Anatomies: A Cultural History of the Human Body (11 page)

The relationship between the two men is a fascinating one. Carter was aware early on of Gray’s rising star within the hospital. At first, the grammar school boy from Hull thought Gray and his set ‘snobs’, but he soon saw that he was ‘very clever and industrious’, ‘a capital worker’ and ‘a nice fellow’. Yet when Gray won the Astley Cooper Prize for his essay on the spleen, Carter notes that it was gained at the price of ‘beating good men’. He both admires and envies Gray – he complains in his diary of Gray’s ‘Do it!’ approach when he himself cannot get started on things, and feels ‘emulous’ of Gray’s first book, to which he had contributed a few drawings. Yet he also despises him – Gray’s aim is ‘money’, and he is ‘not candid quite’ in making it clear that Carter will not be credited for his work. When they embark on the much larger, and ostensibly more equal, project of the anatomy, Carter calls the agreement reached for his illustrations ‘shabby’, but goes ahead anyway. Gray was to earn royalties of £150 for every 1,000 copies sold, Carter just a one-off payment of £150. When Gray saw the proofs of the title page with his name and Carter’s set in the same size of type, he struck through Carter’s name and instructed that it be set in a smaller size. In later editions, Carter’s name was reduced again, and by the seventeenth edition, published in 1909, it was gone altogether.

So Gray’s
Anatomy
it was. These are the words that appear on the spine of the first edition of 1858, although the proper title of the work is
Anatomy Descriptive and Surgical
. The publisher’s hope was that ‘Gray’s’ single handy volume would be compared favourably with the established multi-volume anatomies – Quain’s, Wilson’s, and so on. And it was. To the reviewer in the
Lancet
, Gray’s
Anatomy
was ‘a work of no ordinary labour, and demanded the highest accomplishments both as anatomist and surgeon, for its successful completion. We may say with truth, that there is not a treatise in any language, in which the relations of anatomy and surgery are so clearly and fully shown.’

It was indeed in presenting human anatomy for the needs of modern surgery that Gray’s made its lasting reputation. Gray laid his emphasis on what an operating surgeon would actually be likely to see when opening a patient up in order to carry out treatment. With major surgery becoming safer and the recent introduction of inhaled anaesthetics (Queen Victoria received chloroform during the birth of Prince Leopold in 1853), his timing was perfect. His prose is plain and workmanlike, graceless even, with no pretensions to grandeur. Carter’s drawings brilliantly fulfil the same brief. They are exceptionally bold – a happy accident arising from the fact that the engraved plates turned out to be over-sized for the book format. Gone are the Classical props and peekaboo antics of Vesalius and other traditional anatomies, Carter being blessedly unaffected by art school training. Instead, text labels appear directly on the drawings in order to help the student link the appearance and name of so many body parts. The art historian Martin Kemp likens Carter’s style – or lack of it – to engineering drawings. To me, his illustrations resemble an old department store catalogue or geographical features named on an Ordnance Survey map.

Just three years after the
Anatomy
was published, at the home where he still lived with his mother, Henry Gray died of smallpox caught from his nephew. He was thirty-four. His book, of course, lives on, now in its fortieth edition, produced by a team of eighty-five editorial contributors and twelve illustrators in place of Gray and his single hired artist: Gray’s
Anatomy
has become
Gray’s Anatomy.

We began this tour of anatomical science with questions about the discrete existence of organs. Nearly 400 years ago, Helkiah Crooke could already write in his
Microcosmographia
, ‘The division of parts into principall, and lesse principall, is verie famous, and hath held the Stage now a long time.’ Those principal parts were the heart, the liver and the brain. Galen had counted the testicles as principal too, because of their role in procreation, but Crooke does not award them this high status because they are not essential for survival.

But is the body meaningfully divisible into such parts? I may have body parts, but I cannot ‘part’, which is to say separate, any one part from the rest of my body without drawing blood. Are the parts, as Darwin believed species had to be, ‘tolerably well-defined objects’? Does this separation tell us much that is useful about the body, or does it tell us more about anatomists’ attitudes in exploring it?

