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Pounds & Inches
A NEW APPROACH TO OBESITY
BY: DR. A.T.W. SIMEONS
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 – ROME VIALE MURA GIANICOLENSI, 77

FOREWORD

This book discusses a new interpretation of the nature of obesity, and while it does not
advocate yet another fancy slimming diet it does describe a method of treatment which
has grown out of theoretical considerations based on clinical observation.

What I have to say is an essence of views distilled out of forty years of grappling with the
fundamental problems of obesity, its causes, its symptoms, and its very nature. In these
many years of specialized work thousands of cases have passed through my hands and
were carefully studied. Every new theory, every new method, every promising lead was
considered, experimentally screened and critically evaluated as soon as it became known.
But invariably the results were disappointing and lacking in uniformity.

I felt that we were merely nibbling at the fringe of a great problem, as, indeed, do most
serious students of overweight. We have grown pretty sure that the tendency to
accumulate abnormal fat is a very definite metabolic disorder, much as is, for instance,
diabetes. Yet the localization and the nature of this disorder remained a mystery. Every
new approach seemed to lead into a blind alley, and though patients were told that they
are fat because they eat too much, we believed that this is neither the whole truth nor the
last word in the matter.

Refusing to be side-tracked by an all too facile interpretation of obesity, I have always
held that overeating is the result of the disorder, not its cause, and that we can make little
headway until we can build for ourselves some sort of theoretical structure with which to
explain the condition. Whether such a structure represents the truth is not important at
this moment. What it must do is to give us an intellectually satisfying interpretation of
what is happening in the obese body. It must also be able to withstand the onslaught of all
hitherto known clinical facts and furnish a hard background against which the results of
treatment can be accurately assessed.

To me this requirement seems basic, and it has always been the center of my interest. In
dealing with obese patients it became a habit to register and order every clinical
experience as if it were an odd looking piece of a jig-saw puzzle. And then, as in a jig
saw puzzle, little clusters of fragments began to form, though they seemed to fit in
nowhere. As the years passed these clusters grew bigger and started to amalgamate until,
about sixteen years ago, a complete picture became dimly discernible. This picture was,
and still is, dotted with gaps for which I cannot find the pieces, but I do now feel that a
theoretical structure is visible as a whole.

With mounting experience, more and more facts seemed to fit snugly into the new
framework, and when then a treatment based on such speculations showed consistently
satisfactory results, I was sure that some practical advance had been made, regardless of
whether the theoretical interpretation of these results is correct or not.

The clinical results of the new treatment have been published in scientific journal[1] and
these reports have been generally well received by the profession, but the very nature of a
scientific article does not permit the full presentation of new theoretical concepts nor is
there room to discuss the finer points of technique and the reasons for observing them.
During the 16 years that have elapsed since I first published my findings, I have had
many hundreds of inquiries from research institutes, doctors and patients. Hitherto I could
only refer those interested to my scientific papers, though I realized that these did not
contain sufficient information to enable doctors to conduct the new treatment
satisfactorily. Those who tried were obliged to gain their own experience through the
many trials and errors which I have long since overcome.

Doctors from all over the world have come to Italy to study the method, first hand in my
clinic in the Salvator Mundi International Hospital in Rome. For some of them the time
they could spare has been too short to get a full grasp of the technique, and in any case
the number of those whom I have been able to meet personally is small compared with
the many requests for further detailed information which keep coming in. I have tried to
keep up with these demands by correspondence, but the volume of this work has become
unmanageable and that is one excuse for writing this book.

In dealing with a disorder in which the patient must take an active part in the treatment, it
is, I believe, essential that he or she have an understanding of what is being done and
why. Only then can there be intelligent cooperation between physician and patient. In
order to avoid writing two books, one for the physician and another for the patient – a
prospect which would probably have resulted in no book at all – I have tried to meet the
requirements of both in a single book. This is a rather difficult enterprise in which I may
not have succeeded. The expert will grumble about long-windedness while the lay-reader
may occasionally have to look up an unfamiliar word in the glossary provided for him.
To make the text more readable I shall be unashamedly authoritative and avoid all the
hedging and tentativeness with which it is customary to express new scientific concepts
grown out of clinical experience and not as yet confirmed by clear-cut laboratory
experiments. Thus, when I make what reads like a factual statement, the professional
reader may have to translate into: clinical experience seems to suggest that such and such
an observation might be tentatively explained by such and such a working hypothesis,
requiring a vast amount of further research before the hypothesis can be considered a
valid theory. If we can from the outset establish this as a mutually accepted convention, I
hope to avoid being accused of speculative exuberance.

THE NATURE OF OBESITY

Obesity a Disorder

As a basis for our discussion we postulate that obesity in all its many forms is due to an
abnormal functioning of some part of the body and that every ounce of abnormally
accumulated fat is always the result of the same disorder of certain regulatory
mechanisms. Persons suffering from this particular disorder will get fat regardless of
whether they eat excessively, normally or less than normal. A person who is free of the
disorder will never get fat, even if he frequently overeats.

Those in whom the disorder is severe will accumulate fat very rapidly, those in whom it
is moderate will gradually increase in weight and those in whom it is mild may be able to
keep their excess weight stationary for long periods. In all these cases a loss of weight
brought about by dieting, treatments with thyroid, appetite-reducing drugs, laxatives,
violent exercise, massage, baths, etc., is only temporary and will be rapidly regained as
soon as the reducing regimen is relaxed. The reason is simply that none of these measures
corrects the basic disorder.

While there are great variations in the severity of obesity, we shall consider all the
different forms in both sexes and at all ages as always being due to the same disorder.
Variations in form would then be partly a matter of degree, partly an inherited bodily
constitution and partly the result of a secondary involvement of endocrine glands such as
the pituitary, the thyroid, the adrenals or the sex glands. On the other hand, we postulate
that no deficiency of any of these glands can ever directly produce the common disorder
known as obesity.

If this reasoning is correct, it follows that a treatment aimed at curing the disorder must
be equally effective in both sexes, at all ages and in all forms of obesity. Unless this is so,
we are entitled to harbor grave doubts as to whether a given treatment corrects the
underlying disorder. Moreover, any claim that the disorder has been corrected must be
substantiated by the ability of the patient to eat normally of any food he pleases without
regaining abnormal fat after treatment. Only if these conditions are fulfilled can we
legitimately speak of curing obesity rather than of reducing weight.

Our problem thus presents itself as an enquiry into the localization and the nature of the
disorder which leads to obesity. The history of this enquiry is a long series of high hopes
and bitter disappointments.

The History of Obesity

There was a time, not so long ago, when obesity was considered a sign of health and
prosperity in man and of beauty, amorousness and fecundity in women. This attitude
probably dates back to Neolithic times, about 8000 years ago; when for the first time in
the history of culture, man began to own property, domestic animals, arable land, houses,
pottery and metal tools. Before that, with the possible exception of some races such as the
Hottentots, obesity was almost non-existent, as it still is in all wild animals and most
primitive races.

Today obesity is extremely common among all civilized races, because a disposition to
the disorder can be inherited. Wherever abnormal fat was regarded as an asset, sexual
selection tended to propagate the trait. It is only in very recent times that manifest obesity
has lost some of its allure, though the cult of the outsize bust – always a sign of latent
obesity – shows that the trend still lingers on.

The Significance of Regular Meals

In the early Neolithic times another change took place which may well account for the
fact that today nearly all inherited dispositions sooner or later develop into manifest
obesity. This change was the institution of regular meals. In pre-Neolithic times, man ate
only when he was hungry and only as much as he required to still the pangs of hunger.
Moreover, much of his food was raw and all of it was unrefined. He roasted his meat, but
he did not boil it, as he had no pots, and what little he may have grubbed from the Earth
and picked from the trees, he ate as he went along.

The whole structure of man’s omnivorous digestive tract is, like that of an ape, rat or pig,
adjusted to the continual nibbling of tidbits. It is not suited to occasional gorging as is, for
instance, the intestine of the carnivorous cat family. Thus the institution of regular meals,
particularly of food rendered rapidly assimilable, placed a great burden on modern man’s
ability to cope with large quantities of food suddenly pouring into his system from the
intestinal tract.

The institution of regular meals meant that man had to eat more than his body required at
the moment of eating so as to tide him over until the next meal. Food rendered easily
digestible suddenly flooded his body with nourishment of which he was in no need at the
moment. Somehow, somewhere this surplus had to be stored.

Three Kinds of Fat

In the human body we can distinguish three kinds of fat. The first is the structural fat
which fills the gaps between various organs, a sort of packing material. Structural fat also
performs such important functions as bedding the kidneys in soft elastic tissue, protecting
the coronary arteries and keeping the skin smooth and taut. It also provides the springy
cushion of hard fat under the bones of the feet, without which we would be unable to
walk.

The second type of fat is a normal reserve of fuel upon which the body can freely draw
when the nutritional income from the intestinal tract is insufficient to meet the demand.
Such normal reserves are localized all over the body. Fat is a substance which packs the
highest caloric value into the smallest space so that normal reserves of fuel for muscular
activity and the maintenance of body temperature can be most economically stored in this
form. Both these types of fat, structural and reserve, are normal, and even if the body
stocks them to capacity this can never be called obesity.

But there is a third type of fat which is entirely abnormal. It is the accumulation of such
fat, and of such fat only, from which the overweight patient suffers. This abnormal fat is
also a potential reserve of fuel, but unlike the normal reserves it is not available to the
body in a nutritional emergency. It is, so to speak, locked away in a fixed deposit and is
not kept in a current account, as are the normal reserves.

When an obese patient tries to reduce by starving himself, he will first lose his normal fat
reserves. When these are exhausted he begins to burn up structural fat, and only as a last
resort will the body yield its abnormal reserves, though by that time the patient usually
feels so weak and hungry that the diet is abandoned. It is just for this reason that obese
patients complain that when they diet they lose the wrong fat. They feel famished and
tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper
arms show little improvement. The fat they have come to detest stays on and the fat they
need to cover their bones gets less and less. Their skin wrinkles and they look old and
miserable. And that is one of the most frustrating and depressing experiences a human
being can have.

Injustice to the Obese

When then obese patients are accused of cheating, gluttony, lack of will power, greed and
sexual complexes, the strong become indignant and decide that modern medicine is a
fraud and its representatives fools, while the weak just give up the struggle in despair. In
either case the result is the same: a further gain in weight, resignation to an abominable
fate and the resolution at least to live tolerably the short span allotted to them – a fig for
doctors and insurance companies.

Obese patients only feel physically well as long as they are stationary or gaining weight.
They may feel guilty, owing to the lethargy and indolence always associated with
obesity. They may feel ashamed of what they have been led to believe is a lack of
control. They may feel horrified by the appearance of their nude body and the tightness of
their clothes. But they have a primitive feeling of animal content which turns to misery
and suffering as soon as they make a resolute attempt to reduce. For this there are sound
reasons.

In the first place, more caloric energy is required to keep a large body at a certain
temperature than to heat a small body. Secondly the muscular effort of moving a heavy
body is greater than in the case of a light body. The muscular effort consumes Calories
which must be provided by food. Thus, all other factors being equal, a fat person requires
more food than a lean one. One might therefore reason that if a fat person eats only the
additional food his body requires he should be able to keep his weight stationary. Yet
every physician who has studied obese patients under rigorously controlled conditions
knows that this is not true.

Many obese patients actually gain weight on a diet which is calorically deficient for their
basic needs. There must thus be some other mechanism at work.

Glandular Theories

At one time it was thought that this mechanism might be concerned with the sex glands.
Such a connection was suggested by the fact that many juvenile obese patients show an
under-development of the sex organs. The middle-age spread in men and the tendency of
many women to put on weight in the menopause seemed to indicate a causal connection
between diminishing sex function and overweight. Yet, when highly active sex hormones
became available, it was found that their administration had no effect whatsoever on
obesity. The sex glands could therefore not be the seat of the disorder.

The Thyroid Gland

When it was discovered that the thyroid gland controls the rate at which body-fuel is
consumed, it was thought that by administering thyroid gland to obese patients their
abnormal fat deposits could be burned up more rapidly. This too proved to be entirely
disappointing, because as we now know, these abnormal deposits take no part in the
body’s energy-turnover – they are inaccessibly locked away. Thyroid medication merely
forces the body to consume its normal fat reserves, which are already depleted in obese
patients, and then to break down structurally essential fat without touching the abnormal
deposits. In this way a patient may be brought to the brink of starvation in spite of having
a hundred pounds of fat to spare. Thus any weight loss brought about by thyroid
medication is always at the expense of fat of which the body is in dire need.

While the majority of obese patients have a perfectly normal thyroid gland and some
even have an overactive thyroid, one also occasionally sees a case with a real thyroid
deficiency. In such cases, treatment with thyroid brings about a small loss of weight, but
this is not due to the loss of any abnormal fat. It is entirely the result of the elimination of
a mucoid substance, called myxedema, which the body accumulates when there is a
marked primary thyroid deficiency. Moreover, patients suffering only from a severe lack
of thyroid hormone never become obese in the true sense. Possibly also the observation
that normal persons – though not the obese – lose weight rapidly when their thyroid
becomes overactive may have contributed to the false notion that thyroid deficiency and
obesity are connected. Much misunderstanding about the supposed role of the thyroid
gland in obesity is still met with, and it is now really high time that thyroid preparations
be once and for all struck off the list of remedies for obesity. This is particularly so
because giving thyroid gland to an obese patient whose thyroid is either normal or
overactive, besides being useless, is decidedly dangerous.

The Pituitary Gland

The next gland to be falsely incriminated was the anterior lobe of the pituitary, or
hypophysis. This most important gland lies well protected in a bony capsule at the base of
the skull. It has a vast number of functions in the body, among which is the regulation of
all the other important endocrine glands. The fact that various signs of anterior pituitary
deficiency are often associated with obesity raised the hope that the seat of the disorder
might be in this gland. But although a large number of pituitary hormones have been
isolated and many extracts of the gland prepared, not a single one or any combination of
such factors proved to be of any value in the treatment of obesity. Quite recently,
however, a fat-mobilizing factor has been found in pituitary glands, but it is still too early
to say whether this factor is destined to play a role in the treatment of obesity.

The Adrenals

Recently, a long series of brilliant discoveries concerning the working of the adrenal or
suprarenal glands, small bodies which sit atop the kidneys, have created tremendous
interest. This interest also turned to the problem of obesity when it was discovered that a
condition which in some respects resembles a severe case of obesity – the so called
Cushing’s Syndrome – was caused by a glandular new-growth of the adrenals or by their
excessive stimulation with ACTH, which is the pituitary hormone governing the activity
of the outer rind or cortex of the adrenals.

When we learned that an abnormal stimulation of the adrenal cortex could produce signs
that resemble true obesity, this knowledge furnished no practical means of treating
obesity by decreasing the activity of the adrenal cortex. There is no evidence to suggest
that in obesity there is any excess of adrenocortical activity; in fact, all the evidence
points to the contrary. There seems to be rather a lack of adrenocortical function and a
decrease in the secretion of ACTH from the anterior pituitary lobe.[3]
So here again our search for the mechanism which produces obesity led us into a blind
alley. Recently, many students of obesity have reverted to the nihilistic attitude that
obesity is caused simply by overeating and that it can only be cured by under eating.

The Diencephalon or Hypothalamus

For those of us who refused to be discouraged there remained one slight hope. Buried
deep down in the massive human brain there is a part which we have in common with all
vertebrate animals the so-called diencephalon. It is a very primitive part of the brain and
has in man been almost smothered by the huge masses of nervous tissue with which we
think, reason and voluntarily move our body. The diencephalon is the part from which the
central nervous system controls all the automatic animal functions of the body, such as
breathing, the heart beat, digestion, sleep, sex, the urinary system, the autonomous or
vegetative nervous system and via the pituitary the whole interplay of the endocrine
glands.

It was therefore not unreasonable to suppose that the complex operation of storing and
issuing fuel to the body might also be controlled by the diencephalon. It has long been
known that the content of sugar – another form of fuel – in the blood depends on a certain
nervous center in the diencephalon. When this center is destroyed in laboratory animals,
they develop a condition rather similar to human stable diabetes. It has also long been
known that the destruction of another diencephalic center produces a voracious appetite
and a rapid gain in weight in animals which never get fat spontaneously.

The Fat-bank

Assuming that in man such a center controlling the movement of fat does exist, its
function would have to be much like that of a bank. When the body assimilates from the
intestinal tract more fuel than it needs at the moment, this surplus is deposited in what
may be compared with a current account. Out of this account it can always be withdrawn
as required. All normal fat reserves are in such a current account, and it is probable that a
diencephalic center manages the deposits and withdrawals.

