Causes

Emaciation is a relative term, for there are families who are habitually thin. Members of such families may be strong and vigorous, although noticeably spare. In these cases leanness is an inherited condition. In other instances it may be due to insufficiency of food, poor cooking, or bad quality of food, or to imperfect mastication and indigestion. In most cases of emaciation a strong nervous element, often a genuine state of neurasthenia or hysteria, is a causative factor. When children grow tall rapidly, they are often very thin; as likewise are, in general, children who are nervous and extremely active. Both excessive nervous or muscular waste and slow or imperfect assimilation are important causes of emaciation. In old age a loss of flesh is commonly observed. It is sometimes excessive, producing emaciation. In such cases several factors usually contribute to produce the result: mastication is imperfect, appetite is poor, digestion is not uniformly good, assimilation is defective, and usually the lesion of generalized arteriosclerosis interferes mechanically with a good supply of nourishment to the tissues. Diseases, especially chronic ones, of the digestive organs also lead to excessive thinness. Many structural diseases of the brain and cord likewise cause muscular atrophy. Diabetes, tuberculosis, cancer, and acute and chronic fevers are equally common causes of loss of flesh. Each requires its appropriate treatment. It need not be said that in all cases of emaciation the cause must be removed if possible. When the condition is inherited, but little can be accomplished to relieve it. All nervous waste must be prevented, sleeplessness, intellectual excitement, worry, and excess of venery must be prevented or obviated. It is rare that muscular waste from work alone causes emaciation, but excessive physical work as well as excessive mental work must be avoided. In many cases rest in bed for days or weaks must be enjoined in order to obtain such mental and physical repose as is necessary. Weir Mitchell's treatment, which has already been described as applicable to cases of neurasthenia, is of great service in treating many cases of morbid thinness. By this method prolonged mental and physical rest is obtained, and simultaneously an excess of easily digested food is given to the patient. Assimilation is aided by massage. In stubborn cases, more can be accomplished by such treatment than by any other.

Treatment

Emaciation that is due to a specific disease demands the removal of its cause rather than treatment for itself.

When digestion is good, an excess of food should be given, but not enough to provoke indigestion. Frequent meals of moderate size are surest to be well tolerated. It is generally best to first increase the protein foods for they are easiest to digest; then the fats and carbohydrates. Eggs are particularly useful for they are capable of adding much weight without taxing digestion, especially if eaten raw or soft cooked. From three to six daily can often be taken advantageously. Carbohydrates should be given in increased amount but care must be taken not to overtax the digestive organs and create dyspepsias. The starches and sugars are especially fattening. Oils and fats are also useful, but, with few exceptions, they quickly produce a feeling of satiety that prevents the consumption of considerable quantities of food. Butter is an exception to this rule, and cream may be used freely upon cereals and fruits. Olive oil may also be used freely upon salads. A little crisp fried bacon is appetizing and wholesome to most persons. Even cold boiled ham when it is well covered with fat is digestible. Such articles of food should be recommended for those who are emaciated, but they should be prescribed in moderate amounts only. Food should be given finely divided. In all cases attention should be directed to the need of complete mastication of all solids that are eaten.

The following may be regarded as a typical menu for a day: Breakfast: One or two glasses of milk; if possible, two dishes of a cereal food, such as oatmeal, cracked wheat, or soft-boiled rice, with as much sugar and cream as the individual will tolerate, eggs and bacon, stewed fruit, and bread. Dinner: Two glasses of milk, a small portion of chicken or roast, mashed or baked potato, puree of other vegetables, such as peas, a salad with oil dressing, a farinaceous pudding, preferably one that can be eaten with sugar or syrup, and bread. Supper: Two glasses of milk, bread or cream toast, or pancakes or waffles with syrup, cold boiled ham, stewed fruit, or baked apples with cream.

Butter should be used freely on bread. If in individual cases it seems best, tea and coffee may be taken at meal-time, and milk with bread, crackers, or fruit may be taken between meals and at bedtime.

Sweet beverages are useful, and syrup is an agreeable condiment for emaciated patients. Like fats, it is apt to create a feeling of satiety if taken too freely. Beer, stout, and especially the sweetest malted beverages are prescribed, both because they are appetizing and because they contain a percentage of sugar that is easily absorbed. The small percentage of alcohol that they contain also helps to make tissue oxidation slower and fat to accumulate in the body. Sweet wine is prescribed for the same reasons. The amount of fat-producing matter, however, is much greater, measure for measure, in rich milk than in these beverages. In order to obtain good results, the need of freedom from mental or emotional excitement must be remembered.