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Soranus Caelius on Obesity.Pdf Abstract Caelius Aurelianus is believed to have lived in the fifth century AD and he is famous for his translations into Latin of the writings of Soranus of Ephesus. In his book On acute and chronic diseases Caelius gives an almost complete edition of the works of Soranus of Ephesus, while he adds some material of his own and that of other writers. Obesity was even then thought to be a disease and the authors treated the subject extensively. The nature, the etiology and the clinical manifestations of obesity are described, though treatment covers the greatest part of the material. Infliction of perspiration, diet and mental exercises are proposed while the authors don’t hesitate to express the disapproval of methods used by other physicians for the treatment of obesity. Finally, one cannot overlook the strong similarities of the treatments used by Soranus and Caelius Aurelianus with those used as secondary aids for weight loss. Introduction Caelius Aurelianus is believed to have lived in the fifth century AD and he is famous for his translations into Latin of the writings of Soranus of Ephesus. In his book On acute and chronic diseases Caelius gives an almost complete edition of the works of Soranus, while he adds some material of his own and that of other writers. Soranus of Ephesus was trained in Alexandria and practiced in Rome at the time of the emperors Trayan and Hadrian. He was a famous physician and the most distinguished one of the Methodists1. The most well known treatises of Soranus are Gynaecia and Acute and chronic diseases. Nature - Etiology – Clinical manifestations Caelius Aurelianus and Soranus describe obesity as the disease where the body keeps acquiring additional flesh beyond what is needed. They describe obesity as an “unsightly affliction” because there are no apparent symptoms besides those caused by the increase of flesh2. The cause for this disease is the un-natural increase of food intake. The patient suffers from the accumulation of flesh that is fully apparent in the body; he 1 Veith I., Caelius Aurelianus, On acute and chronic diseases, Book Review, Classical philology, 2 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 993 moves in a slothful way while he feels heavy and weak. Only a few steps cause shortness of breath and sweating in such a point that the patient “feels suffocated by his own body and cannot endure even light clothing”3. In agreement with Soranus, Caelius rejects the belief that obesity is a form of “evexia”, which means “good state of the body”. They both admit that we can only speak of “good state of the body” when there is strength combined with a moderate amount of flesh. Accumulation of flesh can only be characterized as a diseased condition and in no way as an expression of health of the body, since the symptoms are extremely dangerous. It is noticeable that Soranus and Caelius compare obese people with animals kept in feeding stalls and designated for fattening4. Treatment Caelius and Soranus believe that the treatment of obesity may take two forms: the first one restrains the excessive food intake of the body and the second one alters the unhealthy state of the body. The first kind of treatment employs passive exercise and a small amount of nonfattening food. The other kind uses the “cyclical regimen” and “drastic metasyncritic measures”5. Infliction of perspiration Soranus and Caelius suggest the infliction of perspiration by means of exercise or of high temperature. Exercise is one of the measures used for the treatment of obesity, and especially passive exercise. The movement of a small carriage drawn by animals or riding a horse or sailing or swift walking for the exercise of the calves of the legs and running is appropriate. Furthermore, vocal exercise is useful: reading aloud, practicing for contests in poetry and song. Moreover, vigorous exercises in the “palaistra” are prescribed: “corycomachia”6, “hoplomachia”7, “heterocopia” and “trachelismos”8, 3 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 993 4 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 993 5 Drabkin IE, Remarks on ancient psychopathology, Isis, vol. 46, no 3, 1955, pp. 223-234 6 a kind of boxing with a leather bag 7 a battle with heavy armor 8 kinds of wrestling. “macron sparton”9 and swift wrestling. After exercising Caelius advises the use of vigorous and prolonged massage without oil or any other kind of substance, with bare hands or with a rough linen cloth10. Caelius and Soranus suggest the infliction of perspiration by means of high temperature as another measure for the treatment of obesity. The patient should first use the properties of the sun and sunbathe for a long time. Then, the application of intense heat with the use of hot coals and dry steam are prescribed. Hot baths are considered to reduce flesh, while cold baths are thought to condense the body. After the hot baths, the patients’ body should be sprinkled with salt and rubbed with a cleansing preparation of powdered nitrum (in Greek “smigma”). Swimming in the sea or in waters with natural curative properties was found to be helpful11. Diet Eating and drinking are forbidden, according to Caelius and Soranus, after baths because bathing reduce the appetite and giving food would revive it. Moreover, drinking is also forbidden before eating, and only a small quantity is allowed during consumption, because a large amount of fluid dissolves the consumed food and renders the body soft; solid food can be assimilated by digestion in a quicker way12. Among foods, spelt groats, starch, milk, pine kernels, brains, eggs, tender fish and any other kind of fatty property are prohibited by Caelius and Soranus. Contrarily, cold, leavened, whole-wheat bread, especially the stale one, is appropriate. Furthermore, food with drying properties like vegetables, tough fish, the drier varieties of fowl or of game animals like hare, roe and preserved pork, i.e. salted pork dried for a long time13. The patient should eat only once a day and stay awake for a long time so that his body may be exhausted by the parallel digestion and inhalation process. “Cyclical treatment” may be 9 Exercise with a long traction device 10 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 995 11 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 995-7 12 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 997 13 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 997 used depending on the type of obesity present, first withholding food altogether, then permitting a little food and water and then increasing the amounts according to the procedure followed in this treatment14. Caelius and Soranus advise the physicians to prescribe radishes so as to provoke vomiting when the stomach is empty and then give the patient acrid foods, foods of the “middle class”, fowl and game animals. These diets should not be prolonged more than a few days but they can be used for more than one time with frequent intervals. Among vegetables, Caelius and Soranus suggest those with a strong diuretic property like asparagus, parsnip, parsley, fennel, wild carrot and scallions15. In general, these are the instructions for the so-called “metasycritic” treatment. Mental exercise Caelius and Soranus suggest that the obese patient should apply himself intensively – more than necessary – to mental concerns and problems. They believe that this type of exercise is the reason why studious people always have thin bodies, while the opposite happens with people who have a laze and generally inactive way of living16. Disapproval of measures Caelius and Soranus take thought of the measures advised by other physicians for the treatment of obesity, in order to clarify mistakes that might be fatal. Venesection, purgative drugs, intercourse, sleeping and certain types of vomiting are denounced. Venesection weakens the body, reduces the natural strength and causes wrinkling of the body. Purgative drugs and enemas have the same effects and furthermore, decompose the bodily fluids and cause abnormal temperament of the body. Sexual intercourse weakens the body and reduces the natural strength. The same happens when physicians prescribe bathing twice a day and sleeping before eating; because sleep provokes “thickening rather 14 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 997 15 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 999 16 Caelius Aurelianus, Soranus, On acute diseases and On chronic diseases, Drabkin IE (ed.), Chicago, University of Chicago Press, 1950, p. 1001 than thinning of the body”. Vomiting after eating is also harmful because the strength of the patient is impaired, even if the amount of flesh on the body is diminished. “Congestion in the head, injures the sensory channels, causes rotting of the gums, affects the mouth with a foul odor, abrades the esophagus, and brings about in the patient a state of malaise and an indisposition like that found in cases of fever”17. Vomiting should only be prescribed if the obese patient has eaten a great amount of food, because the harm of the body by excessive eating is more serious that the agitation caused by vomiting18.
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