Rumbles, page 16
In 1543 the Flemish physician Andreas Vesalius published his De Humani Corporis Fabrica (On the Fabric of the Human Body), seven books that described every part of the body from the bones and the muscles to the veins, the heart and the brain, in rich and vivid detail. This remarkable verisimilitude was achieved, in part, by the inclusion of woodcut illustrations, drawn from direct observation, depicting the anatomical body in different poses (Figure 24). Based on a series of lectures Vesalius delivered to medical students at the University of Padua, the book was a teaching aid that not only described the body, but also provided step-by-step instructions on how to locate, examine and dissect its organs. The first lesson that every budding anatomist had to learn concerned the order of dissection: how and where to begin. Some theoretical works recommended starting with the head and finishing at the feet, while others proposed that the body be sliced down the middle and opened like a book, but practical guides like De Humani Corporis Fabrica always started with the gut. As cultural historian Jonathan Sawday explains in The Body Emblazoned: Dissection and the Human Body in Renaissance Culture (1995), ‘The anatomist dissected the body according to its rate of decay, commencing with the abdominal viscera, and then moving on to the thoracic cavity, the head, and, finally, the external members – the limbs.’214 In other words, because the stomach, intestines and colon decayed quickly after death they had to be examined first. So, in the grand anatomical theatre of Padua, where onlookers gathered to watch learned men like Vesalius unveil the deepest mysteries of the body, it was the messy viscera of the digestive system that ultimately set the pace (Figure 25).
Figure 24: Illustration of a dissected torso from De Humani Corporis Fabrica, Andreas Vesalius (1543)
Figure 25: Scale model of anatomy theatre built at Padua in 1594
More than simply the anatomist’s timekeeper, the stomach could also be called upon to reveal secrets about the last moments of its owner. The origins of what we would now recognise as the modern autopsy can be traced to the late eighteenth century and the gut played a pivotal role in the development of the discipline from the beginning. Fuelled by the publication of key texts like Giovanni Battista Morgagni’s The Seats and Causes of Diseases Investigated by Anatomy (1761) – which was the first to correlate findings after death with the clinical picture in life – and later made possible by developments in microscopic technology, pathological anatomy emerged as the only scientific field dedicated to understanding death. By carefully examining organs and tissues for signs of disease, noting internal changes alongside external signs and symptoms, it became possible to retrace the steps that led the deceased to the mortuary table. For the post-mortem detective, the gut could provide several important clues. Most obviously, in cases of poisoning or overdose the stomach might directly reveal the cause of death; and even when no trace of the noxious substance remained, changes in the colour and appearance of the other digestive organs could provide evidence that something unpleasant had passed through the system. Beyond toxicology, the stomach has also been called upon to help determine the time of death. The classical method for estimating this involves measuring post-mortem changes to the body like algor mortis and rigor mortis (cooling and stiffening), maceration (tissue softening due to the presence of liquid), putrefaction, discoloration and examining the gastric contents. Though digestion varies from person to person, a meal is typically fully digested between four and six hours after eating, and this fact has often been used to help calculate the time of death. Paused at the moment of death and filled with the half-digested remnants of its last meal, by the twentieth century the stomach came to be imagined as a kind of gastronomic time capsule. Today most forensic pathologists are wary of relying too heavily on gastric analysis as a technique, especially as part of a criminal investigation, but there remains something appealing in the image of the gut as a record of the world buried deep in the abdominal cavity. In the autopsy room the ancient oracle stomach retains some of its potency as a seer of unseen events, revealing the secrets of the dead through its contents.
