Book Review

The Mysteries Within: A surgeon reflects on medical myths

N Engl J Med 2000; 343:75July 6, 2000

Article

The Mysteries Within: A surgeon reflects on medical myths
By Sherwin B. Nuland. 274 pp. New York, Simon & Schuster, 2000. $24. ISBN: 0-684-85486-4

In this book, Nuland combines his long experience of research into early beliefs about the nature and function of major visceral organs (stomach, heart, spleen, liver, and uterus) with anecdotes about each of these organs drawn from his 35-year surgical career. The result is an understanding of the affection that this surgeon has developed for these organs over the many years. We are treated to his personal insights through these stories and come to realize not only his admiration for the anatomical beauty of the variations of our innards, but also the fears surgeons privately shoulder during the operating-room battle. Surgeons in particular will relate on a personal level to these reminiscences.

Nuland considers the idea of the Sicilian philosopher Empedocles that matter is made of fire, air, earth, or water. Taking this lead, Galen codified the four corresponding humors — blood, yellow bile, black bile, and phlegm — in the second century and dictated that it was the relations among them that determined health and even personality. It becomes clear throughout this book that the doctrinal stranglehold that the “magisterial physician” and prolific writer Galen maintained for over 1000 years on medical thinking was responsible for our long dark period.

By today's standards the stomach is a mundane organ, but in Galen's era it had a divine aura. The stomach and heart were thought to be related, and even before Galen's time the upper portion of the stomach was called the cardia; the ancient Egyptian word for stomach meant “mouth of the heart.” Today we speak of heartburn, which has little to do with the heart. If you believed, as did Aristotle, that the mind was located in the heart then it follows that equally important functions could be ascribed to the stomach. Nuland points out that “not having the heart for it” is close to “not having the stomach for it.” Moreover, the diaphragm, derived from the Greek word phren, meaning mind, was thought to be the seat of reason. Today we speak of frenetic, schizophrenia, and phrenology.

Nuland treats us to similar detailed analyses throughout his book. Particularly intriguing is the history of the heart's relation to our mind and emotions, exemplified by the term “heartache.” Nuland's tour of the organs ends with a discussion of the reproductive organs. Tales of the wandering uterus and the idea that hysteria, considered a disease limited to women, is linked to this peripatetic organ are amusing today, but it is surprising how long these concepts persisted.

In the epilogue, Nuland discusses how incontrovertible evidence of anatomy and physiology could be replaced by magical thinking, often tied to religious beliefs, to explain how our bodies function. Nuland argues that scientists have defended their viewpoint most vehemently, but he fails to mention the lingering effects of the 1925 Scopes trial, as manifested by recent attempts to remove mention of evolution from high-school biology books in some states. Nuland, a master storyteller, has written a wonderful book for physicians and surgeons with a love of medical history.

Steven D. Schwaitzberg, M.D.
New England Medical Center, Boston, MA 02111