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| ISBN-13: | 9781784100575 |
|---|---|
| Publisher: | Carcanet Press, Limited |
| Publication date: | 08/15/2015 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 328 |
| File size: | 911 KB |
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A Doctor's Dictionary
Writings on Culture & Medicine
By Iain Bamforth
Carcanet Press Ltd
Copyright © 2015 Carcanet Press LtdAll rights reserved.
ISBN: 978-1-78410-057-5
CHAPTER 1
A anecdote
A Taste of Bitter Almonds
A STENDHAL CAPSULE
When the rotund Henri Beyle (Stendhal) dropped dead in a Paris street in 1842 —'of apoplexy'— only three mourners accompanied the coffin to its resting place in the Cimetière de Montmartre: one of them was the younger writer Prosper Mérimée. Incensed by the fact that no words had been spoken at this 'pagan funeral', Mérimée wrote a short memoir of their friendship. Fact is he didn't know much about his friend other than that he had served in the Napoleonic campaigns and been a mostly indifferent diplomat in Italy, and that he was known in Paris as an occasional wit ('homme d'esprit') and writer with a mania for disguises; what he had read of his books didn't inspire him terribly. Perhaps because he didn't know so much about the social figure, the sketchy portrait he left, with the bare title HB, is a captivating one.
For a son of the post-revolutionary years like Mérimée, Beyle (born 1783) bore all the contradictory traits of a man of the previous century: 'All his life he was dominated by his imagination, and never did anything except abruptly and with enthusiasm. However, he got it into his head that he acted in conformity with reason. "One must be guided in everything by LO-GIQUE", he would say, pausing between the first syllable and the remainder of the word. But he had no patience for those whose logic differed from his own.' In fact, Stendhal was every bit a fully-fledged nineteenth-century writer of self-exploration, and he anticipated his own discovery in the twentieth (in his autobiography La Vie de Henry Brulard he addresses readers in 1935, not his contemporaries). Long before Flaubert and Proust, he was aware of the fitfulness and ambiguity of memory, its elusiveness when we try to snare it. Hence his famous digressive style, the comic zigzag he took from the celebrated author of Tristram Shandy.
Stendhal had his mnemonic devices too. As a young boy in Grenoble he had been made to take drawing lessons by his father: this got him out of the house, which he found stifling. The 175 sketches scattered throughout the text of his autobiography, showing mostly street scenes or room arrangements, reminded him of that brief moment of freedom, and served as a visual framework for his writing. Feeling that there was truth in spontaneity, he wrote quickly (his autobiography was written over four months in the winter of 1835); and although he often presents exact dates in his writings (an early talent for mathematics had allowed him at sixteen to quit the damp provincialism of Grenoble and enter the new École polytechnique in Paris), he was often slapdash in respect of actual chronology. What counted for Stendhal was the sharp, acutely characterised, discriminating account of motive or emotion. 'Love has always been for me the most important of affairs, or rather the only matter of account', he wrote, as if the ending of the sentence had only occurred to him once he had voiced the beginning. His famously mineralogical book on love talked about it in terms of a 'crystallisation'. A thinker had to be dry, clear, without illusions: a banker, he once wrote, might have the requisite character 'to make discoveries in philosophy'.
And there is his famous, light, Mozartian touch: he was as unsparing of himself as he was of others, the young provincial who hoped to cut a figure in the world and become a celebrated Don Juan even though he didn't have the physique (or, indeed, the inheritance) for it; writing his autobiography under an assumed name at fifty-three he is prepared to acknowledge that all he will be able to convey about his life of vagabondage and gallantry is the 'chasse au bonheur'— the pursuit of happiness and not the experience itself. There is no cynicism in the writing, only a serene wistfulness.
