Obesity

Among the Africans, of whose sufferings on board the slave ship Dr. Trotter has given so particular and affecting an history, corpulence seems to have been , as it were, the first stage of scurvy. “When a negro was becoming rapidly fat,'” says he, “it was no difficult matter to determine how soon he would be seized with the scurvy; so that corpulence seems here to have been the harbinger of the scurvy. Writers have been particular in noticing that this disease seldom or never produces emaciation. Dr. Trotter, upon whose information we may place full reliance , tells us, that having purposely inquired among his medical acquaintances in the navy, he did not find one who considered the wasting of the flesh or absorption of fat as a symptom congenial to scurvy . He immediately subjoins some observations of his own, that clearly indicate a connection between the scurvy and obesity (p. 98 , 99.). "In a corpulent state of the body,” he says, “the most hideous features of the disease are expressed; such are the bloated looks and countenance, & c. In a mess of midshipmen, who lived altogether on the ship’s fare, the only one he ever saw affected with the scurvy was a young man remarkably corpulent. From the whole of his observations it appears clearly that obesity predisposed his patients to scurvy, or rather was to them what cachexia is to dropsy.

Captain Meredith began the above treatment on Oct. 19, 1796. Two days later the quantity of urine passed in twenty-four hours had fallen from seven or eight quarts to six quarts. By November 1 the quantity did not exceed four quarts and on November 4 "he drank only three pints of water, and made only two quarts of urine, which to him and his servants (who had been in the habit of tasting his urine from curiosity) was not sweet." As time went on, the opium at bedtime was discontinued and the rubbing with hog's lard was left off. The latter was found to be a "troublesome and disagreeable" part of the treatment. Rollo decided to simplify therapy to include those features which were considered really essential: animal food, confinement with limitation of activity, and hepatized ammonia. The hepatized ammonia (ammonium sulphide) was used in place of "kali sulphuratum," originally prescribed, with the thought that it might be "a more certain and active medicine than the other on the stomach, in diminishing its action." 

Captain Meredith was directed to keep notes regarding his symptoms, diet, medication and progress of his illness. He did this quite faithfully, recording his transgressions as well as his attempts at cooperation. When at times he indulged in apples, bread and beer, Rollo found it necessary "to point out in stronger language the impropriety of such deviations." By December 30 the patient was free from abnormal thirst and polyuria, was regaining some of his lost weight and felt well. Continuation of treatment with a somewhat more liberal allowance of bread in the diet was prescribed.

CHAPTER VII.
ON THE SELECTION OF ALIMENTARY SUBSTANCES FAVOURABLE TO THE REDUCTION OF CORPULENCE.

It is to be borne in mind, that in dividing alimentary matter into two kinds—one fitted to develop fat, and the other having an opposite tendency—my object is merely to suit the indispensable requirements of my plan of treatment. Nor is the conclusion to be drawn, that in order to diminish corpulence, an exclusive meat diet is absolutely necessary. Man is omnivorous; that is to say, he partakes of everything entering into the composition of ordinary alimentation; but, for the purposes of my system, azotized substances should constitute, though not exclusively, his principal food.

Large quantities both of animal and vegetable substances compose the ordinary diet of man. According to some philosophers, man should live on flesh only; while others maintain that man is by nature a vegetable feeder. Most naturalists, however, are agreed that the human species is omnivorous; that is to say, can live both upon vegetable and animal matter. A certain proof, in my opinion, that such is the case, is to be found in the fact that man is provided with the two kinds of teeth, the one appertaining especially to carnivorous, and the other to herbivorous animals.

It is remarkable that man, in his present state of civilization, does not instinctively recognize the kind of food which is beneficial or prejudicial to his well-being. Experience alone teaches him what is good or bad. With the lower animals it is otherwise; they have the power to discern that which is suitable for food. The colt and the kid know how to select, among the varied herbage, the particular grasses which are suitable to their organization. Domesticated animals, having but an insufficiency of food, do sometimes partake of noxious plants. It may be that man, in consequence of his civilization, has lost that instinct possessed by the lower animals, and in blind confidence partakes of everything which is served to him in the shape of food; and this view derives support from the fact, that savages, and people but partially civilized, refuse to eat anything they are unacquainted with, no matter how temptingly it may be prepared.

The uneducated peasantry of France, at this day, will not taste food to which they are unaccustomed, or if they do, it is only with great mistrust.

It is matter of daily experience, that man can simultaneously feed upon both vegetable and animal matter, and can also live when restricted to one of these alone; such restriction, however, being better borne under the varied conditions of age, season and climate.

From these considerations it follows that, for the accomplishment of a given purpose, man has the privilege of selecting certain alimentary substances, and of refusing many others; the health of the individual, who may thus submit to the diet of his choice, being in no wise affected thereby.