One body part more than any other shows how the human anatomy is still not fully mapped even now. The clitoris seems to have been known, lost, found, lost again and found once more during the course of 2,000 years of medical history.

The difficulty might have been alleviated had there been more female anatomists. There were a few, especially in Italy where some of the universities gave influential positions to women. In the eighteenth century, Anna Morandi succeeded to her husband’s chair in anatomy at the University of Bologna. Her fine anatomical wax models were acquired by Catherine the Great of Russia, as were those of her French contemporary, Marie Marguerite Biheron, who taught John Hunter in London. A century later, Marie-Geneviève-Charlotte Thiroux d’Arconville studied anatomy in Paris, and translated an osteology textbook of Alexander Monro, the founder of a dynasty of Scottish anatomists. She also supervised the drawings for it, while taking steps to preserve her anonymity in the work. She ensured the inclusion of a female skeleton – regarded as highly optional in anatomies of the day – but regrettably allowed culture rather than biology to dictate its appearance. D’Arconville’s illustration has the broader pelvis of women, but a disproportionately small head and a sharply tapered ribcage, indicating either that she was unduly influenced by contemporary expectations of ideal feminine form or that she used a model who had spent her formative years in corsets. The d’Arconville skeleton became the pin-up of male osteologists everywhere.

The clitoris was known to the Greeks, regarded either as an imperfect version of the male penis or, in a fanciful analogy with the uvula and the throat, as the guardian placed at the entry of the uterus. This understanding then seems to have been lost in translations of the medical literature from Greek to Arabic and Arabic to Latin during the post-Roman and medieval periods. Falloppio rediscovered the clitoris as a definite body part in the sixteenth century, although it was Falloppio’s rival Colombo who published first, adding his own significant observation about its role in generating sexual pleasure. Vesalius, however, was unimpressed. He told Falloppio: ‘you can hardly ascribe this new and useless part, as if it were an organ, to healthy women.’ He insisted that the clitoris was no more than a pathological feature found only in ‘women hermaphrodites’.

The clitoris disappeared from much of the anatomical literature again during the nineteenth century – labelling deleted, for example, from some American editions of Gray – owing to social (male) discomfort about female sexuality. According to Helen O’Connell, an Australian urologist, the worst offender was Last’s
Anatomy
, a present-day textbook popular with students cramming for examinations. In other medical textbooks, it is still often adumbrated as the ‘female equivalent of the penis’, and given cursory schematic treatment perhaps showing no more than the external appearance. A sectional drawing, if included at all, is likely to be one through the mid-plane of the body from front to back of the sort that suffices to show the centrally located functional attributes of the penis, but which does not fully represent the three-dimensional internal extent of the female organ.

The more recent ‘discovery’ and description of the ‘G spot’ reveals similar difficulties. In the decadent Berlin of Marlene Dietrich and Kurt Weill, a gynaecologist by the name of Ernst Gräfenberg made his reputation with the invention of one of the first intrauterine contraceptive devices. He escaped from the Nazis in 1940 and eventually set up a private practice in New York, where he was able to pursue his researches into the female orgasm. He did not live to see the term ‘G spot’ coined in his honour in 1980, and, more to the point, did not in this work himself ever refer to any kind of ‘spot’, only to a ‘zone’, involved in female ejaculation. Of course, the G spot is not new except as a cultural construction. Some believe it exists, and others don’t, even now.

What the debate sadly shows is that we seem incapable of moving on from the explorer mentality in our investigations of a human body that must, for our convenience, be composed of discrete parts with clear boundaries, like countries, and precise spots where important physiological events are concentrated, like their capital cities. In this sense, we have turned the physical geography of the body into a political geography.

