Tuesday, November 2, 2010

"Vice Pioneers" : Anorexia Nervosa

Karen Carpenter: the case that brought anorexia to light

Sir William Gull's resume: Queen Victoria's physician, Jack the Ripper speculation, and namer of "anorexia nervosa"

Miss A: one of Gull's anorexia study patients (shown before and after treatment)

Vice is not always sexy or appealing. This week for "Vice Pioneers," were taking a look into anorexia. With ideals of female (and male to a less extent) beauty permeating our brains from every facet of the media, eating disorders have become a normal practice. We will likely delve into some of the other ones down the road, but for now let's take a look into the act of starving onseself into disappearance.

From Wikipedia: The history of anorexia nervosa begins with early descriptions dating from the 16th century and 17th century and the first recognition and description of anorexia nervosa as a disease in the late 19th century.

In the late 19th century, the public attention drawn to "fasting girls" provoked conflict between religion and science. Such cases as Sarah Jacob (the "Welsh Fasting Girl") and Mollie Fancher (the "Brooklyn Enigma") stimulated controversy as experts weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria, superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to physicians, transforming anorexia nervosa from revered to reviled.

Early Descriptions
1556: Mary, Queen of Scots: Mary Stewart, known as Mary, Queen of Scots, was brought up as a child in the court of Henry II of France. Her medical history is documented in some detail thanks to the accounts of various ambassadors who sent reports back to their respective sovereigns. It is known, for example, that she had measles when she was five, rubella when she was seven, dysentery and malaria when she was 14 and smallpox when she was 15.

She also had an unnamed illness as a teenager that some now believe to have been anorexia nervosa. Her condition is described as involving weight loss, uneven appetite, vomiting and diarrhoea, pallor, fainting fits and breathing difficulties. She was, however, physically active throughout the illness; she continued to ride on horseback and dance in the evenings at the same time as these symptoms were observed.

1613: Jane Balan – the “French fasting girl of Confolens”: The case of Jane Balans, the “French Fasting Girl of Confolens,” was described in 1613 by Pedro Mexio. He noted that she “lived without receiving meat or drink for at least three years.” The condition began on 15 February 1599, when Jane Balans was around 10 years old. After suffering a fever and vomiting, she became withdrawn and weakened, refusing all food.

Contemporary superstition blamed the wicked power of an apple given her by an old woman some months prior to the start of the condition; Mexio diagnosed the case as a “drying up of the liver and of all the parts serving to nourishment due to hurtful humours.”

19th Century descriptions
1859: Louis-Victor Marcé’s case descriptions: Louis-Victor Marcé (1828–1864), a Paris-based French physician, published a number of case studies describing psychiatric disorders of women during and following pregnancy. His case descriptions included that of a patient displaying the symptoms of anorexia nervosa in 1859. In 1860, Marcé wrote:
I would venture to say that the first physicians who attended the patients misunderstood the true significance of this obstinate refusal of food and The hypochondriacal delirium, then, cannot be advantageously encountered so long as the subjects remain in the midst of their own family and their habitual circle.… It is therefore, indispensable to change the habitation and surrounding circumstances, and to entrust the patients to the care of strangers.

1868: William Gull (address to the British Medical Association): In 1868, William Gull was a leading British physician based in London. That year, he described his observations of an emaciated condition in young women in an address to the British Medical Association (BMA) in Oxford. He observed that the causes of the condition were unknown, but that the subjects affected were "mostly of the female sex, and chiefly between the ages of sixteen and twenty three" although he also qualified this statement by adding that he had occasionally seen it in males of the same age.

The following extract is from the Lancet (the BMA’s in-house journal) of 1868:
At present our diagnosis is mostly one of inference, from our knowledge of the liability of the several organs to particular lesions; thus we avoid the error of supposing the presence of mesenteric disease in young women emaciated to the last degree through hysteric apepsia, by our knowledge of the latter affection, and by the absence of tubercular disease elsewhere.'’

1873: Sir William Gull’s "Anorexia Nervosa" paper: By 1873, Sir William Gull had been made a Baronet and was one of four Physicians-in-Ordinary to Queen Victoria. In that year, he published his seminal work “Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica)", in which he describes the four cases of Miss A, Miss B, Miss K and a fourth unnamed case.

