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.