Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx

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Studies in History and Philosophy of Biological and

Biomedical Sciences
journal homepage: www.elsevier.com/locate/shpsc

‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750)
Michael Stolberg
Institut für Geschichte der Medizin der Universität Würzburg, Oberer Neubergweg 10a, 97074 Würzburg, Germany

a r t i c l e i n f o a b s t r a c t

Article history: Contrary to a widely held belief, the medicalization of obesity is not a recent development. Obesity was
Available online xxxx 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 dis-
Keywords: cussed the negative impact of obesity upon health and linked it with premature death. Obesity was par-
Obesity ticularly associated with apoplexy, paralysis, asthma and putrid fevers, and a range of therapeutic options
Fat was proposed. This paper offers a first survey of the medical understanding of the causes, effects and
Body concepts
treatment of obesity in the early modern period. It examines the driving forces behind the physicians’
Body imagery
Early modern medicine
interest and traces the apparently rather limited response to their claims among the general public. Com-
Dieting paring 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.
Ó 2011 Elsevier Ltd. All rights reserved.

When citing this paper, please use the full journal title Studies in History and Philosophy of Biological and Biomedical Sciences

1. Introduction ten futile attempts to lose weight, but also fall victim to massive pre-
judice and, at times, outright discrimination.3
The history of obesity has attracted considerable scholarly Studies on the history of obesity have thus far focused on the time
interest in recent years.1 This interest reflects the prominent place from the eighteenth or, more commonly, the nineteenth century on-
which obesity has come to occupy on the political agenda, in the wards, when the modern ideal of the slender, thin body took centre
media, and in the private lives of ordinary citizens.2 From the sociol- stage, when a small belly began to be viewed in negative terms
ogist’s and historian’s point of view, obesity also offers a particularly rather than as a sign of virility, and when dieting became fashion-
intriguing example of the massive influence of the social, cultural, able.4 In contrast, the time before 1750 has attracted very little atten-
economic and political context on medical science and public health. tion to date.5 As this paper will show, this has created a deplorable gap
Many of the warnings against the dangerous health effects of over- in our historical understanding of the medical and cultural history of
weight, including official World Health Organization standards for obesity, however. For the common assumption that obesity was iden-
an ‘ideal’ body mass index, remain highly contested, or have been tified (or defined) as a major health hazard only by modern medicine is
shown to be insufficiently supported by epidemiological data. At clearly contradicted by dozens of medical treatises and dissertations
the same time, obesity is associated with a range of negative physical on the topic which from the sixteenth century onwards discussed
qualities and character traits, such as sloth, lack of self-control and the pathological aspects of obesity and gave advice on how to fight it.
inferior intelligence. In consequence, those declared as ‘overweight’ In this paper, which presents the first results of Ayers (1958) my
or ‘obese’ frequently not only suffer the effects of numerous and of- ongoing research on the medical history of obesity from 1500 to

E-mail address: [email protected]

1
See e.g. Schwartz (1986), Klotter (1990), Bray (1990), Thoms (1995), Thoms (2000), Stearns (1997), Guerrini (2000), Merta (2003), Oliver (2006), Poulain (2009).
2
To name just a few, Hell and Miller (2000), Benecke and Vogel (2003), Kasper and Schlenk (2003).
3
Allon (1982), Gard & Wright (2005), Oliver (2006), Schmidt-Semisch & Schorb (2008).
4
Schwartz (1986), Stearns (1997), Merta (2003, 2008).
5
Notable exceptions are Gourevitch (1985), on ancient medicine Ayers (1958), Klotter (1990), Forth & Carden-Coyne (2005).

1369-8486/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.shpsc.2011.10.029

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
2 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx

