Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378

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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 15 November 2011 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
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 sociol-
ogist’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 over-
weight, 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 of-
ten futile attempts to lose weight, but also fall victim to massive pre-
judice 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 on-
wards, 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 fashion-
able.4 In contrast, the time before 1750 has attracted very little atten-
tion 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 iden-
tified (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

E-mail address: michael.stolberg@uni-wuerzburg.de

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
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378
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 nega-
tive character traits which early modern physicians associated with
obesity.
2. 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 (‘mor-
bum facit’). For the innate heat, he explained, was overwhelmed
by the masses of excessive food which, as a result, was only insuf-
ficiently ‘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 accumulated inside
the body. The vessels were overburdened with excrements which
could not be sufficiently evacuated. Everything inside the body be-
came compressed and tight. The pathways in the body were nar-
rowed or obstructed and the body was no longer permeable and
sufficiently ventilated. As a result, cold diseases such as cachexia,
paralysis and apoplexy arose, even when the excessive food was
hot in and of itself. Since innate heat was used up in the effort of
concocting and assimilating all that food, the senses, the mind
and the workings of the soul suffered as well. They were deprived
of the beneficial influence of the innate heat and could not perform
their tasks correctly. When the compression in the body reached a
maximum, the innate heat could be extinguished or vessels could
rupture, leading to sudden death.6
Other authors ascribed very similar effects to obesity. Giovanni
Argenterio, for example, in a commentary on Galen, warned in
1566 that people with ‘too much fat’ had shorter lives. Since most
of their blood was transformed into fat, the body was robbed of its
necessary nutrition and the fat also pressed on the vessels and suf-
focated the vital heat. Like excessively fat pigeons or sheep, fat
people were prone to suffer a sudden death. They also tended to
be infertile. The quality of their semen deteriorated and the grow-
ing bulk of their belly shortened their penis and made them unfit
for sexual intercourse. In fat women, as the Hippocratic aphorism
5.46 had already stated, the mouth of the uterus was compressed
and no longer let the semen pass through.7 By their nature, Levinus
Lemnius (1505–1568) similarly explained, the very fat did not live as
long as skinny people. They had less innate heat, the vital spirits and
the blood were not so hot, and their natural faculties were weaker
because they had to be dissipated inside a larger body.8
In spite of the book’s title, Girolamo Mercuriale’s lengthy chapter
on obesity in his De decoratione liber of 1587 also dealt primarily
with the medical, pathological aspects of obesity. As long as what
others called ‘oboesitas’, ‘polysarkia’ or ‘corpulentia’, and which he
preferred to call ‘crassities’, only harmed the form and the beauty
of the body, it was a mere symptom (‘symptoma’).9 But when it dam-
aged the actions or functions of the body, it became a disease. Obese
people had shorter lives. The pathological effects of obesity were
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.
371
due above all to the sheer weight or bulk of their fat, which pressed
on the vessels and narrowed them, blocking the free passage of blood,
spirits and vital heat. The obese were prone to dangerous diseases like
apoplexy, paralysis, asthma, syncope and pestilential fevers. Their
excessive bulk meant that every movement was an effort for them.
Their pulse was weak, they suffered from palpitations, and breathed
with difficulty. They also tended to be slow to take note of their dis-
eases, and had them treated too late; once they did seek treatment,
the effect of medicines was weaker. They were often infertile. Fre-
quently their intellectual faculties suffered as well, especially when
obesity was not innate but acquired through gluttony; this was due
to their impure blood which, in turn, brought forth impure spirits.
The Lacedemonians had been quite right to scold those who were
fat from indulging in food as having little intelligence and courage.10
There are some differences in detail, but the general picture
which medical authors well into the seventeenth century painted
of the dangers of excessive fat or obesity is remarkably uniform,
even if it does not always correspond to modern understanding.
