CHAPTER V.

ON THE TREATMENT OF OBESITY.

It can scarcely be necessary that I should record all the several methods which have been proposed and adopted for the reduction of obesity; yet, lest I should be charged with ignorance, some mention must be made of the several useless and contradictory opinions and methods which have been adopted, frequently to the serious injury of the general health of the patient.

Some ancient authors inform us of the means that were employed in former times by slave dealers at Rome to render their merchandize fat or lean, in accordance with the requirements of the market. But these means, in our present state of society, are no longer available. I shall briefly say that the ladies of Rome, in order to reduce the size of their breasts, which, when largely developed, were considered unsightly, were in the habit of using a poultice composed of Lemnian clay, lime, sugar, parsley and white of egg. I have used this poultice to arrest the secretion of milk after childbirth, and under its influence the breasts have diminished in size to such an extent that it was manifest a reduction of the fat surrounding the glands had taken place. Instead of Lemnian earth, I substitute an argillaceous substance possessing all its properties. This poultice is the only remedial means worth recalling: all the others which are given are based upon superstition or some vulgar error. Thus it was believed to be possible, by means of a surgical operation, to remove with safety the fat _en masse_ from the abdomen, in the case of persons labouring under obesity. This belief has derived support from a story related by the historian of a certain pacha named Schisman, who it is said always had a surgeon accompanying him in his travels, whose duty it was to remove the fat from his abdomen whenever it became troublesome.

In 1718, Rothonet, a Parisian surgeon, is said to have delivered a well-known personage of that time of an enormous belly. After the operation the person became small and active. Rothonet was soon besieged on all sides by a crowd of people desirous of undergoing the operation of delarding. Rothonet explained that the person upon whom he had operated had been afflicted with a fatty hernia protruding from the umbilicus, and covering the whole external surface of the abdomen; that by removing this mass of fat he had restored the former agility of the patient; but that he would never dare to open the abdominal walls for the purpose of removing fat. Many people, however, believe to this day that it is possible thus to remove fat.

Cases are recorded of individuals of excessive obesity, who, being subject to the authority of an absolute master, have been submitted to most rigorous treatment for the purpose of reducing their fat. They have been shut up in a room, and fed upon an amount of food only sufficient to sustain life, and consisting solely of dry bread and water. Dry bread and water however, in sufficient quantity, and an endurable captivity, are not infallible means of inducing leanness. A foreign prince, still young, and subject to the will of his father, has been submitted to this treatment for some length of time, in the hope that his excessive fatty development might be arrested. But in spite of violent exercise, and the use of medicinal means, the prince weighs, at the present time, over three hundred and fifty pounds. In the case of horse-jockeys requiring to reduce their weight to the necessary standard, we may observe that, in order to accomplish their object, they put on a large amount of extra clothing, and take violent exercise (by running or otherwise) during several hours, and afterwards, while bathed in perspiration, are submitted to violent friction by means of a coarse cloth. The employment of such means is not devoid of danger; but the fat lost is soon recovered if the general health has not suffered impairment.

Drinking vinegar is a means unfortunately too frequently resorted to for the reduction of corpulence. This acid destroys the mucous tufts of the absorbents in the alimentary canal, and consequently only an insufficient quantity of nutrient matter is introduced into the system, thereby inducing a general wasting. When death does not result, the patient is for a long time, and frequently ever afterwards, subject to gastralgia, &c.

A lady once consulted me who, during a whole month, had taken every morning, while fasting, a spoonful of citric acid with syrup. It had not the effect of reducing her _embonpoint_, but had given rise to painful sensations in the stomach, which lasted for several years. I am sorry to say that I have known medical men, who, from their standing in the profession, ought to have set an example of prudence, when consulted in reference to the reduction of corpulence, have ventured to prescribe the use of iodine, iodide of potassium, and even arsenic in small doses. Patients whom I have seen, and who have followed these prescriptions, have told me that they have been compelled to abandon them before obtaining the desired effect, owing to the troublesome consequences attending the use of these powerful medicinal agents. The law takes cognizance of crime less serious than that committed by the physician, who prescribes such poisons when not imperatively called for.

Many authors, both ancient and modern, and many physicians also, recommend, in order to reduce obesity, that the patient should eat a less amount by weight than the body loses. By such means a wasting of all the organs of the body would be simultaneously effected; not only fat, but muscle, nerve, tissue, blood--all must suffer.

