Tag Archives: pathology

The Venice Dwarf

Even the hospital, in Venice, is a Renaissance masterpiece: the facade of the Scuola Grande di San Marco, which opens into Campo SS. Giovanni e Paolo, is considered one of the greatest architectural and artistic jewels of the lagoon city.
Right next to the main entrance, located in the spaces of the former Scuola di Santa Maria della Pace, it is possible to visit the small “Andrea Vesalio” Museum of Pathological Anatomy.

The birth of the collection can be traced back to 1874, when the hospital’s anatomical dissector was recommended to preserve the most relevant anatomopathological specimens. From that time on, the collection was regularly supplemented, particularly thanks to the work of Giuseppe Jona. The museum houses the death mask of Jona himself, an extraordinary figure of a physician and a man who under in 1943 committed suicide in order not to reveal to the German authorities the names of the Jews left in Venice.

The museum consists of one small room, and has nine display cases with dry and liquid preparations. Among the osteological exhibits are bone tumors, hyperostosis, trauma, a collection of 10 femurs and 32 skull caps showing various pathologies. A collection of ancient calculi shows how this affliction, in the days when it could not be treated promptly, could become a very serious problem. The liquid preparations, on the other hand, are principalmnte designed to illustrate certain diseases that affected the Venetian lagoon in particular, related to epidemics (tuberculosis), to once-common diseases (leprosy), or to glassmaking.

But it is one preparation in particular that attracts attention, in a display case placed right in the center of the room: the whole body of a male affected by various malformations, including kyphosis and dwarfism.
The striking details of this find, with a stature of 67 cm and an estimated age of around 50 years, are many. The shrunken body still possesses hair, facial hair, but most importantly-uncommon detail-it still has eyes in situ.

The visible incision on the skull is typical of an autopsy, but it is the two large sutures on the chest and back that are unusual. After the autopsy, evidently this gentleman was prepared for museum purposes. Initially scholars thought the method used was tannization by Lodovico Brunetti, the same anatomist who prepared the “Punished Suicide“. Tannization was an anatomical preservation process that involved, after cleaning and degreasing the tissues, ultilizing them with tannic acid diluted with demineralized water and dehydrating them with compressed hot air.

But when this Venetian artifact was inspected radiographically, it was discovered that it was devoid of internal organs, which had been replaced by a filling material. This gentleman was eviscerated, his skin removed, dehydrated, and finally repositioned on his previously treated skeleton by filling the remaining empty cavities with tow or other material. This is thus an authentic human taxidermy, the same procedure used for stuffing animals.

I have often been asked over the years why we do not “stuff” human beings. The answer is that it’s been tried, but the results are not particularly good. Over time, dried human skin tends to shrink, becomes brittle and easy to crack, and any prosthetic eyes eventually emerge unnaturally. The color of the epidermis is also not kept particularly true, and the questionable results of this technique can be seen in the few taxidermies in anatomical museums (below is a display case of human taxidermies at the Museum of Sanitary Art in Rome).

The taxidermied human specimen from Venice is truly unique, both because of the decision to prepare it in this rather unusual way and because of the pathologies it illustrates. And, like all “integral” anatomical specimens, it also encourages our emotional reaction: it is impossible not to wonder what kind of life this man, dwarfed and hunchbacked, had in the Venice of the second half of the 19th century; what hardships and pains he suffered, but also what desires and happiness he might have known, before ending up eternalized in a museum. The treatment meted out to him, commonly used for animals, might seem like a final affront, but it actually relates back to a fervent period of continuous experimentation, in which countless different techniques were tried out to perfect the art of anatomical preparation.

Personally, therefore, I find both specular aspects, pathos and pietas, moving and humane. The pathos of the human subject that forms the basis of the anatomical object, the often anonymous existence behind any preparation, with its sometimes tragic uniqueness; and the pietas that is inherent in the medical vocation as well as in the desire to preserve deformity and disease for the purpose of study, to understand their mystery and to try, if possible, to cure and alleviate the suffering of others.

Strange Connections (S02E06)

In this episode of season 2 of Bizzarro Bazar: the mysterious ways in which your day is influenced by events far away in time and space; a series of curiosities from the Cabinet of Comparative Anatomy; a formidable weapon capable of terrifying enemies.

Produced in collaboration with the Civic Museums of Reggio Emilia.
Directed & animated by Francesco Erba.

The Poet’s Brain

What does poet Walt Whitman have to do with an autopsy manual?

Here’s a post about a curious book, and a mystery that lasted more than a century.

THE BOOK

A few days ago I added to my library a book I had been looking for for some time: a 1903 first edition of Post Mortem Pathology by Dr. Henry Ware Cattell.

