A Cultural History of Anemia

A few weeks back, I spotted this picture floating around social media. When viewed from our position of extreme temporal privilege, from a world of Big Macs and modern medical knowhow, the idea of eating a heart for medicinal purposes is pretty funny. But even as I laughed, I got to thinking about how great a problem iron-deficiency anemia ¹ has been for women historically, and still IS for many women around the world (even a surprising number here in what is so irritatingly called “the first world” – a whopping 10%).

To this very day, anemia is one of the most common nutritional deficiencies in the world and while men can become anemic, it most often affects women of childbearing age.

Anemia — it’s a women’s issue, and as such, it seemed worthy to me of a closer look.

Many people look back at history and see women as hapless victims of patriarchy. Most people attribute a lack of historically important accomplishments by women as signs of misogynistic oppression — and sexism certainly comes into play. But the biggest oppressor of women throughout time, at least where precious iron is concerned, has been Mother Nature herself.²

Women have menstrual cycles that cause us to lose a fair amount of blood every month, and we also can become pregnant — miscarriage, pregnancy, childbirth, and the postpartum period also make great demands on our iron stores. Women may have endometriosis and fibroids that can cause heavy internal blood loss. We are far more likely to have autoimmune disorders which negatively affect the body’s ability to store and use iron effectively. We are also at greater risk of disordered eating which can both reduce the amount of iron we take in, and also can affect the body’s ability to absorb iron from foods and supplements. A whole lot of women even here in 2020 are anemic or close to it all the time, walking around in a perpetual state of mild, moderate, or even severe iron deficiency, bearing the burden of chronic illness even though it’s something no one can see from the outside.

Being chronically anemic sucks. I know this because I’m prone to anemia myself. Anemia makes you feel tired all the time; it saps your strength and your motivation. Your heart races as it struggles to carry oxygen through your body, making you feel anxious or irritable, and anemia also revs up your sympathetic nervous system, further contributing to feeling emotionally unstable. Your muscles grow weak and you get exhausted from simple tasks but at the same time it’s harder to fall asleep because you’re anxious and your heart is pounding. Your mind is less sharp because your blood carries less oxygen, so less gets to your brain. Memory grows unreliable, you become easily confused especially in stressful situations where your body requires increased blood flow, and it becomes difficult, well-nigh impossible to concentrate. Reduced oxygen makes your hair fall out and gives you severe headaches and makes you feel cold even in warm rooms. Ironically, your periods may get heavier as your blood stops clotting well — a state of affairs that also leads to heavy bruising and longer bleeding times, further aggravating the anemia.

Being anemic is life-disrupting state of affairs, all the more awful for how sneaky it can be. The characteristic paleness of anemia takes a long time to develop and the other symptoms are so vague they’re easily waved away as the result of a busy lifestyle, stress, aging, pregnancy, depression. Women with anemia often walk around sick for months, even years, generally with no idea they’re anemic until their doctor tells them. But once you start taking those iron pills, you feel suddenly, miraculously better. It’s only in retrospect you realize how poorly you actually were.

It’s possible to become anemic, even severely anemic, eating a normal, healthy diet; even taking standard multivitamins isn’t enough to keep it at bay for some of us. I truly wonder what life was like for those women who lived in 1940 or 1840 or 1740 who had to live with anemia day in and day out their entire lives while simultaneously enduring parasitic infections and rancid food and dirty drinking water. There are skeletons dating back thousands of years that show signs of severe anemia. Anemia has been a health crisis for women probably as long as there have been women. As funny as that old sign is, historically, anemia is no joke.

Most of us have read about the old medical diagnosis of hysteria dating back to the ancient Greeks. If you haven’t, it was basically the idea that the womb could come loose and wander around causing trouble inside the body, picking fights with the kidneys and casting aspersions on the stomach and challenging the spleen to a duel. Later on, once doctors discovered that this wasn’t actually a thing, rather than give up on the notion of women as perpetually unhinged, they decided that hysteria was a mental illness instead.

Thanks, Freud!

