162 OBESITY 



after seven months in spite of continued insufficient nourishment. On the 

 other hand, upon administration of a purely vegetable diet, especially after 

 partaking of fruit in unlimited quantity, loss of weight again took place. I 

 can only explain these facts by supposing that the patient, after the first 

 seven months, became so hydremic that a further loss of weight was no longer 

 possible. Subsequently, a decrease in weight could only be brought about 

 when, by the diuretic influence of the vegetable acid salts resulting from the 

 ingestion of large quantities of fruit, depletion of the fluids of the body 

 occurred. 



In obesity cures nowadays we naturally do not wish to use any method of 

 treatment which brings about inanition. It is true that in every obesity cure, 

 however rationally it is carried out, there must always be depletion of some 

 kind. This depletion, however, must not go so far that muscle as well as fat 

 is lost. A withdrawal of fat without loss of muscle can be brought about by 

 a suitable change in the diet or by increased muscular activity, or — best of 

 all — by a combination of both methods. By a diminution of the nourishment 

 which has previously been taken in excess, and by an increase of muscular 

 exercise which has previously been insufficient, the superfluous body fat will 

 gradually be consumed. I do not doubt for a moment, and I have often em- 

 phatically said, that this goal may be reached by very simple means. Typical 

 in this respect is the quaint tale of Johann Peter Hebel, which many an indo- 

 lent, fat carouser may take as an example. This story is told of a rich, fat 

 Amsterdamer, whose physician, living a hundred hours' journey from him — 

 and this was no less a personage than the celebrated physician Boerhaave, of 

 Leyden — insisted that the patient visit him, and that he come on foot. He 

 impressed upon him the necessity of a regular mode of life in order to crush 

 the dragon which he carried around in his abdomen. The patient became 

 an expert pedestrian, and then learned to saw wood ; he restricted himself to 

 the food that hunger required, became as healthy as a fish in water, and reached 

 the age of eighty-seven years, four months and eighteen days. These effective 

 means of preventing an excessive increase of body fat, or of causing superflu- 

 ous fat to disappear, have met with little favor, though obviously they are so 

 easy to carry out. We see that celebrated physicians like Johann Peter Frank 

 almost maintain an attitude of hopelessness as regards measures for the re- 

 moval of obesity. Prank joins in the old complaint of a Leipsic physician 

 of his time that " a few succeed, by the aid of very strict diet, in wholly ridding 

 themselves of their superfluous fat; as soon, however, as they have accom- 

 plished this (not without great loss of power), and attempt to recuperate by 

 a less severe nutrition and mode of life, they regain their previous amount of 

 fat, or,^m its place are attacked by a pitiable condition of dropsical accumu- 

 lation." It IS obvious from this that J. P. Frank had starvation cures in 

 mind, and that he was so daunted by these unfortunate experiences that he 

 did not further pursue his endeavors. He mentions no special dietetic rules 

 for the relief of obesity. 



It seems to me best to present in chronological order a comprehensive 

 review of the methods of treatment which have been employed in our time, 

 and I desire expressly to state that much that has been claimed by individual 