At the same time these authors universally forbid the use of meat, and permit only an exclusively vegetable diet. Any one, after reading the preceding pages, is competent to judge how great must be the error of these writers, who always end, however, by affirming obesity to be incurable. Incurable, no doubt, it is, by such treatment. But to diminish obesity, without affecting the general health, the patient must feed chiefly upon meat. I say chiefly, because man, being naturally disposed to partake of both animal and vegetable food, cannot live exclusively upon meat without prejudice to his general health. The use of a small quantity of vegetable matter will not prevent the diminution of fat. At a future page the several alimentary substances will be arranged from a chemical point of view, in the order they truly occupy as reducing or inducing obesity. For the present, it may be stated that among alimentary substances, exclusive of meat, those containing the greatest amount of water, such as watery vegetables, sweet fruits, &c., have an especial tendency to develop fat. The result of my own observation, in a great number of cases, is in perfect accordance with the chemical fact, viz., that the chief constituents of fat are also constituents of water. So that although a person should live exclusively upon meat, and at the same time drink a great deal, he would not experience any perceptible reduction of fat. This affords an explanation why many who eat very little, but drink large quantities of water, beer, cider, brandy or wine, labour under obesity. Whoever desires to avoid corpulence must therefore feed chiefly upon meat, partaking very sparingly of any other kind of food, and at the same time should drink but little.

Nor can it be supposed that, although obedient to the previous directions, the vast mass of fat existing in the body of an obese person will disappear in the course of a few hours. They who are exceedingly anxious to get rid of it speedily, whether for appearance sake, or because it is productive of inconvenience, infirmity or ill-health, must make use, at the same time, of those medicinal agents which help its removal. Among substances having an affinity for fat, the alkalis hold a prominent position; and these, when administered in the usual medicinal doses, are productive of no inconvenience, but increase rather than lessen the appetite, and aid the removal of fat. Soap pills have been in vogue for centuries, for the cure of portal obstruction. Vichy water is also recommended. The free alkali contained in the soap pills and in vichy water, is the active agent in such cases. Many persons are known to have grown thin while using Vichy water; and, on the other hand, many thin persons have resumed their natural _embonpoint_ under its use. An emaciated patient, suffering from liver disease, will regain his normal weight, on recovery from the disease, whether using Vichy water or not.

Cullen, in his Elements of the Practice of Physic, mentions a Dr. Fleming, who had sometimes succeeded in reducing obesity by the use of soap pills; and the author himself recommends, for the same purpose, abstinence, together with the use of alkalis, that is, to eat as little as possible of the least nutritive food, such as vegetables, and to drink water. The author states, as the result of his observation, that fat persons must not be bled; that loss of blood only weakens the system, and favors an increase of obesity. Another author speaks of the value of alkaline baths in the treatment of the obese.

Under the head of "Obesity," in the Dictionary of Medicine and Practical Surgery, we find the following:--"Our colleague, Dr. Melier, has witnessed the speedy reduction of great obesity in a lady, under the use of bicarbonate of soda and soda water, which had been prescribed with another object in view. If this effect should prove constant, we might be inclined to agree with him, that alkaline substances are capable of inducing saponification of fat in the living body, and that the resulting compound, being more soluble, is more readily absorbed. Whatever may be the explanation, it would be well to repeat the experiment, and we shall endeavour to do so upon the first opportunity."

I am not aware that the experiment has been repeated; but if it has been, the result has probably not proved satisfactory; because, for its success, the patient taking alkalis should be fed chiefly upon meat, with a small quantity of vegetables, and but little drink. Failing these conditions, alkalis are powerless. Cases do occur, of persons growing thin, who intentionally have done nothing to reduce their fat. In the same way it might happen that while making use of alkalis, without observing the precepts laid down, the fat might disappear. Such a case would be exceptional, and extremely rare.

Alkalis alone are incompetent to cure a case of obesity: this is capable of chemical demonstration. If a supply of fat, equal in combining proportion with the alkali ingested, be supplied by means of food to the body, the action of the alkali upon the previously deposited fat constituting the obesity, must be null. For the speedy reduction of obesity, therefore, the food must contain a less than ordinary amount of the elements of fat, by making it to consist chiefly of meat, and bringing about a reduction of the superabundant fat by means of alkalis, which should be administered in every variety of form, in order not to induce a sense of disgust on the part of the patient.

While undergoing this course of treatment, the person should not be called upon to make the slightest change in his ordinary habits, or in the amount of his daily labour. His appetite, which ought to be excellent, should be always satisfied; and while losing fat, he ought to experience increase of muscular firmness and vigour. Such have been the invariable effects produced in those patients under my immediate care, as will be fully shewn in the cases about to be reported.

After ten or twelve days of this mode of treatment, and with the help of alkalis, obesic patients experience a feeling of freedom from oppression, and already a reduction of fat has become apparent. This diminution continues; and by the end of the month, which is the shortest period of treatment, the weight has been reduced to the extent of ten pounds at least; but if the instructions have been rigidly observed, thirty pounds or even more. And this course may be continued for six months or longer, with marked improvement of the general health.