Cachexia

“ The negro, however, must be healthy and in good condition—sickness, hard usage and chronic ailments, particularly that cachexia, improperly called consumption, speedily extracts the coloring matter out of the mucous membranes, leaving them paler and whiter than in the Caucasian. ”

“ It is true that what may be called the manifestations or lesions of the disease are often excited by some preceding dyscrasia, and also that the long persistence of these lesions may excite a cachectic condition which we might call the scrofulous cachexia ”

“ Malarial Cachexia.—Although the malignant tertian infection has the greatest tendency to produce anaemia yet any type may, when untreated, bring about the more or less profound anaemia with earthy skin, enlarged spleen, dyspnoea on slight exertion, and oedema of the ankles characteristic of malarial cachexia.
Oroya Fever.—In this disease we have what might well be termed a fulminating pernicious anaemia. The rod-shaped protozoon which attacks the red cells seems to be peculiarly active in the bone marrow, excruciating bone pains being quite a feature of the disease. ”

“ A final cachexia, with dementia, loss of control of the vesical sphincter and a terminal diarrhoea, marks the end. Recurrences of clinical manifestations each spring, or possibly skipping a year, are striking features of the disease. While the skin and alimentary tract disturbances are usually in abeyance in the winter, this holds to less degree with the nervous symptoms. ”

“ Animals suffering from osseous cachexia should be fed on cereals and forage obtained from rich districts where the disease has never occurred; but, as in times of scarcity questions of expense almost always receive first consideration, it may be necessary to substitute bran for such products, or give oats, maize, beans, rice, and oil or cotton cake, etc., all of which can be obtained commercially, and are of sufficient nutritive richness. ”

“ In course of time they give rise to a condition of ill-health or cachexia, the patient becoming pale, sallow, feverish, and emaciated, probably as a result of chronic poisoning from the absorption of toxic products from the tumour. They ultimately destroy life, it may be by their local effects, such as ulceration and hæmorrhage, by favouring the entrance of septic infection, by interfering with the function of organs which are essential to life, by cachexia, or by a combination of these effects. ”

“ Deficiency of Cheek (Total and Partial) .—A total lack of proper contour of the cheek, generally termed flattening, may be due to hereditary causes, but is generally dependent upon a cachexia due to a general disease, or fatty degeneration of the muscular structure of the cheeks, as found in those beyond middle age.
A partial deficiency of the cheek or cheeks is usually hereditary, but may be dependent upon digestive disorders or other causes of malnutrition.
This class of deformity is found more often in women than men. It is usually bilateral. ”

“ And, to continue the comparison, just as the habitual use of opium produces a species of chronic poisoning or cachexia without narcosis, so the habitual presence of the malaria toxin may produce its peculiar cachexia without giving rise to fever. As a rule, however, particularly in the case of Europeans forced to reside in highly malarious countries, attacks of fever are of frequent occurrence in malarial cachectics. ”

“ In extreme cases of gastrectasia, even without organic obstruction, the patient may be reduced to a degree of emaciation and of cachexia indistinguishable from that of cancer. As in so many other gastric diseases, the patient is usually mentally depressed and hypochondriacal. ”

“ Sometimes the respiratory murmur is whistling or blowing if the bronchial pressure is less decided. Progressive emaciation and cachexia are commonly present, not only from the inherent tendencies of the disease, but also depending upon the disturbance of the functions of many important organs which have been encroached upon by the tumor. ”

“ The prognosis depends upon the degree of lead cachexia present, the possibility of withdrawing the patient from the exposure, and finally upon the degree and extent of the paralysis and of the atrophy. It is rendered unfavorable by the necessity of the prolonged exposure of the patient to lead, by a high degree of disturbance of the general nutrition of the patient; and by the fact of his having presented for a considerable period the evidences of lead disease, with occasional attacks of colic or arthralgia; by the complete loss of power and electrical reactions in the affected muscles ”