When now, for reasons which will be discussed later, the deposits grow rapidly while
small withdrawals become more frequent, a point may be reached which goes beyond the
diencephalon’s banking capacity. Just as a banker might suggest to a wealthy client that
instead of accumulating a large and unmanageable current account he should invest his
surplus capital, the body appears to establish a fixed deposit into which all surplus funds
go but from which they can no longer be withdrawn by the procedure used in a current
account. In this way the diencephalic “fat-bank” frees itself from all work which goes
beyond its normal banking capacity. The onset of obesity dates from the moment the
diencephalon adopts this labor-saving ruse. Once a fixed deposit has been established the
normal fat reserves are held at a minimum, while every available surplus is locked away
in the fixed deposit and is therefore taken out of normal circulation.

THREE BASIC CAUSES OF OBESITY:

(1) The Inherited Factor
Assuming that there is a limit to the diencephalon’s fat banking capacity, it follows that
there are three basic ways in which obesity can become manifest. The first is that the fatbanking
capacity is abnormally low from birth. Such a congenitally low diencephalic
capacity would then represent the
inherited factor in obesity. When this abnormal trait is markedly present, obesity will
develop at an early age in spite of normal feeding; this could explain why among brothers
and sisters eating the same food at the same table some become obese and others do not.

(2) Other Diencephalic Disorders
The second way in which obesity can become established is the lowering of a previously
normal fat-banking capacity owing to some other diencephalic disorder. It seems to be a
general rule that when one of the many diencephalic centers is particularly overtaxed; it
tries to increase its capacity at the expense of other centers.
In the menopause and after castration the hormones previously produced in the sexglands
no longer circulate in the body. In the presence of normally functioning sex-glands
their hormones act as a brake on the secretion of the sex-gland stimulating hormones of
the anterior pituitary. When this brake is removed the anterior pituitary enormously
increases its output of these sex-gland stimulating hormones, though they are now no
longer effective. In the absence of any response from the non-functioning or missing sex
glands, there is nothing to stop the anterior pituitary from producing more and more of
these hormones. This situation causes an excessive strain on the diencephalic center
which controls the function of the anterior pituitary. In order to cope with this additional
burden the center appears to draw more and more energy away from other centers, such
as those concerned with emotional stability, the blood circulation (hot flushes) and other
autonomous nervous regulations, particularly also from the not so vitally important fatbank.
The so-called stable type of diabetes heavily involves the diencephalic blood sugar
regulating center. The diencephalon tries to meet this abnormal load by switching energy
destined for the fat bank over to the sugar-regulating center, with the result that the fatbanking
capacity is reduced to the point at which it is forced to establish a fixed deposit
and thus initiate the disorder we call obesity. In this case one would have to consider the
diabetes the primary cause of the obesity, but it is also possible that the process is
reversed in the sense that a deficient or overworked fat-center draws energy from the
sugar-center, in which case the obesity would be the cause of that type of diabetes in
which the pancreas is not primarily involved. Finally, it is conceivable that in Cushing’s
syndrome those symptoms which resemble obesity are entirely due to the withdrawal of
energy from the diencephalic fat-bank in order to make it available to the highly
disturbed center which governs the anterior pituitary adrenocortical system.
Whether obesity is caused by a marked inherited deficiency of the fat-center or by some
entirely different diencephalic regulatory disorder, its insurgence obviously has nothing
to do with overeating and in either case obesity is certain to develop regardless of dietary
restrictions. In these cases any enforced food deficit is made up from essential fat
reserves and normal structural fat, much to the disadvantage of the patient’s general
health.

3) The Exhaustion of the Fat-bank
But there is still a third way in which obesity can become established, and that is when a
presumably normal fat-center is suddenly — the emphasis is on suddenly — called upon to
deal with an enormous influx of food far in excess of momentary requirements. At first
glance it does seem that here we have a straight-forward case of overeating being
responsible for obesity, but on further analysis it soon becomes clear that the relation of
cause and effect is not so simple. In the first place we are merely assuming that the
capacity of the fat center is normal while it is possible and even probable that only
persons who have some inherited trait in this direction can become obese merely by
overeating.

Secondly, in many of these cases the amount of food eaten remains the same and it is
only the consumption of fuel which is suddenly decreased, as when an athlete is confined
to bed for many weeks with a broken bone or when a man leading a highly active life is
suddenly tied to his desk in an office and to television at home. Similarly, when a person,
grown up in a cold climate, is transferred to a tropical country and continues to eat as
before, he may develop obesity because in the heat far less fuel is required to maintain
the normal body temperature.

When a person suffers a long period of privation, be it due to chronic illness, poverty,
famine or the exigencies of war, his diencephalic regulations adjust themselves to some
extent to the low food intake. When then suddenly these conditions change and he is free
to eat all the food he wants, this is liable to overwhelm his fat-regulating center. During
the last war[4] about 6000 grossly underfed Polish refugees who had spent harrowing
years in Russia were transferred to a camp in India where they were well housed, given
normal British army rations and some cash to buy a few extras. Within about three
months, 85% were suffering from obesity.

In a person eating coarse and unrefined food, the digestion is slow and only a little
nourishment at a time is assimilated from the intestinal tract. When such a person is
suddenly able to obtain highly refined foods such as sugar, white flour, butter and oil
these are so rapidly digested and assimilated that the rush of incoming fuel which occurs
at every meal may eventually overpower the diecenphalic regulatory mechanisms and
thus lead to obesity. This is commonly seen in the poor man who suddenly becomes rich
enough to buy the more expensive refined foods, though his total caloric intake remains
the same or is even less than before.

Psychological Aspects
Much has been written about the psychological aspects of obesity. Among its many
functions the diencephalon is also the seat of our primitive animal instincts, and just as in
an emergency it can switch energy from one center to another, so it seems to be able to
transfer pressure from one instinct to another. Thus, a lonely and unhappy person
deprived of all emotional comfort and of all instinct gratification except the stilling of
hunger and thirst can use these as outlets for pent up instinct pressure and so develop
obesity. Yet once that has happened, no amount of psychotherapy or analysis, happiness,
company or the gratification of other instincts will correct the condition.

Compulsive Eating
No end of injustice is done to obese patients by accusing them of compulsive eating,
which is a form of diverted sex gratification. Most obese patients do not suffer from
compulsive eating; they suffer genuine hunger – real, gnawing, torturing hunger – which
has nothing whatever to do with compulsive eating. Even their sudden desire for sweets
is merely the result of the experience that sweets, pastries and alcohol will most rapidly
of all foods allay the pangs of hunger. This has nothing to do with diverted instincts.
On the other hand, compulsive eating does occur in some obese patients, particularly in
girls in their late teens or early twenties. Compulsive eating differs fundamentally from
the obese patient’s greater need for food. It comes on in attacks and is never associated
with real hunger, a fact which is readily admitted by the patients. They only feel a feral
desire to stuff. Two pounds of chocolates may be devoured in a few minutes; cold, greasy
food from the refrigerator, stale bread, leftovers on stacked plates, almost anything edible
is crammed down with terrifying speed and ferocity.

I have occasionally been able to watch such an attack without the patient’s knowledge,
and it is a frightening, ugly spectacle to behold, even if one does realize that mechanisms
entirely beyond the patient’s control are at work. A careful enquiry into what may have
brought on such an attack almost invariably reveals that it is preceded by a strong
unresolved sex-stimulation, the higher centers of the brain having blocked primitive
diencephalic instinct gratification. The pressure is then let off through another primitive
channel, which is oral gratification. In my experience the only thing that will cure this
condition is uninhibited sex, a therapeutic procedure which is hardly ever feasible, for if
it were, the patient would have adopted it without professional prompting, nor would this
in any way correct the associated obesity. It would only raise new and often greater
problems if used as a therapeutic measure.

Patients suffering from real compulsive eating are comparatively rare. In my practice
they constitute about 1-2%. Treating them for obesity is a heartrending job. They do
perfectly well between attacks, but a single bout occurring while under treatment may
annul several weeks of therapy. Little wonder that such patients become discouraged. In
these cases I have found that psychotherapy may make the patient fully understand the
mechanism, but it does nothing to stop it. Perhaps society’s growing sexual
permissiveness will make compulsive eating even rarer.

Whether a patient is really suffering from compulsive eating or not is hard to decide
before treatment because many obese patients think that their desire for food — to them
unmotivated — is due to compulsive eating, while all the time it is merely a greater need
for food. The only way to find out is to treat such patients. Those that suffer from real
compulsive eating continue to have such attacks, while those who are not compulsive
eaters never get an attack during treatment.

Reluctance to Lose Weight
Some patients are deeply attached to their fat and cannot bear the thought of losing it. If
they are intelligent, popular and successful in spite of their handicap, this is a source of
pride. Some fat girls look upon their condition as a safeguard against erotic involvements,
of which they are afraid. They work out a pattern of life in which their obesity plays a
determining role and then become reluctant to upset this pattern and face a new kind of
life which will be entirely different after their figure has become normal and often very
attractive. They fear that people will like them – or be jealous – on account of their figure
rather than be attracted by their intelligence or character only. Some have a feeling that
reducing means giving up an almost cherished and intimate part of themselves. In many
of these cases psychotherapy can be helpful, as it enables these patients to see the whole
situation in the full light of consciousness. An affectionate attachment to abnormal fat is
usually seen in patients who became obese in childhood, but this is not necessarily so.
In all other cases the best psychotherapy can do in the usual treatment of obesity is to
render the burden of hunger and never-ending dietary restrictions slightly more tolerable.

Patients who have successfully established an erotic transfer to their psychiatrist are often better able to bear their suffering as a secret labor of love.

There are thus a large number of ways in which obesity can be initiated, though the
disorder itself is always due to the same mechanism, an inadequacy of the diencephalic
fat-center and the laying down of abnormally fixed fat deposits in abnormal places. This
means that once obesity has become established, it can no more be cured by eliminating
those factors which brought it on than a fire can be extinguished by removing the cause
of the conflagration. Thus a discussion of the various ways in which obesity can become
established is useful from a preventative point of view, but it has no bearing on the
treatment of the established condition. The elimination of factors which are clearly
hastening the course of the disorder may slow down its progress or even halt it, but they
can never correct it.

Not by Weight alone…
Weight alone is not a satisfactory criterion by which to judge whether a person is
suffering from the disorder we call obesity or not. Every physician is familiar with the
sylphlike lady who enters the consulting room and declares emphatically that she is
getting horribly fat and wishes to reduce. Many an honest and sympathetic physician at
once concludes that he is dealing with a “nut.” If he is busy he will give her short shrift,
but if he has time he will weigh her and show her tables to prove that she is actually
underweight.

I have never yet seen or heard of such a lady being convinced by either procedure. The
reason is that in my experience the lady is nearly always right and the doctor wrong.
When such a patient is carefully examined one finds many signs of potential obesity,
which is just about to become manifest as overweight. The patient distinctly feels that
something is wrong with her, that a subtle change is taking place in her body, and this
alarms her.

There are a number of signs and symptoms which are characteristic of obesity. In
manifest obesity many and often all these signs and symptoms are present. In latent or
just beginning cases some are always found, and it should be a rule that if two or more of
the bodily signs are present, the case must be regarded as one that needs immediate help.

Signs and symptoms of obesity
The bodily signs may be divided into such as have developed before puberty, indicating a
strong inherited factor, and those which develop at the onset of manifest disorder. Early
signs are a disproportionately large size of the two upper front teeth, the first incisor, or a
dimple on both sides of the sacral bone just above the buttocks. When the arms are
outstretched with the palms upward, the forearms appear sharply angled outward from
the upper arms. The same applies to the lower extremities. The patient cannot bring his
feet together without the knees overlapping; he is, in fact, knock-kneed.
The beginning accumulation of abnormal fat shows as a little pad just below the nape of
the neck, colloquially known as the Duchess’ Hump. There is a triangular fatty bulge in
front of the armpit when the arm is held against the body. When the skin is stretched by
fat rapidly accumulating under it, it may split in the lower layers. When large and fresh,
such tears are purple, but later they are transformed into white scar-tissue. Such striation,
as it is called, commonly occurs on the abdomen of women during pregnancy, but in
obesity it is frequently found on the breasts, the hips and occasionally on the shoulders.
In many cases striation is so fine that the small white lines are only just visible. They are
always a sure sign of obesity, and though this may be slight at the time of examination
such patients can usually remember a period in their childhood when they were
excessively chubby.

Another typical sign is a pad of fat on the insides of the knees, a spot where normal fat
reserves are never stored. There may be a fold of skin over the pubic area and another
fold may stretch round both sides of the chest, where a loose roll of fat can be picked up
between two fingers. In the male an excessive accumulation of fat in the breasts is always
indicative, while in the female the breast is usually, but not necessarily, large. Obviously
excessive fat on the abdomen, the hips, thighs, upper arms, chin and shoulders are
characteristic, and it is important to remember that any number of these signs may be
present in persons whose weight is statistically normal; particularly if they are dieting on
their own with iron determination.

Common clinical symptoms which are indicative only in their association and in the
frame of the whole clinical picture are: frequent headaches, rheumatic pains without
detectable bony abnormality; a feeling of laziness and lethargy, often both physical and
mental and frequently associated with insomnia, the patients saying that all they want is
to rest; the frightening feeling of being famished and sometimes weak with hunger two to
three hours after a hearty meal and an irresistible yearning for sweets and starchy food
which often overcomes the patient quite suddenly and is sometimes substituted by a
desire for alcohol; constipation and a spastic or irritable colon are unusually common
among the obese, and so are menstrual disorders.

Returning once more to our sylphlike lady, we can say that a combination of some of
these symptoms with a few of the typical bodily signs is sufficient evidence to take her
case seriously. A human figure, male or female, can only be judged in the nude; any
opinion based on the dressed appearance can be quite fantastically wide off the mark, and
I feel myself driven to the conclusion that apart from frankly psychotic patients such as
cases of anorexia nervosa; a morbid weight fixation does not exist. I have yet to see a
patient who continues to complain after the figure has been rendered normal by adequate
treatment.

The Emaciated Lady
I remember the case of a lady who was escorted into my consulting room while I was
telephoning. She sat down in front of my desk, and when I looked up to greet her I saw
the typical picture of advanced emaciation. Her dry skin hung loosely over the bones of
her face, her neck was scrawny and collarbones and ribs stuck out from deep hollows. I
immediately thought of cancer and decided to which of my colleagues at the hospital I
would refer her. Indeed, I felt a little annoyed that my assistant had not explained to her
that her case did not fall under my specialty. In answer to my query as to what I could do
for her, she replied that she wanted to reduce. I tried to hide my surprise, but she must
have noted a fleeting expression, for she smiled and said “I know that you think I’m mad,
but just wait.” With that she rose and came round to my side of the desk. Jutting out from
a tiny waist she had enormous hips and thighs.

By using a technique which will presently be described, the abnormal fat on her hips was
transferred to the rest of her body which had been emaciated by months of very severe
dieting. At the end of a treatment lasting five weeks, she, a small woman, had lost 8
inches round her hips, while her face looked fresh and florid, the ribs were no longer
visible and her weight was the same to the ounce as it had been at the first consultation.

Fat but not Obese
While a person who is statistically underweight may still be suffering from the disorder
which causes obesity, it is also possible for a person to be statistically overweight without
suffering from obesity. For such persons weight is no problem, as they can gain or lose at
will and experience no difficulty in reducing their caloric intake. They are masters of
their weight, which the obese are not. Moreover, their excess fat shows no preference for
certain typical regions of the body, as does the fat in all cases of obesity. Thus, the
decision whether a borderline case is really suffering from obesity or not cannot be made
merely by consulting weight tables.

The Treatment Of Obesity
If obesity is always due to one very specific diencephalic deficiency, it follows that the
only way to cure it is to correct this deficiency. At first this seemed an utterly hopeless
undertaking. The greatest obstacle was that one could hardly hope to correct an inherited
trait localized deep inside the brain, and while we did possess a number of drugs whose
point of action was believed to be in the diencephalon, none of them had the slightest
effect on the fat-center. There was not even a pointer showing a direction in which
pharmacological research could move to find a drug that had such a specific action. The
closest approach were the appetite-reducing drugs – the amphetamines—– but these
cured nothing.

A Curious Observation
Mulling over this depressing situation, I remembered a rather curious observation made
many years ago in India. At that time we knew very little about the function of the
diencephalon, and my interest centered round the pituitary gland. Froehlich had described
cases of extreme obesity and sexual underdevelopment in youths suffering from a new
growth of the anterior pituitary lobe, producing what then became known as Froehlich’s
disease. However, it was very soon discovered that the identical syndrome, though
running a less fulminating course, was quite common in patients whose pituitary gland
was perfectly normal. These are the so-called “fat boys” with long, slender hands, breasts
any flat-chested maiden would be proud to posses, large hips, buttocks and thighs with
striation, knock-knees and underdeveloped genitals, often with undescended testicles.
It also became known that in these cases the sex organs could he developed by giving the
patients injections of a substance extracted from the urine of pregnant women, it having
been shown that when this substance was injected into sexually immature rats it made
them precociously mature. The amount of substance which produced this effect in one rat
was called one International Unit, and the purified extract was accordingly called
“Human Chorionic Gonadotrophin” whereby chorionic signifies that it is produced in the
placenta and gonadotropin that its action is sex gland directed.

