Photo Essay: Vesalius at 500

Earlier this week I finally found the time to check out the exhibit, Vesalius at 500 at Thomas Fisher Rare Books Library in Toronto, curated by Philip Oldfield. The exhibit chronicles the history of anatomy and anatomical illustrations prior to, and following, the anatomist Andreas Vesalius’ (1514-1564) publication of De humani corporis fabrica (The Fabric of the Human Body), which was first published in 1543. De Fabrica exemplifies the perfect marriage between art and anatomy, between text and illustration. It is enormously detailed, brilliantly and profusely illustrated and helped to spearhead the new method for anatomical studies in which the anatomist combined the roles of dissector and instructor. Moreover, the book set the standard for all future publications of anatomical illustrations.

With de Fabrica, Vesalius introduced a number of important changes in the study of anatomy, including the notion that students must not depend their learning from authoritative textbooks, or even their teachers. Rather, Vesalius advocated the humanist doctrine to see for oneself: students should see and understand anatomy by looking and investigating the bodies themselves. Truth could be found under the skin, not in the books. While de Fabrica did not outline any shattering discoveries, Vesalius did correct 200 previously unquestioned theories, many of them from the Greek surgeon Galen’s works, which significantly relied on animal cadavers for anatomical studies. Other anatomists had previously criticized isolated pieces of Galenic anatomical doctrine, but de Fabrica was the first publication to systematically demonstrate how Galenic anatomy was mistaken.

As you can see below, de Fabrica is noteworthy for its illustrations, which were drawn by the Dutch artist Jan Stephan van Calcar (1499-1546). Vesalius used these technically accurate drawings of the dissected body to incorporate realism and reveal the process of dissection. De Fabrica thus laid the groundwork for observation-based anatomy, emphasizing anatomical statements could only be revealed by examining human cadavers first hand.

Please excuse the poor quality of some of the photos; I was not allowed to use my flash camera.

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In the second edition of De humani corporis fabrica libri septem (Basel: J. Oporinus, 1555), the entire text was reset, with more space between lines and illustration; passages were deleted or amended. Most of the changes were stylistic. This is a copy of an extensively annotated second edition with Vesalius’ notes, revealing that Vesalius intended to publish a third edition that never came to pass.

In the second edition of De humani corporis fabrica libri septem (Basel: J. Oporinus, 1555), the entire text was reset, with more space between lines and illustration; passages were deleted or amended. Most of the changes were stylistic. This is a copy of an extensively annotated second edition with Vesalius’ notes, revealing that Vesalius intended to publish a third edition that never came to pass.

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The standing book, featuring "Adam & Eve" is the Epitome, which was published as a condensed version of de Fabrica and intended for students. It cost one-sixth of the price and consisted of 12 folio leaves. Most of the illustrations here are reproduced from Fabrica, but some new ones are added for the purposes of instruction, including “Adam and Eve."

The standing book, featuring “Adam & Eve” is the Epitome, which was published as a condensed version of de Fabrica and intended for students. It cost one-sixth of the price and consisted of 12 folio leaves. Most of the illustrations here are reproduced from Fabrica, but some new ones are added for the purposes of instruction, including “Adam and Eve.”

When Vesalius sent his manuscript and woodblocks of illustration to his printer Johannes Oporinus, he attached a letter with specific instructions for printing. The letter included descriptions on how to align the text and illustrations. As well, Vesalius asked Oporinus to forbid anyone from printing any of the illustrations without his consent.  This book is the first unauthorized reproductions of the plates of Fabrica: Thomas Geminus, an engraver and printer from Flanders, who produced Compendiosa totius anatomie delineation (London: John Herford, 1545) under the command of King Henry VIII of England who wanted to improve the state of surgery. The Compendiosa was the first English book to have an engraved title page. In 1553, Geminus produced an English version for surgeons who did not know Latin; the English version was re-issued in 1559 with an engraving of the newly-crowned Queen Elizabeth.

