The Open Heart Club

by Gabriel Brownstein

  “What does it mean?” I asked.

  He was silent and then spoke carefully. I seemed to be tolerating the situation well, and the history of patients after tetralogy correction suggested both that right ventricles, over time, tend to expand and weaken and that most people like me tended to do well despite that.

  “Should I get the catheter exam?” I asked.

  He asked me how I felt about the exam. I told him.

  He nodded. He needed time, he said. He wanted to look over the information that had been sent to him by Columbia. I was in no immediate danger, he assured me. He promised to give the case some thought and get back to me with a letter. I left the office. I stood out on Longwood Avenue and tried to hail a cab. I stepped like a New Yorker into traffic and raised an imperious hand. Every cab slipped by me. That wasn’t how it was done in Boston.

  I took the train back home feeling calmed. I had taken some kind of action. I had seen the oracle, and now I had to wait for the oracle’s report. This warm, gentle Harvard professor doctor was going to take care of me. I was sure of it.

  16.

  IMAGINE STENO AT the dissecting table in the anatomy theater in Leiden. It is 1663, winter in the Netherlands, cold, salty air. He is performing a three-day exploration of the brain. The corpse on the table has been disemboweled to reduce its odor. The audience is packed in rows. Light flows from the big windows. Candles burn close by the body. Steno dresses elegantly but simply. He wears a smock. Packs of drunken students fill the back rows. In the front row sit the university professors, chief among them Sylvius, the leading doctor in all of Holland, a large, bearded, darkly handsome man who makes twice the salary of any physician in the Netherlands. Beside Sylvius sits a foreign dignitary, Melchisédech Thévenot, an aristocrat, a scholar, and a spy, whose inventions included both the spirit level and ipecac as a cure for dysentery. (Thévenot’s book, The Art of Swimming, would later be a favorite of Ben Franklin’s; Thévenot advocated the breaststroke.) He was librarian to Louis XIV. The salons in his Paris home were the beginnings of the French Académie de Sciences, and from his collections of books and maps grew the Bibliotèque Nationale.

  Behind the faculty and the dignitaries sit the more advanced anatomy students, among them Jan Swammerdam. Swammerdam will become the greatest entomologist of his time, but right now he’s studying respiration, conducting loud, messy vivisections of dogs in rented rooms above public houses (he’s had to move four times in the last year). No one really knows what Swammerdam looked like. There’s a Rembrandt portrait of a man said to be him, but its authenticity is in dispute. So let’s make him small, handsome, and blond. He and Steno are inseparable.

  Beside Swammerdam stands Regnier de Graaf, twitchy and ambitious, a few years older than Steno and his great rival. After Steno has given up natural philosophy, de Graaf will claim Steno’s observations on the ovary as his own, and the follicle that releases the egg during ovulation—which Steno discovered—will be called the Graafian follicle. Steno, having abandoned science, will not protest. In the back row of the crowded room, incognito, stands Baruch Spinoza, who has recently been driven out of Amsterdam after being excommunicated by its rabbis. Spinoza is living not far from the university, among the Mennonites, making his living as a lens grinder. He has a high forehead and enormous brown eyes, and it’s never clear if he’s smiling or frowning.

  The dead man on the dissecting table has a neck that’s marked and twisted by the rope that hung him. “When the soul is in its own house,” Steno says, to open his discourse on the brain, “it cannot describe it and does no longer know itself.” From within the mind, Steno argues, we cannot understand the brain.

  He is elegant in his work with the saw, scalpel, scissors, and probe. He’s much stronger than his small frame lets on and cuts through the skull without much effort. After sawing a line on either side of the head, he asks for a hammer and chisel. He smacks the chisel smartly, removes it, and delivers a blow to the other side. He frees the top of the head, which he hands like a bowl to his waiting assistant.

  Steno directs his audience’s attention to the brain and how little can be viewed from the outside. “All you can say is that there are different substances, one grayish, and one white, that the white substance is continuous with nerves which are distributed all over the body.” His lecture is less about the anatomy of the brain than about the impossibility of knowing it. Slice it in pieces, unravel its folds, still you cannot see how it functions. “Personally I assert that the true dissection would be to follow the threads of the nerves through and where they arrive at. It is true that this manner meets so many difficulties that I do not know it could ever be completed.” He shows how the substance of the brain can be manipulated, how different anatomists mold it to support their various arguments and explanations.

