Adventures in Human Being

by Gavin Francis

  In a crypt-like chamber there were stacks of fetal bones in little cartons, each bone as delicate as a frond of coral. There was a leathery, desiccated face, collected by anthropologists on the Pacific island of New Britain and donated to the museum; it had been peeled off and embedded with clay in an unrecorded rite. In the eye sockets the New British had inserted little cowries, which gazed out glassily at the brick walls. I found the skeleton of an achondroplastic dwarf, stunted with rickets, its femurs and tibias tangled together like gnarled offcuts of oak, and a fetolith, or “stone baby,” retrieved by surgeons from a woman’s belly decades after it had died. On a lower shelf there was a glass case and inside it another curled up, mummified baby. “I don’t know where that came from,” said Gordon, “it could be two hundred years old.”

  In an alcove to one side, with a raised floor and lowered ceilings, Gordon pushed through a door hung with an old tin sign: “Area D,” it said, “under no circumstances move anything from these shelves.” Inside were racks of what the Renaissance medical texts called “Monsters and Marvels”: aberrations of human development, which the nineteenth-century anatomists had salvaged from the middens and fire grates of the city. Mermaid babies with fused legs floated in chambers of briny fluid, alongside a series of Siamese twins, ending in a child with a normal body but two heads. Another shelf illustrated various degrees of “hydrocephalus,” or water on the brain, in which skulls ballooned by fluid pressed hard against the confines of the glass. Fetuses dead by miscarriage over a century ago floated in vitrine wombs, their bones stained scarlet, their bodies translucent as jellyfish. It was macabre, but there were sound reasons for filling these shelves at the time: the babies were studied for clues as to the way embryos develop in the womb. Then as now it was hoped that understanding how development went wrong would inform the likelihood of a particular couple having another baby affected.

  Another series of shelves seemed like a recapitulation of everything I had ever studied in anatomy class, all hidden here in the lowest and most overlooked reaches of the anatomy department: sagging, deflated brains; a wax model of the kidneys; an eyeball cut in section. One shelf was occupied with a series illustrating the cochlea and the semicircular canals. A plaster-cast head demonstrated the muscles of facial expression. A heap of placentas and cauls, poorly preserved, disintegrated in wooden cases. On the top shelf, close to the arched vault of the ceiling, a woman’s vulva had been staked out in a shallow chamber, exposing the urethra and the thickened tissue around Skene’s glands.

  Down near the floor, on the rough pine shelves, a bear skull lay beside the skeleton of a bear’s foot. The bear is one of the few mammals able to walk upright, and bears, like humans, strike the ground heel-first as they walk. When Leonardo da Vinci was unable to get hold of a human foot, he dissected instead the foot of a bear. The specimen stood next to a series of human feet, stripped in layers from the skin down to the bony arch.

  It was time to get back to work. The lights crackled off; the shelves and skeletons returned to darkness. The door clanged behind us as if shutting a bank vault. I trundled a bin of feet toward the elevator, past the chiller room and the embalming tables. Darkness again, then the close, cold feeling of stone walls and stale air. We stepped into the crisp northern light of the dissecting room as if emerging from a tomb and back into life. “We’ve got to do something with all that stuff,” Gordon said as we emerged. “We can’t just leave it down there, hidden from everyone but a few specialists.”

  In Granada I had felt strongly how as humans we charge our bodies with meaning, whether funny or solemn, and the basement too had felt charged with meaning. On the shelves was the evidence of two or three centuries of restless intellectual energy: mankind’s attempts to make sense of the human body, with the aim of healing it when it fails, and easing suffering. There was wonder there too: walking the catacombs reminded me of something Virginia Woolf once wrote about the mind of Sir Thomas Browne: “A halo of wonder encircles everything that he sees … a chamber stuffed from floor to ceiling with ivory, old iron, broken pots, urns, unicorns’ horns, and magic glasses full of emerald lights and blue mystery.” Perhaps to some the basement would be an unsettling space, but there were halos of wonder there in the darkness. I agreed with Gordon: anatomy is too important, too wonderful, to be hidden away or left to specialists alone.

