(From ill or bad, and a habit ) A bad.habit of body. The bad habit which constitutes cachexy consists of a want of vigour of the solid parts, and appears in universal languor, with every mark of defective digestion or assimilation, attended with diminished heat, strength, and activity. The skin is pale, yellow, or dark, and the white of the eyes often almost transparent. If difficult menstruation is the cause, it is called a chlorosis. In Dr. Cullen's Nosology, it is the third class of diseases. He defines it to be ' a depravity of the constitution of the whole or of a great part of the body, without any febrile or nervous disease as the primary one.' This class comprehends three orders; marcores, intumescentie, and impetiginea.
They are the most disposed to this disease who arc-naturally of a lax habit, which consists in the softness of the moving fibres, the smallness and number of the vessels, and the slenderness of the tendons. Women are more subject to it than men; men of a phlegmatic habit than those of different one; for such persons are apt to be plethoric, which occasions the liver to be sometimes obstructed: whence the train of consequences which form this disorder.
It is distinguished by a pale white countenance, but oftener by a yellowish or green colour in the skin, a fulness, coldness, a want of elasticity of the muscles, general feebleness, weariness, a difficulty of breathing on the least exercise, swelled feet, an inactive mind, oppression during sleep, urine white and turbid, the pulse slow and soft, the eye lids oedematous. When a difficult rnenstruation in girls is the cause, besides these symptoms, there is a pain in the head, a frequent palpitation of the heart, and a preternatural longing for things noxious and unfit for food; pain in the back and loins, a plethora either of the sanguineous or phlegmatic kind, and a sense of weight across the eyes. See Chlorosis.
Cachexy is, however, too general an association to be treated of in a single article. It forms with great propriety a natural order of diseases, agreeing in numerous obvious appearances, but differing in their causes. When we speak of it in general, we should say that it is commonly connected with suppressed evacuations, or with causes which influence the digestion and assimilation of the aliment; and, among the latter, scirrhosities of the chylopoietic viscera are the chief. Yet it is a mark of chronic debility in general, from whatever cause it may proceed. One of its distinguishing symptoms is a deficiency of the red globules of the blood. In our examination of the vital fluid we found it difficult to discover their origin, but, like the fibrin, they seem to be connected with tone and strength. The blood without these is of a yellowish hue; and the union of this colour with the red, gives the peculiar tinge styled the flesh colour. It may be considered as a single disease, when unconnected with suppressed menstrua, with jaundice, with scurvy, dropsy, any external tumours or ulcers, or hectic fever. In this view, it is often the effect of long continued anxiety, of ' hope deferred,' of too sedentary a life, indulgence in spirituous, liquors, too copious evacuations, particularly those excited by artificial or unnatural means. It is not that the disease differs, but that its cause is not obvious. A scirrhous liver, scirrhous mesenteric glands, an incipient dropsy, impaired digestion, may be produced by all these causes; but it often happens that the symptoms of neither betray the origin of the disease, and our remedies must be directed by general views only.
When the causes of cachexy are obvious, the disease becomes cither of those just noticed; nor is the distinction then difficult. We recollect but one instance
Q q 2 in which it is less easy, that is, between cachexy and hectic. In the weak cachectic state, a little fever attends in the evening, which may be easily mistaken for a hectic exacerbation. In hectic, the cough is often trifling and unnoticed, nor is the evening paroxysm strongly marked. In this difficulty, the uneasiness in laying on one side rather than the other, the narrow or deformed chest, the prevailing tendency to consumption in the family, may determine us. But, perhaps, the state of the pulse is the most certain criterion. If in any cachectic state the pulse is generally under 70, and does not at any time greatly exceed 80, we may be satisfied that the lungs are, at least for a time, secure. The young practitioner must, however, recollect, that there is no universal rule in medicine: the most general rules are liable to numerous exceptions. Old age is attended with cachexy, and of a most incurable kind. Indeed, it was long since observed, senectus ipsa morbus.
The indications of cure arc to correct the bad quality of the juices, to strengthen the stomach, and to invigorate the system.
Hence the diet should be nutritious, cordial, such as nourishes in the least quantities, and repeated often, to afford nourishment adapted to the state of the stomach, without overloading it. No error is more common or more fatal, than, in cases of weakness, to accumulate food. It is not what can be swallowed, but what the stomach can digest, that is serviceable, and it should be of such a nature as to oppose the cause and circumstances of the disorder. Exercise should be constant and regular, but within the compass of the strength. When the primae viae are evacuated, medicines which increase the vital heat, as warm bitters, aromatics, and chalybe-ates, should be given; antimonials relax the stomach, and therefore should be avoided.
It has been usual to give small doses of rhubarb previous to the dinner, that it may digest with the food. This plan, as well as the columbo root given at the same time, may have been useful; but very certainly not in consequence of its being digested. Each may give a temporary stimulus, and each may correct the effect of too rapid a digestion of the food, the evolution of an acid. A glass of white wine, previous to the dinner, would be equally, perhaps more, effectual.
Chalybeates are a favourite remedy with many practitioners, and, from their usual effects, they seem well adapted to the disease. We have said that all metallics are apparently tonic, and that chalybeates seem to join an inflammatory stimulus; yet steel is a remedy we have not often employed, and when given, its effects have not been apparently more beneficial than those of tonics and aromatics. But we mean not to set up our opinion as a standard; we are aware on this subject of a little prejudice, and can add, that practitioners of the highest character, and the correctest judgment, recommend chalybeates in this complaint.
In the usual directions, however, there is a want of discrimination which we must endeavour to supply. In every instance of cachexy, visceral obstructions are to be suspected; and we should not accumulate our tonics and stimulants, without relieving overloaded glands by gentle stimulants applied to their excretories, we mean slight laxatives. The warmer resinous purgatives are adapted for this purpose, and among them rhubarb and aloes are the most conspicuous. These may be given in every variety of form, not to purge violently, but to keep up a regular discharge, and on some days to give an additional evacuation to the usual daily one.
With similar views we have often advantageously given small doses of calomel, not exceeding a grain, or, at most, a grain and a half, every night. We have already spoken sufficiently of the general effects of mercury to explain its use in this case; and as there is always some internal obstruction to dread, its probable utility will be obvious.
See Dr. James's Dictionary, the article Cachexia. Boerhaave on the Cachexy. Shebbeare's Theory and Practice of Physic. Lewis's Translation of Hoffman's Practice of Medicine, vol. ii.
Cachexia uterina. See Fluor albus.
Cachexia icterica. See Icteris.