A voracious appetite; (from a particle which, in composition, augments the sense, and hunger). Boulimos, or bulimus, for which word Avicenna uses bolismus, signifies an ox's appetite, though this disease is more frequently called funics canina, or appetitus caninus; a canine appe-itue: it is also called phugedaena, adephagia, bulimia, bupeina.
Dr. Cullen names this genus of disease bulimia. He places it in the class locales, and order dysorexia; and distinguishes three species. 1. Bulimia heluonum, in which there is no other disorder of the stomach than an excessive craving of food. 2. Bulimia syncopal is, in which there is a frequent desire of food, and the sense of hunger is preceded by swooning. 3. Bulimia emetica, also cynorexia, in which an extraordinary appetite for food is followed by vomiting.
In some it may be a natural misfortune; for on dissection it hath been found, in a few instances, that the right orifice of the stomach was too large, consequently the aliment was too soon expelled through it. Galen says it is caused by an intense acid in the stomach, or other acrimony in the gastric juice. Others attribute it to a weakness in the lower orifice of the stomach, or to worms.
The complaint was perhaps more common formerly than at present, since the ancient authors consider it with great apparent anxiety. The cause of hunger, in general, we shall find to be an emptiness of the stomach, inducing an uneasy contraction. An increase of this contraction may arise from a rapid digestion, from a weakness of the stomach, or perhaps from worms. The food is retained in the stomach by its contraction, raising the larger curvature of the stomach to an horizontal position, and thus rendering the escape of the food from the pylorus difficult. In this way, weakness may occasion imperfect digestion, and, of course, insatiable hunger; but this cause may be easily ascertained by the lienteric discharge. Indeed, we believe it seldom occurs, and acids scarcely in any instance produce the complaint. From worms we have, we think, seen this disease: but we own that this cause is doubtful, for a plain and obvious reason, that no known species of worm lives on a chylous fluid, and the general effect of worms is irritation.
Lommius observes, that in this case there is great hunger, much is eaten, which, oppressing the stomach, is again thrown up; the patient is thus relieved, but the appetite returns; the stomach eased, by eating is again oppressed, and is again relieved, as that of a dog by vomiting.
There is no danger if food is supplied, though the patient be pregnant, except fainting is frequent. Fainting, with a full stomach, is a dangerous symptom; and the breath failing when a fainting comes on, adds to the danger: but these appearances are uncommon.
If an acid should be the cause, after vomiting, the testaceous powders, the lixivium of tartar, and iron filings, have been given.
If worms are suspected, anthelmintics must be prescribed; and in every instance, food of a less nutritious kind should be employed.
When the cause is not very manifest, moderate doses of opium may be given at proper intervals; but some circumspection is required in administering it. Besides vomiting, purges with aloes will be adviseable, wormwood, and such other medicaments as warm and strengthen the stomach. Galen commends frequent small doses of brandy; and Riverius says, that ambergris is peculiarly useful if five or six grains be repeated at due intervals; and coffee we have found of great service.
This disorder terminates in alientery, dropsy, atrophy, or cachexy. Boulimus, it is said, is not attended with a vomiting, but with a fainting; and that in the fames canina, the patient vomits up his greedy meals, or they run off by stool. In the bulimia, it is remarked, the same inclination to eat exists as in the boulimus, but without the power; and after the patient does eat, he faints. See Galen, Alexander Trallian, Paulus AEgineta, and Lommius.