1900, I will start with a general overview of the principal features, due above all to the sheer weight or bulk of their fat, which pressed
causes and consequences of obesity as outlined in these works and on the vessels and narrowed them, blocking the free passage of blood,
sketch the prophylactic and therapeutic conclusions at which their spirits and vital heat. The obese were prone to dangerous diseases like
authors arrived. I will proceed to ask more briefly what may have apoplexy, paralysis, asthma, syncope and pestilential fevers. Their
prompted the marked and sustained interest of early modern physi- excessive bulk meant that every movement was an effort for them.
cians in obesity, and trace the lay response to their warnings about Their pulse was weak, they suffered from palpitations, and breathed
the condition. Finally, I will provide an outline of the images and with difficulty. They also tended to be slow to take note of their dis-
negative character traits which early modern physicians associated eases, and had them treated too late; once they did seek treatment,
with obesity. the effect of medicines was weaker. They were often infertile. Fre-
quently their intellectual faculties suffered as well, especially when
2. Obesity in early modern medical writing obesity was not innate but acquired through gluttony; this was due
to their impure blood which, in turn, brought forth impure spirits.
In his influential ‘Universa medicina’, the French physician Jean The Lacedemonians had been quite right to scold those who were
Fernel (1497–1555) provided a drastic account of the dangers of fat from indulging in food as having little intelligence and courage.10
overeating. Eating more than was natural caused sickness (‘mor- There are some differences in detail, but the general picture
bum facit’). For the innate heat, he explained, was overwhelmed which medical authors well into the seventeenth century painted
by the masses of excessive food which, as a result, was only insuf- of the dangers of excessive fat or obesity is remarkably uniform,
ficiently ‘concocted’—humoral medicine likened the digestion and even if it does not always correspond to modern understanding.
assimilation of food to the cooking of food on a stove. Raw, crude The reasons for this consensus are not difficult to establish: these
matter prone to corruption and putrefaction accumulated inside authors all relied on more or less the same sources, on the same
the body. The vessels were overburdened with excrements which passages in the writings of ancient and medieval medical authori-
could not be sufficiently evacuated. Everything inside the body be- ties. Hippocrates [Aphorisms 2.44] maintained that the ‘very fat’ or
came compressed and tight. The pathways in the body were nar- ‘very thick’ (Greek: ‘pachys’) died faster than the lean or, as others
rowed or obstructed and the body was no longer permeable and understood the term ‘tachythanateroi’, were more likely to die a
sufficiently ventilated. As a result, cold diseases such as cachexia, sudden death. The very obese aged quickly, Aristotle [On the gener-
paralysis and apoplexy arose, even when the excessive food was ation of animals 4.6] claimed similarly, and they tended to be ster-
hot in and of itself. Since innate heat was used up in the effort of ile. Galen, who discussed fat and obesity in a number of his works,
concocting and assimilating all that food, the senses, the mind clarified their pathological status.11 He argued that excessive corpu-
and the workings of the soul suffered as well. They were deprived lence harmed the actions or functions of the body and thus was a
of the beneficial influence of the innate heat and could not perform preternatural, morbid state, a disease [On tumors 9]. He ranked obes-
their tasks correctly. When the compression in the body reached a ity among the diseases of size or quantity and declared its ‘cure’, in
maximum, the innate heat could be extinguished or vessels could other words ridding the patient of excessive fat, an important task.
rupture, leading to sudden death.6 To fight obesity, Galen [Method of healing 14.15], recommended
Other authors ascribed very similar effects to obesity. Giovanni exercise, dieting and various medicines, ranging from parsley to salt
Argenterio, for example, in a commentary on Galen, warned in made from burnt vipers. Galen [Diseases 9] also reported what would
1566 that people with ‘too much fat’ had shorter lives. Since most become the most quoted case of extreme obesity well into the sev-
of their blood was transformed into fat, the body was robbed of its enteenth century, that of Nicomachus Smyrnaeus, who grew so fat
necessary nutrition and the fat also pressed on the vessels and suf- that he was eventually unable to move.12
focated the vital heat. Like excessively fat pigeons or sheep, fat Based on the writings of Galen and Aristotle in particular, the
people were prone to suffer a sudden death. They also tended to Persian physician-philosopher Avicenna (Abu ‘Ali al-Husayn ibn
be infertile. The quality of their semen deteriorated and the grow- Sina, 980–1037) offered a succinct synthesis of ancient medical
ing bulk of their belly shortened their penis and made them unfit writing on the dangers of obesity in his famous Canon medicinae.
for sexual intercourse. In fat women, as the Hippocratic aphorism The chapter ‘De nocumento superfluae pinguedinis’, roughly trans-
5.46 had already stated, the mouth of the uterus was compressed lating as ‘Of the harmfulness of superfluous fat’, does not even oc-
and no longer let the semen pass through.7 By their nature, Levinus cupy an entire page, and is followed by an equally brief chapter on
Lemnius (1505–1568) similarly explained, the very fat did not live as how to lose weight. Yet much of what early modern medicine had
long as skinny people. They had less innate heat, the vital spirits and to say about obesity can be found here in a nutshell. Avicenna de-
the blood were not so hot, and their natural faculties were weaker picted the effects of too much fat in the body in drastic terms. It
because they had to be dissipated inside a larger body.8 compressed the vessels, hindered the movement of the subtle
In spite of the book’s title, Girolamo Mercuriale’s lengthy chapter warm spirits and often corrupted the spirits or extinguished them
on obesity in his De decoratione liber of 1587 also dealt primarily altogether; according to Galen and Avicenna, the vital spirits
with the medical, pathological aspects of obesity. As long as what played a crucial role in keeping the body alive, and in the sensory
others called ‘oboesitas’, ‘polysarkia’ or ‘corpulentia’, and which he and motor faculties, in particular. The breathing and heart of the
preferred to call ‘crassities’, only harmed the form and the beauty obese were constricted, and their innate heat, which had its prin-
of the body, it was a mere symptom (‘symptoma’).9 But when it dam- cipal seat in the heart, was weakened. The obese had little blood
aged the actions or functions of the body, it became a disease. Obese and plenty of the cold moist humour of phlegm, so that their
people had shorter lives. The pathological effects of obesity were complexion was very cold. The consequences were grave. Obese

6
Fernel (1644a), pp. 361f.
7
Argenterio (1566); the latter notion still appears in Hulsebusch (1728), p. 18.
8
Lemnius (1579), book 2, ch. 20.
9
Well into the nineteenth century, the terms ‘obesity’ (‘obesitas’), ‘fleshiness’ (‘polysarkia’) and the more general term ‘corpulence’ (‘corpulentia’) were often not clearly
distinguished.
10
Mercuriale (1587), pp. 16–34, ‘De oboesitate totius corporis, & partium’; a similar account was given by Minadoi (1600); on both, see also Gadebusch Bondio (2005), pp. 120–
125.
11
Cf. Gourevitch (1985).
12
Mercuriale (1587), pp. 20, 28, Wucherer (1716), p. 6.