When Vesalius sent his manuscript and woodblocks of illustration to his printer Johannes Oporinus, he attached a letter with specific instructions for printing. The letter included descriptions on how to align the text and illustrations. As well, Vesalius asked Oporinus to forbid anyone from printing any of the illustrations without his consent.
This book is the first unauthorized reproductions of the plates of Fabrica: Thomas Geminus, an engraver and printer from Flanders, who produced Compendiosa totius anatomie delineation (London: John Herford, 1545) under the command of King Henry VIII of England who wanted to improve the state of surgery. The Compendiosa was the first English book to have an engraved title page. In 1553, Geminus produced an English version for surgeons who did not know Latin; the English version was re-issued in 1559 with an engraving of the newly-crowned Queen Elizabeth.

Another plagiarism: Juan de Valverde de Amusco, Anatomia del corpo humano (Rome: Ant. Salmanca & Antonio Lafreri, 1560).

Another plagiarism: Juan de Valverde de Amusco, Anatomia del corpo humano (Rome: Ant. Salmanca & Antonio Lafreri, 1560).

The exhibit continued downstairs, but there was a class present. Alas, I didn’t get a chance to take a look at the second part of the exhibit. Go check out the exhibit when you can–it closes August 29.

You can see more illustrations from de Fabrica here.

Inside an Operating Theatre of the 1900s: A Review of Cinemax’s “The Knick”

This post includes a review of Cinemax’s The Knick and contains minor spoilers.

On arriving to Bellevue Hospital in New York in the 1880s, American surgeon Robert Morris (1857-1945) commented on the new surgical operating rooms at the institution:

[T]he operating room was similar to that of other large general hospitals. The set-up consisted of a plain wooden table to carry instruments, lint or oakum dressing, unbleached muslin bandages (we had no absorbent gauze or cotton), and a large tin basin of tap water. Sometimes plaster of paris and other splint outfit was added.[1]

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Dr. William Williams Keen conducts a surgical clinic in the Jefferson Medical College Hospital amphitheater, c.1890s.
Archives & Special Collections, Thomas Jefferson University, Philadelphia.

I’m utterly fascinated with the surgical operating theater and how it evolved from a simple room with minor equipment to a packed theatre stage, and eventually to the sterile and spacious environment of modern operating rooms. The transformation of the operating theatre mirrors many tremendous advancements in the surgery during the twentieth century, as surgeons became more skilled and innovative as they mastered complicated and dangerous procedures. It’s no surprise then that I was completely riveted by Cinemax’s new television series, The Knick, directed by Steven Soderbergh, written  by Jack Amiel and Michael Begler, and starting Clive Owen.

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The show takes place in turn-of-the-century New York City, with Owen playing the anti-hero Dr. John Thackray, surgeon at the Knickerbocker Hospital. The pilot episode, “Method and Madness” brilliantly captures the dual nature of medicine: we see Thackray begging his nurse (Eve Hewson) to inject him with 22cc of cocaine, and a short time later, watch him order her to prepare a 2% solution as an innovative spinal anaesthetic to inject a patient on the operating table.

The show’s opening scene in the operating room is, in a word, gory, illustrating the difficulty of procedures that are considered as routine today. Bareknuckle surgery. 100 seconds to perform a caesarean section on a patient with haemorrhage in the womb. Brass hand cranks for suction. White aprons and rolled-up sleeves of street clothes. The rubber apron of Dr. Jules Christiansen (Matt Frewer), which could barely camouflage the surgeon’s hopelessness and despair over 12 unsuccessful caesarean operations. When the patient and baby die on the operating table, Christiansen turns to his audience and reminds them that surgery is about advancement: “It seems…it seems we are still lacking. I hope, if nothing else…this has been instructive for you all.”

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During the early 19th century, operative surgery was limited to breakages, fractures, and amputations. Experimental operations to save the life of a patient were incredibly painful, gruesome, and, in many instances, unsuccessful. Two major advances during the mid-19th century would establish a foundation for surgeons to innovate new life-saving operations with greater confidence: the discovery of anaesthetics and the introduction of antiseptics. Analgesics were always made use of in medicine, as medical practitioners were aware of certain natural substances contained properties for relieving pain, such as opium or alcohol. During the 1790s, experiments of the effects of inhaling various gases and vapours first initiated the possibility pain relief could be achieved by inhalation of some suitable vapour or gas. Humphrey Davy (1778-1829) experimented with nitrous oxide (laughing gas), but other medical practitioners did not pay attention to his developments. The 1840s introduced ether as a more satisfactory anaesthetic, though chloroform anaesthesia became widespread as well after 1847 when James Young Simpson (1811-1870) first used it to relieve a patient’s difficult childbirth pains.

