A discourse on the nature, causes, and cure of corpulency. Illustrated by a remarkable case, read before the Royal Society, November 1757. And now first published, by Malcolm Flemyng, M.D:

A DISCOURSE ON CORPULENCY.

CORPULENCY, when in an extraordinary degree, may be rec∣koned a disease, as it in some measure obstructs the free exercise of the animal functions; and hath a ten∣dency to shorten life, by paving the way to dangerous distempers.

It is too great an accumulation of animal oil or fat, more or less over the whole body; but chiefly immediately under the skin, in the interstices of the muscles; and within the cavity of the abdomen or lower belly.

That Corpulency is caused by an increa∣sed quantity of fat, and not of blood, or any other substance whatsoever, is so clear and evident, that we may spare ourselves the trouble of proving it. Butchers stalls suffi∣ciently evince it's truth, and the common sense of mankind acquiesces in it; fat and corpulent being synonymous epithets in common conversation.

Till within a century ago, anatomists had a very imperfect notion of the manner, in which the fat is distributed, and lodged in the animal body; they imagined that it lies in confused clusters or heaps, sticking to the parts where it is found, without being contained in cells, or small membranous cavities. But now it is generally and cer∣tainly known, that it is reposited in the cells or vesicles of a certain web or texture, called membrana, or tela cellulosa; which is spread over the whole body, not only im∣mediately under the skin, but penetrating likewise into it's inmost recesses; and enter∣ing, more or less, into the composition of almost every part. The cells of this web

or tissue are so framed, as to communicate together all over. Where they are widest, they contain oil or fat. Where they are too minute for that purpose, they receive a fluid jelly or moist vapour.

The fat is a secretion from the blood, made by the most simple secretory appara∣tus, to wit, arteries bringing the blood, from which the fat is to be separated; and lateral vessels of a lesser diameter ari∣sing from these arteries, which strain off the fat or oil, and convey it to the cells or vesicles, where it is to be reposited; while small veins, continued with the arteries, re∣turn into the common channel of circula∣tion that part of the blood, which hath passed by the mouths of the lateral secretory canals. The tumidity, with which the oil, when new separated, abounds, is sucked up by extremely small tubules of the venous kind, opening into or communicating with the fatty cells, and so the fat or oil remains more pure or unmixed.

The use of the fat is in general to lubri∣cate the parts, that they may move and slip over one another easily, and therefore mus∣cles

are plentifully supplied with it; to pre∣vent brittleness in the bones, which for that reason are furnished with marrow (for mar∣row and fat scarce differ at all from one an∣other) to temper, and, as it were, sheath a∣crimony; and lastly, to fill up the chasms and interstices, which, without some such contrivance, would be left between parts ad∣jacent to each other, thus procuring a beau∣tiful sleekness to the skin. In particular we have good reason to believe, that the fat of the omentum or cawl, where it is always found in considerable quantity, if the sub∣ject is not very much emaciated, is subser∣vient to the functions of the liver, and con∣tributes towards the matter of the bile. But I confine myself to the principal subject of this discourse.

The efficient causes of Corpulency may be deduced to these following:

First, the taking in of too large a quan∣tity of food, especially of the rich and oily kind, with a suitable digestion. Every thing that nourishes, contains oil more or less, which however scanty in proportion to the other constituent parts, is yet actually sepa∣rated

and extracted from them by the pow∣ers of the animal machine, and, as it were, treasured up for it's proper uses. Horses, cows, sheep, and many other animals, thrive and fatten upon grass, hay, and even straw, with water. But the poorest diet, that can nourish, and tolerably support the human species, contains much more oil, than grass or straw. Oil may be pressed out of the farinaceous grains in common use. Animals of every kind, however lean, yet contain some fat, and those we daily feed on, a very great deal. Whoever, therefore, throws in a large quantity even of the plainest whole∣some food, at the same time lays in matter, out of which Corpulency is more likely to be produced, than out of a more sparing measure thereof. And, beyond all doubt, that effect will more speedily and certainly be brought about, if the aliment is oily and rich; provided it is rightly digested. Not that all corpulent persons are great eaters; or all thin persons spare feeders. We daily see instances of the contrary. Tho' a vo∣racious appetite be one cause of Corpulency, it is not the only cause; and very often not even the conditio sine qua non thereof.

