The bowels did not move; and if they had moved the weight would still have remained upon the bed except for a slow loss by the evaporation of moisture, depending, of course, upon the fluidity of the feces. The bladder evacuated one or two drams of urine. This remained upon the bed and could only have influenced the weight by slow gradual evaporation and therefore in no way could account for the sudden loss.
There remained but one more channel of loss to explore, the expiration of all but the residual air in the lungs. Getting upon the bed myself, my colleague put the beam at actual balance. Inspiration and expiration of air as forcibly as possible by me had no effect upon the beams….
After watching another five patients shed similar weight as they died, Macdougall moved on to dogs. Fifteen dogs breathed their last without registering a significant drop in weight, which Macdougall took as corroborating evidence, for he assumed, in keeping with his religious doctrine, that animals have no souls. While Macdougall’s human subjects were patients of his, there is no explanation of how he came to be in the possession of fifteen dying dogs in so short a span of time. Barring a local outbreak of distemper, one is forced to conjecture that the good doctor calmly poisoned fifteen healthy canines for his little exercise in biological theology.
Macdougall’s paper sparked an acrid debate in the American Medicine letters column. Fellow Massachusetts doctor Augustus P. Clarke took Macdougall to task for having failed to take into account the sudden rise in body temperature at death when the blood stops being air-cooled via its circulation through the lungs. Clarke posited that the sweating and moisture evaporation caused by this rise in body temperature would account both for the drop in the men’s weight and the dogs’ failure to register one. (Dogs cool themselves by panting, not sweating.) Macdougall rebutted that without circulation, no blood can be brought to the surface of the skin and thus no surface cooling occurs. The debate went on from the May issue all the way through December, whereupon I lost the thread, my eye having strayed across the page to “A Few Points in the Ancient History of Medicine and Surgery,” by Harry H. Grigg, M.D. It is with thanks to Harry H. Grigg that I can now hold forth at cocktail parties on the history of hemorrhoids, gonorrhea, circumcision, and the speculum.[27]
With improvements in stethoscopes and gains in medical knowledge, physicians began to trust themselves to be able to tell when a heart had stopped, and medical science came to agree that this was the best way to determine whether a patient had checked out for good or was merely down the hall getting ice. Placing the heart center stage in our definition of death served to give it, by proxy, a starring role in our definition of life and the soul, or spirit or self. It has long had this anyway, as evidenced by a hundred thousand love songs and sonnets and I ♥ bumper stickers.
The concept of the beating-heart cadaver, grounded in a belief that the self resides in the brain and the brain alone, delivered a philosophical curveball. The notion of the heart as fuel pump took some getting used to.
The seat-of-the-soul debate has been ongoing some four thousand years. It started out not as a heart-versus-brain debate, but as heart-versus-liver.
The ancient Egyptians were the original heart guys. They believed that the ka resided in the heart. Ka was the essence of the person: spirit, intelligence, feelings and passions, humor, grudges, annoying television theme songs, all the things that make a person a person and not a nematode. The heart was the only organ left inside a mummified corpse, for a man needed his ka in the afterlife. The brain he clearly did not need: cadaver brains were scrambled and pulled out in globs, through the nostrils, by way of a hooked bronze needle. Then they were thrown away. (The liver, stomach, intestines, and lungs were taken out of the body, but kept: They were stored in earthen jars inside the tomb, on the assumption, I guess, that it is better to overpack than to leave something behind, particularly when packing for the afterlife.)
The Babylonians were the original liver guys, believing the organ to be the source of human emotion and spirit. The Mesopotamians played both sides of the argument, assigning emotion to the liver and intellect to the heart. These guys clearly marched to the beat of a freethinking drummer, for they assigned a further portion of the soul (cunning) to the stomach.
Similar freethinkers throughout history have included Descartes, who wrote that the soul could be found in the walnut-sized pineal gland, and the Alexandrian anatomist Strato, who decided it lived “behind the eyebrows.”
With the rise of classical Greece, the soul debate evolved into the more familiar heart-versus-brain, the liver having been demoted to an accessory role.[28] Though Pythagorus and Aristotle viewed the heart as the seat of the soul—the source of “vital force” necessary to live and grow—they believed there to be a secondary, “rational” soul, or mind, located in the brain. Plato agreed that both the heart and the brain were soul terrain, but assigned primacy to the brain. Hippocrates, for his part, seemed confused (or perhaps it’s me). He noted the effects of a crushed brain upon speech and intelligence, yet referred to it as a mucus-secreting gland, and wrote elsewhere that intelligence and “heat,” which he said controlled the soul, were located in the heart.
The early anatomists weren’t able to shed much light on the issue, as the soul wasn’t something you could see or set your scalpel to. Lacking any scientific means of pinning down the soul, the first anatomists settled on generative primacy: What shows up first in the embryo must be most important and therefore most likely to hold the soul. The trouble with this particular avenue of learning, known as ensoulment, was that early first-trimester human embryos were difficult to come by. Classical scholars of ensoulment, Aristotle among them, attempted to get around the problem by examining the larger, more easily obtained poultry embryo. To quote Vivian Nutton, author of “The Anatomy of the Soul in Early Renaissance Medicine” in The Human Embryo, “Analogies drawn from the inspection of hen’s eggs foundered on the objection that man was not a chicken.”
According to Nutton, the man who came closest to actually examining a human embryo was an anatomist named Realdo Colombo, who, at the behest of the Renaissance philosopher Girolamo Pontano,[29] dissected a one-month-old fetus. Colombo returned from his lab—which in all likelihood was not equipped with a microscope, as the device had barely been invented—bearing the fascinating if flat-out wrong news that the liver formed before the heart.
Living amid our culture’s heart-centric rhetoric, the valentines and the pop song lyrics, it is hard to imagine assigning spiritual or emotional sovereignty to the liver. Part of the reason for its exalted status among the early anatomists was that they erroneously believed it to be the origin of all the body’s blood vessels. (William Harvey’s discovery of the circulatory system dealt the liver-as-seat-of-the-soul theory a final fatal blow; Harvey, you will not be surprised to hear, believed that the soul was carried in the blood.) I think it was something else too. The human liver is a boss-looking organ. It’s glossy, aerodynamic, Olympian. It looks like sculpture, not guts. I’ve been marveling at H’s liver, currently being prepped for its upcoming journey. The organs around it are amorphous and unappealing. Stomachs are flappy, indistinct; intestines, chaotic and soupy. Kidneys skulk under bundles of fat. But the liver gleams. It looks engineered and carefully wrought. Its flanks have a subtle curve, like the horizon seen from space. If I were an ancient Babylonian, I guess I might think God splashed down here too.
27
Since the odds of our meeting at a cocktail party are slim and the odds of my managing to swing the conversation around to speculums slimmer still, let me take this opportunity to share: The earliest speculum dates from Hippocrates’ day and was a rectal model. It was to be another five hundred years before the vaginal speculum made its debut. Dr. Grigg theorizes that this was because, in the Arabian model of medicine followed at the time, women could be examined only by women, and there were very few women doctors to do the examining. This implies that most women in Hippocrates’ day never went to the gyno. Given that the Hippocratic gynecological cabinet included cow-dung pessaries and fumigation materials “of heavy and foul smell”—not to mention rectal speculums—they were probably better off.
28
We are fortunate that this is so, for we would otherwise have been faced with Celine Dion singing “My Liver Belongs to You” and movie houses playing