  Steno reviews the history of brain science. He dismisses those philosophers who have opined on the nature of the brain without ever practicing anatomy. “One can read them only as amusement.” Finally, at the end of a long day, after having displayed the organ in all its detail, Steno praises the example of his mentor. He describes “the simplicity of Sylvius, who speaks to this matter only with uncertainty though he has worked on it more than anyone I know.” This is his conclusion: to be careful in one’s studies and modest in one’s claims. Steno bows.

  Sylvius congratulates him. Thévenot insists that Steno must come to France, to his salon, to lecture. Swammerdam, dazzled, cannot look Steno in the face. A banquet awaits, but just as Steno reaches the exit, a stranger accosts him and asks what implication his lecture has for René Descartes, for the posthumously published Treatise on Man, which scandalously proposes that the human body is a clockwork thing.

  Steno has been reading and rereading the Treatise on Man all week. He is obsessed with Descartes’s backward anatomy (Descartes has the heart working like a furnace, heating up the blood) and his scandalous theology. (If a person is like a clock and has no free will, then the whole moral order is thrown into question; if the person is built to sin, like a clock is built to tell time, then what point is there in repentance?) Steno has yet to meet anyone so interested in Descartes as he is. He and the stranger gesture excitedly as they talk. They finish each other’s sentences. Swammerdam tries to hustle Steno out the door.

  “You must come visit me in Rijksberg.” The stranger has big brown eyes and a long, delicate nose.

  Swammerdam is pulling at Steno’s arm.

  “I would be delighted,” Steno says. As he says it, he realizes who he’s talking to: the excommunicated Jew Spinoza, the famous heretic—talk to him and you will burn in hell! But Steno is open to everything.

  It takes him an hour to walk from Leiden to Rijksberg, past canals and windmills, farms and pastures, and hothouses full of tulips. Steno has been studying circulation, muscles and blood and hearts, and as he walks, he imagines the blood flying up his carotid artery and bathing his brain in light. He imagines the newly discovered blood vessels, the microscopic capillaries that run finely beneath the skin of his fingers. He can feel his heartbeat, he can feel his legs moving, muscles getting warm and sore, but he cannot, cannot feel a single fiber of his brain, a single function inside his mind. Will Spinoza have horns? Will the house smell of brimstone? There is an anxious moment as he approaches the door. But the room is bright. Steno is impressed by the simplicity of the place. The door is shut, and it’s like Steno has stepped into another world.

  They speak in Latin, a language that Steno has understood as long as he can remember and that Spinoza has only recently taught himself. They talk at first cautiously but then excitedly about Descartes and the nature of God, the relation between the divine and the physical. It is in the close study of nature that one sees the works of God, Steno avers, and it enrages him how Descartes fails to grasp the natural world’s complexity, a complexity much more baffling than any simple cuckoo clock. A question of mathematics, Spinoza says, and he argues that the divine is demonstrably inherent, logically
, in all things: in the brain, in the heart, and in the cuckoo clock. We are all, all made of God. Steno leaves Spinoza’s house, and it’s like he’s stoned.

  Watching the windmills turn, and the sunset, and the cows, it comes to him: he knows how to destroy Descartes. In Leiden in 1663, William Harvey’s theory of circulation was as controversial as global warming is in any university environmental studies program today, which is to say, circulation was accepted fact. There was a professional class, physicians, who opposed the theory of circulation because they feared it would undermine their business, and in the general population the notion of circulating blood was too spooky to be believed, but anatomists knew it was true: the blood moved around the body. As to the nature of the heart, anatomists were less unified. Descartes, in his Treatise on Man, described the heart the same way Shakespeare had—as a furnace, a warming engine. Steno doubted this was accurate. And he wondered how someone like Descartes, who didn’t understand the workings of something as simple as the heart, how such a person could claim to understand something as complex as the nature of God.