The usual way of treating “fat boys” with underdeveloped genitals is to inject several
hundred International Units twice a week. Human Chorionic Gonadotrophin which we
shall henceforth simply call HCG is expensive and as “fat boys” are fairly common
among Indians I tried to establish the smallest effective dose. In the course of this study
three interesting things emerged. The first was that when fresh pregnancy-urine from the
female ward was given in quantities of about 300 cc. by retention enema, as good results
could be obtained as by injecting the pure substance. The second was that small daily
doses appeared to be just as effective as much larger ones given twice a week. Thirdly,
and that is the observation that concerns us here, when such patients were given small
daily doses they seemed to lose their ravenous appetite though they neither gained nor
lost weight. Strangely enough however, their shape did change. Though they were not
restricted in diet, there was a distinct decrease in the circumference of their hips.

Fat on the Move
Remembering this, it occurred to me that the change in shape could only be explained by
a movement of fat away from abnormal deposits on the hips, and if that were so there was
just a chance that while such fat was in transition it might be available to the body as fuel.
This was easy to find out, as in that case, fat on the move would be able to replace food.
It should then he possible to keep a “fat boy” on a severely restricted diet without a
feeling of hunger, in spite of a rapid loss of weight. When I tried this in typical cases of
Froehlich’s syndrome, I found that as long as such patients were given small daily doses
of HCG they could comfortably go about their usual occupations on a diet of only 500
Calories daily and lose an average of about one pound per day. It was also perfectly
evident that only abnormal fat was being consumed, as there were no signs of any
depletion of normal fat. Their skin remained fresh and turgid, and gradually their figures
became entirely normal, nor did the daily administration of HCG appear to have any sideeffects
other than beneficial.

From this point it was a small step to try the same method in all other forms of obesity. It
took a few hundred cases to establish beyond reasonable doubt that the mechanism
operates in exactly the same way and seemingly without exception in every case of
obesity. I found that, though most patients were treated in the outpatients department,
gross dietary errors rarely occurred. On the contrary, most patients complained that the
two meals of 250 Calories each were more than they could manage, as they continually
had a feeling of just having had a large meal.

Pregnancy and Obesity
Once this trail was opened, further observations seemed to fall into line. It is, for
instance, well known that during pregnancy an obese woman can very easily lose weight.
She can drastically reduce her diet without feeling hunger or discomfort and lose weight
without in any way harming the child in her womb. It is also surprising to what extent a
woman can suffer from pregnancy-vomiting without coming to any real harm.
Pregnancy is an obese woman’s one great chance to reduce her excess weight. That she so
rarely makes use of this opportunity is due to the erroneous notion, usually fostered by
her elder relations, that she now has “two mouths to feed” and must “keep up her strength
for the coming event. All modern obstetricians know that this is nonsense and that the
more superfluous fat is lost the less difficult will be the confinement, though some still
hesitate to prescribe a diet sufficiently low in Calories to bring about a drastic reduction.
A woman may gain weight during pregnancy, but she never becomes obese in the strict
sense of the word. Under the influence of the HCG which circulates in enormous
quantities in her body during pregnancy, her diencephalic banking capacity seems to be
unlimited, and abnormal fixed deposits are never formed. At confinement[5] she is
suddenly deprived of HCG, and her diencephalic fat-center reverts to its normal capacity.
It is only then that the abnormally accumulated fat is locked away again in a fixed
deposit. From that moment on she is suffering from obesity and is subject to all its
consequences.

Pregnancy seems to be the only normal human condition in which the diencephalic fatbanking
capacity is unlimited. It is only during pregnancy that fixed fat deposits can be
transferred back into the normal current account and freely drawn upon to make up for
any nutritional deficit. During pregnancy, every ounce of reserve fat is placed at the
disposal of the growing fetus. Were this not so, an obese woman, whose normal reserves
are already depleted, would have the greatest difficulties in bringing her pregnancy to full
term. There is considerable evidence to suggest that it is the HCG produced in large
quantities in the placenta which brings about this diencephalic change.

Though we may be able to increase the dieneephalic fat banking capacity by injecting
HCG, this does not in itself affect the weight, just as transferring monetary funds from a
fixed deposit into a current account does not make a man any poorer; to become poorer it
is also necessary that he freely spends the money which thus becomes available. In
pregnancy the needs of the growing embryo take care of this to some extent, but in the
treatment of obesity there is no embryo, and so a very severe dietary restriction must take
its place for the duration of treatment.

Only when the fat which is in transit under the effect of HCG is actually consumed can
more fat be withdrawn from the fixed deposits. In pregnancy it would be most
undesirable if the fetus were offered ample food only when there is a high influx from the
intestinal tract. Ideal nutritional conditions for the fetus can only be achieved when the
mother’s blood is continually saturated with food, regardless of whether she eats or not,
as otherwise a period of starvation might hamper the steady growth of the embryo. It
seems that HCG brings about this continual saturation of the blood, which is the reason
why obese patients under treatment with HCG never feel hungry in spite of their
drastically reduced food intake.

The Nature of Human Chorionic Gonadotropin
HCG is never found in the human body except during pregnancy and in those rare cases
in which a residue of placental tissue continues to grow in the womb in what is known as
a chorionic epithelioma. It is never found in the male. The human type of chorionic
gonadotrophin is found only during the pregnancy of women and the great apes. It is
produced in enormous quantities, so that during certain phases of her pregnancy a woman
may excrete as much as one million International Units per day in her urine – enough to
render a million infantile rats precociously mature. Other mammals make use of a
different hormone, which can be extracted from their blood serum but not from their
urine. Their placenta differs in this and other respects from that of man and the great
apes. This animal chorionic gonadotrophin is much less rapidly broken down in the
human body than HCG, and it is also less suitable for the treatment of obesity.

As often happens in medicine, much confusion has been caused by giving HCG its name
before its true mode of action was understood. It has been explained that gonadotrophin
literally means a sex-gland directed substance or hormone, and this is quite misleading. It
dates from the early days when it was first found that HCG is able to render infantile sex
glands mature, whereby it was entirely overlooked that it has no stimulating effect
whatsoever on normally developed and normally functioning sex-glands. No amount of
HCG is ever able to increase a normal sex function; it can only improve an abnormal one
and in the young hasten the onset of puberty. However, this is no direct effect. HCG acts
exclusively at a diencephalic level and there brings about a considerable increase in the
functional capacity of all those centers which are working at maximum capacity.

The Real Gonadotrophins
Two hormones known in the female as follicle stimulating hormone (FSH) and corpus
luteum stimulating hormone (LSH) are secreted by the anterior lobe of the pituitary
gland. These hormones are real gonadotrophins because they directly govern the function
of the ovaries. The anterior pituitary is in turn governed by the diencephalon, and so
when there is an ovarian deficiency the diencephalic center concerned is hard put to
correct matters by increasing the secretion from the anterior pituitary of FSH or LSH, as
the case may be. When sexual deficiency is clinically present, this is a sign that the
diencephalic center concerned is unable, in spite of maximal exertion, to cope with the
demand for anterior pituitary stimulation.[6] When then the administration of HCG
increases the functional capacity of the diencephalon, all demands can be fully satisfied
and the sex deficiency is corrected.

That this is the true mechanism underlying the presumed gonadotrophic action of HCG is
confirmed by the fact that when the pituitary gland of infantile rats is removed before
they are given HCG, the latter has no effect on their sex-glands. HCG cannot therefore
have a direct sex gland stimulating action like that of the anterior pituitary
gonadotrophins, as FSH and LSH are justly called. The latter are entirely different
substances from that which can be extracted from pregnancy urine and which,
unfortunately, is called chorionic gonadotrophin. It would be no more clumsy, and
certainly far more appropriate, if HCG were henceforth called chorionic
diencephalotrophin.

HCG no Sex Hormone
It cannot he sufficiently emphasized that HCG is not sex-hormone, that its action is
identical in men, women, children and in those cases in which the sex-glands no longer
function owing to old age or their surgical removal. The only sexual change it can bring
about after puberty is an improvement of a pre-existing deficiency, but never a
stimulation beyond the normal. In an indirect way via the anterior pituitary, HCG
regulates menstruation and facilitates conception, but it never virilizes a woman or
feminizes a man. It neither makes men grow breasts nor does it interfere with their
virility, though where this was deficient it may improve it. It never makes women grow a
beard or develop a gruff voice. I have stressed this point only for the sake of my lay
readers, because, it is our daily experience that when patients hear the word hormone they
immediately jump to the conclusion that this must have something to do with the sexsphere.

They are not accustomed as we are, to think thyroid, insulin, cortisone, adrenalin
etc, as hormones.

Importance and Potency of HCG
Owing to the fact that HCG has no direct action on any endocrine gland, its enormous
importance in pregnancy has been overlooked and its potency underestimated. Though a
pregnant woman can produce as much as one million units per day, we find that the
injection of only 125 units per day is ample to reduce weight at the rate of roughly one
pound per day, even in a colossus weighing 400 pounds, when associated with a 500-
Calorie diet. It is no exaggeration to say that the flooding of the female body with HCG
is by far the most spectacular hormonal event in pregnancy. It has an enormous protective
importance for mother and child, and I even go so far as to say that no woman, and
certainly not an obese one, could carry her pregnancy to term without it.

If I can be forgiven for comparing my fellow-endocrinologists with wicked Godmothers,
HCG has certainly been their Cinderella, and I can only romantically hope that its
extraordinary effect on abnormal fat will prove to be its Fairy Godmother.
HCG has been known for over half a century. It is the substance which Aschheim and
Zondek so brilliantly used to diagnose early pregnancy out of the urine. Apart from that,
the only thing it did in the experimental laboratory was to produce precocious rats, and
that was not particularly stimulating to further research at a time when much more
thrilling endocrinological discoveries were pouring in from all sides, sweeping, HCG into
the stiller back waters.

Complicating Disorders
Some complicating disorders are often associated with obesity, and these we must briefly
discuss. The most important associated disorders and the ones in which obesity seems to
play a precipitating or at least an aggravating role are the following: the stable type of
diabetes, gout, rheumatism and arthritis, high blood pressure and hardening of the
arteries, coronary disease and cerebral hemorrhage.

Apart from the fact that they are often – though not necessarily – associated with obesity,
these disorders have two things in common. In all of them, modern research is becoming
more and more inclined to believe that diencephalic regulations play a dominant role in
their causation. The other common factor is that they either improve or do not occur
during pregnancy. In the latter respect they are joined by many other disorders not
necessarily associated with obesity. Such disorders are, for instance, colitis, duodenal or
gastric ulcers, certain allergies, psoriasis, loss of hair, brittle fingernails, migraine, etc.
If HCG + diet does in the obese bring about those diencephalic changes which are
characteristic of pregnancy, one would expect to see an improvement in all these
conditions comparable to that seen in real pregnancy. The administration of HCG does in
fact do this in a remarkable way.

Diabetes
In an obese patient suffering from a fairly advanced case of stable diabetes of many
years duration in which the blood sugar may range from 3-400 mg%, it is often possible
to stop all antidiabetic medication after the first few days of treatment. The blood sugar
continues to drop from day to day and often reaches normal values in 2-3 weeks. As in
pregnancy, this phenomenon is not observed in the brittle type of diabetes, and as some
cases that are predominantly stable may have a small brittle factor in their clinical
makeup, all obese diabetics have to be kept under a very careful and expert watch.
A brittle case of diabetes is primarily due to the inability of the pancreas to produce
sufficient insulin, while in the stable type, diencephalic regulations seem to be of greater
importance. That is possibly the reason why the stable form responds so well to the HCG
method of treating obesity, whereas the brittle type does not. Obese patients are generally
suffering from the stable type, but a stable type may gradually change into a brittle one,
which is usually associated with a loss of weight. Thus, when an obese diabetic finds that
he is losing weight without diet or treatment, he should at once have his diabetes expertly
attended to. There is some evidence to suggest that the change from stable to brittle is
more liable to occur in patients who are taking insulin for their stable diabetes.

Rheumatism
All rheumatic pains, even those associated with demonstrable bony lesions, improve
subjectively within a few days of treatment, and often require neither cortisone nor
salicylates. Again this is a well known phenomenon in pregnancy, and while under
treatment with HCG + diet the effect is no less dramatic. As it does after pregnancy, the
pain of deformed joints returns after treatment, but smaller doses of pain-relieving drugs
seem able to control it satisfactorily after weight reduction. In any case, the HCG method
makes it possible in obese arthritic patients to interrupt prolonged cortisone treatment
without a recurrence of pain. This in itself is most welcome, but there is the added
advantage that the treatment stimulates the secretion of ACTH in a physiological manner
and that this regenerates the adrenal cortex, which is apt to suffer under prolonged
cortisone treatment.

Cholesterol
The exact extent to which the blood cholesterol is involved in hardening of the arteries,
high blood pressure and coronary disease is not as yet known, but it is now widely
admitted that the blood cholesterol level is governed by diencephalic mechanisms. The
behavior of circulating cholesterol is therefore of particular interest during the treatment
of obesity with HCG. Cholesterol circulates in two forms, which we call free and
esterified. Normally these fractions are present in a proportion of about 25% free to 75%
esterified cholesterol, and it is the latter fraction which damages the walls of the arteries.
In pregnancy this proportion is reversed and it may he taken for granted that
arteriosclerosis never gets worse during pregnancy for this very reason.

To my knowledge, the only other condition in which the proportion of free to esterified
cholesterol is reversed is during the treatment of obesity with HCG + diet, when exactly
the same phenomenon takes place. This seems an important indication of
how closely a patient under HCG treatment resembles a pregnant woman in diencephalic
behavior.

When the total amount of circulating cholesterol is normal before treatment, this absolute
amount is neither significantly increased nor decreased. But when an obese patient with
an abnormally high cholesterol and already showing signs of arteriosclerosis is treated
with HCG, his blood pressure drops and his coronary circulation seems to improve, and
yet his total blood cholesterol may soar to heights never before reached.

At first this greatly alarmed us. But then we saw that the patients came to no harm even if
treatment was continued and we found in follow-up examinations undertaken some
months after treatment that the cholesterol was much better than it had been before
treatment. As the increase is mostly in the form of the not dangerous free cholesterol, we
gradually came to welcome the phenomenon. Today we believe that the rise is entirely
due to the liberation of recent cholesterol deposits that have not yet undergone
calcification in the arterial wall and therefore highly beneficial.

Gout
An identical behavior is found in the blood uric acid level of patients suffering from gout.
Predictably such patients get an acute and often severe attack after the first few days of
HCG treatment but then remain entirely free of pain, in spite of the fact that their blood
uric acid often shows a marked increase which may persist for several months after
treatment. Those patients who have regained their normal weight remain free of
symptoms regardless of what they eat, while those that require a second course of
treatment get another attack of gout as soon as the second course is initiated. We do not
yet know what diencephalic mechanisms are involved in gout; possibly emotional factors
play a role, and it is worth remembering that the disease does not occur in women of
childbearing age. We now give 2 tablets daily of ZYLORIC to all patients who give a
history of gout and have a high blood uric acid level. In this way we can completely
avoid attacks during treatment.

Blood Pressure
Patients who have brought themselves to the brink of malnutrition by exaggerated
dieting, laxatives etc, often have an abnormally low blood pressure. In these cases the
blood pressure rises to normal values at the beginning of treatment and then very
gradually drops, as it always does in patients with a normal blood pressure. Normal
values are always regained a few days after the treatment is over. Of this lowering of the
blood pressure during treatment the patients are not aware. When the blood pressure is
abnormally high, and provided there are no detectable renal lesions, the pressure drops, as
it usually does in pregnancy. The drop is often very rapid, so rapid in fact that it
sometimes is advisable to slow down the process with pressure sustaining medication
until the circulation has had a few days time to adjust itself to the new situation. On the
other hand, among the thousands of cases treated, we have never seen any untoward
incident which could be attributed to the rather sudden drop in high blood pressure.
When a woman suffering from high blood pressure becomes pregnant her blood pressure
very soon drops, but after her confinement it may gradually rise back to its former level.

Similarly, a high blood pressure present before HCG treatment tends to rise again after
the treatment is over, though this is not always the case. But the former high levels are
rarely reached, and we have gathered the impression that such relapses respond better to
orthodox drugs such as Reserpine than before treatment.

