PRESCRIPTIONS: Fat Folios

By Lisa Haushofer

Obesity is often thought to be a twenty-first century disease. Our “modern lifestyle,” so the theory goes, with its rich diet, lack of exercise, and sedentary occupations, has led to the spread of a fatal condition. How far back would you date the beginning of this new epidemic? 20 years? 30? 50? Turns out, obesity was a concern as early as 1816. These medical tracts, held by the Center for the History of Medicine at the Countway Library, and published online in the Medical Heritage Library attest to longstanding anxiety. Go on, leaf through!

In 1816, William Wadd (1776-1829) published his “Cursory remarks on corpulence, or, Obesity considered as a disease: with a critical examination of ancient and modern opinions, relative to its causes and cure.” (1816) He was surgeon-extraordinaire to George IV, a fellow of the Linnean Society, and an associate of the Société de Médecine of Paris – in other words, very well-situated and well-connected. According to Wadd, it was the “increase of wealth and the refinement of modern times,” the “luxury” of Queen Elizabeth’s reign, (3) which led to the recent increase in “corpulence” in England. He suggests an array of treatments tested by various physicians – from a modest diet and exercise to chewing tobacco, drinking vinegar and applying soap (18-24). Curiously, he believed that obese people were susceptible to “contagion,” and that they were at risk of bursting into flames spontaneously! He recounts the story of a young, “very fat” woman, who “was found on fire in her chamber, where nothing else was burning. The neighbors heard a noise of something like frying, and when the body was removed it left a layer of black grease.” (54)

68 years later, Wilhelm Ebstein (1836-1912) published a very different treatise, with the telling title “Corpulence and its treatment on physiological principles (1884). Ebstein had studied medicine at the universities of Breslau and Berlin, graduating in 1859. At the time he published his book on corpulence, he was professor at Göttingen University and director of the university hospital and dispensary. German medicine in the 19th century was closely linked with the emergence of experimental physiology, and a new understanding of bodily processes in physical and chemical terms. Ebstein’s understanding of obesity rests mainly on a chemical system of processes involving fat. He understood the accumulation of fat as mainly a result of an “absolutely or relatively abundant consumption of food,” which was always in proportion to the “waste of the substance”. In other words, Ebstein’s conception of obesity was a mechanical equation of food consumption versus food used as fuel. Unlike many of his contemporaries, however, Ebstein didn’t think that the problem could be solved simply by eating less fat. He believed that chemical analysis proved the crucial role of fat in the digestion of protein. “Fat,” he reasoned, “checks the decomposition of albumen.” (45) This decomposition of albumen, however, was exactly the reason why people felt hungry in the first place – a decomposition or digestion of one substance signaled to the body that another substance, fat, was needed to replace it. Ebstein therefore recommended a “rational” diet, consisting of meat but also of fat in moderation.

However different their conceptions of corpulence, Wadd and Ebstein agreed that diet was a key treatment for obesity, but was by no means the only cure. In 1913, Francis Howard Humphris published a treatise on electrotherapy, and obesity featured as one of the most obvious and well-established conditions requiring treatment. It was only during the last 40 years, Humphris reflected, that the “condition” of obesity” had been recognized as a “disease.” Contrary to Ebstein, obesity was not a simple mathematical input/output formula. The name obesity, meaning “fully fed,” was misleading, “for it  by no means necessarily follows that the very corpulent person is either a large or injudicious eater; for while an excess of food may be a determining cause, it is a known fact that very thin people are large eaters, and also that many sufferers from obesity are small eaters” (98). Instead, obesity could be understood as a “state of disordered metabolism” – an unnecessary and wrongful storing of “superfluous adipose deposits.” Electrotherapy was a promising approach for a condition that seemed to affect the organism in such a complex way. The organs of the body were understood to be linked to the body as a whole, and a properly functioning organ did not only benefit that particular organ – it also promised to have a positive effect on the entire body. Training the muscles, for example, did not only lead to stronger and bigger muscles, but had an effect on all conditions in which “combustion” was “insufficient,” such as obesity or diabetes (102). Electrotherapy would provoke an “electrically provoked exercise” of the muscles, “being contracted by electric stimulation some hundred times a minute, the aim being exercise without fatigue – a desideratum which has long been sought, and will be admitted to be of the greatest therapeutic value” (102). Indeed.

Special thanks to Kathryn Hammond Baker from the Center for the History of Medicine at Countway Library for collaboration with this piece.

© Remedia.2012

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