  Steno returned from Rijksberg and in his laboratory began to investigate the heart of a deer. He boiled the heart so as to firm it up before he looked more closely at its structure. He stripped off the pericardium. He examined the fibers strip by strip, strand by strand. “The first fibers of the heart which I touched, led me to the lower tip and from the tip upwards again,” he wrote, “a truth explaining the whole structure of the heart which up to that moment neither I nor anyone else had ever known.” His observations demonstrated that the heart was a muscle, shaped like a muscle, with fibers that worked like the fibers in other muscles. He compared the muscle fibers in his deer heart with those in the leg of a rabbit and found them to be identical.

  He had made his breakthrough. The heart, Steno wrote (emphasis his), was “not the seat of a determined substance like fire or innate heat or of the soul; also not the creator of a determined liquid, like the blood; also, not the producer of certain spirits like the vital spirits.” Everything Descartes had said about the heart was wrong. If Descartes could not know the heart, how could he presume to know God? “I knocked down all the constructions of these finest heads without words, only evidence,” he wrote. “The ancients did not know what is obvious every time meat is brought to the table.” Steno proved that the heart was made of meat and did so with holy purpose, to destroy the arguments of a heretic.

  After the publication of this discovery, Steno took up Thévenot’s invitation and left for Paris, bringing with him his companion Jan Swammerdam and a few other friends. They visited the Sorbonne together, and the Louvre, and the menagerie at Versailles. In the Tuileries, they saw Louis XIV bless and touch a crowd of scrofula patients, whose necks bulged with tumors. They attended a party where the Sun King led the dance. For Thévenot’s guests, Steno explored a calf’s head and showed the tear ducts, the salivary glands, and the ductus stenonius. He cut into the brain and pointed out the Sylvian fissure. Vivisecting a dog, Steno demonstrated circulation by ligating its abdominal aorta and paralyzing its legs. To refute Descartes’s claim that animals felt no pain, Steno touched the dog’s sciatic nerve. The dog writhed and howled.

  He performed an autopsy of a dead, deformed child. Windows were open. The smell of the corpse mixed with the stink of the street. The Frenchmen wore wigs and heavy coats, jewelry and high heels. They carried canes. The baby had a hand like a flipper, with all the fingers fused, and a ghastly harelip that the mother blamed on her own fondness for eating carrots.

  The stillborn appeared to be a hermaphrodite, but Steno showed that what looked like a penis was in fact a clitoris. His hair was long. He had a thick, drooping mustache between his big nose and fleshy lips. Andre Graindorge, a doctor who saw Steno perform at Thévenot’s, wrote, “To say it straight, compared with him we are like pupils.” According to another Parisian physician, “In this field he leaves behind him the ancients and the moderns.”

  The infant chest was almost entirely cartilaginous. The heart, the liver, and the spleen, Steno reported, “all adhered to the stomach.” What interested him most was the heart. He entered it and noted odd absences. The pulmonary artery was narrowed, narrower than the aorta. Steno opened the right ventricle and introduced his probe. Where he expected to find the solid muscle wall, he found a hole. There were “three orifices [leading] into the ventricle.” He saw that “the same canal” came from both ventricles into the aorta.

  Three hundred years before I was born, Steno saw it all: the ventricular septal defect, the overriding aorta, the stenosis of the pulmonary artery, and the thickened ventricle wall, the birth defect that has come to be known as the tetralogy of Fallot. Why God would form a child like that, Steno restrained from speculating. He declared, “I have nothing to say about the cause of this phenomenon.”

  That summer, he and Swammerdam moved to Thévenot’s country home to collaborate in their studies of reproduction. Picture the young men running through the high grass after specimens: chasing butterflies, catching tadpoles and frogs, examining the eggs of chickens, witnessing the sex of invertebrates, a summer of delight in the natural world. Swammerdam wrote sexy descriptions of the coitus of snails:

  After all is finished, the little creature, having wantonly consumed the strength of life, becomes dull and still, rests quietly without much creeping, until the furious lust of generation gathers new strength and effaces the memory of weariness suffered after the former coitus.

  The summer ended. Swammerdam went back to Holland to complete his studies and to be with his family. Steno had been turned down for a professorship at the University of Copenhagen and had no official position in Leiden or in France. Thévenot used his connections with the Medicis to secure Steno a position at the Pitti Palace, where the students of Galileo had formed a new scientific society, the Academia del Cimento. The couple parted. Steno walked all the way to Tuscany, sometimes with company and sometimes alone, more than six hundred miles. Decades of war and plague had left the roads dangerous, with roving bandits and desperate refugees. Steno wore a sword, but he didn’t really know how to use it.

