Anatomies: A Cultural History of the Human Body (7 page)

I’m reminded of the problematic nature of fat when I see an unusual wax model of a dissected body at the Boerhaave Museum. In the early nineteenth century, Petrus Koning, a morbid anatomist at Utrecht University, took the unusual step of making realistic wax models rather than the idealized versions typically crafted in Italy. Wax models were made as durable substitutes for cadavers for the instruction of medical students. Realism was the ostensible aim of their gifted creators, but some tidying up clearly went on, and sometimes an allegorical dimension crept into the works. They remain more beautiful and affecting than the brightly coloured plastic kits that have superseded them. Koning’s departure was to extend the realism of his models to include the yellow layers of fat that other artists chose to omit – and that continue to be left out of today’s plastic models.

Our attitude towards our own fat is highly ambivalent. In Genesis, Pharaoh promises that his followers shall eat ‘the fat of the land’, and it is clear that the fat is the best of what the land can offer. In times when few people could aspire to being fat, fatness was an ideal in itself, a sign of prosperity and health. Wanting for nothing, rulers from Hapshepsut to William the Conqueror to Henry VIII all attained a fine girth. Extreme obesity was not unheard of either. The Greek physician Galen attended one Nichomachus of Smyrna, who was apparently unable to move from his bed for sheer weight. What the philosopher Susan Bordo calls the ‘tyranny of slenderness’ only began to assert itself in the late Victorian period among a few of the wealthy who reacted ascetically to the greater abundance of food. New scientific ideas about diet and exercise helped them in this direction, as, surely, did the invention of the bathroom scales around this time. It is telling that the latest versions of such scales send small electric currents through your body so as to track changes in the weight of your fat quite separately from the weight of your body overall.

One response to the growing fashion for thinness was to find new labels to suit those who were not thin. The splendid adjective Rubenesque dates from 1913. Derived from the voluptuous nudes painted by Peter Paul Rubens three centuries before, it is a reminder that ‘fleshy’ was not always bad. A Rubenesque figure is a paradox in the world where size zero is queen. It means not fat, not even large, but somewhat plump and definitely curvaceous – and desirable, not repulsive. It suggests soft flesh, not the hard body of
homo clausus
: more Marilyn Monroe than late-period Madonna.

Scientists interested in attraction have recently examined the Flemish artist’s works in order to test the supposition widely accepted by evolutionary psychologists that men are biologically conditioned to prefer women with low waist-to-hip ratios, around 0.70, equivalent to a twenty-five-inch waist and thirty-six-inch hips, despite evidence that in some non-Westernized societies attraction is primarily driven by a high body weight. They measured the waist-to-hip ratios of twenty-nine Rubens nudes, accepted as representing an artistic standard of beauty, and found that they came out substantially higher, at 0.78, providing further evidence to suggest that the hourglass figure represented by the 0.70 ratio is not an ideal for all societies or all times.

So how much fat is too much? Fat is known to serve a number of vital functions, of which the most obvious is the storage of energy. There are around thirty billion fat cells in the body. This figure does not change if you gain weight – at least at first. What happens is that each cell stores more energy-rich lipid, increasing up to fourfold in weight. If weight gain proceeds beyond a certain point, however, these cells begin to divide, and new fat cells are formed. After that, it’s harder to lose weight. Fat performs a number of other useful jobs, though, such as providing fatty acids that control cell activity and the hormones that regulate various body functions.

It’s clear, then, that fat is not merely stuffing or padding, although it remains far less studied than flesh, bone and the organs of the body. Yet this is how it easily seems to us. It may be present in abundance or largely absent. When it appears, it is amorphous and unruly. It seems continuous, homogeneous, without structure and potentially endless. It serves no visible purpose but accretes anyway, making its own space in the expanding envelope of the body. It flouts the rules of ideal human form. And, bulging out almost anywhere, it makes a mockery of pert
homo clausus
.

Pliny the Elder was one of the first to take against fat, in his
Natural History
, where he tells us that fat is without sense. Flesh can feel and touch, but a layer of fat is a spongy obstacle to sensation and therefore a hindrance to our connection with the world. In contemporary discourse, too, fat is seen not as the necessary complement of flesh, but in some ways as its inverse. Some people even equate the removal of fat with the addition of muscle tissue or the development of a leaner physique. One cosmetic surgeon I interviewed explained that an increasingly popular operation for men is the removal of subcutaneous fat from the stomach in narrow furrows so as to leave the illusion of a ‘six-pack’, that is to say, a well-developed rectus abdominis, the large, flat muscle that stretches across the stomach, and in which, with good definition, three transverse tendon lines appear.