It is a well-known, thoroughly-illustrated autoptic manual detailing the methods used to carry out post-mortem examinations at the end of the 19th century.

On the title page one can find a tasty quote in Italian from the Divine Comedy:

These verses come from Chant XXVIII of Dante’s Inferno, describing the punishment inflicted on Muhammad (translation: “Rent from the chin to where one breaketh wind. / Between his legs were hanging down his entrails; / His heart was visible, and the dismal sack / That maketh excrement of what is eaten“), and they are quoted here as a clear allusion to autopsies, which offer a similar macabre spectacle.

Post Mortem Pathology is an interesting book for at least two historical reasons.

First, it contains some “advice” on how to obtain consent from the dead person’s relatives in order to perform an autopsy; but it would be more correct to say that Cattell gives indications on how to deceive the deceased’s family members, obtaining consent for example from someone “connected with the household, though not necessarily from the nearest relative“, taking care not to specify which anatomical parts are to be preserved, etc. Dr. Cattell also complains about the absence of a law allowing autopsies on all those who die in hospitals, without distinction.

As James R. Wright writes, these are “unique and important insights into local autopsy consent “practice” in Philadelphia in the 1880s which allowed […] pathologists to get away with performing autopsies at Blockley Hospital without legal consent. […] these questionable and highly paternalistic approaches to autopsy consent, although morally incomprehensible now, permitted outstanding clinicopathological correlations which made Blockley an excellent teaching environment.” (1)James R. Wright Jr., Henry Ware Cattell and Walt Whitman’s Brain, in Clinical Anatomy, 31:988–996 (2018)

Second, Cattell’s book describes the procedure, originally developed by the gynecologist Howard Kelly, to perform the removal of the internal organs per vaginam, per rectum, and per perineum. (2)Julius P. Bonello, George E. Tsourdinis, Howard Kelly’s avant-garde autopsy method, Hektoen International Journal of Medical Humanities (2020) .

The method consisted of incising the vagina in women, or the anus in men; by inserting the arm up to his shoulder inside the body, the anatomist proceeded to pierce the diaphragm and remove the heart, lungs, liver, kidneys and the rest of the organs through that single cut.

Why all this effort? One might ask.

The answer is unfortunately linked to what we said above: it was a trick to perform an autopsy in the absence of legal consent; the organs were removed without disturbing the external appearance of the body, so that the relatives would not notice anything unusual.

But the real curiosity linked to this book is the fact that its author was implicated in a very peculiar incident.

 

THE MYSTERY OF THE MISSING BRAIN

In 1892 one of the most famous and celebrated American poets, Walt Whitman, died.

By the end of the 19th century, phrenology had already been discredited, yet it was still believed that the brains of “geniuses” could show some difference compared to those of normal people; this was the reason why in Philadelphia, as in other cities, there existed a Brain Club, a nickname for the Anthropometric Society, a — more or less secret — lodge  of doctors and pathologists who took care of preserving the brains of illustrious men. (Clearly just male brains, not women’s, but that’s OK.)

Famous pathologist William Osler, a member of the “Brain Club”, performing a brain autopsy ath the Bockley morgue in Philadelphia.

A reunion of anatomists in Philadelphia.

Henry Cattell was part of it, and at the time of Whitman’s death he held the position of prosector, that is, the one who did the “dirty work” by opening and dissecting the body.
He was therefore the one who dealt with the poet’s corpse during the autopsy that took place at Whitman’s house in Mickle Street on March 27, 1892, under the supervision of prof. Francis Dercum.

The brain of the immortal cantor of the “electric body” was removed and entrusted to Cattell to join those of the other important intellectuals preserved in liquid by the Anthropometric Society.

At this point, though, something went horribly wrong, and the precious organ disappeared into thin air.

This enigmatic incident changed Cattell’s life forever, making him doubt his talents as a pathologist so much that he decided to increasingly rarefy his commitments in the autopsy room, and to devote himself to scientific publications. Post Mortem Pathology represents, in fact, the first release of his publishing house.

But what had really happened?

The first testimony about it was published in 1907 in a paper by Dr. Edward Spitzka, which was apparently based on Cattell’s confidences to some members of the Society. Spitzka wrote that “the brain of Walt Whitman, together with the jar in which it had been placed, was said to have been dropped on the floor by a careless assistant. Unfortunately, not even the pieces were saved.” (3)Edward Spitzka, A study of the brains of six eminent scientists and scholars belonging to the American Anthropometric Society, together with a description of the skull of Professor E. D. Cope, in Trans Am Philos Soc 21:175–308 (1907)

The news caused quite a sensation, so much so that it evidently entered the common imagination: this episode was likely the inspiration for the Frankenstein (1931) scene in which the Doctor’s assistant, who breaks into the university in search of a brain for the Creature, drops the jar with the “normal” brain and steals the “abnormal” one.