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx 3

people were prone to apoplexy, paralysis, syncope, palpitations, help and quickly became breathless. Another of his patients, appar-
diarrhoea, shortness of breath and putrid fevers. Particularly those ently a nobleman, acquired such bulk that he could hardly move at
who were obese from a young age, and therefore had smaller veins all, and risked suffocating while lying in bed or when rising from a
due to the constant pressure of fat within their bodies, risked dying sitting position. A third patient, a bookseller by trade, became so fat
a sudden death. Obese people could not tolerate hunger and thirst that he was unable to climb the stairs. At first he followed Timaeus’s
well. Obese men produced little sperm; fat women conceived only dietetic and pharmaceutical advice, and lived on, though plagued
with difficulty, and when they did get pregnant, they aborted.13 by difficult breathing. When he stopped the treatment he gained
In the late Middle Ages, Nicolaus Falcuccio, alias Nicolaus Flor- much bulk, and eventually succumbed to a sudden death.20 Thomas
entinus (d. 1410 or 1411), provided an extensive account of obesity Short told the story of a young lady ‘who died of corpulency in the
in his Sermones medicinales, a major synopsis of contemporary 25th year’, ‘a monster in nature for bulk’, weighing more than 500
medicine published in 1484.14 Drawing generously on Avicenna’s pounds.21 Some authors also published cases of extremely obese chil-
Canon, his warnings could hardly have been more drastic. ‘Abhorreas dren. Among Nicolaas Tulp’s numerous case histories we find the
pinguedinem’, ‘abhor fat’ he admonished his readers. For excessive story of a 5-year-old boy from Geldria who was put on a scales in
fat in the body posed great dangers; among other things, the innate Amsterdam and found to weigh 150 pounds, and whose belly mea-
heat was suffocated, the visible and occult vessels or pathways were sured 6 cubits around.22 Thomas Bartholinus reported the case of a
blocked and threatened to burst, the parts were not sufficiently ven- 10-year-old girl from Brabant who weighed 200 pounds and whose
tilated, the spirits corrupted and the senses weakened. Fat people belly extended from her breasts to her feet. She could not walk but
noticed too late when they got sick, and treating their diseases had to lie down, and was for a time exhibited at the markets.23
was more difficult. Those with excessive fat in their body were well Medical writing on the clinical aspects of obesity received impor-
advised to get rid of superfluous fat before there was any manifest tant additional input from anatomical and physiological writing.24
harm. It led, among other things, to epilepsy, paralysis, difficult The pathological consequences of obesity were not central to these
breathing, diarrhoea, fainting and hot fevers. Fat women tended to works, but indirectly helped to elaborate theoretical medical under-
be infertile, and once they conceived they were prone to abort or standings of obesity and its effects. Thomas Erastus in Heidelberg,
their babies were weak.15 writing in 1580, provided a first major synthesis of the anatomy and
Sixteenth- and seventeenth-century medical textbooks contin- physiology of fat in the human body. He explained that fat resulted
ued the same tradition. Daniel Sennert, for example, in what was from the sweetest, most elaborate and airy parts in the blood. These
to become the most widely quoted work on medical practice in parts were produced, like the blood itself, in the liver, in the second
the seventeenth century, painted a very bleak picture of the many stage of concoction, and thus ultimately derived from food and drink.
negative effects of fatness. Quoting extensively from Avicenna’s Mixed with the blood, they arrived in the various parts of the body, and
Canon, he stressed, in particular, the growing immobility and exuded from the little vessels or were squeezed through their walls.
breathing difficulties of corpulent people.16 From the early seven- While the blood itself nourished the various parts of the body, fat
teenth century onwards, and with increasing frequency after 1650, was excremental matter, though, like semen and milk, a useful one.
dozens of medical dissertations and disputations were devoted to It fostered the vital heat in the body; it protected the body from exces-
the physiology and pathology of (excessive) fat and to the causes, sive cold and other bad external influences. And, last but not least, it
consequences and treatment of corpulence.17 Some provided a gen- contributed to bodily beauty, by filling out the holes, cavities or cre-
eral survey of the role of fat in the body and/or of the clinical aspects vices between the muscles and other anatomical structures, giving
of excessive corpulence.18 Others approached specific issues such as the body a smoother, softer appearance, especially in women.25
whether obese people should sleep less, whether the blood circu- Erastus also raised a question which continued to spark contro-
lated more sluggishly in them, or whether blood-letting should be versy.26 What made the fat accumulate and turn into solid matter in
less copious in their case.19 Such works provide clear evidence that the body? Was it due to a cooling-off of fluid, oily matter, since com-
the dangers of obesity had become part of ordinary textbook knowl- mon observation suggested that women and eunuchs, who were en-
edge, something with which medical students and ordinary physi- dowed with a colder temperament, had a greater tendency to
cians were expected to be acquainted. fatness? Or did fat rather harden and solidify under the impact of
Scholarly discussion of obesity was supplemented and corrobo- heat, which made the fluid parts evaporate? Erastus’s compromise
rated by evidence from individual cases. Daniel Sennert mentioned solution was that fat did solidify in moderate heat, but that this heat
two contemporary examples of extreme corpulence: a woman from was relatively cold compared to innate heat. This became the dom-
Strasbourg who was known to have weighed 480 pounds at the age inant view shared by, among others, Laurent Joubert.27
of 36, and a man weighing more than 400 pounds whom he had Up to the middle of the eighteenth century, hundreds if not
personally seen. Timaeus von Güldenklee recounted, among others, thousands of pages were devoted to obesity and to the physiology
the story of a 37-year old man who had sought his advice because and pathology of excessive fat in the body. Much of this writing
had grown so fat that he could no longer mount a horse without was repetitive and redundant, but gradually some new clinical