The reasons for this consensus are not difficult to establish: these
authors all relied on more or less the same sources, on the same
passages in the writings of ancient and medieval medical authori-
ties. Hippocrates [Aphorisms 2.44] maintained that the ‘very fat’ or
‘very thick’ (Greek: ‘pachys’) died faster than the lean or, as others
understood the term ‘tachythanateroi’, were more likely to die a
sudden death. The very obese aged quickly, Aristotle [On the gener-
ation of animals 4.6] claimed similarly, and they tended to be ster-
ile. Galen, who discussed fat and obesity in a number of his works,
clarified their pathological status.11 He argued that excessive corpu-
lence harmed the actions or functions of the body and thus was a
preternatural, morbid state, a disease [On tumors 9]. He ranked obes-
ity among the diseases of size or quantity and declared its ‘cure’, in
other words ridding the patient of excessive fat, an important task.
To fight obesity, Galen [Method of healing 14.15], recommended
exercise, dieting and various medicines, ranging from parsley to salt
made from burnt vipers. Galen [Diseases 9] also reported what would
become the most quoted case of extreme obesity well into the sev-
enteenth century, that of Nicomachus Smyrnaeus, who grew so fat
that he was eventually unable to move.12
Based on the writings of Galen and Aristotle in particular, the
Persian physician-philosopher Avicenna (Abu ‘Ali al-Husayn ibn
Sina, 980–1037) offered a succinct synthesis of ancient medical
writing on the dangers of obesity in his famous Canon medicinae.
The chapter ‘De nocumento superfluae pinguedinis’, roughly trans-
lating as ‘Of the harmfulness of superfluous fat’, does not even oc-
cupy an entire page, and is followed by an equally brief chapter on
how to lose weight. Yet much of what early modern medicine had
to say about obesity can be found here in a nutshell. Avicenna de-
picted the effects of too much fat in the body in drastic terms. It
compressed the vessels, hindered the movement of the subtle
warm spirits and often corrupted the spirits or extinguished them
altogether; according to Galen and Avicenna, the vital spirits
played a crucial role in keeping the body alive, and in the sensory
and motor faculties, in particular. The breathing and heart of the
obese were constricted, and their innate heat, which had its prin-
cipal seat in the heart, was weakened. The obese had little blood
and plenty of the cold moist humour of phlegm, so that their
complexion was very cold. The consequences were grave. Obese
372 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378
people were prone to apoplexy, paralysis, syncope, palpitations,
diarrhoea, shortness of breath and putrid fevers. Particularly those
who were obese from a young age, and therefore had smaller veins
due to the constant pressure of fat within their bodies, risked dying
a sudden death. Obese people could not tolerate hunger and thirst
well. Obese men produced little sperm; fat women conceived only
with difficulty, and when they did get pregnant, they aborted.13
In the late Middle Ages, Nicolaus Falcuccio, alias Nicolaus Flor-
entinus (d. 1410 or 1411), provided an extensive account of obesity
in his Sermones medicinales, a major synopsis of contemporary
medicine published in 1484.14 Drawing generously on Avicenna’s
Canon, his warnings could hardly have been more drastic. ‘Abhorreas
pinguedinem’, ‘abhor fat’ he admonished his readers. For excessive
fat in the body posed great dangers; among other things, the innate
heat was suffocated, the visible and occult vessels or pathways were
blocked and threatened to burst, the parts were not sufficiently ven-
tilated, the spirits corrupted and the senses weakened. Fat people
noticed too late when they got sick, and treating their diseases
was more difficult. Those with excessive fat in their body were well
advised to get rid of superfluous fat before there was any manifest
harm. It led, among other things, to epilepsy, paralysis, difficult
breathing, diarrhoea, fainting and hot fevers. Fat women tended to
be infertile, and once they conceived they were prone to abort or
their babies were weak.15
Sixteenth- and seventeenth-century medical textbooks contin-
ued the same tradition. Daniel Sennert, for example, in what was
to become the most widely quoted work on medical practice in
the seventeenth century, painted a very bleak picture of the many
negative effects of fatness. Quoting extensively from Avicenna’s
Canon, he stressed, in particular, the growing immobility and
breathing difficulties of corpulent people.16 From the early seven-
teenth century onwards, and with increasing frequency after 1650,
dozens of medical dissertations and disputations were devoted to
the physiology and pathology of (excessive) fat and to the causes,
consequences and treatment of corpulence.17 Some provided a gen-
eral survey of the role of fat in the body and/or of the clinical aspects
of excessive corpulence.18 Others approached specific issues such as
whether obese people should sleep less, whether the blood circu-
lated more sluggishly in them, or whether blood-letting should be
less copious in their case.19 Such works provide clear evidence that
the dangers of obesity had become part of ordinary textbook knowl-
edge, something with which medical students and ordinary physi-
cians were expected to be acquainted.