  One disassembles a machine to understand its construction, he thinks. One knows the artificer by knowing his designs. The heart is made of tiny fibers, the same kind of fibers as the muscles in the legs, but those muscles in the heart are twisted into a powerful ingenious knot, clenching and unclenching for a lifetime. Yet a heart can be formed imperfectly; a heart can be a monstrous thing. At night he dreams of Swammerdam, and in the morning he repents. He watches a procession of pilgrims: “The thought came into my mind: either this Host is a simple piece of bread and those who render it such honor are mad, or else truly it is the body of Christ.”

  At the Abbaye Royale de Frontevraud, Steno met with the abbess in her private chamber, where she prayed every day from 5 to 9 a.m. In Montpellier he performed an anatomy lesson, dazzling his audience, among them traveling English scientists. Over dinner, the Englishmen discussed the work of one of their colleagues, Robert Hooke, who was investigating the strangely shaped stones found in mountaintops and fields, with shapes in them like sea animals. The Frenchmen at the table mentioned Guillaume Rondelet, a naturalist who worked in Montpellier a century earlier, who had argued that the so-called tongue stones, or glossopetrae, found on local beaches were once the teeth of ancient sharks.

  Steno arrived in Pisa. In Tuscany, the viscera of the earth are exposed, and he runs his fingers across the lines of sandstone, examining the strata. Provando e reprovando, test and test again, is the motto of the Academia del Cimento. The Medici dukes show Steno Galileo’s instruments: his telescope, his astrolabe, and his armillary sphere. Here, convicts are strangled gently to death so as not to disturb the anatomy of their necks before dissection by anatomists. The grounds of the Pitti Palace reek with the experiments of Francisco Redi, who has been investigating the way that maggots rise from rotting flesh. At the dukes’ palace, a strange, thin woman is shocked
by Steno’s Lutheranism. This is Sister Maria Flavia, a nun and the daughter of a senator. She has enormous bulging eyes. What is it like to live unconfessed, she asks, to live outside the possibility of redemption? Steno tells her, shyly, that it is not his custom to dispute matters of faith, but he will listen to all arguments.

  Then a monster is discovered!

  Fishermen have caught an enormous shark, the largest anyone has ever seen. The behemoth is decapitated and its head brought to the palace. Steno measures the jaws: they are so large a man can walk right through them. The skin is tough. The brain is tiny. But what really impresses him are the teeth, the ones easily picked from the jawbone. They are exactly the same shape as the glossopetrae, the tongue stones he discussed with the Englishmen at Montpellier. He thinks of the hills all around, the crags in the landscape, the seashells discovered on high ground.

  He travels to the coast, to Livorno and Piombino. He visits marble quarries in Carrara and salt mines in Cecina, studying the formation and history of the earth. “How the present state of anything discloses the past state of the same thing,” he wrote, “is made abundantly clear by the example of Tuscany above all others.”

  Even as he investigates the nature of the planet, he is being drawn into discussions of the ineffable. Sister Maria Flavia introduces him to Lavinia Arnolfi, a married woman and devout penitent who wears spikes inside her stockings and a hair shirt under her court clothes. The women take Steno to see Paolo Segneri, a charismatic orator who prays naked in cold weather and every day whips himself until he bleeds and faints. Steno falls in with religious cultists.

  In 1667 he publishes a short three-part book. The first part, Elementorum myologiae specimen, examines the geometry of muscles and the way animals move. In the second part, Canis carchariae dissectum caput, Steno describes how sharks’ teeth turn to fossils, and he describes the stratified layers of the earth. The last section is nine pages long, focusing on the dissection of dogfish, and after examining the ovaries of a fish, Steno by analogy concludes that the ovaries of women contain eggs, a radical reimagination of human reproduction. As the historian of science Matthew Cobb describes it in his book Generation, in this short, three-part book, Steno upended the world’s knowledge. According to Cobb, Steno found “a mathematical explanation for one of the most widespread living phenomena—movement.” He laid out “the basis for scientific study for earth and its history,” and finally he proved that “human eggs were like the eggs of other animals.”