Stendhal's commitment to the brisk, discursive, associative feel of experience makes it an exhilarating experience to read his journals and travel books. Every situation in his life seems to lend itself to epigrammatic expression; and anecdotes themselves are occasions for expansive writing: in 1837–38, on leave from his consular job at Cività Vecchia and visiting his own country, he dashed off a book called Memoirs of a Tourist. Here is a nice piece of hearsay reported in its pages which he scribbled down in Lyons, on May 19:
Three days ago Mr. Smith, an English puritan who had been living here for ten years, decided it was time to end his life. He swallowed the contents of an ounce bottle of Prussic acid. Two hours later after being very sick he was anywhere but on the point of dying, and to pass the time rolled about on the floor. His landlord, an honest cobbler, was working in his shop in the room beneath: startled by the inhabitual din and fearing that his furniture was getting a battering, he went upstairs. He knocked on the door; no reply; so he entered the room through a boarded-up door. He was aghast to see his tenant prostrate on the floor, and sent for M. Travers, well-known surgeon and friend of the sick man. The surgeon came, treated Mr. Smith, and very quickly brought him out of danger. Then he asked him: 'What the devil did you drink?'
'Some Prussic acid.'
'Impossible, six drops would have killed you in a jiffy.'
'Well, they told me it was Prussic acid.'
'Who sold it to you then?'
'The little chemist on the Quai de Saône.'
'But usually you get your prescriptions made up at Girard, your neighbour right across the street here, the best pharmacist in Lyons!'
'That's true, but the last time I bought some medicine from him, I had the impression he was overcharging me.'
CHAPTER 2B bodies
The Plastinator
ON THE ETHICS AND AESTHETICS OF A TRAVELLING ANATOMY EXHIBITION
In 1997, in the space of four months, more than three-quarters of a million people — the highest attendance for any post-war exhibition in Germany and more than the famous annual Dokumenta art review in Kassel has ever attracted — queued to be admitted to Mannheim's Regional Technical and Industrial Museum. The exhibition attracted similar attendance figures when it moved to Japan, reportedly receiving more than a million visitors, and to the traditional European capitals of death, Vienna and Basel, where I caught up with it. It is now showing in Cologne; here, too, it is drawing in the crowds.
This is no ordinary exhibition, and not the display of fossilised machine tools from Germany's long and unfinished history of industrial achievement that might have been expected from the museum's name. What is on show, in fact, is a collection of about two hundred human anatomical specimens including the usual kinds of body sections, slides of diseased and healthy tissues, organs in glass cases, and so forth. These are standard objects in an exhibition of this kind. More controversial, and certainly more spectacular, are the eighteen 'plastinated' cadavers — Ganzkörperpräparate, or whole-body preparations.
Anatomy exhibitions have gone on the road before, though you might have to go a long way back, to the living human exhibits in the freak shows of the Victorian circus era, to find an exhibition which has aroused so much curiosity and controversy. Many of the anatomy museums in Europe's famous medical schools are either accessible to the more intrepid kind of tourist or can be consulted by appointment: I spent a long afternoon a few years ago in the mote-filled hall of the University of Montpellier's junk room, examining one of its famous series of wax impressions of syphilitic buboes and chancres from the nineteenth century. Montpellier's anatomy tradition goes back to 1315, when the body would be opened for inspection by two barbers under the instruction of a magister reciting the appropriate Galenic text.
It is a tradition that has been revived in several books by Frank Gonzalez-Crussi, a professor of pathology in the Children's Memorial Hospital at Northwestern University who has created a literary subgenre of his own: portrayals of the unusual and the monstrous drawn from his professional life and given a savant veneer that places them somewhere between Jorge Luis Borges and Sir Thomas Browne. In one of his essays, 'Bologna, the Learned' (in the book Suspended Animation, 1995) he reminds us how popular public dissections were in the fourteenth century when they were advertised by being posted in Latin, the language of the dissections, on the columns of the Archiginnasio days before the event. Public dissections became routine only at the beginning of that century. Prisoners were condemned pro faciendo de eo notomia — to make an anatomy of them. The cutting, rending and division of a body was a chance for the demonstrators to show the 'image of the universe' to the audience, and for learned members of the audience to engage in heated disputatio; it was above all an event in the social calendar. Hogarth's 'Four Stages of Cruelty' offers a very sarcastic visual commentary, in the disembowelment of poor hanged Tom Hero by a pack of doctors, on how the poor were always being held up for scrutiny by their social betters.
