ANOREXIA NERVOSA. — Nervous anorexia.
Definition. — Sympathetic or nervous anorexia may be defined as a manifesta tion of hysteria in which there is total absence of hunger, a distaste for food, and leading to voluntary starvation.
Symptoms. — Without apparent cause the patient expresses a repugnance for food, which gradually increases until all alimentation is persistently refused. In some cases the repugnance is so marked that tricks are resorted to by the patient to avoid swallowing any aliment that may be introduced into the mouth by the attendants. Without showing any active manifestation indicative of a pathological process, the sufferer finally' succumbs. This variety of anorexia is occasionally associated with melancholia. The number of respirations is usually reduced, and the temperature may be subnormal.
Case in a girl, aged 14 years, who showed no organic lesions. Respirations, 12 to 14; pulse, 46; temperature, 97° F. Cured by light food frequently administered. The patient showed a persistent wish to be constantly on the move, notwithstanding her extreme weakness. William Gull (London Lan cet, Mar. 31, 'SS).
In marked cases the skin becomes dry, wrinkled, and cold, and the tongue is parched and sooty.
Etiology.—Ilysteria is probably a fac tor in the majority of cases.
Case in a young girl in whom bromide of potassium caused recovery. It was learned that in the boarding-house in which the patient lived there was a girl affected with an hysterical disorder of the larynx, and that in a short time another young girl had become affected in the same manner as the patient. Schlesinger (Wien. med. BM., No. 3, 'SS).
Careful inquiry usually shows that the patient belongs to a more or less neurotic family. The condition usually occurs in young girls, and occasionally in children.
Case of anorexia nervosa in a girl years old, who exhibited a morbid aver sion to food, and who was reduced to a skeleton, with marked mental troubles; however, after some weeks of rational nursing and treatment she was restored to physical and mental health. Collins (London Lancet, Jan. 27, '94).
Pathology.—According to Sollier, the stomach is more sensitive than is gen erally supposed, and its sensitiveness has a large influence on normal digestion.
The organ has motor and secretory func tions, the latter depending on two fac tors: the condition of the glandular ele ment and the nervous system. It is therefore evident that variations in the nervous system may affect the amount of secretion. The sensitiveness of the stomach is shown in three ways: by sen sation of hunger, by contact of food, and by knowledge of satiety. In the anorexia of hysteria he has often found an area of cutaneous anesthesia over the region of the stomach, which varies in intensity with the degree of altered sensation in the stomach itself; further, it is present only so long as the feeling of hunger is absent, and disappears when desire for food returns. It cannot be satisfactorily made out in the graver forms of hysteria, where cutaneous ansthesia is extensive. If the mechanical functions are also in volved there may be gastric atony.
Case of hysterical anorexia in which, while there was no evidence of visceral disease, and no sugar in the urine, the breath smelled of acetone, and the urine gave a most marked reaction of aceto acetic acid. There was vomiting, and the vomit also contained acetone. In the first, or comparatively fasting, period, acetone, aceto-acetic acid, oxy butyric acid, and ammonia were found. The amount of urine was small, and hence a considerable excretion of acetone occurred through the lungs. With suffi cient nutrition the smell of acetone in the breath, the reaction with ferric chlo ride in the urine, and the increased am monia excretion disappeared. Nebelthau (Centralb. f. inn. Med., Sept. 25, '97).
Diagnosis. —CANCER.—The fact that carcinoma of the stomach may he simu lated by grave forms of hysteria seems scarcely possible, and yet cases are countered in which, after long observa tion, the diagnosis is uncertain. Hyster ical cases have even been met with in which, with all the subjective symptoms of gastric cancer, there has eventually appeared an apparently pathognomonic tumor, the growth being composed of —27 the patient's own hair which she had swallowed.