“ The course of the disease is chronic, and in slight cases, provided fresh infections do not occur, is not unfavourable; in severe cases the cachexia caused by loss of blood, or intercurrent diseases to which the patients easily succumb—e.g., pyelitis, pyelonephritis, pyæmia, or uræmia—lead to a fatal issue. ”

“ If taken, in not too small a quantity, for a long time, the functional activity of the muscular and nervous systems is influenced injuriously, the development of the animal cells is inhibited, the number of the red blood corpuscles decreased, and therefore the oxidising process and metabolism are likewise diminished, leading ultimately to a condition of marked cachexia. ”

“ Females are far more apt to suffer from this affection than males, on account of their more impressionable nature and greater liability to nervous diseases in general. Hereditary tendencies, overtaxing the mental powers during the developmental period of youth, and later in life excessive mental labor and anxiety of business affairs, are causes. It may occur in the cachexia developed during the course of many chronic diseases, as diarrhoea, rheumatism, gout, phthisis, cancer, Bright's disease, etc. ”

“ Expressing the fact in other language than that of personification, the disease may become non-progressive because the unknown, special, constitutional morbid conditions which it is customary to embrace under the name tuberculous cachexia no longer exist ”

“ Alcoholic Cachexia.—The action of alcohol in excessive amounts upon the nutrition of the body at large, and in particular upon the nutrition of the nervous system, is radically unfavorable. This unfavorable influence manifests itself from the beginning, while the subject yet presents the appearance of health, and long before the occurrence of either the symptoms or physical signs of organic disease. The powers of resistance to unfavorable influences of all kinds are diminished; the ability to endure hardships, privations, and fatigue is lessened; sickness and injuries are badly borne ”

“ While anorexia, indigestion, vomiting, and epigastric pain and tenderness point to the existence of a gastric affection, the malignant character of the affection may be surmised by the development of anæmia, emaciation, and cachexia more rapid and more profound than can be explained solely by the local gastric symptoms. The value to be attached in the diagnosis of gastric cancer to the absence of free hydrochloric acid from the contents of the stomach must still be left sub judice. ”

“ The tongue then undergoes rapid tumefaction and becomes the seat of intense pain. The points of inoculation become hard, covered with vesicles containing bloody serum, which blacken, rupture, and leave dark, livid, gangrenous patches of ulceration. Profound cachexia rapidly ensues under typhoid manifestations, and death may result in less than twenty-four hours, though usually not until sixty hours. The prognosis, therefore, is of the gravest character. ”

“ Chronic gouty subjects assert that they are not benefited by colchicum until it has purged them. The [p. 700] lithic-acid diathesis, pyæmia, septicæmia, scurvy,4 diabetes, leucocythæmia, Addison's disease, and syphilis5 have diarrhoea during some part of their progress. The malarial cachexia is often attended with a diarrhoea which quinia alone will relieve ”

“ A little cachectic dropsy may appear about the ankles. While it is true that the general nutrition is less rapidly, less continuously, and, as a rule, less deeply, impaired in gastric ulcer than in gastric cancer, nevertheless sometimes a cachexia develops in the former which is not to be distinguished from that of cancer. Litten46 relates a case of gastric ulcer which simulated for a time pernicious anæmia. In this case the profound anæmia could not be explained by vomiting, hemorrhage, or other symptoms of ulcer. ”

“ While employed in a naval hospital at home, and dealing with diseases from foreign stations, occasionally it is one's fortune to meet with some of the more obscure cases of irregular fever and cachexia, the etiology of which is unknown, or only partially known. Of the latter, the disease called kala-azar, Dum-Dura fever, etc., is of peculiar interest, especially when attacking Europeans, or when it has been possible to demonstrate the parasitic organism. That the disease is more common than is usually supposed is very likely. ”

