Historical and clinical data collected over a 15-year period from the study of 100 young inpatients with anorexia nervosa are presented. A clinical management program with zero mortality is described.
In 1684, the first recorded patient with anorexia nervosa, an Byear-old English girl, developed amenorrhea from "a multitude of cares and passions of her mind." As time passed, she ate less, lost weight, and suffered from syncopal attacks. In 1686, in the "last degree of a marasmus," she sought advice from Dr. Richard Morton. H i s description of her appearance is as follows (Morton, 1694): ' ' I do not remember that I did ever in all my practice see one, that was conversant with the living so much wasted with the greatest degree of a consumption, (like a skeleton only clad with skin), yet there was no fever, but on the contrary a coldness of the whole body; no cough or difficulty of breathing, nor an appearance of any other distemper of the lungs or of any other entrail.. . .Only her appetite was diminished and her digestion uneasy, with fainting fits which did frequently return upon her." Despite Morton's ministrations, his uncooperative patient worsened, lost more weight, and was "taken with a fainting fit and dyed."
Morton, a specialist in tuberculosis, labeled this patient's problem a so- called "nervous consumption," and correctly stated, long before the birth of psychiatry, that this disease, now misnamed anorexia nervosa, "does almost always proceed from sadness and anxious cares."
Today, almost 300 years later, despite monumental advances in medicine, physicians continue to be troubled by this puzzling illness. Fifteen years ago, a program was organized in New York City at Babies Hospital, the pediatric wing of the Columbia-Presbyterian Medical Center, to study and treat patients with anorexia nervosa. This report will present some of the data related to 100 anorexic patients admitted to our unit.