Adventures in Human Being by Gavin Francis

6 May 2015

Both a user’s guide to the body and a celebration of its elegance,

One tradition of visualising the body sees it through the lens of the surgeon-artists of old, who prepared images of disease and mutilation for the purposes of medical education. Though beautifully executed, those images were often amputated from their context – the lives and stories of the women they depicted.

 L0022481 Surgery: cancer of the breast.

Cancer of the Breast, Field Operation, just before the final cut (Wellcome Library).

Galen wrote that backache and limb-ache was common among widows who no longer had sex because of a build-up of female generative fluids within; the cure was to encourage discharge of this fluid, preferably through sex but if necessary through manual stimulation… This perspective on female sexuality went on in attenuated form until the early twentieth century: vibrators were invented for the treatment of women suffering from ‘hysteria’ and their use recommended right up until the diagnosis itself was struck out of the psychiatry textbooks in the 1950s. Some of these devices had fittings so that they could be driven by the home sewing machine.

 Demonstration Using the Vibrator, 1891 (Wellcome Collection).

Demonstration Using the Vibrator, 1891 (Wellcome Library).

I sit down at the side of his trolley, and look down on the muscles of his forearm as they gather towards the wrist. The tendons of the superficial finger flexors glint in the light: the thick bands of collagen are like the quills of a feather, but in place of the barbs and vanes of a feather are fleshy chevrons of muscle. I ask him to flex his fingers, and marvel at the sight of the muscles bunching – the extraordinary intricacy of the pulley systems that control the fingers. How mechanical we are.

 Detail from the Anatomy Lesson of Dr Nicolaes Tulp by Rembrandt.

Detail from the Anatomy Lesson of Dr Nicolaes Tulp by Rembrandt.

For some cultures, it has not been the affinity of afterbirth with the sea that has been celebrated, but its resemblance to a tree: the way that the spiral trunk of the cord seems rooted into the earth of the womb. I’ve been told that during the delivery of a baby – the second stage of labour – the pain women experience is that of relentless waves of pressure combined with the knife-and-fire stretching of the perineum. Passing the afterbirth is quite different; a deep sense of an uprooting, of something long buried being tugged free.

 Human Placenta in Cross-Section, from a German diagram (Wellcome Collection).

Human Placenta in Cross-Section, from a German diagram (Wellcome Library).

Just as a mammal’s need for amniotic fluid in the womb is an echo of a time when all beings gave birth in the sea, the fluids within the inner ear are a reminder that once, our ancestors’ balance organs were simply tubes open to seawater. As they rolled and pitched through the three dimensions, the free flow of seawater through those tubs conveyed our motion to the brain. Though it’s excluded from the usual roll call of five, balance is one of our most ancient senses: a portable sea anchor that moors us in the world.

 Interior of the Inner Ear - Right Osseous Labyrinth (from Gray's Anatomy 1918 edition).

Interior of the Inner Ear – Right Osseous Labyrinth (from Gray’s Anatomy 1918 edition).

When any fluid is forced through a narrow opening there is turbulence, and just as a river flooding through a narrow canyon can be deafening, turbulence within the heart generates noise. Medical students are trained to listen very closely to the subtleties of those noises, and to infer from them how narrow – or obstructed – are the canyons of the heart.

 Slice through the heart showing the ventricular septum (from Gray's Anatomy 1918 edition)

Slice through the heart showing the ventricular septum (from Gray’s Anatomy 1918 edition)

The hip is a strong joint: a bossed knuckle of bone clasped deep into a hollow of the pelvic skeleton. It’s buried beneath layers of the thickest and most powerful muscles in the body. There are four main groups of these, and all of them are active when walking: two groups have their greatest actions on the hip and two groups have their greater actions the knee… Each movement must take into account uneven terrain, movements of the trunk, and the balance and kinetics of the other leg.

 The Bones and Muscles of the Hip and Thigh, 1841 (Wellcome Collection).