The questions don’t go away when the fat is no longer part of us. Is it waste or a useful resource? It is classified as
clinical
waste in operating theatres. But, surely, it cannot be
bodily
waste if it does not leave the body through the orifices reserved for this purpose. If it has to be cut away or sucked out by force, it must surely be precious to us, more akin to our flesh. Yet, once it is removed, nobody wants it, and the bulky substance inspires some of the same revulsion as normal bodily wastes.

Elaborate social rules and taboos govern our views about blood and excrement. But no such rules have been established with regard to fat. All this uncertainty excites artists. The German Joseph Beuys was renowned for his use of fat in his works. Although he actually used animal fat, it seems clear that we should read the fat as our own. Explaining his use of the material, Beuys made the exotic claim that, when he was shot down over the Crimea in 1944 while serving in the Luftwaffe, he was nursed back to health by Tatar tribesmen who wrapped him in layers of fat and felt.

The increasing popularity of liposuction forces us to confront the cultural meaning of fat anew. What does it mean to remove it? And what does its separate existence outside the body represent? In Ancient Greece, human fat was used for sacrificial and burial offerings, its liquidity thought to contain the essence of life and to counter the dryness of the bones. Today, the rituals take bizarre new forms and suggest new meanings. In 2005, the Australian installation artist Stelarc and his partner Nina Sellars both underwent liposuction and then mixed the fat extracted from their bodies in a large transparent chamber to create an artwork that they called
Blender
. Every few minutes, the mixture is stirred with an electric blender in order to maintain its homogenized liquid state. A major part of the artists’ achievement, they say, was to obtain legal ownership of their own bodily residues in order to make the work in the first place. The food writer and self-styled ‘gastronaut’ Stefan Gates arguably went further when he converted fat extracted from his body by liposuction into glycerol for use in icing a cake, which he then proceeded to eat. What do these stunts tell us, the one a weird simulation of sexual union, the other a shocking exercise in autocannibalism? Perhaps only that our relationship with fat is set to continue on its troubled path.

Tabloid tales of murderers rendering the fat from their victims and selling it for large sums to cosmetics manufacturers, or of plastic surgeons running their cars on diesel fuel derived from their patients’ fat, should be treated with caution, however. For most practical purposes, fat from one source is pretty much as good as fat from another, and it is one of the cheapest of animal commodities. There would be no point in going to the trouble of using human fat to do a job that could be done just as well by animal or vegetable fat. If ‘oil of man’ is to have value in the future, it is more likely to be for the cellular matter that it contains than its energy-rich lipids. In 2002, for example, a team led by Patricia Zuk at the University of California at Los Angeles demonstrated that human fat can be a convenient source of stem cells that are capable of being differentiated more readily into muscle, cartilage or bone tissue than adult stem cells harvested from other parts of the body. We may at last have found a reason to love our love handles.

Bones

The skeletons that dangle so prominently in anatomy rooms ancient and modern, in the medical corners of university bookshops and for that matter from the gibbet beg to be admired as pure structure. When we set out the bare bones of an argument we mean to explain its essentials. Our bare bones represent something essential about us. They are also an aesthetic and engineering marvel.

People rushed to see living bones when the opportunity first arose with the advent of X-rays in 1896. The
Neue Freie Presse
of Vienna announced Wilhelm Röntgen’s discovery on 5 January in an article illustrated with an X-ray photograph of Frau Röntgen’s left hand. Only her bones and wedding ring were visible; flesh had become transparent. Within days, enthusiasts were making X-ray devices for their own entertainment as well as for medical diagnosis, the application that Röntgen had identified from the outset. Such was the amateur uptake that doctors would ask their patients to bring in X-rays that they had recorded for themselves at home – a practice that led to some nasty radiation burns from the long exposure times required.

The technology makes a notable appearance in Thomas Mann’s 1924 novel,
The Magic Mountain
. The naive protagonist Hans Castorp visits an alpine tuberculosis sanatorium. He accompanies his cousin as his X-ray is taken and then proffers his own hand even though he is not ill. He sees what he has been led to expect, ‘but which no man was ever intended to see and which he himself had never presumed he would be able to see: he saw his own grave’.

More remarkable is the macabre erotic charge that accompanies these new visions of the body in which one can see not through clothing to the skin but beyond that, through the skin to the bones. At one point, Castorp is shown X-rays of a woman’s arm and is reminded: ‘That’s what they put around you when they make love, you know.’ Awaiting his own X-ray, he fantasizes about a woman patient in whom he sees that ‘the neck-bone stuck out prominently, and nearly the whole spine was marked out under the close-fitting sweater’.

