Historically Speaking: Anorexia’s Ancient Roots And Present Toll

The deadly affliction, once called self-starvation, has become much more common during the confinement of the pandemic.

The Wall Street Journal

February 18, 2022

Two years ago, when countries suspended the routines of daily life in an attempt to halt the spread of Covid-19, the mental health of children plunged precipitously.

Two years ago, when countries suspended the routines of daily life in an attempt to halt the spread of Covid-19, the mental health of children took a plunge. One worrying piece of evidence for this was an extraordinary spike in hospitalizations for anorexia and other eating disorders among adolescents, especially girls between the ages of 12 and 18, and not just in the U.S. but around the world. U.S. hospitalizations for eating disorders doubled between March and May 2020. England’s National Health Service recorded a 46% increase in eating disorder referrals by 2021 compared with 2019. Perth Children’s hospital in Australia saw a 104% increase in hospitalizations and in Canada, the rate tripled.

Anorexia nervosa has a higher death rate than any other mental illness. According to the National Eating Disorders Association, 75% of its sufferers are female. And while the affliction might seem relatively new, it has ancient antecedents.

As early as the sixth century B.C., adherents of Jainism in India regarded “santhara,” fasting to death, as a purifying religious ritual, particularly for men. Emperor Chandragupta, founder of the Mauryan dynasty, died in this way in 297 B.C. St. Jerome, who lived in the fourth and fifth centuries A.D., portrayed extreme asceticism as an expression of Christian piety. In 384, one of his disciples, a young Roman woman named Blaesilla, died of starvation. Perhaps because she fits the contemporary stereotype of the middle-class, female anorexic, Blaesilla rather than Chandragupta is commonly cited as the first known case.

The label given to spiritual and ascetic self-starvation is anorexia mirabilis, or “holy anorexia,” to differentiate it from the modern diagnosis of anorexia nervosa. There were two major outbreaks in history. The first began around 1300 and was concentrated among nuns and deeply religious women, some of whom were later elevated to sainthood. The second took off during the 19th century. So-called “fasting girls” or “miraculous maids” in Europe and America won acclaim for appearing to survive without food. Some were exposed as fakes; others, tragically, were allowed to waste away.

But, confusingly, there are other historical examples of anorexic-like behavior that didn’t involve religion or women. The first medical description of anorexia, written by Dr. Richard Morton in 1689, concerned two patients—an adolescent boy and a young woman—who simply wouldn’t eat. Unable to find a physical cause, Morton called the condition “nervous consumption.”

A subject under study in the Minnesota Starvation Experiment, 1945. WALLACE KIRKLAND/THE LIFE PICTURE COLLECTION/SHUTTERSTOCK

Almost two centuries passed before French and English doctors accepted Morton’s suspicion that the malady had a psychological component. In 1873, Queen Victoria’s physician, Sir William Gull, coined the term “Anorexia Nervosa.”

Naming the disease was a huge step forward. But its treatment was guided by an ever-changing understanding of anorexia’s causes, which has spanned the gamut from the biological to the psychosexual, from bad parenting to societal misogyny.

The first breakthrough in anorexia treatment, however, came from an experiment involving men. The Minnesota Starvation Experiment, a World War II –era study on how to treat starving prisoners, found that the 36 male volunteers exhibited many of the same behaviors as anorexics, including food obsessions, excessive chewing, bingeing and purging. The study showed that the malnourished brain reacts in predictable ways regardless of race, class or gender.

Recent research now suggests that a genetic predisposition could count for as many as 60% of the risk factors behind the disease. If this knowledge leads to new specialized treatments, it will do so at a desperate time: At the start of the year, the Lancet medical journal called on governments to take action before mass anorexia cases become mass deaths. The lockdown is over. Now save the children.

A shorter version appeared in The Wall Street Journal

WSJ Historically Speaking: The Quest for Unconsciousness: A Brief History of Anesthesia

The ancient Greeks used alcohol and opium. Patients in the 12th century got a ‘soporific sponge.’ A look at anesthetics over the centuries

ILLUSTRATION: ELLEN WEINSTEIN

Every year, some 21 million Americans undergo a general anesthetic. During recent minor surgery, I became one of the roughly 26,000 Americans a year who experience “anesthetic awareness” during sedation: I woke up. I still can’t say what was more disturbing: being conscious or seeing the horrified faces of the doctors and nurses.

The best explanation my doctors could give was that not all brains react in the same way to a general anesthetic. Redheads, for example, seem to require higher dosages than brunettes. While not exactly reassuring, this explanation does highlight one of the many mysteries behind the science of anesthesia.

Although being asleep and being unconscious might look the same, they are very different states. Until the mid-19th century, a medically induced deep unconsciousness was beyond the reach of science. Healers had no reliable way to control, let alone eliminate, a patient’s awareness or pain during surgery, though not for lack of trying.

The ancient Greeks generally relied on alcohol, poppy opium or mandrake root to sedate patients. Evidence from the “Sushruta Samhita,” an ancient Sanskrit medical text, suggests that Indian healers used cannabis incense. The Chinese developed acupuncture at some point before 100 B.C., and in Central and South America, shamans used the spit from chewed coca leaves as a numbing balm.

Little changed over the centuries. In the 12th century, Nicholas of Salerno recorded in a treatise the recipe for a “soporific sponge” with ingredients that hadn’t advanced much beyond the medicines used by the Greeks: a mixture of opium, mulberry juice, lettuce seed, mandrake, ivy and hemlock.

Discoveries came but weren’t exploited. In 1540, the German alchemist and astrologer Paracelsus (aka Theophrastus Bombastus von Hohenheim) noted that liquid ether could induce sleep in animals. In 1772, the English chemist Joseph Priestley discovered nitrous oxide gas (laughing gas). Using it became the thing to do at parties—in 1799, the poet Coleridge described trying the gas—but no one apparently tried using ether or nitrous oxide for medicinal purposes.

In 1811, the novelist Fanny Burney had no recourse when she went under the knife for suspected breast cancer. She wrote later, “O Heaven!—I then felt the Knife rackling against the breast bone—scraping it!”

Despite the ordeal, Burney lived into her 80s, dying in 1840—just before everything changed. Ether, nitrous oxide and later chloroform soon became common in operating theaters. On Oct. 16, 1846, a young dentist from Boston named William Morton made history by performing surgery on a patient anesthetized with ether. It was such a success that, a few months later, Frances Appleton Longfellow, wife of Henry Wadsworth Longfellow, became the first American to receive anesthesia during childbirth.

But these wonder drugs were lethal if not administered properly. A German study compiled in 1934 estimated that the number of chloroform-related deaths was as high as 1 in 3,000 operations. The drive for safer drugs produced such breakthroughs as halothane in 1955, which could be inhaled by patients.

Yet for all the continuous advances in anesthesia, scientists still don’t entirely understand how it works. A study published in the December 2017 issue of Annals of Botany reveals that anesthetics can also stop motion in plants like the Venus flytrap—which, as far as we know, doesn’t have a brain. Clearly, we still have a lot to learn about consciousness in every form.