Anatomies: A Cultural History of the Human Body (2 page)

One of the most powerful of these associations, for example, is the idea that the heart is the seat of love. ‘Come bring your sampler, and with art / Draw in’t a wounded heart’, the English poet Robert Herrick wrote four centuries ago in his great poem of unrequited love. But is this meaningful now? It surely is to the shops which see Valentine’s Day spending of more than £2 billion in Britain alone. It is not just as the visual icon on a million cards that the heart lives in our culture. Its pulsing rhythm may underlie the pleasures of the iambic metre in poetry and the beat of rock music.

The eye at the moment of death has long been said to retain the image of the last thing it saw. Has this myth been dispelled? Only just, maybe. In 1888, the Metropolitan Police in London photographed the eyes of Mary Jane Kelly, the last presumed victim of Jack the Ripper, in the desperate hope that they might hold the residual image of her killer.

Such beliefs reflect early attempts to understand and come to terms with our bodies. Often, modern medicine is influenced by these ideas more than it cares to admit. Take blood. Old taboos still echo through the questionnaires one must complete in order to give blood, with their strange hints at tribal purity. Our feelings about organ donation, too, are coloured by deep cultural prejudice. If donors or their kin place restrictions on the organs that may be harvested, they are most likely to be on the heart and the eyes, based on the belief that the heart is the essential core of the person and the eyes are the window into the soul.

The arts can tell us things about our body that medicine and biology do not. The head is an important part, so much so that it can stand for the whole body, as we see in the sculptor’s bust or your own passport photograph. But what happens when the nose alone stands for the head? In Nikolai Gogol’s short story ‘The Nose’, a man’s nose detaches itself from his face and goes off on its own around St Petersburg, pursued by its nasally challenged owner. Importantly for the satirical bite of the tale, the nose takes on the man’s social pretensions. The story raises questions about the way in which certain parts of the body constitute our personal identity and others do not. But most of all it reminds us that the body and its parts are funny, if not ridiculous – or at least our constant self-awareness makes them so.

Separated from their bodies, organs and parts sometimes multiply in alarming ways, gaining strange powers as they do so. In
Gargantua and Pantagruel
, Rabelais imagines a wall of vulvas protecting the city of Paris. ‘I have noticed that, in this town, the thingummybobs of women are cheaper than stone,’ observes Pantagruel’s companion Panurge. ‘You should build walls of them, arranging them with good architectural symmetry, putting the biggest ones in the front ranks, then sloping them back upwards like the spine of a donkey, making ranks of the medium ones next and finally of the smallest.’ A portrait of Queen Elizabeth I painted towards the end of her reign around 1600 shows her wearing a dress covered with appliqué eyes and ears, emblematic of the all-knowing state of which she, of course, was the head. The artist Marcus Harvey caused uproar when he created a vast painting of the child-murderer Myra Hindley using children’s handprints as individual pixels. The work adapted a photograph of Hindley much reproduced in the newspapers at the time of her trial. Was there evil in that face? Is there good in a child’s hand? What did it mean to bring the two together?

This book is about our bodies, their parts, and their multiple meanings. It is also about where we draw the limits of the body, and how we are always seeking to extend those limits, never more so than right now. For ‘extend’, I should perhaps write ‘redraw’, for although we like to think of ourselves as constantly extending the human frontier, the fact is that from time to time we choose tactical withdrawal. We draw the limits closer in, not further out. We think we like the idea of being all-capable, but in fact we’d rather not test our capacity for pain, or even make much use of our senses of smell and touch, for example. We think we’d like to live longer – or is it just that we’d prefer to avoid dying? We dream of escaping our bodies and existing in transformed or dematerialized ways. We may think these dreams are the product of recent or promised advances in biomedical technology. But in fact they are the timeless product of our imagination.

Overarching this part-by-part progress, then, is another idea: the idea of the body as geography, as territory to be discovered, explored and conquered. This powerful metaphor is found throughout human culture, from the plays of Shakespeare to the 1966 film
Fantastic Voyage
, in which miniaturized humans journey through a man’s body in a quest to save his life. It also seems to reflect how science has proceeded, claiming new-found lands, dividing them into parts, proclaiming dominion over them on behalf of specialist new disciplines. It is, I might add, a very male approach, never more so than when it is the female body that is being explored.

At one point in my research, I noted something peculiar about my reading list. I was being curiously drawn to books set on islands –
Robinson Crusoe
for its all-important human footprint,
Gulliver’s Travels
for the changes in human scale it imposes,
Typee
for the tattoos and the cannibals,
The Island of Dr Moreau
for the vivisection and the human-animal hybrids. Why was this? Islands present isolated populations. Here, humans are almost a subspecies of
Homo sapiens
, ripe for the kind of anthropological scrutiny that might seem impertinent among the home population. Islands are places where, for a time, you can observe and control a community as if it is part of an experiment. But the situation cannot be sustained. Eventually, the hero escapes to tell his improbable tale (or not, in the case of Dr Moreau’s visitor, who pretends amnesia because what he has seen is so incredible). As John Donne famously reminds us in his
Meditations
: ‘No man is an island, entire of itself; every man is a piece of the continent, a part of the main.’