Women deemed hysterical were even committed to insane asylums and forced to have hysterectomies against their will. The cure for hysteria was having the cervix bathed in semen, or female orgasms WHICH DOCTORS WERE TRAINED TO BRING ABOUT WTAF, or both, depending on what era’s medical book you happen to be reading. The concept of hysteria hung on for quite some time, well into the 20th century. It wasn’t dropped from medical terminology until 1952. Less than 75 years ago, some doctors still thought hysteria was a thing. (and some still do, amirite ladies? Badump-bah fading into sad trombone)

It’s amazing how closely the medical description of hysteria meshes with anemia — anxiety, lack of emotional control, shortness of breath, fainting, loss of appetite, irritability, insomnia, lassitude (that’s a polite word for laziness). There were also reports of both hypersexuality — which I tend to discount because of the way female sexuality was pathologized throughout history — and low sex drive which is definitely a thing with anemia since any physical exertion when your body is lacking oxygen is not exactly a turn on.

I am coming around to the way of thinking that a lot of psychological maladies that women supposedly suffer from — like hysteria — are actually real diseases doctors haven’t bothered to discover yet. After all, I was treated like I was crazy for years only to find out I had a heart problem, 2 autoimmune diseases, and anemia severe enough to actually affect the way my fingernails were growing. I had actual observable physical symptoms anyone could see with the naked eye, yet no one cared to hear about them since they were so busy trying to prescribe me benzos instead. If it happened to me, it seems well within the realm of possibility it could have happened to women a century ago.

Thus I began to wonder, could that ancient diagnosis of hysteria really just be anemia mixed with a distrust of women’s sexuality?

Delving into the literature with this possibility in mind, I discovered an entirely separate phenomenon from hysteria called chlorosis, also known as “green sickness” or “virgin’s disease”. Chlorosis was a medical condition purported to affect primarily teenage girls prior to marriage, but which could also affect “slender and weakly women that seem consumptive” as one doctor put it. One of the hallmarks tended to be pallor that was described by some as greenish in hue, particularly in women with olive complexions. When doctors looked at chlorotic blood under a microscope, they described small red blood cells that couldn’t carry adequate oxygen.

Another hallmark of green sickness was that a girl’s period either went missing or did not arrive in a timely fashion. While anemia is not believed to cause irregular cycles itself, spotty cycles can and often are caused by poor nutrition — and it doesn’t even take super poor nutrition for it to happen. Women even here in 2020 have their period go missing when they diet, exercise a lot, or lose more than a few pounds (or only a few pounds if they’re thin to start with). Anemia and irregular menstruation can easily occur simultaneously since they’re both caused by less than optimal nutrition.

The operating theory was that chlorosis – or as we call it today, hyperchromic anemia , was caused by a buildup of menstrual blood behind the hymen. This was why one of the common names for chlorosis was virgin’s disease, and why marriage was considered a cure. Get rid of that pesky hymen, the experts believed, and that would allow the menstrual blood to flow freely. Unfortunately another “cure” for chlorosis was bloodletting, which obviously would be pretty much the worst thing for anyone who was anemic. Before bloodletting fell out of favor, doctors more often aggravated chlorosis than cured it.

It’s now believed by most researchers that green sickness is really anemia. The description is spot on — lassitude, fatigue, inability to walk very far, fainting (lest we forget, a good number of these women would have been wearing corsets, reducing oxygen intake even further, not to mention suffering from a variety of other nutrient deficiencies and parasitic infections), heart palpitations, trouble breathing, and of course that characteristic pallor that some described as “green”. Most important, doctors could look through a microscope and see, actually SEE the misshapen red blood cells incapable of carrying oxygen.

That much of the story alone made for very interesting reading, but as I did my research I found a disturbing thread. A lot of folks — including some who would describe themselves as feminists — seemed to be blaming the victims of chlorosis for the phenomenon as much or more than they were the doctors who were possibly overdiagnosing it.

By blaming the victims, I mean that they were suggesting that these women of the past were hypochondriacs, exaggerating their illnesses or making them up entirely to get attention. One study called green sickness a “cultural construction” and claimed girls “learned to have the disease from other girls and family expectations”. Feminist bastion The Mary Sue doubted the disease even existed because people didn’t actually turn green (there is much debate about this, but it’s believed that it was called green sickness for a variety of reasons and a only minority of people actually turned a greenish tone — you know, kind of how we say people have “colds” even though they aren’t actually cold.) The Mary Sue also belittled one of the remedies — drinking “steel water” – without explaining to their readers that it was a common old-school way for anemic people to ingest iron.