  A FEW YEARS AFTER I first visited the crypt beneath the anatomy department an intruder broke into the McEwan Hall next to the old medical school and set off the burglar alarms. The alarm had a direct link to the police station, and officers and a dog team were sent to the scene. With police dogs chasing him, the burglar managed to find a hatch into the basement of the hall, and from there kick his way down a tunnel-like passageway that led beneath street level toward the catacombs.

  His route was discerned later by following his footprints, as well as the marks he made on the doors that he managed to kick open. He ran in darkness, feeling his way along the stone walls, with the police dogs close behind him. The first door he kicked open led into an old boiler room, and from there he felt his way to another door. After repeated attempts (testified by the number of boot marks photographed later) he kicked it open, and managed to get into the basement beneath the anatomy department. Feeling his way through racks of hanging skeletons he passed in darkness the shelves of monsters and marvels, the narwhal horns and the giraffe bones, the staked-out genitals and the dissected bear feet. Some items in the basement were disturbed by his panicked, outstretched hands. At the door toward the embalming room he paused, then spent some time trying to force it open. It’s just as well he didn’t make it through – he would have found himself in the chiller with the cadavers.

  Moments before capture, with the dogs that were pursuing him already in the basement, he caught a glimpse of light at the top of an old coal chute. He groped up to it, squeezing his body into a space as narrow as a coffin, then managed to turn himself round and kick out a grill and escape. He must have been fast: once outside he outran the dogs.

  THE FOOT PROVIDES some of the earliest identifying evidence about our origins as human beings, and footprints are the signatures of our passage through the world. We occupy space in the world with our feet, expressed through phrases like “to set foot,” “get off on the right foot,” or even “one foot in the grave.” The first upright footprints that have been found are those three-million-year-old ones at Laetoli, but now there are footprints in the dusts on the moon that will outlast all of us. Perhaps one day there’ll be footprints on Mars.

  There was a time when to be a physician and to study anatomy was all about collecting bits of bodies and bottling them; pinning them to boards and stockpiling them in archives. The scientists who make sense of footprints are following a tradition, reaching back through da Vinci and beyond, of attending to the subtleties of anatomy, and applying that knowledge to fundamental questions of humanity. There’s still reason to be grateful to those collection-obsessed anatomists; more and more of their work is coming out of darkness and back into the light.

  EPILOGUE

  I bequeath myself to the dirt to grow from the grass I love,

  If you want me again look for me under your boot-soles.

  Walt Whitman, Song of Myself

  MY MEDICAL OFFICE is a converted tenement flat on a busy Edinburgh street. The consulting room faces east: on summer mornings it’s luminous and warm, and in winter it’s sepia-toned and cool. A steel sink is set into one corner beneath cupboards stocked with sample bottles, needles and syringes, while in the other corner is a refrigerator for vaccines. There’s an old examination couch behind a curtain, and on it, a pillow and a rolled-up sheet. One wall is lined with bookshelves, while others are decorated with da Vinci’s anatomical drawings, noticeboards and certificates from medical specialist colleges. There’s a chart of the city marked with the boundaries of the practice – a diagrammatic urban anatomy of colored motorways, rivers and B-roads.

  I journey through the
body as I listen to my patients’ lungs, manipulate their joints, or gaze in through their pupils, aware not just of each individual and his or her anatomy but the bodies of all those I’ve examined in the past. All of us have landscapes that we consider special: places that are charged with meaning, for which we feel affection or reverence. The body has become that sort of landscape for me; every inch of it is familiar and carries powerful memories.

  Imagining the body as a landscape, or as a mirror of the world that sustains us, can be difficult in the center of a city. In terms of geography my practice area is relatively narrow – it’s still possible to visit all of my patients by bicycle – but the cross section of humanity it encompasses is broad. It takes in streets of opulent wealth as well as housing projects of startling poverty, solid professional quarters as well as the student apartments of a university. To be welcomed equally at the crib of a newborn and in a nursing home, at a four-poster deathbed and in a squalid rooming house, is a rare privilege. My profession is like a passport or skeleton key to open doors ordinarily closed, to stand witness to private suffering and, where possible, ease it. Often even that modest goal is unreachable – for the most part it’s not about dramatically saving lives, but quietly, methodically, trying to postpone death.