Scholarly discussion of obesity was supplemented and corrobo-
rated by evidence from individual cases. Daniel Sennert mentioned
two contemporary examples of extreme corpulence: a woman from
Strasbourg who was known to have weighed 480 pounds at the age
of 36, and a man weighing more than 400 pounds whom he had
personally seen. Timaeus von Güldenklee recounted, among others,
the story of a 37-year old man who had sought his advice because
had grown so fat that he could no longer mount a horse without
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.
help and quickly became breathless. Another of his patients, appar-
ently a nobleman, acquired such bulk that he could hardly move at
all, and risked suffocating while lying in bed or when rising from a
sitting position. A third patient, a bookseller by trade, became so fat
that he was unable to climb the stairs. At first he followed Timaeus’s
dietetic and pharmaceutical advice, and lived on, though plagued
by difficult breathing. When he stopped the treatment he gained
much bulk, and eventually succumbed to a sudden death.20 Thomas
Short told the story of a young lady ‘who died of corpulency in the
25th year’, ‘a monster in nature for bulk’, weighing more than 500
pounds.21 Some authors also published cases of extremely obese chil-
dren. Among Nicolaas Tulp’s numerous case histories we find the
story of a 5-year-old boy from Geldria who was put on a scales in
Amsterdam and found to weigh 150 pounds, and whose belly mea-
sured 6 cubits around.22 Thomas Bartholinus reported the case of a
10-year-old girl from Brabant who weighed 200 pounds and whose
belly extended from her breasts to her feet. She could not walk but
had to lie down, and was for a time exhibited at the markets.23
Medical writing on the clinical aspects of obesity received impor-
tant additional input from anatomical and physiological writing.24
The pathological consequences of obesity were not central to these
works, but indirectly helped to elaborate theoretical medical under-
standings of obesity and its effects. Thomas Erastus in Heidelberg,
writing in 1580, provided a first major synthesis of the anatomy and
physiology of fat in the human body. He explained that fat resulted
from the sweetest, most elaborate and airy parts in the blood. These
parts were produced, like the blood itself, in the liver, in the second
stage of concoction, and thus ultimately derived from food and drink.
Mixed with the blood, they arrived in the various parts of the body, and
exuded from the little vessels or were squeezed through their walls.
While the blood itself nourished the various parts of the body, fat
was excremental matter, though, like semen and milk, a useful one.
It fostered the vital heat in the body; it protected the body from exces-
sive cold and other bad external influences. And, last but not least, it
contributed to bodily beauty, by filling out the holes, cavities or cre-
vices between the muscles and other anatomical structures, giving
the body a smoother, softer appearance, especially in women.25
Erastus also raised a question which continued to spark contro-
versy.26 What made the fat accumulate and turn into solid matter in
the body? Was it due to a cooling-off of fluid, oily matter, since com-
mon observation suggested that women and eunuchs, who were en-
dowed with a colder temperament, had a greater tendency to
fatness? Or did fat rather harden and solidify under the impact of
heat, which made the fluid parts evaporate? Erastus’s compromise
solution was that fat did solidify in moderate heat, but that this heat
was relatively cold compared to innate heat. This became the dom-
inant view shared by, among others, Laurent Joubert.27
Up to the middle of the eighteenth century, hundreds if not
thousands of pages were devoted to obesity and to the physiology
and pathology of excessive fat in the body. Much of this writing
was repetitive and redundant, but gradually some new clinical
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378 373

and pathological observations enriched the traditional account.
Obese people were, for example, also found to suffer from heart
polyps, due to the chylous, glutinous particles in their blood, and
from kidney diseases, due to the pressure on the vessels and ducts.
In dissections of obese people the heart was sometimes found lit-
erally to disappear in the masses of fat around it, which could not
but hinder its movements.28 Some of the dangers of obesity also
came to be explained differently. Thus, in light of William Harvey’s
finding that blood circulated in the body and sustained life, the com-
pression of the vessels by excessive amounts of fat appeared even
more dangerous, because the sluggish blood of the obese implied
‘a new superadded work for the heart, lungs, and muscles.’29 Authors
also increasingly relied on the results of new anatomical findings.
