Green Sickness and Virginity

From the mid-16th century to the early 20th century, young girls described as suffering from bodily weakness, dietary disorders, heart palpitations, fainting spells, paleness, and an absence of menstruation (amenorrhoea), were often given the diagnosis of ‘green sickness’, the ‘disease of virgins’. But what was this medical condition? And what can it tell us about the way that female sexuality and puberty were understood in the past? I believe that social and cultural anxieties around young women’s developing sexuality were behind this disease’s construction, and its treatment ultimately aimed to control this sexuality.

But first things first. Medical historians are often asked about the contemporary equivalent of a given condition in the past. But it’s usually a bad idea to try comparing historical sources describing illnesses with how we understand medicine today. Green sickness has been associated with several modern conditions, from anorexia nervosa to pica, malnutrition, or anaemia. However, tempting as they may be, retrospective diagnoses can be misleading. For starters, we can’t assume that all the people described as suffering from the same condition indeed were. But the main issue is that there’s often not a direct contemporary equivalent to diseases of the past.

Our understanding of diseases and the body change more through time than we realise, and green sickness was a disease born out of the humoral understanding of the body, which prioritised fluids over organs as what determined medical conditions. In the case of green sickness, blood (and specifically menstruation) was central. Blockages in the natural economy of fluids, such as menstrual retention, were a serious medical concern. Therefore, it is not surprising that treatments included recipes to provoke menstruation, often using ‘hot and dry’ ingredients, such as onions, ‘red’ sage, betony, or rue. So, where does marriage come into that?

Let’s take a step back and start by thinking of the name ‘disease of virgins’ itself. How do we name diseases? Naming implies defining a condition and, often, gendering it (‘mother’s thumb’ is a great example). ‘Disease of virgins’ implied that it was mainly young women going through puberty who could develop the condition, although not exclusively. The pale colour of the skin was also central in how it was known and remained an important aspect of the description of the disease of virgins. In the early 16th century, it was called ‘white fever’ or ‘green jaundice’, which became green sickness – a disease in its own right rather than a kind of jaundice. The disease was famously associated with virginity in 1554 by the physician Johannes Lange, taking inspiration from Hippocratic writings as well as contemporary vernacular medicine. In the 17th century, with the rise of Greek names for medical conditions (such as catamenia for ‘menstruation’), green sickness became ‘chlorosis’, from the Greek chloros, a yellowish shade of green. Finally, in the 19th century, it was called hypochromic anaemia, and it disappeared from medical teachings and writings in the 1920s and 1930s.

This did not mean that patients suffering from green sickness had green skin, although it emphasised paleness. Letting go of the literal ‘green’, it could also symbolise youth and (sexual) inexperience. And that’s where marriage comes into play. Like fruits turned ripe and left on a tree would rot, girls ‘ripe’ for marriage who remained unmarried were at risk of developing this condition. The English midwife Jane Sharp wrote in 1671 how this disease ‘is more common in maids of ripe years when they are in love and desirous to keep company with a man’.

But ‘green’ could also mean other things. In Shakespearean fashion, it could also signify envy, as young girls could envy older women’s experience and their access to the world of sex (think Snow White, but in reverse!). Besides that, green was also associated with nature, and sex itself (prostitutes were often depicted wearing green in early modern imagery).

Menstruation itself was often referred to as the ‘flowers’, which, following the horticultural metaphor, preceded the fruit (a child). However, the absence of menstruation, one of the main symptoms of green sickness, was an ambiguous sign. What if the ‘innocent’ girl had become pregnant? Contrary to today, the absence of menstruation was not always associated with pregnancy, which would usually only be confirmed by ‘quickening’ (when the pregnant person felt foetal movement). Still, it could raise uncomfortable questions, especially in a patriarchal society where property rights followed a patrilineal logic. It’s not surprising, therefore, that if a young girl stopped menstruating, marriage was advised. This allowed socially and religiously accepted sexual activity, which was thought to have medical benefits to women while keeping them firmly in the role of wives and mothers.

