Obesity

In the month of June, 1853, Madame de L., of Amiens, consulted me on her own behalf, and also on that of her husband—both labouring under obesity. I gave her the necessary directions, together with medicine sufficient to last two months. She wrote to me on the 2nd of July in the following terms:

"Sir,—In fulfilment of my promise, I send you a statement of the result of your treatment. My husband has lost eleven pounds in weight, and enjoys excellent health. As for myself, owing to severe indisposition after my return home from Paris, I have only adopted your treatment during the last eight days. Please inform me whether the medicine you furnished to me a month ago is too old to be of any service.

"I have the honour, &c.,
"F. L."

I answered this letter, and no doubt the lady has derived as much benefit as her husband from the treatment.

It is said, that in order to be understood and believed, it is necessary to repeat the same thing over and over again. But all things must have an end; and all the cases which I might yet report, would still end in diminution of obesity. It may be said, however, that, like most medical writers, I report only favourable cases, and conceal those which are unfavourable. My answer is, that I have never treated a single case in which a favourable result has not been obtained, provided the patient has observed my directions for even eight days; and I am satisfied that if any one could be found to say that he has not been benefited, that it would be because he has not been willing to carry out the treatment for even eight days. It has no doubt frequently happened that a patient has consulted me, and has then followed my directions for two, three, or even four days, and then, for some cause, has given them up: under these circumstances it might be said that no benefit has been derived.

Many such cases have occurred. In one instance, a wealthy man, a gold-beater by trade, living in Paris, sought my advice. He followed my system for several weeks, without success. One day I said to him, "I can only explain your want of success by attributing it to excessive drinking. You live upon meat principally, it is true; but how much liquid do you imbibe daily?" His answer was,—"I cannot abstain from drinking when thirsty, and my thirst is frequent. I spend the whole day in the factory, among fifteen or twenty workmen, and the heat is necessarily great, as the nature of our manufacture demands it, and I am therefore obliged to drink a great deal." I consequently recommended him to abstain from further trial of a system which, under these circumstances, could not possibly be of any benefit.

We meet with people who make, or seem to make, a resolution to live according to a certain plan, for eight or ten days, and who, like spoiled children, forget the very next day the resolution they had made. I have met with many such cases. One would scarcely believe that a lady, reduced to despair on account of her obesity, and threatening to commit suicide unless relieved of her embonpoint, could promise that she would obey my instructions to live chiefly upon a meat diet, and to abstain from inordinate quantities of fluid, yet the very next day would resume her customary mode of living;—breakfasting upon eggs, preserves, and two or three cups of sweetened tea; and dine upon rich pastry and sweetmeats, accompanied with a full allowance of champagne. I could not have believed it possible had I not witnessed it myself.

Men generally carry out my directions more faithfully than women, being firmer and more persevering in their resolves.

I am almost angry at times with this want of perseverance in persons who boast that they have carried out my treatment without success. It would be an easy matter to shew that the want of success in such cases is entirely their own fault.

A young lady of one of the most illustrious families of France, and married to a wealthy foreign nobleman, consulted me in the month of May, 1853, in reference to her corpulence. She told me that her cousin, the Duchess of X., had derived great benefit from my treatment; and from what she had witnessed in her case, she was induced to place herself under my care. She promised to commence my system on the following day.

A few days afterwards I saw her. She told me she had forgotten to take her medicine the day before. In subsequent visits, she confessed that she had not taken any medicine, either because she had been up very late the previous evening and had laid in bed late that morning, or that she had been spending a day or two in the country; or that, having been out for an early ride, she had forgotten all about it. On the occasion of my last visit, she told me that she was going for some time to her country-seat, and from thence intended to visit a watering-place. The Baroness did not follow my treatment for three days consecutively, and consequently lost nothing of her embonpoint. Under such circumstances, want of success ought surely not to be attributed to inefficacy of the treatment.

A very corpulent professor adopted my system for eight days, and lost three pounds and a half in weight. Being relieved at the same time from a sense of oppression which had continually troubled him, he was delighted, and spoke of the happy results to many of his acquaintances. Unfortunately at this time he received from the country a present of a large basket of grapes, and being very partial to them, neglected my instructions, and partook of them inordinately as long as they lasted. The consequence is, that the professor is as fat as ever, although he had followed my plan of treatment for eight days. Now whose fault is this? Nevertheless, his acquaintances, to whom he had spoken of being under my care, will attribute the failure to me. I shall see him again, no doubt, some of these days, when in danger of suffocation.

The reader who has perused the preceding cases of cure, may say that I have omitted to speak of obesity accompanied with skin disease, and in my introduction mention has been made of its frequency. In truth, many such cases have been met with; but skin disease, in my opinion, is of such a nature that it is better not to give a hint even of the parties in whom it has been met with and cured at the same time with co-existing corpulence.