  In the center of the district, not far from the clinic, is a graveyard that is held apart from the city by a high wall. A gravel path winds between mature stands of birch, oak, sycamore and pine; their roots cradle the coffins as they crumble back to earth. My visits are snatched moments between house calls and clinics, and I usually have the place to myself. Occasionally I meet a parents’ group out taking a break, like me, from the noise of the city streets. We smile and nod acknowledgment as we pass; toddlers that I’ve met in the clinic run laughing between the stones; babies I’ve checked over are lulled gently to sleep in their strollers.

  The surnames engraved on those stones are familiar: the same ones appear on my computer screen each day. Some of the memorials have an ostentatious gravitas, while others are modest and simple – just a name and two dates. There’s something democratic about the way the rich and poor lie side by side. A row along one wall is reserved for the local Jewish population: it’s cordoned by steel railings, but the tree roots break through regardless. There are memorials to those who’ve died far away in the service of a lost empire, from bullets, childbirth or tropical fevers. Some celebrate venerable lives, while others grieve the calamity of an early death. The occupations of the dead, engraved on the memorials, reveal social shifts over the past century or so: cloth merchants, millers, clergymen, bankers. There’s an obelisk to a master-apothecary, erected at a time when they mixed their own tinctures, and the gravestone of a physician who once served those lying around him.

  Sparrowhawks nest in the treetops, and hunt the mice and small birds that live among the graves. Ivy runs over the fallen stones, and between the slumped earth of the plots are thickets of sweet brambles. Summer brings a sort of silence, thick and lush, and sometimes I fancy that beyond it I can hear the soft breath of the leaves. By autumn those leaves cover the graves in crimson and gold, then in winter the stones stand like sentinels between drifts of snow. But in springtime the branches thicken with fresh leaves, and shoots of new grass push into dappling patches of light.

  Life is a pure flame, and we live

  by an invisible sun within us.

  Sir Thomas Browne, Hydriotaphia (1658)

  ACKNOWLEDGMENTS

  My thanks most of all go to my patients, past, present and future – without them I’d be a mariner without an ocean. The requirement to honor their confidentiality means that they must go unthanked individually, but that in no way makes me less grateful.

  Hippocrates in his famous Oath emphasized the importance of paying reverence to all those “who taught me this art,” and I’ve been lucky in the examples set by my teachers. There have been scores of them, but thanks in particular to Gordon Findlater, Fanney Kristmundsdottir, Khazeh Fananapazir, John Nimmo, Theresa de Swiet, Hamish Wallace, Peter Bloomfield, John Dunn, the late Wilf Treasure, Clare Sander, Tim White, Colin Robertson, Janet Skinner, Philip Robertson, Mads Gilbert, Iain Grant, Sarah Cooper, Colin Mumford, Rustam Al-Shahi, Jon Stone, Ian Whittle, Stephen Owens, Mike Ferguson, Sandy Reid, Catharine George, Charlie Siderfin and Andy Trevett.

  The foresight, imagination, editorial skill and trust of Andrew Franklin at Profile, and Kirty Topiwala at Wellcome, have been fundamental from the earliest stages. Cecily Gayford at Profile brought her hawk-eyed diligence to bear; and thanks, too, to Susanne Hillen for her meticulous attention, encyclopedic research powers and forbearance. Katy O’Donnell and Lara Heimert at Basic Books in New York have made a potentially rough transatlantic crossing glide smoothly. I’ve also been fortunate to receive support from both Creative Scotland and the K. Blundell Trust, in order to swap some time in the clinic for time in the library. Jenny Brown provides a glittering example of what every literary agent should be: thorough, approachable, and a whiz at table tennis.

