Popular Science Monthly/Volume 1/August 1872/Concerning Corpulence
By W. J. YOUMANS, M. D.
MR. BANTING had defective hearing, and consulted a physician for his deafness. The doctor was William Harvey, aural surgeon to the Royal Dispensary for Diseases of the Ear, and also for the great Northern Hospital of London. Dr. Harvey told the patient that his deafness was complicated with his corpulence, for Mr. Banting was very fat. He told him that, to improve his hearing, it would be necessary to reduce his obesity, and he prescribed a diet for the purpose. This was good news for Mr. Banting; he had come to get his ears syringed for deafness, and a way was pointed out by which he could get back his hearing and get rid of his burden of adipose at the same time. He commenced the dietetic treatment, and so successful did it prove in relieving his corpulence, that he rushed into print to convey the glad tidings to all over-unctuous people. He thus became immortal as a philanthropist, and enriched our speech with a new term—Bantingism—which will last as long as the literature of fatness endures. Banting was, however, only a layman, after all, and his ambition was satisfied to produce a pamphlet; but now comes the doctor himself, with his regular treatise "On Corpulence in Relation to Disease." Dr. Harvey's book is an excellent summary of the subject, and has the weight of professional and scientific authority; the present article is mainly condensed from his pages:
The manner in which fat is distributed over the body is now generally understood to be by the texture of the cellular membrane. Formerly it was thought to adhere in clusters to the parts where it was found—a mistake that has been corrected by the study of minute anatomy. The cellular tissue, as its name implies, is made up of great numbers of minute cells, which communicate with each other, and which are formed by the interlacings of fine, soft, colorless, elastic threads, intermixed with delicate films or laminæ, the tissue presenting, when free from fat, a white, fleecy aspect. This tissue is found everywhere underneath the skin; the serous and mucous membranes are attached by it to subjacent parts; it lies between the muscles, and also among their fibres, surrounds the blood-vessels, and is generally distributed throughout the body. In certain situations, as around the large blood-vessels and nerves, in the omentum and mesentery, about the joints, and especially under the skin, the cells enclose what are known as adipose vesicles, minute spherical pouches, filled with fat or oil; and, when these are present in notable quantity, the structure takes the name of adipose tissue. As thus deposited, the fat appears merely to be held in store, as it remains quite distinct in form and situation from other parts of the animal frame. It, however, enters largely into the composition of nerve-substance, where it becomes an essential part of a highly-organized tissue.
The development of fatty tissue varies considerably at different ages, and in the two sexes. In children and in females, especially in early age, the principal seat of the fatty deposit is in the cellular tissue, immediately under the skin. During adolescence, the fat has a tendency to disappear from this situation; but, about middle age, frequently becomes again deposited, not only in the subcutaneous tissues, but also in the neighborhood of certain internal viscera. The quality of the fat also varies, both with the age and with the part in which it is deposited. It is firmer and higher colored in old persons than in young ones; and is more condensed and solid in parts liable to compression, than in the omentum, or about the heart, stomach, and intestines.
A moderate amount of fat is a sign of good health, and physiologists generally allow that it ought to form about the twentieth part of the weight of a man, and the sixteenth of a woman. Independently of its importance as a non-conducting substance in impeding the too rapid escape of animal heat, fat may also be regarded as a store of material to compensate for waste of tissue, under sickness, or other circumstances, entailing temporary abstinence from food. But when fat accumulates to the extent of interfering with important functions, and becomes a load and a drag, impeding the respiratory movements, making exercise painful, and dulling the sensibilities, it is then not only a source of great discomfort, but the precursor of positive disease.
In a perfectly healthy individual, no abnormal deposition of fat can be supposed to take place, at any age or in any locality, provided the natural appetites and muscular powers be regulated as they ought. Whenever, therefore, we see an individual unnaturally fat or lean, we may safely conclude that an error exists somewhere, and that such an individual either inherits a morbid propensity, or is producing for himself such a propensity.
The conditions which appear to favor an excessive deposit of fat are the following: First, an inherited tendency which predisposes to corpulence, yet always requiring the influence of some exciting cause to bring it into activity. No one can doubt that certain families have a natural tendency to corpulence, which can be often traced through successive generations. It is curious, also, to observe how this tendency is varied in different families, and even in different individuals of the same family. Thus, in one family, we see that the children and females possess a striking tendency to embonpoint, while the male adults, particularly in advanced age, are remarkable for their leanness. In another family, directly the reverse may be observed, the children and females are lean and squalid, while the middle-aged male adults are conspicuous for their corpulence.
