Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of Cure

by J.-F. Dancel

Such is the progress of medical science, that the following ideas as to the diseases which may be engendered by excessive corpulence, would have been deemed, twenty-five years ago, unworthy of a doctor of medicine: a hundred and fifty years ago they would have obtained the applause of the physicians of those days. At the present time I foresee—I am indeed sure, that the medical profession will acknowledge these same ideas to be founded upon reason and observation, two indispensable requisites in all that concerns the healing art.

When the system of medicine founded by Borelli was in vogue, called the "Iatro Mathematical," it would certainly have been acknowledged that a superabundance of fat, when developed in the human body, could interfere with the vital organs in the performance of their functions, and thus be the cause of much disturbance and of many diseases. But this would no longer have been admitted, when Broussais, the distinguished author of "Chronic Phlegmasia," in our own day, in harsh and severe language, and with an air of conviction, loudly proclaimed that all disease resulted from local irritation, whence it was irradiated throughout the organism, as in the case when a sharp instrument pierces the flesh. This theory was the very opposite to the teachings of the majority of medical men of a previous age, who maintained that local disease resulted from a general disturbance of the whole system.

Thus, if the stomach were affected, Broussais called the disease a gastritis (or inflammation of the stomach), which might induce disturbance of the system at large; while many of the old school would have said that if the stomach were especially diseased, it was because nature chose that channel in order to eliminate from the body the morbid principle which in the outset had attacked the entire system.

It belongs not to the subject on hand to endeavour to signalize all the errors of the old school, nor to set forth what truth there may be in the system; but I would ask one simple question. It has happened to every medical practitioner to be called in to see a person recently taken ill, and that he has said, "The disease is not yet well characterized; by-and-bye, or to-morrow, I shall be able to form an opinion, and say what the disease is." But until this "by-and-bye," until this "to-morrow," what happens to the patient? for it is evident that there is sickness, a general ailment. And when one particular portion of the body, an organ, is principally affected, when the disease has there manifested itself, as we say, shall we be far wrong in saying that it is a kind of crisis? It would be just what happens, only more evidently, in those fevers which terminate in a critical abscess.

Nor is it advisable that I should speak of the founder of physiological medicine. His vast labours are the result of great genius, and have long influenced the medical world with all the weight of a master mind. Having been his pupil for many years, I shall never cease to admire his life of scientific labour. Nevertheless, I cannot refrain from remarking how much he has done to lessen the spirit of medical enquiry. By localizing all diseases, and by his system of irritation, without taking into account the constitution as a whole, how greatly is the labour of the physician reduced! how little knowledge is necessary on his part to be deemed worthy of the title of Doctor of Medicine! Once upon the highway of localization, once engaged in this contracted study, there is no stop. It is no longer necessary to be acquainted with all the organs, both in a state of health and of disease; the extent of territory to be explored is reduced. The fashion at the present day is, that a physician of this school should know only how to treat the diseases of one particular organ, and rarely of two; that he should be, in fact, a specialist. But are not the principal organs of the body, for the most part, mutually dependent on each other, and all of them subject to a general consensus? What is the consequence of this medical specialism? Why, that every physician so engaged thinks, and most conscientiously, that the patient before him labours under that particular disease to which he particularly devotes his attention. This is perfectly natural. The mind of man is so formed, that it is narrowed, and loses its powers of comparison and of judgment, whenever it is concentrated and brought to bear solely upon one subject, one single object. Man is no longer capable of reasoning upon a science or an art, when he puts it out of sight as a whole, in order to devote himself entirely to one of its parts; but ends by making the subject of his study the principal point, the all-important one, whence flow, in his opinion, all the rest; and finally assumes that a part is equal to the whole. When a patient complains of palpitation of the heart, he prescribes a bleeding, leeches, digitalis. If another complain of sense of weight or oppression, bleedings, softening syrups, troches, &c., are prescribed. If another complain of headache, dizziness, with threatening apoplexy, he is bled.

Everything is treated locally, without inquiring whether the evil be or be not the effect of some general cause.

Among a vast number of general causes, giving rise to disease, I purpose to treat of one, and that is excessive corpulence, termed obesity. In our recent medical works, no reference is made to this morbid predisposition, in regard to the diseases occasioned by it. I do not mean to say that superabundance of fat is the cause of all the ills that flesh is heir to; but I am persuaded and do affirm that it is often the primary cause of many diseases.

Thus, in cases of headache, there are assuredly many which are produced by superabundance of fat, because they commenced when that superabundance began to appear, and ceased on its being diminished. Frequent headache, becoming periodic, is constantly met with in fat people. Nothing is more common among such persons than dizziness. In these cases, are not the blood-vessels oppressed with fat interfering with a free circulation of the blood, and is not fat therefore the cause of all these troubles?

But it may be said that the blood produces these affections, since, after loss of blood, the patients are relieved. I do not agree with this, and I say that the blood is not in such cases the cause of these ailments; because fat people, both men and women, have no more blood than thin persons: I maintain that they have even less. It is granted that loss of blood in cases of headache, vertigo, alleviate and even cure these affections; but only for a time; for eight days, or a month or two at the most, and then gradually reappear, and bleeding is again required.

This amelioration, these momentary cures, produced by blood-letting, are to be explained in such cases by saying that the quantity of blood, although not so great in fat as in thin people, is impeded in its circulation, and that loss of blood, by still further diminishing the quantity, facilitates for a while its passage through the blood-vessels.