Secondly, too lax a texture of the cellular or fatty membrane, we have already men∣tioned, whereby it's cells or vesicles are lia∣ble to be too easily distended; and therefore receive and retain too great a quantity of fat. And perhaps these cells may be origi∣nally of a larger size and capacity in some, than in others. This disposition may be connected with a general laxity of the solids, but it may likewise be in a great measure local, and subsist by itself; there being no absurdity in supposing one part or set of parts in the human frame to be over-relaxed, while the rest continue in a laudable state. This particular cause of Corpulency I incline to believe often runs in families. It may likewise be connate, that is, interwoven with the original stamina, and brought into the world by the infant, tho' it's parents and ancestors had been otherwise constituted. But, no doubt, it is much ofter acquired by the manner of living of the corpulent per∣sons; such as a plentiful, rich, relaxing diet; a sedentary life; much sleep; an indolent tranquillity of mind; warm bathing, &c.

Thirdly, such a mixture or crasis of the blood and it's serum, as suffers the only parts to be too safely separated from it's other principles, especially it's aqueous vehi∣cle; the whole being too weakly and im∣perfectly blended and united together. This fault may either depend upon the general inaction of the solids, whether constitutional or acquired; and the chief means of bring∣ing it on are, as hath been said, plentiful, luxurious diet, and want of exercise; or upon an over-proportion of oily particles in the blood, and it's serum; which may re∣quire a greater energy in the solids, though otherwise laudably constituted, than they can exert, in order to get the better of that excess, and complete the union of the hete∣rogeneous parts.

Fourthly and lastly, Corpulency is caused by a defective evacuation through the out∣lets of the body, of that fat or oil, which hath been already separated from the blood, and reposited in it's proper cells. As what∣ever is alimentary contains oil, if we did not daily expell part of it out of the body, we should soon be buried under our own

fat. Those, who keep up for a considera∣ble number of years nearly the same weight of body, must discharge daily a quantity of oil or fat, nearly equal to what they take in. Sweat, urine, foeces, and no doubt insensible perspiration likewise, all contain oil in an healthy state; and therefore, if they are not in a pretty constant way sufficiently charg∣ed therewith, to ballance the quantity con∣stantly introduced with our meats and drinks, Corpulency must necessarily ensue. This deficiency is, I believe, most frequently occa∣sioned by a too sedentary way of life. But it likewise may be influenced by the fat's not being so easily dissolvible in, and remix∣ed with the blood as it should be, in order to be readily enough brought to the emunc∣tories; and so may in some cases be a con∣sequence of the cause described in the pre∣ceding paragraph. For, if the blood and it's serum hath already too easily parted with it's oily particles, that happened be∣cause in them the oil was not strongly enough united and blended with the other consti∣tuent principles, and therefore the same quality of the blood and juices will render them so much the more unfit to re-dissolve, and sweep it out of the cells, in which it is

laid up, back into the channels of circula∣tion and excretion.

To recapitulate, Corpulency being an ac∣cumulation of too great a quantity of fat, or animal oil in the vesicles of the membra∣na cellulosa, wherever they are large enough to admit oily particles, it can be caused either by the introduction of too much oil into the habit, through the channels of nourishment, whereby there is so much the greater chance of it's being retained in too great a quantity—or by the over-laxity, or perhaps original over-largeness of the cells, in which it is reposited, disposing them to admit, and retain an over-proportion of it—Or by such a crasis or temperament of the blood, as renders it liable to part too easily with it's oily particles, and let them be strained off in too great plenty by the secre∣tory vessels—Or lastly, by a deficient evacu∣ation or expulsion of oil already taken in and separated from the blood, and laid up in it's cells through the outlets of the body—By one, or more of these causes, or per∣haps all of them concurring in the same constitution, and, I think, scarce by any

other of moment, can Corpulency be pro∣duced and established.

Having enquired into the nature, seat, and efficient causes of Corpulency, we now pro∣ceed to lay down the rational methods of cure, founded on the result of this our en∣quiry. In the doing of which, we shall but briefly treat of such things relating to the subject, as are commonly known and delivered in books; and be more full con∣cerning the particular means we propose, in order to diminish and keep under this burthensome state of body, and prevent it's bad consequences; to recommend and en∣force the use of which, this paper is princi∣pally intended.