But, as James R. Wright writes, “what could not be understood is why the fragments had been discarded as there still would have been some value in examining these. Less clear was whether it was an assistant or Cattell who destroyed Walt Whitman’s brain.”

Be that as it may, in the absence of further clues, for more than a century this remained the official version. Then, in 2012, Cattell’s secret diary appeared on an eBay auction.

Henry W. Cattell during WWI.

The diary does not directly mention the autopsy, but from when it was performed in March 1892 until October of the same year Cattell’s notes have an optimistic tone — it had been a positive and finacially rewarding period of work. Then, starting from October 14, the entries in the diary become much more dark and worried: Cattell seems to suddenly doubt his own abilities, even coming as far as to have suicidal thoughts.

Here is the chronology of his entries, outlining a very different story from that of the assistant dropping the preparation on the ground:

13 ottobre 1892 — “Prepare specimens for path. soc. [Pathological Society of Philadelphia].”

14 ottobre 1892 — “I am a fool.”

16 ottobre 1892 — “I wish that I knew of the best way of keeping an account of my work. It often seems to me that I am so forgetful and yet I remember certain things which others might not be able to mind.”

13 aprile 1893 — “I am a peculiar man in many ways. Why did I get rid of Edwards—in all probability because I was jealous of him.”

15 maggio 1893 — “I am a fool, a damnable fool, with no conscious memory, or fitness for any learned position. I left Walt Whitman’s brain spoil by not having the jar properly covered. Discovered it in the morning. This ruins me with the Anthropometric Society, and Allen, perhaps with Pepper, Kerlin &c. How I ever got in such financial straights [I] do [not] know. When I broke with Edwards I should have told him to go to thunder. Borrowed over $500 more from P & M [Pa and Ma]. They are too good & kind. I would have killed my self before this a dozen times over if it had not been for them.”

18 settembre 1893 — “I should be happy and I suppose in my way I am. Except for my parents I could go to Africa or die and I w[ou]ld be in no way missed.”

30 settembe 1893 — “I look back on my confidence and self possession of last year as somehow wonderful. I now know that I do not know enough pathology for the position which I occupy.”

So here’s the truth: Cattell had badly sealed the jar containing Whitman’s brain; the liquid had probably evaporated, and the organ had dried out, decomposed or been attacked and damaged by some mold. Cattell blamed his assistant Edwards, who had probably started to blackmail him, threatening to tell the truth; this extortion, in addition to Cattell’s financial problems, had forced him to borrow money from his parents, throwing Cattell into a state of depression and mistrust in his abilities.

By publishing Cattell’s diary excerpts for the first time in 2014, Sheldon Lee Gosline wrote:

“Then, too, why put this incriminating evidence down on paper at all, risking public exposure? Clearly Cattell wanted to leave a confession that one day would become public—which now, 120 years later, has finally happened.” (4)Gosline, Sheldon Lee. “I am a fool”: Dr. Henry Cattell’s Private Confession about What Happened to Whitman’s Brain. Walt Whitman Quarterly Review 31 (2014), 158-162.

EPILOGO

June 9, 1924.

Cattell was now 61 years old, and 32 years had passed since Whitman’s unfortunate autopsy.

At the time, as Gosline points out, Cattell “not only had his university staff income, but also charged assistants to privately assist him, provided post-mortems and expert testimony for a fee, ran a medical journal for a profit, and was a successful and lauded author. All of this was possible because he had evaded disgrace from the Whitman incident. “

His luck came from having kept silent regarding his incompetence in preserving the brain of a poet, and it is with a poem that, in a very proper way, the pathologist ends his diaries. These verses sound like a sort of balance sheet of his whole life. And the image that emerges is that of a guilt-ridden soul, convinced that his entire honored career has been earned through fraud; a man divided between a pleasant economic security, which he cannot give up, and the need to confess his imposture.