The term autopsy, derived from the Ancient Greek αὐτοψία, ‘to see for oneself’, conjures a form of extraordinary knowledge of not only the inner world of the body, but also the world – one peopled with friends and enemies – that the living body has moved through. The first surviving record of an autopsy is of the one that was carried out on the corpse of Julius Caesar. Following his assassination in the Theatre of Pompey, his corpse was gathered up by three slaves and returned home, where his personal physician Antistius took over. Having examined him and recorded twenty-three stab wounds, the doctor concluded that the fatal blow had entered just under the left shoulder blade, either striking the heart or nicking a major artery, causing death by massive internal bleeding. From the very beginning, then, there were surprising connections between the prophetic arts and the medical practice of autopsy: Spurinna the haruspex observed Caesar’s future in the guts of sacrificed animals and then Antistius the physician retraced the events of the recent past in his corpse. Later, the arts of uroscopy and scatology continued to blur the line between diagnosis and divination, meaning that the history of medicine is, at least in part, also the history of magic, enchantment and prophecy. Modern research into the microbiome exemplifies this duality: cutting-edge science underpinned by a faith in the gut as the augury of the body, capable of predicting disease and forecasting future health. For all those willing to place their confidence in the prognosticative power of the belly, there have been others who have met its proclamations with suspicion. Whether founded on the possibility of demonic possession or on the dismissal of non-Western medical practices as somehow more ‘primitive’, this scepticism has often betrayed a discomfort with the idea that the organs associated with the grubby business of digestion might have some larger role to play in the life course of a person, let alone in the affairs of the state, the fate of great leaders and the course of nation-shaking events. But whether imbued with miraculous prophetic powers or trusted as a wise diagnostician, throughout history the gut has offered up alternative ways of interpreting and making sense of interior and exterior realities.
Today when we call on a ‘gut feeling’ or scrutinise our evacuations, we place a similar kind of faith in the belly as a soothsayer, sibyl, sage or oracle in possession of a special kind of wisdom. This chapter has examined the future as a key temporal dimension of the belly and we have already observed how the organ has been made to speak to the present, but the past also has a part to play in the cultural history of the gut. However, where the story told here has painted the gut in a fairly positive light, as something that we have used – in various ways – to make sense of the world’s baffling complexities, the past has a different tale to tell.
9 Past
How far would you go to improve the health of your gut? If probiotics did not do the trick, would you consider a more radical solution? The Taymount Clinic, housed in a substantial red-brick building on the outskirts of Letchworth Garden City, is pioneering an approach to digestive wellbeing that goes far beyond the usual advice to eat more natural yogurt. Here it is possible to undertake a faecal microbiota transplant, a procedure that promises to restore gut flora and, in turn, reinvigorate the digestive system. Sometimes described as a human probiotic infusion or more colloquially as a poo transplant, the procedure involves taking intestinal bacteria from a healthy individual – the clinic boasts a bank of over two thousand stool samples for patients to choose from – and implanting them in the body of the patient via a rectal catheter or orally in the form of a capsule. This rather dubious-sounding procedure is based on the science of bacteriotherapy, an emerging understanding of the body that elevates the microbiome, the vast ecosystem of yeasts, fungi, viruses and protozoans that inhabit our gut, as a key player in the health of both body and mind. Faecal transplants have been shown to have some success in preventing the recurrence of gastric infections, especially those like Clostridium difficile (C. diff) which are exacerbated by the use of antibiotics, but the procedure’s boldest advocates claim that it can be used to treat a far wider range of health problems. That the procedure is hailed, in some quarters, as a cure for everything from ulcerative colitis and Crohn’s disease to multiple sclerosis, diabetes and even depression speaks to the power of the microbiome as a new way of imagining and organising knowledge about the body.