Immediately, people wanted X-rays to do more than just show them their bones. On 5 February 1896, only a month after their discovery had been announced, the media mogul William Randolph Hearst wired the inventor Thomas Edison to ask if he would record an X-ray of the human brain. Edison seized first the opportunity and then his assistant’s head, which he positioned in the path of the X-rays for an hour. But all he could see was the ‘curvilinear murkiness’ of the man’s skull. It had to wait many decades until other techniques would reveal something of this most mysterious body part. X-rays, meanwhile, remain the principal medical means for showing the bones in contrast to the flesh and other soft tissue, and their ghostly negative outlines retain their hold on the public imagination.

There may be sins of the flesh, but the skeleton that carries our weight is the body’s innocent slave, a guileless mechanism, admirable in its devotion to duty. It is the only part of the body that endures for ever, which gives it a significance beyond the perishable rest. Although it seems inanimate because it is rigid and hard, the skeleton thus represents the continuation of life (a biologically apt symbolism, as it happens, since bone contains marrow, which generates blood cells).

Chief among the bones of the skeleton in symbolic terms is, of course, the skull. Its eyeless sockets stare, its teeth grin, its lipless mouth accuses. The skull is the ultimate warning against human vanity, the
vanitas
symbol of Classical art, because it is bone but also because it is still recognizable as a face. Such a skull sits ominously on the lid of the tomb in the lesser known of Nicolas Poussin’s two paintings entitled
Et in Arcadia Ego
after the inscription that appears on the tomb. As the head often stands for the whole person in life, so the skull stands for the person when dead. A hand-drawn symbol of a skull was once used in ships’ logs to record the death of a crew member. This custom probably explains the seventeenth-century origin of the Jolly Roger ensign flown by pirate ships, in which a white skull and crossed bones appear on a black background. ‘Jolly Roger’ may be a corruption of the French
jolie rouge
, because the flags were once red, an even bloodier indication of the pirates’ intentions.

But the skull rejoins its body at other times. Whole skeletons perform the
danse macabre
or
Totentanz
, the dance of death, an allegorical artists’ subject that came to prominence in the fifteenth century in the aftermath of the Black Death. When Camille Saint-Saëns wrote his
Danse Macabre
for orchestra in 1874, he made good use of the xylophone to reproduce the spooky clatter of cavorting bones.

Old medical texts typically present the skeleton as one of nature’s wonders. The precision engineering of our bones that allows us to walk and run and lift and carry has often been given as evidence for the existence of God. ‘I challenge any man to produce, in the joints and pivots of the most complicated or the most flexible machine that was ever contrived, a construction more artificial, or more evidently artificial, than that which is seen in the vertebrae of the
human neck
,’ wrote William Paley, in perhaps the most famous of these hymns of praise, his
Natural Theology, or Evidences of the Existence and Attributes of the Deity Collected from the Appearances of Nature
of 1802. Paley admires the vertebrae of the neck in particular because they are articulated so that the head can both nod
and
turn left and right. This is pure teleology, of course: because the bones do their job so miraculously, well, they must have been miraculously formed. Paley it was who came up with the famous analogy of natural creation to a pocket-watch, a mechanism so complex that it could not possibly have been formed without a maker’s intervention. The intricacies of human anatomy were a major part of his inspiration.

At any rate, when we look at a skeleton, we see not only an image of mortality but what is clearly some kind of mechanical system. Some of the bones are supporting columns. Others are like beams. They are called upon to work in a variety of ways. Imagine a skeleton holding a bag of shopping. The weight of this load passes up through the bones of the hand and arm to the hinge point of the shoulder. From there, the load is transmitted via the collar bone, shoulder blade and other bones to the spine, where it then runs down through its vertebrae into the pelvis and thence down through the bones of each leg until it reaches the ground. Lifting the bag, the bones of the arm are placed in tension while the spine and leg bones are compressed. The collar bone acts as a beam, with forces of tension stretching the top side of the bone and forces of compression pushing it together underneath as it bends under the load.

We can surely accept without having to invoke a divine creator Paley’s view that the bones perform remarkable feats. A slight young woman who weighs, let us say, fifty kilogrammes may possess a skeleton with a dry weight of no more than three or four kilogrammes. This is, I think you will agree, almost incredibly light. It is lighter than some of the plastic replica skeletons that are sold to medical students. Why is this so surprising? In life, we tend to think the bones are heavy and the flesh is light. This is because the latter moves while the former must be moved. We think of muscle as active and bone in contrast as passive and therefore inert and resistant to our will. But I find this perception changes in front of a dissected cadaver. If you’ve ever held a bone in your hand you’ll find that, as soon as you lift a whole limb, it is the flesh that is heavy and the bones that are light.

