Introduction

Extreme loss of body tissue in association with severe illness has been observed by physicians since ancient Greek times. The term 'cachexia' was the label for a 'signum mali ominis' in various, mostly fatal, diseases. Observing the chronicity of the course of a disease, cachexia was recognised as a severe complication indicating end-stage disease and poor quality of life. As modern treatment helps to prevent early death for an increasing number of chronic diseases, growing interest is focussed on chronic complications such as cachex-ia. Nevertheless, observation and clinical documentation of this condition go back as long as medical science itself. Pioneering studies on the reasons and mechanisms of cachexia were performed several decades ago. These studies provide fundamental insights and guidance towards a better understanding of cachexia.

In this review we present an historic overview of cachexia from the first anecdotal documentation to the beginning of its systematic investigation. The material reviewed is taken entirely from Western sources. We have concentrated on material that was published prior to the start of the online library Medline and is mainly based on the Index Medicus, which dates back as far as the nineteenth century (Fig. 1). Early thoughts and milestone studies on metabolic abnormalities leading to cachexia are presented.

Cardiac cachexia may serve as an example for cachexia secondary to chronic disease and has been focussed on for three reasons. First, especially in the field of cardiology, modern treatment options often prevent early death from acute events without completely erasing the source of the disease, such as surgical treatment in cases of some cancers. Second and following the former, chronic heart failure leading to cachexia may be

Fig. 1. The historic overview of cachexia is mainly based on material published in Index Medicus, which dates back as far as 1879

viewed as a rather isolated solitary origin for generalised deleterious and mal-adapting processes affecting global body functions. And third, the improved treatment of chronic heart failure and the gradual shift in the (patient) population towards elderly patients result in increasing numbers of patients with late-stage complications such as cachexia and hence a growing focus on this syndrome.

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