Diseases, like other faults and imperfec∣tions, are, in a general way, to be attacked and conquered by remedies, opposite or contrary to the causes that brought them on; and that is exquisitely the case with re∣spect to Corpulency. We shall therefore, in delivering the method of cure, follow the order, in which we have treated of it's causes.

And first, the diet of corpulent persons ought to be as moderate in quantity as pru∣dence may direct, and one's patience can submit to. Celsus advises such to eat only one meal a-day. With us cutting off suppers may be substituted in the place of this rule. As to how much food is to be taken at one time, the best advice I can give is, after eating such a quantity, as is known in a common way to support persons in health and strength, to stop, as soon as the craving of the stomach will permit; and so rise from table with an appetite. In some cases it may be expedient to damp the stomach immediately before meals, by eating fruits or sweetmeats; by drinking a glass of sweet wine; or other such safe means, as one's own experience will best direct. Variety of dishes should not be made free with; as they are apt to tempt one to transgress in quantity.

With respect to quality, the food of the corpulent should be lean and plain, rather than rich and palatable. Celsus enumerates amongst the causes that fill or plump the

body. Assumpta per cibus aut potus maxime dulcia & pinguia. Course brown bread is here preferable to the white, finer sort, as being more opening and less nourishing—Roots, greens, and other esculent vegeta∣bles, with a sparing quantity of butter, dif∣pose less to Corpulency, than animal foods; as they contain less oil; yield juices less viscid, and pass more readily out of the body—Wines in a general way are less feeding than malt liquors; especially such as are thin, sharp and old—Acids, and vine∣gar in particular, have a remarkably emaci∣ating quality; but must be used sparingly, and with caution.

The cause of Corpulency, mentioned in the second place, being a flabby, relaxed state of the membranous texture, in the cells of which the fat is collected, the indi∣cation of cure answering thereto, is to strengthen that texture, so enabling it the better to resist distension; and, by it's con∣tractile power, to expel some part of it's contents. In order to answer this end the more effectually, it is requisite, first to dimi∣nish, if we can, in a considerable degree, the quantity of fat already contained in

these cells, that they may be the more at liberty to contract themselves; and after∣wards remaining in a contracted state, reco∣ver their tone. In the next place we must take care so to concert measures in order to strengthen either the solids in general, or the cellular texture, where the fat is lodged, in particular, as neither to counteract the other methods directed against Corpulency, of which more in the sequel; nor risk hurt∣ing the particular constitution we are treat∣ing. Cold bathing (proper diet and exer∣cise being supposed to go along) bids fairest to answer the end we have in view. But it will be both safer and more effectual after the bulk is considerably diminished than before. And it ought never to be used without great caution, lest it should prove hurtful in other respects; for I scarce know any remedy that is more generally, and more dangerously misapplied, than cold bathing. As to strengtheners taken inward∣ly, whether under the title of diet or medi∣cines, they for the most part either whet the appetite, or render the body costive, both which are unfavourable to the cure of Corpulency; and upon that account they, as well as cold bathing, will come into use

with greater advantage, after the body is considerably reduced, than before.

The third cause of Corpulency being too easy a separation of the oily particles of the blood from it's other contents, especially the aqueous vehicle, arising from a weak and imperfect union of the different ele∣ments together, what occurs to me as most directly tending to it's removal, is,

First, by a spare and plain diet to with∣hold, or at least diminish the daily fresh sup∣plies of oily matter to the blood; that the solids, by whose action and energy that union, and as it were cohesion of the principles of the blood effected, may not have more work, to do than enough: And,

Next to excite the action of the solids; which is to be done chiefly by exercise; un∣der which, I comprehend friction or dry rubbing of the surface of the body, especi∣ally the trunk, as a meterial article. And this kind of exercise is so much the more necessary to extremely corpulent persons, that they can scarcely use any other with remark∣able effect. Strengtheners, that heat mode∣rately,

if judiciously chosen, may come in as auxiliaries.