The Bones and Muscles of the Hip and Thigh, 1841 (Wellcome Library).

X-ray images have a particular ethereal beauty to them, whatever part of the body they represent; contemplating them is a reminder not just of the skeleton and our mortality, but a way of transforming perspective and imagining the body anew. Sometimes they are like portraits, but they can also resemble landscape paintings with contours, horizons and cloudscapes. There are parallels in nomenclature: in emergency departments I’ve often ordered ‘skyline’ views of the knee, or ‘panoramic’ views of the jawbone. That those images have clinical importance, useful in diagnosis and treatment, makes them more, rather than less, beautiful.

 The Large Intestine made visible by Barium Enema (Diagnostic Image Centres, Kansas).

The Large Intestine made visible by Barium Enema (Diagnostic Image Centres, Kansas).

Medical students may learn the anatomy of the foot last and pay it little attention, but the foot is a marvel of engineering – when we run, around half of all the energy used in each step is stored in the elasticity of our Achilles tendons and sprung into the arches of the feet… Like the arrangement of spans on a bridge, the arches of the foot are necessary for strength: without them, the foot cannot adequately bear the weight of our bodies.

 The Longitudinal Arch of the Foot (from Gray's Anatomy 1918 edition).

The Longitudinal Arch of the Foot (from Gray’s Anatomy 1918 edition).

I’ve probably dissected between twenty and thirty human faces, but never lost the sense of privilege it afforded. Exposing each layer of the face was a process of gradual revelation, journeying from the skin, so reminiscent of life, down to the skull, so emblematic of death.  The very fragility of the facial muscles enforced a level of tenderness and respect.

 The Muscles of Facial Expression by Charles Bell 1806.

The Muscles of Facial Expression by Charles Bell 1806.

At first glance umbilical cords seem to come from the sea: opalescent and rubbery like jellyfish fronds or stems of kelp. Their contours are torqued in triple helix of blood vessels; twinned arteries spiralled around a single vein. The purplish blood vessels braid themselves through a greyish jelly composed of a substance used in only one other place in the body: the refractive humours of the eye. They look soft and delicate but are tougher than appearances suggest; for nine months they have to tether a baby to life.

 Foetus attached to the umbilical cord and placenta (Wellcome Collection).

Foetus attached to the umbilical cord and placenta (Wellcome Library).

The lungs are light as spirit because their tissue is so thin and delicate. The membranes within them are arranged so as to maximise exposure to breath, much as the leaves on deciduous trees maximise exposure to air. Just as leaves draw in carbon dioxide and leak oxygen, lungs draw in oxygen and leak carbon dioxide. If you were to stretch flat all the membranes of an adult’s lungs they would occupy over a thousand square feet; equivalent to the leaf coverage of a fifteen-to twenty-year-old oak. Listening with a stethoscope you can hear the flow of air across those membranes, like the rustle of leaves in a light breeze. When doctors listen to the breath, that’s what they want to hear: an openness connecting breath to the sky – lightness and the free motion of air.

 Bronchial Tube with its bronchioles' from Popular Science Monthly, 1881.

Bronchial Tube with its bronchioles’ from Popular Science Monthly, 1881.

It’s an unsettling experience to project an image of someone’s inner eye so neatly into your own, retina examining retina through the intermediary of the lens. It can be disorientating too: gazing down the axis of the beam is like looking up into the night sky with an eyeglass…. The first time I looked into the curved vault of a patient’s eyeball I was reminded of those medieval diagrams that showed the heavens as an upturned bowl.

 L'Atmosphere: Météorologie Populaire (Paris, 1888), pp. 163.

L’Atmosphere: Météorologie Populaire (Paris, 1888), pp. 163.

Gavin Francis is a GP and the author of True North and Empire Antarctica: Ice, Silence & Emperor Penguins. Find out more about his latest book, Adventures in Human Being.