The Head

At the clowns’ church, Holy Trinity in Dalston, north London, I meet Mattie Faint, who oversees his profession’s dwindling register of members. He is a professional clown himself though dressed in mufti today. The register is not a paper list, but a collection of eggs. There are dozens of them lined up in a cabinet on the wall in a dedicated area of the church. Each egg has been painted, usually in black, red and white to resemble a particular clown, and many have a little felt or conical papier mâché hat on them. A few have a protuberant nose, stuck on like a redcurrant. Some convey signs of the performer’s natural appearance beneath the trademark slap – with painted-on crows’ feet or facial creases. I look for famous names in the ranks, and locate Grimaldi – a white face with big, friendly eyes. He has big red triangles for cheeks and three tufts of orange hair. Mattie’s favourite is Lou Jacobs, who introduced the laughably under-size clown car to the circus ring and whose most distinctive feature is the eyebrows that arch across his face like the McDonald’s sign.

The Clown Egg Register is not a joke. It has a serious purpose as an official roster of practising clowns. To be a clown you have to wear make-up – otherwise you’re just a stand-up comedian. Traditionally, clowns keep their personal make-up even though they may refresh their act. ‘As a clown, unlike actors, you’re looked at for who you are,’ Mattie explains. ‘You’re not waiting for a role.’ So if you’re a clown, your egg is indeed a record of professional identity. Once or twice, an egg has even been exhibited in court to resolve cases of infringement. I find it a happy variant on the unsmiling mug shots by which the rest of us are obliged to identify ourselves.

The register works because we are accustomed both to accept a representation of the head as a sign for the actual head and to accept that the head may stand for the whole person. In Greek and other ancient traditions, the chest is the seat of consciousness, but the head contains the psyche, the principle of life and soul, and the power of the person. A nod of the head is to be heeded as a physical sign of transmission of this power into the world. In its more emphatic, explosive way, a sneeze was regarded as even more significant for being involuntary. It had a prophetic force: whatever the sneezer was thinking at that instant would be fulfilled. This belief held up until the seventeenth century. It is in compensation for the forced expulsion of part of the soul from the head that today we still say ‘bless you’ when somebody sneezes. In language, we speak of a head of state or of counting heads (perhaps in a poll, a word that originally meant the back of a head). We abbreviate the whole to the head on coins, in sculpted busts and painted portraits, and above all in official identity documents. Signatures, fingerprints, iris scans and DNA profiles may all be used to establish our identity. These ciphers may in future be joined by such biometric arcana as hand geometry, ear shape and skin reflectance, or our personally distinctive voice, gait and key-stroke habits. But it is the facial photograph that has shown itself to be the most broadly acceptable means of official recognition. Any record of identity is always an unsatisfactory – and often somewhat insulting – reduction of our complex self. But the photograph excites less controversy than methods involving a high degree of technological abstraction, because in this case even we can see it is us. It is nevertheless a particular version of you that the authorities wish to see. United Kingdom passport instructions stipulate that you must have ‘a neutral expression and your mouth closed (no grinning, frowning or raised eyebrows)’. In other words, no clowning.

The head stands for the whole person never more clearly than when it is set upon a spike. This is the ultimate sign that the body is no more. In death, the head becomes the victor’s trophy and a deterrent to others. The weathered head of Oliver Cromwell famously stood outside Westminster Hall for more than twenty years as a warning to would-be republicans, until the spike supporting it broke in a storm, whereupon it was taken into safe keeping by a succession of self-appointed guardians. It was finally buried in the grounds of his old college in Cambridge, the city he had served as a Member of Parliament, 300 years after his posthumous execution, in 1960.

The head is sometimes kept because it provides solid proof of identity, but also for the more superstitious reason that it was thought even in death to harbour the soul. This proposition received an unlikely test during the execution by guillotine of a condemned criminal, Henri Languille, in Orléans on 28 June 1905. A curious physician, Gabriel Beaurieux, examined the man’s head as it fell from the guillotine. First, Languille’s eyelids and lips went into spasm for five or six seconds, which is a commonly observed reaction. Beaurieux continued to observe, and after a few seconds the man’s face relaxed and the eyes turned up. The doctor then did an extraordinary thing: he called out the man’s name. He saw the eyelids lift, and Languille’s eyes ‘fixed themselves on mine and the pupils focused themselves’. As the eyes closed once more, Beaurieux repeated his call, and once more got the same response. ‘I was not, then, dealing with the sort of vague dull look without any expression, that can be observed any day in dying people to whom one speaks: I was dealing with undeniably living eyes which were looking at me.’ Current medical understanding is that a severed head can remain aware and conscious until falling blood pressure and lack of oxygen causes the brain to shut down, which may indeed take quite a few seconds.