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Dr. William Halstead is the inspiration for Clive Owen's character.

However, post-operative sepsis infection accounted for the majority patient deaths after major surgery. Antiseptics and antiseptic surgical methods became widespread with Joseph Lister’s (1828-1912) introduction of carbolic acid (phenol) as a method for eliminating bacteria on skin and on surface objects. The development of anaesthetics and antiseptics spearheaded the notion of a painless surgical operation. In the 1870s, towns with 10,000 residents had only 100 hospitals within their limits or nearby; by 1910, the number of hospitals increased to over 4,000, as new, innovative surgical procedures were became more successful.[2]

Even with anaesthetics and antiseptics, surgery was an incredible gruesome practice. Operations were performed either in patient wards, a small operating room, or in front of hundreds of students in the ordinary lecture theatre. We see this in The Knick, which surely benefited from the medical, historical and technical advice of Dr. Stanley Burns and the Burns Archive.

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The scenes in the operating theatre appear to jump out of the incredible photographic collections housed at the Burns Archives. I found it difficult to get emotionally connected to characters, though the pilot episode did set up a solid foundation to explore their developments as well as the broader cultural strokes of America in the 1900s. Midwifery and “Stretcher Men;” divisions of the rich and poor; hospital administration; and of course, new technological developments like electricity being fitted in the Knick as it undergoes renovation. Dr. Algernon Edwards (Andre Holland) the “Negro” surgeon, gives us an interesting insight into America racial tensions, but I was more captivated with the scenes of the squalor and poverty of immigrants. The New York Public Health Board’s inspections of tuberculosis cases and their forced removal of sick persons, for instance, shows us how medicine was enforced in the legislative level, as laws outlined demands to enforce structural changes in housing to eradicate breeding grounds for disease. These scenes are a reminder of the terrifying cloud of disease and death.

You can watch the first episode here: http://youtu.be/ItBAXOEE8Vk

 

NOTES

[1] Quoted in Roy Porter, Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton & Company, 1997), 374.

[2] Morris J. Vogel, “Managing Medicine: Creating a Profession of Hospital Administration in the United States, 1895-1915,” in Lindsay Granshaw and Roy Porter (Eds.), The Hospital in History (New York: Routledge, 1989).

Surgeons & Surgical Kits

There’s always a scene in any movie or television show depicting a surgical operation: a nurse or assistant clad in scrubs, enters the room pushing a cart. On the cart lies several delicate instruments, their hard steel glistening under the harsh lights of the theatre. None of the instruments touch each other, and they are placed in a carefully organized order.

Then we see the scene after the operation: the once pristine instruments stained with the bright red of blood, and discarded into a bowl. They have fulfilled their purposes, the dangers embodied in their construction has diminished and they are to retire until they are called for again.

I love those scenes. The instruments play as much of a role in surgical operations as the nurse, the lights, the antiseptics anesthetics and of course, the surgeon. But without the instruments there really is no operation. Without the instruments is a surgeon even a surgeon?

The 10th century Arabic scholar and physician, Abu al-Quasim ibn al-Abbas al-Zahrawi (936-1013) introduced many notable surgical instruments in his eponymous Kitab al-Tasrif ( Method of Medicine), a thirty volume encyclopedia on the anatomy and practise of medicine. Al-Zahrawi, also known by his Latinized name Albucasis, details over 200 instruments, many of which he devised himself, combining ideas from ancient Greek and Roman physicians with his own observations and experiences as a surgeon.

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

Al-Zahrawi stressed a skilled surgeon would not only know the uses and benefits of numerous types of instruments, but will apply the knowledge to make sure an instrument was used properly and carefully to prevent excessive pain to the patient. Other medieval surgeons also stressed the importance of instruments–the surgeon’s kit–as an essential part of the surgeon’s practice.

