Another Year, Another Body Part

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This is a story of how, as a historian of medicine, my own aging has affected my sense of my body. For me this is casting new light on questions I have asked in my research on historical bodies. How did people interpret the things that happened in their bodies, and what happened when they were given new information about those bodies?

When I started my research on the history of the body, I was relatively young, and relatively healthy. Not entirely healthy; I intended my PhD in Ancient History to be an analysis of concepts of time, but it changed into a discussion of the female life cycle as represented in the Hippocratic texts. The reason? Because I suffered from what was eventually diagnosed as endometriosis. Nevertheless: relatively healthy.

Aging has changed the questions I ask as a historian of the body. Not for the first time – as I mentioned in a piece I wrote when I broke my wrist – my personal experiences are making me revisit Vesalius’s famous comment about the body being made up “not of ten or twelve different parts (as it seems to the casual observer), but of several thousand diverse parts.” Specifically, what happens to us when we find out there is a part of our bodies about which we didn’t know before? What does it do to our sense of self?

Introducing new parts

It now seems that every year, I confront another body part of which I was previously blissfully unaware. I can’t be alone in this. As the 2020s began, it was the inner ear. I experienced the sensation that I was in a tumble dryer, the diagnosis being benign paroxysmal postural vertigo (BPPV). Like some other diagnoses, this label does not offer an explanation: it simply puts a symptom into medical language. One explanation for the sensation is that invisible crystals in the inner ear have come loose. I am still not sure whether to believe in these crystals. With my history of medicine students, I had raised my eyebrows quizzically at the idea that there must be invisible holes in the septum which allow blood to travel from one side of the heart to the other. What a cop-out from thinking outside the box of the models of the body inherited from antiquity! Having taught others not to believe in an invisible part, it seemed quite a stretch to be asked to believe in invisible crystals. Calling them “tiny” rather than “invisible” may help, but I still find their existence hard to accept.

In 2023, it was the vitreous of my right eye, as I had a posterior vitreous detachment which – although alarming – turns out to be “natural,” unexceptional in people of a certain age. It doesn’t feel like that when it happens; it feels terrifying, as there is a sort of gash in the field of vision, and it isn’t clear whether it is permanent or not.

In 2024, after a chance diagnosis of atrial fibrillation, I discovered that the heart includes a “left atrial appendage.” Because of an unidentified coagulation disorder, something that has affected other members of my family but remains nameless, I am unable to take blood thinners to reduce the risk of stroke. The main site where blood clots may develop during atrial fibrillation is the left atrial appendage. As an alternative to thinners, a cardiologist carried out a procedure to insert an umbrella-like device into my heart to block off this appendage. I observed that the diagrams of the heart on the walls of his waiting room didn’t label this part, although its irregular baggy shape is now familiar to me. Despite twenty years of teaching the history of medicine, including English physician William Harvey’s discovery of the role of the heart in the 1620s, I’d never heard of this appendage, let alone incorporated it into my image of my own body. I knew all about the differences between the left and the right side of the heart, and about the history of valuing the right over the left in other bodily experiences, but in the last few months I have experienced these differences for myself as blood from left and right has mixed in tiny amounts via the hole made by the surgeon in my septum, and this has caused visual disturbances.

The fear of the new

People in past centuries, past decades even, had no idea about invisible crystals and the vitreous, let alone the left atrial appendage. Not only tests and treatments, but also the explanatory models available to them were entirely different. Yet some issues were exactly the same, in particular the shift from the theoretical to the personal: from models of the body, to my body. In recent months not only has that newly-discovered appendage loomed large in my self-image, but so has the heart as a whole: my heart. In owning that body part, the shift from the neutral “the” to the personal “my” is significant. Cardiologists know that, today, when you are told “It’s your heart,” the initial reaction is panic. No matter how often I am told that there is nothing actually wrong with my heart physically, that it’s an electrical fault, I am unable to ignore the weight of cultural baggage. Popular imagery, from Valentine’s Day to the Sacred Heart of Jesus, presents the heart as more than a muscle. It is the deepest part of us – we “learn by heart.” We often think of the heart as the seat of our emotions and passions: we “have a heart” for something. In his radio series after a quadruple bypass, Giles Fraser called it the most symbolic organ of all.

