Anatomies: A Cultural History of the Human Body

Let’s be clear. Your mind has no problem with the idea of living for ever. What’s wrong with just carrying on as it is doing now? It can see no reason not to. No. Your body’s the problem. It begins to work less well. And it starts going on about itself, sending you ever more frequent messages, nagging, needy messages: What about me? Is nobody listening to me? Stop that, it hurts. Or: ‘I need to go to the loo.’ ‘What, now?’ your mind sleepily responds. ‘It’s three in the morning.’ ‘Yes, now.’

At school, I was obliged to give up biology at the age of thirteen, even though I was beginning to veer towards the sciences. One lesson a fortnight became no lesson at all. It now seems to me astonishing that this should be allowed to happen, not only because it was by then already clear that biology was the scientific speciality which offered the greatest scope for discovery, but also because we are each the owner-operator of our own human body, and this surely would have been the time to learn something about it. Instead, I was left in charge of a complex biological organism about which I knew next to nothing and yet, if I was lucky, I would be instructing and inhabiting for another seventy years or so.

One consequence of this educational omission and my own intellectual laziness is that I have no answer to the bathroom-at-three-in-the-morning problem. I have no idea how my bladder works, or why it seems to work differently now from the way it worked when I was younger. And the chances are that you haven’t either.

I have only a vague picture of some sort of watertight balloon that fills and empties itself, located somewhere in my abdomen. For more precise information, I find I must consult an undergraduate textbook. The book is like a paving slab, and it’s full of colourful but artless drawings. I look up ‘bladder’ in the index. It is not there. I see I’m going to be forced to translate my simple enquiry into an alien jargon. I consider the matter briefly, and then turn to the Us to find an entry for ‘urinary system’.

The bladder, I learn, is an elasticated bag made of thin layers of muscle. It is lined internally with mucus to make it watertight. When full, it distends to the size and shape of a large avocado and contains about a pint of urine (or a litre, according to another textbook, nearly twice as much). An accompanying X-ray image, referred to – as if I’m meant to know the meaning of the word – as a pyelogram, shows the arrangement of the urinary system within the body, highlighted by a contrast agent that has been injected into the human subject. I see a bulbous reservoir cradled by the pelvic bones at the base of the spine. Running out of it are the two thin lines of the ureters, which hug the spine on their way up to the kidneys, where each branches into two, and then five, and then many more thinner tubes that terminate in the depths of each kidney, somewhere about level with the bottom rib of the rib cage. The image is rather beautiful, like two long-stemmed irises in a bulb vase.

The ureters are muscular tubes that squeeze the urine produced by the kidneys down into the bladder. As the bladder reaches capacity, stretch receptors in the muscle wall are stimulated, sending signals to your brain that you construe to mean that you should get up and relieve yourself.

Well, not exactly. In fact, the system is smarter than that. The bladder sends out its first signals simply to test your readiness. On this occasion, your brain responds to the news by sending a message back to the bladder that causes its muscles to contract a little, increasing the pressure of fluid within. The purpose of this is to gauge whether another set of muscles, the ones that allow the bladder to drain when they are relaxed, will hold for a bit longer. The brain is stalling, asking the bladder in effect: ‘Do you really mean it?’ When the bladder sends back signals admitting that it was just a bluff, your brain responds with an instruction to the muscles of the bladder wall to relax again and allow more urine to accumulate. All this happens in your sleep, and saves your being awoken until you really need to be. It’s like the snooze button on an alarm clock.

The textbooks gloss over the deterioration of this admirable system in middle age. I try to reason it out. Maybe your bladder contracts, meaning that it must be emptied more often. Or maybe it expands, triggering the stretch receptors sooner. Maybe the stretch receptors themselves become more twitchy. Maybe the neural telegraph between your brain and your bladder goes a bit haywire and starts sending the wrong messages. Maybe your ageing brain just panics and thinks better safe than sorry. There are so many possibilities. I run my theories by a friend who is a hospital consultant. ‘I’ve been trying to look it up myself,’ he tells me after a while, but the process has left him as baffled as I am. Finally, he passes my questions to a colleague who is a urologist. In fact, I’m told, you simply produce more urine in your sleep as you get older. It’s an inconvenient truth to say the least.