13
Avicenna. (1556), p. 968.
14
Falcuccio (1484), fos. 202ff; ‘De decoratione et corporis ornatu’; the treatise concluded his seventh and last ‘Sermo medicinalis’ on the exterior parts of the body.
15
Falcuccio (1484), fol. 204v.
16
Sennert (1656), book 5, part 1, ch. 4: ‘De corpulentia nimia’.
17
Some of these have been analyzed by Albala (2005); my own undoubtedly still incomplete survey comprises about 50 titles before 1800.
18
E.g. Espich (1612), Gosky (1658), Giselerus (1665), Trouillart (1667), Held (1670), Widemann (1681), Leißner (1683), Verdries (1702), Pohl (1734).
19
Gasnier (1733), Le Monnier (1740), Person (1748).
20
Timaeus von Güldenklee (1667), pp. 261–264, ‘Corpulentia nimia’.
21
Short (1727), p. 9.
22
Tulpius (1652), p. 283.
23
T. Bartholin, Historiae anatomicae, Centuria III, 38, quoted in Held (1670), ch. 3.
24
Erastus (1580).
25
Held (1670), ch. 4, Pechlin (1691), pp. 325f.
26
Hoffmann (1674), n. 12, n. 13.
27
Joubert (1582), p. 69.

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
4 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx

and pathological observations enriched the traditional account. vital, innate heat, excessive amounts of fat threatened to suffocate
Obese people were, for example, also found to suffer from heart and extinguish it.36 The huffing and puffing of the obese, their short-
polyps, due to the chylous, glutinous particles in their blood, and ness of breath corresponded to this suffocation of the flame of life.
from kidney diseases, due to the pressure on the vessels and ducts. Much more than today, fat was viewed as the product of a largely
In dissections of obese people the heart was sometimes found lit- irreversible transformation, as an excrement inside the body. seven-
erally to disappear in the masses of fat around it, which could not teenth-century authors therefore often doubted that fat could flow
but hinder its movements.28 Some of the dangers of obesity also back into the vessels and assume its previous state as part of the
came to be explained differently. Thus, in light of William Harvey’s nutritious blood, to be absorbed as nourishment by the individual
finding that blood circulated in the body and sustained life, the com- parts; or else they believed that this only happened when a person
pression of the vessels by excessive amounts of fat appeared even was severely starved.37 Only gradually did the idea take hold that
more dangerous, because the sluggish blood of the obese implied the fat stored in the fatty tissue could be attenuated by movement
‘a new superadded work for the heart, lungs, and muscles.’29 Authors and heat, returned into the vessels and consumed by work or phys-
also increasingly relied on the results of new anatomical findings. ical exercise.38 In support of this notion, Thomas Short, writing in
Marcello Malpighi’s discovery of special adipose vessels or cellules 1727, cited the example of sheep who could survive without eating
in the tissue was widely quoted.30 The basic picture, however, of under deep snow for 30 days.39
what happened in the obese body remained remarkably unchanged. If fat was excremental matter which could not simply be con-
sumed or burnt, the best and most obvious way to get rid of it
3. Etiology, prophylaxis and treatment was to promote its evacuation. Here, as in many other fields of
early modern therapeutics, the physician only had to imitate the
Early modern physicians discussed a range of causes for the body’s natural efforts. It was commonly accepted that Nature con-
accumulation of excessive fat in the body. Some admitted a ‘hered- stantly evacuated considerable amounts of superfluous fatty mat-
itary disposition’ or even distinguished ‘obesitas haereditaria’, run- ter. The importance of these evacuations was demonstrated by
ning in families, from an acquired obesity originally due to the fact that their disruption or obstruction could bring about
lifestyle.31 Most early modern authors assumed, however, that obes- obesity.40 Ageing women, for example, it was well known, tended
ity was due above all to abundant, nutritious, oily blood and that this to grow fat when they no longer had their monthlies.41
blood in turn was produced from excessive food.32 In principle, any kind of evacuation could eliminate fat. Some
In order to fight obesity, eating less, particularly less fat, was authors recommended laxatives or drugs that promoted menstrua-
therefore of paramount importance.33 In addition, one could try tion or salivation.42 The principal excretions by means of which early
and prevent the transformation of food into fat. Sleeping less was modern physicians sought to eliminate excessive fat, however, were
helpful because the concoction and assimilation of food was deemed urine and sweat. Fatty excretions in the urine were, according to
particularly efficient during sleep. Everything that heated the blood numerous early modern treatises on uroscopy, visible even to the
or affected its natural mild complexion, such as ‘hot’, spicy or sour naked eye.43 Malcolm Flemyng especially praised the diuretic virtues
food, would also make it more difficult for the oily parts of the blood of Spanish soap against obesity.44 According to Timaeus von Gülden-
to ooze through the walls of the vessels and to solidify as fat. It was klee, writing in the seventeenth century, mineral water also could
widely acknowledged that people whose constitution was dominated serve this purpose, and in the nineteenth century visiting spas and
by sharp yellow or black bile did not easily grow fat. Similarly, drugs drinking mineral water became one of the most popular ways of
and foodstuffs which increased the blood’s acrimony and made it fighting obesity.45 Sweat was considered an even more efficient path-
hotter promised good effects in the fight against obesity. Even delib- way for the evacuation of superfluous fat. Much of the fat tended to
erately making patients acquire a tertian fever was recommended, if accumulate underneath the skin anyway and was said to exude liter-
this could be done without endangering the patient’s life.34 ally as ‘oily’ sweat.46 Sudorifics, rubbing the skin and sweat baths
Once the fluid fatty matter had left the vascular space and solid- were therefore powerful means of getting rid of fat. The importance
ified into a thick layer, getting rid of it again was more difficult. The of sweating to the excretion of fat also helped explain why hard-
fat could not simply be ‘burnt’. Notions of ‘energy’ or ‘calories’ or working farmers and craftsmen did not easily grow fat, and why
‘kilojoules’ had not yet entered the picture. The flame of life, the vi- physical exercise like frequent running helped to fight obesity: bodily
tal or innate heat, as Espich explained in 1612, did not normally labour and exercise promoted sweating and thus the excretion of
feed on fat.35 On the contrary, rather than being consumed by the fatty matter.47 People in the cold north, like the Germans, were also