My method of reducing obesity being thus frankly explained, is perhaps likely to lose its value in the eyes of many, owing to its extreme simplicity. M. Desbouillons, of Brest, a patient whom I successfully treated, wrote to me on the 15th August, 1853:—"On reading your treatise a second time, I cannot but express my astonishment that the medical faculty should so long have failed to discover the means which you now so successfully employ for the cure of obesity."

Having accomplished the object I had in view, it matters not whether it be the result of little study or of long and deep enquiry into the secrets of animated nature; my satisfaction consists in having destroyed those false and prejudicial doctrines which had existed for ages in the writings and teachings of philosophers, and in having demonstrated a truth destined to render important services to our common humanity.

Towards the latter end of 1851, Madame Wimy, from the town of Marle, came to consult me in reference to her husband, who was labouring under obesity to such a degree as to be unable to attend to his business. I gave her the necessary advice, together with some medicine. On the 19th of December Madame Wimy told me by letter that her husband had already much improved, that his breathing was easier, he was more capable of exertion, and that his corpulence had notably diminished. This lady again wrote to me in the following year, requesting a further supply of medicine. She said:—"My husband, before commencing your treatment, weighed two hundred and seventy pounds: he now weighs only two hundred, and hopes to weigh still less. You are no doubt in the frequent receipt of letters seeking advice, for we have many inquiries for your address."

In truth the case of M. Wimy has brought me a great many patients. Anxious to know whether he still continued my plan of treatment, and wishing to introduce a statement of his case in this the third edition of my work, I wrote to M. Wimy on the 16th of October last and received the following reply:

"Marle, 19th Oct., 1853.

"Sir,—In your letter of the 16th, you requested me to give a somewhat detailed statement of my case. I commenced the treatment under your directions, the latter part of 1851, and continued it during the early part of 1852. My weight was two hundred and seventy pounds, and I measured sixty-one inches in circumference. I walked with great difficulty—suffered much pain in the kidneys—my legs were swollen. I had a constant cough, and was much troubled with drowsiness. Immediately after adopting your system, my fat began to disappear, my appetite improved, and, after a few months, my weight was reduced to one hundred and sixty pounds, and my circumference to thirty-two inches. My health is now excellent. Being landlord of the Golden Lion Hotel, at Marle, where the stages put up, my recovery is known to a great many; and travellers who stopped at my house two years ago, when I was labouring under obesity, on seeing me at present, and noticing the wonderful change which has taken place, invariably ask by what means it has been effected.

"It always affords me great pleasure to acknowledge that my cure is due to your system of treatment.

"I have the honour to be, &c.,
"Jules Wimy.

"Golden Lion Hotel,
Marle, Aisne."

A person who visited Marle about four months ago, and who had not seen M. Wimy since the great change had been effected in his appearance, was much astonished, and made inquiries respecting the cure. Some time afterwards, this person met, at Orleans, a wealthy gentleman, about forty years of age, suffering from obesity, and told him what he had witnessed at Marle; recommending him at the same time to visit Paris, in order that he might have the advice of the doctor who had freed Wimy from his excessive fat. This gentleman wrote to Marle, before coming to Paris, and received a satisfactory answer.

He called to consult with me, saying that he wished to place himself under my care, provided that it would not interfere with his business or with his usual habits. He is postmaster at Orleans, and, previous to the building of the railroad, had a great deal of business to attend to. Having many more horses than necessary for his business at Orleans, he has opened a livery stable in Paris. He is consequently obliged to attend all the fairs and markets, in order to purchase horses and provender for his two establishments,—the one at Paris and the other at Orleans, and is almost constantly travelling between these two cities, and therefore leads a life of great activity. He weighs two hundred and twenty-two pounds, and wishes to lose fifty pounds of fat, but he cannot afford to lose a day from his business.

My reply to Mr. M. was, that so far from my treatment demanding any cessation from work, it would rather give him strength to carry it on. He began the treatment ten weeks since, and has already lost between twenty-eight and thirty pounds of fat; and, as I had promised, without causing him the loss of a single day.

