Arabische üebersetzt worden” (p. 248). Two commentaries on the first eleven chapters ofDiseases of women 1 were, however, known in the Arabic world; see further M. Ullmann, “Zwei spätantike Kommentare…” It is possible that the availability ofOn the diseases of virgins in the Arabic world accounts for the interest in disorders arising from the “thick menstrual blood” of virgins in the writers Ibn al-Jazzar and al-Majusi (H. King, “Once upon a text: Hysteria from Hippocrates” in: S. L. Gilman, H. King, R. Porter, G.S. Rousseau and E. Showalter,Hysteria Beyond Freud, Berkeley 1993, 52–3).

  36. For example,Diseases of women book 1, chapters 1 and 7–38 in Paris BN Lat. 11219 (ninth century) and Leningrad Lat. F.v. VI.3 (eighth or ninth century), on which see F. P. Egert,Gynäkologische Fragmente aus dem frühen Mittelalter nach einer Petersburger Handschrift aus dem VII.–IX. Jahrhundert, Berlin 1936 and G. Walter, “Peri gynaikeion a of the Corpus Hippocraticum in a mediaeval translation,”Bulletin of the History of Medicine 3 (1935), 599–606. See also I. Mazzini and G. Flammini,De Conceptu. Estratti di un'antica traduzione latina del Peri gynaikeion pseudoippocratico I, Bologna 1983. Theeditio princeps is given by M. E. Vazquez Bujan,El De mulierum affectibus del Corpus Hippocraticum, Santiago de Compostela 1986. P. Kibre, “Hippocrates Latinus,”Traditio 36 (1980), 362 argues that no Latin translations ofDiseases of women were made between the eighth and sixteenth centuries.

  37. [Hipp.]Epidemics 2.2.12 (Littré 5. 88).

  38. N. Leoniceno,Libellus de Epidemia, quam vulgo morbum Gallicum vocant (Venice 1497).

  39. Fossel, “Briefen,” 248.

  40. Lange,Epistulae 2.13, which refers to the classical idea that there were three hundred diseases afflicting mankind (cf. the emperor Tiberius contracting the apparently new disease ofcolum in Pliny,Natural History 26.6.9); is this not sufficient, asks Lange, without any new ones? The English Sweat appeared in 1485, with further outbreaks in 1508, 1517, 1528 and 1551; syphilis arrived in Europe in 1495. On the subsequent history of the idea of “new diseases” see L. G. Stevenson, “‘New diseases’ in the seventeenth century,”Bulletin of the History of Medicine 39 (1965), 1–21 and L. Thorndike, “Newness and novelty in seventeenth-century medicine,” in: P. P. Wiener and A. Noland (edd.),Roots of Scientific Thought: A Cultural Perspective, New York 1957, 443–57.

  41. Littré 8. 466–71.

  42. E. Schwarz,Chlorosis: A retrospective investigation, Bruxelles 1951, 146 goes so far as to say thatOn the diseases of virgins” does not contain the faintest hint” of chlorosis.

  43. Contra Starobinski, “Chlorosis,” 460. The Hippocratic passages usually mentioned in this connection areCoan prognoses 333 (Littré 5.656), a discussion of a disorder affecting children at the age of seven, involving paleness, breathing difficulties and eating earth, andProrrhetics 2.31 (Littré 9. 64), a disorder identified as “Chlorose” by Littré, explicitly found in “both men and women,” with symptoms of a bad colour, headaches, piles, and eating stones and earth. This passage is used by Varandal,De morbis mulierum, 4, in order to show that chlorosis is only a variant of cachexia. For de Baillou,De virginum morbis, 66–7, the stated age of seven in theCoan prognoses is not a problem, since according to the Hippocratic principle by which age groups are formed, both seven and fourteen—the age of puberty—are significant and potentially dangerous times of life.

  44. Littré 8. 466–71. The date of the Hippocratic text is not known; C. Bonnet-Cadilhac, “Traduction et commentaire du traité hippocratique ‘Des maladies des jeunes filles’,”History and Philosophy of the Life Sciences 15 (1993), 147–63 argues for a late-fourth-century dating on the grounds of Aristotelian influence, and rejects the suggestion that the text in Littré 8. 466–71 is the work on virgins' diseases mentioned in the main Hippocratic gynecological work,Diseases of women 1.2 (L 8. 22) and 1.41 (L 8. 98). Since both of these passages can be read as claiming that the treatise on the diseases of virgins discusses diverted menstrual blood coming out orally or in the stools, which the extantOn the diseases of virgins does not, another possible explanation is that the extant text was originally the introduction to an otherwise lost treatise which went on to discuss alternative routes for the menses. On the treatise as an “instrument of socialization” see J. Rubin Pinault, “The medical case for virginity in the early second centuryC.E.: Soranus of Ephesus,Gynecology 1.32,”Helios 19 (1992), 129.