In the Victorian chaos of the Pitt Rivers Museum in Oxford, I find several human heads preserved by shrinking in a display case labelled ‘The Treatment of Dead Enemies’. To mitigate my shock, a caption coolly reminds me that taking the heads of one’s enemies has been ‘a socially approved form of violence’ in many cultures, including our own. These particular shrunken heads, or
tsantsas
, are about the size of a cricket ball and somewhat of the same appearance – hard, leathery and mysteriously darkened by age. Some have abundant human hair, some are embellished with streamers. The heads were made by the Shuar tribe of the Upper Amazon in Ecuador and Peru. The Shuar believe that bodies exist in limited numbers. For them, the captured head of an enemy symbolizes the acquisition of an extra body for occupation by your own descendants. When the enemy was closely related by blood, however, it was customary not to take their heads as trophies, but to prepare substitute heads using animals. The Pitt Rivers collection is supplemented with a number of heads of suitably anthropomorphic creatures, such as monkeys and sloths. Like Europeans, the Shuar believe that part of the soul resides in the head, and part of the purpose of shrinking an enemy’s head is to pacify that soul.

You may like to know how to prepare a
tsantsa
. First, carefully remove the skin from the skull by cutting a slit upward from the nape of the neck. Discard the skull, brain and other interior matter. Sew up the slit you have made in the skin, and stitch up the eyes and mouth, ensuring that the facial shape is preserved. Then boil the skin until it has reduced to about a third of its initial size. Scrape off any flesh still adhering to the inside. Then cure the skin by repeatedly filling the head with hot pebbles. This will dry it out while preserving its overall shape and characteristic features. The shrunken head is finally suspended by threads. It may then be subjected to verbal abuse, after which its mouth is skewered shut with wooden pins before it can reply.

The preparation of the heads in this manner was a protracted ritual, conducted in stages during retreat from battle raids. Each stage of the process was significant, and the proper enactment of the whole ritual was more important than the finished artefact. The Pitt Rivers Museum holds a number of shrunken heads that it considers to be counterfeit because of irregularities in the way they have been prepared. Today, I am dismayed to learn, the people of the region make heads for the tourist trade stitched together using animal leather.

As the head may stand for the whole person, so the nose sometimes stands for the head. A red nose is enough to advertise a clown, after all. The nose is not the most important facial feature, but it is unquestionably the most prominent, owing to its singular nature, its central position and its forward projection from the head. For all these reasons, the nose gets noticed. Unsurprisingly, therefore, it is also the facial feature about which people tend to be most self-critical. Statistics from the British Association of Aesthetic Plastic Surgeons show that more people undergo rhinoplasty than any other change to their facial appearance. (Coming in a distant second are ear corrections for men and eyebrow lifts for women.)

Nikolai Gogol’s hilarious short story ‘The Nose’, published in 1836, plays on the confusion that ensues when a nose takes on the life of a person. The story begins one morning in St Petersburg when the barber Ivan Yakovlevich finds a nose in his breakfast roll, and recognizes it as belonging to one of his clients, Collegiate Assessor Kovalyov, whom he shaves twice a week. Meanwhile, Kovalyov awakens to find himself with a smooth expanse of skin in place of his ‘not unbecoming nose of moderate proportions’. As he goes about his morning chores with a handkerchief clutched to his face wondering what to do, he suddenly passes a ‘gentleman in uniform’ who is none other than his own nose. As a collegiate assessor, Kovalyov enjoys a rank in the Russian civil service equivalent to that of a major in the army. And the nose? From its gold braid and cockaded hat, ‘it was apparent that he pretended to the rank of state councillor’. Kovalyov plucks up the courage to challenge the nose: ‘The point is, you’re my very own nose,’ he blusters. But the nose corrects him: ‘I am a person in my own right.’ Indeed, it will have nothing to do with its former owner, who ranks lower in society.