Marcello Malpighi’s discovery of special adipose vessels or cellules
in the tissue was widely quoted.30 The basic picture, however, of
what happened in the obese body remained remarkably unchanged.
3. Etiology, prophylaxis and treatment
Early modern physicians discussed a range of causes for the
accumulation of excessive fat in the body. Some admitted a ‘hered-
itary disposition’ or even distinguished ‘obesitas haereditaria’, run-
ning in families, from an acquired obesity originally due to
lifestyle.31 Most early modern authors assumed, however, that obes-
ity was due above all to abundant, nutritious, oily blood and that this
blood in turn was produced from excessive food.32
In order to fight obesity, eating less, particularly less fat, was
therefore of paramount importance.33 In addition, one could try
and prevent the transformation of food into fat. Sleeping less was
helpful because the concoction and assimilation of food was deemed
particularly efficient during sleep. Everything that heated the blood
or affected its natural mild complexion, such as ‘hot’, spicy or sour
food, would also make it more difficult for the oily parts of the blood
to ooze through the walls of the vessels and to solidify as fat. It was
widely acknowledged that people whose constitution was dominated
by sharp yellow or black bile did not easily grow fat. Similarly, drugs
and foodstuffs which increased the blood’s acrimony and made it
hotter promised good effects in the fight against obesity. Even delib-
erately making patients acquire a tertian fever was recommended, if
this could be done without endangering the patient’s life.34
Once the fluid fatty matter had left the vascular space and solid-
ified into a thick layer, getting rid of it again was more difficult. The
fat could not simply be ‘burnt’. Notions of ‘energy’ or ‘calories’ or
‘kilojoules’ had not yet entered the picture. The flame of life, the vi-
tal or innate heat, as Espich explained in 1612, did not normally
feed on fat.35 On the contrary, rather than being consumed by the
vital, innate heat, excessive amounts of fat threatened to suffocate
and extinguish it.36 The huffing and puffing of the obese, their short-
ness of breath corresponded to this suffocation of the flame of life.
Much more than today, fat was viewed as the product of a largely
irreversible transformation, as an excrement inside the body. seven-
teenth-century authors therefore often doubted that fat could flow
back into the vessels and assume its previous state as part of the
nutritious blood, to be absorbed as nourishment by the individual
parts; or else they believed that this only happened when a person
was severely starved.37 Only gradually did the idea take hold that
the fat stored in the fatty tissue could be attenuated by movement
and heat, returned into the vessels and consumed by work or phys-
ical exercise.38 In support of this notion, Thomas Short, writing in
1727, cited the example of sheep who could survive without eating
under deep snow for 30 days.39
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
was to promote its evacuation. Here, as in many other fields of
early modern therapeutics, the physician only had to imitate the
body’s natural efforts. It was commonly accepted that Nature con-
stantly evacuated considerable amounts of superfluous fatty mat-
ter. The importance of these evacuations was demonstrated by
the fact that their disruption or obstruction could bring about
obesity.40 Ageing women, for example, it was well known, tended
to grow fat when they no longer had their monthlies.41
In principle, any kind of evacuation could eliminate fat. Some
authors recommended laxatives or drugs that promoted menstrua-
tion or salivation.42 The principal excretions by means of which early
modern physicians sought to eliminate excessive fat, however, were
urine and sweat. Fatty excretions in the urine were, according to
numerous early modern treatises on uroscopy, visible even to the
naked eye.43 Malcolm Flemyng especially praised the diuretic virtues
of Spanish soap against obesity.44 According to Timaeus von Gülden-
klee, writing in the seventeenth century, mineral water also could
serve this purpose, and in the nineteenth century visiting spas and
drinking mineral water became one of the most popular ways of
fighting obesity.45 Sweat was considered an even more efficient path-
way for the evacuation of superfluous fat. Much of the fat tended to
accumulate underneath the skin anyway and was said to exude liter-
ally as ‘oily’ sweat.46 Sudorifics, rubbing the skin and sweat baths
were therefore powerful means of getting rid of fat. The importance
of sweating to the excretion of fat also helped explain why hard-
working farmers and craftsmen did not easily grow fat, and why
physical exercise like frequent running helped to fight obesity: bodily
labour and exercise promoted sweating and thus the excretion of
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’.