It seems absurd that finding an explanation of this most banal of bodily functions has required so much expert consultation. But I have more awkward questions, too. Is the bladder just a ‘bag’ or is it something more? Is it an organ? What qualifies as an organ? Where do organs stop and start? Student doctors often buy themselves a plastic skeleton and a plastic model of the body in which brightly painted organs hook neatly into place alongside one another. Is this really what the body is like? Or are the organs perhaps cultural inventions, better regarded as repositories for various ideas that we have formed about life than as discrete entities in biological reality? Does it even make sense to talk about the body in parts? For whom does this make sense? And if so, is the human body merely the sum of those parts, or is it something more? For Aristotle was indeed thinking about the human body when he coined this now overworked phrase – ‘more than the sum of its parts’ – in his
Metaphysics
. And if the human body
is
more than the sum of its parts, then what is this ‘more’?

Anatomies
is my attempt to make amends for my missing education in human biology and to find answers to these questions. Like most of us, I know shamefully little about how my body actually works – and occasionally doesn’t. Those who do know – our doctors – seem keen to keep the knowledge to themselves, guarding their professional status with their long words, their simplified attempts at explanation, and those famously illegible prescriptions.

It is obvious that the human body is a difficult subject. Perhaps we are too close to it. The human body is routinely described as a marvel of nature, but it is surely the marvel of nature we least stop to observe. When all is well, we simply ignore it. I suppose this is as it should be – no other animal spends time pondering its wellbeing, after all. But for us, ignorance is not bliss. We are frequently ashamed of our bodies and embarrassed by them.

At the same time, we are bombarded with images of the human body. These are invariably presented as more perfect versions of ourselves. They look better (supermodels) and perform better (action heroes), but essentially they are doing things we do. These proxies remind us that our body, too, is out there in the world. It is through our body that we sense the world and must interact with it. And it is through our body that we are seen and recognized for who we are.

Yet still our bodies trouble us. We disguise them with clothes. We distract attention from them with accessories, a hairstyle, a gait, a repertoire of gestures, a voice, a way with words, to the extent that these become the greater part of our personal identity. Helped by modern medical techniques, we are becoming bolder with these manipulations. From Brain Gym to boob job, we now seek to transform our minds, personalities, faces and bodies. And in truth we have always altered ourselves in both psychological and physical ways. This is just the latest chapter in a continuing story. The idea of the body as a canvas is not new. It’s just that more people than ever are starting to paint.

Then there is our attitude to medicine, the science of maintaining and restoring bodily health. In most sciences, there is some respect for history. Scientists may not refer much to the past in their field, or even know its key figures and dates, but they readily concede that the discoveries of today are built on those of the past, and that we see further because we stand on the shoulders of giants. The history of human biology and medicine, on the other hand, is easily mocked. We laugh at the once widespread belief that you can deduce somebody’s character from the bumps on their head. We laugh at the hopeless cures and painful procedures of the past – the idea, for example, that field-mouse pie was an effective remedy for whooping cough. We laugh because laughter is a response to fear, and we fear for the fragile workings and the ultimate disposability of the human body – of our own human body.

Meanwhile, science is taking us in a new direction – deeper. Slowly, we are getting used to the idea that we will learn most about our bodies by zooming in on them – to examine the cells, the genes, the DNA, the proteins and other biological molecules that make us the way we are. We are given to understand that the key to the body’s functions and its malfunctions – our diseases – lies in the codes and sequences that determine the character of these minute components, and in the chemical reactions that occur and the electrical signals that pass between them.

