It was not until the nineteenth century, as a result of the labors of Justus v. Liebig with regard to the formation of fat in the animal body, that we not only gained a wider knowledge of the origin of superfluous masses of fat and the deposition of fat, but that we could also devise ways and means directed against the cause and nature of the disease for the prevention or restriction of its grave sequels. The dietetic Banting treatment by Dr. Harvey is based precisely upon the principles governing nutrition, especially in lessening the deposit of fat and in the consumption of the fat in the body. Banting's letter about the result of the treatment and his falling away was the cause of Harvey's method of reducing obesity becoming known by the name of the patient, and of its extensive use both in England and on the Continent. Under the circumstances it was inevitable that the faults inherent in the method should manifest themselves more or less markedly in various cases and stages of obesity and should this limit its further application by unfavorable results.
Our knowledge of the formation of fat and of nutrition first pointed out by Liebig was enlarged in later years by the addition of some facts not fully understood by this investigator, namely, the origin of ani mal fat from carbohydrates and a more complete comprehension of nutrition, which resulted from the important labors of M. v. Pet tenkofer, C. v. Voit, J. Munk, Shubotin, Radziejewski, and others. Their labors disclose the manifold formation of fats from nutritive materials—albumin, fats, and carbohydrates—their consumption and deposition in excessive fat formation, the causes of this process, and the influence of fat and fat-forming materials upon the important presence of albumin in the body. In the field of histology the in vestigations regarding the importance and development of adipose tissue and the formation of fat have not yet come to a harmonious conclusion, and the theories of Toldt, Flemming, Viral ow, and Unna are in irreconcilable contradiction. In the field of pathology the labors of Leyden regarding sclerosis of the coronary arteries must be specially emphasized, since they threw light on the grave heart trouble which so frequently complicates obesity. The same author also more clearly defined meaning of the term fatty heart.
By the widening of our chemico-physiological knowledge of nu trition the treatment has been placed on a firmer basis and it has been made possible to devise comprehensive scientific methods. The Bant
ing method suggested by Harvey was introduced into Germany by Vogel and adapted to the conditions there prevailing. Subsequently Ebstein devised a new method which differed from the latter, owing to a misunderstanding of Voit's labors, in not advocating a special restriction of the consumption of fat as opposed to the carbohydrates and which placed the supply of albumin far too low. Oertel's mode of treatment had reference not only to the restriction of fat and the maintenance of the amount of albumin, but also to the favorable in fluence of the diminution of water in the body upon the reduction of fat and upon the sequels of the disease, while it aimed to prevent and lessen the weakening of the heart muscle and the circulatory distur bances dependent upon it. The same author has moreover lished sanatoria in various hilly and mountainous regions of Ger many, Austria, and Switzerland, where methodical and strictly supervised exercises in the shape of walks and mountain climbing can be performed so as to furnish the necessary mechanical labor and insure the of fat which is its object. Quite recently the question has arisen whether a reduction of fat can be effected by a dietetic-mechanical treatment without the loss of albumin; this has been answered in the affirmative by v. Noorden, who has pointed out the ways in which losses of albumin may arise during the treatment.
Inasmuch as obesity and corpulence are not amenable to medici nal treatment, we find in the history of the disease no remarks bear ing upon the subject. The effect of drink-cures by waters con taining sodium sulphate (Marienbad, Tarasp, etc.) can thus far be said to rest merely upon the fact that they remove a portion of the albuminous and fat-forming substances consumed in the food, by which the nutrition is lessened. These springs, therefore, in cases in which they are indicated, can at most but supplement the dietetic mechanical treatment.
Finally mention should be made of hydrotherapy, which endeavors to utilize the heat-regulating effect of cold baths against corpulence. The combustion of fat necessary to increase the bodily temperature, however, is so slight that hydrotherapy likewise is to be enumerated merely as an adjunct to the above-named modes of treatment.