¹ Hippocrates, , Oeuvres complètes, transl. by Littré, E. (Paris, 1861), vol. ix, pp. 64–65.Google Scholar See also Coan Prénoiions (1846), vol. v, pp. 656–657.Google Scholar

² Hippocrates, , Oeuvres complétes (Paris, 1853), vol. VIII, pp. 466–471.Google Scholar

³ Johann, Lange (Langius) (1485–1565), Medicinalium epislolarum iniscellanea (Basel, 1554).Google ScholarThe morbus virgineus is described in Letter XXI, pp. 74–77.Google Scholar

⁴ Mercatus, De mulierum affectionibus (Venice, 1587), book II, cap. 6Google Scholar: ‘De febre alba et de virginum obstructionis’ (Sic), pp. 201–218. This disorder, he says, affects the most beautiful women and it is difficult to account for it.Google Scholar

⁵ Ambroise, Paré, Les oeuvres (1561). We quote from the 8th edition, Paris, 1627. Chlorosis is discussed in book XXIV, De la génération.Google Scholar

⁶ Varandal, J. (Varandaeus), De morbis et affectibus mulierum (Geneva, 1620), ch. 1, pp. 1–2.Google Scholar

⁷ Paré, , Les oeuvres, book xxiv, ch. 64, p. 985.Google Scholar

⁸ This line from Ovid's Art oj love, book 1, p. 729, had already been quoted by Lange and by Mercato. It was to be repeated, in reference to chlorotic patients, up to the end of the nineteenth century.

⁹ Varandal, De morbis et afflctibus mulierum. An excellent twentieth.century physician, Professor Maurice Roch, quotes the following lines said to have been composed for the tomb of a chlorotic girl:

Pauvrc fille, que je te plains

Dc mourir d'une maladie

Dont il est tant de medecins.

(Poor girl, how I pity you, Dying from a malady For which there are so many physicians.)

¹⁰ de Montaigne, M., Essais, ed. Villey, P. (Paris, 1965). vol. I, ch. XIV, p. 60.Google Scholar

¹¹ Lazare Riviére (1589–1655) of Montpellier, was a disciple of Varandal. His Praxis medica was edited in Paris in 1640. Our quotation is from La pratique de Ia médecine, transl. Deboze, F. (2 vols., Lyon, 1682), vol. II, book xv, ch. I, pp. 318–327.Google Scholar

¹² Daniel Sennert (1572 – 1637) was regarded as an arbiter between the Galenic (radition and the iatrochemistry derived from Paracelsus). The quotaiion is from Operaomnia (3 vols., Lyon, 1560), vol. III, Practicae medicinae, book IV, part II, sect. III, cap. II. De morbo virginco seu febre alba, et foedis virginum coloribus, pp. 79–84.

¹³ Iron, associated with the God Mars and the Planet of Mars, was closely studied by the early chemists, such as Libavius (1560–1616) who praised its therapeutic properties.

¹⁴ Our quotation is from: Renaudot, T., Recuell général des questions traitées es conférences du Bureau d'Adresse (4 vols., Paris, 1655), vol. II, pp. 825–831.Google Scholar

¹⁵ Ibid.

¹⁶ Ibid. This passage provides an excellent illustration of the causal system of Ancient Medicine, going back at least to Galen. Coquetry in young girls and their choice of ‘bad food’ belong to the category of procatarctic (procatarctiques) or immediate causes. ‘Mucous, viscous blood’ is the pre-existing, internal cause, also called the predisposing cause. Thanks to this system of causality, Ancient Medicine was also able to invoke the passions, the effects of climate, ‘erroneous ways of life’, as external, immediate causes. Starobinski, Cf. Jean; ‘The history of passion’, in La Passion; Nouvelle revue de psychanalyse 21 (Paris, Spring 1980), pp. 51–76.Google Scholar

¹⁷ Riviére, La prarique de la médecine.

¹⁸ Encyclopédie méthodique, serie Médecine, vol. IV, 1792, article on Chlorosis by N. Chambon: he praises the good effects of riding, expressing the wish that ‘girls would ride in the same way as men’ and adding: ‘Dancing is an agreeable pastime for nearly all women; it is a salutary one for chlorotic girls. One must recognize that the rhythm which dictates measured steps also lessens the fatigue, because movement which has no uncertainty is easier to endure.’ We come later to remarks of which the social significance is inescapable: ‘When the heart is preoccupied by a nascent passion, functions languish and the circulation is so weak that it can be destroyed by this tiring concentration of attention on one and the same object. It is then wise to have a multiplicity of diversions, in order to prevent too strong an affection; but this precept is difficult to carry out. There is another remedy, which is to choose one's associates so that they consist only of persons who come together in order to avoid dangerous passions which parental control is unable to destroy, and often only strengthens, and which often lead to fatal excesses if the women experiencing them are forced to conceal them from those around them.’ There is clearly a romantic side to chlorosis. Marriage in these circumstances seems to be the antidote of passion: ‘Since it is commonly observed that amorous pleasures induce menstruation, marriage would seem to offer a cure in cases of chlorosis. It would also afford a useful means of ending the destructive effects of a strong passion which would have caused disturbances of function that would prove harmful to the preservation of health.’ There was another remedy which received equal commendation and which employed medical justification for the artistic education of young girls: ‘Among the pastimes which can divert the mind from love, the study of the fine arts also offers a possible entertainment if the patient belongs to a class which is able to indulge in it; but it must not be forgotten that the weak state of a chlorotic girl makes it impossible for her to restrict herself for a long time to a single occupation and often precludes movement. This does not apply to some movements which provide a certain amount of exercise, such as singing, playing instruments, etc.’ (pp. 823–824). See also Tissot, A., Avis du peuple (2 vols., Lausanne, 1792), vol. II, ch. XXVI, pp. 34–47.Google Scholar