The causes of obesity are numerous. It is often hereditary or constitutional, the inclination being derived from either parent. This tendency is seen not only in individuals but in nations: e.g., the Dutch are as stout, as the Americans are proverbially thin. Over-feeding will induce fat, and so will the habit of taking too much fluid. The obese are not always great eaters: but they invariably drink a great deal, even though it be only water. Farinaceous and vegetable foods are fattening, and saccharine matters are especially so. The instance of the slaves in Italy, who got fat during the grape and fig season, has been quoted by Galen. In sugar-growing countries the negroes and cattle employed on the plantations grow remarkably stout while the cane is being gathered and the sugar extracted. During this harvest the saccharine juices are freely consumed; but when the season is over, the superabundant adipose tissue is gradually lost. And then amongst other causes we must reckon insufficient exercise, long continued pros perity and ease of mind, indulgence in too much sleep, and an absence of the sexual appetite. Eunuchs are generally described as being flabby and fat; whilst amongst the lower animals, fattening is readily produced after the removal of the testicles or ovaries. The way in which the same fact can be made to tell in favour of two opposing theories is curiously illustrated by two writers on this subject. Thus, Wadd cites the butchers as examples of corpulence, alleging that their excellent condition is due to animal food. He speaks particularly of the advantages of the “butcher's steak; " and does not believe that these men and their wives owe their good looks to “the effluvia of the meat."* Dancel also speaks of the frequency with which the members of the same class become obese; but he says it is because the butchers eat meat and plenty of vegetables, while their wives generally prefer vegetables to animal food. He has no faith in the opinion that their embonpoint has some connection with the atmosphere of nutritive animal odours in which they live. 

Fats are obtained abundantly from both the animal and vegetable kingdoms. Their predominating elements are carbon and hydrogen. They never contain nitrogen, except as an accidental ingredient. They are made up of three closely allied bodies; viz., stearin (from otéap = suet ], margarin ( from its lustrous appearance, pápyapov = a pearl ], and olein [ oleum = oil ] which is Huid. When fatty matters are heated with the hydrated alkalies, they undergo saponification, during which process a viscid sweet fluid glycerine ( dukùç = sweet ] -is yielded. Now several physiological studies lead to the conclusion that oils and fats may not only be formed in the system from food which contains it ready prepared, but also from the chemical transformation of starch or sugar. Many experiments have been performed on geese, ducks, and pigs, which have proved that these animals accumulate much more fat than could be accounted for by that present in the food. M. Flourens had the bears at the Jardin des Plantes fed exclusively on bread, and they became excessively fat. Magendie, in making experiments on the forage of horses, found that these animals constantly returned more fat in their excrements than their food contained. And several authors have shown that bees form wax, which strictly belongs to the group of fats, when fed exclusively on purified sugar. If with foods of this nature the animals be subjected to a warm atmosphere and allowed but little room for movement, the adipose tissue rapidly gets increased. At Strasburg, the place of all others most noted for its pâtés de foie gras, the geese are fatted by shutting them up in coops within a room heated to a very high temperature, and stuffing them constantly with food. Here all the conditions for insuring obesity are resorted to --- viz. external heat, obscurity, inactivity, and the cramming of the animals with nourishment.

Cantani’s dietary regime involved periods of energy restriction, however the German physiologist Wilhelm Ebstein cites Cantani as an authority for the use of pure fat in diabetic diets. In 1892 Ebstein published his comprehensive review of the literature on diet, lifestyle, and diabetes, Über die Lebensweise der Zuckerkranken, which includes the statement that “up to about 200 grams of fat is well tolerated by the majority of diabetics” [7]. Also in 1892, Ebstein’s book on Corpulence and its Treatment on Physiological Principles, which contained brief summaries of his findings on fat and diabetes, was translated into English [8]. In this book and his subsequent work On the Regimen to be Adopted in Cases of Gout Ebstein discussed experimental evidence on the metabolism of protein and the desirability of limiting both protein and carbohydrate, and increasing fat, in the treatment of metabolic diseases [9].

German Txt (Very hard to read)

https://archive.org/stream/diefettleibigkei00ebst/diefettleibigkei00ebst_djvu.txt

English Translation Scanned PDF:

https://dlcs.io/pdf/wellcome/pdf-item/b21050533/0

Ebstein describes Rabbit Starvation:

Page 37:

Notwithstanding the vastly important part played by nitrogenous food in human dietetics, those substances that contain no nutritive ingredients except albumen, as for instance flesh destitute of fat, are not proper food for man. As flesh satisfies his demand for carbon only when it is consumed four times in excess of the quantity required to yield the nitrogen needed for his nourishment, such a course would in the first place be far from economical, seeing that meat is one of the dearest articles of food. And then we should very soon find it impossible to consume every day the 90 oz. of pure flesh required for this purpose.

The dietetic systems of treatment now in vogue are based on an almost exclusively albuminous diet. In 1850 Chambers had already pronounced in favour of this regimen, his system excluding all fat substances such as fat, oil, butter, milk, cream, as well as sugar. Of starch-flour in the form of potatoes and even of bread he remarked, that they should be looked on with the greatest suspicion. He also insisted on a diminished consumption of liquids. 