 

Perhaps the only one who could have smiled at this whole matter would have been Walt Whitman himself, aware that the individual body (container of “multitudes“) is nothing more than a mere transitory expression of the universal: “For every atom belonging to me as good belongs to you.” (5)Walt Whitman, ‘Song of Myself’, Leaves of Grass (1855)

Note

Note
↑1 James R. Wright Jr., Henry Ware Cattell and Walt Whitman’s Brain, in Clinical Anatomy, 31:988–996 (2018)
↑2 Julius P. Bonello, George E. Tsourdinis, Howard Kelly’s avant-garde autopsy method, Hektoen International Journal of Medical Humanities (2020)
↑3 Edward Spitzka, A study of the brains of six eminent scientists and scholars belonging to the American Anthropometric Society, together with a description of the skull of Professor E. D. Cope, in Trans Am Philos Soc 21:175–308 (1907)
↑4 Gosline, Sheldon Lee. “I am a fool”: Dr. Henry Cattell’s Private Confession about What Happened to Whitman’s Brain. Walt Whitman Quarterly Review 31 (2014), 158-162.
↑5 Walt Whitman, ‘Song of Myself’, Leaves of Grass (1855)

Bizzarro Bazar Web Series: Episode 8

In the 8th episode of Bizzarro Bazar: the most extraordinary lives of people born with extra limbs; a wax crucifix hides a secret; two specular cases of animal camouflage. [Be sure to turn on English captions.]

If you like this episode please consider subscribing to the channel, and most of all spread the word. Enjoy!

Written & Hosted by Ivan Cenzi
Directed by Francesco Erba
Produced by Ivan Cenzi, Francesco Erba, Theatrum Mundi & Onda Videoproduzioni

50 Shades of Green: Sex With Plants

This article originally appeared on
#ILLUSTRATI n.53 – L’uomo che piantava gli alberi

When I was still attending the film school, I wrote a brief script for a short film about a man who bought a flower, a big orchid. He went home, put the orchid on his bed, caressed it, kissed it and, finally, made love with it.
The subject appeared quite comical but my intention was to make a sort of test or, even better, an exercise in style: would I be able to shoot such an absurd sex scene without making it ridiculous? Would I be able to make it even romantic? Was it possible to produce the well-known “suspension of disbelief” in the audience in such an extreme situation?
At that time, I didn’t know that I wasn’t being particularly original.

There is, in fact, a real rare paraphilia, or better a form of fetishism, consisting in deriving sexual arousal from trees and plants. The term defining it is ‘dendrophilia’ and may have been coined by Lawrence Buell when referring to the famous writer Henry David Thoreau’s love of trees – a totally innocent feeling in that case.
Like other paraphilias, dendrophilia is one of those topics that can be the delight of tabloids: when the editorial staff runs out of news, they can simply send a photographer in the courtyard, to take some shots of a lady kissing a tree, and the article is done: “I want to marry a poplar!”.
But does dendrophilia really exist?

© Closer Magazine

A seminal 2007 study from Bologna University estimated that only 5% of all fetishisms refers to inanimate objects that have no relationship with the human body. Within such a low rate, it is no wonder that the more exclusive niche of people with a thing for plants can be almost invisible; this is compounded by the shame of talking about it and by the fact that this sexual preference does not cause any problem; so, you will understand why there is no record of case studies dedicated to dendrophilia in medical literature.

Assuming this sort of paraphilia exists, we can reasonably infer from what we know about the other forms of fetishism, that its manifestations could be much less weird than we expect. Most of the appeal of the fetish relies on the smell, the texture, and the appearance of the object, which becomes important on an evocative level in order to stimulate arousal. In this respect, it is likely that the potential dendrophile simply finds the texture of a bark, the smoothness or the colour of the leaves, the shape of a root extremely pleasant; contact, sometimes associated with a sexually relevant distant memory, becomes effective in stimulating arousal.

Not really different from those people who derive arousal from velvet: we tend to define fetishism on a pathological level only when it becomes a sine qua non in order to get sexual gratification and, actually, many practitioners working in the field tend to make distinctions between optional, preferred and exclusive paraphilias. Only the last ones are considered sexual disorders; this distinction, which can be found in the DSM-5 as well (the most used diagnostic manual in psychiatry), is in fact the distinction between real fetishism and fetishistic behaviour.

Last June, a little scandal broke in Palermo: among the plants of the amazing Botanical Gardens popped up a video installation by the Chinese artist Zheng Bo named Pteridophilia (literally, “love of ferns”). The video shows seven young boys having sex with plants in a Taiwan forest.

Having considered the ruckus raised by this artistic video, maybe it’s a good thing that I never realized my short film. Which, with a little plot twist, ended up playing with the subtle distinction between pathological fetishism and a simple fetishistic act “by proxy”: after making love with the orchid, the main character went to gently put it on the grave of the only woman he had ever loved.

Myrtle The Four-Legged Girl

Mrs. Josephine M. Bicknell died only one week before her sixtieth birthday; she was buried in Cleburne, Texas, at the beginning of May, 1928.

Once the coffin was lowered into the ground,her husband James C. Bicknell stood watching as the grave was filled with a thick layer of cement; he waited for an hour, maybe two, until the cement dried completely. Eventually James and the other relatives could head back home, relieved: nobody would be able to steal Mrs. Bicknell’s body – not the doctors, nor the other collectors who had tried to obtain it.

