(Literary Masterpieces, Volume 24)

Dr. Sherwin B. Nuland, a clinical professor of surgery at the Yale School of Medicine, is the author of several books designed to make current medical information accessible to a general readership. Among them are The Wisdom of the Body (1997) and How We Die (1994), the latter a national best seller that has been translated into sixteen languages. The Mysteries Withinconsiders specifically five of the major organs of the central part of the body: stomach, liver, spleen, heart, and uterus. Nuland discusses the current state of information about these organs in the historical context of the development of that information in the Western world over the past 2,500 years. As he looks at the myths and misunderstandings surrounding these organs in the past, he effectively presents a history of Western medicine.

Nuland sometimes presents cases from his own experience, starting with an operation on a baby’s stomach that he performed forty years earlier at the beginning of his career. The baby boy was six weeks old and had been born prematurely. Now he had a badly distended stomach with a large, firm mass just below the rib cage. This bezoar, a clump of foreign material in the stomach that cannot be passed along to the intestines, did not respond to other treatment and needed surgical intervention. By the end of the chapter the reader learns that the operation successfully removed a lump of wax from the baby’s stomach. The baby’s young and inexperienced mother had regularly been heating waxed cardboard cartons of milk in a pan of hot water, then pouring the milk into the baby’s bottle. Tiny bits of wax lining the inside of the container were being melted and passed directly into the milk. Once the collection of wax in the infant’s little stomach started blocking passage out of the stomach, buildup became rapid. Apparently the mother was remembering her own mother saying she had heated milk that way, but in her mother’s time milk was packaged in glass bottles.

Nuland uses this example and others to illustrate the varying levels of knowledge in a culture at any one time and to discuss prevailing attitudes throughout written history. In the Middle Ages, for example, a bezoar, an unexpected object found in an animal’s stomach, was thought to have magical powers, especially against poisons. Nuland notes that this notion lives on in the form of some people’s belief in amulets and lucky stones and even rabbits’ feet.

Nuland’s examples from his own practice serve also as a starting point for thinking about entire systems of belief that have shaped attitudes toward medicine. One of the main points he makes throughout the work is that societies have traditionally started with some inclusive system that they claim explains everything, including the built-in notion that whatever is not actually known is part of the system too, attributed to God or the gods or the supernatural in general. Thus, any particular observation about the way the body works must be made to fit into the overall belief system or religion. In fact, since the premise is that there is some overall truth or known system, there is really no point in looking further.

The medical thinkers of ancient Greece, for example, considered sickness the result of disequilibrium in the balance of the “four humors”—blood, yellow bile, black bile, and phlegm. Hippocrates, often called “the father of medicine,” spread this theory. Aristotle, who was a young man when Hippocrates died in approximately 370 b.c.e., is the first known person to have used animal dissection to study the body, but that analytical practice did not spread because it was assumed the fluids theory of the four humors explained everything anyway.

The belief in the four humors, inaccurate as it was, continued well into the Renaissance, in effect limiting inquiry into other possibilities. As Nuland says, “The loud, clear voice with which authority so often proclaims itself has ever been a danger to the pursuit of truth.” This was particularly the case throughout the centuries in which religion dominated all attitudes toward life in Western Europe. Early scientists designed their theories to conform to the divine plan as taught by the Church. This practice thus limited their objectivity and even the questions they thought needed to be asked. While it is easy to laugh at some of the absurd notions from the past, it is amazing that the early pioneers in medicine achieved so much given the constraints of their time and the effort to make their discoveries fit pervasive religious beliefs. It should be remembered too that not until relatively recently did physicians and scientists have the benefit of even...

(The entire section is 1915 words.)