  Jack and Jinty Francis, Dawn Macnamara and Flaviana Preston have helped balance the demands of the clinic, the library and the nursery. Will Whiteley read the manuscript early on, gave some magnificent advice, and showed me new perspectives on the brain. For insights and expertise relating to electroconvulsive therapy I’m grateful to Neil McNamara. To John Berger: immeasurable gratitude and a bottle of Talisker for his open-hearted support and his interest in this book from the start. Selçuk Demirel permitted me to reproduce his Les Etoiles. Greg Heath and Hector Chawla helped me navigate the labyrinth of ophthalmology. Robert Macfarlane is an unflagging supporter of the ideas behind this book, as well as denier-in-chief of doubts. Thanks also to Bob Silvers at the New York Review of Books for setting me off on a journey to the inner ear. Thanks to Peter Dorward for his wit, attentiveness, expert reading skills, gold-plated reflections, and for indulging me with The Iliad. I’m grateful to Tim Dee for being a cheerleader of my work, and for his enthusiasm about the noises of the heart. For the section on the wrist, Reto Schneider kept me right and helped me explore the dark and zealous world of Pierre Barbet. Yves Berger permitted me to reproduce a drawing from his exhibition Caring, and gave me the keys and the freedom of Quincy. I would have become tangled in the thorny briars of Grimm’s Tales without the clear-sighted guidance of Marina Warner and the generosity of Lili Sarnyai. David McDowall let me tell some of his story in the chapter on the kidney. Alec Finlay permitted me to quote from his work Taigh: A Wilding Garden, relating to the National Memorial for Organ and Tissue Donors. For the section on the hip, Kurtis Peters was my guide to Hebrew scholarship. David Farrier sprinkled the manuscript with editorial diamond dust, and was the inspiration for the story about Jacob – a true scholar and friend. Adam Nicolson was good enough to talk to me about Zeno and The Iliad. Thanks to Paddy Anderson and Chemi Marquez for their incomparable humor, hosting me at the Carmen del Meñique in Granada, and giving me an insight into the romería.

  Robin Robertson graciously gave me permission to write about and reproduce “The Halving.” Iain Sinclair permitted me to quote from Landor’s Tower. Kathleen Jamie and Brigid Collins permitted me to write about, reproduce and quote from Frissure. Thanks to Iain Bamforth for letting me quote from “Unsystematic Anatomy.” David McNeish – scholar, physician and theologian – guided me to the Hartman paper on Jacob and the Angel. Thanks to Douglas Cairns for confirming the rule that classicists have a hilarious sense of humor.

  Institutions: Thanks to the National Library of Scotland, the anatomy department of the University of Edinburgh, the Anatomy Museum and the library of the University of Turin, the Wellcome Trust, the medical school of Pavia, the staff of the Royal Edinburgh Hospital, and the Department of Clinical Neurosciences in Edinburgh.

  Versions of “Neurosurgery of the Soul” and “On Seagull Murmurs, Ebb & Flow” first appeared as diary pieces in the London Review of Books. I’m grateful to Mary-Kay Wilmers for permitting them to be reprodu
ced here, and Paul Myerscough for editing them so attentively. Some of the material in “Voodoo & Vertigo” was courtesy of my essay “The Mysterious World of the Deaf,” in the New York Review of Books.

  My colleagues at Dalkeith Road Medical Practice put up with my inconvenient absences with magnanimity – I am eternally grateful to Teresa Quinn, Fiona Wright, Ishbel White, Janis Blair, Geraldine Fraser, Pearl Ferguson, Jenna Rowbottom, and Nicola Gray.

  Saying “thank you” doesn’t adequately express how grateful I am to Esa. She is truly one of life’s enthusiasts; in many ways this book is for her.

  NOTES ON SOURCES

  2. Seizures, Sanctity & Psychiatry

  p. 19“a spiritual disease …” Hugh Crone, Paracelsus: The Man Who Defied Medicine (Melbourne: The Albarello Press, 2004), 88.

  p. 20“first recorded instance …” R. M. Mowbray, “Historical Aspects of Electroconvulsive Therapy,” Scottish Medical Journal 4 (1959), 373–8.

  p. 20“he claimed a …” Gabor Gazdag, Istvan Bitter, Gabor S. Ungvari and Brigitta Baran, “Convulsive Therapy Turns 75,” BJP 194 (2009), 387–8.

  p. 21“There was a feeling …” See Katherine Angel, “Defining Psychiatry – Aubrey Lewis’s 1938 Report and the Rockefeller Foundation,” in Katherine Angel, Edgar Jones and Michael Neve (eds.), European Psychiatry on the Eve of War: Aubrey Lewis, the Maudsley Hospital and the Rockfeller Foundation in the 1930s (London: Wellcome Trust center for the History of Medicine at University College London, Medical History Supplement 22), 39–56.

  p. 23“Its author, Ewen …” The program was not a success. See E. Cameron, J. G. Lohrenz and K. A. Handcock, “The Depatterning Treatment of Schizophrenia,” Comprehensive Psychiatry 3(2) (April 1962), 65–76.