Before the operating theatre had instruments nicely laid out on a cart, surgeons often carried their own instruments in a box or bag, taking with them as they attended to patients. Some were of simple designs, while others were more elaborate, with ivory, gold, or silver detailing.

An ivory surgical presentation set, c.1868. It contains  a full complement of scalpels, bistouries, needle threaders and tenaculum hooks.  The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps. This was the Governor's Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

An ivory surgical presentation set, c.1868. It contains a full complement of scalpels, bistouries, needle threaders and tenaculum hooks. The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps.
This was the Governor’s Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

These kits consisted of knives, razors, and lancet for making incisions; cattery irons grasping tools, probes, suture scissors, saws, needles, cannulae, pads, bandages, and in some instances, even tools for trepanation. Some kits also contained analgesics such as opium or hashish as pain relievers, or plasters for treating wounds.

A 19th century 14-piece surgical instrument kit (Barcelona)

A 19th century 14-piece surgical instrument kit (Barcelona)

A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder,  toothed forceps and two plain forceps. (Phisick Medical Antiques)

A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder, toothed forceps and two plain forceps. (Phisick Medical Antiques)

Pre-anesthetic surgery was crude, gruesome, and horrifying. Operations were limited to amputations, suturing, and bone-setting. And because it was preferable patients remained awake during the operation (as it was easier to deduct whether there was serious danger), speed was a crucial factor for ensuring a higher degree of success. Instruments were used over and over, frequently without being cleaned, and without being disinfected–antiseptics wouldn’t arrive until the second half of the nineteenth century.

Five surgeons participating in the amputation of a man's leg while another oversees them.  Coloured Aquatint by Thomas Rowlandson, 1793.

Five surgeons participating in the amputation of a man’s leg while another oversees them.
Coloured Aquatint by Thomas Rowlandson, 1793.

19th century Indian Women in U.S. Medical School III

I haven’t been able to find much on Dora Chatterjee’s career online. I imagine there’s much more to her story in the archives somewhere, but this will be a project I’ll have to save for another time.

Dora Chatterjee, c.1905-10

Dora Chatterjee, c.1905-10

In the Drexel archives, there are some clippings from May 14-16, 1901 about Dora as a “Hindu Prince’s daughter,” slated to graduate from the Women’s Medical College of Pennsylvania along with a “pretty Russian.” These clippings also reveal Dora refused to don the graduating cap and gown, preferring to adorn traditional sari—which is shown in the class photo in my previous post. As with Anandibai Joshi and Gurubai Karmarkar, Dora returned to India shortly after graduating.

I did a search through GoogleBooks looking for mentions of Dora, especially in literature that mentions the work of missionaries in India. Annual reports of Presbyterian missionaries mention she returned to Hoshiarpur (Punjab, India) in 1902, with her parents anxiously awaiting her arrival at the train station. Her parents are fascinating individuals. Her father, Dr. Kali Charan Chatterjee, worked as a missionary for forty-eight years in Hoshiarpur; his life was captured by the revered J.C.R. Ewing, in A Prince of the Church in India (1918).

Kali Charan Chatterjee was born on August 23, 1839 at Sukhchan, a village on the left-bank of the river Hugli, about eight miles north of Calcutta. He was a prince born into an eminent family; his father, Ram Hari Chatterjee, was a Kulin Brahman of the Radhiya class. As a teenager, Kali Charan left home to go to the Free Church Mission House to apply for baptism; on November 8, 1854, he was baptised by his mentor Rev. Dr. David Ewant, the superintendent of the mission who would eventually die from cholera. Kali Charan was shunned from his family for renouncing Hinduism and as a consequence, his position in society was lowered in ranks. As Ewing explains, when Kali Charan left home, “A storm of persecution burst upon him. Driven from his home, separated from friends and relatives, he was once esteemed as an outcast from society and was abused and mocked wherever he went.”