28
Held (1670), ch. 3, Hoffmann (1674), n. 22, Schaper (1701), p. 32, Short (1727), p. 40, Hulsebusch (1728), p. 16.
29
Short (1727), p. 43.
30
Hoffmann (1674), n. 14, Hossauer (1712), thesis III, Short (1727), p. 10, Hulsebusch (1728), pp. 5–7, Quabeck (1752), Boerhaave (1790), p. 483.
31
Hossauer (1712), thesis I, Schaper (1701), p. 10.
32
Cf. the definition in Held (1670), ch. 2 (unpaginated): ‘nimium incrementum molis corporis ab abundante nutrimento inductum’.
33
See, e.g., the advice given by Timaeus von Güldenklee (1667), pp. 261–263.
34
For an extensive overview see e.g. Hossauer (1712), thesis VIII.
35
Espich (1612).
36
Thus Wucherer (1716), p.3.
37
Hoffmann (1674), n. 31.
38
Hulsebusch (1728), pp. 13f.
39
Short (1727), pp. 30f.
40
Flemyng (1760), p. 7f.
41
Held (1670), ch. 4.
42
For a good overview see Flemyng (1760), p. 16–21; emmenagogues were suggested, for example, by Falcuccio (1484), fos. 204v–205v, ‘De extenuatione corporis pinguis’.
43
Stolberg (2009).
44
Flemyng (1760), pp. 19–21.
45
Timaeus von Güldenklee (1667), pp. 263f; cf. e.g. Kisch (1884).
46
Bass (1740), p. 6; Flemyng (1760), pp. 17f.
47
Hossauer (1712), thesis VIII, Sennert (1656), book 5, part 1, ch. 4: ‘De corpulentia nimia’.

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx 5

found to be more prone to obesity than those in the warm south, like was in many respects still very much a bookish discipline. Author-
the Italians or Spaniards.48 ity and fame in the scientific community were based to a large de-
Opening artificial pathways, like cupping or blood-letting, was gree on the publication of scholarly treatises. In many universities,
less commonly recommended.49 If the excessive generation of fat medical students were expected to publish a learned dissertation
was attributed to a copious supply of rich, nutritious blood full of oily on a specific topic in order to acquire their doctorate. As a result,
particles, blood-letting made perfect sense. Some authors had their we encounter a growing number of medical publications on virtu-
doubts, however.50 Since obese people, by their very nature, already ally every imaginable topic. Authors of medical dissertations par-
inclined towards cold diseases, depriving them of warm blood and ticularly favoured topics like obesity, which had already been
thus shifting their complexion even more towards the cold was risky. discussed by ancient and medieval authorities, and thus provided
Other authors went a step further and even argued that obese people the grounds for systematic learned commentary.
had in fact particularly little blood because they converted much of Secondly, conditions like obesity allowed medical writers to
their good, nutritious blood into fat. From this point of view, obesity show their ability to arrive at a plausible account of virtually any
was closer to dropsy, and blood-letting was outright harmful. bodily phenomenon, and especially of rare and ‘monstrous’ phenom-
A detailed analysis of possible changes in the range of early mod- ena like the cases of extreme obesity described by the physicians.
ern therapeutic approaches to obesity has yet to be undertaken, but Those who advocated new medical systems like iatromechanics, iat-
it seems that new medical systems like iatromechanics, iatrochem- rochemistry and Stahlianism could in turn use conditions like obes-
istry and Stahlianism had little impact upon the prevention and ity as a testing ground, to prove that their theories offered a more
treatment of obesity. Even a leading representative of iatrochemis- compelling explanation than those of their rivals.53
try, like Franciscus Sylvius, offered a list of treatments for ‘corporis Thirdly, obesity was a field in which physicians could demon-
obesitas’ which was by now largely conventional: abstaining from strate their superior expertise in dietetic matters and their skills
oily and fat food, physical exercise, sleeping less and changing the in tailoring a ‘regimen’ to a patient’s individual history, lifestyle
mild nature of the blood, by adding sour, sharp, salty or bitter spices and bodily constitution. Early modern patients and relatives often
