Bicycle face: a timely reminder on discarded diagnoses in the age of anxiety

There was a young Maiden named Grace,

Once the prettiest girl in the place;

But she’s changed a great deal,

Since she took to the wheel,

For she now has a bicycle face.¹

During the 1880s, bicycle riding exploded in popularity across North America and Europe, affording women new-found freedoms.² During the 1890s, newspapers and magazines began publishing articles describing how the practice could have deleterious effects, especially to the “delicate” bodies of female cyclists. One prominent concern held that anxiety from having to maintain a constant state of balance, coupled with prolonged facial grimacing, could lead to the double-whammy of nervous exhaustion and facial disfiguration. This new condition was dubbed “bicycle face”.^3,4

This medicalisation of female bicycle riding was given credence and popularised by several prominent members of the medical profession writing in the colloquial press. Foremost among them was British physician and author Arthur Shadwell (1854–1936) who coined the term and believed that cycling rendered women susceptible to nervous depression.⁵ Another influential figure was Arabella Kenealy (1859–1938), a British physician and anti-feminist. In 1899, she warned readers of the literary magazine The Nineteenth Century, that a strained facial expression from vigorous riding could result in females acquiring the masculine features of bicycle face while jeopardising their ability to bear children.⁶

Reaction from the medical community was largely cautious. The American Medico-Surgical Bulletin viewed the condition as questionable and fad-like.^7,8 The New York–based Medical Record portrayed Shadwell as a respected but misguided figure and asserted that unless statistics could be produced clearly showing harm to female riders, his claims must be viewed with scepticism.⁹ Sarah Hackett Stevenson, the first female member of the American Medical Association, also rejected Shadwell’s claims by noting that the anxious facial expression in bicycle face was no different than that of a swimmer straining in water.¹⁰

The first known mention of bicycle face in the New Zealand press was in October 1895 when a reporter for the Otago Witness described it as a nervous condition caused by one who is “addicted” to pedalling rapidly.¹¹ There were no less than 13 articles discussing the condition that year, followed by 27 in 1896 and a peak of 30 in 1897, after which reports gradually declined.¹² During its heyday, a writer for the Tasman-based Golden Bay Argus expressed concern over facial strain during bicycle riding that he believed was diminishing female attractiveness. The editor urged New Zealand women to “submit themselves to the universal mandate of the medical profession against indulging in excess in the new pastime”.¹³ The following year the “Ladies Gossip” column of the Otago Witness warned against the “disfiguring” condition,¹⁴ which by now had become the subject of poems.^15,16 Between 1896 and 1908, there were 11 references to this “nervous condition” in New Zealand Geographic alone. In one instance, a commentator described it as “the hard, tense, muscular expression” which creates “deflections from the lines of feminine beauty [that] make a good looking woman look masculine, and a homely woman look intensely ugly”.¹⁷ A specific concern was the overdevelopment of the muscles in the female legs and thighs which were considered unfeminine.

Despite widespread scepticism within the medical profession, the existence of bicycle face gained a foothold in Western consciousness through a few influential physicians who popularised such claims in the lay press. This opened the floodgates for an array of other kindred ailments being promoted by journalists and rogue physicians. One such condition was cyclemania, supposedly a chronic psychosis that motivated sufferers to ride to excess: too far, too fast and to the point of exhaustion. Cyclemaniacs were believed to have an unnatural obsession with cycling, akin to an addiction or intoxication, which left them more inclined to engage in risky behaviours. A prominent opponent of women cyclists, British writer and early anti-feminist Eliza Lynn Linton, wrote that the chief danger of cycling was the “intoxication which comes with unfettered liberty”.¹⁸ Chief among these was concern over the corruption of female morals and fears that straddling the seat “combined with the motion required to propel a bicycle would lead to sexual arousal”.¹⁹ It was also thought that the riding position on a bicycle could cause hernias and curvature of the spine which became known as “bicycle stoop” and “bicycle hump”.²⁰ Another condition of concern was “bicycle walk” which was described as the gait of the cyclemaniac who “did not swing his foot forward, but lifted it off the ground in a rising, circular motion, as if he were riding the pedal”.²¹

Excessive cycling was also believed to make the rider, particularly women and their supposedly delicate constitutions, more vulnerable to other illnesses.²² The list of ailments tied to bicycle riding was extensive and included cardiovascular diseases (bicycle heart), muscular overdevelopment, anaemia, eyestrain (bicycle eye), hysteria and disorientation. It was also seen as a threat to motherhood as it was said that cycling while pregnant could cause foetal deformities, difficult labour and an inability to breastfeed.²³ There was also concern that “pressure” on the reproductive organs could result in infertility and if one did give birth the supposed pelvic changes made women susceptible to difficult labour. Another complaint was “bicycle throat” characterised by irritation and hoarseness attributed to riding at speed in cold weather, potentially leading to permanent vocal injury.

View Figure 1.

