Alex is more concerned with practical issues. She has found it reassuring to be able to demonstrate using computer graphics that the face that emerges after surgery will not be a macabre mask of the donor’s face, but a completely new appearance resulting from the stretching of the donor’s skin across the bones of the recipient. ‘That helped move us away from the science fiction horror vision,’ she says. Almost a bigger concern than the transplant itself is the lifetime of immunosuppressant drugs that will be necessary to ensure that it is not rejected. Potential recipients will have to be screened to assess their likelihood of coping with the physical demands of many operations and the subsequent drug regime. Not all can: Clint Hallam, a New Zealander who lost his hand in a circular-saw accident, had surgery to reattach the hand, which didn’t take, and had to be amputated. Some years later, he received the first hand transplant. However, after more than two years using his replacement hand, Hallam voluntarily stopped taking his immunosuppressants, and the hand was once again amputated.
There are also psychological issues surrounding the donor. What kind of person wishes to donate their face? Are they altruists like organ donors, or fantasists who imagine achieving a weird kind of immortality through somebody wearing their face after they are dead? What should the recipient know about the donor’s life? Perceptions were not helped when news emerged that Dinoire’s donor was a suicide.
Finally, it has to be remembered that, for all its medical glamour, a facial transplant is not, like a heart transplant, in the end a life-saving procedure. Going ahead has to be weighed against alternatives such as skin grafts and other conventional cosmetic surgery or solely psychological treatment. Where the transplant proceeds, there is still a job to explain to the public that its objective is not actually to give the patient a normal-looking face, but mainly to restore important physiological functions such as the ability to work the jaw. There is even some need to check the impulse of people accustomed to the idea of elective cosmetic surgery that they themselves will one day be able to walk out of an operating room with their ideal face. These people may wish to recall Galton’s discovery that beauty is only average.
The Brain
Albert Einstein – the greatest scientist of all time, according to many, and the greatest Jew since Jesus, in the words of J. B. S. Haldane – died in the early hours of Sunday 17 April 1955 at his home in Princeton. Dr Thomas Harvey of Princeton Hospital performed the autopsy, and determined the cause of death as a ruptured aortic aneurysm. A dozen of those closest to Einstein attended a brief funeral ceremony. His body was then cremated. A little over fourteen hours had passed since the physicist drew his last breath.
However, not all of Einstein’s mortal remains were converted into the ashes that were later scattered at a secret location in order to avoid the attention of celebrity hunters. For at some time during that early Sunday morning, Harvey, acting on his own initiative and without permission from the family, removed Einstein’s brain from the skull where it had resided so profitably for seventy-six years and set it aside for examination.
He injected the internal arteries of the brain with formalin and then placed the whole organ in the preserving liquid. The brain revealed no immediate evidence of the special powers that it had possessed when alive. It was carefully measured and photographed, and then cut up into some 240 numbered pieces. Many of these pieces were further sliced into thin sections and encapsulated in layers of a celluloid-like substance so that they could be viewed under a microscope. Harvey appears to have passed many of these specimens out to scientist friends; others he kept. A Chicago doctor reportedly received one specimen as a Christmas present. Another was acquired by a Japanese professor of mathematics who collected Einstein memorabilia. When a journalist tracked Harvey down in Wichita, Kansas, in 1978, he found the remaining chunks of Einstein’s brain stored in glass jars in a cardboard box bearing the label of a brand of cider.
Parts of Einstein’s brain have been in the hands of scientists for more than fifty years now. What have we learned about how genius manifests itself in the physical body? Harvey promised to publish his findings once he had studied the brain for himself, but for a long time no research was forthcoming. Finally, in 1996, Harvey published a paper in Neuroscience Letters, giving the results of his comparison of a prepared section of Einstein’s right prefrontal cortex – a part of the brain thought to be involved in governing personality and in judging and comparing thoughts – with those of five elderly control subjects. His earth-shattering news was that Einstein’s brain possessed neurons in no greater number and no greater size than the others’.
Marian Diamond at the University of California at Berkeley had only a little more success when she requested a specimen from Harvey and received it in an old mayonnaise jar. In part of the parietal lobe on the top of the head, she found a higher than normal proportion of glial cells to neurons. Glial cells partner neurons in the brain in ways that are as yet poorly understood, contributing to brain growth and function, and are found to increase in animals when they are placed in a stimulating environment. Whether Einstein’s glial surplus was present from birth or was the consequence of his immersion at Princeton’s Institute of Advanced Studies cannot be told.
Sandra Witelson and others at McMaster University in Hamilton, Ontario, claim to have carried out the first examination of the gross anatomy of Einstein’s brain only in 1999. Using calipers, they compared dimensions taken from Harvey’s photographs with thirty-five normal male brains, and found no significant differences except in the parietal regions ‘important for visuospatial cognition and mathematical thinking’. Einstein’s parietal lobes were measured as being about a centimetre wider than the average of Witelson’s controls. Unlike all the other male brains – and unlike another fifty-six female brains also examined – Einstein’s brain also appeared to be missing a feature known as the parietal operculum, a strip of tissue bordering the lateral sulcus, one of the major clefts that divides the brain into its component lobes. Without this, the Canadian scientists speculated, Einstein’s parietal lobes were able to expand beyond the usual size, and to abut more closely with other regions of the brain, with which they may then have built an unusual number of neural connections. Witelson concludes that ‘Einstein’s exceptional intellect . . . and his self-described mode of scientific thinking may be related to the atypical anatomy in his inferior parietal lobules’, but adds ruefully that her work ‘clearly does not resolve the long-standing issue of the neuroanatomical substrate of intelligence’.