In those days, anatomists had to work fast to avoid the deliquescence of the body. The French surgeon Ambroise Paré (1510–90) was already recommending the use of alcohol to preserve tissues, but it was ceroplasty, or wax modelling, as developed in northern Italy — especially Florence — in the seventeenth century, that became the prized method; Gaetano Zummo's technique was brought to a fine art under the abbot Felice Fontana (1730–1805), who was able to convince artists and anatomists to work together on his waxes.
Ceroplasty was a highly skilled procedure requiring an intermixture of purified bees' wax and spermaceti, as hardener, which was then pigmented to the desired hue; special techniques such as dipping silk threads in hot wax were used to achieve the effect of fine structures — that of the lymphatic vessels or nerves for instance. Fontana's waxes were shown to great acclaim in 1780, when he was commissioned to prepare a series of obstetrical specimens for the Emperor Joseph II: these can still be seen in glass cases, as a permanent exhibit, in the palatial Josephinum in Vienna. It was hoped that they would educate Viennese doctors in the use of forceps as advocated by two pioneering Scots, Hunter and Smellie; Tristram Shandy, written at about the same time, descants knowingly on the optimal fulcrum placement of this new technology for use by man-midwives. Along with gross anatomy, or the study of the body as it presents itself to the naked eye, wax models were an important means of advancing the evidence of things seen when so many concepts in medicine had been hitherto deductive, reasoning from the general to the particular.
To understand the body, the body was enough — it is a very modern thought. Prior to William of Ockham, who is generally credited with giving primacy to the particular over the universal, that modern clincher 'whose body is it anyway?' would have been an inconceivable thought. Indeed, to have a body (a possession rather than an attribute, something like Locke's 'first property', extending its domain by assimilating what it can grasp) would have been a novel and disturbing heresy five centuries ago. Visiting Melanesia in the 1940s, the anthropologist Maurice Leenhardt was startled to be told by an elder that the Europeans had 'brought them the body'. Perhaps it was the body itself, as Durkheim suggested, that served to organise the personality. But the epistemological strain is evident enough: after the Middle Ages, an anchorite contempt for the flesh allies itself with the Cartesian doubt that underwrites modern analytical medicine; the body loses its place in the great panpsychia of the cosmos, and the very idea of its incarnating the divine comes to seem absurdly aggrandizing. What is universal in man is now a sign.
Ceroplasty and the vascular injection of fixatives and dyes remained mainstays for teaching anatomical structure into the twentieth century. There is clearly a difference between the two methods: the first is an imitation of nature, a distancing technique, the other an attempt to preserve the corruptible body. This was not to spare the anatomist's feelings; it was to protect him from the dangers of putrefaction. The lifelikeness of prepared wax specimens can be such as to acquire a 'terrorizing' quality, as Gonzalez-Crussi puts it, although the technique met with Goethe's approval: his youthful enthusiasm for anatomy classes in Strasbourg in 1770 gave way to a suspicion that anatomists were cads of the worst kind.
On the other hand, it is probably more accurate to say that what most medical students remember of their dissection classes is not a feeling of horror at having to cut up a body but an anticlimactic sense of how grey and shrunken the fixed cadaver is.
The illustrations from Andreas Vesalius' De humani corporis fabrica ranged in the museum outside the dissection room at Glasgow University were more disturbing than the cadavers inside: even when subject to terrible violence — flensed like Marsyas or hanging by a cord to keep their jaws shut — Vesalius' studies insist on comporting themselves in unmistakably lifelike ways: outrage is made complete, Baudelaire suggests in his poem 'Le Squelette Laboureur', by their being 'tricked out to look like hired hands'. Tool, image, grave: the three artifacts that take the measure of, and surpass, our ordinary human condition are assembled in the poem, yet Baudelaire's slave labourer goes on digging even after he has cut the turf for his grave, refusing to move into the immaterial. Concerning Vesalius' series, Roger Caillois remarked in his essay 'Au Cœur du Fantastique' that 'more genuine mystery crops up in such documents, in which precision is of the essence, than in the wildest inventions of Hieronymus Bosch.'