It is strange to think that a lifeless body could be tempting for so many people.
But the lady who was resting under the cement had been famous across the United States, many years before, under her maiden name: Josephine Myrtle Corbin, the Four-Legged Girl from Texas.

Myrtle was born in 1868 in Lincoln County, Tennessee, with a rare fetal anomaly called dipygus: her body was perfectly formed from her head down to her navel, below which it divided into two pelvises, and four lower limbs.

Her two inner legs, although capable of movement, were rudimentary, and at birth they were found laying flat on the belly. They resembled those of a parasitic twin, but in reality there was no twin: during fetal development, her pervis had split along the median axis (in each pair of legs, one was atrophic).

 Medical reports of the time stated that

between each pair of legs there is a complete, distinct set of genital organs, both external and internal, each supported by a pubic arch. Each set acts independently of the other, except at the menstrual period. There are apparently two sets of bowels, and two ani; both are perfectly independent,– diarrhoea may be present on one side, constipation on the other.

Myrtle joined Barnum Circus at the age of 13. When she appeared on stage, nothing gave away her unusual condition: apart from the particularly large hips and a clubbed right foot, Myrtle was an attractive girl and had an altogether normal figure. But when she lifted her gown, the public was left breathless.

She married James Clinton Bicknell when she was 19 years old, and the following year she went to Dr. Lewis Whaley on the account of a pain in her left side coupled with other worrying symptoms. When the doctor announced that she was pregnant in her left uterus, Myrtle reacted with surprise:

“I think you are mistaken; if it had been on my right side I would come nearer believing it”; and after further questioning he found, from the patient’s observation, that her right genitals were almost invariably used for coitus.

That first pregnancy sadly ended with an abortion, but later on Myrtle, who had retired from show business, gave birth to four children, all perfectly healthy.

Given the enormous success of her show, other circuses tried to replicate the lucky formula – but charming ladies with supernumerary legs were nowhere to be found.
With typical sideshow creativity, the problem was solved by resorting to some ruse.
The two following diagrams show the trick used to simulate a three-legged and a four-legged woman, as reported in the 1902 book The New Magic (source: Weird Historian).

If you search for Myrtle Corbin’s pictures on the net, you can stumble upon some photographs of Ashley Braistle, the most recent example of a woman with four legs.
The pictures below were taken at her wedding, in July 1994, when she married a plumber from Houston named Wayne: their love had begun after Ashley appeared in a newspaper interview, declaring that she was looking for a “easygoing and sensitive guy“.

Unfortunately on May 11, 1996, Ashley’s life ended in tragedy when she made an attempt at skiing and struck a tree.

Did you guess it?
Ashley’s touching story is actually a trick, just like the ones used by circus people at the turn of the century.
This photographic hoax comes from another bizarre “sideshow”, namely the Weekly World News, a supermarket tabloid known for publishing openly fake news with funny and inventive titles (“Mini-mermaid found in tuna sandwich!” “Hillary Clinton adopts a baby alien!”, “Abraham Lincoln was a woman!”, and so on).

The “news” of Ashley’s demise on the July 4, 1996 issue.

 

Another example of a Weekly World News cover story.

To end on a more serious note, here’s the good news: nowadays caudal duplications can, in some instances, be surgically corrected after birth (it happened for example in 1968, in 1973 and in 2014).

And luckily, pouring cement is no longer needed in order to prevent jackals from stealing an extraordinary body like the one of Josephine Myrtle Corbin Bicknell.

The Homunculus Inside

Paracelsus‘ homunculus, the result of complicated alchemic recipes, is an allegorical figure that fascinated the collective uncoscious for centuries. Its fortune soon surpassed the field of alchemy, and the homunculus was borrowed by literature (Goethe, to quote but one example), psychology (Jung wrote about it), cinema (take the wonderful, ironic Pretorius scene from The Bride of Frankenstein, 1935), and the world of illustration (I’m thinking in particular of Stefano Bessoni). Even today the homunculus hasn’t lost its appeal: the mysterious videos posted by a Russian youtuber, purportedly showing some strange creatures developed through unlikely procedures, scored tens of millions of views.

Yet I will not focus here on the classic, more or less metaphorical homunculus, but rather on the way the word is used in pathology.
Yes beacuse, unbeknownst to you, a rough human figure could be hiding inside your own body.
Welcome to a territory where the grotesque bursts into anatomy.

Let’s take a step back to how life starts.
In the beginning, the fertilized cell (zygote) is but one cell; it immediately starts dividing, generating new cells, which in turn proliferate, transform, migrate. After roughly two weeks, the different cellular populations organize into three main areas (germ layers), each one with its given purpose — every layer is in charge of the formation of a specific kind of structure. These three specialized layers gradually create the various anatomical shapes, building the skin, nerves, bones, organs, apparatuses, and so on. This metamorphosis, this progressive “surfacing” of order ends when the fetus is completely developed.