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  45. See for example M. Lefkowitz,Heroines and Hysterics, London 1981, 13–15; H. King, “Bound to bleed: Artemis and Greek women,” in: A. Cameron and A. Kuhrt (edd.),Images of Women in Antiquity, London 1983, 109–27; V. Ando, “La verginità come follia: ilPeri Parthenion ippocratico,”Quaderni Storici 75 (1990), 715–37; J.-P. Catonné, “A nosological reflection on the Peri Parthenion: Elucidating the origin of hysterical insanity,”History of Psychiatry 19 (1994), 361–86; L. Dean-Jones,Women's Bodies in Classical Greek Science, Oxford 1994, 48; N. Demand,Birth, Death, and Motherhood in Classical Greece, Baltimore 1994, 95–9. Cf. also F. Stok, “Follia e malattie mentali nella medicina dell'età romana,” in: W. Haase (ed.),Aufstieg und Niedergang der Römischen Welt (ANRW) II 34,3, Berlin and New York 1996, 2321.

  46. Littré 8. 465; see also B. Bruni Celli,Bibliografía Hipocrática, Caracas (Venezuela) 1984.

  47. “Sed hic morbus virgines infestat, quum viro iam maturae, ex ephebis excesserint. Nam id temporis, natura duce, sanguis menstruus ad matricis loculos, et venas ab epate defluit.”

  48. Galen,On the causes of symptoms 3.3 (Kühn 7.221–2).

  49. Calvus givesOn the diseases of virgins twice; Lange follows the first version, headedDe virginum natura liber. The repeated phrases in these two translations may suggest that the process of translation involved the comparison of Greek manuscripts with an earlier, Latin, translation; the differences between the versions in content, Latin style and knowledge of Greek suggest two different translators at work. The first translation is by far the superior on all counts.

  50. Jean Vassès,Claudii Galeni de causis respirationis libellus. De usu respirationis liber unus. De spirandi difficultate libri tres, Paris 1533, 74 (lines 28–30) gives “In totum siquidem, ut diximus, cum vel tumor, vel dolor in hypochondriis fuerit, parva de necessitate et frequens adest respiratio, ut nihil mirum sit, si in sequentibus, ubi hypochondrium hypolaparou,id est, subinane dixit, adiecerit spirituosum autem non valde”. See also J. Cornarius,Libri V iam primum in Latinam linguam conversi: De causis respirationis. De utilitate respirationis. De difficultate respirationis libri III, Basle 1536, 96.

  51. The roles of arteries and veins in Galenic physiology are, of course, very different from those envisaged in a post-Harvey model of the body; for Galen, veins transport “venous blood” from the liver as part of the nutritive faculty, while arteries carry the superior form, “arterial blood,” from the heart in order to transmit the vital faculty. See G. Whitteridge,William Harvey and the Circulation of the Blood, London, 1971, 41–5.

  52. “Hippocratis…qui in libello de morbis virginum ait: Huius morbi liberatio est, venae sectio, si nihil obstiterit. Ego vero, inquit, praecipio, virgines hoc morbo afflictas, ut quamprimum viris cohabitent, et copulentur: si conceperint, convalescent: si vero in pubertate hoc morbo non corripientur, tum paulo post eas invadet, nisi viro nupserint… Hoc saluberrimo divini Hippocratis consilio, si medicamenta menses provocantia, et obstructionum aperitiva, sanguinis grossi subtiliativa adiunxeris, nihil his praesentius reperire et excogitare poteris.”

  53. Galen,On treatment by venesection 18 (Kühn 11. 304); see P. Brain,Galen on Bloodletting, Cambridge, 1986, 93. In his London medical practice from 1597 onwards, Simon Forman found many of his female patients had “stopped menses” as a symptom; he avoided blood-letting for this. See Traister, “‘Matrix and the pain thereof’,” 438.

  54. “Quare bono sis animo, filiam tuam elocato: nuptiis quoque libens interero. Vale.,”

  55. British Library, C.40.m.10.(161.).

  56. British Library, C.40.m.10.(163.)

  57. A. Fogo,Observations on the opinions of ancient and modern physicians, including those of the late Dr Cullen, Newcastle 1803, 81.

  58. Janus Cornarius,Hippocratis Coi medicorum omnium longe principis, opera quae ad nos extant omnia, Basle 1546, 286.

  59. De Baillou,De virginum morbis, 67.

  60. Brain,Bloodletting, 93 is wrong to claim that there is only one case of bloodletting in the HippocraticDiseases of women; Dean-Jones,Women's bodies, 142 finds six examples in the three books, to which A. E. Hanson (pers. comm.) has added one more. Dean-Jones never-theless argues that bloodletting is essentially regarded by the Hippocratics as “a remedy for the male body.”

