A peculiar type of anorexia is that striking and remarkable digestive disturbance of hysteria which Sir William Gull has called anorexia nervosa. In this malady there is such annihilation of the appetite that in some cases it seems impossible ever to eat again. Out of it grows an antagonism to food which results at last, and in its worst forms, in spasm on the approach of food, and this in its turn gives rise to some of those remarkable cases of survival for long periods without food.
As this goes on there may be an extreme degree of muscular restlessness, so that the patients wander about until exhausted.
According to Osler, who reports a fatal case in a girl who, at her death, only weighed 49 pounds, nothing more pitiable is to be seen in medical practice than an advanced case of this malady.
The emaciation and exhaustion are extreme, and the patient is as miserable as one with carcinoma of the esophagus, food either not being taken at all or only upon urgent compulsion.
Gull mentions a girl of fourteen, of healthy, plump appearance, who in the beginning of February, 1887, without apparent cause evinced a great repugnance to food and soon afterward declined to take anything but a half cup of tea or coffee. Gull saw her in April, when she was much emaciated; she persisted in walking through the streets, where she was the object of remark of passers-by. At this time her height was five feet four inches, her weight 63 pounds, her temperature 97 degrees F., her pulse 46, and her respiration from 12 to 14. She had a persistent wish to be moving all the time, despite her emaciation and the exhaustion of the nutritive functions.
There is another class of abstainers from food exemplified in the exhibitionists who either for notoriety or for wages demonstrate their ability to forego eating, and sometimes drinking, for long periods. Some have been clever frauds, who by means of artifices have carried on skilful deceptions; others have been really interesting physiologic anomalies.
Older Instances.--Democritus in 323 B.C. is said to have lived forty days by simply smelling honey and hot bread. Hippocrates remarks that most of those who endeavored to abstain five days died within that period, and even if they were prevailed upon to eat and drink before the termination of their fast they still perished. There is a possibility that some of these cases of Hippocrates were instances of pyloric carcinoma or of stenosis of the pylorus. In the older writings there are instances reported in which the period of abstinence has varied from a short time to endurance beyond the bounds of credulity. Hufeland mentions total abstinence from food for seventeen days, and there is a contemporary case of abstinence for forty days in a maniac who subsisted solely on water and tobacco. Bolsot speaks of abstinence for fourteen months, and Consbruch mentions a girl who fasted eighteen months. Muller mentions an old man of forty-five who lived six weeks on cold water. There is an instance of a person living in a cave twenty-four days without food or drink, and another of a man who survived five weeks' burial under ruins.
Ramazzini speaks of fasting sixty-six days; Willian, sixty days (resulting in death); von Wocher, thirty-seven days (associated with tetanus); Lantana, sixty days; Hobbes, forty days;Marcardier, six months; Cruikshank, two months; the Ephemerides, thirteen months; Gerard, sixty-nine days (resulting in death);and in 1722 there was recorded an instance of abstinence lasting twenty-five months.
Desbarreaux-Bernard says that Guillaume Granie died in the prison of Toulouse in 1831, after a voluntary suicidal abstinence of sixty-three days.
Haller cites a number of examples of long abstinence, but most extraordinary was that of a girl of Confolens, described by Citois of Poitiers, who published a history of the case in the beginning of the seventeenth century. This girl is said to have passed three entire years, from eleven to fourteen, without taking any kind of aliment. In the "Harleian Miscellanies" is a copy of a paper humbly offered to the Royal Society by John Reynolds, containing a discourse upon prodigious abstinence, occasioned by the twelve months' fasting of a woman named Martha Taylor, a damsel of Derbyshire. Plot gives a great variety of curious anecdotes of prolonged abstinence. Ames refers to "the true and admirable history of the maiden of Confolens," mentioned by Haller. In the Annual Register, vol. i., is an account of three persons who were buried five weeks in the snow; and in the same journal, in 1762, is the history of a girl who is said to have subsisted nearly four years on water. In 1684 four miners were buried in a coal-pit in Horstel, a half mile from Liege, Belgium, and lived twenty-four days without food, eventually ****** good recoveries. An analysis of the water used during their confinement showed an almost total absence of organic matter and only a slight residue of calcium salts.
Joanna Crippen lay six days in the snow without nutriment, being overcome by the cold while on the way to her house; she recovered despite her exposure. Somis, physician to the King of Sardinia, gives an account of three women of Piedmont, Italy, who were saved from the ruins of a stable where they had been buried by an avalanche of snow, March 19, 1765. thirty-seven days before.
Thirty houses and 22 inhabitants were buried in this catastrophe, and these three women, together with a child of two, were sheltered in a stable over which the snow lodged 42 feet deep.