374 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378
found to be more prone to obesity than those in the warm south, like
the Italians or Spaniards.48
Opening artificial pathways, like cupping or blood-letting, was
less commonly recommended.49 If the excessive generation of fat
was attributed to a copious supply of rich, nutritious blood full of oily
particles, blood-letting made perfect sense. Some authors had their
doubts, however.50 Since obese people, by their very nature, already
inclined towards cold diseases, depriving them of warm blood and
thus shifting their complexion even more towards the cold was risky.
Other authors went a step further and even argued that obese people
had in fact particularly little blood because they converted much of
their good, nutritious blood into fat. From this point of view, obesity
was closer to dropsy, and blood-letting was outright harmful.
A detailed analysis of possible changes in the range of early mod-
ern therapeutic approaches to obesity has yet to be undertaken, but
it seems that new medical systems like iatromechanics, iatrochem-
istry and Stahlianism had little impact upon the prevention and
treatment of obesity. Even a leading representative of iatrochemis-
try, like Franciscus Sylvius, offered a list of treatments for ‘corporis
obesitas’ which was by now largely conventional: abstaining from
oily and fat food, physical exercise, sleeping less and changing the
mild nature of the blood, by adding sour, sharp, salty or bitter spices
like vinegar, lemon juice, pepper, cinnamon and mustard.51
4. 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 of nutrition have found, large
parts of the early modern rural and urban population had the
means to buy or produce enough food to reach an intake of calories
which exceeded—often significantly—the minimum levels accepted
by modern medicine.52 Bad harvests, severe epidemics and social
and political turmoil could seriously jeopardize food supplies, but
in normal years many people, not only an affluent minority, had ac-
cess to that small amount of extra food each day which is now
thought to be sufficient to cause obesity in the long run.
Did early modern physicians react to new aesthetic ideals?
Again the possibility cannot be dismissed out of hand. Early mod-
ern medical writing on obesity was pervasively shaped by notions
which go back to ancient Greek and medieval Persian and Arabic
medicine, however, and, at least, in the sixteenth and seventeenth
centuries there is little evidence to suggest that obesity had be-
come less acceptable. This seems to have changed only very grad-
ually in the eighteenth century, towards the end of the period
under consideration, when the obese body came to be described
as lax rather than tense and thus stood in marked contrast to eigh-
teenth and nineteenth-century ideals of a strong, muscular body.
By all appearances, early modern physicians’ interest in obesity
had other and, in a way, less spectacular, causes. Firstly, medicine
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.
was in many respects still very much a bookish discipline. Author-
ity and fame in the scientific community were based to a large de-
gree on the publication of scholarly treatises. In many universities,
medical students were expected to publish a learned dissertation
on a specific topic in order to acquire their doctorate. As a result,
we encounter a growing number of medical publications on virtu-
ally every imaginable topic. Authors of medical dissertations par-
ticularly favoured topics like obesity, which had already been
discussed by ancient and medieval authorities, and thus provided
the grounds for systematic learned commentary.
Secondly, conditions like obesity allowed medical writers to
show their ability to arrive at a plausible account of virtually any
bodily phenomenon, and especially of rare and ‘monstrous’ phenom-
ena like the cases of extreme obesity described by the physicians.
Those who advocated new medical systems like iatromechanics, iat-
rochemistry and Stahlianism could in turn use conditions like obes-
ity as a testing ground, to prove that their theories offered a more
compelling explanation than those of their rivals.53
Thirdly, obesity was a field in which physicians could demon-
strate their superior expertise in dietetic matters and their skills
in tailoring a ‘regimen’ to a patient’s individual history, lifestyle
and bodily constitution. Early modern patients and relatives often
demanded dietetic advice, and dietetics was a field in which
learned physicians saw particularly good prospects of acquiring a
much-desired competitive edge over their numerous competitors
on the medical market, who relied more exclusively on medicine
and blood-letting.54 In the case of obesity, physicians underscored
the crucial importance of their dietetic expertise by warning how
misleading appearances could be. Obese people might look perfectly
healthy, and others might even praise them for their good looks. Yet
a deadly danger lurked inside their bodies, which physicians’ profes-
sional advice could avert.55 Generally speaking, promoting aware-
ness of a neglected or underestimated health hazard—or indeed
inventing it—has also always been a good strategy to promote one’s
personal fame and to create a market for one’s publications, medical
services and drugs. Authors like Short and Flemyng who wrote in
vernacular language and addressed a wide lay audience could hope
to make themselves a name as specialists in the field, and to attract
affluent patients who would consult them in person or by letter.
