OBESITY continued...<< 1  2  3  4  endnotes >>
Roberta J. Park

“MODERN SCIENCES” AND THE PERSISTENCE OF TRADITION

When Edward Hitchcock, Jr.’s father wrote Dyspepsia Forstalled little was known about the chemical processes that occur within the body (metabolism). The brilliant work on respiration by French chemist Antoine Lavoisier, who died on the guillotine in 1794, helped open the way German chemist Justus von Liebig’s (1803-1873) studies on protein, fat, and carbohydrate metabolism, for French physiologist Claude Bernard’s (1813-1873) discovery of glycogen synthesis, and other studies. By the 1890s English chemist Edward Frankland (1825-1899) had established accurate caloric values for a number of foods. In 1913 American biochemist Edward McCollum and others (working independently) proved that more than one vitamin exists³⁶ These and the many other discoveries that ensued laid the foundations for the enormous growth in the biological sciences that continues today.

It often has been difficult to incorporate the findings of science into matters relating to health. One reason is that traditional beliefs can be extremely powerful. Moreover, science typically is concerned with a specific function or item. Health, on the other hand, is extremely broad as reflected by the World Health Organization’s definition---“A state of complete physical, mental, and social-well-being, and not merely the absence of disease or infirmity.”³⁷ During the nineteenth century a variety of “health reform” movements gained prominence. In the United States Sylvester Graham, best remembered for creating the Graham Cracker” in 1822, advocated a diet of no meat, fresh fruits, vegetables, milk, eggs, some cheese, and especially whole wheat bread. Medical doctor John Harvey Kellogg, who became superintendent of what would become known as the Battle Creek Sanitarium,³⁸ believed that most diseases were caused by bacteria in the intestines. As a remedy he advocated laxatives and ample water, and in the 1890s began the production of whole grain cereals, the best known of which was Kellogg’s Corn Flakes. Health reformer Horace Fletcher, “The Great Masticator,” set down rules: chew your food until liquid; never eat until hungry; enjoy every morsel; do not eat when tired, worried, or angry. At age forty Fletcher was fifty pounds overweight. He claimed that he followed these rules and lost over sixty pounds. His several popular books included The New Glutton (1906) and Fletcherism: What It Is or How I Became Young at Sixty (1913).³⁹

As is the case today, anyone could---and did---write about diet, weight gain and loss, and exercise. Music critic Henry Theophilius Finck, for example, dedicated his 1923 book Girth Control to Kellogg, who he credits with saving his life “and thousands of other lives by his hygienic precepts.”⁴⁰

The best-known nineteenth English-language text was probably William Banting’s short Letter on Corpulence, Addressed to the Public, published in 1863. A fashionable London undertaker, Banting had become obese in his thirties. He tried, without much success, rowing, swimming, and other ways to lose weight. At age sixty-four, with deafness becoming a problem, he sought the advice of Dr. William Harvey, a Fellow of the Royal College of Surgeons. Harvey recently had returned from a meeting in Paris where Claude Bernard had discussed a new theory about the role the liver might play in the disease of diabetes. This prompted Harvey to begin to question how sugars, starches, and fats could affect the body. In 1872 he would publish On Corpulence in Relation to Disease: With Some Remarks on Diet.⁴¹

Harvey urged Banting to give up bread, potatoes, butter, milk, sugar, and beer and follow a diet high in protein. A typical breakfast was four or five ounces of beef, mutton, kidneys, bacon, or broiled fish; a large cup of tea with no milk or sugar; a small biscuit or an ounce of dry toast. For dinner (at mid-day) five to six ounces of any meat (except pork) or of any fish (except salmon) or any kind of poultry or game; vegetables (except potatoes); an ounce of dry toast; fruit (in pudding); and two to three glasses of claret, sherry, or Madeira. It was claimed that by following this within a year Banting had lost nearly fifty pounds.⁴²

Nathaniel Davies, a member of the Royal College of Surgeons, was author of the 1889 book Foods for the Fat: A Treatise on Corpulency and a Dietary for its Cure. The task of the dietician, Davis believed, had been made easier by the discovery of saccharin, which he called “a harmless product three hundred times sweeter than sugar.” Breakfast should be tea or coffee with saccharin and cream; stale bread; fried kidneys or broiled mackerel. The noonday dinner included: vegetable soup; broiled mullet, stewed pigeons with mushrooms or roast rabbit, boiled asparagus; French beans; and claret jelly.⁴³ Dieticians today would reject many of the foodstuffs recommended by Banting, Davies, and others. The basic precepts of exercise have remained much more constant.

