M any credit Gull with the discovery of the disorder, which he described as "emaciation as a result of severe emotional disturbance" and "a perversion of the ego." His article entitled "Anorexia Nervosa (Apepsia Hys-terica, Anorexia Hysterica)" was published in the Trans actions of the Clinical Society of London in i874 and was based on a speech he gave at Oxford in i868 (Gull 1896: 205-14). The formulation "anorexia nervosa," however, first appears in his i874 essay. It is clear that there was a complex history of the disease that reached back to the seventeenth century. Gull's contemporaries, many of whom he acknowledged, also sharpened the diagnosis in the nineteenth century. The French neu-ropsychiatrist Charles Lasegue (1816-83) developed a diagnostic category very similar to that of Gull at the same time and is often acknowledged as one of the creators of anorexia (Vandereycken and van Deth 1989). Both built on older discussions of the pathologies of eating.
Gull's description was among the first to acknowledge the psychological factors involved in anorexia nervosa, although it focused on the physical symptoms (Madden 2004: 150). In fact, he was praised for "his powers of discernment, especially in distinguishing real disease from the troubles of nervous and hysterical people" (Anon. "Obituary: Sir William Gull" 1890: 261-2). Gull identified reduced food intake and hyperactivity as risk factors for anorexia nervosa, which are still among the current definitions of the disorder. He described patients as refusing to be treated and with such physical features as loss of menstrual period, decreased pulse, breathing and temperature, and binge-eating. Further, he found most patients to be female between the ages of sixteen and twenty-three. Unlike his peers, he viewed anorexia as a disease of the mind and not of the gastrointestinal system even, as he wrote, though "in the stage of greatest emaciation one might have been pardoned for assuming that there was some organic lesion" (Gull 1896: 307). Gull's recommendation for treatment was to administer food without "allowing the starvation-process to go on" (Gull 1896: 307). His paper presented two case studies, accompanied by "before and after" images. At the end of his life he presented one further case study of anorexia, again accompanied by "before and after" images proving that the return to a healthy state of mind from the "perversions of the 'ego' being the cause and determining the course of the malady" could literally be seen on the patient (Gull 1896: 311-14).
In addition to his role in defining anorexia nervosa, Gull also studied other diseases that impacted on bodily appearance such as the marked physiognomy and mental deficiency of hypothyroidism, known as "Gull's disease" (a term also applied by physicians in the early twentieth century to anorexia). He is credited with identifying the association between myxoedema and thyroid atrophy;
although Gull credited Dr. Hilton Fagge with this discovery. Gull was named a baronet after treating the Prince of Wales's (later Edward VII) typhoid. He was also the physician to Queen Victoria and, consequently, was one of many physicians of the time suspected to be "Jack the Ripper" because of the seemingly "medical" mutilation of "Jack's" victims.
His philosophy included the minimal use of drugs in treatment, focusing on diagnostics rather than disease and looking at large numbers of patients to identify health problems.
SLG/Dorothy Chyung See also Anorexia; Binge-eating; Morton; Murray
References and Further Reading
Anon. (1890) "Obituary: Sir William Withy Gull,"
Lancet 1: 324-26. Anon. (1890) "Obituary: Sir William Gull," British
Medical Journal 1: 256-63. Bergh, Cecilia and Per Sodersten (1998) "Anorexia Nervosa: Rediscovery of a Disorder," Lancet 351 (9113) (May 9): 1427-9. Enersen, O.D. (2002) "Sir William Withy Gull. Who Named It?" available online at <http:// www.whonamedit.com/doctor.cfm/85.html> (accessed February 19, 2006). Gull, William Withey (1896) A Collection of the Published Writings of William Withey Gull, Vol. II, London: New Sydenham Society. Herman, Joseph (1999) "Setting the Record Straight: An Episode in the Life of Sir William Withy Gull," Perspectives in Biology and Medicine 42 (4): 507-11. Madden, Sloane (2004) " 'Anorexia Nervosa': Still Relevant in the Twenty-First Century? A Review of William Gull's Anorexia Nervosa," Clinical Child Psychology and Psychiatry 9 (1): 149-54. Silver, Anna Krugovoy (2002) Victorian Literature and the Anorexic Body, Cambridge: Cambridge University Press. Vandereycken, Walter and van Deth, Ron (1989) "Who Was the First to Describe Anorexia Nervosa: Gull or Lesegue?" Psychological Medicine 19: 837-45.
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