The cause of Corpulency assigned in the fourth and last place, being a defective eva∣cuation through the outlets of the body of the animal oil or fat already taken in, the cu∣rative indication naturally arising therefrom, is to promote and increase that discharge, by the safest and most effectual methods; that so the daily waste of the oily parts being brought to exceed the constant supplies there∣of, the quantity remaining within the habit may be properly diminished. Now the common natural excretions, to wit, urine, foeces, sweat, and insensible perspiration be∣ing in a healthy state, always more or less charged with animal oil, its expulsion is to be procured through these channels; and indeed it can scarce be brought about any other way, without violence to the consti∣tution. If therefore, one or more of these excretions be increased with safety to the ge∣neral health, and without lessening propor∣tionably the rest, the quantity of fat in the body must in time be diminished.

Insensible perspiration, in our climate can carry off but little oil, especially in corpulent persons, where the extraordinary accumula∣tion of fat under the skin must compress the arteries that go to it; through the small ex∣cretory vessels, that arise from which, the matter of perspiration passes, and is convey∣ed off; and therefore no mighty stress is to be laid upon promoting that discharge, more than what friction may effect.

Frequent purging, if it could be safely brought on, would no doubt be a speedy and effectual means of reducing Corpulency. We see often in practice what vast quantities of animal juices, all which contain oil more or less, are evacuated per annum, in a diar∣rhaea or cholera morbus; and how much the patient is emaciated thereby in not many hours. But it is dangerous to proceed far this way by art. Purgatives often exhibited, besides weakening the general habit by car∣rying off the nutritive serum, hurt the sto∣mach through which they must pass; and the intestines still more, where they exert their principal efficacy, and must remain longer; they may bring on dysenteries and

ulcerations of the guts, with all their dire∣ful train of symptoms, by abating the natu∣ral mucus of the parts, dysenteries, hemorr∣hoids, &c. What therefore is most advise∣able to be done by the corpulent person in this respect is, to use such a diet and man∣ner of living, as may prevent costiveness; and occasionally take safe openers in small doses, and no oftner than is necessary to re∣move it. Aloetic medicines are here prefer∣able to rhubarb (except where piles are trou∣blesome) as they are less apt to leave a bind∣ing quality after their operation is over, walk∣ing, in a general way, promotes the evacu∣ation per anum. Riding, as well as a se∣detary life, encourages costiveness.

Sweat seems to contain more oil than the other fluid excretions; and therefore promot∣ing it often, if it could be done safely and conveniently, might no doubt be of the highest efficacy in reducing a corpulent habit—The safest way of raising sweat is by en∣creased muscular motion, as walking hard, playing at tennis, exercising some laborious mechanic employment, or the like. The next safest way in my opinion, is by moist heat; as in a bagnio. Medicines given to sweat

upon, besides the uncertainty of their ope∣ration, may do hurt by overheating and by changing the crasis of the blood and juices, for the worse, if they are frequently admi∣nistred.

The last of the natural excretions, by which animal oil is carried out of the body, is urine. The urine of a sound person, made after a due concoction of the aliments and chyle, contains an animal oil exalted by re∣peated circulations, and the heat of the bo∣dy, and tending somewhat to the volatile and putrid, as all chymists of note agree. Now, as the excretion of urine may be pro∣moted by a variety of diuretics, with less shock to the constitution, than that by sweat, or stools; and with tolerable certainty too, where there is no morbid obstruction of the passages; it would appear highly reasonable to conclude, that animal oil may both more safely, and more effectually in the end, be discharged out of the body through the chan∣nels of urine, than by any of the other ways already treated of; as the increasing of that evacuation can be brought about more con∣stantly and uniformly; and longer persisted in, because attended with less danger or in∣conveniency.

But that diureticts may be em∣ployed to the best advantage, in order to dis∣charge the animal oil, and by that means re∣duce Corpulency, it is requisite to choose out of that extensive class of medicines, such as, besides increasing the quantity of urine, may at the same time render the animal oil more mixible with the watry vehicle of the blood, than otherwise it would be. Urine, besides water, which constitutes much the greatest part of it, contains oil, as hath been already said, an essential salt peculiar to itself, resembling sal armoniac in many respects, but differing from it in some material pro∣perties; and a fine subtilised earth abraded from the vessels, by the constant motion of the liquids through them. But 'tis the in∣crease of the evacuation of the oil only, that can diminish Corpulency; and therefore it is evident that such diuretics, as are endow∣ed with the property above-mentioned, are to have the preference here.