The fear of new technologies

The emergence of bicycle face is a reminder of the longstanding relationship between health scares and new technologies. During the sixteenth and seventeenth centuries, the strains from certain musical instruments were linked to an array of suspected nocebo-generated health complaints.²⁴ The invention of the telephone by Alexander Graham Bell in 1876 generated anxiety over its possible health effects and the appearance of a new condition in switchboard operators, “telephone tinnitus”, which was attributed to long periods of listening on the device. In September 1889, a writer in the British Medical Journal warned of this new malady which was typified by “nervous excitability, with buzzing noises in the ear, giddiness, and neuralgic pains”.²⁵ During the late nineteenth and early twentieth centuries “railway spine” was used to describe a constellation of symptoms including chronic pain and fatigue that were experienced by people who were involved in serious train accidents but who had suffered no obvious damage to the spinal cord. While these complaints were initially attributed to microscopic spinal damage, a major shift in perspective occurred in 1883, when London surgeon Herbert Page established “that in many cases no damage had been sustained to the spinal cord”, which led him to conclude that “fright alone” precipitated the symptoms. There is now a consensus in the medical community that “railway spine” resulted from psychological trauma and stress-related conditions including post-traumatic stress disorder (PTSD) and functional neurological disorder as opposed to structural injury to the spine.²⁶

The spread of medical misinformation

The history of bicycle face is a germane illustration of how anxieties and moral panic around new technologies can become medicalised and propagated by the media. In the 1890s, bicycle face and kindred conditions circulated through newspapers and periodicals. Today’s social media age has had a profound impact on the spread of health-related misinformation about new technologies by creating a global village where fears can attain international saturation within hours. A major mechanism of spread involves the business model of algorithmic biases which prioritise user engagement over factual accuracy by exacerbating fear, outrage and division. Sensational and often negative claims about the health risks of new technologies tend to be more engaging than cautious, peer-reviewed reports and consequently are spread more quickly.²⁷ Another factor is the echo chamber effect whereby social media platforms create, attract and reinforce self-validating online communities of people with similar beliefs. This allows pseudo-medical conditions to quickly transition from fringe theories to group consensus, effectively replacing the colloquial press of the Victorian era.

Another factor amplifying contemporary health concerns is the rise of social media influencers. During the 1890s, figures like Shadwell and Kenealy needed a medical degree and an established publication to attract a large readership. Today, prominent influencers without a medical degree can attract more followers in a week from a single video than their Victorian counterparts could have attained over months. Influencers often utilise anecdotes and conspiracy theories to establish audience credibility. A related factor is the erosion of institutional trust. Unlike the scepticism of the Victorian medical community toward bicycle face, today misinformation is accelerated by the widespread distrust of governments, large corporations and big pharma, while online personalities are often trusted more than mainstream medical authorities.²⁸

The modern equivalent of bicycle face is not a single condition but a series of techno-somatic syndromes which are centred on the effects of electromagnetic radiation from mobile phones, Wi-Fi and 5G towers,²⁹ and ultrasound from the turning of windfarm turbines.³⁰ “Wi-Fi Sickness”, “5G sensitivity” and “Wind Turbine Syndrome” parallel the Victorian fear of bicycle-induced “nervous exhaustion” where non-specific anxiety and physical symptoms have been misattributed to a novel, invisible technology that is poorly understood by the public.

Managing pseudo-medical conditions

How should physicians manage pseudo-medical conditions, which are as common today as in the past? Focus should be on acknowledging and validating anxieties around new technologies as common and real; a strategy that was alluded to by Dr Sarah Hackett Stevenson’s comparison of bicycle face to a swimmer’s strain. Instead of dismissing fears around new technologies as imaginary, physicians can validate a patient’s feelings of discomfort and fear of unseen forces. In this regard, the history of bicycle face can be used as a teaching tool to illustrate how the fear of new technologies is a historical pattern from railway spine and telephone sickness to contemporary fears surrounding Wi-Fi and 5G towers. This frames the problem as a cultural phenomenon instead of a biological one.

Medical organisations and journals should seek to partner with social media companies to counter the appearance of pseudoscientific videos with productions from authoritative sources such as the National Institutes of Health or the American Medical Association. These videos should be placed at the top of the video feed or search results. The medical community should exhibit the scepticism shown by the Medical Record, demanding statistics and empirical evidence, while working to improve how that information is communicated. One area of focus is on relative risk. Instead of asserting that a claim is false, the risk should be placed in context.

Concluding remarks

It is important to keep the fear of technology-related health concerns in perspective. Not all new technologies have been benign. While bicycle face proved to be a pseudo-medical condition, the early design of the penny farthing posed a genuine risk of physical injury due to the large front wheel and ineffective braking system, which resulted in riders suffering serious injuries after tumbling head-first over the handlebars. This manoeuvre became so common that it even had a name—“taking a header”—and earned it the nickname the “widow maker”.³¹ It should be noted that bicycle face was more than a technical health concern articulated by physicians: fundamentally it was a response to female mobility and independence at a time when Victorian era patriarchal culture was firmly entrenched in British society. This may have contributed as much if not more to the fear of new technology. The condition was less about public health and more about males using the medicalisation of bicycle riding to enforce traditional gender roles and exercise social control over women.

The diagnosis and treatment of bicycle face serves as a cautionary tale of how cultural anxieties can shape popular perceptions of health and how physicians can lend scientific legitimacy to unfounded fears, inadvertently solidifying the perceived reality of unfounded conditions in the public consciousness. The history of bicycle face illustrates that while some socially and culturally driven fears about new technologies were without merit, others such as X-rays and radiation exposure have been scientifically proven, underscoring the need for evidence-based assessments that are free of cultural bias. The re-examination of discarded diagnoses is a timely reminder of the complex interplay between culture and health, and the importance of ensuring that public health discourse about new technologies is guided by evidence rather than the shifting sands of popular opinion.