Clinical Manifestations

A historical example of a disease that died only to leave behind a host of sprightly ghosts is the "green sickness" or chlorosis. Although noted in two Hippo-cratic treatises, Prorrhetic and The Diseases of Girls, the condition received its now classic description by Johann Lange in 1554 (Hippocrates 1853, 1861). He called the condition morbus virgineus. His description contains many of the elements found in the Hippocratic texts, as does the account by Ambroise Paré in 1561. Also reflecting the Hippocratic corpus is the work of Jean Varandal who is credited with first using the word "chlorosis" in 1615 (Starobinski 1981). For Varandal, chlorosis was a class of syndromes.

Reflecting a different approach, Thomas Sydenham's description in 1683 embodied many of the clinical features relied upon at least two centuries later:

The face and body lose colour, the face also swells; so do the eyelids and ankles. The body feels heavy; there is tension and lassitude in the legs and feet, dyspnoea, palpitation of the heart, headache, febrile pulse, somnolence, pica, and suppression of the menses. (Sydenham 1850)

The actual clinical entity was only defined later, by Friedrich Hoffmann in 1731.

After centuries of nosologic confusion, chlorosis was associated almost entirely with Caucasian girls encountering puberty. Still, from clinical observations alone, the etiology remained obscure. Inconsistencies abounded. Not all young women developed the disease at the age of menarche. It struck the rich as well as the poor. Some, but not all, suffered a morbid appetite termed pica (the consumption of stones, clay, chalk, and other substances of no nutritional value). Even into the nineteenth century, confusion permeated medical thinking about chlorosis. The ailment has been likened to a lion in elephant grass; all physicians heard its roar, but none could delineate it with absolute certainty. S. Ashwell opened his lengthy analysis in 1836 by saying. "Disease of menstruation, especially chlorosis and amenorrhea, are, in this country, of very frequent occurrence. . . . They are too greatly neglected in their early stages, when they are most curable; and lastly, there is by no means an agreement of professional opinion as to their exact nature."

By the time of William Osier later in the century, medical opinion was far more confident. The clinical features of chlorosis had been distilled to the point that in many instances the condition could be "recognized at a glance" (Osier 1893).

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