Anorexia, 138 Years Ago

On the final day of Women’s History Month, let’ s take a moment to remember Miss A, the first woman medically diagnosed with anorexia, and the pioneering doctor who used her case to challenge the era’s prevailing presumption that eating disorders were simply a mark of an hysterical woman.

On October 24, 1873, esteemed English physician–and Queen Victoria’s personal doctor–Sir William Withey Gull stood before the Clinical Society of London and described his patient, the 17-year-old Miss A, in a paper entitled “Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica).

Gull wrote that Miss A was 5 feet 5 inches tall and weighed 82 pounds. Other doctors had given Miss A concoctions containing mercury, iodine and other skeptical substances. Yet she remained gaunt and withdrawn. Gull noted that her gaze was often downcast and her eyes skewed.

Unlike many of his colleagues, Gull did not think that Miss A’s condition was a mark of insanity. He believed she had an independent disease that could be treated outside of the mental asylum. He believed this disease, though more prominent in women, could also afflict men.

Gull provided Miss A at-home care for two years. He kept Miss A on a strict re-feeding regimen—a course of therapy that involved an abundance of foods (eggs, fish, oils, chicken, cream soups) administered at regular intervals by a nurse. Eventually, Miss A reached 128 pounds.

The case study of Miss A helped create the medical diagnosis still named “anorexia nervosa.” How would Miss A be medically treated today? Nearly 140 years later, surprisingly, in many ways the same. Gull’s treatment model has resurfaced with the Maudsley Method—a family-based treatment where food is, again, treated as medicine. This time, however, Miss A’s parents and not a nurse would administer her cream soups and eggs. Clinical trials show that the Maudsley Method, so far, is the most effective way to treat people suffering from anorexia, particularly young patients, with recovery rates more than double individual therapy.

But much else would have changed for Miss A. Today, women researchers are exploring a host of issues that male researchers have historically overlooked. For instance, they’re studying anorexia during pregnancy and finding that the disease can have lasting, sometimes lethal, effects for both mother and child. They’re turning their attention to women of color, a group in which eating disorders remain under-diagnosed, because doctors still subconsciously believe anorexia and bulimia to be “upper-middle-class white girls’” diseases. Women researchers are figuring out ways to stop anorexia in its tracks and prevent it from becoming a lifelong illness. Stay tuned to the Ms. Blog for a series of posts in which I’ll share recent research and developments in the scientific study of eating disorders—research now led by women.

Photo of Miss A. from Wikimedia Commons.

Comments

  1. Very informational, I’ve never personally encountered an anorexic person but the history really is scary. Good thing the doctor didn’t give up though.

  2. Excellent! Refeeding to a truly healthy weight is the first step towards recovery from anorexia. A malnourished individual can't benefit from talk therapy to help change thinking and behavior patterns.

  3. Fantastic research. I can’t wait to read more.

  4. I'm a fan of Gull whose work has been in and out of fashion in the eating disorders world more often than most.
    His comment that families are "often the worst attendants" has had him relegated to the dustbin by several Maudsley thinkers, but to me it's just a sensible and sensitive observation.
    WITHOUT HELP, families DO often buckle under the strain of nursing a very sick patient who is terrified to take the medicine (food) that is so necessary and will therefore often react very strongly to its administration. Many families need more help than a therapist every couple of weeks telling them how badly they are doing at this.
    Let's give some credit to Miss A's nurse as well and to all her successors. May there be many more of them helping Miss and Master As and their families to full recovery from these horrible illnesses.

    • * wild applause * Hear Hear!

    • Aahhh, the Maudsley Method. Focusing on archaic treatment methods, over 138 years old and counting.

      While nutritional interventions are essential aspects of the treatment process, we’re still waiting for many treatment providers to accept that forced compliance with a feeding regimen does not equal a cure for whatever caused the individual to self-starve in the first place.

      Long live revolving-door refeeding compliance programs!

      • Anakira says:

        You don’t seem to understand that refeeding and nourishment is only HALF of the treatment. Perhaps back then, it was the entire treatment, but today, refeeding is only the first step of a very long process. You can’t help someone on the precipice of death. Your brain works very differently on 0 calories and 0 resources than it does in a healthier body. Cognitive Behavioral Therapy is administered alongside the refeeding, helping people to understand their condition and rework their brain to properly cure the disease. Sometimes, in more extreme cases, anti-depressants are prescribed alongside the therapy. Do some other research before making comments like this, please.

  5. Thank you for this history lesson. It is a fresh perspective on this issue. I have read and watched dozens of pieces on this topic and appreciate this clinical rather than sensational approach. The sensationalism only precipitates the theories of hysteria.

  6. Thank you for this informative and eye opening account.

  7. I’m glad you mentioned anorexia during pregnancy. My grandmother was anorexic when she was pregnant with my father (and still is, sadly). She brags she only weighed 90 pounds when she was pregnant with him, and my grandfather was always very proud of this fact. My father was born 2 months premature; it was a miracle he lived. Anorexia during pregnancy is something that’s often perpetrated by the media (she just had a baby–look how great she looks! Look how fast she lost the baby weight!) and there is not nearly enough discussion about it.

  8. By the way, “Strep” Infection May Cause One Type Of Anorexia

  9. I find this thread sexist in a very subtle way. Anyway, good information provided.

    • Anakira says:

      No sexism here. It is simply numbers and raw statistics that show that anorexia nervosa is diagnosed in many, many, MANY more females than males.

  10. Im in recovery for anorexia.

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