Views & Reviews Review of the Week

Of acupuncture, art, and testicles

BMJ 2008; 337 doi: (Published 09 September 2008) Cite this as: BMJ 2008;337:a1620
  1. Sanjay Pai, consultant pathologist and head, Pathology and Laboratory medicine, Columbia Asia Referral Hospital, Bangalore, India
  1. sanjayapai{at}

    A collection of essays by the American surgeon and writer Sherwin Nuland entertains Sanjay Pai hugely

    Sherwin Nuland wears many hats—surgeon, historian, writer, and medical philosopher (see BMJ 2008;337:a922, doi:10.1136/bmj.a922). For many years he has combined these many interests with writing prize winning books and columns in various magazines. The Uncertain Art is based almost entirely on selected essays from The American Scholar, a journal to which Nuland was a contributing editor. The essays are on a wide variety of topics, with medicine being central to the theme. The title, of course, refers to the fact that medicine is an art as much as a science, as so many others have noted, from the Hippocratic corpus (“Life is short, and the art is long . . . experience fallacious, and judgement difficult”) to William Osler (“Who can tell of the uncertainties of medicine as an art”).

    The subtitle is appropriate, and the range of topics wide—these include grave robbing, predictions on the future of medicine, etymology of medical terms, scatology, pumping iron, electroconvulsive therapy, and even the 11 September 2001 attacks in the United States. He recalls, for instance, the occasions on which he has been in a public place and heard the words, “Is there a doctor in the house?” These are words that most doctors dread: often there is little that a doctor can do without colleagues and without technology. Yet such moments that can be the defining ones in a doctor’s life.

    In the aftermath of the Beijing Olympics this may be an appropriate time to do what Nuland suggests: investigate aspects of ancient Chinese medicine to derive benefit for modern medicine. As a member of a US team of surgeons in China he saw acupuncture being used successfully instead of conventional anaesthesia for thyroidectomy. His anecdotes on the topic reminded me of an article by another great surgeon, Richard Selzer, about 30 years ago. Selzer had written of the diagnosis of ventricular septal defect made by Yeshi Dhonden, then the Dalai Lama’s physician, on merely feeling the pulse of a patient in an American hospital.

    Part of the fun in reading any article by Nuland is his questioning of accepted beliefs and the way he suggests new historical theories. In The Uncertain Art Nuland makes a cogent argument that the famous painting of an American physician—Thomas Eakins’s The Gross Clinic, painted in 1875—is a caricature of the man rather than a portrait showing him in good light. In another essay he tell us that Gray’s Anatomy, when first published, was praised by practically all but one anonymous reviewer, who signed his name with a single H, in the Boston Medical and Surgical Journal (the forerunner of the New England Journal of Medicine). Nuland has a startling suggestion as to the identity of this person. I will not disclose who it is—suffice it to say that he is widely revered in medical circles. Nuland hypothesises that this saint of medicine ran down Gray’s because he could not have accepted a young upstart overtaking his revered authors, Sharpey and Quain, whose book was then the authoritative text in anatomy.

    Many practitioners of the uncertain art of medicine have a mischievous sense of humour, and this author is no different. While explaining the origin of the word “orchidectomy” he states that the word orchis refers to “like a testicle”; hence the orchid is so named because of its ball shaped double root. He continues: “A man . . . awaiting orchidectomy . . . is not about to have flowers removed from his room,” and adds, “Some men would rather lose their souls than their testicles.” He also informs us that the vibrator was invented in the 1880s for the clinical purpose of creating doctor induced manual orgasm as a treatment for hysteria and that “those who view with nostalgia that earlier time before instruments replaced the doctor’s touch might look on such an innovation as a mixed blessing.”

    The one previously unpublished article, “Letters from a heart transplant candidate,” deals with uncertainty—but of life, not in medicine. It speaks of the uncertainty of life for a patient awaiting a heart transplant. Much of the article consists of the patient’s own writing, in the form of periodic letters to Nuland. The letters reflect a warm, honest, and tough human being, one who is humane and optimistic yet worried and philosophical. They remind us that as doctors we can learn much from our patients—and, to use Robert Frost’s line, that “we have miles to go before we sleep.”


    Cite this as: BMJ 2008;337:a1620


    • The Uncertain Art: Thoughts on a Life in Medicine

    • Sherwin B Nuland

    • Random House, pp 224, $25

    • ISBN 978-1-4000-6478-6

    • Rating: ****

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