Climate and locality seem also to exert considerable influence on the deposition of fat. The inhabitants of low, swampy situations, in temperate climates, are usually remarkable for their bulky flabbiness, and propensity to corpulence; while the inhabitants of very hot and of very cold climates, as well as the inhabitants of mountainous regions, have, perhaps, less tendency to obesity. There is this remarkable difference, however, between the dwellers in hot, and in cold climates: those living in hot climates rarely become fat, without becoming otherwise diseased; while the people of cold climates seem not only to derive protection against the influence of external cold by the layer of fat with which their bodies may be enveloped, but the carbon of the fat, combining with oxygen during the process of secondary assimilation, has with some reason been supposed to contribute to the production of animal heat.
But, of all the agencies which influence the deposition of fat, probably diet and exercise are the most important. Foods have been divided, according to their composition, into nitrogenous and non-nitrogenous. The former, including albumen, fibrine, and casein, consist of only carbon, hydrogen, oxygen, and nitrogen, with some minor ingredients; the latter, embracing starch, sugar, and the fats, are made up of only carbon, hydrogen, and oxygen. It has been thought that the nitrogenous foods are consumed chiefly in the formation of the tissues, while the non-nitrogenous are devoted mainly to the function of respiration, going principally to the maintenance of the animal temperature. Whatever basis in fact this view may have, it is pretty well established that the substances belonging to the latter class of foods are especially favorable to the production of fat, when taken into the system. This fat may exist ready formed in the food, as it is furnished abundantly by both the animal and vegetable kingdoms; or, as is held by many physiologists, it may be formed in the system by the chemical transformation of starch and sugar. Numerous experiments have been made on geese, ducks, pigs, bees, etc., which go to prove that these animals accumulate much more fat than can be accounted for by the quantity present in the food. M. Flourens had the bears in the Jardin des Plantes fed exclusively on bread, and they became excessively fat. Bees confined to a diet of purified sugar continue to produce wax, which strictly belongs to the group of fats. But, whatever its source, the excessive use of non-nitrogenous food, conjoined with inactivity, frequently leads to the deposit of an inordinate amount of oleaginous matter. This fact is illustrated by numerous instances both among the lower animals and among men. At Strasbourg, the geese are fattened by shutting them up in darkened coops within a heated room, and stuffing them constantly with food. The high temperature lessens the escape of heat, and thus favors the process. Here all the conditions for insuring obesity are resorted to—viz., external heat, obscurity, inactivity, and the cramming of the animals with fattening food. A still greater refinement for pandering to the appetite is resorted to by the Italians who relish the fat of the ortolan. To procure this in perfection the natural habits of the bird were watched, and, it having been found that it only takes food at the rising of the sun, they cheat the birds by producing an artificial sunrise. To effect this, the ortolans are placed in a dark, warm chamber which has but one aperture in the wall. Food being scattered over the floor, a lantern is placed at a certain hour in the opening, when the birds, misled by the dim light, at once commence feeding. The meal finished, the lantern is withdrawn, and more food scattered about, when the ortolans sleep. Two or three hours having elapsed, and digestion being completed, the lantern is again made to throw its light into the apartment. The rising sun recalls the birds to the habit of again feeding; and they again sleep with returning darkness. This process is repeated several times in the twenty-four hours, and in a very short time the ortolan becomes literally a ball of fat, which, strung on a wick, is said to make an excellent lamp.
It is known that farinaceous and vegetable foods are fattening, and saccharine matters are especially so. The instance of laborers in Italy, who get fat during the grape and fig season, has been frequently quoted. 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. It is said that, among the Asiatics, there are Bramins who pride themselves on their extreme corpulency. Their diet consists of farinaceous vegetables, milk, sugar, sweetmeats, and ghee, a species of Indian butter. Dr. Fothergill remarks, that a strictly vegetable diet produces excess of fat more certainly than other means.
The use of a large amount of liquid in the diet also favors the deposit of fat. Alcoholic drinks are especially objectionable in this respect, for, according to Dr. Harvey, the elements which are chemically convertible into fat are rendered more fattening if alcoholic liquids be added to them in the stomach; perhaps, because of the power which alcoholic liquids possess of lessening or delaying destructive metamorphosis.
Inactivity, by decreasing waste in the system, acts in a negative way toward the production of obesity. In order to fatten animals, they are habitually confined, and, if the process is to be a rapid one, they are kept in the dark as a means of securing the utmost quiet. Now, indolence on the part of the human animal, associated, as it generally is, with excessive eating and drinking, and much sleep, constitutes a similar set of conditions, and is likely to lead to a similar result.
