The Homunculus Inside

Paracelsushomunculus, 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.

Life

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.)