The attempt to locate the origins of genius in great scientists is not new. When Isaac Newton died in 1727, the Flemish sculptor Jan Rysbrack made a plaster of Paris death mask of the great man to assist him in the preparation of the extravagant memorial statue of Newton that now stands in Westminster Abbey. It shows a squat, angular face with a broad, severe crease for a mouth and an equally severe frown. The great man’s visage is notably dissimilar to the familiar portrait by Godfrey Kneller, painted in oils, which gives him a long face and red, feminine lips. Rysbrack, too, chose to soften the authentic features for his final sculpture. Both mask and bust have been frequently copied since in plaster, bought and sold like a saint’s relics to sit on the desks of pretentious thinkers of following generations. In this way did Newton become one of the favourite subjects of the phrenologists.
The pioneer of this new science, the German Franz Joseph Gall, began collecting such heads in 1792, gradually developing a theory of localization of brain function that he claimed first occurred to him when he was still at school. There he noticed that a fellow pupil with excellent verbal memory had a distinct physical feature: large, protruding eyes. This apparent correlation, observed again in students when he was at university in Vienna, led Gall to believe that an area of the brain directly behind the eyes must be responsible for verbal memory. Gall made systematic measurements of the bumps and dips on the hundreds of specimen heads that he amassed. Believing the best subjects to be those who exhi
bited the most extreme behaviour or capabilities, he sought out the skulls of murderers, lunatics, renowned statesmen and military leaders, and geniuses in the arts, sciences and philosophy. His ambition was nothing less than to found an anatomy and physiology of the brain that would ultimately reveal a complete psychology of man.
Through his process of ‘cranioscopy’, Gall identified twenty-seven separate ‘organs’ of the brain, which he described in terms of the instincts and mental faculties that he supposed they furnished. They included wisdom, kindness, friendship, courage, pride, vanity, caution and firmness of purpose, as well as others to do with senses (of place and space, musical, numerical and mathematical) and the ability to remember (people, words, facts). There were also regions of the brain that he identified with talent as a poet, as a satirist, and as a mimic. At least two of the qualities – the tendency to steal and tendency to murder – surely reflect Gall’s access to subjects in prisons. Gall’s ideas ran counter to the orthodoxy of the time that the brain was a homogeneous organ whose functions could not be localized, and were deemed too materialistic by the church and by the Viennese authorities. His pinpointing of religious feeling in only one of the twenty-seven areas of the brain may not have helped his case. In 1805, he left Vienna to seek support for his theory elsewhere in Europe, and settled eventually in Paris, where, in 1810, he published his full theory, accompanied by a magnificently illustrated atlas of the brain.
A young British physician, Henry Reeve, was among the many who attended Gall’s lectures. Though impressed to begin with, Reeve found Gall vulgar and mannered on a second occasion, writing in his journal that ‘like many things seen at a distance, the veil vanishes on narrow inspection and pleasure with it’. Reeve was perhaps not typical, however, as Gall’s ideas were to be taken up in Britain, and later in America, with more enthusiasm than they were on the continent.
Gall’s chief acolyte on his European tour was his dissectionist and lecturing assistant, Johann Kaspar Spurzheim. However, Spurzheim saw a greater opportunity to popularize the subject that was now becoming known as phrenology, and the two men fell out in 1812. Spurzheim reorganized Gall’s system of brain organs, giving many of them appealing new names, and adding a further eight to the list. He divided his now thirty-five organs into the intellectual and the affective or moral. His eye-catching labels included Amativeness, Inhabitiveness, Adhesiveness, Combativeness, Destructiveness, Veneration, Self-esteem, and Marvellousness, which replaced Gall’s category of religion. Spurzheim also started the practice of inscribing little desktop busts with these named regions, which proved to be popular souvenir icons of the new science.
Whereas Gall had been concerned with the pure science of the brain, Spurzheim and his followers saw both a moral agenda and a commercial opportunity in demonstrating and offering readings of character. Local phrenological societies sprang up. Having one’s bumps felt became the fashionable thing. Every chemist’s shop sold phrenological busts. Scientific journals of phrenology began to multiply, filling their pages with detailed analyses of the famous and infamous based on measurement of their skulls or head casts.
The great thing about all this, of course, was that you knew the answer before you began. In 1846, George Combe of Edinburgh, the leading British authority in the field, published a detailed analysis of the skull of the artist Raphael. He described the skull itself as ‘a beautiful graceful oval; and its surface was remarkably smooth and equal’. This regularity was central in his view to Raphael’s greatness as an artist: ‘Taste is the result of a harmonious combination of all the organs, with a fine temperament, and on contemplating these endowments in Raphael, we see the source of his exquisite refinement and grace.’ William Stark, the president of the Phrenological Association in Norwich, kept a collection of casts, each of which he captioned with a single personal trait that likewise is curiously consonant with the known facts of the person’s life. For example, ‘secretiveness’ is identified as the most prominent faculty in a man already known to be a ‘cunning debtor’.
