Dr. Sherwin Nuland, author of the National Book Award-winningHow We Die,once again combines knowledge, compassion, and elegance of expression to shed light on the workings of our bodies from the perspective of a surgeon. Dr. Nuland recounts age-old legends about the functions and "personalities" of the body's organs and, in riveting vignettes of the surgery he has performed, he describes the connections between myth and reality. A brilliant blend of science and folklore,The Mysteries Withinreveals the enigmas not only of the body but also of the human imagination.

Sherwin B. Nuland, M.D., F.A.C.S., is clinical professor of surgery at Yale School of Medicine, where he has taught since 1962. How We Die was a finalist for the Pulitzer Prize and the National Book Critics Circle Award. His most recent book is The Wisdom of the Body, published in paperback as How We Live.

Introduction

15

(8)

The Stomach: A Little Boy's Big Secret

23

(21)

The Stomach: Soul, Spirit, and Centrality

44

(21)

The Stomach: Ghostly Gases, Mystical Acids

65

(19)

The Liver: Dumb Luck and the Surgeon

84

(25)

The Liver: Source of Life

109

(26)

The Spleen: Organ of Mystery, Organ of Melancholy

135

(28)

The Heart: Cracking the Valve

163

(20)

The Heart: The First and Last Dying

183

(24)

The Uterus: The Hysterical Passion

207

(25)

Reproduction: Babies in Boxes

232

(21)

Epilogue

253

(22)

Index

275

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Introduction

Each of our internal organs has a personality of its own, and a mythology too. Any surgeon will tell you that, but even surgeons know only a small percentage of the stories that have shaped the image of one or another of the structures they fondle daily in the name of healing.

Long before physicians had so much as made a start toward any valid understanding of human anatomy, rumors abounded over just what it is that goes on beneath the layers of skin, fat, and fiber hiding the inner man from his own direct scrutiny. Sounds were heard, rumblings were felt, and it must often have seemed to our earliest forebear that autonomous lives were being lived in the capacious cavities of his body. Through the slaughter of beasts and of his enemies, he knew that inside of him dwelt structures of various shapes, colors, and consistencies. Some of them continued to wriggle or pulsate for seconds or minutes after a chest or an abdomen had been laid open with primitive weapons. To our ancient ancestors, life was movement. If an organ moved in the depths of their bodies, perhaps it had a life of its own. Perhaps there were animals within. At the very least, there was mystery.

That notion took tens of millennia to fade from the minds of humanity, as people developed cultures and societies, and began to live together in villages and then cities. Meanwhile, it came to be thought that certain of the organs determined the character of some of the qualities in a man's nature, such as intellect and mood. Like so many other peoples, the Egyptians believed that the larger structures were creatures with whims of their own, migrating where they wished from neck to pelvis. Such fantastical notions did not entirely disappear even when societies reached a high level of sophistication and rational philosophies of man's existence came into being. Not unexpectedly, the sex organs were the last to lose the reputation of being independent. When Plato called the uterus "an animal within an animal," he was not speaking metaphorically. Echoing a common belief of his time, he was convinced that under proper conditions it "becomes seriously angry and moves all over the body."

From such shrouded and uncertain beginnings, an entire body (and the word is here used advisedly) of mythology and legend gradually developed, in which every organ ultimately became surrounded with superstitions, fanciful stories, and real events involving real people. Whatever the viscus, a singular personal history exists for it. Century after century -- slowing almost to a halt during the Middle Ages but accelerating with the late Renaissance -- new knowledge was brought forward, and new bits of narrative were added to the lore. Also, new investigators entered the arena. Once science came onto the scene in the sixteenth and seventeenth centuries, the mystically perceived personalities of the various viscera began to take on a more well-defined form, molded from the experiences and observations -- and in some cases, exploits -- of an ever-enlarging corps of highly individualistic personalities. Not only physicians but soldiers, storytellers, poets, and adventurers of every sort were quick to comment on the tubular or solid, firm or soft, moving or still, undulating or pulsating viabilities they were becoming familiar with at the bedside, in autopsy rooms, and at scenes of carnage.

