- The history of anorexia - hard facts
- 19th century
- 20th century
The history of anorexia - 19th century
1859: Louis Victor describe Mars
Louis Victor Mars (1828-1864), a French doctor who worked in Paris, has published several studies with descriptions of mental disorders in women during and after pregnancy. Among them was a case of a patient with whom he worked Mars in 1859; she showed symptoms characteristic of anorexia nervosa. In addition to the persistent refusal of food, the patient was observed hypochondriac delirium.
1868: William Gull
In the second half of the nineteenth century, William Gull was a leading London-based physician. In 1868, he wrote in his letter to the British Medical Association (BMA) has described an unusual disease that occurs mainly in young women and is characterized by extreme exhaustion. He wrote that the cause of the disease is unclear, but we know that it affects mainly the female between the ages of sixteen and twenty-three years. William Gull also noted that sometimes this disease occurs in men of the same age. Dr. Gall called the disease Apepsia hysterica, then - Anorexia hysterica, and then finally changed its name to Anorexia nervosa - anorexia nervosa.
1873: William Gall article about anorexia nervosa
In 1873, Sir William Gull was one of four royal physician at the court of Queen Victoria. In the same year, he published an article about anorexia nervosa, which describes the case of Miss A, Miss B, and another unnamed patient. In 1887, he also described the case of Miss K - this article was the last of his publications.
Miss A to William Gallus sent her physician; She first came to the examination of 17 January 1866. She was 17 years old, and she was much exhausted - she lost almost 15 kg. Weight Miss A was slightly more than 37 kg with height 167 cm. Dr. Gall writes that patient for nearly a year suffered from amenorrhea
The absence of menstruation (amenorrhea) - ambiguous symptom
(absence of menstruation), but the rest of her physical health was mostly normal. She had no problems with breathing and heartbeat, no vomiting and diarrhea, the language was clear, the color and smell of urine is not of concern. The patient was a little slowed heart rate (it ranged from 56 to 60 beats per minute), but it had little effect on her health. In fact, the only obvious problem was starving - she completely abandon the products of animal origin, and almost did not eat other food.
Dr. Gall wrote out a variety of means (including products from cinchona bark, bichloride of mercury, quinine citrate), and various changes in the diet, but to achieve a noticeable improvement was not possible. He noted that from time to time the girl woke up very strong appetite, but these periods were short and rare, exceptional and more than regular. The patient also happens quite frequent bouts of anxiety and high activity, and the doctor wrote that it seemed incredible how much emaciated body could be that kind of energy.
Although not the first unsuccessful attempts at treatment, Ms. A went to the amendment. In his article, William Gull posted images of their patients before and after treatment, noting that in 21 years, had almost recovered, she looked in accordance with their age, whereas in 17 years, looking at her, one would think that it is not less than thirty years.
Miss A remained under the supervision of Dr. Galla from January 1866 to March 1868. By the time she was fully recovered, and her weight increased to 58 kg.
Miss B went to Dr. Gallus October 8, 1868, at age 18, at the urging of his parents, who suspected that their daughter tuberculosis
Tuberculosis - a full recovery is not guaranteed
And wanted to take her away for the winter in the South of England.
William Gull immediately noticed that it looks more exhausted than the majority of patients with tuberculosis. Examination of the chest and abdomen did not help to identify any abnormalities, except for a slow heart rate - 50 beats per minute. However, the doctor noted that the patient exhibits an unusual concern that it is unable to control. Her mother told the doctor that her daughter "never gets tired." Dr. Gall was surprised by the similarity of this case with the case of Miss A - even in such details as the slow pulse and restless behavior.
Miss B was treated at Dr. Gall until 1872; By this time her condition has improved significantly, and she was on her way to a full recovery. In his notes Gall acknowledged that the treatment consists, mainly, to accept a variety of tonics and nutritious food use, apparently, not too contributed to recovery. The mechanism of the disease and its treatment was still remained a mystery.
Miss K sent to Dr. Gallus her doctor in 1887. She was the third of six children in the family; one child of her parents died in infancy. The father of the patient died at the age of 68 from pulmonary tuberculosis. The mother was still alive, and was characterized by good health. Miss K was a sister who have had a variety of symptoms of nervous diseases, and nephew, who suffered from epilepsy. For these exceptions, a family history of Miss K was not any neurological disease.
Miss K, which before 1887 was, according to the descriptions, full, healthy girl, in February of that year, beginning to give up food, accepting only half a cup of tea or coffee a day
. The first time she came to see Dr. Gallus 20 April 1887
. In his notes, he notes that the girl insisted to come to him on foot, despite the fact that because of its appearance, it has become the object of increased attention of passers-by
. The patient has no evidence of any organic disease; respiratory rate she was 12-14 per minute (the norm for an adult - 16-20 breaths), heart rate - 46 beats per minute, the body temperature - 36
. The urine of the patient was normal
. Miss K weighed 28
. 6 kg with height 163 cm
. She told the doctor that he feels "very good"
. Gull recommended the patient to take a light meal every few hours, and insisted that Miss K was a nurse who was supposed to monitor the implementation of doctor's instructions
Six weeks later, the girl told the physician Dr. Gallus significant improvement, and on July 27 her mother reported that Miss K is almost completely recovered and she no longer needs the services of a nurse.
The picture of Miss K, made April 21, 1887 shows that the body is in a state of extreme exhaustion - the skin literally clings collarbone and ribs. In the second photograph, which was made on June 14 can see clear signs of recovery.
Although Miss A, Miss B and Miss K recovered, William Gall wrote that he had to watch at least one case where a result of anorexia nervosa death occurred ("at least" because there was no clear criteria for diagnosis of the disease, and In some cases, the physician might confuse it with other diseases). An autopsy of the patient who died of anorexia, showed no abnormalities except for thrombosis
Thrombosis - the cause of heart attack and stroke
femoral veins. William Gull came to the conclusion that the death was caused by exhaustion.
The doctor noted that the slow pulse and breathing are common symptoms he described cases. He suggested that it is the result of decreased body temperature
Lowered body temperature - or the rate of disease?
And suggested as a possible means for the treatment of fever from the outside (for example, using hot packs or baths). This proposal is still the subject of dispute of modern scholars.
Dr. Gill also wrote about the tendency of health professionals to listen to the wishes of the patient ("to give them the opportunity to do what they want, not to force them there against their will"), can be dangerous and should not be encouraged, especially in the early stages of treatment of anorexia nervosa . He has formed such an opinion after it has learned to control his own desire not to put pressure on the patient; In some cases, the pressure is the only way to achieve improvements.