Richard Morton and anorexia nervosa – psychiatry in history

‘Like a Skeleton only clad with skin’

Richard Morton, an English physician, writing in Latin in 1689, is usually credited with the first description of anorexia nervosa. Morton's ‘A Treatise of Conſumptions’ is best known for his contribution to the solution of tuberculosis. Less well-known is that chapter 1 is entitled ‘Of a Nervous Conſumption’. Morton provides a case history (original spelling has been retained).

Mr Duke's Daughter in St. Mary Axe, in the Year 1684 and the Eighteenth Year of her Age, in the Month of July fell into a total ſuppreſſion of her Monthly Courſes from a multitude of Cares and Paſſions of her Mind, but without any Symptom of the Green-Sickneſs following upon it. From which time her Appetite began to abate, and her Digeſtion to be bad; her Fleſh alſo began to be flaccid and looſe, and her looks pale, with other Symptoms uſual in an Univerſal Conſumption of the Habit of the Body, and by the extream and memorable cold Weather which happened the Winter following, this Conſumption did ſeem to be not a little improved; for that ſhe was wont by her ſtudying at Night, and continual poring upon Books, to expoſe her ſelf both Day and Night to the injuries of the Air, which was at that time extreamly cold, not without ſome maniſeſt Prejudice to the Syſtem of her Nerves. The Spring following, by the Preſcription of ſome Emperick, ſhe took a Vomit, and after that I know not what Steel Medicines, but without any Advantage. So from that time loathing all ſorts of Medicaments, ſhe wholly neglected the care of her ſelf for two full Years, till at laſt being brought to the laſt degree of a Maraſmus, or Conſumption, and thereupon ſubject to frequent Fainting Fits, ſhe apply'd her ſelf to me for Advice.

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: No Looſneſs, or any other ſign of a Colliquation, or Preternatural expence of the Nutritious Juices. Only her Appetite was diminiſhed, and her Digeſtion uneaſie, with Fainting Fits, which did frequently return upon her. Which Symptoms I did endeavour to relieve by the outward application of Aromatick Bags made to the region of the Stomack, and by Stomack-Plaiſters, as alſo by the internal uſe of bitter Medicines, Chalybeates, and Juleps made of Cephalick and Antihyſterick Waters, ſufficiently impregnated with Spirit of Salt Armoniack, and Tincture of Caſtor, and other things of that Nature. Upon the uſe of which ſhe ſeemed to be much better, but being quickly tired with Medicines, ſhe beg'd that the whole Affair might be committed again to Nature, whereupon conſuming every day more and more, ſhe was after three Months taken with a Fainting Fit, and dyed.