This is exciting and specialized work. For a privileged few, it offers a newly informed view of the body. But it is a very partial view. It may be that the human person can be described as a string of letters or numbers based on these new methods of investigation, and that such a description is useful in some kinds of research. But this is not the description that interests me. This is not the description we have lived by these past tens of thousands of years as a species. This is not the image we have of ourselves. Knowing that each human body has a set of chromosomes called a genome containing more than 20,000 genes, each of those genes being described by a given sequence of DNA, and that all of these genes are present in every cell of that body is important, but it does not supersede the older knowledge that the body contains a heart, two eyes, 206 bones and a navel. It merely augments it. In its technical detail, it is the sort of description that for many of us seems to miss the point. It doesn’t tell us about ourselves in the round.

‘Know thyself’, famously ran the inscription at the temple of the oracle at Delphi in Ancient Greece. Yet, for all our scientific prowess, we seem to know ourselves, and above all our physical selves, less and less. Perhaps it’s even the case that the quest for scientific understanding of the body becomes a substitute for actual bodily experience: a recent survey of students at an American university found the highest levels of virginity among students studying biology and other sciences (the lowest levels were among those studying art and anthropology).

Something of this kind of displacement has certainly happened in medical schools. The emphasis now is on the detail, not the whole. The sense of the wholeness of the human body has been diminished by the rise of specialization, which insists that the body is regarded in terms not just of parts but of isolated parts. The need to grasp the basics of genetics, molecular biology, pharmacology, epidemiology and public health has all but forced out the teaching of human anatomy, which was central to medical education for hundreds if not thousands of years. In 1900, a medical student might have attended 500 hours of gross anatomy – the anatomy of the whole body. Today, the figure might be one-third of that. And increasingly, that anatomy is seen not in the literal flesh but as a digital image on a screen.

In short, the body is taken as read. It is assumed not only that the medical profession know all they need to know about its general arrangement and function, but that, at our much lower level of understanding, the rest of us do too. I am no medic and naturally try to avoid hospitals. Before embarking on this project, I had never seen an opened body. It’s almost as if somebody has figured it’s better that way. It’s better that we don’t know too much. Then we won’t question our doctors. Then we won’t worry about what actually happens to us when we fall ill and when we die.

Still, chin up. Unique among species, we are blessed as well as cursed with this awareness of our selves and our bodies. Shouldn’t we use this critical distance to come to a more informed view, indeed to come to some kind of reconciliation with our mortal flesh?

Anatomies
is a personal attempt to do this. As you’d expect for a subject with such a rich cultural history as the body, it draws not only on past and present perspectives in medical science, but also on views of the body and its parts taken by philosophers, writers and artists. The body is not just a thing, whether that’s the object on the anatomist’s table or the subject in a life-drawing class. It is animate. So I will look also at the body in action – the body that moves and performs, and expresses thought and emotion. This, as much as our genes, makes us what and who we are. But don’t worry. I will spare you descriptions of my own body’s shortcomings. To misquote Montaigne: ‘I myself am
not
the subject of my book.’

Anatomies
is arranged in chapters based on significant body parts. This provides a familiar structure, although it will quickly be seen that the content of these chapters ranges well beyond the bounds of those parts. We have an idea about all of the parts I have singled out, whether they are internal organs or visible features of our bodies, an idea that owes relatively little to modern science or medicine. Instead, it is shaped by our culture, which has bestowed symbolism and meaning on the parts of the body through long and intimate familiarity with them. To rediscover these meanings, we need to touch and feel, look and listen to the body that we think is so familiar, and which we have preferred to consider in the abstract.

Other books

Turning the Tide by Christine Stovell

Three Summers by Judith Clarke

Blood Wounds by Susan Beth Pfeffer

The Second Siege by Henry H. Neff

Rat Poison by Margaret Duffy

The Child Whisperer by Carol Tuttle

Damaged (The Dark Billionaire, #6) by L.N. Pearl

The Corpse on the Dike by Janwillem Van De Wetering

Miss Matched by Shawn K. Stout

The Cantaloupe Thief by Deb Richardson-Moore