  61. Galen,On treatment by bloodletting 13 (Kühn 11. 290); Brain,Bloodletting, 87.

  62. Galen,On treatment by bloodletting 9 (Kühn 11. 279–80); tr. Brain,Bloodletting, 81.

  63. De Baillou,De virginum morbis, 87.

  64. Galen,On the causes of symptoms 3.12 (Kühn 7. 267).

  65. De Baillou,De virginum morbis, 57.

  66. De Baillou,De virginum morbis, 84–5 discusses the difference betweenachroia, which he takes to mean paleness, andkakochroia, bad coloration coming from the presence of bad humours.

  67. Cornarius,Hippocratis Coi, 286.

  68. John Pechey,Some observations made upon the Bermudas Berries imported from the Indies; shewing their admirable virtues in curing the green-sickness, London 1694, 10.

  69. King, “Bound to Bleed.”

  70. Homer,Iliad 5. 341–2; Aristotle,De partibus animalium 650a 34–5, 651a 14–15; J. Longrigg, “A ‘seminal’ debate in the fifth centurybc?” in: A. Gotthelf (ed.),Aristotle on Nature and Living Things: Philosophical and Historical Studies presented to D. M. Balme, Pittsburgh 1985, 277–87.

  71. Littré 7. 472–4; I. M. Lonie,The Hippocratic Treatises On Generation, On the Nature of the Child, Diseases IV, Berlin and New York 1981, Ars Medica Abt. II: Griechisch-lateinische Medizin 7, 1–2.

  72. De Baillou,De virginum morbis, 68.

  73. Aristotle's Masterpiece, or, the Secrets of Generation, London 1694, 2–3.

  74. J. Sharp,The Midwives Book, London 1671, 326; Brumberg, “Chlorotic girls,” 1473–4 suggests, for the late nineteenth century, that the rejection of meat by “good” girls is seen as “a positive social virtue.”

  75. See for exampleDe alimentorum facultatibus 3.26 (K 6.714).

  76. Mercado,De mulierum affectionibus, 216 and 219.

  77. Aristotle's Masterpiece, 72; Sharp,Midwives Book, 263; cf. Stengel, inTwentieth Century Practice, 348.

  78. W. Bullein,The Government of Health, London 1559, 217. Starobinski, “Chlorosis,” 460 discusses seventeenth-century sources which blame green sickness patients for their condition.

  79. H. King, “The daughter of Leonides: Reading the Hippocratic corpus” in: A. Cameron (ed.),History as Text, London 1989, 23–4; H. King, “Producing woman: Hippocratic gynaecology” in: L. J. Archer, S. Fischler, M. Wyke (edd.),Women in Ancient Societies: An Illusion of the Night, London 1994, 102–114.

  80. Mercado,De mulierum affectionibus, 217.

  81. Varandal,De morbis mulierum, 98–9.

  82. Aetius of Amida,Libri medicinales, 16.61.

  83. N. Fontanus,The Womans Doctour, London 1652, 1.

  84. C. Tardy,In libellum Hippocratis de virginum morbis: commentatio paraphrastica, Paris 1648.

  85. Fox,Observations, 117.

  86. von Noorden,Chlorosis, 523–4.

  87. The alternative Latin disease name for the condition,foedi colores, “ugly complexions,” is significant here.

  88. R. L. Tait,Diseases of Women, Philadelphia 1889, 282–3, cited in Brumberg, “Chlorotic girls,” 1472. This idea is also found in the early sources; for example, Mercado,De mulierum affectionibus, 215–6.

  89. Loudon, “Chlorosis, anaemia and anorexia nervosa,” 1669.

  90. V. Nutton, “Hippocrates and the Renaissance,”Die Hippokratischen Epidemien (Proceedings of the Colloque hippocratique, Berlin 10–15 September, 1984, G. Baader and R. Winau, edd.) =Sudhoffs Archiv Beiheft 27 (Stuttgart 1989), 435.

  91. Nutton, “Hippocrates and the Renaissance,” 426. Cf. Idem, “Greek Science in the Sixteenth-Century Renaissance,” in: J. V. Field and F. A. J. L. James (edd.),Renaissance and Revolution: Humanists, Scholars, Craftsmen and Natural Philosophers in Early Modern Europe, Cambridge 1993, 17.

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  1. Department of History, Liverpool Institute of Higher Education, Stand Park Road, L16 9JD, Liverpool, UK

    Helen King

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Based on papers given at the Third Meeting of the International Society for the Classical Tradition, Boston University, March 8–12, 1995, at the universities of Leeds, Bristol and Birmingham, the Wellcome Unit for the History of Medicine, Oxford, and the University of Michigan Medical Center. I would like to thank the audiences on those occasions for their lively interest, Irvine Loudon for his encouragement when an earlier version of some of this material was presented at the Wellcome Institute, London in 1987, together with Ann Ellis Hanson, the anonymous referee for this journal, and Vivian Nutton for their invaluable comments on the present version. The completion of this article was made possible by the British Academy Research Leave Scheme.

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King, H. Green sickness: Hippocrates, Galen and the origins of the “disease of virgins”. International Journal of the Classical Tradition 2, 372–387 (1996). https://doi.org/10.1007/BF02678065

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