Even when made by scientists, the commentary was not always scientific. There was often a colorful subjectivity about it -- even a note of wishful thinking, awe, or perhaps fear or warning. An organ's legend is the sum of the accumulated memories that have become associated with it. The memories, the recorded history, and our present scientifically obtained knowledge form the basis upon which to understand that organ's personality. Beginning perhaps with the mystical musings of a Babylonian or Egyptian priest and ending in the ultramicroscopic manifestations of today's shamans of molecular medicine, the legend is imbedded with the stories of the people who are the witnesses to its details. They are that legend's creators.

Whether a discovery, military battle, interpersonal conflict, intellectual current, or simply one of the myriad daily occurrences that chronicle the course of centuries of development, each event in the cavalcade of a growing legend comes from the annals of someone's life. Whatever else it may be, the legend surrounding an organ is a tale of the individual men and women who have added bits and pieces to the whole. It is permeated with their humanity. Be the fragments of the narrative harrowing scenes in the operating room, tales of discovery in deprived or opulent surroundings, the result of serendipity, of chance, of competitiveness, of collaboration, or even of error -- or perhaps the issue of an obsessed seeker's determined quest -- they are the stuff of human experience; they are the expression of mankind's nature.

It is also mankind's nature to cling to myths even when new information reveals their basis to be, in fact, nothing more than the fabled storytelling of a people. Science has never completely replaced mythology, and it never will. Instead, alongside the knowledge that can be validated by evidence acceptable to an intellect trained in the dispassionate methods of experiment and induction, there seems always to flow a parallel stream of unverifiable perceptions. Such a system of alternate varieties of understanding fulfills, in its own way, the need for mystery that has always permeated all levels of human consciousness. It preserves what might be thought of as a demotic form of biology, associated with the kitchen-wisdom of grandmothers and the notions of all manner of unorthodox healers. Superstition, too, abounds. Folktales involving the viscera being as old as humankind itself, we cling like children to their familiar rhythms, sometimes allowing them to influence our perceptions of reality.

The tendency toward mysticism is ingrained in human nature. Superstition, religion, and medicine have made their long journey together, and even now are unable to let go of one another's hands. Religion is the reluctant fellow traveler of superstition, and science attempts to disown them both -- in vain. The links joining the three are indissoluble. They will never be destroyed.

Even after the so-called scientific revolution of the seventeenth century, researchers imbued their theories of the body with the superstitious and also the religious beliefs that permeated the thinking of all people of the time. The new discoveries in human biology, in particular, were interpreted in such a way that they fit into the perspective of Church dogma. Even by the most astute minds, spiritual forces were thought to actuate the functioning of organs; the soul and Divine Will were seen in the behavior of all living things; supernatural causes were invoked to explain what was not yet understood. But in doing this, the scientists and churchmen hid their eyes, refusing to see that they were merely following in the same path that had always been trod since men first looked up at the skies and attributed everything in nature to celestial influences. The great teachers of classical Greece had been no exception. While seeking wisdom in nature stripped of supernature, they nevertheless succumbed to the human predisposition to see the basis of life in preconceived patterns, in their case based on entire philosophies of the universe that they had no way of confirming. Though not called religion, theirs was a religion of its own; though not called superstition, theirs was a superstition of its own.

The history of modern biomedicine -- and modern science, too -- is the history of man's diminishing need to fill the gaps in his understanding of nature by resorting to the mystical, whether in the form of magic or through the teachings of philosophy or the Church. In thus separating himself, he has had to take leave of precious reassurances that he can control his destiny by appealing to higher power in moment-to-moment aspects of his life. He has had to reject -- at least when interpreting scientific evidence -- any possibility that there is some greater purpose guiding the universe and his life. Such a departure from eons-long certainty is frightening, and in any event not totally possible. For there is that in each of us which craves the mystery we have with such difficulty tried to abandon in our thirst for detached scientific knowledge. And there is another craving too, related to the first in that it is a form of magical thinking: Like the child that each of us remains, we have preconceptions of what is real and interpret all that we see through the lens of our own desires and fears. A thing is so because we ordain it to be so; we can make things happen by ordaining that they happen. In the subterranean depths of our inchoate expectations of how the world works, we hear the old refrain, "Wishing will make it so."