¹⁹ Chambon, , Encylopédie méthodique, p. 820.Google Scholar

²⁰ These methods are mentioned by DrColombat, de l'Isére, in his Traité complet des maladies des femmes (Paris, 1843), pp. 1006–1017.Google Scholar He quotes them, but does not approve of them. His preferences lie, reasonably enough, in good and abundant food, in a ‘dry, airy environment, with plenty of sun and, above all, living in the mountains’. He favours walking, dancing, sea bathing and the mental distractions afforded by travel. His prescriptions for good hygiene are not entirely free of moral considerations: he is against ‘too tight corsets’, too much sleep, beds that are too warm or too soft, ‘particularly for those whose chlorotic state is maintained under the influence of contrary love’. He goes on to enumerate further prohibitions – those which might possibly serve to nourish a passionate state of mind: ‘One should forbid stimulating drinks, the use of wine. overrich food, lively emotions, attendance at balls and playhouses, the reading of too passionate novels and the viewing of lascivious pictures; finally, one should avoid all possible circumstances that might arouse emotions and excite too ardent passions. It is precisely in these cases that one must insist on warm drinks, warm baths and above all constant distraction of the mind.’ This rather stern regime is coupled, fortunately, with pharmaceutical treatment in which iron features prominently in its various forms (especially Blaud's pills, the forerunners of the P.P.P.P.P.P. – ‘petites pilules pink pour personnes pâles’ (little pink pills for pale persons). N.B. Flaubert to Louise Colet: ‘We should all take iron to rid us of the gothic chloroses transmitted to us by Rousseau, Chateaubriand and Lamartinc.’

²¹ Labat, L., article on Chlorosis in the Dictionnaire de le conversation (Paris, 1834), vol. XIV, pp. 157–161.Google Scholar

²² Trousseau, A. and Pidoux, H., Traité de thérapeulique (2 vols., Paris, 1862), vol. II, p. 102.Google Scholar

²³ Hutinel, V., Les maladies des enfants (5 vols., Paris, 1909), vol. II, pp. 464–476.Google Scholar

²⁴ Boissier de Sauvages, F., Nosologie méthodique (3 vols., Paris, 1771), vol. III, pp. 460–467.Google Scholar For Sauvages true chlorosis was still governed by menostasia (suppression of menses). He maintains that in addition to ‘true paleness of colour’ there is a variety which he calls ‘chlorosis of love’: it ‘affects girls who feel the pangs of love: it is accompanied by profound melancholy, love of solitude, continuous sadness, and a mind that dwells constantly on the object of desire’.

²⁵ Gardien, C.-M., Dictionnaire des sciences médicates (Paris, 1813, Panckoucke), vol. v, pp. 129–137.Google Scholar Moreau de Ia Sarthe defends the same theory in his article on ‘Pale complexions’ in the Encyclopédie, méthodique, vol. XI. He criticizes the article on ‘Chlorosis’ published by Chambon in 1792 in the same dictionary and, following Ballard and Chaussier, he incriminates ‘the profound and possibly neuralgic change in the digestive organs’. One may thus say that the dominant theory at the beginning of the nineteenth century was that invoking a gastric or digestive cause, which itself was influenced by moral or emotional factors. Hence the possibility of supporting a psychosomatic causal chain.