Bearing in mind the well established principles of physiology and chemistry, together with the precepts set forth in the preceding pages, we may be safely guided in the selection of such alimentary substances as will conduce to the fixity of a certain condition of embonpoint, although having a tendency to redundancy; or which, on the other hand, will insure a diminution of obesity. 

Such results can be obtained by paying attention to the following remarks:

• That kind of meat known as game is very nutritious, occupies but small space, and consequently only moderately distends the alimentary canal. It contains but a small amount of carbon, relatively to the other compounds, and therefore should be used as much as possible: such as venison, hare, the warren rabbit, woodcock, snipe, partridge, quail, plover, wild duck, &c.

• The fluid portion of all ragouts should be avoided by those who dread corpulence, and game should therefore be roasted rather than stewed. The same may be said of butcher's meat, such as surloin of beef, beefsteak, veal cutlet, mutton chop, fresh pork, leg of mutton, &c. Gelatinous dishes, such as calves' feet and tripe, should be avoided. Poultry, when roasted, is not contra-indicated.

• It is a matter of observation, that those races which live chiefly upon fish are gross and dull, pale and lymphatic, and less courageous than such as live upon flesh. A fish diet is consequently favourable to the development of fat, and the usual accompaniment of butter sauce is also productive of a like result.

• The anti-obesic treatment, therefore, requires that fish should be partaken of sparingly; still it has been remarked that patients, while undergoing treatment, who eat principally of meat, with a very small amount of fish, do nevertheless succeed in the accomplishment of the object they have in view. The most nutritious fish are turbot, trout, sole, salmon, perch, pike, tench and carp. On the other hand, shell fish, such as oysters, lobsters, crabs and shrimps, have a tendency to impede the formation of fat.

• Vegetables, such as lettuce, chicory, sorel, artichokes, spinach, green pease, beans, cabbage, celery, and all such as are used by way of salad, are not very nutritive, but contain much watery and mucilaginous matter, favourable to the development of corpulency: the same may be said of carrots, turnips, potatoes, rice, beet-root, maccaroni and vermicelli bread; all kinds of cakes, pastry and biscuits, which are made of wheaten flour, are decidedly contra-indicated, as are also eggs, cream, cheese and butter.

• In reference to chocolate, much difference of opinion has hitherto existed as to its nutritious properties; but we know by experience that it is easy of digestion, and eminently suited to such as are subject to great mental exertion. Some dietists have held that chocolate has a tendency to prevent any augmentation of corpulency. When made with water, it is decidedly preferable to coffee made with milk, the latter being productive of fat. Milk, by virtue of its composition, combines all the elements which are fitted for the development and nutrition of the body; casein containing nitrogen, a fatty matter (butter), and a saccharine substance (sugar of milk).

• Chemistry reveals the remarkable fact, that the composition of casein or the cheesy portion of milk, is identical with that of the fibrin and albumen of the blood. Under this aspect, therefore, milk is very nutritious.

• The sugar and butter which exist in milk, have no analogy with flesh; according to analysis, they are composed of carbon and the elements of water. When, therefore, we partake of milk, we obtain in one and the same substance all the elements which are necessary for the growth and nutrition of the body, and such is the case in infant life. Since, however, both carbon and hydrogen, in very large proportion, enter into the composition of milk, it is advisable, whenever there is a manifest tendency to corpulence, that the use of it as an article of diet should be avoided. Infants are usually fat, owing to the elements of adipose matter forming so large a proportion of their food, whether that consist of milk alone, or in combination with starchy or farinaceous and saccharine substances.

▽Jean-Francois Dancel (a French physician) presented his thoughts on obesity in 1844 to the French Academy of Sciences and then published a book, Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of a Cure.
“All food which is not flesh ―all food rich in carbon and hydrogen [i.e., carbohydrates] ―must have a tendency to produce fat,” wrote Dancel.

Dancel also noted that carnivorous animals are never fat, whereas herbivores, living exclusively on plants, often are.

Dancel claimed that he could cure obesity “without a single exception” if he could induce his patients to live “chiefly upon meat," and partake “only of a small quantity of other food."

Dancel argued that physicians of his era believed obesity to be incurable because the diets they prescribed to cure it were precisely those that happened to cause it. (pp.151-152)

These chemical principles are founded upon facts—upon observation. As I have said, carnivorous animals are never fat, because they feed upon a substance rich in nitrogen—flesh; which flesh makes flesh, and very little fat. They have no belly, because flesh, taken in small quantity, suffices for one day, or twenty-four hours.