All of this was expressed aphoristically by Claude Bernard, the great French scientist of the mid-nineteenth century, who is appropriately considered to be the father of modern physiology. Bernard devoted considerable thought to the personal characteristics required to do dispassionate research, and decided that the kind of reasoning needed for the purpose does not exist as an innate quality of the human mind. Here is how he summed it all up, in 1865: "Man is by nature metaphysical and arrogant. Accordingly, he thinks that the idealistic creations of his mind, which correspond to his feelings, are identical with reality. From this it follows that the experimental method is not really natural to him, and that only after lengthy wanderings in theological and scholastic discussion has he recognized at last the sterility of his efforts in this direction."

This book is not an attack on religion. Far from it. But it is a testament to its author's unshakable conviction that religion and science do not mix well. Only natural means can be used to explain natural phenomena. Only a mind imbued with faith can comprehend the wonders of faith. But true religious faith is not superstition, and it is certainly not magic.

The first healers were indeed magicians, and even today doctors are magicians of a sort, though they deny the role that mysticism plays in their authority, and even in their power to heal. They are heir to a millennia-old tradition in which confidence in their ability and acceptance of their authority have been useful in healing. They are heir to mythologies which can on the one hand be employed in their therapies or on the other may subvert their attempts at cure.

These mythologies take on different forms, resulting in practices as harmless as saying "gesundheit" when someone sneezes, all along the spectrum of increasing danger to such counterproductive behaviors as refusing medical treatment in order to seek guidance from questionable sources or quacks. Every system of what is called traditional medicine finds its origins in the lore associated with the organs of the body, having remarkable similarities in all societies. Because some of the lore is based on accurate understanding obtained through centuries of observation, it has real value; because some of it, like so much New Age belief, is the result of unfocused thought, misinterpreted experience, or downright fraud, it is not only unhelpful but may do serious harm. The role of millennia of mythology is stronger in our everyday thinking than most of us realize.

The purpose of this book is to explore the journey that superstition, religion, and medicine have taken in one another's company. Having considered the various ways in which such an exploration might be most pleasurably conducted -- both for readers and myself -- I elected to choose a group of internal organs with which I have become very familiar through the years of my surgical career and to use them as examples of what mankind experienced during our travels toward modern thought. What I have done for each organ is to trace from earliest times the ways in which it -- stomach, liver, spleen, heart, and uterus -- was understood by physicians and the laity of every era, until biomedical science finally elucidated its most minute workings. As an extension of the story of the uterus, I have added a chapter on the evolution of knowledge of reproduction. Each of these chronicles begins in myth and ends in modernity.

These are stories about the evolution of specifically Western thought. Though evidence abounds of the historic influence of certain Eastern concepts and of similarities in some of our mystical notions with tribal healing beliefs in various areas of the world, I have restricted myself to one more or less direct line. It stretches from earliest humans to the Fertile Crescent where our civilization began, and then on to the formulations of the ancient Egyptians and Greeks, before eventually reaching the modern cultures of which we are a part.

As in past writings, I have not been able to resist telling the stories of certain of my own most unforgettable experiences with these organs. (All but one, that is. Absent is a tale of the uterus because I have had less personal contact with its clinical behavior than with the others.) My fascination with medicine has been renewed over and over again by challenging and exhilarating contacts with patients, disease, and the response of the organs of the body that I have come to know so well. In writing this book, it has seemed to me that an enjoyable introduction to the narrative of each organ's journey through superstition and science might be a case history taken from the annals of my own encounters with it. Perhaps in doing this I have indulged myself just a bit, but the storytelling has added immeasurably to what was for me already an immensely gratifying re-creation of these voyages. I can only hope that readers will find as much pleasure in reading about these memorable events as I have had in recalling them.

Excerpted from The Mysteries Within: A Surgeon Explores Myth, Medicine, and the Human Body by Sherwin B. Nuland
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.