Now we are so happy as to be in possession of a diuretic medicine, which hath that quali∣ty in a singularly eminent degree; and is withal so safe, as that it may be taken in large quan∣tities every day for years together, without remarkably impairing the general health:

that medicine is soap, which we shall here endeavour to prove, both by reason and ob∣servation, to be exquisitely proper for reduc∣ing Corpulency, in the safest and most effec∣tual manner; in a word, its true remedy where it is curable.

Soap in general (for there is a variety of soaps) is a composition consisting of a veget∣able, fixt, alcaline salt, made by incineration, and oil or fat, whether animal or vegetable, with the addition of quick-lime, in some form or other, intimately and inseparably incorporated together, by boiling accord∣ing to art. Quick-lime, by the assistance of boiling, hath been found by experience to be the fittest bond of union between these two so different and repugnant sub∣stances, without which it cannot be complete∣ly effected, at least not so easily and commo∣diously. Soap, as is well known, is entirely dissolvable in soft water; and that solution assisted by heat, agitation and friction, dis∣solves, besides gums and resins, likewise oil, and animal fat, incorporating them with it∣self, thus fitting them to be scoured and washed off from the substances they adhere to. And therefore its general, as well as its original use, is to clean cloaths, especially

linnen, when soiled with animal filth, in which oil is the predominant ingredient, as being both most penetrating, and adhering most obstinately; at the same time cement∣ing with itself other soiling particles of what∣ever kind. And yet, by the means of soap, they are easily restored to cleanness, sweet∣ness, and whiteness.

It is less to be wondered that soap should have been introduced into the regular prac∣tice of physic, as an inward medicine, con∣sidering its wonderful dissolving virtue; than that it was introduced so late. In Lemery's Dictionaire des Drogues, first published at Paris, in 1694, the fullest and most noted book of its kind in the hands of the public at that time, and for some years after, there is no mention made of the internal use of soap. It hath been much used inwardly since, and deservedly held in great esteem as a resolvent, detergent, and deobstruent; and of late as a lithontriptic. It is found to be a diuretic of the milder sort. The great run of Mrs. Stephen's medicines, both as published by herself, and as since new mo∣deled and amended, not to mention num∣berless cases well known to the public, in

which soap hath been given for the stone ei∣ther by itself or with lime water, sufficient∣ly evince its safety, whole ounces having been exhibited every day for years together, without remarkably injuring the constitu∣tion.

As therefore soap is diuretic; hath a sin∣gular power of rendering oil or fat mixible with water; and withall is so fafe, as that it may be given in large quantities, and its use long continued, we may fairly conclude, that it is a most effectual, harmless and easy re∣medy for reducing Corpulency; and, to sum up all, more to be depended upon than any other yet proposed. This will farther ap∣pear from the following considerations. Per∣sons inclined to Corpulency seldom think on reducing their size, till they grow very bulky; and then they scarce can, or will use exercise enough to be remarkably serviceable. It be∣comes a great trouble to them: Indolence usually gets the better of resolution, and feeds the growing evil, until what was at first only disagreeable and difficult, becomes at length impracticable—Where a rich and plentiful diet is one principal cause of Corpulency, as it often is, the habits of good eating and

drinking becomes so deeply rivetted, as scarce to be conquered. A luxurious table, a keen appetite, and good company are temptations to exceed often too strong for human nature to resist. Sweating and purging for the in∣crease of insensible perspiration, as hath been already observed, is herein insignificant, though very proper now and then, yet can∣not be used with safety frequently and con∣stantly enough to do the business by itself, and atone for errors in point of regimen—whereas soap may be safely used in large quantities every day for years together.

It is no small additional recommendation in favour of this remedy, that it is highly proper for relieving complaints, and curing diseases arising from Corpulency, even inde∣pendently on diminishing it, such as amongst the chronic tribe, short windedness; lethar∣gy, &c. of the acute kind, bastard peripneu∣monics, which are more difficult to cure in very sat persons than others: and in general whatever disorders may be owing to viscidity of juices, a never failing attendant on pleni∣tude, and defect of motion. But to prose∣cute this head farther, would lead us beyond

the bounds we have at present prescribed to ourselves.