So… was the ‘disease of virgins’ just a convenient excuse to police female sexuality? That would be too simplistic, yet it is striking how many conditions would fit this mould. Nymphomania, which became a prominent disorder from the 17th century, was also gendered, affecting women and young girls – coincidentally, particularly when they started menstruating. Masturbation was an important symptom and again, this condition was also best treated by marriage, which kept developing sexuality within a heterosexual and patriarchal institution.

But green sickness patients were described in a very different way to nymphomaniacs. Like many other medical conditions (think of Victorian ‘hysterical’ women), this was a disease of ‘delicate femininity’, which could even make girls more attractive, by underlining their fragility and getting them closer to the feminine ideal. In the construction of the ‘disease of virgins’, the emphasis on paleness was central, and the racial aspect shouldn’t be underestimated. This was a disease connected to whiteness: patients had a pretty ‘rosy and white’ complexion. Physicians described the beauty of their patients, who were often blondes. Besides race, there was a class element at play as well: green sickness was rarely diagnosed in countrywomen, who were thought to be stronger and used to more physical work. Green sickness was a disease of ‘weak’, ‘fragile’ people. It could even affect ‘feeble boys’, although this was much rarer. For instance, Shakespeare mentioned male green sickness in Henry IV Part 2, describing these young men as ‘fools and cowards’. Misogyny meant that a man suffering from this disease was effeminate and fragile, and his masculinity was threatened.

Young girls suffering from the ‘disease of virgins’ were described as passive and submissive by physicians, often in an eroticised way. These inexperienced girls were in sharp contrast to the ‘difficult’ hysterics of the late 19th and early 20th centuries described by Freud and other psychoanalysts. The innocent patient suffering from green sickness was much more pliable than the more sexually experienced, ‘manipulative’ hysterics. However, both conditions were heavily gendered, relied on misogynistic ideas, and could be treated in similar ways (such as with electric shocks).

How a society constructs medical conditions can give us insight into how the body is understood. In the case of the female body, it is not unusual for medical discourse to find ‘natural’ ways of explaining women’s inferiority to men, or to justify our role in the domestic sphere, as wives and mothers. The ‘disease of virgins’ was not a stable category: the perception of symptoms, causes, and appropriate treatments varied depending on time and place. Because of the vagueness and variety of how symptoms presented, this diagnosis could mean many different things. At certain points in time, virtually any girl behaving like a moody adolescent could be diagnosed as suffering from green sickness. This was also true for hysteria. Medical categories shift with time, often reinforcing gender norms under the guise of biology.  As its name indicates, the ‘disease of virgins’ was thought to affect primarily pubescent girls, whose sexuality was starting to develop. The easiest ‘treatment’ was therefore marriage and socially sanctioned sexual activity, which ensured the status quo wouldn’t be too disrupted by these ‘desirous maids’.


Jane Sharp, The Midwives Book (London: 1671).

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

Johannes Lange, ‘De morbo virgineo’, in Medicinalium epistolarum miscellanea (Basel: 1554).

Luis Mercado, De mulierum affectionibus, (Cordoba: 1579).

Further reading:

Helen King, The Disease of Virgins: Green Sickness, Chlorosis and the Problems of Puberty, (London: Routledge, 2004).

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Key Concepts

What is the Humoral Theory?

‘He was trying to gather up the scarlet threads of life and to weave them into a pattern; to find his way through the sanguine labyrinth of passion through which he was wandering’
(The Picture of Dorian Gray, Oscar Wilde)

Humours are everywhere. People can react cholerically to an insult, music can make us melancholic, time with friends can lift our spirits, and we can be in good or bad humour. This is not surprising. The humoral theory has a long history, beginning with the Greek Hippocratic writers in the fifth century BC, being reinterpreted by the Roman physician Galen in the second century AD. Humorism survived thanks to its translations into Latin in the medieval period and started to be taught in the newly founded universities. Later, the humoral theory was incorporated into vernacular medical texts in the early modern period. It remained the primary way to conceptualise medicine and the body until well into the nineteenth century.

For over two millennia, humorism (or humoralism) was the framework within which people thought about and practised medicine, especially in the West. It is the backdrop for most of our discussions about the history of medicine and gender, which is why it is such an important topic. So, what were the humours?

