J IS FOR JENNY CRAIG

     I'll be the first to admit that there were some pretty bizarre forms of medical treatment in the 16th century (just wait until you get to my post for R).  But although we of the 21st century might not agree with our 16th century peers about the causes of obesity, most of the recommended remedies would strike us as quite familiar.
     In early human history, it was virtually impossible for anyone to be overweight.  Having to hunt for one's food required a tremendous amount of physical activity, and food itself often came in the form of large animals fully capable of killing and eating you first. 

     But eventually, based on the urgent need of ensuring an adequate food supply, humans learned both to farm crops and to domesticate food animals, and the activity of getting your next meal became much less fraught with peril.   In fact, people got so good at producing food for themselves that eventually most societies had a comfortable abundance (at least for those who could afford it).  Simultaneously, lifestyles were becoming more sedentary, and by Roman times, physicians were treating excess weight as a public health problem.  What treatments did they suggest?  For the most part, exercise and a healthy diet.
      Since the time of Hippocrates (460-370 B.C.), through the 16th century, and for at least 100 years after it, most people believed that good health was maintained by a proper balancing of the four humors in the body: blood, phlegm, yellow bile and black bile.  Obesity, like many other physical ailments, resulted from an imbalance in the system, and the goal was to figure out ways to rebalance.
     The Roman physician Galen (A.D. 131-201?), whose theories governed medical practice up to and throughout the Middle Ages, described his treatment for obesity as follows:
           
               I have made any sufficiently stout patient moderately thin in a short time,
               by compelling him to do rapid running, then wiping off his perspiration
               with very soft or very rough muslin, and then massaging him maximally
               with restoratives, and after such massage leading him to the bath after
               which I give him nourishment immediately but bid him rest for a while
               or do nothing to which he was accustomed, then lead him to a second
               bath and then give him abundant food of little nourishment so as to
               fill him up but distribute little of it to the entire body.
 
     Similarly, Avicenna (A.D. 980-1037), a highly influential physician of the Arab world, wrote:

               The regimen which will reduce obesity.  Produce a rapid descent of the
                food from the stomach and intestines, in order to prevent completion
                of absorption by the mesentery.  Take food which is bulky but feebly
                nutritious.  Take the bath before food, often.  Hard exercise...
 
     The early 16th century marked the beginning of the so-called Age of Science, during which people began to use hypothesis and experiment as methods to discovering solutions.  Antonio di Paolo Benivieni (1443-1502) was the author of a pathology textbook published posthumously in 1507, in which he provided the first known pathological descriptions (case studies) of obese individuals, as well as discussions of treatments.
     Luigi Cornaro (1467-1566) was an Italian layman who published a short book, Discourses on a Sober Life, in 1558 describing his own struggles to conquer obesity and his eventual success.  He made no secret of what he believed to be the cause of his excess weight; his book began, "O wretched, miserable Italy!  Does not thou plainly see that gluttony deprives us of more soul years than either war or the plague itself could have done?"  Cornaro came from a wealthy Venetian family and had freely indulged himself in food and drink until about the age of 40, when his health problems began to catch up with him.  He consulted with his doctor, who advised him to eat only wholesome foods, and only in small quantities.  Cornaro immediately followed this advice and lost all of his excess weight, and his health problems all disappeared.  He became a zealot for healthy living, published his book at age 80, and lived to see the fourth edition published when he was 99.
      But, as we know in the 21st century and as physicians probably knew in the 16th, prescribing diet and exercise to counteract obesity doesn't always work.

V IS FOR ANDREAS VESALIUS

                                                                  (1514 - 1564)
     In my posts about Louise Bourgeois Boursier and Ambroise Pare, I mocked the physicians of the sixteenth century for being close-minded, snobbish, petty, lacking in imagination, and willing to blindly adhere to ancient traditions even when their own experiences showed them those traditions were wrong.  In today's post I'm going to present the flip side: a sixteenth-century physician who was brilliant, innovative, and not afraid to buck the establishment.
     Andreas Vesalius, born in Brussels, was the son of Emperor Charles V's apothecary.  Andreas received the best medical education available in Europe and received his degree of Doctor of Medicine with highest honors in 1537 from the renowned University of Padua.  Two days after he passed the examination, the University installed him as a professor of surgery and anatomy.
     It soon became apparent to everyone that in teaching anatomy, Vesalius was not going to conduct business as usual.  Once again, I'm going to quote from the brilliant Daniel J. Boorstin, writing in THE DISCOVERERS: "unlike the professors before him, Vesalius did not stay seated high in his professorial cathedra while a barber-surgeon with bloody hands pulled organs out of the cadaver.  Vesalius himself handled the body and dissected the organs."  (Sorry if you're squeamish.  At least I'm not telling you where they got the cadavers from.  Believe me, you don't want to know.)  In addition, although charts and drawings were very uncommon teaching tools at the time, "To help his students, he prepared... four large anatomical charts, detailed enough to show the student the body structure when there was no cadaver at hand.  Each part was labeled with its technical name.  An accompanying glossary and index listed the names of the parts in Greek, Latin, Arabic and Hebrew."
     In 1538, Vesalius published his Six Anatomical Tables, in part because one of his teaching charts was plagiarized and it seemed that the others might soon be.  So he collected them all and published them in book form, along with his own drawings of the veins, arteries, muscles and nervous system.

     Even with all his new techniques, though, Vesalius was basically using the same source materials for his teaching that everyone else was: the writings of Galen, an eminent Greek physician who had died in the year 200 A.D.  As was the case with other scientific fields (see my "C" post on Copernicus), it was still considered sacrilege to question any of the pronouncements of the classical scholars.
     But as he continued teaching and dissecting, Vesalius couldn't help but notice that many of the features Galen described did not actually exist in the human body, although they may have existed in other animals.  Vesalius did not leap to any conclusions, but the method he proposed for checking Galen's findings was revolutionary in itself.  As he wrote in 1539, "I gave careful consideration to the possibility that anatomical dissection might be used to check speculation."  In other words: Vesalius proposed to apply the scientific method of checking Galen's writings against his own observations. And when he did that, he found verifiable proof that in many instances, Galen had been wrong.
     As a result of his studies, Vesalius produced his masterwork: De Humanis Corporis Fabrica (Structure of the Human Body) published in 1543.  Below is the illustrated title page:
    

     The scene shows Vesalius himself performing a "public anatomy," as the University of Padua required.  The two men crouched unhappily under the dissecting table are barber-surgeons, who used to do this kind of work themselves, but are now reduced to sharpening the professor's razors.
     The book was gorgeously illustrated throughout by some of the best Italian artists available.  It was an instant success.  Fifty years later, most European medical schools were teaching Vesalian anatomy.  Some of his findings were later disproven, but the findings themselves were far less important than his innovation in method.  He taught physicians to think for themselves.
     Ironically, soon after the Fabrica was published, Vesalius left the university setting to become a physician to the court of Emperor Charles V.   He stayed there for another twenty years, being mocked by the other physicians as a mere "barber" and catering to the whims of spoiled, capricious patients.  Vesalius may well have regretted his impetuous decision, but because he had been replaced at Padua by his friend and pupil Fallopius (yes, the one the tubes were named after), it isn't clear whether he could have returned to the academic life even if he had wanted to.  Aside from updating the Fabrica in 1555, Vesalius never published another book. 
     In 1564 Vesalius left for a pilgrimage to the Holy Land.  But as soon as he arrived in Jerusalem, he received a message from the Venetian Senate asking him to return and assume the professorship at Padua that had just become vacant due to the death of Fallopius.  Vesalius began the voyage back, but he was killed in a shipwreck off the Greek coast.