like vinegar, lemon juice, pepper, cinnamon and mustard.51 demanded dietetic advice, and dietetics was a field in which
learned physicians saw particularly good prospects of acquiring a
4. The medicalization of obesity in context much-desired competitive edge over their numerous competitors
on the medical market, who relied more exclusively on medicine
Why were early modern physicians so concerned about obesity? and blood-letting.54 In the case of obesity, physicians underscored
Why did they put so much effort into describing its dangers and in the crucial importance of their dietetic expertise by warning how
devising prophylactic and therapeutic advice? Was obesity perhaps misleading appearances could be. Obese people might look perfectly
on the rise because the food supply had improved? The possibility healthy, and others might even praise them for their good looks. Yet
cannot be ruled out, but there is no hard evidence to support this a deadly danger lurked inside their bodies, which physicians’ profes-
claim, and it is telling that the individual cases of obesity which sional advice could avert.55 Generally speaking, promoting aware-
the physicians reported came from all ranks of society. Throughout ness of a neglected or underestimated health hazard—or indeed
the early modern period, historians of nutrition have found, large inventing it—has also always been a good strategy to promote one’s
parts of the early modern rural and urban population had the personal fame and to create a market for one’s publications, medical
means to buy or produce enough food to reach an intake of calories services and drugs. Authors like Short and Flemyng who wrote in
which exceeded—often significantly—the minimum levels accepted vernacular language and addressed a wide lay audience could hope
by modern medicine.52 Bad harvests, severe epidemics and social to make themselves a name as specialists in the field, and to attract
and political turmoil could seriously jeopardize food supplies, but affluent patients who would consult them in person or by letter.
in normal years many people, not only an affluent minority, had ac- Last but not least, obesity allowed physicians to make use of
cess to that small amount of extra food each day which is now their science in order to justify and reinforce societal norms and
thought to be sufficient to cause obesity in the long run. accepted standards of behaviour. Though not all authors, as we
Did early modern physicians react to new aesthetic ideals? have seen, agreed that obese people necessarily ate more than oth-
Again the possibility cannot be dismissed out of hand. Early mod- ers, obesity was particularly linked to voracious eating.56 From this
ern medical writing on obesity was pervasively shaped by notions perspective, obesity was the epitome of immoderation, gluttony and
which go back to ancient Greek and medieval Persian and Arabic lack of self-control. By stuffing themselves with food, the obese be-
medicine, however, and, at least, in the sixteenth and seventeenth haved like animals, until their bodies finally resembled those of a
centuries there is little evidence to suggest that obesity had be- ‘fully masted pig or ox’.57 The contemporary ideal of rational man,
come less acceptable. This seems to have changed only very grad- whose reason lifted him above beasts (and women), was also at
ually in the eighteenth century, towards the end of the period stake. Contemporary medical theory lent scientific authority to the
under consideration, when the obese body came to be described notion of the intellectual inferiority of fat people. Admittedly, some
as lax rather than tense and thus stood in marked contrast to eigh- very obese men had been known to possess a bright intellect, but in
teenth and nineteenth-century ideals of a strong, muscular body. general obese people were said to suffer from inferior intelligence,
By all appearances, early modern physicians’ interest in obesity poor memory and weak senses, and according to physicians, this
had other and, in a way, less spectacular, causes. Firstly, medicine was the consequence of their bodily condition.58 The vital and