And Kyra Kramer — a woman who wrote not one, but TWO books on how health issues may have influenced Henry VIII’s behavior — disdainfully claims that chlorosis became a disease of “femininity” and the “girly”, slammed women who suffered from chlorosis as being “dainty, timid, passive”, lacking in “emotional fortitude” and claimed that Jane Austen’s heroine Fanny Price would have (in a hypochondriacal way) surely suffered from green sickness because she had trouble walking very far without getting out of breath, had little appetite, had headaches, cried easily, and suffered from anxiety.

You know, just like people with anemia might.

Here’s a thought: maybe some women in history were dainty, timid, and passive because they were freaking sick and weren’t up for a confrontation when they were trying not to faint. Maybe the women of the past weren’t all fakers and malingerers, maybe a good percentage of them were actually physically ill. People up until very, very recently were going through much of their lives on the brink of death. They got sick and died from hangnails. Babies got sick and died from cutting teeth. Cosmetics containing lead and mercury were commonplace. They lived for decades with diseases like tuberculosis and syphilis. We can’t just dismiss women of the past as behaving like stereotypical “consumptive waifs”, if they ACTUALLY WERE consumptive waifs. And while we can certainly sit around and debate the possibiity that some of the young women diagnosed with chlorosis might have been exaggerating their illnesses due to a teenage flair for the dramatic, I’d wager that a fairly high proportion of them were actually suffering from disease(s) that medicine at that point in time didn’t fully understand. As I mentioned before, anemia can happen alongside or as a result of lots of other illnesses/deficiencies/infections, making it impossible to go back through historical records and declare chlorosis even just partly psychological because the fact is we cannot know.

Since this is a cultural history, and we’re living in both culture and history ourselves, our modern attitudes towards the chlorotic girls seems worthy of examination. And upon examination it seems a pretty arrogant position to take, assuming that we know what is happening inside another woman’s head, particularly a woman who lived in dramatically different circumstances than we did. It doesn’t seem very different from the attitudes of those olden times doctors who decided that the cure for a woman’s mental illness was a healthy dose of semen or a hysterectomy for the truly stubborn. Rolling our collective eyes at namby-pamby, lily-livered girly-girls swooning on chaises seems to me to be just as sexist a take as hysterical wombs wandering around wreaking havoc.

Ok maybe not JUST as sexist, but still pretty darn sexist nonetheless. We are looking back through the mists of time and seeing women — our fellow women — as not only victims of sinister medical manipulations, but WILLING victims. Self-described feminists are judging our female forebears in absentia, and declaring them as hypochondriacs, as FAKERS, as weaklings and wimps and wussies. And they’re doing it from a position of immense privilege as well-fed, well-rested, and cozy warm people without hookworms, tuberculosis, and with an excess of iron flowing through their veins.

I will go to my grave wondering how it is that we as feminists could (rightfully) reject one overly narrow acceptable definition of “femininity” in which other ways of being a woman are devalued, only to embrace another overly narrow acceptable definition of “femininity” in which other ways of being a woman are devalued. It’s super awesome that being a strong, assertive, physically powerful woman brimming over with vim, vigor, and verve is celebrated here in 2020, but can we maybe try to celebrate those qualities without mocking and diminishing women who don’t happen to fit in that category? Can we not include women who are limited by physical weakness or health challenges, women who are shy or anxious or emotional, women who are perhaps…dare I say it, girly…within the bounds of our sisterhood? Can we resist the temptation to look back at the women who came before us — women who faced challenges we can’t even imagine — as our inferiors, writing them off as crazy, lazy drama princesses because they didn’t smash the patriarchy in the ways we imagine we would have had we walked in their shoes?

Personally, I choose to #believeallwomen, even sickly teenage girls who lived in 1830.

1. There are several types of anemia (anemia is a medical term for a reduction of the body’s ability to carry adequate oxygen, which can happen from several causes) but for the purposes of this article, we’re discussing iron-deficiency anemia alone. For brevity’s sake I’ll just use the word “anemia” from here on in.
2. Some of you may be saying “but men have periods too” and “not all women have periods” with a particular political agenda in mind (and it’s probably not an attempt to raise awareness of women who have PCOS, had hysterectomies, are postmenopausal, or have other medical conditions that prevent them from menstruating, just sayin’). While that may be true in 2020, historically it was far less likely to be the case as most people were forced by social strictures to live life fitting within very narrow gender roles that were assigned to them at birth. It would be rather uncool to have to derail a discussion about women in history and menstruation, a biological experience that a majority of women have, have had, or will have, to include a very small minority of people whose experience is really not terribly applicable to the topic at hand.