Peptic Ulcers
In our cases of obesity with gastric or duodenal ulcers we have noticed a surprising
subjective improvement in spite of a diet which would generally be considered most
inappropriate for an ulcer patient. Here, too, there is a similarity with pregnancy, in which
peptic ulcers hardly ever occur. However we have seen two cases with a previous history
of several hemorrhages in which a bleeding occurred within 2 weeks of the end of
treatment.

Psoriasis, Fingernails, Hair, Varicose Ulcers
As in pregnancy, psoriasis greatly improves during treatment but may relapse when the
treatment is over. Most patients spontaneously report a marked improvement in the
condition of brittle fingernails. The loss of hair not infrequently associated with obesity is
temporarily arrested, though in very rare cases an increased loss of hair has been
reported. I remember a case in which a patient developed a patchy baldness – so called
alopecia areata – after a severe emotional shock, just before she was about to start an
HCG treatment. Our dermatologist diagnosed the case as a particularly severe one,
predicting that all the hair would be lost. He counseled against the reducing treatment, but
in view of my previous experience and as the patient was very anxious not to postpone
reducing, I discussed the matter with the dermatologist and it was agreed that, having
fully acquainted the patient with the situation, the treatment should be started. During the
treatment, which lasted four weeks, the further development of the bald patches was
almost, if not quite, arrested; however, within a week of having finished the course of
HCG, all the remaining hair fell out as predicted by the dermatologist. The interesting
point is that the treatment was able to postpone this result but not to prevent it. The
patient has now grown a new shock of hair of which she is justly proud.

In obese patients with large varicose ulcers we were surprised to find that these ulcers
heal rapidly under treatment with HCG. We have since treated non obese patients
suffering from varicose ulcers with daily injections of HCG on normal diet with equally
good results.

The “Pregnant” Male
When a male patient hears that he is about to be put into a condition which in some
respects resembles pregnancy, he is usually shocked and horrified. The physician must
therefore carefully explain that this does not mean that he will be feminized and that
HCG in no way interferes with his sex. He must be made to understand that in the interest
of the propagation of the species nature provides for a perfect functioning of the
regulatory headquarters in the diencephalon during pregnancy and that we are merely
using this natural safeguard as a means of correcting the diencephalic disorder which is
responsible for his overweight.

Warnings
I must warn the lay reader that what follows is mainly for the treating physician and most
certainly not a do-it-yourself primer. Many of the expressions used mean something
entirely different to a qualified doctor than that which their common use implies, and
only a physician can correctly interpret the symptoms which may arise during treatment.
Any patient who thinks he can reduce by taking a few “shots” and eating less is not only
sure to be disappointed but may be heading for serious trouble. The benefit the patient
can derive from reading this part of the book is a fuller realization of how very important
it is for him to follow to the letter his physician’s instructions.

In treating obesity with the HCG + diet method we are handling what is perhaps the most
complex organ in the human body. The diencephalon’s functional equilibrium is
delicately poised, so that whatever happens in one part has repercussions in others. In
obesity this balance is out of kilter and can only be restored if the technique I am about to
describe is followed implicitly. Even seemingly insignificant deviations, particularly
those that at first sight seem to be an improvement, are very liable to produce most
disappointing results and even annul the effect completely. For instance, if the diet is
increased from 500 to 600 or 700 Calories, the loss of weight is quite unsatisfactory. If
the daily dose of HCG is raised to 200 or more units daily its action often appears to be
reversed, possibly because larger doses evoke diencephalic counter-regulations. On the
other hand, the diencephalon is an extremely robust organ in spite of its unbelievable
intricacy. From an evolutionary point of view it is one of the oldest organs in our body
and its evolutionary history dates back more than 500 million years. This has tendered it
extraordinarily adaptable to all natural exigencies, and that is one of the main reasons
why the human species was able to evolve. What its evolution did not prepare it for were
the conditions to which human culture and civilization now expose it.

History taking
When a patient first presents himself for treatment, we take a general history and note the
time when the first signs of overweight were observed. We try to establish the highest
weight the patient has ever had in his life (obviously excluding pregnancy), when this
was, and what measures have hitherto been taken in an effort to reduce.

It has been our experience that those patients who have been taking thyroid preparations
for long periods have a slightly lower average loss of weight under treatment with HCG
than those who have never taken thyroid. This is even so in those patients who have been
taking thyroid because they had an abnormally low basal metabolic rate. In many of these
cases the low BMR is not due to any intrinsic deficiency of the thyroid gland, but rather
to a lack of diencephalic stimulation of the thyroid gland via the anterior pituitary lobe.
We never allow thyroid to be taken during treatment, and yet a BMR which was very low
before treatment is usually found to be normal after a week or two of HCG + diet.

Needless to say, this does not apply to those cases in which a thyroid deficiency has been
produced by the surgical removal of a part of an overactive gland. It is also most
important to ascertain whether the patient has taken diuretics (water eliminating pills) as
this also decreases the weight loss under the HCG regimen.

Returning to our procedure, we next ask the patient a few questions to which he is held to
reply simply with “yes” or “no”. These questions are: Do you suffer from headaches?
rheumatic pains? menstrual disorders? constipation? breathlessness or exertion? swollen
ankles? Do you consider yourself greedy? Do you feel the need to eat snacks between
meals?

The patient then strips and is weighed and measured. The normal weight for his height,
age, skeletal and muscular build is established from tables of statistical averages,
whereby in women it is often necessary to make an allowance for particularly large and
heavy breasts. The degree of overweight is then calculated, and from this the duration of
treatment can be roughly assessed on the basis of an average loss of weight of a little less
than a pound, say 300-400 grams-per injection, per day. It is a particularly interesting
feature of the HCG treatment that in reasonably cooperative patients this figure is
remarkably constant, regardless of sex, age and degree of overweight.

The Duration of Treatment
Patients who need to lose 15 pounds (7 kg.) or less require 26 days treatment with 23
daily injections. The extra three days are needed because all patients must continue the
500-Calorie diet for three days after the last injection. This is a very essential part of the
treatment, because if they start eating normally as long as there is even a trace of HCG in
their body they put on weight alarmingly at the end of the treatment. After three days
when all the HCG has been eliminated this does not happen, because the blood is then no
longer saturated with food and can thus accommodate an extra influx from the intestines
without increasing its volume by retaining water.

We never give a treatment lasting less than 26 days, even in patients needing to lose only
5 pounds. It seems that even in the mildest cases of obesity the diencephalon requires
about three weeks rest from the maximal exertion to which it has been previously
subjected in order to regain fully its normal fat-banking capacity. Clinically this
expresses itself, in the fact that, when in these mild cases, treatment is stopped as soon as
the weight is normal, which may be achieved in a week, it is much more easily regained
than after a full course of 23 injections.

As soon as such patients have lost all their abnormal superfluous fat, they at once begin
to feel ravenously hungry in spite of continued injections. This is because HCG only puts
abnormal fat into circulation and cannot, in the doses used, liberate normal fat deposits;
indeed, it seems to prevent their consumption. As soon as their statistically normal weight
is reached, these patients are put on 800-1000 Calories for the rest of the treatment.
The diet is arranged in such a way that the weight remains perfectly stationary and is thus
continued for three days after the 23rd injection. Only then are the patients free to eat
anything they please except sugar and starches for the next three weeks.

Such early cases are common among actresses, models, and persons who are tired of
obesity, having seen its ravages in other members of their family. Film actresses
frequently explain that they must weigh less than normal. With this request we flatly
refuse to comply, first, because we undertake to cure a disorder, not to create a new one,
and second, because it is in the nature of the HCG method that it is self limiting. It
becomes completely ineffective as soon as all abnormal fat is consumed. Actresses with a
slight tendency to obesity, having tried all manner of reducing methods, invariably come
to the conclusion that their figure is satisfactory only when they are underweight, simply
because none of these methods remove their superfluous fat deposits. When they see that
under HCG their figure improves out of all proportion to the amount of weight lost, they
are nearly always content to remain within their normal weight-range.

When a patient has more than 15 pounds to lose the treatment takes longer but the
maximum we give in a single course is 40 injections, nor do we as a rule allow patients to
lose more than 34 lbs. (15 Kg.) at a time. The treatment is stopped when either 34 lbs.
have been lost or 40 injections have been given. The only exception we make is in the
case of grotesquely obese patients who may be allowed to lose an additional 5-6 lbs. if
this occurs before the 40 injections are up.

Immunity to HCG
The reason for limiting a course to 40 injections is that by then some patients may begin
to show signs of HCG immunity. Though this phenomenon is well known, we cannot as
yet define the underlying mechanism. Maybe after a certain length of time the body
learns to break down and eliminate HCG very rapidly, or possibly prolonged treatment
leads to some sort of counter-regulation which annuls the diencephalic effect.
After 40 daily injections it takes about six weeks before this so called immunity is lost
and HCG again becomes fully effective. Usually after about 40 injections patients may
feel the onset of immunity as hunger which was previously absent. In those
comparatively rare cases in which signs of immunity develop before the full course of 40
injections has been completed-say at the 35th injection- treatment must be stopped at
once, because if it is continued the patients begin to look weary and drawn, feel weak and
hungry and any further loss of weight achieved is then always at the expense of normal
fat. This is not only undesirable, but normal fat is also instantly regained as soon as the
patient is returned to a free diet.

Patients who need only 23 injections may be injected daily, including Sundays, as they
never develop immunity. In those that take 40 injections the onset of immunity can be
delayed if they are given only six injections a week, leaving out Sundays or any other day
they choose, provided that it is always the same day. On the days on which they do not
receive the injections they usually feel a slight sensation of hunger. At first we thought
that this might be purely psychological, but we found that when normal saline is injected
without the patient’s knowledge the same phenomenon occurs.

Menstruation
During menstruation no injections are given, but the diet is continued and causes no
hardship; yet as soon as the menstruation is over, the patients become extremely hungry
unless the injections are resumed at once. It is very impressive to see the suffering of a
woman who has continued her diet for a day or two beyond the end of the period without
coming for her injection and then to hear the next day that all hunger ceased within a few
hours after the injection and to see her once again content, florid and cheerful. While on
the question of menstruation it must he added that in teenaged girls the period may in
some rare cases be delayed and exceptionally stop altogether. If then later this is
artificially induced some weight may be regained.

Further Courses
Patients requiring the loss of more than 34 lbs. must have a second or even more courses.
A second course can be started after an interval of not less than six weeks, though the
pause can be more than six weeks. When a third, fourth or even fifth course is necessary,
the interval between courses should be made progressively longer. Between a second and
third course eight weeks should elapse, between a third and fourth course twelve weeks,
between a fourth and fifth course twenty weeks and between a fifth and sixth course six
months. In this way it is possible to bring about a weight reduction of 100 lbs. and more
if required without the least hardship to the patient.

In general, men do slightly better than women and often reach a somewhat higher
average daily loss. Very advanced cases do a little better than early ones, but it is a
remarkable fact that this difference is only just statistically significant.
Conditions that must be accepted before treatment

On the basis of these data the probable duration of treatment can he calculated with
considerable accuracy, and this is explained to the patient. It is made clear to him that
during the course of treatment he must attend the clinic daily to be weighed, injected and
generally checked. All patients that live in Rome or have resident friends or relations
with whom they can stay are treated as out-patients, but patients coming from abroad
must stay in the hospital, as no hotel or restaurant can be relied upon to prepare the diet
with sufficient accuracy. These patients have their meals, sleep, and attend the clinic in
the hospital, but are otherwise free to spend their time as they please in the city and its
surroundings sightseeing, bathing or theater-going.

It is also made clear that between courses the patient gets no treatment and is free to eat
anything he pleases except starches and sugar during the first 3 weeks. It is impressed
upon him that he will have to follow the prescribed diet to the letter and that after the first
three days this will cost him no effort, as he will feel no hunger and may indeed have
difficulty in getting down the 500 Calories which he will be given. If these conditions are
not acceptable the case is refused, as any compromise or half measure is bound to prove
utterly disappointing to patient and physician alike and is a waste of time and energy.
Though a patient can only consider himself really cured when he has been reduced to his
statistically normal weight, we do not insist that he commit himself to that extent. Even a
partial loss of overweight is highly beneficial, and it is our experience that once a patient
has completed a first course he is so enthusiastic about the ease with which the – to him
surprising – results are achieved that he almost invariably comes back for more. There
certainly can be no doubt that in my clinic more time is spent on damping overenthusiasm
than on insisting that the rules of the treatment be observed.

Examining the patient
Only when agreement is reached on the points so far discussed do we proceed with the
examination of the patient. A note is made of the size of the first upper incisor, of a pad
of fat on the nape of the neck, at the axilla and on the inside of the knees. The presence of
striation, a suprapubic fold, a thoracic fold, angulation of elbow and knee joint, breastdevelopment
in men and women, edema of the ankles and the state of genital
development in the male are noted.

Wherever this seems indicated we X-ray the sella turcica, as the bony capsule which
contains the pituitary gland is called, measure the basal metabolic rate, X-ray the chest
and take an electrocardiogram. We do a blood-count and a sedimentation rate and
estimate uric acid, cholesterol, iodine and sugar in the fasting blood.

Gain before Loss
Patients whose general condition is low, owing to excessive previous dieting, must eat to
capacity for about one week before starting treatment, regardless of how much weight
they may gain in the process. One cannot keep a patient comfortably on 500 Calories
unless his normal fat reserves are reasonably well stocked. It is for this reason also that
every case, even those that are actually gaining must eat to capacity of the most
fattening food they can get down until they have had the third injection. It is a
fundamental mistake to put a patient on 500 Calories as soon as the injections are started,
as it seems to take about three injections before abnormally deposited fat begins to
circulate and thus become available.

We distinguish between the first three injections, which we call “non-effective” as far as
the loss of weight is concerned, and the subsequent injections given while the patient is
dieting, which we call “effective”. The average loss of weight is calculated on the number
of effective injections and from the weight reached on the day of the third injection which
may be well above what it was two days earlier when the first injection was given.

Most patients who have been struggling with diets for years and know how rapidly they
gain if they let themselves go are very hard to convince of the absolute necessity of
gorging for at least two days, and yet this must he insisted upon categorically if the
further course of treatment is to run smoothly. Those patients who have to be put on
forced feeding for a week before starting the injections usually gain weight rapidly – four
to six pounds in 24 hours is not unusual – but after a day or two this rapid gain generally
levels off. In any case, the whole gain is usually lost in the first 48 hours of dieting. It is
necessary to proceed in this manner because the gain re-stocks the depleted normal
reserves, whereas the subsequent loss is from the abnormal deposits only.

Patients in a satisfactory general condition and those who have not just previously
restricted their diet start forced feeding on the day of the first injection. Some patents say
that they can no longer overeat because their stomach has shrunk after years of
restrictions. While we know that no stomach ever shrinks, we compromise by insisting
that they eat frequently of highly concentrated foods such as milk chocolate, pastries with
whipped cream sugar, fried meats (particularly pork), eggs and bacon, mayonnaise, bread
with thick butter and jam, etc. The time and trouble spent on pressing this point upon
incredulous or reluctant patients is always amply rewarded afterwards by the complete
absence of those difficulties which patients who have disregarded these instructions are
liable to experience.

During the two days of forced feeding from the first to the third injection – many patients
are surprised that contrary to their previous experience they do not gain weight and some
even lose. The explanation is that in these cases there is a compensatory flow of urine,
which drains excessive water from the body. To some extent this seems to be a direct
action of HCG, but it may also be due to a higher protein intake, as we know that a
protein-deficient diet makes the body retain water.

Starting treatment
In menstruating women, the best time to start treatment is immediately after a period.
Treatment may also be started later, but it is advisable to have at least ten days in hand
before the onset of the next period. Similarly, the end of a course of HCG should never
be made to coincide with menstruation. If things should happen to work out that way, it is
better to give the last injection three days before the expected date of the menses so that a
normal diet can he resumed at onset. Alternatively, at least three injections should be
given after the period, followed by the usual three days of dieting. This rule need not be
observed in such patients who have reached their normal weight before the end of
treatment and are already on a higher caloric diet.

Patients who require more than the minimum of 23 injections and who therefore skip one
day a week in order to postpone immunity to HCG cannot have their third injections on
the day before the interval. Thus if it is decided to skip Sundays, the treatment can be
started on any day of the week except Thursdays. Supposing they start on Thursday, they
will have their third injection on Saturday, which is also the day on which they start their
500 Calorie diet. They would then have no injection on the second day of dieting; this
exposes them to an unnecessary hardship, as without the injection they will feel
particularly hungry. Of course, the difficulty can be overcome by exceptionally injecting
them on the first Sunday. If this day falls between the first and second or between the
second and third injection, we usually prefer to give the patient the extra day of forced
feeding, which the majority rapturously enjoy.

