|by Leonard Hoenig, M.D., Section Editor|
Beginning with this issue, the OJCPCD presents a new feature called “A Medical
Humanities Challenge” that will appear several times a year, to test your knowledge of medical humanities.
Quiz #1 examines your ability to identify the medical condition in the following quote from Shakespeare’s play Romeo and Juliet:
“ Out, you green-sickness carrion! Out, you baggage!
You tallow face!”
(Lord Capulet to Juliet: Act 3, Scene 5)
Scroll down for answer:
ANSWER: Chlorosis (green sickness) caused by iron deficiency anemia.
COMMENT: Green sickness, or chlorosis, was a common disorder during the 16th thru 19th Centuries that typically affected young, unmarried girls causing a distinct green tinge to their skin. It was one of the clinical manifestations of iron deficiency. The English physician, Thomas Sydenham (1624-1689) is credited with the introduction of iron therapy to treat chlorosis, although the medicinal use of iron dates back to antiquity.
In the aforementioned quote, Lord Capulet, Juliet’s father, becomes enraged and
verbally abusive to his daughter because she refuses to marry Paris. He calls her a
green-sick piece of meat and pale faced (“tallow face”). During the early 20th century, chlorosis disappeared as a clinical feature of iron deficiency, probably because iron deficiency was more readily diagnosed and treated than in earlier times.
The other cutaneous features of iron deficiency likewise have become clinically less frequent, including:
- Koilonychia (spoon nails)
- Angular stomatitis (cracked epithelium at the lips edges)
- Glossitis (smooth, red tongue).
Recently, the first case of chlorosis in 70 years was reported in a 9 year old girl with
a green complexion and iron deficiency. A striking photograph of the patient with her greenskin tone can be seen in the article (see reference 1 and accompanying link). Her skin condition resolved with iron therapy
The story of chlorosis, and its clinical decline, illustrates the phenomenon of “disease evolution” which means that a disease, for various reasons, can change its clinical presentation over time. Thus chlorosis, once so common, is rarely seen anymore. A remembrance of this greenish skin condition is found in Shakespeare’s masterful portrayal of the beloved Juliet.
Perdahl-Wallace E, Schwartz RH. A girl with green complexion and iron deficiency: chlorosis revisited. Clin Pediatr 2006; 45: 187-189.
Apreviously healthy, 9-year- old girl of Mediter- ranean/Filipino descent was referred for a 2-month history of her face, hands, and fingers. “becoming green
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.891.8610&rep=rep1&type=pdf (Accessed 12/9/18