Dry bones are chiefly composed of hydroxyapatite, a hydrated form of calcium phosphate. The density of this mineral substance is enough to block X-rays. These can then reveal where the bones are inside the body and the material flaws in them, but unfortunately nothing about how they work. They do tell us, though, that there are roughly 206 bones in the human body.

Why
roughly
206? It’s not as if 206 is such a high number that one can’t make an exact count. The number is an approximation because certain bones fuse together while we are growing. A bone called the sacrum forms when the lowest five load-bearing vertebrae fuse together where they meet the pelvis. Beneath them, another three, four or five vertebrae fuse together to form the much smaller coccyx, which attaches to the bottom of the sacrum. The coccyx is our vestigial tail. In tailed creatures, many more articulated vertebrae go on to provide its flexible structure. The coccyx might be assumed to be redundant in humans, but it has evolved in parallel with our sedentary lifestyles to serve as the third leg of the bony tripod on which we sit (the other two legs being the catchily named ischial tuberosities of the pelvis): we carry around with us our own bony three-legged stool. Usually, there are more than 206 bones in the body; occasionally, a few more fuse than really should, and we end up with a slightly lower number.

Bones fuse because of gravity. In the effectively weightless environment underwater, the bones of whales and fish may never fuse, and so they carry on growing. Growth is so unimpeded in some cases that size is a good guide to an animal’s age. Humans, on the other hand, stop growing at a remarkably constant size. The biologist and philosopher J. B. S. Haldane put it thus in a famous essay:

Let us take the most obvious of possible cases, and consider a giant man sixty feet high – about the height of Giant Pope and Giant Pagan in the illustrated Pilgrim’s Progress of my childhood. These monsters were not only ten times as high as Christian, but ten times as wide and ten times as thick, so that their total weight was a thousand times his, or about eighty to ninety tons. Unfortunately the cross sections of their bones were only a hundred times those of Christian, so that every square inch of giant bone had to support ten times the weight borne by a square inch of human bone. As the human thigh-bone breaks under about ten times the human weight, Pope and Pagan would have broken their thighs every time they took a step. This was doubtless why they were sitting down in the picture I remember. But it lessens one’s respect for Christian and Jack the Giant Killer.

This argument, incidentally, while persuasive on the ideality of human
size
, all but disproves the existence of an ideal human
proportion
, for if we had evolved to be sixty feet tall, then our proportions would have to have been very different from those given by Polykleitos and Vitruvius.

With 200-plus bones weighing only a few kilogrammes in sum, the average weight of a human bone comes out at less than an ounce. Of course, these bones range widely in both size and shape. The ‘longest, largest and strongest bone in the skeleton’, as
Gray’s
Anatomy
puts it, is the thigh bone. With its long, straight shaft and enlarged ball-jointed ends, it makes a handy club, as the apes find in the opening scenes of
2001: A Space Odyssey
. At the other end of the scale are the famously tiny bones of the ear – the malleus, incus and, smallest of all, the stapes (hammer, anvil and stirrup). The stapes, which may weigh as little as three milligrammes, is indeed shaped almost exactly like a riding stirrup.

Many of the names of the bones are visually descriptive like this, even if they sometimes refer to now less than familiar objects. The sternum or breast bone is said to be shaped like a Roman dagger, with its fused parts – the manubrium and the gladiolus – named after its handle and blade. The skull, meanwhile, is likened to a house: the bones at the side are called parietal after the Latin for wall. Below them are the temporal bones, which may relate either to the idea of a temple, as a location on the head appropriate to higher thought, or to the passage of time, as it is here that the hair first starts to turn grey. The clavicle (collar bone), which Gray describes as like an italic letter
f
, gets its name from the Latin for ‘little key’ (keys were bigger in those days). In the wrist there is the pisiform bone, the size and shape of a pea. Other bones in the hands and feet owe a debt to geometry: the trapezium, trapezoid and cuboid bones. It’s all very straightforward if you have conversational Latin and Greek. The question is why more of the bones don’t have ordinary Anglo-Saxon names as the major organs and external parts do. Only the spine, ribs and the most obvious bone of all, the skull, have names rooted in the vernacular. Other bones, mainly in the limbs and joints, are named simply after their enfleshed counterparts.

All of these names and descriptions are based on the male skeleton. Feminist reappraisals of historical medical texts have suggested that ‘[n]o description of the female skeleton existed before the eighteenth century’, and there is only one crude illustration from earlier than this, dating from 1605. This lamentable situation has lately been somewhat rectified, but at the price now of regarding the female skeleton largely in terms of its differences from the male, and especially in relation to its supposed function or purpose of child-bearing.