²⁶ The fact that editions of Sydenham, the English Hippocrates (1624–1689), were still being published in 1838 gives us some idea of the longevity of medical theories before the era of experimental medicine. Our quotation is from La médecine pratique de Sydenham, transl. Jault, A.- F. (2 vols.,) Montpellier, 1838), vol. II, pp. 157–158.Google Scholar The ‘spirits’ of which Sydenham speaks are of course the ‘animal spirits’ of Galenic tradition, a subtle vapour produced from the blood or from the ‘natural’ spirits formed in the heart. For Cullen, by contrast, chlorosis was a kind of hypochondriasis, and hypochondriasis was a ‘state of the soul’. Cf. Cullen, M., Elements de Médecine prailque, transl. Bosquillon, E.-F.-M. (2 vols., Paris, 1787), vol II, pp. 299–312.Google Scholar Cullen's translator and editor adds a note in which he disagrees. The note is worth quoting. since for the modern reader it presents a strange mixture of ‘correct’ intuition and ‘erroneous’ hypotheses: ‘It must be said that in this disorder there seems to be a deficiency in the red cells of the blood and even a lack of a due amount of coaguable lymph; this is why the most fluid parts of the blood separate and give rise to anasarchia (anasarque). We cannot attribute chlorosis to the stomach or the alimentary canal, since it is not preceded by a loss of appetite. It seems to exist in the viscera which are involved in the preparation of chyle: but it is the uterus which determines whether these viscera are affected’ (p. 11).

²⁷ Colombat, de l'lsere, Traité complet des maladies des femmes (Paris, 1843), pp. 993–994.Google Scholar Here we have the familiar reference to Ovid, as in Mercato, Varandal and others. These views recur even in L'Héritier, S. D., whose Traité de chimie pathologique (Paris, 1842)Google Scholar may be regarded as a very modern book: ‘It is possible that there is some other less perceptible change which is connected no doubt with the nature of the ganglionic nervous system or the system in which all the disorders examined seem to have their origin’ (p. 249).

²⁸ Poujol, F.-A. A., Dictionnaire des facultés intellectuelles et affectives de l'âme, Encyclopédie théologique (Migne) (Paris, 1849) vol. XXXIX, col. 634–635.Google ScholarAndré, Tissot, in L'onanisme (7th edition, Lausanne, 1781, pp. 60–61)Google Scholar, emphasizes the thinness, pallor and weakness of masturbators. He prescribes, in addition to fresh air and exercise, iron (or ‘Mars’), quinine, camomile.

²⁹ Trousseau, A., Clinique médicale de l' Hótel-Dieu de Paris (3 vols., Paris, 1865), vol. III, lesson LXXXV, on true and false chloroses, pp. 492–507.Google Scholar

³⁰ Ibid. pp. 498–499.

³¹ Parrot, J., in Dictionnaire encyclopédique des sciences médicales, ed. Dechambre, A.(Paris, 1876), vol. XVI, pp. 699–719.Google Scholar

³² Huysmans, J.-K., A Rebours, ed. Marc, Fumaroli (Paris, 1977, Gallimard), coil. Folio, p. 80.Google Scholar

³³ Brochin, H., article on ‘Passions, moral affections’, in Dictionnaire encyclopédique des sciences médicales, ed. Dechambre, A. (Paris, 1876), vol. LXXIII, pp. 524–525.Google Scholar

³⁴ The word anaemia has existed in zoology since the days of Aristotle. It is used by some seventeenth-century writers to designate a fail in the total quantity of blood, or to denote an ‘epidemic’ ‘disorder of a particular type (the miners’ ‘disease in the mine of Anzin’, described by Hailé). Cf. the Dicrionnaire des sciences médicales (Paris, 1813, Panckoucke) vol. II, article on ‘Anaemia’. For the quasisynonymous nature of chlorosis and anaemia, see Bouillaud, , De la chlorose et de l'anaemie, Académic de Médecine, 15 February 1859Google Scholar, and the article on ‘Anaemia’ (written by C. Potain), in vol. IV, of the Dictionnaire encyclopédique des sciences medicates ed. A. Dechambre (Paris, 1876), 327–406.

³⁵ Jaccoud, F. S., De l'humorisme ancien comparé à l'humorisme moderne (Paris, 1863), pp. 99–100.Google Scholar

³⁶ Harrison's Principles of Internal Medicine, ed. Kurt, J. (7th edn, McGraw-Hill, 1974), p. 1582.Google Scholar

³⁷ Hufeland, C.-G. (1762–1836), Enchiridion medicum, ou manuel de médecine pratique, transl. Jourdain, A.-J.-L. (Paris, 1838), pp. 500–501.Google Scholar Hufeland was one of those physicians who thought that the disease may be ‘produced by onanism’. To iron therapy he then added ‘a diet of succulent meat’.

³⁸ Reallexikon der Medizin, ed. Thiele, G. and Walter, H. (Urban-Schwarzenberg, 1967), col. 102.Google Scholar For the medical history of chlorosis from the middle of the 19th century, see Eugene, Stransky, ‘On the history of chlorosis’, Episteme (Milan), January – March 1974, vol. VIII, pp. 26–45.Google Scholar References to the history of chiorosis in English literature are to be found in the very detailed article by Robert, P. Hudson, ‘The biography of disease: lessons from chlorosis’, Bulletin on the History of Medicine 51 (1977), 448–463.Google Scholar For the history of gynaecoiogy, with which chiorosis is so closely associated, see the Esther, Fischer-Homberger'sKrankheit Frau (Bern, 1979, Hans Huber).Google Scholar