Rebuffed, Kovalyov is at a loss how to go about his life without his nose, especially as he is hoping for promotion and a good marriage. This was not part of his plan. Ironically, to wind up with nothing in Russian is ‘to be left with a nose’. But he has been left without a nose: what does
that
mean? It is not as if he had lost a toe, he moans; then he could just tuck the injured foot into a boot and no one would be any the wiser. ‘If only I had lost an arm or a leg – it would have been far better; or even my ears – that would have been hard, yet I could have borne it; but without his nose a man is nothing.’ He tries to place an advertisement in the newspaper, but the clerk refuses, fearing such an announcement would bring ridicule on his publication, which already stands accused of publishing a lot of nonsense. Kovalyov is indignant: ‘this is about my very own nose, which amounts to practically the same thing as myself’.

Eventually, the nose is apprehended. Now it must be reunited with its face. ‘And what if it won’t stick?’ At first, Kovalyov tries to reaffix it himself, but it falls to the table with a thud, like a piece of cork. A doctor warns that restorative surgery might only make matters worse. Then, after a couple of weeks, the nose reappears on Kovalyov’s face in circumstances just as inexplicable as when it vanished, and Kovalyov resumes his normal life in high spirits as if nothing had ever happened.

It would be foolish to seek too much meaning in what is essentially a brilliant nonsense story. Gogol gleefully exploits the visible absurdity of the human nose. The ridicule that Kovalyov encounters as he walks around St Petersburg, and that he invites from the reader, is amplified by the thought of this most ridiculous facial appendage. The collegiate assessor’s acute status anxiety means that, while he professedly never takes personal offence, he simply will not have his rank or title abused. Once his proboscis is restored, he is newly confident but just as status-conscious. After a conciliatory trip to the barber, he visits a pastry shop where he allows himself the pleasure of casting a ‘supercilious glance at two officers, one of whom had a nose no bigger than a waistcoat button’.

The temporary autonomy of Kovalyov’s nose also provides a playful rehearsal of some of the ideas in Gogol’s uncompleted masterpiece,
Dead Souls
, which revolves around the illicit trading in serfs who ‘exist’ for tax purposes even though they have died. In such a world, the question of a man’s ownership of another person, whole or in bodily part, gains a sharp satirical edge. At the end of ‘The Nose’, Gogol’s narrator teases his reader with the observation that strange things do happen, even in St Petersburg, even things that may be of no benefit to the nation. The detachment of a nose from a face, we are led to understand, is not the oddest experience a Russian citizen could expect to undergo. The story occasioned the first of Gogol’s several run-ins with the censors for laying bare the absurdities of the system of rank, privilege and favouritism upon which the state depended. It may not be irrelevant to add that Gogol himself had a great beak of a nose.

Conspicuousness begs significance. The size and shape of noses has always provided material for those looking for meaning and difference as well as material for comedy. Why, asks Rabelais’s Gargantua, does Frère Jean have such a handsome hooter? Various theories are advanced: God fashioned it so, ‘as a potter fashions his vessels’; or, he got first choice when noses were for sale. Jean himself suggests that it ‘rose like dough’ in the warmth of his wet-nurse’s soft breasts. Gargantua adds the bawdy profanity that ‘from the shape of his nose you can judge a man’s
I lift up unto Thee
’. Tristram Shandy, the narrator of Laurence Sterne’s eighteenth-century masterpiece of that title, also refers sadly to the ‘succession of short noses’ in his family, observing that his grandfather was limited in his choice of wife ‘owing to the brevity of his nose’. In short, you don’t have to be Sigmund Freud to see that the nose is a symbol of that other forward body part, the penis. There is a hint of this symbolism in Gogol’s story, too. When Kovalyov’s nose is restored, he finds that he is invigorated in other ways, too, less interested in marriage now, but quite up for sex.