48
Held (1670), ch. 4, Hossauer (1712), thesis V, Wucherer (1716), p. 9.
49
Sennert (1656), p. 799, Timaeus von Güldenklee (1667), pp. 261–263.
50
Falcuccio (1484), fol. 204v.
51
Sylvius (1671), pp. 525–527.
52
Morineau (1996), esp. p. 591.
53
Cf. Daston & Park (1998), Albala (2005), p. 170.
54
Cf. Albala (2002).
55
Schaper (1701), pp. 5, 32, Hulsebusch (1728), p. 20.
56
Cf. the title of Pohl (1734): ‘De obesis et voracibus eorumque vitae incommodis ac morbis’.
57
Guarinonius (1610), p. 762.
58
Guarinonius (1610), pp. 30f.

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
6 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx

animal spirits on which the senses and the workings of the soul de- regular basis until his cacochymy was gone and his former vigor
pended were impure, and could not move freely through the body and health returned. Philipp Grünling recommended bloodletting,
and its vessels, compressed by masses of fat. As a result, the obese sparse food and physical exercise after eating when his former fam-
were also ‘slow, lazy [and] idle’, they tired quickly or even developed ulus asked him for advice because he had grown so fat that he was
an irresistibly strong propensity to fall asleep.59 The obese became afraid he would soon no longer be able to move. But he added that
the antithesis of the industrious, productive citizen, the virile, coura- physicians rarely had to deal with this particular affliction.67
geous soldier or the bright, devoted scholar. Similarly, in the many hundreds of manuscript consultations
and patient letters which I have studied, obesity hardly figures. A
5. The lay response rare exception is a ‘Consil[ium] ad minuendam obesitatem et inde
ortum asthma’ written in 1699 by Heinrich Meibom (1638–1700)
Whether physicians’ warnings of the dangers of obesity were of Helmstedt for a 23-year old princess from Saxony.68 The princess
heeded, and their dietetic advice both sought and accepted, is, of had grown very fat after the delivery of her last child, and had devel-
course, quite a different matter. The general idea that great corpu- oped a strange kind of dyspnea, characterized by sudden attacks of
lence could, in principle, constitute a health hazard seems to have shortness of breath which made her feel as if she were about to suf-
reached the general public. It even made it into broadsheets: in focate. Obesity, Meibom noted, was hereditary among the Saxon
1612, a popular illustration of a very obese roper’s wife stressed princely families, and she had a good appetite and ate plentifully.
the fact that the person in question was ‘noch bei Leben, frisch This, he assumed, made her produce too much blood, which inter-
und gesund’, i.e. ‘still alive, fresh and healthy’, in spite of her ex- fered with her circulation, and, being very fatty, was the cause of
treme weight, implying that negative effects on health would nor- her massive increase in bulk (‘starcke[s] Zunehmen’). Meibom ad-
mally be expected.60 Isaac Cattier, writing in the late seventeenth vised the princess to refrain from eggs, milk, rice, chocolate and
century, even claimed that many people sought the physician’s ad- sweet wine in particular. Rye bread was better than wheat bread.
vice because they wanted to lose weight and be able to move better Tea and coffee were permitted, but in general she was not to drink
again.61 There is also some anecdotal evidence of individual obese much, because drink nourished the body. Meat broths were to be
patients who asked for medical advice and engaged in weight-losing cooked with parsley and celery, which promoted urinary excretion.
activities. The case of a fat Spanish general, who was physically fit For medicine, he prescribed decoctions of sarsaparilla, which would
but ultimately had to support his huge belly with straps, was repeat- dry the body and so prevent corpulence, as well as cream of tartar, to
edly mentioned in this context. He managed to lose 87 pounds, be taken half an hour before eating, which would keep the body
above all by switching from wine to vinegar.62 Johann Nicolaus Pech- ‘open’ and had been found to act against increasing corpulence
lin, in 1691, reported the case of a nobleman who asked several phy- and ‘fatness’ (‘gegen die Zunahme und Fettigkeit’), too.
sicians for advice on how to get rid of his huge belly, which confined
him to his house. He died nevertheless, because his excessive fat, as 6. Images of obesity: continuity and change
Pechlin explained, compressed his vessels so much that the move-
ment of his blood and spirits was obstructed.63 As the numerous early modern works which decried the harm-
Even from physicians’ case stories, however, it would seem that ful consequences of obesity and advised on the best means to fight
only the very obese, who believed they were already feeling nega- it make abundantly clear, the medicalization of obesity is by no
tive health effects, sought medical advice. More moderate degrees means a product of modern medicine. Sixteenth- and seven-
of corpulency, by contrast, seem to have been widely accepted or teenth-century physicians were already framing obesity, in clear
even desired, based on the idea, as Short put it, that ‘there is some- and unambiguous terms, as a potentially deadly medical condition
what of modishness or pleasure in it, and that it challenges respect in need of treatment. Some of the dangers and negative conse-
from others.’64 Some women in particular allegedly even ate very quences of obesity expounded by early modern physicians are still
nutritious food on purpose in order to acquire a ‘juicier’ (‘succulent- widely recognized today. Obesity continues to be associated, for
ior’) body, which they considered to be beautiful.65 example, with a higher mortality and a risk of sudden death from
The impression that lay people, if at all, only sought treatment strokes and cardiac disease. On closer analysis, there are also some
for very advanced degrees of obesity is confirmed by a survey of profound differences, however, between the way in which the
hundreds of letters of consultation and medical consilia published causes, features and effects of obesity were described in early mod-
by early modern physicians. Requests for advice on how to fight ern medical writing and the way they are presented today.
obesity and physicians’ responses to such requests are very rare. A first major difference concerns the limits between the healthy
The earliest example I have so far come across is a consilium ‘De in- and the pathological. Early modern works on obesity focused on
signi obesitate corporis’ by Jean Fernel.66 In order to prevent more very considerable degrees of corpulence, on ‘obesitas immensa’,
serious harm from developing as a consequence of the obese (‘obe- ‘nimia obesitate’ or ‘corpulentia nimia’ as the titles of several dis-
sus’) patient’s excessive bulk, and the predominance of cold, phleg- sertations expressed it.69 The authors had in mind those who could
matic humor in his body, Fernel advised the patient not only to hardly move, who became breathless just from walking, and who
eat less but also to use laxatives, though not too drastic ones, on a might need special machines to climb the stairs or to hoist them

59
Gosky (1658), Hulsebusch (1728), p. 16; this latter quality is reminiscent of what, based on Charles Dickens’s description, was later called ‘Pickwick syndrome’; cf. Kryger
(1985).
60
This was possibly the same woman from Strasbourg whose representation in ‘public images’ (‘picturis publicis’) was mentioned by Sennert (1656) in his chapter on obesity.
61
Cattier (1676), pp. 45f.
62
Espich (1612).
63
Pechlin (1691), pp. 325f.
64
Short (1727), preface.
65
Wucherer (1716), p. 8.
66
Fernel (1644b), pp. 278f; the title may have been added by a later editor.
67
Grüling (1668), book 6, pp. 1–3.
68
Staats- und Universitätsbibliothek Göttingen, Ms. Meibom 115, foll. 6r-11r (draft), title added in different ink but in contemporary handwriting.
69
Flemyng (1760), p. 1, Held (1670), Widemann (1681), Schaper (1701), Bass (1740).

