There seems to be a discussion that simply will not die in the world of eating disorders (particularly when it comes to anorexia nervosa) around whether the “desire for thinness” is culturally bound and whether AN is a “modern phenomenon”.

A few years ago I was fortunate enough to acquire a copy of Pthsiologia, a book written in 1689 by Richard Morton, an astute observer and physician of his day.  Morton’s description of two cases—one in a boy and one in a girl-- of what we now call anorexia nervosa and which he called “a nervous consumption” were the first in Western literature.  The chapter Of a Nervous Consumption  was only one chapter in what was intended to be a treatise on the many “consumptive” (wasting) illnesses of his day, most prominently tuberculosis.  I find it interesting that in 1689 AN was being categorized with other medical illnesses.

As was common for medical texts, Pthsiologia was written first in Latin and later re-published in English (1719).  I feel privileged to hold a copy of this little brown leather-bound book, now more than 300 years old, and I wanted to share it with you.

Below is the introduction and discussion piece to Morton’s chapter.  In subsequent blogs I want to look at each of the two case histories he presented, but today I want to cover his discussion as, similar to contemporary scientific publications, it was written to tell the reader what he thought about what he had seen.  My comments are in italics and brackets.

Of A nervous Consumption

A nervous atrophy or consumption, is a wasting of the body without any remarkable Fever, Cough, or shortness of breath; but it is attended with a Want of Appetite, and a bad Digestion, upon which there follows a Languishing Weakness of Nature, and a falling away of the Flesh every day more and more. [He notes that weight loss is the presenting complaint. But note that he nowhere talks about a desire to be thin.  In Morton’s day weight loss was not seen as a good thing since it was a common symptom of consumptive illnesses like TB, which were fatal.  It was therefore important for other physicians to be able distinguish between these conditions and so he emphasizes that there is no fever and no cough or other lung symptoms present.]

Which kind of Consumption I have sometimes observed in England, but most frequently among those that have lived in Virginia, after they have come over hither. [now that’s interesting…. I wonder what that could mean?]

In the Beginning of this Disease the state of the Body appears oedematous and blouted, and as it were stufft with dispirited Chyle;  [his observation of water retention] the face is pale and squalid, the Stomach loaths everything but liquids, the Strength of the Patient declines at that rate, that before the fleshy Parts of the Body are evidently consum’d, he is render’d plainly feeble, and almost always confin’d to his Bed.  The Urine also keeps not constant to any Color, though for the most Part it be high-color’d, and but little in quantity.  [We see urine of this dark color in those patients who restrict their fluid intake as well as their food; in my experience this is common in the very young patient.]

Yet it is sometimes, (as it happens commonly to be in Nervous Distempers) though seldom, pale and plentiful.  [This is common where the patient drinks a lot of water-- often the patient who is older, say 15 years or older.]

But there is no considerable Fever to be discovered, either by the Pulse, or a Thirst, or Heat, how high-colour’d soever the Urine appears.  So that the Pathognomonick Signs, or those which do evidently manifest the beginning of this Consumption, are a Decrease of the Patient’s Strength, and a Loss of Appetite, without any remarkable Fever, Cough, or Shortness of Breath, though in the Progress of the Distemper, when a Consumption of the Flesh has gradually affected the whole Habit of the Body, there is some Difficulty and Trouble in breathing to be observed, as it uses to happen to all those who are under a great Weakness. [A “pathognomonic” sign is one which is so characteristic of a given disease that its presence means the disease is almost certainly present; Morton is re-iterating his teaching point that despite the wasting there are no fevers or pulmonary symptoms.]

The Causes: The immediate Cause of this Distemper I apprehend to be in the System of the Nerves proceeding from a Preternatural State of the Animal Spirits, and the Destruction of the Tone of the Nerves; whereupon I have used to call this a Consumption in the Habit of the Body.  [It seems to me that Morton is saying that this illness which leads to the observed wasting, is a brain disorder, emanating from the nervous system, of which the brain is but a part.]

For as the Appetite and Concoction are overthrown by the weak and infirm Tone of the stomach, so also the Assimulation, the Fermentation, and Volatilization of the Nutritious Juice are hindred in the whole Habit of the Body, from the distemper’d State of the Brain and Nerves. [Again, the ‘distemper’ of the brain and nerves are causative.]

The Causes which dispose the patient to this Disease, I have for the most part observed to be violent Passions of the Mind, the intemperate Drinking of Spirituous Liquors, and an  unwholesome Air, by which it is no wonder if the Tone of the Nerves, and the Temper of the Spirits are destroy’d. [This leaves a lot to be argued about, doesn’t it?]

This Distemper, as most other Nervous Diseases, is chronical, but very hard to be cured, unless a Physician be called at the beginning of it.  [The chronic nature of this illness and the need for early recognition is something I and others have written about repeatedly.]

At first it flatters and deceives the Patient, for which reason it happens for the most part that the Physician is called too late.  [Oh god! This is the most true and the most painful statement in the whole discussion and it resonates as loudly today, across the span of nearly a third of a millennium, as it did then]

And at last it terminates in an Hydropical and Oedematous Swelling of the body, especially of the lower and depending Parts, in which case there remains no hopes of the Patient’s Life, neither is there anything more to be done for his Cure, than giving him some Ease, whereby his miserable Life may be lengthened for some days. [Not so fast! We have ways of dealing with these medical complications today]

There follows a long recitation of medications and herbals to be given, such as balm of Gilead, filings of steel, old conserve of red roses, spirit of hartshorn and many other things too numerous to go into here, but available to read about on Google Books.  

Morton ends his discussion on ‘cure’ by saying:

Let the Patient endeavor to divert and make his Mind cheerful by Exercise, and the Conversation of his Friends. [Please note his consistent use of the pronouns “he” and “his”.]  

For this Disease does almost always proceed from Sadness, and anxious Cares.  Let him also enjoy the benefit of an open, clear, and very good Air, which does very much relieve the Nerves and the Spirits.  And because the Stomach in this Distemper is principally affected, a delicious Diet will be convenient, and the Stomach ought not to be too long accustomed to one sort of Food.

I guess we must ask ourselves: have we learned anything new in 300 years?