Rev. Kali Charan Chatterjee, Portrait taken in Edinburgh, Scotland, 1910

Rev. Kali Charan Chatterjee, Portrait taken in Edinburgh, Scotland, 1910

Educated by the Missionary society and having learned English, Kali Charan Chatterjee travelled with missionaries, educating others and providing medical care where necessary. Like so many others, he witnessed changes in India: the spread of education, introduction of new facilities for travel and communication, and increased travel to Europe and America. Even he would travel: in 1910, he was invited to participate in the World Missionary Conference in Edinburgh.

In Punjab, Chatterjee became acquainted with a Mr. Golaknath, the first Brahman convert of the American Presbyterian Church in India, and who was in charge of the Mission at Jalandhar. On June 6, 1862, Chatterjee wed Golaknath’s second daughter, Mary. They eventually had five children: Golaknath, a son who had a brilliant career as a student in India and University of Cambridge, and was appointed as Professor of Mathematics in the Government College in Lahore; Mona, the eldest daughter who became wife of Dr. D.N.P. Datta, a surgeon and medical missionary; Lena, who served as a missionary in Hoshiarpur and eventually married Kanwar Raghbir Singh, a member of the Punjab Service; Nina, wife of Dr. George Nundy of the Hyderabad State Service. The youngest child was Dora. The family lived comfortably in a large white bungalow “encircled by wide verandas and set far back from the road amid shade trees, orchards and gardens.”[1]

Mrs. Mary Chatterjee, photo taken in America, 1887

Mrs. Mary Chatterjee, photo taken in America, 1887

Upon returning from the United States in 1902, Dora established the Denny Hospital for Women and Children in Hoshiarpur and worked alongside her father. Funds for the hospital were provided by Miss Anna Denny of New York, who chose Dora to be in charge of the hospital; additional liberal grants were given by the Government. Dora remained at her position until 1910, when at the age of 33, she married Rai Sahib Manghat Rai, a member of the provincial Civil Service in the Northwest Frontier Province.

Sometime around the early 1900s, Dora was hosted a visit from the American physician and surgeon, fellow WMCP graduate  Arley Isabel Munson Hare (1817-1941), who had also visited Gurubai Karmarkar in Bombay as well as Dora’s sister Nina in Hyderabad. Arley describes their visit:

“Dora’s cousin, a young Indian prince, met me at Jullunda, and we chatted pleasantly until Dora’s father, Dr. Chatterjee, the well-known scholar and philanthropist of the Punjab, arrived to take me to Hoshiarpur, some twenty-five miles distant. As we bowled over the smooth, hard road, as well kept as a city mall, Dr. Chatterjee told me fascinating tales of his boyhood days when he was a Bengali Brahman, and of the bitter persecution he suffered when he became a Christian. The long drive seemed scarcely to have begun before it ended and we were at Hoshiarpur, where my dear college mate and her charming mother and sisters greeted me most cordially…The days passed swiftly and pleasantly. Every morning Dora and I rose with the sun, and, after working most of the day at Dora’s hospital in the city, we spent the early evening in one festivity or another—a tennis or badminton party, a drive, a dinner or tea, calls, and usually two or three combined, for there are many English people of the Civil Service stationed at Hoshiarpur. It was hard indeed to leave my friends and the happy life of the Punjaub [sic] to begin the long, hot journey southward.”[2]

 

NOTES

[1] Arley Munson, Jungle Days: Being the Experiences of an American Woman Doctor in India (New York & London: D. Appleton and Company, 1913), 84-5.

[2] Ibid.

Dieting Deafness Away

I’m sure some of you have heard of London-based undertaker William Banting (1797-1878), who was the first to popularize a low-carb diet that formed the basis of modern-day diets (think Atkins). Banting was an upper middle-class funeral director whose family held the Royal Warrant for burials for five generations, until 1928; George III, George IV, Prince Albert, and Queen Victoria were buried by the Banting family.

