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.