It has been objected that the carnivora do not always obtain food when hungry, and that they are often obliged to chase their prey for a long time before catching it. This is true; but on the other hand, carnivorous animals, when domesticated and fed upon meat, are not more fat, and have no belly. The celebrated traveller, Levaillant, in his Travels in Africa, says that he has seen, in the southern part of the continent, flocks of gazelles, which live in the interior, numbering from ten to fifty thousand. These flocks are almost continually on the move; they travel from north to south, and from south to north. Those of the flock which are in advance, and in the enjoyment of a rich pasturage, frequently come upon the borders of the settlements of Cape Colony, and are fat; those composing the centre of the herd are less fat; while those in the rear are extremely poor, and dying with hunger. Being thus stayed in their course by the presence of man, they retrace their steps; but those which composed the rear are now in advance, and regain their fat, while those which were in advance become the rear, and lose fat. Notwithstanding the vast numbers which daily perish, their natural increase suffices to maintain the integrity of the herd. In connexion with my subject I may state that these flocks are always accompanied or followed by lions, leopards, panthers and hyenas, which kill as many of them as they please for food, devour a part, and leave the rest to the jackals and other small carnivorous animals, which follow upon their steps. Now, these lions, panthers, leopards and hyenas, which need make but the slightest exertion to find food when hungry, are never fat.

It has been said, by way of objection to my system, that butchers are generally fat, due to their living upon meat. Now, I have made some enquiries in this matter, and have satisfied myself that butchers, as a general thing, are not fond of meat, but live chiefly upon vegetable food, and usually drink a great deal. It has been said also that their good condition is due to the atmosphere (filled with animal miasm) in which they live, a supposition which has yet to be proven. Again, it has been said that hogs can be fattened upon horse-flesh. My reply is, that they drink at the same time a large amount of water. And here I may remark, that the lard of hogs thus fattened upon flesh is soft and watery, and is considered by dealers to be of little value. It is evidently not due to the flesh upon which these hogs are fed, that their fat is soft and watery, but to the great amount of fluid they imbibe.

On the other hand, those animals which are enormously fat, live exclusively upon vegetables, and drink largely. The hippopotamus, for example, so uncouth in form from its immense amount of fat, feeds wholly upon vegetable matter—rice, millet, sugar-cane, &c. Naturalists long entertained the opinion that this animal, living mostly in the water, fed chiefly upon fish. It is now, however, well ascertained that the hippopotamus never touches fish, and is wholly a vegetable feeder.

The walrus, which, according to Buffon, seems to afford the connecting link between amphibious quadrupeds and the cetacea, is a veritable mass of fat, and lives exclusively upon marine herbage. The walrus of Kamschatka measures from twenty to twenty-three feet in length, sixteen to eighteen feet in circumference, and weighs from six to eight thousand pounds.

The following fact may be cited as a remarkable proof that the quantity of fat in any animal is mainly dependent on the character of its food: Among the whale tribe, those monsters in size, that of Greenland (Balæna mysticetus of Linnæus) possesses the greatest amount of blubber, and it feeds upon zoophytes, of which many resemble as much in character the plant as the animal. The fin-backed whale (Balæna böops of Linnæus), which does not feed upon mucilaginous matter, but upon small fish, has a much thinner layer of blubber than the former. The sperm whale or cachalot (Balæna physalus of Linnæus), which feeds on mackerel, herrings, and northern salmon, although nearly as long as the Greenland whale, is much thinner. The layer of blubber is not so thick as in the fin-backed, and yields only ten or twelve tuns of oil; while the Greenland whale yields fifty, sixty, and even eighty tuns.

Now, chemistry, as we have said, furnishes a rational explanation of these facts. With the exception of flesh, all alimentary substances (the mucilaginous, the gummy, the saccharine, the aqueous, &c.) consist of carbon and hydrogen, and fat is composed of the same elements. Success in the treatment of disease would be more frequent, if medical practitioners would pay greater attention to the chemistry of the vital functions; and the reason why certain articles of diet have a greater tendency than others to the formation of fat, would, by the aid of the exact science of chemistry, be rendered self-evident.

CHAPTER VI.
CASES OF REDUCTION OF CORPULENCE.