Sometimes it might happen that this very process, for some reason, gets activated again in adulthood.
It is as if some cells, falling for an unfathomable hallucination, believed they still are at an embryonic stage: therefore they begin weaving new structures, abnormal growths called teratomas, which closely resemble the outcome of the first germ differentiations.

These mad cells start producing hair, bones, teeth, nails, sometimes cerebral or tyroid matter, even whole eyes. Hystologically these tumors, benign in most cases, can appear solid, wrapped inside cystes, or both.

In very rare cases, a teratoma can be so highly differentiated as to take on an antropomorphic shape, albeit rudimentary. These are the so-called fetiform teratomas (homunculus).

Clinical reports of this anomaly really have an uncanny, David Cronenberg quality: one homunculus found in 2003 inside an ovarian teratoma in a 25-year-old virginal woman, showed the presence of brain, spinal chord, ears, teeth, tyroid gland, bone, intestines, trachea, phallic tissue and one eye in the middle of the forehead.
In 2005 another fetiform mass had hairs and arm buds, with fingers and nails. In 2006 a reported homunculus displayed one upper limb and two lower limbs complete with feet and toes. In 2010 another mass presented a foot with fused toes, hair, bones and marrow. In 2015 a 13-year-old patient was found to carry a fetiform teratoma exhibiting hair, vestigial limbs, a rudimentary digestive tube and a cranial formation containing meninxes and neural tissue.

What causes these cells to try and create a new, impossible life? And are we sure that the minuscule, incomplete fetus wasn’t really there from the beginning?
Among the many proposed hypothesis, in fact, there is also the idea that homunculi (difficult to study because of their scarcity in scientific literature) may not be actual tumors, but actually the remnants of a parasitic twin, incapsulated within his sibling’s body during the embryonic phase. If this was the case, they would not qualify as teratomas, falling into the fetus in fetu category.

But the two phenomenons are mainly regarded as separate.
To distinguish one from the other, pathologists rely on the existence of a spinal column (which is present in the fetus in fetu but not in teratomas), on their localization (teratomas are chiefly found near the reproductive area, the fetus in fetu within the retroperitoneal space) and on zygosity (teratomas are often differentiated from the surrounding tissues, as if they were “fraternal twins” in regard to their host, while the fetus in fetu is homozygote).

The study of these anomalous formations might provide valuable information for the understanding of human development and parthenogenesis (essential for the research on stem cells).
But the intriguing aspect is exactly their problematic nature. As I said, each time doctors encounter a homunculus, the issue is always how to categorize it: is it a teratoma or a parasitic twin? A structure that “emerged” later, or a shape which was there from the start?

It is interesting to note that this very uncertainty also has existed in regard to normal embryos for the over 23 centuries. The debate focused on a similar question: do fetuses arise from scratch, or are they preexistent?
This is the ancient dispute between the supporters of epigenesis and preformationism, between those who claimed that embryonic structures formed out of indistinct matter, and those who thought that they were already included in the egg.
Aristotle, while studying chicken embryos, had already speculated that the unborn child’s physical structures acquire solidity little by little, guided by the soul; in the XVIII Century this theory was disputed by preformationism. According to the enthusiasts of this hypothesis (endorsed by high-profile scholars such as Leibniz, Spallanzani and Diderot), the embryo was already perfectly formed inside the egg, ab ovo, only too small to be visible to the naked eye; during development, it would just have to grow in size, as a baby does after birth.
Where did this idea come from? An important part was surely played by a well-known etching by Nicolaas Hartsoeker, who was among the first scientists to observe seminal fluid under the microscope, as well as being a staunch supporter of the existence of minuscule, completely formed fetuses hiding inside the heads of sperm cells.
And Hartsoeker, in turn, had taken inspiration precisely from the famous alchemical depictions of the homunculus.

In a sense, the homunculus appearing in an ancient alchemist’s vial and the ones studied by pathologists nowadays are not that different. They can both be seen as symbols of the enigma of development, of the fundamental mystery surrounding birth and life. Miniature images of the ontological dilemma which has been forever puzzling humanity: do we appear from indistinct chaos, or did our heart and soul exist somewhere, somehow, before we were born?