The discovery of this trillion-strong army of bacteria has been hailed as a significant advancement in contemporary medicine, but the assumption that digestive processes dictate our overall wellness has a far longer history in the field of alternative therapy. Today the Taymount Clinic is joined by a bevy of nutritionists, hypnotherapists, homeopaths, naturopaths, reflexologists and herbalists who have also chosen to set up shop in Letchworth. A proliferation that might be surprising elsewhere in the Hertfordshire countryside, but which is quite in keeping with the town’s heritage. Built in 1904 by Ebenezer Howard, a social reformer who argued that new communities should be established between the city and the countryside, so that people could live apart from industry and have easy access to green, open spaces, Letchworth was intended to serve as a blueprint for the healthy cities of the future. An experiment in new ways of living, whose high street featured several health food shops, a vegetarian restaurant and a temperance pub called the Skittles Inn, from the beginning the town attracted a certain class of resident. The ‘typical Garden citizen’ was, according to a satirical sketch from 1920, ‘clad in knickerbockers, and, of course, sandals, a vegetarian, and a member of the Theosophical Society, who kept tortoises which he polishes regularly with the best Lucca oil’.215 Elsewhere, sharp-tongued writers like George Orwell lampooned the Letchworth ‘type’ as excruciatingly earnest bean-eaters with unpleasant ‘wilting beards’.216 Dismissed as cranks, these ‘Garden citizens’ spoke, nonetheless, to a broader set of attitudes regarding the pace of modernity, mechanisation and urbanisation.
Returning to the early decades of the twentieth century, this chapter explores how the workings of the gut came to be seen as simultaneously out of step with the rapid rhythm of the age and as representative of an older, more authentic state of being to which many aspired to return. This was a period of great upheaval and from the catastrophe of the Great War, when Europe had teetered on an economic and political precipice, came a shared desire to remake and reimagine the world. For many, this rejuvenation could only be enacted by going back to ‘natural’ ways of living, by getting back to the land and finding spiritual fulfilment there. This enthusiastic embrace of the great outdoors saw membership to cycling clubs soar, and rambling societies established, while organised nudism, nature-based mysticism and sunbathing flourished among the urban middle classes. The construction of towns like Letchworth was another expression of this turn to the rural as the site of fresh air and happiness. With this valorisation of the countryside came a demonisation of the city as a source of illness and unhappiness. As has already been touched upon in relation to the history of the working lunch, the rapid growth of cities – overcrowded and often polluted – led many to wonder whether the urban environment might not be conducive to the health of their residents. Focusing on the work of a surgeon who became notorious for his obsession with the ill effects of modern life on the digestive system, this chapter looks at how the gut came to be understood as an organ under threat from the forces of the present.
One result of the collective turn to nature was a renewed focus on the importance of raw fruits and vegetables to good health, with the result that the consumption of what were referred to as ‘sun-fired’ foods hit an all-time high during the interwar period. Advances in nutritional science revealed vegetables to be rich in essential vitamins and, as a result, governments in Britain and the United States launched dietary education plans that emphasised the body’s need for fresh produce. Reformers began looking to vegetables to build a healthy and vital national body, and this was an important project because, as the draft had revealed, a substantial portion of the population were far from fighting fit. What else was standing in the way of the nation’s health? Not only poverty, dangerous working conditions and poor healthcare, but also the rather hazier threat of ‘over-civilisation’. In the bustling metropolis man lost some essential connection to the natural world: living in heated homes, travelling to work in comfortable omnibuses and eating canned foods, twentieth-century man was becoming a soft and ineffectual creature. Modern life, according to health reformers, caused nervousness, lethargy and depression, but worst of all was the damage it inflicted on the digestive system. Just as medical scientists today look for clues in the microbiome, so their forebears identified the gut as a barometer of bodily and emotional health. One common complaint, costiveness, was held to be especially dangerous to wellbeing and several high-profile health reformers dedicated themselves to ridding the population of this unfortunate affliction.