“ The most successful treatment of this variety of insomnia is that form of medication which is addressed to the particular cause of the cachexia or dyscrasia. But the palliative treatment necessitated by the [Pg 108] immediate suffering of the patient will often tax to the uttermost the ingenuity of the physician. Usually, there is a chronic atonic dyspepsia, or a chronic catarrhal gastro-enteritis, or a combination of both conditions, to be remedied. Gently stimulating laxatives are needed for the relief of these disorders. An animal diet is most easily digested. ”

“ Of the mortality due to malarial disease a small part only is referable to the direct attack of intermittent, and chiefly to the fever in its pernicious form. Remittent fever is much more fatal in its direct attack. But probably the greater part of the enormous total of deaths set down to malaria is due to the malarial cachexia. ”

“ Complete removal of the body in animals invariably terminates fatally, the patient exhibiting a definite train of symptoms—cachexia hypophyseopriva—and dying within a few days or weeks, the younger [226] animals living longer than the older. The symptoms of apituitarism are as follows: fall of body temperature, lowering of blood-pressure, increasing feebleness, muscular tremors, a curious attitude resembling that of defæcation, coma, and death. ”

“ Profound anæmia with an appearance of cachexia is always present in advanced cases. Milder cases may reveal themselves by no signs. The symptoms arising from other parts implicated in the degeneration may completely mask those depending upon the spleen. When the stomach is involved, vomiting and hæmatemesis even to a fatal termination may occur, or uncontrollable diarrhoea from intestinal changes may supervene. Splenic enlargement is not [p. 967] unusually accompanied by enlargement of the liver. Ascites, however, is always a rare accompaniment. ”

“ Serious cachexia, such as that caused by carcinoma or other growths, gives low blood pressure. Diabetes causes low blood pressure, provided there are no nephritis and no marked suprarenal stimulation. ”

“ After an indefinite length of time the growth, which has increased somewhat in size, becomes painful, ulcerated, and there is more or less of an offensive ichorous discharge. If the disease pursues its natural course, the ulceration will rapidly extend until neighboring tissue becomes involved; the inguinal glands become affected, and after the characteristic cachexia becomes apparent there is no known remedy or means of treatment that can prevent the progress of the disease to a fatal termination. ”

“ The rigor stage is relatively less marked; the pyrexial stage is more prolonged, and is often characterized by a tendency to adynamic conditions, together with vomiting, intestinal catarrh, pains in the limbs, anorexia, severe headache, and depression. After apparent recovery from the fever there is a great proneness to relapse at more or less definite intervals of from eight to fourteen days. Such fevers are accompanied by rapid destruction of corpuscles, and are usually followed by marked cachexia. At any time in their course symptoms of the gravest character may declare themselves. ”

“ The local diseases of the arthritic cachexia are principally seen in adult males past the age of forty-five. They consist especially in chronic inflammation of the muscular and articular tissues; in calcification of the basilar and coronary arteries, and of the cardiac valves. These changes give rise to hæmorrhagic apoplexy, angina pectoris, cardiac hypertrophy and dilation; and to secondary pulmonary affections, as emphysema, pulmonary apoplexy, and asthma. Irritation of the mucous surfaces may give rise to nephritis, pharyngeal and laryngeal coughs, and diarrhœa.—Med. ”

“ The animal’s general appearance is bad, the ears are pendant, the wool is dry and dull, and can be removed in handfuls by the slightest pull. There are no other external symptoms, and the diagnosis can only be arrived at by discovering the eggs of the parasite in the fæces.
Lesions. Post-mortem examination reveals all the general lesions of advanced cachexia and of gastro-enteritis of varying intensity. The abomasum and first portions of the small intestine usually contain a considerable number of strongyles ”

“ A still more serious and frequent cause of œsophageal stricture is that due to cancerous growth in the canal, which may occur at any part, but is most common at the lower end, in the vicinity of the entrance into the stomach. The symptoms of this condition are increasing difficulty in the passage downwards of the food, the steady decline in strength, and the development of the cancerous cachexia, together with enlargements of the glands in the neck ”