It was the close of the fall term, and to thank a class of exceptionally bright and enthusiastic students for a wonderful semester, I passed out some homemade cream cheese brownies. The plate went around the room and not a single female student took a brownie. When I commented on their apparent lack of appetite, two students informed me that they were unwilling to eat such a fattening snack the week of a formal dance. Although disappointed at their extreme self-discipline in the face of culinary temptation, I forgot about the incident until a summer afternoon in the British Museum Library, when I read Samuel Ashwell's 1844 case study of a fifteen-year-old patient: “Her appetite,” writes Ashwell, “was capricious … She was sedulously watched; and her exercise, diet, and clothing were carefully regulated … The appetite was, at times, morbidly great; while at other times scarcely anything was eaten.” This anonymous young woman, who eventually died, reminded me of the young women in my classroom and in high-school and college classrooms across the country who are not only extremely thin, but who are obsessively concerned with the amount and kinds of food that they eat and who resort to both fasting and vomiting in order to control their weight.

Could “Miss ----” have suffered from anorexia nervosa or bulimia, as an estimated one million American teenage girls and two million American women between the ages of nineteen and thirty-nine do today? Even before anorexia nervosa was independently diagnosed by two physicians, Charles Lasègue and Sir William Withey Gull, in 1873, doctors had described diseases very much like it.