The Diet
The 500 Calorie diet is explained on the day of the second injection to those patients who
will be preparing their own food, and it is most important that the person who will
actually cook is present – the wife, the mother or the cook, as the case may be. Here in
Italy patients are given the following diet sheet.

Breakfast: Tea or coffee in any quantity without sugar.
Only one tablespoonful of milk allowed in 24
hours. Saccharin or Stevia may be used.

Lunch: 1. 100 grams of veal, beef, chicken breast,
fresh white fish, lobster, crab, or shrimp. All
visible fat must be carefully removed before
cooking, and the meat must be weighed raw. It
must be boiled or grilled without additional
fat. Salmon, eel, tuna, herring, dried or pickled
fish are not allowed. The chicken breast must
be removed from the bird.

2. One type of vegetable only to be chosen
from the following: spinach, chard, chicory,
beet-greens, green salad, tomatoes, celery,
fennel, onions, red radishes, cucumbers,
asparagus, cabbage.

3. One breadstick (grissino) or one Melba
toast.

4. An apple, orange, or a handful of
strawberries or one-half grapefruit.

Dinner : The same four choices as lunch (above.)
The juice of one lemon daily is allowed for all purposes. Salt, pepper, vinegar, mustard
powder, garlic, sweet basil, parsley, thyme, majoram, etc., may be used for seasoning, but
no oil, butter or dressing.

Tea, coffee, plain water, or mineral water are the only drinks allowed, but they may be
taken in any quantity and at all times.

In fact, the patient should drink about 2 liters of these fluids per day. Many patients are
afraid to drink so much because they fear that this may make them retain more water.

This is a wrong notion as the body is more inclined to store water when the intake falls
below its normal requirements.

The fruit or the breadstick may be eaten between meals instead of with lunch or dinner,
but not more than than four items listed for lunch and dinner may be eaten at one meal.

No medicines or cosmetics other than lipstick, eyebrow pencil and powder may be used
without special permission.

Every item in the list is gone over carefully, continually stressing the point that no
variations other than those listed may be introduced. All things not listed are forbidden,
and the patient is assured that nothing permissible has been left out. The 100 grams of
meat must he scrupulously weighed raw after all visible fat has been removed. To do this
accurately the patient must have a letter-scale, as kitchen scales are not sufficiently
accurate and the butcher should certainly not be relied upon. Those not uncommon
patients who feel that even so little food is too much for them, can omit anything they
wish.

There is no objection to breaking up the two meals. For instance having a breadstick and
an apple for breakfast or an orange before going to bed, provided they are deducted from
the regular meals. The whole daily ration of two breadsticks or two fruits may not be
eaten at the same time, nor can any item saved from the previous day be added on the
following day. In the beginning patients are advised to check every meal against their diet
sheet before starting to eat and not to rely on their memory. It is also worth pointing out
that any attempt to observe this diet without HCG will lead to trouble in two to three
days. We have had cases in which patients have proudly flaunted their dieting powers in
front of their friends without mentioning the fact that they are also receiving treatment
with HCG. They let their friends try the same diet, and when this proves to be a failure –
as it necessarily must – the patient starts raking in unmerited kudos for superhuman
willpower.

It should also be mentioned that two small apples weighing as much as one large one
never the less have a higher caloric value and are therefore not allowed though there is no
restriction on the size of one apple. Some people do not realize that a tangerine is not an
orange and that chicken breast does not mean the breast of any other fowl, nor does it
mean a wing or drumstick.

The most tiresome patients are those who start counting Calories and then come up with
all manner of ingenious variations which they compile from their little books. When one
has spent years of weary research trying to make a diet as attractive as possible without
jeopardizing the loss of weight, culinary geniuses who are out to improve their unhappy
lot are hard to take.

Making up the Calories
The diet used in conjunction with HCG must not exceed 500 Calories per day, and the
way these Calories are made up is of utmost importance. For instance, if a patient drops
the apple and eats an extra breadstick instead, he will not be getting more Calories but he
will not lose weight. There are a number of foods, particularly fruits and vegetables,
which have the same or even lower caloric values than those listed as permissible, and yet
we find that they interfere with the regular loss of weight under HCG, presumably owing
to the nature of their composition. Pimiento peppers, okra, artichokes and pears are
examples of this.

While this diet works satisfactorily in Italy, certain modifications have to be made in
other countries. For instance, American beef has almost double the caloric value of South
Italian beef, which is not marbled with fat. This marbling is impossible to remove. In
America, therefore, low-grade veal should be used for one meal and fish (excluding all
those species such as herring, mackerel, tuna, salmon, eel, etc., which have a high fat
content, and all dried, smoked or pickled fish), chicken breast, lobster, crawfish, prawns,
shrimps, crabmeat or kidneys for the other meal. Where the Italian breadsticks, the socalled
grissini, are not available, one Melba toast may be used instead, though they are
psychologically less satisfying. A Melba toast has about the same weight as the very
porous grissini which is much more to look at and to chew.

In many countries specially prepared unsweetened and low Calorie foods are freely
available, and some of these can be tentatively used. When local conditions or the
feeding habits of the population make changes necessary it must be borne in mind that
the total daily intake must not exceed 500 Calories if the best possible results are to be
obtained, that the daily ration should contain 200 grams of fat-free protein and a very
small amount of starch.

Just as the daily dose of HCG is the same in all cases, so the same diet proves to be
satisfactory for a small elderly lady of leisure or a hard working muscular giant. Under
the effect of HCG the obese body is always able to obtain all the Calories it needs from
the abnormal fat deposits, regardless of whether it uses up 1500 or 4000 per day. It must
be made very clear to the patient that he is living to a far greater extent on the fat which
he is losing than on what he eats.

Many patients ask why eggs are not allowed. The contents of two good sized eggs are
roughly equivalent to 100 grams of meat, but fortunately the yolk contains a large amount
of fat, which is undesirable. Very occasionally we allow egg – boiled, poached or raw – to
patients who develop an aversion to meat, but in this case they must add the white of
three eggs to the one they eat whole. In countries where cottage cheese made from
skimmed milk is available 100 grams may occasionally be used instead of the meat, but
no other cheeses are allowed.

Vegetarians
Strict vegetarians such as orthodox Hindus present a special problem, because milk and
curds are the only animal protein they will eat. To supply them with sufficient protein of
animal origin they must drink 500 cc. of skimmed milk per day, though part of this ration
can be taken as curds. As far as fruit, vegetables and starch are concerned, their diet is the
same as that of non-vegetarians; they cannot be allowed their usual intake of vegetable
proteins from leguminous plants such as beans or from wheat or nuts, nor can they have
their customary rice. In spite of these severe restrictions, their average loss is about half
that of non-vegetarians, presumably owing to the sugar content of the milk.

Faulty Dieting
Few patients will take one’s word for it that the slightest deviation from the diet has under
HCG disastrous results as far as the weight is concerned. This extreme sensitivity has the
advantage that the smallest error is immediately detectable at the daily weighing but most
patients have to make the experience before they will believe it.

Persons in high official positions such as embassy personnel, politicians, senior
executives, etc., who are obliged to attend social functions to which they cannot bring
their meager meal must be told beforehand that an official dinner will cost them the loss
of about three days treatment, however careful they are and in spite of a friendly and
would-be cooperative host. We generally advise them to avoid all-round embarrassment,
the almost inevitable turn of conversation to their weight problem and the outpouring of
lay counsel from their table partners by not letting it be known that they are under
treatment. They should take dainty servings of everything, hide what they can under the
cutlery and book the gain which may take three days to get rid of as one of the sacrifices
which their profession entails. Allowing three days for their correction, such incidents do
not jeopardize the treatment, provided they do not occur all too frequently in which case
treatment should be postponed to a socially more peaceful season.

Vitamins and Anemia
Sooner or later most patients express a fear that they may be running out of vitamins or
that the restricted diet may make them anemic. On this score the physician can
confidently relieve their apprehension by explaining that every time they lose a pound of
fatty tissue, which they do almost daily, only the actual fat is burned up; all the vitamins,
the proteins, the blood, and the minerals which this tissue contains in abundance are fed
back into the body. Actually, a low blood count not due to any serious disorder of the
blood forming tissues improves during treatment, and we have never encountered a
significant protein deficiency nor signs of a lack of vitamins in patients who are dieting
regularly.

The First Days of Treatment
On the day of the third injection it is almost routine to hear two remarks. One is: “You
know, Doctor, I’m sure it’s only psychological, but I already feel quite different”. So
common is this remark, even from very skeptical patients that we hesitate to accept the
psychological interpretation. The other typical remark is: “Now that I have been allowed
to eat anything I want, I can’t get it down. Since yesterday I feel like a stuffed pig. Food
just doesn’t seem to interest me any more, and I am longing to get on with your diet”.
Many patients notice that they are passing more urine and that the swelling in their ankles
is less even before they start dieting.

On the day of the fourth injection most patients declare that they are feeling fine. They
have usually lost two pounds or more, some say they feel a bit empty but hasten to
explain that this does not amount to hunger. Some complain of a mild headache of which
they have been forewarned and for which they have been given permission to take
aspirin.

During the second and third day of dieting – that is, the fifth and sixth injection-these
minor complaints improve while the weight continues to drop at about double the usually
overall average of almost one pound per day, so that a moderately severe case may by the
fourth day of dieting have lost as much as 8- 10 lbs.

It is usually at this point that a difference appears between those patients who have
literally eaten to capacity during the first two days of treatment and those who have not.
The former feel remarkably well; they have no hunger, nor do they feel tempted when
others eat normally at the same table. They feel lighter, more clear-headed and notice a
desire to move quite contrary to their previous lethargy. Those who have disregarded the
advice to eat to capacity continue to have minor discomforts and do not have the same
euphoric sense of well-being until about a week later. It seems that their normal fat
reserves require that much more time before they are fully stocked.

Fluctuations in weight loss
After the fourth or fifth day of dieting the daily loss of weight begins to decrease to one
pound or somewhat less per day, and there is a smaller urinary output. Men often
continue to lose regularly at that rate, but women are more irregular in spite of faultless
dieting. There may be no drop at all for two or three days and then a sudden loss which
reestablishes the normal average. These fluctuations are entirely due to variations in the
retention and elimination of water, which are more marked in women than in men.
The weight registered by the scale is determined by two processes not necessarily
synchronized. Under the influence of HCG, fat is being extracted from the cells, in
which it is stored in the fatty tissue. When these cells are empty and therefore serve no
purpose, the body breaks down the cellular structure and absorbs it, but breaking up of
useless cells, connective tissue, blood vessels, etc., may lag behind the process of fatextraction.
When this happens the body appears to replace some of the extracted fat with
water which is retained for this purpose. As water is heavier than fat the scales may show
no loss of weight, although sufficient fat has actually been consumed to make up for the
deficit in the 500-Calorie diet. When then such tissue is finally broken down, the water is
liberated and there is a sudden flood of urine and a marked loss of weight. This simple
interpretation of what is really an extremely complex mechanism is the one we give those
patients who want to know why it is that on certain days they do not lose, though they
have committed no dietary error.

Patients who have previously regularly used diuretics as a method of reducing, lose fat
during the first two or three weeks of treatment which shows in their measurements, but
the scale may show little or no loss because they are replacing the normal water content
of their body which has been dehydrated. Diuretics should never be used for reducing.

Interruptions of Weight Loss
We distinguish four types of interruption in the regular daily loss. The first is the one that
has already been mentioned in which the weight stays stationary for a day or two, and
this occurs, particularly towards the end of a course, in almost every case.

The Plateau
The second type of interruption we call a “plateau”. A plateau lasts 4-6 days and
frequently occurs during the second half of a full course, particularly in patients that have
been doing well and whose overall average of nearly a pound per effective injection has
been maintained. Those who are losing more than the average all have a plateau sooner or
later. A plateau always corrects, itself, but many patients who have become accustomed
to a regular daily loss get unnecessarily worried and begin to fret. No amount of
explanation convinces them that a plateau does not mean that they are no longer
responding normally to treatment.

In such cases we consider it permissible, for purely psychological reasons, to break up the
plateau. This can be done in two ways. One is a so-called “apple day”. An apple-day
begins at lunch and continues until just before lunch of the following day. The patients
are given six large apples and are told to eat one whenever they feel the desire though six
apples is the maximum allowed. During an apple-day no other food or liquids except
plain water are allowed and of water they may only drink just enough to quench an
uncomfortable thirst if eating an apple still leaves them thirsty. Most patients feel no need
for water and are quite happy with their six apples. Needless to say, an apple-day may
never be given on the day on which there is no injection. The apple-day produces a
gratifying loss of weight on the following day, chiefly due to the elimination of water.
This water is not regained when the patients resume their normal 500-Calorie diet at
lunch, and on the following days they continue to lose weight satisfactorily.

The other way to break up a plateau is by giving a non-mercurial diuretic[7] for one day.
This is simpler for the patient but we prefer the apple-day as we sometimes find that
though the diuretic is very effective on the following day it may take two to three days
before the normal daily reduction is resumed, throwing the patient into a new fit of
despair. It is useless to give either an apple-day or a diuretic unless the weight has been
stationary for at least four days without any dietary error having been committed.

Reaching a Former Level
The third type of interruption in the regular loss of weight may last much longer – ten
days to two weeks. Fortunately, it is rare and only occurs in very advanced cases, and
then hardly ever during the first course of treatment. It is seen only in those patients who
during some period of their lives have maintained a certain fixed degree of obesity for ten
years or more and have then at some time rapidly increased beyond that weight. When
then in the course of treatment the former level is reached, it may take two weeks of no
loss, in spite of HCG and diet, before further reduction is normally resumed.

Menstrual Interruption
The fourth type of interruption is the one which often occurs a few days before and
during the menstrual period and in some women at the time of ovulation. It must also be
mentioned that when a woman becomes pregnant during treatment – and this is by no
means uncommon – she at once ceases to lose weight. An unexplained arrest of reduction
has on several occasions raised our suspicion before the first period was missed. If in
such cases, menstruation is delayed, we stop injecting and do a precipitation test five days
later. No pregnancy test should be carried out earlier than five days after the last
injection, as otherwise the HCG may give a false positive result.

Oral contraceptives may be used during treatment.

Dietary Errors
Any interruption of the normal loss of weight which does not fit perfectly into one of
those categories is always due to some possibly very minor dietary error. Similarly, any
gain of more than 100 grams is invariably the result of some transgression or mistake,
unless it happens on or about the day of ovulation or during the three days preceding the
onset of menstruation, in which case it is ignored. In all other cases the reason for the
gain must be established at once.

The patient who frankly admits that he has stepped out of his regimen when told that
something has gone wrong is no problem. He is always surprised at being found out,
because unless he has seen this himself he will not believe that a salted almond, a couple
of potato chips, a glass of tomato juice or an extra orange will bring about a definite
increase in his weight on the following day.

Very often he wants to know why extra food weighing one ounce should increase his
weight by six ounces. We explain this in the following way: Under the influence of HCG
the blood is saturated with food and the blood volume has adapted itself so that it can
only just accommodate the 500 Calories which come in from the intestinal tract in the
course of the day. Any additional income, however little this may be, cannot be
accommodated and the blood is therefore forced to increase its volume sufficiently to
hold the extra food, which it can only do in a very diluted form. Thus it is not the weight
of what is eaten that plays the determining role but rather the amount of water which the
body must retain to accommodate this food.

This can be illustrated by mentioning the case of salt. In order to hold one teaspoonful of
salt the body requires one liter of water, as it cannot accommodate salt in any higher
concentration. Thus, if a person eats one teaspoonfull of salt his weight will go up by
more than two pounds as soon as this salt is absorbed from his intestine.

To this explanation many patients reply: Well, if I put on that much every time I eat a
little extra, how can I hold my weight after the treatment? It must therefore be made
clear that this only happens as long as they are under HCG. When treatment is over, the
blood is no longer saturated and can easily accommodate extra food without having to
increase its volume. Here again the professional reader will be aware that this
interpretation is a simplification of an extremely intricate physiological process which
actually accounts for the phenomenon.

Salt and Reducing
While we are on the subject of salt, I can take this opportunity to explain that we make no
restriction in the use of salt and insist that the patients drink large quantities of water
throughout the treatment. We are out to reduce abnormal fat and are not in the least
interested in such illusory weight losses as can be achieved by depriving the body of salt
and by desiccating it. Though we allow the free use of salt, the daily amount taken should
be roughly the same, as a sudden increase will of course be followed by a corresponding
increase in weight as shown by the scale. An increase in the intake of salt is one of the
most common causes for an increase in weight from one day to the next. Such an increase
can be ignored, provided it is accounted for. It in no way influences the regular loss of
fat.