Last but not least, obesity allowed physicians to make use of
their science in order to justify and reinforce societal norms and
accepted standards of behaviour. Though not all authors, as we
have seen, agreed that obese people necessarily ate more than oth-
ers, obesity was particularly linked to voracious eating.56 From this
perspective, obesity was the epitome of immoderation, gluttony and
lack of self-control. By stuffing themselves with food, the obese be-
haved like animals, until their bodies finally resembled those of a
‘fully masted pig or ox’.57 The contemporary ideal of rational man,
whose reason lifted him above beasts (and women), was also at
stake. Contemporary medical theory lent scientific authority to the
notion of the intellectual inferiority of fat people. Admittedly, some
very obese men had been known to possess a bright intellect, but in
general obese people were said to suffer from inferior intelligence,
poor memory and weak senses, and according to physicians, this
was the consequence of their bodily condition.58 The vital and
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378
animal spirits on which the senses and the workings of the soul de-
pended were impure, and could not move freely through the body
and its vessels, compressed by masses of fat. As a result, the obese
were also ‘slow, lazy [and] idle’, they tired quickly or even developed
an irresistibly strong propensity to fall asleep.59 The obese became
the antithesis of the industrious, productive citizen, the virile, coura-
geous soldier or the bright, devoted scholar.
5. 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 corpu-
lence 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 and healthy’, in spite of her ex-
treme weight, implying that negative effects on health would nor-
mally be expected.60 Isaac Cattier, writing in the late seventeenth
century, even claimed that many people sought the physician’s ad-
vice because they wanted to lose weight and be able to move better
again.61 There is also some anecdotal evidence of individual obese
patients who asked for medical advice and engaged in weight-losing
activities. The case of a fat Spanish general, who was physically fit
but ultimately had to support his huge belly with straps, was repeat-
edly mentioned in this context. He managed to lose 87 pounds,
above all by switching from wine to vinegar.62 Johann Nicolaus Pech-
lin, in 1691, reported the case of a nobleman who asked several phy-
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
Pechlin explained, compressed his vessels so much that the move-
ment of his blood and spirits was obstructed.63
Even from physicians’ case stories, however, it would seem that
only the very obese, who believed they were already feeling nega-
tive health effects, sought medical advice. More moderate degrees
of corpulency, by contrast, seem to have been widely accepted or
even desired, based on the idea, as Short put it, that ‘there is some-
what of modishness or pleasure in it, and that it challenges respect
from others.’64 Some women in particular allegedly even ate very
nutritious food on purpose in order to acquire a ‘juicier’ (‘succulent-
ior’) body, which they considered to be beautiful.65
The impression that lay people, if at all, only sought treatment
for very advanced degrees of obesity is confirmed by a survey of
hundreds of letters of consultation and medical consilia published
by early modern physicians. Requests for advice on how to fight
obesity and physicians’ responses to such requests are very rare.
The earliest example I have so far come across is a consilium ‘De in-
signi obesitate corporis’ by Jean Fernel.66 In order to prevent more
serious harm from developing as a consequence of the obese (‘obe-
sus’) patient’s excessive bulk, and the predominance of cold, phleg-
matic humor in his body, Fernel advised the patient not only to
eat less but also to use laxatives, though not too drastic ones, on a
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).