In the month of August, 1849, M. Guénaud, a master baker, still residing in the Rue St. Martin, Paris, presented the following appearance:—Age, twenty-eight years; height, four feet eleven inches. His obesity was such that he was scarcely able to walk, and whenever he attempted to do so, suffered from difficulty of breathing. When standing for a short time, he experienced great pain in the region of the kidneys. He was incapable of superintending the workshop and attending the flour market, duties which devolved upon him as manager of an extensive bakery. An unconquerable drowsiness overcame him the moment he sat down, and rendered him unable to attend to his numerous accounts. When in bed he was obliged to be propped up by a number of pillows, in a semi-recumbent position; for if his head happened to be too low, he suffered from vertigo, dizziness, &c. His countenance was suffused, and the veins of the head, especially the temporal, were more than usually distended. The slightest exercise was attended with excessive perspiration. The cerebral circulation was so much impeded, that he could not bear even the pressure of a hat; and asserted that he would not dare to stoop, even were it to insure him a fortune. In this distressing condition he sought the advice of a physician, under whose directions he was repeatedly bled, and freely purged. He was recommended to live upon the smallest quantity of food that nature would permit, and to diet chiefly upon watery vegetables, such as cabbage, turnips, salad, spinach, sorrel, &c., and only occasionally to partake of a very small quantity of meat. He was also directed to use active exercise, to work in the bake-house, and to take long walks. But he found it impossible to follow the latter part of this advice, on account of a feeling of impending suffocation, and severe pains in the region of the kidneys. He was therefore recommended to take exercise on horseback; but this even could not be borne, and in spite of every effort his obesity was constantly on the increase. At last he could not walk a quarter of a mile, and was obliged to confine himself to the house, passing his time in a listless, somnolent condition, entirely deprived of all mental and bodily energy. His mother, who lived in the neighbourhood of Paris, having seen the advertisement of my book upon Obesity, and thinking of the melancholy condition of her son, procured a copy and read it. She thereupon brought her son in a carriage to my office. Guénaud was quite out of breath from having to ascend one pair of stairs; he seated himself upon a sofa in my room, and soon fell asleep. Occasionally he would wake up, and take some part in the conversation. The mother and her son went home, and on the following day Guénaud began to carry out the directions he had received from me; and at the end of thirteen days he was able to walk from the Porte St. Martin to La Chapelle, where his mother resided, delighted at having recovered the use of his legs. What astonished him most was that he had been able to perform the journey on foot, without once taking his hat off. The latter remark may appear trivial; it shows, however, the great inconvenience he had been wont to suffer from the violent perspiration hitherto induced by the slightest exercise. By the end of the month Guénaud had reduced his weight from one hundred and ninety to one hundred and seventy-four pounds, and his circumference round the belly from fifty to forty-three inches. He was recovering his activity, both of mind and body, and his respiration was already considerably improved. The treatment was continued two months longer, and at the end of the three months his circumference was reduced fourteen inches, having lost forty pounds of fat. His muscular powers were now much increased. Guénaud had a very short neck; the two masses of fat, which made his cheeks appear continuous with his chest, have disappeared. The line of the lower jaw is now perfectly distinct, and without the slightest wrinkle. Instead of his former aged appearance, induced by obesity, his figure is now youthful, his countenance intelligent and sparkling. Before commencing my system of treatment, the patient was in continual danger from threatening head symptoms. It was generally said, even by the medical men under whose care he had placed himself, that he suffered from excess of blood; yet he has not lost a single drop during the whole course of treatment, and is now free from somnolency, giddiness and headache. The veins of the head are no longer turgid, nor does he suffer from excessive perspiration of the head.

I am satisfied that this man, at the present time, has more blood in his system than he had when labouring under obesity; but the circulation being now free, all inconvenience has disappeared.

It is unnecessary to add that, owing to the lungs being no longer oppressed on all sides by a superabundance of fat, their movement is unimpeded, air finds easy access, and the difficulty of breathing, with sense of impending suffocation, no longer exist. Guénaud can now sleep in the ordinary recumbent position. Men of great corpulence, when walking, experience severe pain in the kidneys, and this arises from the enormous mass of fat which surrounds these organs, inducing by its weight a dragging sensation. Guénaud, having lost his big belly, is no longer troubled with this uneasiness when walking.

With respect to this patient, and in all the other cases which have come under my care, it may be well to remark that the muscular system has recovered its tone, and that the muscles are harder than they were before treatment; and I can safely say, without fear of contradiction, that every person who has been submitted to my system for the cure of obesity, is convinced that his flesh, his muscle, has increased both in firmness and in size.

I have had men under my care weighing two hundred and fifty pounds. Upon the occasion of their first visit, having felt their limbs, I have said, "I can diminish your weight by fifty pounds; but these enormous muscles will be increased rather than diminished in size. You must not expect a reduction of more than fifty pounds; but fifty pounds less of fat, distributed among organs overloaded with it, will be highly beneficial to health."

Guénaud is far from being thin, but he is strong and muscular, and has the physical and moral energy of a robust young man. His enormous size had rendered him conspicuous in that part of the city where he carried on his business as a baker; but when he had become reduced to the normal size of other men, the change produced considerable sensation, and excited curiosity as to the cause. He has done justice to the treatment which has made him once more a man. I will also do him the justice to say that he has honestly carried out my instructions. A beefsteak or a couple of cutlets, with a very small allowance of vegetables, together with half a cup of coffee, constituted his breakfast. Dinner consisted of meat and a very small quantity of vegetables. From being a great water-drinker, he had come down to an allowance of a bottle or a bottle and a half of liquid in a day. When thirsty he drank but little at a time; and between meals, used to gargle his mouth with fresh cold water.