Water
Patients are usually hard to convince that the amount of water they retain has nothing to
do with the amount of water they drink. When the body is forced to retain water, it will
do this at all costs. If the fluid intake is insufficient to provide all the water required, the
body withholds water from the kidneys and the urine becomes scanty and highly
concentrated, imposing a certain strain on the kidneys. If that is insufficient, excessive
water will be with-drawn from the intestinal tract, with the result that the feces become
hard and dry. On the other hand if a patient drinks more than his body requires, the
surplus is promptly and easily eliminated. Trying to prevent the body from retaining
water by drinking less is therefore not only futile but even harmful.

Constipation
An excess of water keeps the feces soft, and that is very important in the obese, who
commonly suffer from constipation and a spastic colon. While a patient is under
treatment we never permit the use of any kind of laxative taken by mouth. We explain
that owing to the restricted diet it is perfectly satisfactory and normal to have an
evacuation of the bowel only once every three to four days and that, provided plenty of
fluids are taken, this never leads to any disturbance. Only in those patients who begin to
fret after four days do we allow the use of a suppository. Patients who observe this rule
find that after treatment they have a perfectly normal bowel action and this delights many
of them almost as much as their loss of weight.

Investigating Dietary Errors
When the reason for a slight gain in weight is not immediately evident, it is necessary to
investigate further. A patient who is unaware of having committed an error or is
unwilling to admit a mistake protests indignantly when told he has done something he
ought not to have done. In that atmosphere no fruitful investigation can be conducted; so
we calmly explain that we are not accusing him of anything but that we know for certain
from our not inconsiderable experience that something has gone wrong and that we must
now sit down quietly together and try and find out what it was. Once the patient realizes
that it is in his own interest that he play an active and not merely a passive role in this
search, the reason for the setback is almost invariably discovered. Having been through
hundreds of such sessions, we are nearly always able to distinguish the deliberate liar
from the patient who is merely fooling himself or is really unaware of having erred.

Liars and Fools
When we see obese patients there are generally two of us present in order to speed up
routine handling. Thus when we have to investigate a rise in weight, a glance is sufficient
to make sure that we agree or disagree. If after a few questions we both feel reasonably
sure that the patient is deliberately lying, we tell him that this is our opinion and warn
him that unless he comes clean we may refuse further treatment. The way he reacts to this
furnishes additional proof whether we are on the right track or not we now very rarely
make a mistake.

If the patient breaks down and confesses, we melt and are all forgiveness and treatment
proceeds. Yet if such performances have to be repeated more than two or three times, we
refuse further treatment. This happens in less than 1% of our cases. If the patient is
stubborn and will not admit what he has been up to, we usually give him one more
chance and continue treatment even though we have been unable to find the reason for
his gain. In many such cases there is no repetition, and frequently the patient does then
confess a few days later after he has thought things over.

The patient who is fooling himself is the one who has committed some trifling, offense
against the rules but who has been able to convince himself that this is of no importance
and cannot possibly account for the gain in weight. Women seem particularly prone to
getting themselves entangled in such delusions. On the other hand, it does frequently
happen that a patient will in the midst of a conversation unthinkingly spear an olive or
forget that he has already eaten his breadstick.

A mother preparing food for the family may out of sheer habit forget that she must not
taste the sauce to see whether it needs more salt. Sometimes a rich maiden aunt cannot be
offended by refusing a cup of tea into which she has put two teaspoons of sugar,
thoughtfully remembering the patient’s taste from previous occasions. Such incidents are
legion and are usually confessed without hesitation, but some patients seem genuinely
able to forget these lapses and remember them with a visible shock only after insistent
questioning.

In these cases we go carefully over the day. Sometimes the patient has been invited to a
meal or gone to a restaurant, naively believing that the food has actually been prepared
exactly according to instructions. They will say: “Yes, now that I come to think of it the
steak did seem a bit bigger than the one I have at home, and it did taste better; maybe
there was a little fat on it, though I specially told them to cut it all away”. Sometimes the
breadsticks were broken and a few fragments eaten, and “Maybe they were a little more
than one”. It is not uncommon for patients to place too much reliance on their memory of
the diet-sheet and start eating carrots, beans or peas and then to seem genuinely surprised
when their attention is called to the fact that these are forbidden, as they have not been
listed.

Cosmetics
When no dietary error is elicited we turn to cosmetics. Most women find it hard to
believe that fats, oils, creams and ointments applied to the skin are absorbed and interfere
with weight reduction by HCG just as if they had been eaten. This almost incredible
sensitivity to even such very minor increases in nutritional intake is a peculiar feature of
the HCG method. For instance, we find that persons who habitually handle organic fats,
such as workers in beauty parlors, masseurs, butchers, etc. never show what we consider
a satisfactory loss of weight unless they can avoid fat coming into contact with their skin.

The point is so important that I will illustrate it with two cases. A lady who was
cooperating perfectly suddenly increased half a pound. Careful questioning brought
nothing to light. She had certainly made no dietary error nor had she used any kind of
face cream, and she was already in the menopause. As we felt that we could trust her
implicitly, we left the question suspended. Yet just as she was about to leave the consulting room she suddenly stopped, turned and snapped her fingers. “I’ve got it,” she said. This is what had happened : She had bought herself a new set of make-up pots and bottles and, using her fingers, had transferred her large assortment of cosmetics to the new containers in anticipation of the day she would be able to use them again after her treatment.

The other case concerns a man who impressed us as being very conscientious. He was
about 20 lbs. overweight but did not lose satisfactorily from the onset of treatment. Again
and again we tried to find the reason but with no success, until one day he said:“I never
told you this, but I have a glass eye. In fact, I have a whole set of them. I frequently
change them, and every time I do that I put a special ointment in my eyesocket.. Do you
think that could have anything to do with it?” As we thought just that, we asked him to
stop using this ointment, and from that day on his weight-loss was regular.

We are particularly averse to those modern cosmetics which contain hormones, as any
interference with endocrine regulations during treatment must be absolutely avoided.
Many women whose skin has in the course of years become adjusted to the use of fat
containing cosmetics find that their skin gets dry as soon as they stop using them. In such
cases we permit the use of plain mineral oil, which has no nutritional value. On the other
hand, mineral oil should not be used in preparing the food, first because of its undesirable
laxative quality, and second because it absorbs some fat-soluble vitamins, which are then
lost in the stool. We do permit the use of lipstick, powder and such lotions as are entirely
free of fatty substances. We also allow brilliantine to be used on the hair but it must not
be rubbed into the scalp. Obviously sun-tan oil is prohibited.

Many women are horrified when told that for the duration of treatment they cannot use
face creams or have facial massages. They fear that this and the loss of weight will ruin
their complexion. They can be fully reassured. Under treatment normal fat is restored to
the skin, which rapidly becomes fresh and turgid, making the expression much more
youthful. This is a characteristic of the HCG method which is a constant source of
wonder to patients who have experienced or seen in others the facial ravages produced by
the usual methods of reducing. An obese woman of 70 obviously cannot expect to have
her pued face reduced to normal without a wrinkle, but it is remarkable how youthful her
face remains in spite of her age.

The Voice
Incidentally, another interesting feature of the HCG method is that it does not ruin a
singing voice. The typically obese prima donna usually finds that when she tries to
reduce, the timbre of her voice is liable to change, and understandably this terrifies her.
Under HCG this does not happen; indeed, in many cases the voice improves and the
breathing invariably does. We have had many cases of professional singers very carefully
controlled by expert voice teachers, and the maestros have been so enthusiastic that they
now frequently send us patients.

Other Reasons for a Gain
Apart from diet and cosmetics there can be a few other reasons for a small rise in weight.
Some patients unwittingly take chewing gum, throat pastilles, vitamin pills, cough syrups
etc., without realizing that the sugar or fats they contain may interfere with a regular loss
of weight. Sex hormones or cortisone in its various modern forms must be avoided,
though oral contraceptives are permitted. In fact the only self-medication we allow is
aspirin for a headache, though headaches almost invariably disappear after a week of
treatment, particularly if of the migraine type.

Occasionally we allow a sleeping tablet or a tranquilizer, but patients should be told that
while under treatment they need and may get less sleep. For instance, here in Italy where
it is customary to sleep during the siesta which lasts from one to four in the afternoon
most patients find that though they lie down they are unable to sleep.

We encourage swimming and sun bathing during treatment, but it should be remembered
that a severe sunburn always produces a temporary rise in weight, evidently due to water
retention. The same may be seen when a patient gets a common cold during treatment.
Finally, the weight can temporarily increase – paradoxical though this may sound – after
an exceptional physical exertion of long duration leading to a feeling of exhaustion. A
game of tennis, a vigorous swim, a run, a ride on horseback or a round of golf do not
have this effect; but a long trek, a day of skiing, rowing or cycling or dancing into the
small hours usually result in a gain of weight on the following day, unless the patient is in
perfect training. In patients coming from abroad, where they always use their cars, we
often see this effect after a strenuous day of shopping on foot, sightseeing and visits to
galleries and museums. Though the extra muscular effort involved does consume some
additional Calories, this appears to be offset by the retention of water which the tired
circulation cannot at once eliminate.

Appetite-reducing Drugs
We hardly ever use amphetamines, the appetite-reducing drugs such as Dexedrin,
Dexamil, Preludin, etc., as there seems to be no need for them during the HCG treatment.
The only time we find them useful is when a patient is, for impelling and unforeseen
reasons, obliged to forego the injections for three to four days and yet wishes to continue
the diet so that he need not interrupt the course.

Unforeseen Interruptions of Treatment
If an interruption of treatment lasting more than four days is necessary, the patient must
increase his diet to at least 800 Calories by adding meat, eggs, cheese, and milk to his diet
after the third day, as otherwise he will find himself so hungry and weak that he is unable
to go about his usual occupation. If the interval lasts less than two weeks the patient can
directly resume injections and the 500-Calorie diet, but if the interruption lasts longer he
must again eat normally until he has had his third injection.

When a patient knows beforehand that he will have to travel and be absent for more than
four days, it is always better to stop injections three days before he is due to leave so that
he can have the three days of strict dieting which are necessary after the last injection at
home. This saves him from the almost impossible task of having to arrange the 500
Calorie diet while en route, and he can thus enjoy a much greater dietary freedom from
the day of his departure. Interruptions occurring before 20 effective injections have been
given are most undesirable, because with less than that number of injections some weight
is liable to be regained. After the 20th injection an unavoidable interruption is merely a
loss of time.

Muscular Fatigue
Towards the end of a full course, when a good deal of fat has been rapidly lost, some
patients complain that lifting a weight or climbing stairs requires a greater muscular
effort than before. They feel neither breathlessness nor exhaustion but simply that their
muscles have to work harder. This phenomenon, which disappears soon after the end of
the treatment, is caused by the removal of abnormal fat deposited between, in, and around
the muscles. The removal of this fat makes the muscles too long, and so in order to
achieve a certain skeletal movement – say the bending of an arm – the muscles have to
perform greater contraction than before. Within a short while the muscle adjusts itself
perfectly to the new situation, but under HCG the loss of fat is so rapid that this
adjustment cannot keep up with it. Patients often have to be reassured that this does not
mean that they are “getting weak”. This phenomenon does not occur in patients who
regularly take vigorous exercise and continue to do so during treatment.

Massage
I never allow any kind of massage during treatment. It is entirely unnecessary and merely
disturbs a very delicate process which is going on in the tissues. Few indeed are the
masseurs and masseuses who can resist the temptation to knead and hammer abnormal fat
deposits. In the course of rapid reduction it is sometimes possible to pick up a fold of skin
which has not yet had time to adjust itself, as it always does under HCG, to the changed
figure. This fold contains its normal subcutaneous fat and may be almost an inch thick. It
is one of the main objects of the HCG treatment to keep that fat there. Patients and their
masseurs do not always understand this and give this fat a working-over. I have seen such
patients who were as black and blue as if they had received a sound thrashing.

In my opinion, massage, thumping, rolling, kneading, and shivering undertaken for the
purpose of reducing abnormal fat can do nothing but harm. We once had the honor of
treating the proprietress of a high class institution that specialized in such antics. She had
the audacity to confess that she was taking our treatment to convince her clients of the
efficacy of her methods, which she had found useless in her own case.

How anyone in his right mind is able to believe that fatty tissue can be shifted
mechanically or be made to vanish by squeezing is beyond my comprehension. The only
effect obtained is severe bruising. The torn tissue then forms scars, and these slowly
contract making the fatty tissue even harder and more unyielding.

A lady once consulted us for her most ungainly legs. Large masses of fat bulged over the
ankles of her tiny feet, and there were about 40 lbs. too much on her hips and thighs. We
assured her that this overweight could be lost and that her ankles would markedly
improve in the process. Her treatment progressed most satisfactorily but to our surprise
there was no improvement in her ankles. We then discovered that she had for years been
taking every kind of mechanical, electric and heat treatment for her legs and that she had
made up her mind to resort to plastic surgery if we failed.

Re-examining the fat above her ankles, we found that it was unusually hard. We
attributed this to the countless minor injuries inflicted by kneading. These injuries had
healed but had left a tough network of connective scar-tissue in which the fat was
imprisoned. Ready to try anything, she was put to bed for the remaining three weeks of
her first course with her lower legs tightly strapped in unyielding bandages. Every day
the pressure was increased. The combination of HCG, diet and strapping brought about a
marked improvement in the shape of her ankles. At the end of her first course she
returned to her home abroad. Three months later she came back for her second course.
She had maintained both her weight and the improvement of her ankles. The same
procedure was repeated, and after five weeks she left the hospital with a normal weight
and legs that, if not exactly shapely, were at least unobtrusive. Where no such injuries of
the tissues have been inflicted by inappropriate methods of treatment, these drastic
measures are never necessary.

Blood Sugar
Towards the end of a course or when a patient has nearly reached his normal weight it
occasionally happens that the blood sugar drops below normal, and we have even seen
this in patients who had an abnormally high blood sugar before treatment. Such an attack
of hypoglycemia is almost identical with the one seen in diabetics who have taken too
much insulin. The attack comes on suddenly; there is the same feeling of lightheadedness,
weakness in the knees, trembling, and unmotivated sweating; but under HCG, hypoglycemia does not produce any feeling of hunger. All these symptoms are almost instantly relieved by taking two heaped teaspoons of sugar.

In the course of treatment the possibility of such an attack is explained to those patients
who are in a phase in which a drop in blood sugar may occur. They are instructed to keep
sugar or glucose sweets handy, particularly when driving a car. They are also told to
watch the effect of taking sugar very carefully and report the following day. This is
important, because anxious patients to whom such an attack has been explained are apt to
take sugar unnecessarily, in which case it inevitably produces a gain in weight and does
not dramatically relieve the symptoms for which it was taken, proving that these were not
due to hypoglycemia. Some patients mistake the effects of emotional stress for
hypoglycemia. When the symptoms are quickly relieved by sugar this is proof that they
were indeed due to an abnormal lowering of the blood sugar, and in that case there is no
increase in the weight on the following day. We always suggest that sugar be taken if the
patient is in doubt.

Once such an attack has been relieved with sugar we have never seen it recur on the
immediately subsequent days, and only very rarely does a patient have two such attacks
separated by several days during a course of treatment. In patients who have not eaten
sufficiently during the first two days of treatment we sometimes give sugar when the
minor symptoms usually felt during the first three days of treatment continue beyond that
time, and in some cases this has seemed to speed up the euphoria ordinarily associated
with the HCG method.

The Ratio of Pounds to Inches
An interesting feature of the HCG method is that, regardless of how fat a patient is, the
greatest circumference — abdomen or hips as the case may be is reduced at a constant rate
which is extraordinarily close to 1 cm. per kilogram of weight lost. At the beginning of
treatment the change in measurements is somewhat greater than this, but at the end of a
course it is almost invariably found that the girth is as many centimeters less as the
number of kilograms by which the weight has been reduced. I have never seen this clear
cut relationship in patients that try to reduce by dieting only.

Preparing the Solution
Human chorionic gonadotrophin comes on the market as a highly soluble powder which
is the pure substance extracted from the urine of pregnant women. Such preparations are
carefully standardized, and any brand made by a reliable pharmaceutical company is
probably as good as any other. The substance should be extracted from the urine and not
from the placenta, and it must of course be of human and not of animal origin. The
powder is sealed in ampoules or in rubber-capped bottles in varying amounts which are
stated in International Units. In this form HCG is stable; however, only such preparations
should be used that have the date of manufacture and the date of expiry clearly stated on
the label or package. A suitable solvent is always supplied in a separate ampoule in the
same package.

Once HCG is in solution it is far less stable. It may be kept at room-temperature for two
to three days, but if the solution must be kept longer it should always be refrigerated.
When treating only one or two cases simultaneously, vials containing a small number of
units say 1000 I.U. should be used. The 10 cc. of solvent which is supplied by the
manufacturer is injected into the rubber- capped bottle containing the HCG, and the
powder must dissolve instantly. Of this solution 1.25 cc. are withdrawn for each
injection. One such bottle of 1000 I.U. therefore furnishes 8 injections. When more than
one patient is being treated, they should not each have their own bottle but rather all be
injected from the same vial and a fresh solution made when this is empty.

