Exploratory surgery

The mysteries within: a surgeon reflects on medical myths Sherwin B. Nuland New York: Simon & Shuster; 2000 274 pp. $35 ISBN 0-684-85486-4

Sherwin B. Nuland's latest nonfiction work, The Mysteries Within: A Surgeon Reflects on Medical Myths is an informative and entertaining chronicle of Western medicine as reflected in the science and mythology of five internal organs: the stomach, liver, spleen, heart and uterus. From the "mystical musings" of Babylonian times to the "ultramicroscopic manifestations" of today, Nuland offers a thoughtful guide to ”the journey that superstition, religion, and medicine have taken in one another‚s company.” In so doing he traverses two geographies: the landscape of the body and the landscape of scientific thought.

Nuland's impulse to frame the book with his own experiences in the operating room heightens the reader's interest in the legend and lore surrounding each of the organs that he confronts as a surgeon. Sometimes, however, his anecdotes are almost too good. Although the historical chapters are filled with drama, interesting personalities and lively analyses, they are not as gripping as the introductory tales. One has to resist the urge to flip to the next dramatic scene from the operating room.

The historical sections require some concentration, but Nuland rewards the reader with his gentle wit and conversational tone. One of the strengths of the book is the author's ability to present historical events and scientific facts in an accessible manner. From Galen, to Aristotle, to Harvey, he relates in the context of particular organs the contributions, errors and beliefs of some of the greatest movers and shakers in the history of medicine. Throughout, he reiterates his thesis that, although humankind has often resorted to mystical and supernatural explanations of biologic phenomena, the foundation of Western medicine is critical thought, skepticism and reason.

Historically, medicine‚s journey has been coloured by "mysticism, magical thinking, superstition, philosophy, religion, authority, rationalistic patterns of thought, preconception, misapprehension of the criteria for evidence, ambition, and … deceit." Early conceptions of the structure and function of organs, he explains, was based on the theory of humours, and explanations of biologic processes relied on notions of "spiritual and other non-verifiable energies." It wasn't until the 16th and 17th centuries that the scientific method of experiment and observation finally began to be practised and, in some manner, instituted. Nuland traces the shift within science from attempting to explain the functioning of all living things with a unified theory (with divinity at its core) toward making small observations and small claims without necessarily putting divinity at the centre. This shift, Nuland argues, is the basis for the progress of Western medicine.

Nuland has spent a lifetime occupied with both the immediate, visceral reality of the internal organs and the more distant, theoretical contemplation of their history. One senses that he is engaged with his subject with both his head and his heart. Indeed, it is his descriptions of the heart that best convey the spirit of the book:

I have never lost that awe. It remains with me in spite of all I have since learned of the heart's nuts and bolts and valves and cords — not to mention its flows and its fluid forces, its electricity and its chemical influences. I know them and know also the heart's weaknesses just as well as I do any other part of this human body of ours that I have never stopped studying since those youthful days. And yet, the thorough familiarity with cardiac anatomy and physiology — and romance and breakability — has not lessened by an iota the spell cast on me when I first gazed at it that day in the laboratory.

One appreciates the range of Nuland's intellectual curiosity as he roams through literature, religion, metaphysics, science and history to assemble a story for each organ. To take again the example of the heart, he moves from discussing this organ in the context of the Talmudic Midrash Rabbah, to Homer‚s Iliad, Shakespeare‚s The Merchant of Venice and an account by a 16th-century French battlefield surgeon.

Nuland is skeptical and critical, but he retains a sufficient sense of wonder for his subject matter to create a book that synthesizes his experience with the human body. Anyone interested in the history of medicine and organ folklore will enjoy this work. In the future, however, one hopes Nuland will venture farther into the area that is the true foundation of this book: the operating-room stories of his encounters with patients, colleagues and, most important, organs.