These fictional island laboratories are places for the exploration not just of human nature writ large, but also of the identity of the individual. The body may be seen as territory with parts that have been more or less thoroughly explored, but somewhere within that territory, we are convinced, is a special place, the seat of the soul, as we once said, or of the self, as we might say today. In medieval times, a person’s heart was often preserved or buried separately from the rest of the body because it was the part thought to be most closely associated with the soul. During the Renaissance, a more sophisticated notion took over. The soul was to be found in the divine proportions of the human body, which was the answering microcosm to the macrocosm of the ordered universe. The ideal bodies and the anatomies of this period, from Leonardo da Vinci’s Vitruvian man to Rembrandt’s paintings of dissections, reflect this belief. With the progress of science, however, the urge to find a focal point was soon reasserted. Attention settled on the head, as physiognomists sought their answers to the problem of the self in human expression and phrenologists in the bumps of the skull. Today, we look at magnetic resonance imaging scans of the brain and believe these bring us closer to knowing our selves. It seems that only a visual image will give us the reassurance we seek.

This need to see the self is strong because we live in a society that prizes human individualism, and also because we sense that the self is susceptible to manipulation in ways that it never has been before. We are aware that our personal identity may be altered – and perhaps improved – by consciously undertaken extension. Such extension may be psychological (self-help books), physical (cosmetic surgery), chemical (mind-altering drugs) or technological (virtual environments). At the moment, these possibilities are perhaps only crudely being tested. However, it seems certain that in future it will be increasingly easy, and probably increasingly acceptable, to manipulate both the external appearance of the body and our genetic make-up, and that this may disrupt what one bioethicist calls the former ‘naturalness of the self’.

These are exciting and troubling times for the human body. We seem both excessively aware of it and yet at the same time profoundly dissatisfied with it. The biological sciences promise many things about the way we will live in future. But, however beautiful we are, however super-capable we become, however long we live, we still must inhabit our bodies. Perhaps, by recognizing the human body as a site of
continual
invention, we may overcome the distortions of the present moment.

Finally, one barrier to a broader comprehension of the body is the profusion of Greek and Latin names – names that those in the medical professions were themselves once put to great labour to learn. There is an argument that these provide a universal language much like the Mass sung in Latin, but I am not convinced. So I have tried to minimize my use of these words, many of which were baffling to me as I set out. I won’t use ‘anterior’ where ‘front’ will do, or ‘femur’ for ‘thigh bone’. It seems wrong that the parts of our own bodies should be described in a vocabulary that is alien to us.

Now, if you’ll excuse me, I have to go and pee.

Prologue: The Anatomy Lesson

Who, I am wondering, is the subject of this painting?

I am at the Mauritshuis, one of the world’s great collections of Dutch art, housed in a perfect little palace on the lakeside in the centre of The Hague. I have just seen Vermeer’s
Girl with a Pearl Earring
. Its sheer beauty produces a choke of emotion. Now, two rooms away, I am standing in front of Rembrandt’s painting known as
The Anatomy Lesson of Doctor Tulp
.

It is his breakthrough painting. Rembrandt arrived in Amsterdam in 1631 aged twenty-five looking for portrait work. He found it almost immediately when Nicolaes Tulp, the praelector, or public lecturer, of the Amsterdam guild of surgeons, asked the young artist to paint him with his fellow guild members. The job must have surpassed Rembrandt’s hopes for it offered a fantastic challenge: to paint not just one man but many men, to find a way to communicate the individuality of each of them, and yet also to conform to the expectations of the seventeenth-century equivalent of a team photograph. And would there, Rembrandt must have mused as he accepted the work, be scope also to tell a more universal story?

It is a massive canvas. It shows a group of seven men, almost life-size, attending closely to Doctor Tulp, who sits in an armchair, enthroned and slightly elevated, demonstrating a point of detail in human anatomy. Yet it may not be Doctor Tulp who is the subject, as the earringed girl is so obviously the subject of the Vermeer. The painting’s title only came later. It is, as it was meant to be, a genre painting of a group of professional achievers. The identities are known of the other men depicted. They too are surgeons. They may appear agog to learn, but Tulp’s audience in the painting are his equally proficient peers. He has no anatomy lesson for them. So perhaps all the surgeons together are the subject. It was they who paid for the painting, and it was immediately hung on the wall in their guild.

But I don’t think these fellows with their florid cheeks and extravagant ruffs are truly the subject either. For us, and for Rembrandt, the true subject is the one remaining person in the picture – the dead man on the dissection table around whom the surgeons are gathered.