As we are usually treating a fair number of patients at the same time, we prefer to use
vials containing 5000 units. With these the manufactures also supply 10 cc. of solvent. Of
such a solution 0.25 cc. contain the 125 I.U., which is the standard dose for all cases and
which should never be exceeded. This small amount is awkward to handle accurately (it
requires an insulin syringe) and is wasteful, because there is a loss of solution in the
nozzle of the syringe and in the needle. We therefore prefer a higher dilution, which we
prepare in the following way: The solvent supplied is injected into the rubbercapped
bottle containing the 5000 I.U . As these bottles are too small to hold more solvent, we
withdraw 5 cc., inject it into an empty rubber-capped bottle and add 5 cc. of normal
saline to each bottle. This gives us 10 cc. of solution in each bottle, and of this solution
0.5 cc. contains 125 I.U. This amount is convenient to inject with an ordinary syringe.

Injecting
HCG produces little or no tissue-reaction, it is completely painless and in the many
thousands of injections we have given we have never seen an inflammatory or
suppurative reaction at the site of the injection.

One should avoid leaving a vacuum in the bottle after preparing the solution or after
withdrawal of the amount required for the injections as otherwise alcohol used for
sterilizing a frequently perforated rubber cap might be drawn into the solution. When
sharp needles are used, it sometimes happens that a little bit of rubber is punched out of
the rubber cap and can be seen as a small black speck floating in the solution. As these
bits of rubber are heavier than the solution they rapidly settle out, and it is thus easy to
avoid drawing them into the syringe.

We use very fine needles that are two inches long and inject deep intragluteally in the
outer upper quadrant of the buttocks. The injection should if possible not be given into
the superficial fat layers, which in very obese patients must be compressed so as to enable
the needle to reach the muscle. Obviously needles and syringes must be carefully washed,
sterilized and handled aseptically.[8] It is also important that the daily injection should be
given at intervals as close to 24 hours as possible. Any attempt to economize in time by
giving larger doses at longer intervals is doomed to produce less satisfactory results.
There are hardly any contraindications to the HCG method. Treatment can be continued
in the presence of abscesses, suppuration, large infected wounds and major fractures.
Surgery and general anesthesia are no reason to stop and we have given treatment during
a severe attack of malaria. Acne or boils are no contraindication; the former usually
clears up, and furunculosis comes to an end. Thrombophlebitis is no contraindication, and
we have treated several obese patients with HCG and the 500-Calorie diet while suffering
from this condition. Our impression has been that in obese patients the phlebitis does
rather better and certainly no worse than under the usual treatment alone. This also
applies to patients suffering from varicose ulcers which tend to heal rapidly.

Fibroids
While uterine fibroids seem to be in no way affected by HCG in the doses we use, we
have found that very large, externally palpable uterine myomas are apt to give trouble.
We are convinced that this is entirely due to the rather sudden disappearance of fat from
the pelvic bed upon which they rest and that it is the weight of the tumor pressing on the
underlying tissues which accounts for the discomfort or pain which may arise during
treatment. While we disregard even fair-sized or multiple myomas, we insist that very
large ones be operated before treatment. We have had patients present themselves for
reducing fat from their abdomen who showed no signs of obesity, but had a large
abdominal tumor.

Gallstones
Small stones in the gall bladder may in patients who have recently had typical colics
cause more frequent colics under treatment with HCG. This may be due to the almost
complete absence of fat from the diet, which prevents the normal emptying of the gall
bladder. Before undertaking treatment we explain to such patients that there is a risk of
more frequent and possibly severe symptoms and that it may become necessary to
operate. If they are prepared to take this risk and provided they agree to undergo an
operation if we consider this imperative, we proceed with treatment, as after weight
reduction with HCG the operative risk is considerably reduced in an obese patient. In
such cases we always give a drug which stimulates the flow of bile, and in the majority of
cases nothing untoward happens. On the other hand, we have looked for and not found
any evidence to suggest that the HCG treatment leads to the formation of gallstones as
pregnancy sometimes does.

The Heart
Disorders of the heart are not as a rule contraindications. In fact, the removal of abnormal
fat – particularly from the heart-muscle and from the surrounding of the coronary arteries
– can only be beneficial in cases of myocardial weakness, and many such patients are
referred to us by cardiologists. Within the first week of treatment all patients – not only
heart cases – remark that they have lost much of their breathlessness.

Coronary Occlusion
In obese patients who have recently survived a coronary occlusion, we adopt the
following procedure in collaboration with the cardiologist. We wait until no further
electrocardiographic changes have occurred for a period of three months. Routine
treatment is then started under careful control and it is usual to find a further
electrocardiographic improvement of a condition which was previously stationary.

In the thousands of cases we have treated we have not once seen any sort of coronary
incident occur during or shortly after treatment. The same applies to cerebral vascular
accidents. Nor have we ever seen a case of thrombosis of any sort develop during
treatment, even though a high blood pressure is rapidly lowered. In this respect, too, the
HCG treatment resembles pregnancy.

Teeth and Vitamins
Patients whose teeth are in poor repair sometimes get more trouble under prolonged
treatment, just as may occur in pregnancy. In such cases we do allow calcium and
vitamin D, though not in an oily solution. The only other vitamin we permit is vitamin C,
which we use in large doses combined with an antihistamine at the onset of a common
cold. There is no objection to the use of an antibiotic if this is required, for instance by
the dentist. In cases of bronchial asthma and hay fever we have occasionally resorted to
cortisone during treatment and find that triamcinolone is the least likely to interfere with
the loss of weight, but many asthmatics improve with HCG alone.

Alcohol
Obese heavy drinkers, even those bordering on alcoholism, often do surprisingly well
under HCG and it is exceptional for them to take a drink while under treatment. When
they do, they find that a relatively small quantity of alcohol produces intoxication. Such
patients say that they do not feel the need to drink. This may in part be due to the
euphoria which the treatment produces and in part to the complete absence of the need
for quick sustenance from which most obese patients suffer.

Though we have had a few cases that have continued abstinence long after treatment,
others relapse as soon as they are back on a normal diet. We have a few “regular
customers” who, having once been reduced to their normal weight, start to drink again
though watching their weight. Then after some months they purposely overeat in order to
gain sufficient weight for another course of HCG which temporarily gets them out of
their drinking routine. We do not particularly welcome such cases, but we see no reason
for refusing their request.

Tuberculosis
It is interesting that obese patients suffering from inactive pulmonary tuberculosis can be
safely treated. We have under very careful control treated patients as early as three
months after they were pronounced inactive and have never seen a relapse occur during
or shortly after treatment. In fact, we only have one case on our records in which active
tuberculosis developed in a young man about one year after a treatment which had lasted
three weeks. Earlier X-rays showed a calcified spot from a childhood infection which had
not produced clinical symptoms. There was a family history of tuberculosis, and his
illness started under adverse conditions which certainly had nothing to do with the
treatment. Residual calcifications from an early infection are exceedingly common, and
we never consider them a contraindication to treatment.

The Painful Heel
In obese patients who have been trying desperately to keep their weight down by severe
dieting, a curious symptom sometimes occurs. They complain of an unbearable pain in
their heels which they feel only while standing or walking. As soon as they take the
weight off their heels the pain ceases. These cases are the bane of the rheumatologists and
orthopedic surgeons who have treated them before they come to us. All the usual
investigations are entirely negative, and there is not the slightest response to antirheumatic
medication or physiotherapy. The pain may be so severe that the patients are
obliged to give up their occupation, and they are not infrequently labeled as a case of
hysteria. When their heels are carefully examined one finds that the sole is softer than
normal and that the heel bone – the calcaneus – can be distinctly felt, which is not the case
in a normal foot.

We interpret the condition as a lack of the hard fatty pad on which the calcaneus rests and
which protects both the bone and the skin of the sole from pressure. This fat is like a
springy cushion which carries the weight of the body. Standing on a heel in which this fat
is missing or reduced must obviously be very painful. In their efforts to keep their weight
down these patients have consumed this normal structural fat.

Those patients who have a normal or subnormal weight while showing the typically
obese fat deposits are made to eat to capacity, often much against their will, for one
week. They gain weight rapidly but there is no improvement in the painful heels. They
are then started on the routine HCG treatment. Overweight patients are treated
immediately. In both cases the pain completely disappears in 10-20 days of dieting,
usually around the 15th day of treatment, and so far no case has had a relapse though we
have been able to follow up such patients for years.

We are particularly interested in these cases, as they furnish further proof of the
contention that HCG + 500 Calories not only removes abnormal fat but actually permits
normal fat to be replaced, in spite of the deficient food intake. It is certainly not so that
the mere loss of weight reduces the pain, because it frequently disappears before the
weight the patient had prior to the period of forced feeding is reached.

The Skeptical Patient
Any doctor who starts using the HCG method for the first time will have considerable
difficulty, particularly if he himself is not fully convinced, in making patients believe that
they will not feel hungry on 500 Calories and that their face will not collapse. New
patients always anticipate the phenomena they know so well from previous treatments
and diets and are incredulous when told that these will not occur. We overcome all this
by letting new patients spend a little time in the waiting room with older hands, who can
always be relied upon to allay these fears with evangelistic zeal, often demonstrating the
finer points on their own body.

A waiting-room filled with obese patients who congregate daily is a sort of group
therapy. They compare notes and pop back into the waiting room after the consultation to
announce the score of the last 24 hours to an enthralled audience. They cross-check on
their diets and sometimes confess sins which they try to hide from us, usually with the
result that the patient in whom they have confided palpitatingly tattles the whole
disgraceful story to us with a “But don’t let her know I told you.”

Concluding a Course
When the three days of dieting after the last injection are over, the patients are told that
they may now eat anything they please, except sugar and starch provided they faithfully
observe one simple rule. This rule is that they must have their own portable bathroomscale
always at hand, particularly while traveling. They must without fail weigh themselves every morning as they get out of bed, having first emptied their bladder. If they are in the habit of having breakfast in bed, they must weigh before breakfast.

It takes about 3 weeks before the weight reached at the end of the treatment becomes
stable, i.e. does not show violent fluctuations after an occasional excess. During this
period patients must realize that the so-called carbohydrates, that is sugar, rice, bread,
potatoes, pastries, etc, are by far the most dangerous. If no carbohydrates whatsoever are
eaten, fats can be indulged in somewhat more liberally and even small quantities of
alcohol, such as a glass of wine with meals, does no harm, but as soon as fats and starch
are combined things are very liable to get out of hand. This has to be observed very
carefully during the first 3 weeks after the treatment is ended otherwise disappointments
are almost sure to occur.

Skipping a Meal
As long as their weight stays within two pounds of the weight reached on the day of the
last injection, patients should take no notice of any increase but the moment the scale
goes beyond two pounds, even if this is only a few ounces, they must on that same day
entirely skip breakfast and lunch but take plenty to drink. In the evening they must eat a
huge steak with only an apple or a raw tomato. Of course this rule applies only to the
morning weight. Ex-obese patients should never check their weight during the day, as
there may be wide fluctuations and these are merely alarming and confusing.

It is of utmost importance that the meal is skipped on the same day as the scale registers
an increase of more than two pounds and that missing the meals is not postponed until the
following day. If a meal is skipped on the day in which a gain is registered in the morning
this brings about an immediate drop of often over a pound. But if the skipping of the meal
– and skipping means literally skipping, not just having a light meal – is postponed the
phenomenon does not occur and several days of strict dieting may be necessary to correct
the situation.

Most patients hardly ever need to skip a meal. If they have eaten a heavy lunch they feel
no desire to eat their dinner, and in this case no increase takes place. If they keep their
weight at the point reached at the end of the treatment, even a heavy dinner does not
bring about an increase of two pounds on the next morning and does not therefore call for
any special measures. Most patients are surprised how small their appetite has become
and yet how much they can eat without gaining weight. They no longer suffer from an
abnormal appetite and feel satisfied with much less food than before. In fact, they are
usually disappointed that they cannot manage their first normal meal, which they have
been planning for weeks.

Losing more Weight
An ex-patient should never gain more than two pounds without immediately correcting
this, but it is equally undesirable that more than two lbs. be lost after treatment, because a
greater loss is always achieved at the expense of normal fat. Any normal fat that is lost is
invariably regained as soon as more food is taken, and it often happens that this rebound
overshoots the upper two lbs. limit.

Trouble After Treatment
Two difficulties may be encountered in the immediate post-treatment period. When a
patient has consumed all his abnormal fat or, when after a full course, the injection has
temporarily lost its efficacy owing to the body having gradually evolved a counter
regulation, the patient at once begins to feel much more hungry and even weak. In spite
of repeated warnings, some over-enthusiastic patients do not report this. However, in
about two days the fact that they are being undernourished becomes visible in their faces,
and treatment is then stopped at once. In such cases – and only in such cases – we allow a
very slight increase in the diet, such as an extra apple, 150 grams of meat or two or three
extra breadsticks during the three days of dieting after the last injection.

When abnormal fat is no longer being put into circulation either because it has been
consumed or because immunity has set in, this is always felt by the patient as sudden,
intolerable and constant hunger. In this sense, the HCG method is completely selflimiting.

With HCG it is impossible to reduce a patient, however enthusiastic, beyond his
normal weight. As soon as no more abnormal fat is being issued, the body starts
consuming normal fat, and this is always regained as soon as ordinary feeding is
resumed. The patient then finds that the 2-3 lbs. he has lost during the last days of
treatment are immediately regained. A meal is skipped and maybe a pound is lost. The
next day this pound is regained, in spite of a careful watch over the food intake. In a few
days a tearful patient is back in the consulting room, convinced that her case is a failure.
All that is happening is that the essential fat lost at the end of the treatment, owing to the
patient’s reluctance to report a much greater hunger, is being replaced. The weight at
which such a patient must stabilize thus lies 2-3 lbs. higher than the weight reached at the
end of the treatment. Once this higher basic level is established, further difficulties in
controlling the weight at the new point of stabilization hardly arise.

Beware of Over-enthusiasm
The other trouble which is frequently encountered immediately after treatment is again
due to over-enthusiasm. Some patients cannot believe that they can eat fairly normally
without regaining weight. They disregard the advice to eat anything they please except
sugar and starch and want to play safe. They try more or less to continue the 500-Calorie
diet on which they felt so well during treatment and make only minor variations, such as
replacing the meat with an egg, cheese, or a glass of milk. To their horror they find that in
spite of this bravura, their weight goes up. So, following instructions, they skip one
meager lunch and at night eat only a little salad and drink a pot of unsweetened tea,
becoming increasingly hungry and weak. The next morning they find that they have
increased yet another pound. They feel terrible, and even the dreaded swelling of their
ankles is back. Normally we check our patients one week after they have been eating
freely, but these cases return in a few days. Either their eyes are filled with tears or they
angrily imply that when we told them to eat normally we were just fooling them.

Protein deficiency
Here too, the explanation is quite simple. During treatment the patient has been only just
above the verge of protein deficiency and has had the advantage of protein being fed back
into his system from the breakdown of fatty tissue. Once the treatment is over there is no
more HCG in the body and this process no longer takes place. Unless an adequate amount
of protein is eaten as soon as the treatment is over, protein deficiency is bound to
develop, and this inevitably causes the marked retention of water known as hungeredema.

The treatment is very simple. The patient is told to eat two eggs for breakfast and a huge
steak for lunch and dinner followed by a large helping of cheese and to phone through the
weight the next morning. When these instructions are followed a stunned voice is heard
to report that two lbs. have vanished overnight, that the ankles are normal but that sleep
was disturbed, owing to an extraordinary need to pass large quantities of water. The
patient having learned this lesson usually has no further trouble.

Relapses
As a general rule one can say that 60%-70% of our cases experience little or no difficulty
in holding their weight permanently. Relapses may be due to negligence in the basic rule
of daily weighing. Many patients think that this is unnecessary and that they can judge
any increase from the fit of their clothes. Some do not carry their scale with them on a
journey as it is cumbersome and takes a big bite out of their luggage-allowance when
flying. This is a disastrous mistake, because after a course of HCG as much as 10 lbs. can
be regained without any noticeable change in the fit of the clothes. The reason for this is
that after treatment newly acquired fat is at first evenly distributed and does not show the
former preference for certain parts of the body.

Pregnancy or the menopause may annul the effect of a previous treatment. Women who
take treatment during the one year after the last menstruation – that is at the onset of the
menopause – do just as well as others, but among them the relapse rate is higher until the
menopause is fully established. The period of one year after the last menstruation applies
only to women who are not being treated with ovarian hormones. If these are taken, the
premenopausal period may be indefinitely prolonged.