Figure 26: Advertisement for Carter’s Little Liver Pills, 1920
The early twentieth century was constipation’s belle époque. Sales of purgatives, tonics, syrups and patent medicines like Carter’s Little Liver Pills (Figure 26) went through the roof as ordinary people were encouraged to closely monitor the frequency and quality of their bowel movements. In Britain the campaign against costiveness was spearheaded by a man named William Arbuthnot Lane, who spent much of his medical career popularising the idea that bodily health depended on the regular elimination of its waste. A highly regarded surgeon based at Guy’s Hospital in London, he undertook pioneering work in the field of orthopaedics and neonatal care before becoming interested in the mysteries of the gastrointestinal tract. Born in Inverness in 1856, Lane hailed from a long line of medical men and his early childhood was spent with his military surgeon father in war zones across the British Empire. He returned to Scotland to complete his education before, having taken a particular interest in the study of anatomy, he enrolled as a student at Guy’s Hospital. He remained there for his entire career, where he distinguished himself as an expert in numerous medical fields. In addition to mastering the rigors of ear, nose and throat surgery, Lane designed several surgical instruments – bone-holding forceps, a periosteal elevator and an osteotome, a bone-cutting device – which are still in use today. In theatre he championed the use of strict aseptic procedures that reduced the risk of infection for patients. Following in the footsteps of his father, during the First World War he joined the Royal Army Medical Corps and helped to found Queen Mary’s Hospital, where reconstructive surgery on returning soldiers was first pioneered. For his wartime efforts and in recognition of his remarkable contribution to modern medicine, he was honoured with a knighthood. As these achievements reveal, by the end of the war Lane was one of the best-known and most respected medical men in the country, and yet by 1920 he found himself embroiled in a bitter dispute with the British Medical Association, which would eventually see him struck off the medical register, forced to give up his lucrative private practice and ostracised by the wider professional community.
This dramatic fall from grace was the consequence of Lane’s long-standing, almost monomaniacal preoccupation with constipation. More than a discomfort or an embarrassment, costiveness was, he claimed, ‘the cause of all chronic diseases of civilization’ and the most serious public health crisis facing the developed world.217 The danger came from the threat of autointoxication, a medical theory which held that half-digested matter sitting in the gut for too long would begin leaking toxins into the rest of the body. Chronic intestinal stasis occurred, according to Lane, when ‘the passage of the contents of the intestinal canal is delayed sufficiently long to result in the production of an excess of toxic material, and in the absorption into the circulation of a greater quantity of poisonous products than the organs which convert and excrete them are able to deal with’.218 These ‘poisonous products’ were the cause of a whole host of seemingly unrelated health problems: from stomach pain and sallow complexion to muscle pain, cold hands, baldness, excessive perspiration, a compromised immune system, rheumatoid arthritis and even cancer.
Less quantifiable, but just as worrisome, were the mental and emotional problems that could arise from irregular bowel movements. Writing in 1916, Frank Crane, an American physician and another proponent of the theory of autointoxication, observed that most ‘domestic friction’ – misbehaving children, fractious spouses and cantankerous relations – could be attributed to the malignant influence of unhealthy bacteria lurking in the gut. What the religiously minded might be tempted to label ‘sin’ was, he insisted, often due to ‘what the physician calls stasis’.219 Beyond family squabbles, incomplete digestion could, in extreme cases, cause full-blown insanity. One of the founding members of modern psychiatry, the German physician Emil Kraepelin, was particularly adamant that many diseases of the mind originated deep in the viscera. Dementia praecox, what we would now define as schizophrenia, was caused by ‘an endogenous process of chronic autointoxication which led to a self-poisoning of the body and, eventually, its brain’.220 Interestingly, recent research has explored possible connections between the microbiome, cognitive function and the symptoms associated with schizophrenia. Having compared stool samples from sufferers and non-sufferers, a team from the University of Wollongong in Australia found dramatic differences in their microbial make-up and they have posited that this may impact the neuronal functioning of the brain.221 While today scientists tend to view the gut–mind relationship as a fundamentally friendly one, sometimes set off course by miscommunication, doctors working at the beginning of the twentieth century took a much dimmer view of this alliance. The theory of autointoxication elevated digestion as the primary determinant of physical and mental wellbeing, but it also recast the bowel as the primary site of pollution in the body.