We thus perceive that strictly speaking Chambers' cure differs in no respect from that, by which Banting grew lean in the hands of his physician Harvey, and which has received the name of the Banting cure from the patient, who has written an account of his malady and curative process. From it's specially operative factor Kisch has named it the "Anti-Fat Cure".

Cantani has gone still more vigourously to work. He bars not only all fats - fat meat, fat fish, cheese (owing to its sebacic acid), but all farinaceous preparations, all saccharine foods, sweet and aromatic fruits. Only when the patient is unable to continue this diet long enough, either through excessive repugnance to meat, or nausea of the stomach, or muscular debility, he combines it with the Harvey-Banting system, which also no doubt anathematises the fats, but allows a certain quantity of carbohydrates. 

    Hence these cures have this in common that both alike to the very utmost exclude fats, which they regard as the chief source of the accumulation of fat in the body.

    Now I will by no means deny that a series of cures does result from the Harvey-Banting and Cantani methods, that is to say, by these means corpulent persons become thin. But on the other hand it must be allowed that: 

Page 44:

Ebstein strongly supports fat for satiety.

"I would now specially insist that the suitable quantity of alimentary fat must not forsooth remove hunger in such a way as to produce dyspeptic symptoms or injure the digestion; and this I dwell upon because the question has already been more than once placed before me by competent colleagues. It is of course a tacit assumption that the fat like all other human aliments, be of unexceptionable quality. The experiments made on persons suffering from fistula in the stomach, have already shown that fat substances disturb the digestion only when they are consumed too abundantly, and I have myself often enough administered with surprising succcess alimentary fat to dyspeptics of the worst type, while limitng their allowance of carbohydrates. But my own numerous experiences have also convinced me, that in the treatment of corpulency fat agrees perfectly well even with those, who had previously regarded it with nausea. I have even noticed a total disappearance of the dyspeptic affections, which the corpulent had hitherto brought upon themselves by an improper diet. The patients preserve a good appetite, which they must learn to moderate by yielding only the actual feeling of hunger. 

The reason of this alleviation of the feeling of hunger with a proper allowance of fat in the diet is due to the circumstance, that fat checks the decomposition of albumen, and that consequently the craving to make good the waste makes itself felt more slowly and less urgently. Precisely because fewer albuminates have been decomposed, fewer require to be replaced. As by the addition of fat to the diet in the same proportion as the decomposition of albumen is diminished, the quantity of nitrogenous refuse from the assimilated substances is also limined, a smaller amount of drink is needed for its removal. Hence in this way thirst as well as hunger becomes appeased. That fats reduce the craving for food was already known to Hippocrates, who remarks in the section dealing with those that wish to become fat or lean: "the dishes must be succelent, for in this way we are easiest sated." Very interesting to me was a communication from Loew, bearing on the point that the use of fat is also effective in checking the craving for liquids. After the consumption of fat in hot climates he always noticed a diminished demand for water; thirst became decidely less irksome.

This property of fat to produce satiety more rapidly, to diminish the craving for food and abate the feeling of thirst, facilitates to an extraordinary degree the introduction of the modified diet. For to the sacrifices which after all must in any case be required of the corpulent, nothing further need be superadded at least in this direction. On the contrary, the permission to enjoy certain succulent things, always of course in moderation, as for instance salmon, pate de foie gras and such like delicacies, reconciles the corpulent gourmet to his sacrifices. These consist in the exclusion of the carbohydrates. Sugar, sweets of all kinds, potatoes in every form I forbid unconditionally. The quantity of bread is limited at most to from 3 to 3.5 oz a day, and of vegetables I allow asparagus, spinach, the various kinds of cabbage and especially the leguminous, whose value as conveyors of albumen, as Voit rightly observes, is known to few. Of meats I exclude none, and the fat in the flesh I do not wish to be avoided, but on the contrary sought after. I permit bacon fat, fat roast pork and mutton, kidney fat, and when no other fat is at hand I recommend marrow to be added to soups. I allow the sauces as well as the vegetables to be made juicy, as did Hippocrates, only for his sesam-oil I substitute butter. 

In spite of all this it would be little to the point to say that I treat the corpulent with fat, whereas I simply vindicate the full claims to which fat is entitled as an article of food. I do not suppose that the corpulent, with who we are practically concerned, will have to consume anything like the quantity of fat that Voit concedes to the working man, or that is allowed to the rank and file of the German imperial army in time of war, say from 7 to 9 oz. daily. I reduce this daily allowance of fat to from 2 to 3.5 oz on an average. The quantity of course changes with the individual relations, nor is it the same for every day. Under the influence of this diet it becomes possible to do with a less quantity of meat. This again I reduce to fully one half or three-fifths of the quantity required in the Banting system, which varies from 13 to 16 oz. a day.