‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750)

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Abstract

Contrary to a widely held belief, the medicalization of obesity is not a recent development. Obesity was extensively discussed in leading early modern medical textbooks, as well as in dozens of seventeenth- and eighteenth-century dissertations. Drawing upon ancient and medieval writings, these works discussed the negative impact of obesity upon health and linked it with premature death. Obesity was particularly associated with apoplexy, paralysis, asthma and putrid fevers, and a range of therapeutic options was proposed. This paper offers a first survey of the medical understanding of the causes, effects and treatment of obesity in the early modern period. It examines the driving forces behind the physicians’ interest and traces the apparently rather limited response to their claims among the general public. Comparing early modern accounts of obesity with the views and stereotypes prevailing today, it notes the impact of changing medical, moral and aesthetic considerations and identifies, among other things, a shift in the early modern period from concepts of pathological compression to images of the obese body as lax and boundless.

Introduction

The history of obesity has attracted considerable scholarly interest in recent years.1 This interest reflects the prominent place which obesity has come to occupy on the political agenda, in the media, and in the private lives of ordinary citizens.2 From the sociologist’s and historian’s point of view, obesity also offers a particularly intriguing example of the massive influence of the social, cultural, economic and political context on medical science and public health. Many of the warnings against the dangerous health effects of overweight, including official World Health Organization standards for an ‘ideal’ body mass index, remain highly contested, or have been shown to be insufficiently supported by epidemiological data. At the same time, obesity is associated with a range of negative physical qualities and character traits, such as sloth, lack of self-control and inferior intelligence. In consequence, those declared as ‘overweight’ or ‘obese’ frequently not only suffer the effects of numerous and often futile attempts to lose weight, but also fall victim to massive prejudice and, at times, outright discrimination.3

Studies on the history of obesity have thus far focused on the time from the eighteenth or, more commonly, the nineteenth century onwards, when the modern ideal of the slender, thin body took centre stage, when a small belly began to be viewed in negative terms rather than as a sign of virility, and when dieting became fashionable.4 In contrast, the time before 1750 has attracted very little attention to date.5 As this paper will show, this has created a deplorable gap in our historical understanding of the medical and cultural history of obesity, however. For the common assumption that obesity was identified (or defined) as a major health hazard only by modern medicine is clearly contradicted by dozens of medical treatises and dissertations on the topic which from the sixteenth century onwards discussed the pathological aspects of obesity and gave advice on how to fight it.

In this paper, which presents the first results of my ongoing research on the medical history of obesity from 1500 to 1900, I will start with a general overview of the principal features, causes and consequences of obesity as outlined in these works and sketch the prophylactic and therapeutic conclusions at which their authors arrived. I will proceed to ask more briefly what may have prompted the marked and sustained interest of early modern physicians in obesity, and trace the lay response to their warnings about the condition. Finally, I will provide an outline of the images and negative character traits which early modern physicians associated with obesity.

Section snippets

Obesity in early modern medical writing

In his influential ‘Universa medicina’, the French physician Jean Fernel (1497–1555) provided a drastic account of the dangers of overeating. Eating more than was natural caused sickness (‘morbum facit’). For the innate heat, he explained, was overwhelmed by the masses of excessive food which, as a result, was only insufficiently ‘concocted’—humoral medicine likened the digestion and assimilation of food to the cooking of food on a stove. Raw, crude matter prone to corruption and putrefaction

Etiology, prophylaxis and treatment

Early modern physicians discussed a range of causes for the accumulation of excessive fat in the body. Some admitted a ‘hereditary disposition’ or even distinguished ‘obesitas haereditaria’, running in families, from an acquired obesity originally due to lifestyle.31 Most early modern authors assumed, however, that obesity was due above all to abundant, nutritious, oily blood and that this blood in turn was produced from excessive food.

The medicalization of obesity in context

Why were early modern physicians so concerned about obesity? Why did they put so much effort into describing its dangers and in devising prophylactic and therapeutic advice? Was obesity perhaps on the rise because the food supply had improved? The possibility cannot be ruled out, but there is no hard evidence to support this claim, and it is telling that the individual cases of obesity which the physicians reported came from all ranks of society. Throughout the early modern period, historians

The lay response

Whether physicians’ warnings of the dangers of obesity were heeded, and their dietetic advice both sought and accepted, is, of course, quite a different matter. The general idea that great corpulence could, in principle, constitute a health hazard seems to have reached the general public. It even made it into broadsheets: in 1612, a popular illustration of a very obese roper’s wife stressed the fact that the person in question was ‘noch bei Leben, frisch und gesund’, i.e. ‘still alive, fresh

Images of obesity: continuity and change

As the numerous early modern works which decried the harmful consequences of obesity and advised on the best means to fight it make abundantly clear, the medicalization of obesity is by no means a product of modern medicine. Sixteenth- and seventeenth-century physicians were already framing obesity, in clear and unambiguous terms, as a potentially deadly medical condition in need of treatment. Some of the dangers and negative consequences of obesity expounded by early modern physicians are

Conclusion

As this paper has made clear, obesity and its effects on body and mind were widely discussed in early modern academic medicine, in general textbooks as well as in dozens of treatises and dissertations devoted specifically to the topic. Virtually every major early modern medical author had something to say about obesity. A wide range of therapies was proposed to fight it. We should definitely dismiss the idea that obesity was medicalized only in the nineteenth and twentieth centuries, with the

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