375
regular basis until his cacochymy was gone and his former vigor
and health returned. Philipp Grünling recommended bloodletting,
sparse food and physical exercise after eating when his former fam-
ulus asked him for advice because he had grown so fat that he was
afraid he would soon no longer be able to move. But he added that
physicians rarely had to deal with this particular affliction.67
Similarly, in the many hundreds of manuscript consultations
and patient letters which I have studied, obesity hardly figures. A
rare exception is a ‘Consil[ium] ad minuendam obesitatem et inde
ortum asthma’ written in 1699 by Heinrich Meibom (1638–1700)
of Helmstedt for a 23-year old princess from Saxony.68 The princess
had grown very fat after the delivery of her last child, and had devel-
oped a strange kind of dyspnea, characterized by sudden attacks of
shortness of breath which made her feel as if she were about to suf-
focate. Obesity, Meibom noted, was hereditary among the Saxon
princely families, and she had a good appetite and ate plentifully.
This, he assumed, made her produce too much blood, which inter-
fered with her circulation, and, being very fatty, was the cause of
her massive increase in bulk (‘starcke[s] Zunehmen’). Meibom ad-
vised the princess to refrain from eggs, milk, rice, chocolate and
sweet wine in particular. Rye bread was better than wheat bread.
Tea and coffee were permitted, but in general she was not to drink
much, because drink nourished the body. Meat broths were to be
cooked with parsley and celery, which promoted urinary excretion.
For medicine, he prescribed decoctions of sarsaparilla, which would
dry the body and so prevent corpulence, as well as cream of tartar, to
be taken half an hour before eating, which would keep the body
‘open’ and had been found to act against increasing corpulence
and ‘fatness’ (‘gegen die Zunahme und Fettigkeit’), too.
6. Images of obesity: continuity and change
As the numerous early modern works which decried the harm-
ful 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 seven-
teenth-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 conse-
quences of obesity expounded by early modern physicians are still
widely recognized today. Obesity continues to be associated, for
example, with a higher mortality and a risk of sudden death from
strokes and cardiac disease. On closer analysis, there are also some
profound differences, however, between the way in which the
causes, features and effects of obesity were described in early mod-
ern medical writing and the way they are presented today.
A first major difference concerns the limits between the healthy
and the pathological. Early modern works on obesity focused on
very considerable degrees of corpulence, on ‘obesitas immensa’,
‘nimia obesitate’ or ‘corpulentia nimia’ as the titles of several dis-
sertations expressed it.69 The authors had in mind those who could
hardly move, who became breathless just from walking, and who
might need special machines to climb the stairs or to hoist them
376 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378

while in bed so they could have sex.70 Presumably due to this focus
on massive obesity, the precise weight was of marginal importance.
Until the nineteenth century, we do not find the notion of a ‘normal’
or ‘ideal’ weight, applicable to all people of a certain height, age, sex
and race.71 People were not ‘overweight’. Obesity was principally de-
fined in terms of visual appearance, the sheer bodily bulk, not
weight. Physicians who presented cases of particularly corpulent
individual patients frequently did mention their weight, as we have
seen, and sometimes with a fair degree of precision, but this was
only in order to underscore their exceptional fatness.
The characteristics of the obese body and the pathological
changes occurring inside it were also described in strikingly differ-
ent terms. Far more than today, obesity was associated with impu-
rity, decay and putrefaction. The crude, raw humours which
resulted from the insufficient concoction of the excessive food by
the over-burdened and weakened innate heat, and the ‘undesirable
load of useless and pernicious matter’, in other words the fat itself,
accumulating and stagnating in the vessels and cavities of the body,
were particularly prone to corruption and putrefaction.72 This was
even obvious to the senses. The obese, Nicolaus Falcuccio bluntly sta-
ted, had ‘fetid sweat’.73 It was due to the abundant foul matter in their
body, Guarinonius explained in 1610, that fat people—particularly fat
women—stank, as those who were married to them knew best.74
Even the corpses of obese people were said to putrefy more quickly.
In a sense, the decay and putrefaction normally observed only in
corpses began in obese people during their lifetime.75
Far more than today, sixteenth- and seventeenth-century ac-
counts of the obese body were also framed by notions of pressure
and tightness, rather than flabbiness and loose tissue. In the obese,
masses of fat accumulated within the limited space of the body,
and were the major reason for many of obesity’s negative effects.
