Chlorosis, anaemia, and anorexia nervosa.

Abstract

For nearly four centuries a disease known as chlorosis, the green sickness or the virgin's disease, was commonly recognised. There are many references to it in literature and art from the sixteenth to the nineteenth centuries1-8 and numerous clinical descriptions by physicians. Until the middle of the nineteenth century there was, however, no general agreement on the cause of the disease; then, after the development of haematology it was believed to be a form of hypochromic anaemia confined to young women. When the mystery of its aetiology seemed to have been solved, however, it was succeeded by another mystery: chlorosis, which had reached "epidemic proportions" throughout the eighteenth and nineteenth centuries,4 suddenly began to decline at die beginning of this century. Within two decades it had to all intents and purposes disappeared.6 Although various explana tions were offered for its disappearance (usually along the lines of improvements in diet and living conditions) Witts remarked as recently as 1969 that "one is left with the uneasy feeling that the mystery of chlorosis, like that of Edwin Drood, remains unsolved."4 Ths history of chlorosis is more clearly understood if it is divided into four phases : (1) In the first phase, before 1750, it was described as the "disease of virgins" or the "febris amatoria," a disorder due to "unrequited love." (2) In the second phase, roughly 1750 to 1850, it was generally believed to be a uterine disorder or a disorder of menstruation characterised by amenorrhoea. (3) From 1850, with a complete change of ideas, it was considered to be a special form of anaemia peculiar to young women.