I manage my fear by sharing my experience with an international online community for people with atrial fibrillation, who take the same medications and, in some cases, have even had the same surgical procedure. The main response to diagnosis that features in the forums is precisely the fear that I experienced, something documented in the literature on heart disease more widely; for example, David S. Jones describes the “visceral impact” of fear “on how doctors and patients have thought about and treated heart disease” from the 1920s.^[1]

In the past, without the sorts of detailed, named diagnoses offered by medicine today, without our range of drugs and surgical procedures, and in the absence of a community large enough to find others in the same situation, was similar fear felt? We could read Vesalius as evidence that the “casual observer” was content with thinking of their body as made up of “ten or twelve different parts.” So what happens when that shifts to the high level of detail provided by modern knowledge of the many parts of the body? Am I taking sufficient notice of historical fear, and can I assume it was there, even if unexpressed? Have I paid enough attention to this dimension in my own work, and how can we do better at recreating it in the histories we write?

Managing fear in the past

Last year I published a book on four body parts with long histories of being used to tell women what they are, and what they can do: Immaculate Forms, now also available in the USA. One of the historical figures I revisit in my chapter on the breasts is Elena Duglioli, born in 1472. She lactated while a virgin, something that would have been understood in terms of Mary and of the images of her feeding Jesus, producing milk despite her virginity. And Elena’s body continued to produce milk even after her death. In my book, I consider this in terms of the enduring belief that breast milk is simply a version of menstrual blood. If read according to the dominant medical models of much of Western history, Jesus, his flesh made from Mary’s blood, drank the milk made from that blood, and then shed his blood – which derived from hers – for believers to drink. Some believers imagined themselves taking Mary’s milk; others, as drinking the blood from Jesus’s side wound, a wound that could be understood as somehow vulval.

But after my heart experience I found myself revisiting the life of Elena, focusing on a different aspect: her reported comment that Jesus had taken her heart away from her. Today we could not imagine living without a heart. It was Elena’s “spiritual son” Pietro Ritta, the first to press her breasts and produce milk from her dead body, who claimed that, in 1507, she had told him that Jesus took her heart so it would not feel pain. The surgeons who performed a post-mortem on her body testified that her heart was like “a piece of soft liver.” They had never seen anything like it.

I used this material when I was writing course materials for The Open University. One of the students who took that course – himself a practicing physician – commented to me that there are indeed heart conditions where the muscle becomes flabby, and is not easily recognizable as a heart. Like the presence of “milk” post-mortem, he attributed this to a benign tumor of the pituitary gland, which can thicken the epicardial adipose tissue. While not a fan of retrospective diagnosis, I find this helpful in showing how what the sources describe is not impossible.

Both Elena and those in whom she confided viewed her body through a religious lens. Her story shows that, before Harvey’s discovery of the heart’s role in blood circulation, and in the absence of our knowledge of the heart’s core functions, people still found ways to integrate unexpected bodily phenomena into their sense of self. Still today, when we find that we do not know our own bodies as well as we’d thought, a diagnosis from an “expert” may be a way of reducing the (understandable) fear, as a reassuring acknowledgment that our sensations are not unique to us. But I am now wondering what it felt like for Elena, supposedly having no heart? And I wonder what changed for patients after Harvey put the heart at the center; for example, were they more, or less, likely to be aware of, and disturbed by, their hearts, for example by missing or extra beats? Did these make them feel insecure, as such arrhythmias do today?

As I have grown older, I have tried to find medical explanations and a wider community to help me live with worrying bodily phenomena, although some of the current explanations – in particular, those invisible crystals – I find difficult to accept. By contrast, when Elena’s body did things she was not expecting, she managed her fear by reading sensations, parts and fluids in religious terms. Both of us, however, have had to integrate new information into our sense of self.

Notes

1. David S. Jones, Broken Hearts: The Tangled History of Cardiac Care (Johns Hopkins University Press, 2013), 102. ↑

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Featured image caption: An embroidered human heart. Courtesy Magdaline Nicole.