Bulimia ( ox,hunger) or cynorexia ( dog,appetite), or hyperorexia, denotes a condition in which the feeling of hunger is enhanced, appearing more frequently and in a more intense degree than in the normal state. Bulimia may exist alone as a primary affection or may he associated with various other disorders, and is then considered as a secondary affection. Thus ulcer of the stomach, hy-perchlorhydria, cancer of the stomach, intestinal troubles, tapeworm, Graves' disease, hysteria and neurasthenia, and tumors of the brain are all liable to be complicated with bulimia.

Symptomatology

Bulimia may appear periodically and last only a short time (a few days) or may exist chronically and last for months or even years. The periodical form is usually characterized by much greater intensity than the chronic. An attack of bulimia may be described as follows: In the midst of perfect euphoria, a feeling of intense hunger overcomes the patient with a persistent desire to satisfy it. This hungry sensation is associated with a gnawing feeling in the stomach, and the utmost fear and anxiety, as if something alarming were going to happen. If the feeling of hunger is not satisfied very quickly, then severe headache and trembling of the body or even fainting spells may occur. The patient in such a condition, as a rule, disregards conventionalities and tries to obtain whatever food he can, in order to overcome this painful craving of his stomach. Generally a small quantity of nourishment is sufficient to arrest the attack, sometimes, however, large quantities of food have to be taken. Thus Peyer1 describes the case of a woman who was suddenly seized with an attack of bulimia, so that she could not return home from the house of a neighbor whom she was visiting. In forty-five minutes she ravenously devoured three pints of milk, twenty-three eggs, and two pints of strong wine.

After this meal she became quieter, went to sleep, and awoke perfectly well on the next day.

The primary cause of bulimia appears to be a derangement of the nervous apparatus for the hunger sensation. This derangement may be either central or peripheral. Hypermotility was found by Leo 2 in a patient troubled with bulimia; but although present in some instances it is by no means a constant symptom. Thus Ewald3 reports a case of bulimia in which the motor function of the stomach was perfectly normal.

Treatment

The treatment should always be directed against the primary cause of the trouble. Thus helminthiasis must be removed by extract of male fern. Hyperchlorhydria should be treated by carbonate of soda, diabetes by a meat diet, and so on. Cases of neurasthenia or hysteria will have to be treated as such. The following means at our command may be directed against bulimia as a distinct disorder:

Very frequent light meals (every two hours).

1 A. Peyer: "Beitrag zur Kenntnissder Neuroeen des Magens und des Darms." Correspondenzbl. schweizer Aerzte, 1888, No. 20.

2 Leo: "Verhandlungen des Vereins fur innere Medicin," Berlin, 1889.

3C. A. Ewald: l. c, p. 379.

The bromides should be given in large doses, twice daily, as for instance potassium or sodium bromide, in doses of 1.5 gm. (gr. xx.), or bromide of strontium 12 gm. to 60c.c. peppermint water, one teaspoonful twice:

℞ Ammon. brom.,

Sodii brom.,......aa 8.0 Ʒ ij.

Aq. menth. pip.,.....60.0 ℥ ij.

S. One teaspoonful twice daily.

Rosenthal1 recommends the use of cocaine in doses-of 3 to 5 cgm. twice daily.

Opium or codeine, in doses of 3 to 4 cgm. (gr. ss.) three times daily, may be advantageously employed.

Arsenic, is also of value.

℞ Sol. arson. Fowleri,

Aq. menth. pip. • • • • . aa 5.0 Ʒ iss. S. Six drops three times daily.

A change of climate, sojourn in the mountains or at the seashore, is frequently beneficial.