Little addendum of anatomical pathology (and a bit of genetics)
by Claudia Manini, MD

Teratomas are germ cell tumors composed of an array of tissues derived from two or three embryonic layers (ectoderm, mesoderm, endoderm) in any combination.
The great majority of teratomas are benign cystic tumors mainly located in ovary, containing mature (adult-type) tissues; rarely they contains embryonal tissues (“immature teratomas”) and, if so, they have a higher malignant potential.
The origin of teratomas has been a matter of interest, speculation, and dispute for centuries because of their exotic composition.
The partenogenic theory, which suggests an origin from the primordial germ cell, is now the most widely accepted. The other two theories, one suggesting an origin from blastomeres segregated at an early stage of embryonic development and the second suggesting an origin from embryonal rests have few adherents currently. Support for the germ cell theory has come from anatomic distribution of the tumors, which occurs along the body midline of migration of the primordial germ cell, from the fact that the tumors occur most commonly during the reproductive age (epidemiologic-observational but also experimental data) and from cytogenetic analysis which has demonstrated genotypic differences between omozygous teratomatous tissue and heterozygous host tissue.
The primordial germ cells are the common origins of gametes (spermatozoa and oocyte, that are mature germ cells) which contain a single set of 23 chromosomas (haploid cells). During fertilization two gametes fuse together and originate a new cell which have a dyploid and heterozygous genetic pool (a double set of 23 chromosomas from two different organism).
On the other hand, the cells composing a teratoma show an identical genetic pool between the two sets of chromosomes.
Thus teratomas, even when they unexpectedly give rise to fetiform structures, are a different phenomenon from the fetus in fetu, and they fall within the scope of tumoral and not-malformative pathology.
All this does not lessen the impact of the observation, and a certain awe in considering the differentiation potential of one single germ cell.

References
Kurman JR et al., Blaustein’s pathology of the female genital tract, Springer 2011
Prat J., Pathology of the ovary, Saunders 2004

His Anatomical Majesty

The fourth book in the Bizzarro Bazar Collection, published by Logos, is finally here.

While the first three books deal with those sacred places in Italy where a physical contact with the dead is still possible, this new work focuses on another kind of “temple” for human remains: the anatomical museum. A temple meant to celebrate the progress of knowledge, the functioning and the fabrica, the structure of the body — the investigation of our own substance.

The Morgagni Museum in Padova, which you will be able to explore thanks to Carlo Vannini‘s stunning photography, is not devoted to anatomy itself, but rather to anatomical pathology.
Forget the usual internal architectures of organs, bones and tissues: here the flesh has gone insane. In these specimens, dried, wet or tannized following Lodovico Brunetti’s method, the unconceivable vitality of disease becomes the real protagonist.

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A true biological archive of illness, the collection of the Morgagni Museum is really a time machine allowing us to observe deformities and pathologies which are now eradicated; before the display cases and cabinets we gaze upon the countless, excruciating ways our bodies can fail.
A place of inestimable value for the amount of history it contains, that is the history of the victims, of those who fell along the path of discovery, as much as of those men who took on fighting the disease, the pioneers of medical science, the tale of their committment and persistence. Among its treasures are many extraordinary intersections between anatomy and art.

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The path I undertook for His Anatomical Majesty was particularly intense on an emotional level, also on the account of some personal reasons; when I began working on the book, more than two years ago, the disease — which up until then had remained an abstract concept — had just reached me in all its destabilizing force. This is why the Museum, and my writing, became for me an initiatory voyage into the mysteries of the flesh, through its astonishments and uncertainties.
The subtitle’s oxymoron, that obscure splendour, is the most concise expression I could find to sum up the dual state of mind I lived in during my study of the collection.
Those limbs marked by suffering, those still expressive faces through the amber formaldehyde, those impossible fantasies of enraged cells: all this led me to confront the idea of an ambivalent disease. On one hand we are used to demonize sickness; but, with much the same surprise that comes with learning that biblical Satan is really a dialectical “adversary”, we might be amazed to find that disease is never just an enemy. Its value resides in the necessary questions it adresses. I therefore gave myself in to the enchantment of its terrible beauty, to the dizziness of its open meaning. I am sure the same fruitful uneasiness I felt is the unavoidable reaction for anyone crossing the threshold of this museum.

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The book, created in strict collaboration with the University of Padova, is enriched by museology and history notes by Alberto Zanatta (anthropologist and curator of the Museum), Fabio Zampieri (history of medicine researcher), Maurizio Rippa Bonati (history of medicine associated professor) and Gaetano Thiene (anatomical pathology professor).

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You can purchase His Anatomical Majesty in the Bizzarro Bazar Collection bookstore on Libri.it.

Collectible tattoos

For some days now I have been receiving suggestions about Dr. Masaichi Fukushi‘s tattoo collection, belonging to Tokyo University Pathology Department. I am willing to write about it, because the topic is more multifaceted than it looks.