We now proceed to take into consideration the manner of exhibiting soap, with a view to reduce Corpulency. And first let us choose the fittest kind for that purpose. Spanish soap, particularly that from Alicant, is at pre∣sent most esteemed for inward use. And al∣though in the observation I am going to re∣late, the common home made Castile soap was used, yet, I hesitate not to give the pre∣ference to that from Alicant. It is not only a more cleanly and less disagreeable medicine, but is much more easily dissolved in water; and therefore must answer better in every intention where soap is required.

As to the manner of exhibiting it, I think once a-day may be sufficient. And I appre∣hend the properest time is at night when going to bed. A drachm (the eighth part of an ounce) may be tried for the first four or five days: and if that creates no remark∣able disorder in the stomach or bowels, the quantity should be increased to two, three, and in very stubborn cases, to four drachms; which last dose, I think, needs not in any

case to be exceeded. It may be taken either sliced down small, and made into the form of a bolus or electuary, with any pala∣table syrup, as that made with orange or ci∣tron peel; or it may be swallowed in the shape of pills; or it may be dissolved in a gill or more of soft water, and so drank.

This course should be continued at least three months, in order to give it a fair trial; in which time, without great errors on the cor∣pulent person's side, I think it highly proba∣ble, that remarkable benefit will be felt in a common way. If good service is really done, the patient will, at least ought to be, encouraged to go on. If his patience should sometimes be tired out, he may intermit the use of the remedy for some days; and afterwards resume it for three or four months longer; and so on, dropping or renewing the course, as his own direction, or skilful advice may best direct.

The following case, will, I hope, greatly both illustrate and confirm what hath been hitherto said. A worthy acquaintance of mine, a judicious and experienced physician, in his younger days had been very active,

and used much exercise, both on foot and on horseback; and for many years seemed as little liable to extreme Corpulency as most people. By insensible degrees, as he dimi∣nished his daily labours, satness stole upon him, and kept increasing; insomuch that, when I met with him about six years ago, I found him in the greatest distress through mere Corpulency, of any person not ex∣ceeding middle age, I ever knew. He was then about forty-five. He was obliged to ride from house to house to visit his patients in the town where he practised, being quite unable to walk an hundred yards at a stretch; and was in no small degree lethargic. In other respects, he seemed pretty clear of any remarkable disease, except gout, of which he had felt some, not very violent, attacks. I warmly recommended the inward use of soap, in order to reduce his Corpulency, as the only safe and effectual remedy in his case, and a remedy which he might con∣tinue to use the longest; I enforced my advice by the reasonings above urged, of which he was too good a judge not to per∣ceive their full cogency. Accordingly, he began to take it July, 1754, at which time he weighed twenty stone and eleven pounds,

jockey weight, a vast load for him to bear, who is little above middle stature, and withal small boned. He took every night at bed-time, a quarter of an ounce of com∣mon home-made castile soap, dissolved in a quarter of a pint of soft water. In about two or three months time, he be∣gan to feel more freedom, and an increase of activity, which encouraged him to per∣severe. And that he did with such success, that in August, 1756, (as he informs me in a letter now lying before me) his bulk was reduced two whole stone weight; and he could walk a mile with pleasure. He had continued the use of the soap all the time between June, 1754, and August, 1756, with very short interruptions, in the manner and quantity above mentioned; it operated remarkably by urine, without ever produ∣cing the least troublesome effect. And now, while I am sending these pages to the press, (April 1760) I am certainly in∣formed that he is hearty, and well.

These facts are well known all over the town, where my friend resides, and it's neighbourhood; and it is the general opi∣nion, that, had it not been for the relief

that was then given him, he must have been in his grave long before now. Let me add, that he used no other method or medicine all the while, to which the extra∣ordinary change in his favour, can with any colour of reason be imputed.

I have taken opportunities of recommend∣ing the same remedy to others, in similar circumstances; but have not been as yet informed of any case, in which a thorough trial thereof was made. However, as it proved so signally serviceable in the instance above-mentioned, under such disadvantages, I hope it may be fairly concluded it may prove useful in a general way, at least in cases less stubborn: which consideration is sufficient to recommend it to the attention of physicians, and the public.

FINIS.