Noorden Carl Von 18581944 German Internist

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Trained in Leipzig (MD, 1881), in 1894, Noorden became Director for Internal Medicine at the City Hospital in Frankfurt, where he created a private clinic for diabetes and dietetic cures. In 1906, he became the Head of the Clinic for Internal Medicine in Imperial Vienna and was as much a celebrity doctor there as his contemporary Sigmund Freud. In 1913, he returned to Frankfurt and then, in 1929, returned again to Vienna (now the capital of a republic), recalled by the new Socialist Minister of Health, Julius Tandler, as Head of the Clinic for Metabolic Diseases. His clinical reputation rested on the devel opment of dietetic treatments for diabetes and obesity. It was, in fact, his understanding of the impact of diet on diabetes that shaped his understanding of obesity. He conceptually linked these two expressions of human metabolism, which is reflected in his view of the nature of obesity and the importance of a medically supervised diet. After Noorden, the celebrity "diet doc" becomes a fixture of the dieting culture in the twentieth century.

One of Noorden's central contributions was his categorization of different types of obesity into (a) exogenous obesity, caused by manifest overeating with less expenditure of energy and (b) endogenous obesity, caused by abnormalities within the body that may deal with endocrine function or faulty metabolism (Noorden 1907: 693). Examples of an endocrine factor causing obesity are castration and hypo-thyroidism (Noorden 1907: 703). Yet, at the core of Noorden's movement to medicalize obesity by creating classifications for its origins was the desire to reclaim this ever-expanding category of patient from the "quacks," "reduction cures have become so popular that many patients undergo a course of treatment . . . on their own accord and without consulting a physician" (Noorden 1907: 703). The legacy of Banting was clear: self-cure meant not only fewer patients but also more importantly abdicating an entire arena of medicine to the quacks.

The demographics of this self-treating patient population at the turn of the century were also clear to him. Self-treatment is found more frequently in women than in men and "more commonly in young girls and in middle-aged women than in older women" (Noorden 1903: 15). Among men, Noorden found that patients came to him for the treatment of symptoms, which he understood as the result of their obesity but "they do not understand how a reduction cure can be of any benefit nor how their trouble can be relieved by causing a loss of fat" (Noorden 1903: 15). In their own estimation, his patients were not fat and, even if they were, it had nothing to do with their complaints!

Noorden's view about the efficacy of specific diets is vague; in fact, it was clear to him that any number of diets suggested by physicians might well work. But if "the character and morals of the patient seem to indicate that they will not exercise in moderation in work and are apt to over-indulge in the good things of life" the patients should be forced onto a supervised diet and sent to a sanitarium, even if there are no overt symptoms (Noorden 1903: 22). Simply sending these people for the "water cure" to reduce their weight is useless (Noorden 1903: 28). Only medically supervised weight reduction, Noorden believed, can have the desired impact on long-term health.

Noorden was also very much attuned to the gender politics of his age. Thus, he advocates being very careful with "the whims and fancies of our lady patients" that, having given birth, are appalled at their abdominal fat. Radical reduction of such fat may lead, Noorden warns, to further medical complications even if changes of appearance are achieved (Noorden 1903: 31). In pathological cases, the general tendency towards a weakness of will in the obese is manifest. Hysterics (who are primarily women) "are usually persons who 'cannot' or 'will not,' whose will power is small. Subjects of this kind usually eat a great deal and are at the same time lazy so that they do not get enough muscular exercise and do not develop any energy and readily grow moderately fat" (Noorden 1903: 54). Noorden placed his reduction cures in the service of a new medical science that seemed also to be answering S. Weir Mitchell's "rest cure" with its weight gain and enforced bed rest. Noorden's views impacted the later focus of obesity studies, which went on to examine factors that may regulate appetite and food consumption, such as caloric intake.

Much of Noorden's work also focused on diabetes, a disease that seemed to be increasing in late-nineteenth century Europe. The model for Noorden's insistence on medicalized diet rests on his experience with diabetics. Defined as a disease of diet in the age before Frederick Grant Banting and Charles Herbert Best discover insulin in 1921, diabetes seemed only to be controlled (if at all) through diet. As early as the work of John Rollo in 1796, it was clear that the reduction of carbohydrates would reduce the amount of sugar. As a result, Rollo urged that diabetics consume only meat and fat. In 1865, Apollinaire Bouchardat in Paris suggested that all foodstuffs should be reduced, including fats. As a result of the latter view, Edgar Allen created a radical hunger cure for the control of diabetes, which also functioned as a radical cure for overweight. Noorden supported the "Allen Cure," but in 1902 he made his own breakthrough in the dieting culture when he discovered that oatmeal (paired with a bit of butter and some plant protein) would reduce sugar levels. Ironically, it duplicated a fad diet of the time.

Noorden's understanding of diabetes rested both on his grasp of the metabolic underpinnings of the disease, which became evident during his academic life. But one must not forget that diabetes also came to be considered the disease of modern life. Only through diet could the disease be controlled, and weight came to be a symbol of that which had to be conquered. From the nineteenth century, diabetes had been seen as a disease of the obese and, in an odd set of associations, the Jew was seen as obese due to an apparent increased presence of diabetes among Jews in Central Europe. According to Noorden, mainly rich Jewish men are fat (Noorden 1910: 63). But rather than arguing for any inborn metabolic inheritance, he stated that it is the fault of poor diet among the rich—

too much rich food and alcohol, this being yet another stereotype of the Jew. For all of Noorden's reliance on the cutting edge of medical science, racial stereotypes also played a role in his view of the obese and their diseases.

SLG/Rakhi Patel

See also Aboulia; Banting; Jews; Kneipp; Medical Use of Dieting; Mitchell; Murray; Pregnancy; Risks Associated with Dieting; Tarnower

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