Said collection is both well-known and somewhat obscure.
Born in 1878, Dr. Fukushi was studying the formation of nevi on the skin around 1907, when his research led him to examine the correlation between the movement of melanine through vascularized epidermis and the injection of pigments under the skin in tattoos. His interest was further fueled by a peculiar discovery: the presence of a tattoo seemed to prevent the signs of syphilis from appearing in that area of the body.

In 1920 Dr. Fukushi entered the Mitsui Memorial Hospital, a charity structure where treatment was offered to the most disadvantaged social classes. In this environment, he came in contact with many tattooed persons and, after a short period in Germany, he continued his research on the formation of congenital moles at Nippon Medical University. Here, often carrying out autopsies, he developed an original method of preserving tattooed epidermis he took from corpses; he therefore began collecting various samples, managing to stretch the skin so that it could be exhibited inside a glass frame.

It seems Dr. Fukushi did not have an exclusively scientific interest in tattoos, but was also quite compassionate. Tattooed people, in fact, often came from the poorest and most problematic bracket of japanese society, and Fukushi’s sympathy for the less fortunate even pushed him, in some instances, to take over the expenses for those who could not afford to complete an unfinished tattoo. In return, the doctor asked for permission to remove their skin post mortem. But his passion for tattoos also took the form of photographic records: he collected more than 3.000 pictures, which were destroyed during the bombing of Tokyo in WWII.
This was not the only loss, for a good number of tattooed skins were stolen in Chicago as the doctor was touring the States giving a series of academic lectures between 1927 and 1928.
Fukushi’s work gained international attention in the 40s and the 50s, when several articles appeared on the newspapers, such as the one above published on Life magazine.

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As we said earlier, the collection endured heavy losses during the 1945 bombings. However some skin samples, which had been secured elsewhere, were saved and — after being handed down to Fukushi’s son, Kalsunari — they could be today inside the Pathology Department, even if not available to the public. It is said that among the specimens there are some nearly complete skin suits, showing tattoos over the whole body surface. All this is hard to verify, as the Department is not open to the public and no official information seems to be found online.

Then again, if in the Western world tattoo is by now such a widespread trend that it hardly sparks any controversy, it still remains quite taboo in Japan.
Some time ago, the great Italian tattoo artist Pietro Sedda (author of the marvelous Black Novel For Lovers) told me about his last trip to Japan, and how in that country tattooers still operate almost in secret, in small, anonymous parlors with no store signs, often hidden inside common apartment buildings. The fact that tattoos are normally seen in a negative way could be related to the traditional association of this art form with yakuza members, even though in some juvenile contexts fashion tattoos are quite common nowadays.

A tattoo stygma existed in Western countries up to half a century ago, ratified by explicit prohibitions in papal bulls. One famous exception were the tattoos made by “marker friars” of the Loreto Sanctuary, who painted christian, propitiatory or widowhood symbols on the hands of the faithful. But in general the only ones who decorated their bodies were traditionally the outcast, marginalized members of the community: pirates, mercenaries, deserters, outlaws. In his most famous essay, Criminal Man (1876), Cesare Lombroso classified every tattoo variation he had encountered in prisoners, interpreting them through his (now outdated) theory of atavism: criminals were, in his view, Darwinianly unevolved individuals who tattooed themselves as if responding to an innate primitiveness, typical of savage peoples — who not surprisingly practiced tribal tattooing.

Coming back to the human hides preserved by Dr. Fukushi, this is not the only, nor the largest, collection of its kind. The record goes to London’s Wellcome Collection, which houses around 300 individual pieces of tattoed skin (as opposed to the 105 specimens allegedly stored in Tokyo), dating back to the end of XIX Century.

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The edges of these specimens show a typical arched pattern due to being pinned while drying. And the world opened up by these traces from the past is quite touching, as are the motivations that can be guessed behind an indelible inscription on the skin. Today a tattoo is often little more than a basic decoration, a tribal motif (the meaning of which is often ignored) around an ankle, an embellishment that turns the body into a sort of narcissistic canvas; in a time when a tattoo was instead a symbol of rebellion against the establishment, and in itself could cause many troubles, the choice of the subject was of paramount relevance. Every love tattoo likely implied a dangerous or “forbidden” relationship; every sentence injected under the skin by the needle became the ultimate statement, a philosophy of life.

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These collections, however macabre they may seem, open a window on a non-aligned sensibility. They are, so to speak, an illustrated atlas of that part of society which is normally not contemplated nor sung by official history: rejects, losers, outsiders.
Collected in a time when they were meant as a taxonomy of symbols allowing identification and prevention of specific “perverse” psychologies, they now speak of a humanity who let their freak flag fly.

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(Thanks to all those who submitted the Fukushi collection.)