(From extenuo, to diminish ). Leanness. This may arise in two ways: one from the increased evacuation of the nutritious particles; the other from cacochymia, or a depravation of the fluids. Prosper Alpinus observes, in his Presages of Life and Death, that if, after being extenuated by a disease, the body continues lean, though the nutriment be duly received, it denotes a relapse. Again, leanness from a spitting of blood, attended with a slow fever, is highly dangerous; and it is equally a bad sign in an ardent fever for the body not to become speedily lean, or to waste rapidly: the first prognosticates a tedious disease; the latter, death.

In general, leanness Is not a disease: and, whatever are the evacuations, or the degree of extenuation, if without fever, and the appetite keeps up, there is little danger. Extenuation alone is not a disease, nor a pre-disponent cause: the same cannot be said of its opposite, obesity. An acrimony in the fluids rather than increased discharges occasions it; but the source of the greatest emaciation is the effusions of dropsy. The body is never so thoroughly extenuated as in dropsy, though greatly so in hectics, from absorbed purulent matter, and cancer. Some recent remarks, by Dr. Pem-berton, in his Practical Treatise on various Diseases of the Abdominal Viscera, are so truly ingenious and comprehensive, that we shall select them in his own words. We cannot compress or give them in language more scientific and elegant.

"A proneness in the body to waste or not, as the same disease shall happen to be situated in this or that part, is in itself a circumstance very remarkable; and as an attention to this proneness may help to lead us through the obscurities which too often attend internal complaints, it is a subject well worthy of further consideration.

"To assist us in this inquiry it may be right to specify a few examples, where the difference of the effect of disease on the bulk is most striking. Let us take the two cases, of a diseased state of the mesenteric glands, and a diseased or scrofulous affection of the breast. In the former we shall find there is a great emaciation; in the latter, none at all.-in an ulceration of the small intestines, great emaciation takes place; in scirrhus of the rectum, none.- In a disease of the gall bladder, which is subservient to the liver, the bulk of the body is rapidly diminished; but in a disease of the urinary bladder, which is subservient to the kidneys, scarcely any diminution of bulk is to be perceived.-in 4 M 2 an abscess of the liver the body becomes much emaciated; but in an abscess of the kidneys the bulk is not diminished.

"If we examine into the functions of those parts, the diseases of which do or do not occasion emaciation, we may perhaps be led to the true cause of this difference of their effect on the bulk. In order, however, to understand more clearly how the functions of these parts bear relation to each other, it may be necessary to premise, that the glands of the body are divided into those which secrete a fluid from the blood for the use of the system, and those which secrete a fluid to be discharged from it. The former may be termed glands of supply; the latter glands of waste.

"The small intestines, in consideration of the great number of absorbents with which they are provided for the repair of the system, may be considered as performing the office of glands of supply.

"The large intestines, on the contrary, may be considered as performing the office of glands of waste; inasmuch as they are furnished very scantily with absorbents; and abundantly with a set of glands which secrete or withdraw from the system a fluid, which serves to lubricate the canal for the passages of the faeces, and Which itself, together with these faeces, is destined to be discharged from the system.

"I have often imagined that this mode of considering the subject might, in many cases, assist us in approaching to the seat of a chronic disorder, by deciding where the disorder is not situated, and consequently by contracting within narrower limits the difficulties of our researches.

"Thus the symptom exhibited by the patient either In retaining his bulk, or in being emaciated, might serve as a diagnostic, according to my conception, for the purpose of deciding whether the disorder is seated in the glands of supply, or in the glands of waste. - "The glands which secrete a fluid to be employed in the system, as well as the glands of direct supply, may be considered the liver, the pancreas, the mesenteric glands, perhaps the stomach, and the small intestines: and the glands of waste are the kidneys, breasts, exhalant arteries, and the large intestines.

"In an abscess of the liver, and an abscess of the kidneys, both of which glands frequently run into suppuration, without exhibiting any pain in the part affected, it seems impossible to decide in what part of the system the derangement manifested in both these cases by the hectic fever is situated.

"According to the foregoing idea, if emaciation takes place, we might then determine that the disorder must be situated in a gland of supply; and thus we should be led to decide, that the disorder was certainly not in the kidneys, consequently we should be secured from the danger of misapplying our remedies upon a part which was not affected.

"The same hectic attends a chronic disease of the. mesenteric glands, and of the small intestines: and here likewise, if emaciation does not take place, we should decide that the disorder was not situated in these parts, or in the liver.

"Now it is surely of considerable importance to determine where the disorder is not found, that our enquiries may be solely directed to those parts in which it is to be found.

"If this position respecting the bulk of the body,un-der disease, should be admitted as true, will it not af-ford a probability that the spleen, whose diseases produce great emaciation, is a gland of supply ?

"What has been here advanced must be considered as applying to local diseases unattended by pain, as pain will itself sometimes waste the body, though sometimes it will not. Here, too, the wasting from pain seems to vary according to the part from which it proceeds. A stone in the bladder of urine, or in the kidneys, nearly stopping the discharge of urine, and occasioning the greatest pain, will not in the least affect the bulk; but a biliary stone, under similar circumstances, will occasion great and rapid emaciation."

Extenuatio tympani auris. See Laxator externus.