In the dissection groups of six to a table that were a feature of my days in the anatomy department of Glasgow University, imagination was stilled by the unpleasantness of the task and the pedagogic imperative: learn, learn, learn. Rote learning is drudgery: even surgeons don't need to know all the sulci, tuberosities and foramina of every bone, nor every pulley and conduit of the softer parts as detailed by Alexander Monro in his The Anatomy of the Humane Bones (1726). What isn't clinically important tends to be forgotten. Cynicism beckons, or you come to grief. My own enduring memory of the anatomy class is its smell, the pungent odour of formalin; it penetrated clothes and gloves, and lingered in the hair, a kind of olfactory ectoplasm from a cold place in which people no longer mattered.
Enter Professor Doktor Günther von Hagens (the 'von' is an affectation), who describes himself as 'inventor, anatomist, physician and synthetic chemist'. In the mid 1970s, at the University of Heidelberg, he developed — and patented — a new technique for preserving biological tissue called plastination. It had taken him fifteen years of experimentation with industrial solvents.
Plastination is now used by medical schools across the world for the teaching of gross anatomy. It requires tissues, or whole bodies, to be fixed in the standard way with formaldehyde or some other preservative. Specimens are then dehydrated, a process in which the fluid in the tissues is replaced with a chilled organic solvent such as acetone. The next, and central, step of the process is forced impregnation: the solvent is replaced under vacuum with a polymer, silicone or epoxy resin, producing an object which can then be manipulated in ways that were quite impossible with previous preservation techniques. The final stage involves hardening of the polymer. Tissues can be rendered pliable or hard, and with a high degree of realism. The essential organic architecture of the body is preserved, although it is now about eighty percent plastic. In all, the process takes 500–1000 working hours. It is undoubtedly an elegant technique, and produces specimens which are much more resistant to oxidation and decay than the old formalin-phenol injected bodies. Plastination can give a body 500 years of postmortem standing.
This technique, for instance, allows the skeleton to be guddled out, leaving the rest of the body, once the muscles have stiffened after absorbing the polymer, as a self-supporting 'shell'. Hagens has exploited this feature in one of his dissections on show at the Mannheim museum, where the menacing musculature of the Muscleman is displayed a step ahead of his skeleton. The skeleton has been 'shucked' of its muscles, which have been left to stand free, their bloatedness no doubt resulting from the sheer difficulty of extricating the cranium, rib cage and long bones — of outing the inner man. It is a virtuoso piece of dissection work, but the raised left arm and flailing triceps conjure up a film image: Boris Karloff as Frankenstein's monster.
Several other of the whole-body preparations in the exhibition are similarly 'exploded' to show the relationships between the internal organs, or the arterial system. Nearby, the Orthopaedic Body is decorated with twelve different prosthetic devices, and sponsored by Johnson & Johnson.
Another preparation suggests that the association between the Muscleman and Frankenstein was not fanciful: a standing figure has been defrocked of his skin which he holds in his right hand, all of a piece, with an imploring gesture. It is a direct 'quote' of the famous flayed man published by the Spanish anatomist Juan Valverde in Rome, in 1560.
(Continues...)
Excerpted from A Doctor's Dictionary by Iain Bamforth. Copyright © 2015 Carcanet Press Ltd. Excerpted by permission of Carcanet Press Ltd.
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Table of Contents
Contents
Preface,Acknowledgements,
Anecdote A Taste of Bitter Almonds,
Bodies The Plastinator,
Cynicism Knock! Knock!,
Depression A Conspiracy of Good Intentions,
Ethics Insomnia (in the Bed of Being),
Funerals An American Book of the Dead,
Galen Crise de Foie,
Happiness The Moral Life of Happiness,
Integrity An Empty Plot,
Journeys Chekhov Goes to Sakhalin,
Kafka Uncle Siegfried,
Language Is There Life on Earth?,
Mouth Tell Me about Teeth,
Nose Hygiene of the Soul,
Obit The Importance of Being an Agoraphobe,
Posture The Human Position,
Qi Emergent Properties,
Resilience A Mining Town in Australia,
Science (envy) Lamplighters and Lucefactors,
Translating Machine Made of Words,
Upas The Poison Tree,
Vertigo Stendhal's Syndrome,
Weightlessness The War of Eye and Ear,
X-rays Under the Magic Mountain,
Yellow Fever The Life and Times of Ernst Weiss,
(meta-)Zoology Parasites,
Endnotes,
Index of Names,