John Wirvell was a taxi driver, divorcee and an intermittent heavy drinker when he was struck down, in his late 50s, by severe bouts of nausea and vertigo. The attacks were so incapacitating, he could hardly stand, let alone work. Gavin Francis, then his doctor, diagnosed benign paroxysmal positional vertigo or BPPV. The condition, although not fatal, is highly debilitating and well recorded. Hippocrates said it was the fault of a southerly wind.
More recently doctors have blamed the chalky grains that are embedded in jelly in the semicircular canals of the inner ear. Their positions there help to maintain our balance but sometimes these particles become attached to the wrong membranes in the ear. In this way, a patient’s sense of balance was disrupted, it was thought. Treatments involved repeating the movements that triggered a person’s vertigo until he or she became numbed to them. In severe cases, skulls were opened up and nerves cut round the inner ear, risking deafness.
And that is what John Wirvell might well have been put through had it not been for the work of John Epley, a US pioneer of cochlear implant surgery. In the 1980s, Epley claimed BPPV attacks were caused not by chalky grains adhering to wrong membranes but by the fact that these particles were actually breaking loose and were rolling round the semicircular canals, creating eddies that were perceived by the brain as movement. All you had to do was adjust the position of a patient’s head a few times, he said, and the offending particles would be dislodged and would move on, curing BPPV in minutes.
For his pains, Epley “was laughed at in conferences… [and] accused by some as unfit to practise”, says Francis. However, in the end his pioneering technique was accepted and used by Francis to treat his patient, John Wirvell. After pushing the man’s head into various prescribed positions, Francis allowed his now vertigo-free patient to stand. “It’s like magic… voodoo medicine,” Wirvell announced.
The story is intriguing – for several reasons. For a start, it has a happy ending which is by no means the rule in most of the stories contained in this frequently dark, but always enlightening exploration of the human body. “It is also a reminder that for all the advances of modern medicine, the body and its ways can still surprise us,” says Francis. “Physicians had been stumped for millennia about how to treat episodes of severe and incapacitating vertigo.” Yet it was cured without recourse to using a new scanner or microsurgical procedure. A little bit of creative thinking was all that was needed.
It is typical, provocative fare for Francis, who comes to this book – which he describes as “a journey though the most intimate landscape of all: our own bodies” – armed with two key attributes. First, he is an award-winning travel writer. His True North is a particularly fine exploration of Europe’s Arctic wildernesses, for example. Second, he is a highly experienced doctor: a former paediatrician, a physician on a long-stay geriatric ward, a trainee surgeon in neurosurgery, an expedition medic in the Arctic and Antarctic, and now a GP. This is a man who has seen it, done it, and – most importantly – knows how to write about it.
Take his description of a casualty ward (in Edinburgh) whose main double doors act “like a storm drain, with all the madness and misery of humanity pouring through them”. It is in this setting that a young doctor is expected to learn how to approach every injury and intoxication that men and women can inflict on themselves. “What I didn’t bargain for were the stories,” Francis writes.
There is the prisoner with a broken jaw, sitting beside a prison warder with a fractured fist, a link so obvious it seemed almost discourteous to mention it, the author notes. Or the builder who can no longer stand waiting around in A&E and who heads home still with a large nail driven through his hand.
And then there is the self-harmer, a young teenager whose forearms are covered in dressings from the wounds she has made herself and for whom Francis has special sympathy. “Self-harmers are often teenage girls who are placed in impossible situations: pulled between the expectations of their parents, the demands of their peers and an anguish that’s partly about grieving for their childhood and partly about finding an adult identity. Cutting conveys the depth of conflict they feel.”
With each vignette, we are provided with a smattering of medical insights: the physiological effects of crucifixion (a practice brought to Francis’s mind by the nail through the builder’s palm); details of the boxer’s fracture suffered by the prison warder; and the links between self-harm and abuse suffered in childhood.
It is a fraught catalogue of misfortune, illuminated with flashes of mordant wit. In response to a question about his profession, one powerfully built casualty patient, nursing a shattered fist, replies that he is “a pickpocket, what is it to you?” “Just checking you’re not a concert pianist,” Francis responds.
Francis starts his grand tour of the human frame at the brain. (“I was 19 years old when I first held a human brain,” we are told in the book’s opening, arresting sentence.) Then we head downwards towards the feet and toes in a series of 18 essays on organs that include the kidney, inner ear, genitalia, the rectum – described as “a magnificent work of art” – and the lungs.
The last on this list is one of the most intriguing of Francis’s bodily peregrinations – for our lungs turn out to be the least dense organs in our bodies, and that is because they are composed almost entirely of air. Made of layers of thin delicate tissue, designed to maximise exposure to breath, an adult’s lungs would occupy over a thousand square feet: the equivalent to the leaf coverage of a mature oak tree. Throughout our lives this vast membrane draws in oxygen and leaks carbon dioxide, keeping us alive.
“When I think about lungs, the associations that come to mind are of light, airiness and vitality,” Francis notes. “When they become diseased they lose their lightness; they become ballast that pulls towards the grave.”
It is grand, eloquent stuff, occasionally humorous, frequently moving, and invariably informative. In other hands, Adventures in Human Being might well have become cluttered with cliche, detail or sentimentality but Francis has a lightness of touch that helps him avoid these pitfalls. His use of quotes is sparing but erudite and his lack of self-importance – often a failing in his profession – is welcome. The end result is a thoroughly entertaining, provocative work.
Adventures in Human Being by Gavin Francis (Profile Books, £14.99). To order a copy for £11.99, go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min. p&p of £1.99.
