This is the second and final case presentation Dr. Morton makes of two illustrative examples of anorexia nervosa.  This time it is a young man.  He mentions that the patient is the son of a friend—so imagine how motivated he was to establish the correct diagnosis and find a successful treatment! First Morton discusses the differential diagnosis, establishes the correct diagnosis, discusses failed treatments and finally discusses his successful treatment of what, to him, is a chronic disease.

The Son of the Reverend Minister Mr. Steele, my very good Friend, about the Sixteenth Year of his Age [I remember a time when everyone spoke of anorexia nervosa as if it was unusual to present this “early”, whereas as it has been our experience that sixteen would be a high-average age of presentation], fell gradually into a total Want of Appetite, occasioned by his studying too hard [excessive preoccupation with studies is common, although parents are not usually displeased—at first]), and the Passions of his Mind, and upon that into an Universal Atrophy [he means by this that the visible wasting was over the entire body not just any certain part; he is talking to other physicians reading this and building a case that this affliction arose from the nerves and not, say, from syphilis], pining away more and more for the Space of two Years, without any Cough, Fever, or any other Symptom of any Distemper of his Lungs [so it’s not tuberculosis], or any other Entrail [for example cardiac wasting]; as also without a Looseness, or Diabetes [remember that there was no cure or effective treatment for diabetes and it would have presented with wasting and a sweet urine], or any other Sign of a Colliquation [the degeneration of bodily tissue to a liquid state], or preternatural [a supernatural-seeming phenomenon which nonetheless has a rational—but unknown—explanation] Evacuation.  And therefore I judg’d this Consumption to be Nervous, and to have its seat in the whole Habit of the Body, and to arise from the System of Nerves being distempered [so it is a brain disorder, arising from the nervous system].  I began, and first attempted his Cure with the Use of Antiscorbutick [anti-scurvy medication, e.g. vitamin C], Bitter, and Chalybeate of Medicines [Iron containing supplements], as well Natural as Artificial, but without any Benefit; and therefore when I found that the former Method did not answer our Expectations, I advis’d him to abandon his Studies, to go into the Country Air, and to use Riding, and a Milk Diet (and especially to drink Asses Milk) [the milk of a female donkey is considered the closest to human breast milk that is available in the animal kingdom] for a long time.  By the Use of which he recover’d his health in a great measure, though he is not yet perfectly freed from a Consumptive State; and what will be the Event of this Method, does not yet plainly appear [the chronic nature of this disease is re-iterated, even when great improvement is seen].

As far as I am concerned, having read and re-read this case history of a young man with anorexia nervosa in the seventeenth century, the take-home message is that neither vitamins nor supplements did any good until he was re-fed (with asses milk!).