The consequences of obesity are often more serious than is generally believed. To put aside the many minor inconveniences, which, however, may be sufficiently annoying to make the sufferer desirous of reducing his weight, it may be taken as a general rule that obesity does not conduce to longevity. Usually it is accompanied with diminished vital power; there are disturbances of the organs of respiration, circulation, and digestion. The blood is proportionately deficient in quantity or quality, and the muscles are weak and have but little firmness. And, although the disposition is often sanguine, so that the sufferer continues lively and cheerful, and has the happy habit of looking at the best side of every thing, yet physical and mental occupations are generally uncongenial. There are several notable exceptions to this, however, and many can call to mind cases where both the bodily and mental habits are quite as active in the obese as in others. Maccaz gives the case of an enormously fat man, whom he met at Pavia, that was celebrated as a dancer, and whose movements were exceedingly agile and graceful. David Hume and Napoleon may be instanced as examples where corpulence was associated with great mental powers; and Raggi, an Italian physician, who was an eminent authority on corpulence, relates numerous cases of extreme obesity in which the intellect remained quite alert to the last. Nevertheless, the rule holds good that extreme fatness is very much in the way of either bodily or mental work.
By an over-development of adipose tissue the capillary system of blood-vessels is vastly increased in aggregate bulk, while at the same time no corresponding increase takes place in the forces which supply the means of action to those capillaries. Hence there is a comparative weakness in the conservative vital processes, and any injury to a part, especially if remotely situated, is less easily repaired.
The senses of hearing, taste, and smell, are frequently much impaired in corpulent people, a condition due in the majority of cases, according to Dr. Harvey, to deposits of fat in the organs concerned. The nasal passages, mouth, and throat, are, as all know, lined with mucous membrane, which continues through the Eustachian tubes into the middle ear. This mucous membrane may become the seat of a fatty deposit, and thus impair the function of the part. The sense of smell depends upon the contact of odorous emanations with the sensitive olfactory membrane, and such contact can only take place when there is a free passage for them through the nose. If the nasal membranes become thickened from any cause, thus partially or wholly preventing the passage of air, the capacity of smell is correspondingly affected. The sense of taste, which, to according many physiologists, is properly limited to the perception of the acid, bitter, sweet, or saline properties of food, does not appear to suffer; but the power to recognize and enjoy flavors, which is commonly associated with taste, but which in reality belongs to the nose, is sometimes lost along with the sense of smell. Access of air to the middle ear through the Eustachian tubes is an essential to the sense of hearing, and this, too, is greatly interfered with oftentimes by the fatty thickening of the mucous membrane of the nose and throat. At all events, whatever the nature of the cause, it has resulted, in great numbers of cases where corpulence was attended by these defects of sense, that removal of the deposit by a proper dietary has been immediately followed by recovery, after all sorts of local remedies had failed to afford relief.
Dr. Harvey thinks that both gout and rheumatism are aggravated by corpulence. Another troublesome attendant is. a tendency to the formation of gravel and calculus. In regard to this, Dr. Harvey states that, after the usual remedies prescribed for its relief have completely failed, he has seen a well-directed dietary, designed with a view to restraining the formation of adipose, completely successful in finally preventing these distressing formations.
Although obesity may be ranked among the diseases arising from original imperfection in the functions of some of the organs, it is also, without doubt, most intimately connected with our habits of life. The inconveniences arising from it are, therefore, to be removed by correcting those habits, especially such as relate to diet and regimen. Drugs without number have been tried, both for the removal of corpulence itself, and for the many troubles to which it gives rise; but they have almost uniformly failed when diet and exercise have been neglected. On the other hand, attention to these points, persistently carried out, has been as uniformly followed by improvement without the aid of medicine. It is a true maxim in physic that diseases which are long in their advancement are, as a rule, only to be remedied by long-continued curative attention. Common-sense proves the fallacy of expecting to eradicate old-established errors of the body by any sudden remedies; the diet and medical regimen of such persons should therefore be undeviatingly suited to their disordered tendencies, and resolutely maintained as long as they afford any hope of relief.
We have seen that certain foods, such as the fats themselves, and others that consist principally of starch or sugar, favor the development of corpulence; and it will be observed that in the following dietary designed by Dr. Harvey, and prescribed by him in the famous case of Banting, foods of this class are reduced to a minimum, though not altogether interdicted, the nitrogenous foods being correspondingly increased.
Breakfast.—Four to six ounces of meat, two ounces of biscuit or toast, and a large cup of tea, but without milk or sugar.
Dinner.—Ten to twelve ounces of any fish except salmon; any vegetable except potatoes and vegetable roots; any kind of poultry or venison, and two ounces of toasted bread. With it drink two or three glasses of good red wine, sherry or madeira, avoiding champagne, port, or beer.
In the afternoon, four to six ounces of fruit, one or two biscuits, and again a large cup of tea without milk or sugar.
Supper.—Six to eight ounces of meat or fish, and one or two glasses of red wine.
Dr. Harvey remarks: "When once the body has reached its full development in manhood, the quantity and quality of the food should be regulated by the demand made by the wear and tear of the system. If, for instance, a person, already sufficiently stout, is growing fatter and fatter, he is taking more fattening food than is necessary or safe, and must restrict himself if he would restore the balance of the functions."