The vessels and pathways inside the body were increasingly com-
pressed and narrowed, the free movement of blood, humours and
spirits was affected, and the muscles could not be sufficiently ‘in-
flated’.76 When the flow of humours was thus obstructed, stagnation
set in, which further promoted corruption and putrefaction. At times,
the obese body seemed almost ready to burst. Early modern physi-
cians’ image of the obese body and especially that of the obese belly
was fairly close in this respect to their view of dropsy, especially
ascites, the type of dropsy in which the belly was distended with
fluid. In both cases, nature was known to seek, at times, relief of
the pressure by evacuating superfluous humor through the skin,
especially around the umbilicus.77 For this reason even paracentesis,
the creation of an opening in the abdominal wall by surgical means—
a well-known treatment of last resort in severe, suffocating dropsy—
was discussed as a possible remedy for obesity, too.78
This image of the tight, compressed obese body underwent a
gradual but nevertheless striking shift during the early modern
period, however, which ultimately opened the way to the familiar
modern image of the obese body as flabby and boundless. In the
eighteenth century, the obese body was increasingly described in
terms of lax tissue and skin and of dissolving bodily limits. It be-
came associated with a pathological distension rather than a nar-
rowing of the vessels, with a loss of tension and elastic force.79
An excessive laxity in the membranes which were easily extended
by accumulating fat was now declared a major cause of obesity.80
Some had such ‘flexible, lax, and dilatable fibres, that even temper-
ance, exercise, study, abstinence, and abridgment of rest and sleep,
cannot prevent corpulency’.81 Moist or foggy climates, such as pre-
vailed in Holland or in some parts of England, were declared an
important cause of corpulency, because they relaxed the fibres so
much.82 When the fibres and vessels of the corpulent were no longer
able to contract sufficiently, the flow of blood and humours became
more sluggish and threatened to grind to a halt. Again, just as in the
earlier notion of compression and obstruction of vessels, obesity was
associated with humoral stagnation and the danger of putrefaction—
but for opposite reasons.
Last but not least, the way in which early modern physicians
gendered obesity reveals some remarkable differences. It was
widely acknowledged that women were by their very nature gen-
erally fatter than men.83 This was not necessarily to their disadvan-
tage. Most physicians agreed that fat was a desirable and indeed
indispensable element of female beauty. Breasts without fat, for
example, would be hard and uneven and would not embellish the
chest.84 Women with very fat bodies or breasts, however, lost the es-
sence of their feminity. They were described as ugly, if not repulsive,
and they risked becoming infertile as well.85 This (alleged) female
propensity to obesity had significant consequences for the percep-
tion of obese men. Women were said to grow fat more easily both
because they cultivated a more sedentary life-style, and also because
their bodies were generally colder and moister than those of men,
and their innate heat was not as strong. Their moderate coldness
compared to men promoted the formation of layers of fat outside
the vessels. Men’s bodies were ‘naturally’ warmer and drier, and en-
dowed with a stronger innate heat. The more men’s bodies were
filled with masses of relatively cold and moist fat, which weakened
their vital, innate heat, the more closely they approached the body of
a woman. Prosper Alpinus was often quoted in this respect, for his
account of Egyptian men who had grown so fat that their breasts
were bigger than those of a woman.86 Fatness could not turn men
into women completely, but they lost their virility, resembling eu-
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.
 M. Stolberg / Studies in History and Philosophy of Biological and Biomedical Sciences 43 (2012) 370–378
too, due to their cold, watery sperm, fat men might even become
infertile or impotent.87
7. 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 disserta-
tions 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 defi-
nitely dismiss the idea that obesity was medicalized only in the
nineteenth and twentieth centuries, with the rise of modern med-
icine and epidemiological statistics. Equally, many of the mostly
negative characteristics which are commonly associated with
obesity and the obese body today can already be found in the early
modern period and have remained part of our cultural heritage.
The way in which early modern physicians framed obesity as a
pathological condition and explained its effects, however, differed
markedly from prevailing medical understandings today. Early
modern physicians derived their notions of obesity largely from
humoral pathology. They associated obesity with weakened innate
heat, with an accumulation of excremental fatty matter or with
outright putrefaction, and well into the eighteenth century, they
described the obese body in terms similar to those used of the
87
Hulsenbusch (1728), p. 18. The argument was refuted, however, on the basis of ‘daily experience’, quoting the numerous offspring of King Henry VIII as an example, in
Academia (1746), p. 348.
88
Viviani (1926), Gilman (2004), Ritter (1969).
377
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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