The humours were fluids or spirits (humon in Greek means fluid) concocted in the stomach in the heat of the digestion, which circulated in the body. There were four humours: blood, phlegm, yellow bile (choler), and black bile (melancholy). All bodies contained the four humours but in different proportions, which could vary according to gender, age, and the season of the year. Each person had a different combination of humours, which determined their temperament, personality, and physical health: humorism saw the mind and body as deeply connected. This is why we still have adjectives such as melancholic, choleric, sanguine, and phlegmatic to describe people.

The humours were associated with the natural world, such as seasons and elements, but they also corresponded to a life stage and a specific organ. This web of connections was the basis for how illnesses would be treated. Foods deemed hot, such as spices and red meat, could be used to treat an excess of phlegm or melancholy, heating the body. (For the same reason, they could act as aphrodisiacs.) On the other hand, cucumber and melon would be appropriate to counteract an excess of yellow bile. Physicians could also advise patients to change their location, going somewhere where the weather was more suited to treat their condition.

HumourBloodPhlegmCholer (yellow bile)Melancholy (black bile)
Life StageChildhoodOld AgeYouthMaturity
Personality Traits Brave
Astrological BodyJupiterMoonMarsSaturn

The delicate balance of humours determined a person’s natural good health; therefore, illness was contra-natural, often resulting from a humoral imbalance. Besides changes in their diet and environment, physicians could prescribe herbal remedies to counteract their patient’s condition. Moreover, if a humoral excess or lack caused illness, physicians recommended treatments such as enemas, emetics, purging, and bloodletting to restore the lost balance. Besides that, they gave patients specific advice about diet, exercise, and sleep, which might help rebalance their humours. Some of these medicines might shock us today – the use of leeches to treat haemorrhoids comes to mind! – but they mainly consisted of empirical knowledge adapted to fit the humoral understanding of the body.

For instance, menstruation was deemed essential for women of fertile age, as it was the body’s natural purgation. This is why amenorrhea (the lack of menstruation) was usually considered a serious medical concern, as blood would accumulate in their bodies and cause illness. Herbal remedies to stimulate uterine contractions and provoke menstruation were ubiquitous in medical texts: saffron, parsley, pennyroyal, cinnamon, cyclamen, and mugworts were some of the ingredients in these formulas. 

Humorism changed through the centuries, combining local influences and merging traditions. However, for centuries, the four humours’ paradigm was orthodoxy among physicians, surgeons, midwives, and patients alike. It was challenged at times, such as by the rise of chemical medicine and Paracelsianism in the sixteenth century. Still, it remained central to how the body was understood in premodern times. It was a deterministic system: people might treat illnesses but not change their physical and psychological makeup.

Humours do not survive only in our language. Humorism underpinned how the body was understood, both in physiological and psychological terms, for centuries, until the germ theory of disease supplanted it. Humours went beyond the medical domain, shaping how we think about the body and surviving perhaps most clearly in the arts and literature. For instance, as Shakespeare’s Richard II asked people to achieve a bloodless resolution to their conflict, he referenced physicians’ bloodletting practices. This play on words between purging excessive blood and a bloody fight would have been clear to Shakespeare’s contemporaries:

Wrath-kindled gentlemen, be ruled by me;
Let’s purge this choler without letting blood:
This we prescribe, though no physician;
Deep malice makes too deep incision;
Forget, forgive; conclude and be agreed
(Richard II, Shakespeare)

After the Enlightenment and the Industrial Revolution, a new mechanical understanding of the body, conceptualised as a machine composed of parts that could be disassembled, replaced the humoral system. The germ theory became the primary way to understand diseases, made possible by technological advances and more precise microscopes in no small measure. However, we have also seen a return to a more holistic understanding of the body over the last fifty years. Medical practitioners and patients alike have started to explore alternative medical models inspired by traditional Chinese and Ayurvedic medicine, which consider individuality and understand the body as a whole. This is not a return to humorism as it used to be centuries ago; still, it is striking how Hippocratic doctors would approve of this paradigm change.


Galen, De Temperamentis. Translated by P. N. Singer and Philip J. van der Eijk (Cambridge: 2018).

Hippocrates and Heracleitus. Nature of Man, Regimen in Health, Humours, and Others. Translated by W. H. S. Jones (Cambridge, MA: 1931).

Jacques Jouanna, Hippocrates (London: 1999).

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