William Banting. (Wikipedia)

William Banting. (Wikipedia)

There’s plenty of commentaries on Banting’s diet floating around the Internet. A retired widower, he was obese, 5’5 and 202lbs at age 66, his heaviest weight. He wore a truss to hold in place an umbilical rupture. His weight—and the associated complications—was so bad he could not stop to tie his shoe, and had to go down the stairs backwards to limit the pain of weight on his knees and ankles. He tried various attempts to drop some pounds: “sea air and bathing in various localities, with much walking exercise; taken gallons of physic and liquor potassae, advisedly and abundantly; riding on horseback; the waters and climate of Leamington many times, as well as those of Cheltenham and Harrogate frequently…”[1] All of these were in vain.

In 1862, after finding his eyesight failing and his hearing greatly impaired, Banting consulted an aural surgeon, but was disappointed with the surgeon’s medical approach: He “made light of the case, looked into my ears, sponged them internally, and blistered the outside, without the slightest benefit, neither inquiring into any of my bodily ailments, which he probably thought unnecessary, nor affording me time to name them.”[2] After the surgeon went on holiday, Banting sought other assistance to relieve him from his ailments. He likely visited the Royal Dispensary for Diseases of the Ear (est. 1816), which in 1862, was directed by the aural surgeon William Harvey (1805/6-1876/9).

Harvey was a well-known aurist in London and had a steady career as a surgeon. He was educated at Guy’s Hospital and practiced general surgery for a few years before establishing himself as an aural specialist and publishing The Ear in Health and Disease in 1854. In addition to his post at the Royal Dispensary, Harvey was also aural surgeon to the Freemason’s Asylum for Female Children and the Great Northern Hospital. As he repeated often, he bore no relation to the physician William Harvey who experimented with blood circulation.

Upon examining Banting’s ears and assessing his obese stature, Harvey explained that the deafness was symptom of fat deposits in the Eustachian tubes. He advised Banting to overhaul his diet to lose weight, explaining that as the pounds came off, his hearing would be improved. Banting was advised to abstain from bread, butter, milk, sugar, beer, and potatoes, which had “been the main…elements of [his] existence.”[3] Instead, he was to eat four meals a day composed of meat, greens, fruit, and dry wine. The diet worked: Banting lost 46 pounds in a few months. He was so astounded by the results he gave Harvey an extra £50 to his usual fees, to be distributed amongst his favourite hospitals. In addition, Banting published a pamphlet in the form of an open testimonial, Letter on Corpulence, Addressed to the Public (1863).

The first edition was self-published at his own expense, but became so popular that he sold it; later editions were published by Harrison, London. The pamphlet and Banting’s dietary success became so well-known that “Do you bant?” became a referred to fashionable way of asking whether people were trying to drop a few pound.

Where did an aurist get the idea for dietary management as a way to improve hearing? According to Harvey, in 1856, while he was out for a walk in Paris, he came across an announcement for a lecture by Claude Bernard at the Paris School of Medicine. Through Bernard’s lectures, Harvey learned how starch could affect the body negatively and played a role in the production of insulin. Diabetics management in particular, could be handled with a proper diet—and of course, assist in losing weight.

Unfortunately for Harvey, false rumours spread in London that the diet had ruined Banting’s health, and that Harvey was to blame. Furthermore, his practice suffered as he was constantly ridiculed for being unable to explain why the diet worked; medical practitioners criticized the diet as “unscientific” and Harvey’s application of diet management as a process that could not be replicated under similar variables.

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In 1872, Harvey published his own account of the diet, On Corpulence in Relation to Disease as a way to address some of the critique against him. In particular, he outlined how his treatment was misapplied in many cases, applied rashly and indiscreetly without proper medical advice. And of course, he points out, it “was…natural to expect that a pamphlet on a dietary for the cure of Corpulence, coming from a lay source, would not have found much favour with the profession, and that it would receive some severe criticism.”[4]The book is technically detailed, with information on the physiology and anatomy of the body, how fat deposits affect tissues and muscles, and symptoms of illness that arise from obesity. He also provides an explanation of how fatty deposits can enter the Eustachian tubes and result in temporary deafness through the mucus membranes.

 

NOTES:

[1] William Banting, Letter on Corpulence, Addressed to the Public (1863), 12.

[2] Ibid, 16.

[3] Ibid, 17.

[4] William Harvey, On Corpulence in Relation to Disease (1872), vi.