As promised, here is the first patient case report by Richard Morton in his 1689 book, Pthisiologia. My comments are in regular italics and his original text in bold (with original, Stuart England grammar and spelling!).
History 1
Mr. Duke’s Daughter in S Mary Axe (a medieval parish in London memorialized by a modern London street of that name) in the year 1684. and the Eighteenth Year of her Age, in the month of July fell into a total Supression of her monthly Courses from a Multitude of cares and Passions of her Mind — It certainly makes sense that her presenting symptom would be amenorrhea—lack of menstruation– although here it seems to have preceded her weight loss and wasting. This has been reported off and on in the literature since Morton’s observation but largely ignored, as it seems counter-intuitive. Apparently, with Mr Duke’s daughter, the Mind (brain) had shut off the hormones even before she lost weight. Morton seems astonishingly clear that suppression of the menses was caused by the mind/brain, even without the benefit of our intervening 300 plus years of physiological and biochemical research. — but without any Symptom of the Green-sickness following upon it. In distinguishing this presentation from that of “green sickness” or hypochromic anemia, Morton is building a case for his colleagues that this consumptive disease is not like the many others they more frequently saw. Per Wikipedia: “Hypochromic anemia was historically known as chlorosis or green sickness for the distinct skin tinge sometimes present in patients, in addition to more general symptoms such as a lack of energy, shortness of breath, dyspepsia, headaches, a capricious or scanty appetite and amenorrhea.” 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 extreme and memorable cold Weather which happened in 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 herself both day and Night to the injuries of the Air, which was at that time extremely cold, not without some manifest Prejudice to the System of her Nerves. If this idea that vapours and cold air could cause major illnesses seems laughable to you, remember that physicians of Morton’s time did not even have the benefit of the germ theory. Robert Koch’s formal postulates regarding the existence of germs and their role in disease causation lay far in the future (1890), and Darwin’s work only a bit before that; the father of genetics Gregor Mendel did his (overlooked) work in the 1850’s though its importance was not recognized until the twentieth century.
The Spring following, by the Prescription of some Emperick, she took a Vomit (I think by this he means an emetic, i.e. something to make her vomit therapeutically), and after that I know not what Steel Medicines (some form of iron supplementation), but without any Advantage. So from that time loathing all sorts of Medicaments, she wholly neglected the care of herself for two full Years, (wow! a great description of “denial of the seriousness of the illness” which is reported in modern systems of classification for anorexia nervosa) till at last being brought to the last degree of a Marasmus (wasting), or Consumption, and therefore subject to frequent Fainting-Fitts, she apply’d herself to me for Advice (remember what he said about late advice in these cases, from his introduction and discussion).
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) how often I have made this observation to medical students when caring for our most severely wasted patients yet there was no Fever again he is differentiating this illness from the Other consumptive illness of the day: TB, 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 any other Entrail: no Looseness, or any other sign of a Colliquation, or Preternatural Expence of the Nutritious Juices — over-exercise? Only her Appetite was diminished, and her Digestion uneasy, with Fainting-Fitts (fainting is still a very common way for eating disordered children to present to the general pediatrician or family doctor), which did frequently return upon her. Which Symptoms I did endeavor to relieve by the outward Application of Aromatick Bags made to the region of the Stomach, and by Stomach-Plaisters (this was done as recently as my grandfather’s day) 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 (ick!). Upon the use of which she seemed to be much better; but being quickly tired with Medicines, she beg’d that the whole Affaire might again be committed to Nature, whereupon, she was after three months taken with a fainting-Fitt and died.
And preventing these deaths are what it’s all about.