He is, or was, Adriaen Adriaenszoon, nicknamed ’t Kint, ‘the kid’, twenty-eight years old, and well known to the courts for a string of assaults and thefts over the preceding nine years. In Amsterdam, in that winter of 1631–2, he swiped a man’s cape. Unfortunately for Adriaenszoon, his victim resisted, and he was caught. He was tried and sentenced to death by hanging, to be followed by dissection of his body, the usual punishment for serious crimes, dissection having been added specifically to disabuse criminals and their families of any hope they might still cling to of a Christian bodily resurrection. Three days later, on 31 January 1632, his lifeless corpse was taken down from one of the gallows that lined the city’s waterfront and moved, ready for the final stage of its punishment, to the city’s anatomy theatre.

For in the seventeenth century a dissection was indeed a theatrical occasion. One could only take place when there was a fresh body available, usually from a criminal execution. It would have to happen in the winter months, when the cold would preserve the body long enough for the anatomy to be demonstrated before the stench of decay became overpowering. For many, the chance to witness the criminal getting his just desserts was too good an opportunity to pass up. You might see him hang, and then go along afterwards to the dissection to be sure he was really finished. So among the surgeons and physicians who came looking for instruction and the civic leaders who came to see that justice was done were also those looking for good moral entertainment. Tickets cost perhaps six or seven stuivers (about a third of a guilder, steeper than the price of admission to a players’ theatre at the time).

These rare occasions were an assault on the senses. Cold was not enough: incense was burned to disguise the smells coming from the corpse. Music played. Food was eaten, beer and wine were drunk. The magnificent frontispiece illustration in the greatest Renaissance textbook of anatomy, Andreas Vesalius’s seven volumes of
De Humani Corporis Fabrica
(On the Structure of the Human Body) of 1543, shows a dog and a monkey loose among a rowdy-looking crowd. By the time it was over and all of the body parts had been scraped off the table and bagged up for disposal, the gate might have reached 200 guilders or more, enough to pay off the hangman and provide a feast for the members of the surgeons’ guild, with a torchlight procession to round off the day.

Rembrandt shows Adriaenszoon’s body lying on the table at an angle to us, foreshortened in view. Light pours down on to his barrel chest. I measure him off, and find he stretches more than 120 centimetres from head to toe. Even allowing for the foreshortening, which squashes the criminal up so that he resembles a goblin, he appears to be a powerful man, large and muscular in comparison to the black-coated surgeons. Though partly veiled in a shadow of death, Adriaenszoon’s face is open to our gaze. In fact, it looks as if his head must have been propped up on something to allow this surprising indiscretion. His neck, though, which would have been scarred by rope marks from the gallows, remains hidden from view. In contrast to the rosy health of the surgeons, Adriaenszoon’s flesh is a pale grey-green. Rembrandt has mixed a tiny bit of lamp-black into his paint to produce this ashen pallor. When Joshua Reynolds saw the painting in 1781, he commented in his travel diary: ‘Nothing can be more truly the colour of dead flesh.’

Yet the painting is a fictional construction. In a normal anatomical dissection, the praelector opens the abdomen in order to reveal the major organs, and to allow the most offensive-smelling parts of the digestive system to be shown and then swiftly removed from the scene. Rembrandt gives us Adriaenszoon’s trunk intact. Only the left forearm has had the skin pulled away in order to reveal the muscles and tendons beneath. Rembrandt and his client Tulp have chosen to show the criminal’s
hand
in dissection. This is a deliberate falsification. Why have they done it?

It is more than likely that Rembrandt was among the audience as ’t Kint was gradually disembowelled and dismembered. He may also have found an opportunity to make some quick sketches of Adriaenszoon’s body before the anatomy took place. It’s possible, too, that he painted in the flayed left forearm and hand from a different subject some time later. Or perhaps he worked from a specimen part long kept in his studio, since an antiquarian who visited the artist shortly before his death in 1669 apparently found in his collection ‘four flayed arms and legs anatomized by Vesalius’. There is a suspicion, furthermore, that the
right
hand may not belong to the body we see. Adriaenszoon may have had this hand cut off as a previous punishment for theft, and again Rembrandt may have painted from a different hand. X-ray studies indicate that the right arm of the painted corpse once ended in a stump, and the present manicure is, in the view of some who have examined the painting, ‘certainly not that of a thief’.

So not all is as it seems in Rembrandt’s early masterpiece. In order for Adriaenszoon’s anatomy to take up its position as the subject of the work, his body has had to undergo dual indignities. It has been disassembled by the doctor. But it has also had to be pieced together like Frankenstein’s monster by the artist. Both of these actions rely on a new perception of the body, as something that may be opened like a store-room or a treasure chest, an assemblage and a container of mysterious and intriguing parts.

