For all of you who considered becoming a doctor but, for one reason or another, didn't get to the four years of pre-med courses, four years of medical school, and three to six years of resident and fellowship training, take heart. You have saved time and money and can now learn almost as much, and laugh quite a bit more, if you read, Bill Bryson's latest book.
"The Body: A Guide for the Occupant" (Doubleday, 2019) stuffs anatomy, physiology, biochemistry, microbiology, embryology, and a number of other "ologies" into a fascinating, entertaining, and informative 450 pages. As usual, Bryson, a former resident of the Upper Valley, does it with wit, humor, and elan.
Beginning with the chapter entitled "The Outside: Skin and Hair," Bryson takes us on a guided tour of the human body from top to bottom, ending with "Nerves and Pain" before turning to diseases and finishing with excellent chapters on aging and the American health system.
As he works his way through the body, Bryson provides the reader with details that in other hands could be overwhelming. He artfully avoids that pitfall with his unerring eye and ear for the humorous and the ineluctable. We learn that the average sized human has two square meters of skin that are covered with 100,000 bacteria per square centimeter and that we touch our face around 16 times every hour. Just as we're trying to figure out how all those little micro-organisms fit on our outer layer, Bryson gives us a sense of their size by pointing out that if a virus were the size of a tennis ball, a bacterium would be the size of a beach ball, and we would stand 500 feet tall!
We learn that we produce 1.5 quarts of saliva a day that travels down our alimentary canal, which would stretch more than 40 feet in length were our intestines laid out in a straight line, and if opened up, would measure half an acre in surface area. While still in the bowels, so to speak, Bryson then shares with us the story of Henry Cotton, the superintendent of Trenton State Hospital in New Jersey from 1907 to 1930, who weirdly decided that mental illness was due to congenitally misshapen bowels and embarked on a program of surgery to remove the large colon of his charges. More than 30 percent of his patients died, and those who survived derived no benefit.
Moving on to the circulatory system, we learn that our heart beats 3.5 billion times over the course of a year, pushing 1680 gallons of blood each day through 25,000 miles of blood vessels. Each teaspoon of that blood contains 25 billion red blood cells each of which contains 250,000 molecules of hemoglobin. Those hemoglobin molecules each carry a molecule of oxygen, one of 2.5 sextillion (that's 2.5 followed by 22 zeroes!) that are breathed in with every one of the 20,000 breaths per day that we inhale into the 2.4 pounds of lungs that contain 1,000 square feet of lung tissue through which 1,500 miles of airways course. Just as we're about to sink under the weight of all those numbers, Bryson reminds us that it was William Harvey (1578-1657) who accurately described the circulatory system at least in part by doing autopsies on both his father and sister. He was widely ridiculed in his time described as "crack-brained" by a contemporary diarist.
Exhausted yet? And exhausting it would be, but for Bryson's spot-on sense of when to introduce yet another fascinating person or take a detour into one of medicine's periodic misadventures. We learn of Walter Jackson Freeman, a psychiatrist with no surgical training, who performed hundreds of lobotomies, destroying the frontal lobes of the brain by driving an ice pick (yes, an ice pick) through the eye socket and waggling it back and forth. Two thirds of his patients either were worse off or derived no benefit including John F. Kennedy's sister, Rosemary, who was 23 in 1941when Freeman did a lobotomy on her for mood swings and learning difficulties. She lived her final 64 years in a nursing home unable to speak, incontinent, and bereft of personality.
Bryson also points out the obscure fact that three people with fascinating medical history stories all lived in tiny Cavendish, Vermont at one time or another. There was Alexis St. Martin, a young Canadian fur trapper who had the misfortune of being shot in the abdomen but who survived with a fistula that allowed his doctor, William Beaumont to conduct experiments about digestion via this direct access to St. Martin's stomach. There was Phineas Gage, a young railroad worker whose misadventure with dynamite drove an iron bar through his brain; he survived with major memory and personality changes providing a natural experiment in brain science. We also meet Nettie Stevens, who earned a doctorate from Stanford at the turn of the 19th century and discovered the Y chromosome, the source of maleness in our genes.
Bryson points out that the accumulation of scientific knowledge and technical skills over the course of medicine's history has resulted in longer and healthier lives today. Remarkable strides in overcoming infectious diseases (antibiotics and vaccines) and addressing the cellular mistakes that result in cancer (survival rates for childhood acute lymphocytic leukemia have now reached 90 percent) have unfortunately been offset by our behavior around eating, exercise, and the stress of modern living have resulted in an explosion of chronic diseases such as obesity, type 2 diabetes, asthma, and dementia.
These chronic illnesses are, in part, the result of living longer. Life expectancy in the U.S. has nearly doubled in the last century from 46 years for an American male in 1900 to the current projection of 78-plus years for that American male today. Characteristically, Bryson takes that fact and dives more deeply into the details pointing out that living longer is not a uniform experience across the world or in the U.S. The U.S. overall stands at 35th in global rankings of life expectancy, behind Cyprus, Costa Rica, and Chile and just ahead of Albania and Cuba. These national differences are even starker in local environments. Take a 20 minute drive from the prosperous city of Clayton, abutting St. Louis to the inner-city neighborhood of Jeff-Vander-Lou, and life expectancy drops by one year for every minute of the journey, two years of life lost for every mile. Similarly, a 30-year-old Black male in Harlem is at much greater risk of dying than a 30-year-old Bangladeshi male — not from street drugs or violence, but from stroke, heart disease, cancer, and diabetes.
We know so much more than we did in the past, but our sedentary lifestyle, a diet stuffed with fat and processed sugars, and stress-filled lives combined with a health system that employs two bill processors for every doctor, have resulted in poor health outcomes in the U.S. If that weren't bad enough, Bryson points out that Americans spend twice as much as any other industrialized nation on healthcare to achieve these mediocre results — more than $3.4 trillion per year, one out of every six dollars of gross national product. Bryson doesn't have an easy solution for these problems, but does a fine job of identifying and presenting them.
By the time you finish this marvelous book, you will have learned loads of information, enjoyed fascinating anecdotes, and developed a sense of wonder about the incredible "machine" that is the human body. It will have taken you much less time, effort, and money than if you had gone to medical school, and you will still be able to wow your cocktail party companions with stories about Meissner corpuscles and Proust's asthma.
Before another day goes by, use some of those 7.3 million breaths per year to get yourself down to your local independent bookstore to buy this book, and then use some of those 86 billion neurons in your brain to figure out what all those little black squiggles on the page mean. You'll laugh out loud, shake your head in wonder, and have a wonderful experience along the way.
Michael F. Epstein is a retired physician who reads and writes in Cambridge, Mass., and Brownsville. He can be contacted through his web site, EpsteinReads.com where you will find more than 1,000 book reviews to answer the question of "What should I read next?"