Late teenage girls who suffer from attacks of compulsive eating have by far the worst
record of all as far as relapses are concerned.

Patients who have once taken the treatment never seem to hesitate to come back for
another short course as soon as they notice that their weight is once again getting out of
hand. They come quite cheerfully and hopefully, assured that they can be helped again.
Repeat courses are often even more satisfactory than the first treatment and have the
advantage, as do second courses, that the patient already, knows that he will feel
comfortable throughout.

Plan of a Normal Course
125 I.U. of HCG daily (except during menstruation) until 40 injections have been given.
Until 3rd injection forced feeding.

After 3rd injection, 500 Calorie diet to be continued until 72 hours after the last injection.
For the following 3 weeks, all foods allowed except starch and sugar in any form (careful
with very sweet fruit).

After 3 weeks, very gradually add starch in small quantities, always controlled by
morning weighing.

CONCLUSION
The HCG + diet method can bring relief to every case of obesity, but the method is not
simple. It is very time consuming and requires perfect cooperation between physician and
patient. Each case must be handled individually, and the physician must have time to
answer questions, allay fears and remove misunderstandings. He must also check the
patient daily. When something goes wrong he must at once investigate until he finds the
reason for any gain that may have occurred. In most cases it is useless to hand the patient
a diet-sheet and let the nurse give him a “shot.”

The method involves a highly complex bodily mechanism, and even though our theory
may be wrong the physician must make himself some sort of picture of what is actually
happening; otherwise he will not be able to deal with such difficulties as may arise during
treatment.

I must beg those trying the method for the first time to adhere very strictly to the
technique and the interpretations here outlined and thus treat a few hundred cases before
embarking on experiments of their own, and until then refrain from introducing
innovations, however thrilling they may seem. In a new method, innovations or
departures from the original technique can only be usefully evaluated against a
substantial background of experience with what is at the moment the orthodox procedure.

I have tried to cover all the problems that come to my mind. Yet a bewildering array of
new questions keeps arising, and my interpretations are still fluid. In particular, I have
never had an opportunity of conducting the laboratory investigations which are so
necessary for a theoretical understanding of clinical observations, and I can only hope
that those more fortunately placed will in time be able to fill this gap.

The problems of obesity are perhaps not so dramatic as the problems of cancer, or polio,
but they often cause life long suffering. How many promising careers have been ruined
by excessive fat; how many lives have been shortened. If some way -however
cumbersome – can be found to cope effectively with this universal problem of modern
civilized man, our world will be a happier place for countless fellow men and women.

GLOSSARY[9]
ACNE . . . Common skin disease in which pimples, often containing pus, appear on face,
neck and shoulders.
ACTH . . . Abbreviation for adrenocorticotrophic hormone. One of the many hormones
produced by the anterior lobe of the pituitary gland. ACTH controls the outer part, rind or
cortex of the adrenal glands. When ACTH is injected it dramatically relieves arthritic
pain, but it has many undesirable side effects, among which is a condition similar to
severe obesity. ACTH is now usually replaced by cortisone.
ADRENALIN . . . Hormone produced by the inner part of the Adrenals. Among many
other functions, adrenalin is concerned with blood pressure, emotional stress, fear and
cold.
ADRENALS . . . Endocrine glands. Small bodies situated atop the kidneys and hence
also known as suprarenal glands. The adrenals have an outer rind or cortex which
produces vitally important hormones, among which are Cortisone similar substances. The
adrenal cortex is controlled by ACTH. The inner part of the adrenals, the medulla,
secretes adrenalin and is chiefly controlled by the autonomous nervous system.
ADRENOCORTEX... See adrenals.
AMPHETAMINES . . . Synthetic drugs which reduce the awareness of hunger and
stimulate mental activity, rendering sleep impossible. When used for the latter two
purposes they are dangerously habit-forming. They do not diminish the body’s need for
food, but merely suppress the perception of that need. The original drug was known as
Benzedrine, from which modern variants such as Dexedrine, Dexamil, and Preludin, etc.,
have been derived. Amphetamines may help an obese patient to prevent a further increase
in weight but are unsatisfactory for reducing, as they do not cure the underlying disorder
and as their prolonged use may lead to malnutrition and addiction.
ARTERIOSCLEROSIS . . . Hardening of the arterial wall through the calcification of
abnormal deposits of a fatlike substance known as cholesterol.
ASCHHIEIM-ZONDEK . . . Authors of a test by which early pregnancy can be
diagnosed by injecting a woman’s urine into female mice. The HCG present in pregnancy
urine produces certain changes in the vagina of these animals. Many similar tests, using
other animals such as rabbits, frogs, etc. have been devised.
ASSIMILATE . . . Absorb digested food from the intestines.
AUTONOMOUS . . . Here used to describe the independent or vegetative nervous
system which manages the automatic regulations of the body.
BASAL METABOLISM . . . The body’s chemical turnover at complete rest and when
fasting. The basal metabolic rate is expressed as the amount of oxygen used up in a given
time. The basal metabolic rate (BMR) is controlled by the thyroid gland.
CALORIE . . . The physicist’s calorie is the amount of heat required to raise the
temperature of 1 cc. of water by 1 degree Centigrade. The dieticiari’s Calorie (always
written with a capital C) is 1000 times greater. Thus when we speak of a 500 Calorie diet
this means that the body is being supplied with as much fuel as would be required to raise
the temperature of 500 liters of water by 1 degree Centigrade or 50 liters by 10 degrees.

This is quite insufficient to cover the heat and energy requirements of an adult body. In
the HCG method the deficit is made up from the abnormal fat-deposits, of which 1 lb.
furnishes the body with more than 2000 Calories. As this is roughly the amount lost
every day, a patient under HCG is never short of fuel.
CEREBRAL . . . Of the brain. Cerebral vascular disease is a disorder concerning the
blood vessels of the brain, such as cerebral thrombosis or hemorrhage, known as
apoplexy or stroke.
CHOLESTEROL . . . A fatlike substance contained in almost every cell of the body. In
the blood it exists in two forms, known as free and esterified. The latter form is under
certain conditions deposited in the inner lining of the arteries (see arteriosclerosis). No
clear and definite relationship between fat intake and cholesterol-level in the blood has
yet been established.
CHORIONIC . . . Of the chorion, which is part of the placenta or after-birth. The term
chorionic is justly applied to HCG, as this hormone is exclusively produced in the
placenta, from where it enters the human mother’s blood and is later excreted in her urine.
COMPULSIVE EATING. . . A form of oral gratification with which a repressed sexinstinct
is sometimes vicariously relieved. Compulsive eating must not be confused with
the real hunger from which most obese patients suffer.
CONGENITAL . . . Any condition which exists at or before birth.
CORONARY ARTERIES . . . Two blood vessels which encircle the heart and supply
all the blood required by the heart-muscle.
CORPUS LUTEUM . . . A yellow body which forms in the ovary at the follicle from
which an egg has been detached. This body acts as an endocrine gland and plays an
important role in menstruation and pregnancy. Its secretion is one of the sex hormones,
and it is stimulated by another hormone known as LSH, which stands for luteum
stimulating hormones. LSH is produced in the anterior lobe of the pituitary gland. LSH is
truly gonadotrophic and must never be confused with HCG, which is a totally different
substance, having no direct action on the corpus luteum.
CORTEX . . . Outer covering or rind. The term is applied to the outer part of the adrenals
but is also used to describe the gray matter which covers the white matter of the brain.
CORTISONE . . . A synthetic substance which acts like an adrenal hormone. It is today
used in the treatment of a large number of illnesses, and several chemical variants have
been produced, among which are prednisone and triamcinolone.
CUSHING . . . A great American brain surgeon who described a condition of extreme
obesity associated with symptoms of adrenal disorder. Cushing’s Syndrome may be
caused by organic disease of the pituitary or the adrenal glands but, as was later
discovered, it also occurs as a result of excessive ACTH medication.
DIENCEPHALON . . . A primitive and hence very old part of the brain which lies
between and under the two large hemispheres. In man the diencephalon (or
hypothalamus) is subordinate to the higher brain or cortex, and yet it ultimately controls
all that happens inside the body. It regulates all the endocrine glands, the autonomous
nervous system, the turnover of fat and sugar. It seems also to be the seat of the primitive
animal instincts and is the relay station at which emotions are translated into bodily
reactions.
DIURETIC. . . Any substance that increases the flow of urine.
DYSFUNCTION . . . Abnormal functioning of any organ, be this excessive, deficient or
in any way altered.
EDEMA . . . An abnormal accumulation of water in the tissues.
ELECTROCARDIOGRAM . . . Tracing of electric phenomena taking place in the heart
during each beat. The tracing provides information about the condition and working of
the heart which is not otherwise obtainable.
ENDOCRINE . . . We distinguish endocrine and exocrine glands. The former produce
hormones, chemical regulators, which they secrete directly into the blood circulation in
the gland and from where they are carried all over the body. Examples of endocrine
glands are the pituitary, the thyroid and the adrenals. Exocrine glands produce a visible
secretion such as saliva, sweat, urine. There are also glands which are endocrine and
exocrine. Examples are the testicles, the prostate and the pancreas, which produces the
hormone insulin and digestive ferments which flow from the gland into the intestinal
tract. Endocrine glands are closely inter dependent of each other, they are linked to the
autonomous nervous system and the diencephalon presides over this whole incredibly
complex regulatory system.
EMACIATED . . . Grossly undernourished.
EUPHORIA . . . A feeling of particular physical and mental well being.
FERAL . . . Wild, unrestrained.
FIBROID . . . Any benign new growth of connective tissue. When such a tumor
originates from a muscle, it is known as a myoma. The most common seat of myomas is
the uterus.
FOLLICLE . . . Any small bodily cyst or sac containing a liquid. Here the term applies
to the ovarian cyst in which the egg is formed. The egg is expelled when a ripe follicle
bursts and this is known as ovulation (see corpus luteurn).
FSH . . . Abbreviation for follicle-stimulating hormone. FSH is another (see corpus
luteum) anterior pituitary hormone which acts directly on the ovarian follicle and is
therefore correctly called a gonadotrophin.
GLANDS . . . See endocrine.
GONADOTROPHIN . . . See corpus luteum, follicle and FSH. Gonadotrophic literally
means sex gland-directed. FSH, LSH and the equivalent hormones in the male, all
produced in the anterior lobe of the pituitary gland, are true gonadotrophins.
Unfortunately and confusingly, the term gonadotrophin has also been applied to the
placental hormone of pregnancy known as human chorionic gonadotrophin (HCG). This
hormone acts on the diencephalon and can only indirectly influence the sex-glands via
the anterior lobe of the pituitary.
HCG . . . Abbreviation for human chorionic gonadotrophin
HORMONES . . . See endocrine.
HYPERTENSION . . . High blood pressure.
HYPOGLYCEMIA . . . A condition in which the blood sugar is below normal. It can be
relieved by eating sugar.
HYPOPHYSIS . . . Another name for the pituitary gland.
HYPOTHESIS . . . A tentative explanation or speculation on how observed facts and
isolated scientific data can be brought into an intellectually satisfying relationship of
cause and effect. Hypotheses are useful for directing further research, but they are not
necessarily an exposition of what is believed to be the truth. Before a hypothesis can
advance to the dignity of a theory or a law, it must be confirmed by all future research.
As soon as research turns up data which no longer fit the hypothesis, it is immediately
abandoned for a better one.
LSH . . . See corpus luteum.
METABOLISM . . . See basal metabolism.
MIGRAINE . . . Severe half-sided headache often associated with vomiting.
MUCOID . . . Slime-like.
MYOCARDIUM . . . The heart-muscle.
MYOMA . . . See fibroid.
MYXEDEMA . . . Accumulation of a mucoid substance in the tissues which occurs in
cases of severe primary thyroid deficiency.
NEOLITHIC . . . In the history of human culture we distinguish the Early Stone Age or
Paleolithic, the Middle Stone Age or Mesolithic and the New Stone Age or Neolithic
period. The Neolithic period started about 8000 years ago when the first attempts at
agriculture, pottery and animal domestication made at the end of the Mesolithic period
suddenly began to develop rapidly along the road that led to modern civilization.
NORMAL SALINE . . . A low concentration of salt in water equal to the salinity of
body fluids.
PHLEBITIS . . . An inflammation of the veins. When a blood-clot forms at the site of
the inflammation, we speak of thrombophlebitis.
PITUITARY . . . A very complex endocrine gland which lies at the base of the skull,
consisting chiefly of an anterior and a posterior lobe. The pituitary is controlled by the
diencephalon, which regulates the anterior lobe by means of hormones which reach it
through small blood vessels. The posterior lobe is controlled by nerves which run from
the diencephalon into this part of the gland. The anterior lobe secretes many hormones,
among which are those that regulate other glands such as the thyroid, the adrenals and the
sex glands.
PLACENTA . . . The after-birth. In women, a large and highly complex organ through
which the child in the womb receives its nourishment from the mother’s body. It is the
organ in which HCG is manufactured and then given off into the mother’s blood.
PROTEIN . . . The living substance in plant and animal cells. Herbivorous animals can
thrive on plant protein alone, but man must have some protein of animal origin (milk,
eggs or flesh) to live healthily. When insufficient protein is eaten, the body retains water.
PSORIASIS . . . A skin disease which produces scaly patches. These tend to disappear
during pregnancy and during the treatment of obesity by the HCG method.
RENAL . . . Of the kidney.
RESERPINE . . . An Indian drug extensively used in the treatment of high blood
pressure and some forms of mental disorder.
RETENTION ENEMA . . . The slow infusion of a liquid into the rectum, from where it
is absorbed and not evacuated.
SACRUM . . . A fusion of the lower vertebrate into the large bony mass to which the
pelvis is attached.
SEDIMENTATION RATE . . . The speed at which a suspension of red blood cells
settles out. A rapid settling out is called a high sedimentation rate and may be indicative
of a large number of bodily disorders of pregnancy.
SEXUAL SELECTION . . . A sexual preference for individuals which show certain
traits. If this preference or selection goes on generation after generation, more and more
individuals showing the trait will appear among the general population. The natural
environment has little or nothing to do with this process. Sexual selection therefore
differs from natural selection, to which modern man is no longer subject because he
changes his environment rather than let the environment change him.
STRIATION . . . Tearing of the lower layers of the skin owing to rapid stretching in
obesity or during pregnancy. When first formed striae are dark reddish lines which later
change into white scars.
SUPRARENAL GLANDS . . . See adrenals.
SYNDROME . . . A group of symptoms which in their association are characteristic of a
particular disorder.
THROMBOPHLEBITIS . . . See phlebitis.
THROMBUS . . . A blood-clot in a blood-vessel.
TRIAMCINOLONE . . . A modern derivative of cortisone.
URIC ACID . . . A product of incomplete protein-breakdown or utilization in the body.
When uric acid becomes deposited in the gristle of the joints we speak of gout.
VARICOSE ULCERS . . . Chronic ulceration above the ankles due to varicose veins
which interfere with the normal blood circulation in the affected areas.
VEGETATIVE . . . See autonomous.
VERTEBRATE . . . Any animal that has a back-bone.

Literary References to the Use of
Chorionic Gonadotrophin in Obesity

THE LANCET
Nov. 6, 1954 Article Simeons
Nov. 15, 1958 Letter to Editor Simeons
July 29, 1961 Letter to Editor Lebon
Dec. 9, 1961 Article Carne
Dec. 9, 1961 Letter to Editor Kalina
Jan. 6, 1962 Letter to Editor Simeons
Nov. 26, 1966 Letter to Editor Lebon

THE JOURNAL OF THE AMERICAN GERIATRIC SOCIETY
Jan. 1956 Article Simeons
Oct. 1964 Article Harris& Warsaw
Feb. 1966 Article Lebon

THE AMERICAN JOURNAL OF CLINICAL NUTRITION
Sept.-Oct. 1959 Article Sohar
March 1963 Article Craig et al.
Sept. 1963 Letter to Editor Simeons
March 1964 Article Frank
Sept. 1964 Letter to Editor Simeons
Feb. 1965 Letter to Editor Hutton
June 1969 Editorial Albrink
June 1969 Special Article Gusman

THE JOURNAL OF PLASTIC SURGERY (British)
April 1962 Article Lebon

THE SOUTH AFRICAN MEDICAL JOURNAL
Feb 1963 Article Politzer, Berson & Flaks
A.T.W. SIMEONS
POUNDS AND INCHES Privately printed: obtainable only from A.T.W. Simeons,
Salvator Mundi International Hospital, Rome, Italy

VETSUCHT (Netherlands Edition) Wetenschappelijke Uitgeverij, N.V. Amsterdam
MAN’S PRESUMPTUOUS BRAIN Longman’s, Green, London
E.P. Dutton, New York (hardback)
Dutton Paperbacks, New York . . .