In the years between the publication of Vesalius’s treatise on human anatomy in 1543 and Rembrandt’s painting of 1632, the topic of human anatomy became something of a craze. The fall of Constantinople in 1453 to the Ottomans saw an influx into Europe of medical scholarship based on Arabic and ancient Greek sources. Restrictions on opening the human body that had prevailed when physicians were also men of the cloth no longer applied. Papal and royal decrees released the bodies of executed criminals for dissection. Suddenly, everything could be ‘anatomized’, if not physically then at least philosophically. John Donne proclaimed in his
Devotions
: ‘I have cut up mine owne
Anatomy
.’ The depressive Robert Burton published
The Anatomy of Melancholy
. William Shakespeare had King Lear cry out in his anguish: ‘Then let them anatomize Regan; see what breeds about her heart.’

A proper anatomy theatre became essential for any university that hoped to be competitive in the study of medicine. In Protestant areas, these theatres were often converted chapels, indicative not of atheistic medicine taking over from religion, but certainly of the church’s acceptance of the new methods of science. This was the case at Leiden University, where an anatomy theatre was built in 1596. Rembrandt grew up in Leiden, twenty miles from Amsterdam, and Tulp studied there, so this was surely the first such space that either of them saw. Today, there is a stylish reconstruction of the theatre at the Boerhaave Museum in the city. It is a circular space with ledges that are steeply raked in order that as many spectators as possible get a clear view of the anatomy that would have taken place on a rotating table in the centre of the room. The Leiden theatre has been adorned with skeletons, both human and animal, including a skeleton man on skeleton horseback, supported on poles from the floor. These macabre embellishments echo a seventeenth-century engraving of the theatre, in which the skeletons mingle with the audience, holding banners proclaiming ‘MEMENTO MORI’ and ‘NOSCE TE IPSUM’. The theatre set up in Amsterdam in 1619 was of similar design. This is where Tulp performs his anatomy. This theatre is long gone today, but the inscription ‘THEATRUM ANATOMICUM’ remains above the entrance to one of the turrets of St Anthony’s Gate, where it was located.

Doctor Tulp, then, was both a pioneer and a leading member of a respectable profession. He had worked to get there. It was as Nicolaes, or Claes, Pieterszoon that he enrolled at Leiden University, the son of a Calvinist linen merchant. He wrote his dissertation on cholera, duly qualified as a doctor of medicine, and returned to his native city of Amsterdam to set up his practice. He was not a specialist in anatomy but a generalist, able to prescribe either medical treatment or surgery for his patients. He adopted the tulip as his emblem, displaying it on his house and coat of arms. The flower, newly arrived from Turkey, would soon become a national mania in the Dutch Republic, sparking the world’s first economic bubble as people bid up the price for the latest exotic bulb. But that was a few years away. The doctor was ahead of the game and, as he prospered, his symbol became his name: Doctor Tulip. By 1628, he had risen to the post of praelector in the surgeons’ guild. He performed his first public anatomy in January 1631. In Rembrandt’s painting, we see him a year later, approaching the age of forty, at the height of his powers, a city alderman, immersed in his second anatomical demonstration.

Tulp’s character is the key to the painting’s broader message. It turns out to be, as we hope from Rembrandt, rather more than another group portrait. Look at the assembled surgeons’ faces, flushed with the January cold and their own importance. Like a cartoon flip book, they move through time from left to right, revealing different stages of expression, from simple perception to intellectual comprehension and finally to something like divine revelation. Tulp himself has the inner light of religious conviction. For, with Rembrandt as his interpreter, Tulp is revealing metaphysical as well as scientific truth. The two men’s choice of the hand as the focus of the anatomy demonstrates their true intent. He can show all his dexterity and skill and invention and sleight – as a surgeon, as a painter, as a light-fingers – and then he dies. Man is both vital and mortal; he creates, but he is God’s creation.

As if the message is not clear enough, the surgeon standing at the back of the group is pointing at the corpse and looking out of the painting directly at us. He is almost accusing.

It is we who should prepare to receive the lesson.

My own first sight of a body under dissection comes as a surprise. It is a woman. Anatomy texts place unfair emphasis on the male body, not only because anatomists and surgeons were men, but also because male cadavers were what tended to issue from the gallows. The emerging medical profession may have struggled with the constant shortage of bodies for study, but fit young men were not underrepresented among them. Illustrated anatomical texts are filled with well-muscled male youth.

I find other surprises too. The woman I am looking at was obviously of a considerable age when she died. Her skin is the colour of putty, like chicken that has been kept in the freezer too long. The greatest shock is that her head has been cut off, and not where you expect, at the neck, but awkwardly through the chin, because the teeth have been taken away with the rest of the head for dental studies, leaving just the lower part of the skull and jawbone.