Sir William Gull writes that Miss A was referred to him on 17 January 1866. She was aged 17 and was greatly emaciated, having lost 33 pounds. Her weight at this time was 5 stones 12 pounds (82 pounds); her height was 5 ft 5 inches. Gull records that most of her physical condition was normal, with healthy respiration, heart sounds and pulse; no vomiting nor diarrhoa; clean tongue and normal urine. The condition was that of simple starvation, with total refusal of animal food and almost total refusal of everything else.

Gull prescribed various remedies (including preparations of cinchona, biochloride of mercury, syrup of iodide of iron, syrup of phosphate of iron, citrate of quinine) and variations in diet without noticeable success. He noted occasional voracious appetite for very brief periods, but states that these were very rare and exceptional. He also records that she was frequently restless and active and notes that this was a "striking expression of the nervous state, for it seemed hardly possible that a body so wasted could undergo the exercise which seemed agreeable".

In Gull's published medical papers, images of Miss A are shown that depict her appearance before and after treatment. Gull notes her aged appearance at age 17: It will be noticeable that as she recovered she had a much younger look, corresponding indeed to her age, twenty-one; whilst the photographs, taken when she was seventeen, give her the appearance of being nearer thirty.

Miss A remained under Gull's observation from January 1866 to March 1868, by which time she seemed to have made a full recovery, having gained in weight from 82 to 128 pounds.

Miss B was referred to Gull on 8 October 1868, aged 18, as a case of suspected tuberculosis. Gull noted that her emaciated appearance was more extreme than normally occurs in tubercular cases. His physical examination of her chest and abdomen discovered nothing abnormal, but he recorded a "peculiar restlessness" that was difficult to control. The mother advised that "She is never tired". Gull was struck by the similarity of the case to that of Miss A, even to the detail of the pulse and respiration observations.

Miss B was treated by Gull until 1872, by which time a noticeable recovery was underway and eventually complete. Gull admits in his medical papers that the medical treatment probably did not contribute much to the recovery, consisting, as in the former case, of various tonics and a nourishing diet.

Although the cases of Miss A and Miss B resulted in recovery, Gull states that he observed at least one fatality as a result of anorexia nervosa. He states that the post mortem revealed no physical abnormalities other than thrombosis of the femoral veins. Death appeared to have resulted from starvation alone.

In Contemporary Society
Although the medical facts of anorexia nervosa have been documented since the 1870s, personal details of anorexics' lives are more publicized today than ever before. It was the death of Karen Carpenter, (a very famous singer/drummer in the 1970s) on February 4, 1983 that brought eating disorders to attention of the general public. Prior to 1983, almost no one outside of the medical community had heard of anorexia nervosa or bulimia. In 1981, the made-for-tv movie; "The Best Little Girl in the World", with Jennifer Jason Leigh as an anorexic, aired on ABC, but, it had no real impact on the average person. After Karen Carpenter died from the effects of anorexia nervosa, the world wanted to know more about the mysterious medical illness. Since Karen Carpenter's death in 1983, which resulted from complications of the disorder, people recognize that being extremely thin is not healthy and a few casually label overly thin women as anorexics. Since the late 1980s, many special eating disorder clinics have opened, but it may be difficult to change the eating behavior and mindset of an anorexia victim, especially when they are surrounded by numerous other thin women who have similar eating behaviors. Today, many young women are obsessed with dieting as a form of cultural expression and a way to look as thin as models and celebrities. Anorexia nervosa seems to be more prevalent as the ideal female body image becomes thinner.

In the 1980s, slimness embodied the supposed "ideal" of feminine beauty. It is this that caused many women to incessantly diet in order to keep up with the demands of modern fashion. In a 1984 survey carried out by Glamor magazine of thirty-three thousand women between the ages of eighteen and thirty-five, 75% believed they were fat, although only 25% were actually overweight. Indications of being thin was important to women of the upper class, and this class specific cultural model was pervasive throughout the media including television, film, magazines, and advertising.

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