Gustav Gaertner’s Reducing Weight Comfortably: The Dietetic Treatment of Obesity was published in English the same year that it had appeared in German (Diätetische Entfettungskuren, 1913). Gaertner rejected the Banting treatment because it relied upon too much meat and included almost no carbohydrates or fat.⁴⁴ Using a method that he had begun in 1903, the Austrian pathologist claimed that sixteen or seventeen hundred of his patients had been satisfactorily treated.⁴⁵ As did the German pathologist Carl von Noorden, Gaertner rejected withholding water⁴⁶; he also objected to treatments such as cathartic tea and purgatives. He held that it was important to understand that there were individual differences in the ways food was assimilated, and that conditions such as hyperthyroidism, high blood pressure, and rapid heart rate could be caused by excessive weight gain.⁴⁷

The tendency to overeat, Gaertner believed, often began at an early age.⁴⁸ To better understand why three children (ages 8, 11, 16) in southern Austria were “abnormally fat” in spite of engaging in sports like cycling, he joined the family for a day’s meals and determined that the large quantity of dry wheat bread that the children consumed (4,800 calories in one case) was a major factor. On the other hand, he found that two overweight thirteen year old girls that he examined ate too much meat.⁴⁹

Aware that food preparation varied among countries, Gaertner recommended for overweight patients in Austria boiled (not broiled) beef, boiled potatoes (a “good ballast” food), green salad, radishes, asparagus, artichokes, and especially fruit (except grapes, which contain too much sugar).⁵⁰ The best jockey in Vienna, Gaertner claimed, had improved when he abandoned the typical weight-loss methods used by athletes (a mostly meat diet with few liquids, and sweating) and adopted his recommended diet.⁵¹“ Efforts to secure a reduction in weight by increase of muscular work,” he believed, were ineffectual unless the quantity of nutriment also was decreased.⁵²

Although he repeatedly insisted that there could be “no obesity cure without dieting,”⁵³ Gaertner did not discount the value of exercise. All his patients, unless some condition prohibited it, were expected to walk out of doors for at least an hour each day. Swimming was especially valuable because it exercised the whole muscular system. So was Das Ruderbad (the rowing bath). Young men with normal blood pressure were encouraged to row, cycle, fence, ride, play golf and tennis, do gymnastics , and exercise with the ergostat (which he had invented) but not play football or cycle up mountains during the period of their treatment.⁵⁴

In the preface to his 1926 book Obesity, British physician Leonard Williams states: “The excuse for this book is that no work in English dealing with the subject has appeared for a great many years.” Advances in endocrinology and the discovery of vitamins had“ so altered hitherto accepted views concerning metabolism and nutrition that it seemed desirable to present a study of the question of obesity which gave due prominence to the fresh light which these two factors reflect.”⁵⁵ However, in spite of these words, except for Francis Heckel’s Ce qu’il faut faire et ce qu’il ne faut pas faire pour Maigrir (What One Should and Should Not Do to Lose Weight, 1925) and Arthur Weil’s The Internal Secretions (1924), Williams’ book contains few of the newer citations. He notes that he has drawn especially upon Heckel’s⁵⁶Les Grandes et Petites Obésités ( published in 1911) and Wadd’s Comments on Corpulency, which was published in 1822! Fortunately, others were writing more up-to-date works.

CLINICAL AND RESEARCH STUDIES OF OBESITY BEGIN TO APPEAR

As the physiological sciences became more specialized to what extent did scientific and clinical investigations of obesity occur? Citations in Index Medicus,⁵⁷ initiated in 1879 by Dr. John Shaw Billings (Head of the Library of the Office of the Surgeon General, United States Army), offer one perspective. During the first three decades of the publication of Index Medicus citations under the heading “Obesity” ranged from six to twelve. The greatest number had been published in German or French journals. Undoubtedly there were several reasons. However, one of the more significant was that before the First World War science-based medical training had advanced first in France then in Germany (and German-speaking parts of Europe such as Austria). Between 1870 and 1914 American physicians who desired the best training typically sought it in Germany.⁵⁸

By 1930 the number of “obesity” citations in Index Medicus was fifty-eight. Of these, over forty percent had been published in German-language medical and scientific journals and reports. When citations in French and other European publications are included, the number exceeds sixty percent. An additional thirty appear under the heading “obesity treatment”; sixty-three percent are in German, French, or Swedish. Over the next decade an increasing number of studies would bring forth new information.

In 1940 Hugo Rony, who had been Chief of the Endocrine Clinic at Northwestern University’s School of Medicine and Attending Physician at Cook County Hospital, published Obesity and Leanness. Often referred to as the most comprehensive single treatment of the subject available, the book opens with the following observation: “Although the scientific literature of obesity and leanness is rich in papers dealing with various pathological and clinical aspects of the problem. . . . no comprehensive presentation of the subject has appeared since [Carl von] Noorden’s monograph on obesity in 1900.”⁵⁹ Fields like endocrinology, neurology, genetics, cell physiology, and intermediary metabolism, Rony observed, now were providing important information.

Although Rony had little to say about the role of exercise, he did note that many obese persons had a “decreased impulse to muscular activity” and that in childhood they often had showed a tendency “to avoid all unnecessary activity, outdoor play, athletics, etc.” However, some individuals, in spite of being obese, had a “strong impulse to exercise.”⁶⁰ In the chapter titled “The Therapy of Obesity” he stated that increased physical activity was likely to lead to increased appetite; yet he opened the book’s last section (“Prevention of Obesity”) with the observation: “The ‘tendency to obesity’. . . can be lessened by restriction of food intake and increase of muscular activity.”⁶¹

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