Would this Kill Me in the 1800s: Anemia

Feeling tired? Run down? Memory problems? Muscle aches and weakness?

You might have anemia and not know it.

There a many different forms of anemia, so I won’t be able to delve into all of them here, but basically anemia is a shortage of red blood cells. This can have many causes from outside factors to inherited conditions, or it could be a side effect of another illness or treatment, but essentially it means that either your body doesn’t produce red blood cells at the correct rate, or they break down faster than they should. It could also mean that you have a decreased level of hemoglobin, which is what allows those red blood cells to carry oxygen.

A few of the most common types or causes of anemia:

  • blood loss due to trauma or disease
  • iron or B12 deficiency
  • bone marrow disease
  • genetic blood disorders
  • malaria
  • other diseases or autoimmune disorders

For a more complete list, check some of the links below.

Today, it’s the most common blood disorder and affects about 1/3 of the population worldwide. It’s more common in women than in men (three guesses why), and even with modern medical practices it accounts for about about 200,000 deaths a year internationally, in addition to leaving many patients disabled and unable to work.

Symptoms and Treatment

If we’re talking Victorian times here (and we are), then anemia is something every Victorian lady would aspire to, just as once upon a time consumption was thought to increase a woman’s beauty (more on that another time). Weakness, fatigue, and shortness of breath are all common symptoms, and things that in women would frequently be written off as just having their corset being laced too tightly, or the general “fragility” of the female sex. Add to the list that memory lapses and poor concentration are also common, and you basically have the 19th century justification for misogyny.

Other symptoms include increased or erratic heart rate as the cardiovascular system attempts to compensate for the oxygen the blood isn’t carrying. In extreme cases, this can also lead to heart failure, particularly if there is a pre-existing heart condition. Sometimes, this lack of oxygen leads to a general pallor (oh so desired by the Victorian lady, to the point they would put arsenic on their faces). But the skin isn’t the only thing that might change colors–the whites of the eyes may turn blue or yellow, as some forms of anemia can lead to liver or kidney problems.

Some of the less common symptoms include bone deformities, leg ulcers, restless leg syndrome, an enlarged heart, and pica. Pica is a craving for non-food items like ice, paper, or foam, though it’s pretty unusual. Chronic anemia can lead to behavior changes or problems, especially in children, as it prevents the brain from sending, receiving, and interpreting signals correctly.

Thankfully, the modern treatment for anemia is typically straightforward, unless it is complicated by an infection or inherited disorder. Patients are advised to eat iron rich foods, such as broccoli and spinach, or to cook with add ins like the Lucky Iron Fish which add iron to anything in the pot, in addition to taking B12 supplements. Iron supplements may be prescribed, though these are not always tolerated well by patients. For more severe cases, blood transfusions or iron infusions may be given.


The symptoms of anemia have been recognized since the time of the Romans. The waters of many Roman baths–including the famous ones at Bath, England–include high iron content, which would have helped relieve symptoms.

In the 1600s, when the use of lenses was just beginning to develop enough for early microscopes, scientists began noting the shape and structure of blood cells, though the odd shape or color was not yet linked to what we today call anemia.

At this time, anemia patients were described as “green” or having chlorosis, which was a name given to it in 1520 by Johannes Lange. Today, historians and doctors suspect this was the result of a general lack of sunlight and nutrition, but could it also be the yellow of an impaired liver or kidney combined with the “blue” hue of oxygen deprivation? Remember, alcohol was much stronger and more common back then, and some anemia causes red blood cells to die off faster than they should, which backs up the body’s waste filtration systems. This combination could easily lead to a jaundiced or yellowed complexion.

To treat chlorosis, a Dr. Sydenham proscribed something he called “chalybeate”: mixing iron filings with cold Rhenish wine, straining it, then adding sweetener and boiling it into a syrup.

In 1832 a supplement for those suffering from chlorosis was developed which combined ferrous sulphate (iron salts) and potassium carbonate. They had 64mg of iron but later versions were often laced with arsenic, or contained it as a “health” additive, as many physicians thought iron was more effective if consumed with arsenic–even into the 1930s. Unfortunately, most of these early supplements were completely indigestible by humans because too little was known about the human body and the digestion and absorption of minerals.

In the late 1800s as microscopes became more advanced and effective, doctors turned from looking at blood cells and counting them to looking at the gastrointestinal tract of patients, seeking answers in the gut rather than the blood. Many doctors during this period concluded that it was the result of “poor hygiene” because improved diet and exercise often improved the condition. I guess it didn’t matter that with improved diet, the patients gained more red blood cells and actually had the energy to exercise.

It wasn’t until the 1930s that the diagnostics evolved enough to make different types of anemia recognizable, and in the 1950s and 60s research that started a hundred years earlier in France allowed for the first drug to treat anemia caused by other illnesses (such as cancer or AIDS).


While not usually fatal on its own, severe cases of anemia can lead to death, even today. A 19th century person’s survival would depend a great deal on their class and how clever their doctor was. If, for example, our anemia patient is a coal miner who rarely sees the sun, works 12 hours days, has no sick leave (because who did back then?) and was the only source of income for his family, who then would fall into poverty without his income, then the death rate is pretty high. A middle to upper class white woman might have better chances, proved her doctor didn’t write off her symptoms as a female hysteria or just being a woman. And it almost goes without saying that people of color, who were often in the lowest economic ranks of society, had the worst chances for survival or improved quality of life.

I haven’t touched on sickle cell anemia in this post because it is a pretty huge topic on its own, separate from your “basic” iron deficient anemia. Traditionally a “black” disease, it has been known in Africa for about 5,000 years, but wasn’t “discovered” until 1910 (again, three guesses why). I know that’s a lot of air quotes for one paragraph, but as a genetic disorder that affects the physical shape of the cells and their function, it was just a bit too much to cover in a single blog post. If you would like to see a part two to this post just for SCD, let me know! I’d be happy to do it.


Further reading:
Anemia Clinical Presentation
Clinical Methods
A Brief History of Sickle Cell Disease 
Historical Aspects of Iron Therapy in Anemia
Early History of Iron Deficiency
The Story of Erythropoietin

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