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx 7

while in bed so they could have sex.70 Presumably due to this focus This image of the tight, compressed obese body underwent a
on massive obesity, the precise weight was of marginal importance. gradual but nevertheless striking shift during the early modern
Until the nineteenth century, we do not find the notion of a ‘normal’ period, however, which ultimately opened the way to the familiar
or ‘ideal’ weight, applicable to all people of a certain height, age, sex modern image of the obese body as flabby and boundless. In the
and race.71 People were not ‘overweight’. Obesity was principally de- eighteenth century, the obese body was increasingly described in
fined in terms of visual appearance, the sheer bodily bulk, not terms of lax tissue and skin and of dissolving bodily limits. It be-
weight. Physicians who presented cases of particularly corpulent came associated with a pathological distension rather than a nar-
individual patients frequently did mention their weight, as we have rowing of the vessels, with a loss of tension and elastic force.79
seen, and sometimes with a fair degree of precision, but this was An excessive laxity in the membranes which were easily extended
only in order to underscore their exceptional fatness. by accumulating fat was now declared a major cause of obesity.80
The characteristics of the obese body and the pathological Some had such ‘flexible, lax, and dilatable fibres, that even temper-
changes occurring inside it were also described in strikingly differ- ance, exercise, study, abstinence, and abridgment of rest and sleep,
ent terms. Far more than today, obesity was associated with impu- cannot prevent corpulency’.81 Moist or foggy climates, such as pre-
rity, decay and putrefaction. The crude, raw humours which vailed in Holland or in some parts of England, were declared an
resulted from the insufficient concoction of the excessive food by important cause of corpulency, because they relaxed the fibres so
the over-burdened and weakened innate heat, and the ‘undesirable much.82 When the fibres and vessels of the corpulent were no longer
load of useless and pernicious matter’, in other words the fat itself, able to contract sufficiently, the flow of blood and humours became
accumulating and stagnating in the vessels and cavities of the body, more sluggish and threatened to grind to a halt. Again, just as in the
were particularly prone to corruption and putrefaction.72 This was earlier notion of compression and obstruction of vessels, obesity was
even obvious to the senses. The obese, Nicolaus Falcuccio bluntly sta- associated with humoral stagnation and the danger of putrefaction—
ted, had ‘fetid sweat’.73 It was due to the abundant foul matter in their but for opposite reasons.
body, Guarinonius explained in 1610, that fat people—particularly fat Last but not least, the way in which early modern physicians
women—stank, as those who were married to them knew best.74 gendered obesity reveals some remarkable differences. It was
Even the corpses of obese people were said to putrefy more quickly. widely acknowledged that women were by their very nature gen-
In a sense, the decay and putrefaction normally observed only in erally fatter than men.83 This was not necessarily to their disadvan-
corpses began in obese people during their lifetime.75 tage. Most physicians agreed that fat was a desirable and indeed
Far more than today, sixteenth- and seventeenth-century ac- indispensable element of female beauty. Breasts without fat, for
counts of the obese body were also framed by notions of pressure example, would be hard and uneven and would not embellish the
and tightness, rather than flabbiness and loose tissue. In the obese, chest.84 Women with very fat bodies or breasts, however, lost the es-
masses of fat accumulated within the limited space of the body, sence of their feminity. They were described as ugly, if not repulsive,
and were the major reason for many of obesity’s negative effects. and they risked becoming infertile as well.85 This (alleged) female
The vessels and pathways inside the body were increasingly com- propensity to obesity had significant consequences for the percep-
pressed and narrowed, the free movement of blood, humours and tion of obese men. Women were said to grow fat more easily both
spirits was affected, and the muscles could not be sufficiently ‘in- because they cultivated a more sedentary life-style, and also because
flated’.76 When the flow of humours was thus obstructed, stagnation their bodies were generally colder and moister than those of men,
set in, which further promoted corruption and putrefaction. At times, and their innate heat was not as strong. Their moderate coldness
the obese body seemed almost ready to burst. Early modern physi- compared to men promoted the formation of layers of fat outside
cians’ image of the obese body and especially that of the obese belly the vessels. Men’s bodies were ‘naturally’ warmer and drier, and en-
was fairly close in this respect to their view of dropsy, especially dowed with a stronger innate heat. The more men’s bodies were
ascites, the type of dropsy in which the belly was distended with filled with masses of relatively cold and moist fat, which weakened
fluid. In both cases, nature was known to seek, at times, relief of their vital, innate heat, the more closely they approached the body of
the pressure by evacuating superfluous humor through the skin, a woman. Prosper Alpinus was often quoted in this respect, for his
especially around the umbilicus.77 For this reason even paracentesis, account of Egyptian men who had grown so fat that their breasts
the creation of an opening in the abdominal wall by surgical means— were bigger than those of a woman.86 Fatness could not turn men
a well-known treatment of last resort in severe, suffocating dropsy— into women completely, but they lost their virility, resembling eu-
was discussed as a possible remedy for obesity, too.78 nuchs, who were known to grow particularly fat. Like eunuchs,

70
Schaper (1701), p. 8.
71
Cf. the famous concept of ‘l’homme moyen’ in Quetelet (1835); a first small step towards a general quantitative norm was taken by Held (1670, foreword), who declared that
thread put around a belly with a full stomach should not measure more than three feet.
72
Short (1727), preface; cf. Dacome (2005).
73
Falcuccio (1484), fol. 204v.
74
Guarinonius (1610), p. 761.
75
Hulsebusch (1728), p. 22.
76
Pechlin (1691), pp. 325f.
77
Sennert (1656), p. 798.
78
Hossauer (1712): ‘An in obesis tuta sit incisio abdominis?’
79
Short (1727), pp. 10–12, Hulsebusch (1728), p. 20, Quabeck (1752), p. 39, Ludwig (1760), Boerhaave (1790), p. 484.
80
Flemyng (1760), p. 6.
81
Short (1727), p. 36.
82
Short (1727), pp. 10–12.
83
Held (1670), ch. 4, Wucherer (1716), p. 7. For illuminating sociological work on the gendering of obesity today, see Monaghan (2008), Warin, Turner, Moore, and Davies
(2008).
84
Hoffmann (1674), n. 29.
85
On top of that, according to Castro (1662), part 2, pp. 146f, fat women ran a greater risk of developing breast cancer.
86
Cf. Alpinus (1980), pp. 31f.

Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
8 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2011) xxx–xxx

dropsical body, as a body under pressure in which spirits and hu-

mours could hardly move.
Future research will need to explore the differences between
individual authors and schools of thought in greater detail, and
trace changes during the early modern period. It will need to link
the analysis of medical works with that of non-medical sources,
such as autobiographical and literary writing and visual represen-
tations.88 Moreover, it will need to trace, more precisely than I have
been able to do here, the impact of learned medical discourse on the
perception and experience of obesity among lay people of different
social and educational status.

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Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029
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Please cite this article in press as: Stolberg, M. ‘Abhorreas pinguedinem’: Fat and obesity in early modern medicine (c. 1500–1750). Studies in History and
Philosophy of Biological and Biomedical Sciences (2011), doi:10.1016/j.shpsc.2011.10.029