The great brain of Newton was accorded similar uncritical treatment. In 1845, the Phrenological Journal (and Magazine of Moral Science, to give it its full title and to distinguish it from various other Phrenological Journals) published the findings that Newton’s head indicated ‘mathematical talents of the highest order’, endowed as it was with large faculties of Weight, Form, Size, Order and Number, as well as ‘a tolerable share of Causality and Comparison’, which explained his ability to trace the relation of cause and effect and to discover analogies, resemblances and differences. The challenge today is to decide whether this kind of thing is actually any less valid than analysis of Einstein’s brain that, as we have seen, finds special things to say about the parietal regions at the top of his head ‘important for visuospatial cognition and mathematical thinking’.
Phrenology is curious for having serious adherents and all the paraphernalia of proper science – journals, societies, conferences – at the same time as it was attacked by other scientists as quackery, satirized in theatres and magazines, and derided by a sceptical public. For instance, the famous caricaturist George Cruikshank made fun of Spurzheim’s faculties of the brain, illustrating ‘Adhesiveness’ – meaning the propensity to form friendships – by a couple stuck knee-deep in mud. Others suggested bizarre and specific new faculties, such as a talent ‘for driving a Tilbury gig’. It is hard to think of another science that has lived such a double life for even a fraction of the century and more during which phrenology persisted.
Phrenology’s strength lay in its social promise. The moral dimensions of the human mind could be gauged by the almost ridiculously easy expedient of physical measurements of the head. The phrenologist with an eye to the main chance could set himself up as a proto-psychoanalyst, a careers adviser, a recruitment consultant or even a matchmaker, according to the needs of his client.
Meanwhile, critics of the method noted its obvious flaws, such as the apparently arbitrary number of brain organs, and their interchangeable and contradictory qualities, which allowed any number of conclusions to be drawn from a character assessment. Fittingly, Voltaire’s head was adopted as a prop by those seeking to discredit phrenology. Apparently, this ‘most celebrated of infidels, and more, the most violent and implacable enemy of Christianity’ exhibited an unfeasibly large organ of Veneration. Why did the great philosopher have such a thing if he clearly didn’t use it? Phrenology was not to be so easily done down, however. In 1825, one phrenologist wrote that the example of Voltaire actually confirmed the technique’s veracity, since, while the Frenchman might not show much godly veneration, he surely showed it to the French court where he sought his patronage.
As we have seen, Thomas Edison failed to capture an X-ray image of the brain for William Randolph Hearst in 1896. The first rudimentary brain X-rays were not made until 1918, when it was found that air could be introduced into its ventricles to heighten the contrast with the surrounding tissue. However, a practical technique for routinely seeing inside the brain would not emerge until the 1970s. What would it show us? Would it reveal the sites of the powers that lift us above the animals?
Scientific references typically describe the brain as the most complex organ in the human body. It does not look it. It is less multifarious than the heart, less intricate than the lungs. Removed from the head, sliced into sections and squeezed between layers of glass for easy inspection, as I saw it prepared in medical museums, it is white and opaque – literally of course, but also figuratively. It hides its mechanism well. Perhaps it is just human vanity that insists on complexity.
Hippocrates himself may have made the discovery that the brain is not simply a lumpen mass. Around 400 BCE, probably based on his examination of Greek soldiers injured in battle, he compiled a book called On Injuries of the Head. Here he noted, for example, that injuries on one side of the brain tend to lead to convulsions on the opposite side of the body. Later, Galen sought the location of the soul in the brain, and
made reference to the brain’s having parts dedicated to specific body functions. Medieval figures such as the Persian scholar Avicenna regarded the four ventricles of the brain that contain the cerebrospinal fluid as storage spaces for images and ideas, respectively governing perception, imagination, cognition and memory. Much later, Descartes felt he had located the soul in the tiny pineal gland at the base of the brain. The phrenologists did little to advance the science, but they too shared the conviction that the brain was not a homogeneous and holistically functioning unit, but an organ of distinct parts. This conviction has strengthened with the advent of new ways to probe and map the brain.
The methods are often brutal. As in Hippocrates’s day, war is a spur to knowledge. In the Russo-Japanese war, an ophthalmologist named Tatsuji Inouye was able to map the visual cortex in new detail based on gunshot wounds received to the occipital lobe at the back of the head. He benefited – if that’s the word – from the Russians’ use of new guns that fired bullets that were more penetrating but less damaging to the surrounding flesh than previous weapons. British neurologists were similarly able to make strides in understanding the role that the occipital lobe plays in vision because the Brodie helmets worn by British soldiers provided such poor protection in this area. (Unfortunately for them, the phrenologists had tended to locate visual faculties unimaginatively just behind the eye, nowhere near the occipital lobe, to which they ascribed qualities of love and friendship.)
Anatomies: A Cultural History of the Human Body Page 14