Our eloquent hands

Listen to this essay 22 minute listen Signs of the future are marked in our hands, or so any palmist will declare. But do hands also hold signs of the past? Do they have a history? Over decades of research as a historian of medicine and of human bodies, I’d never imagined such a niche question. And then it was sparked in an instant, between one second and the next, in the time it takes to open a manila folder. For another project altogether I was in the UK to research the papers of Charlotte Wolff, a physician trained in Berlin in the 1920s and living in London in the late 1930s, a Jewish refugee. Opening a file labelled ‘Zoo, 1938’, I came across a massive, delicate palm print: it belonged to Mok, a lowland gorilla at London Zoo. Two days after Mok’s death, the keeper had granted Wolff special permission to enter the morgue and collect a pattern that had been too dangerous to acquire in life. Mok’s palm print was both forceful and touching. Indeed, I was tempted to literally touch, to hold hands across time, across species, and across the worlds of the living and the dead. The emotive power was unmistakeable, yet for all my training as a historian, it was inscrutable to me. I was also puzzled why Wolff, an exceptionally clever physician, seemed to be practising palm-reading, which today is associated with magic and the occult. Could there be such a thing as medical palmistry? Over time, I learned that the answer is a clear, but unlikely, ‘yes’. Wolff was looking for the so-called ‘simian line’, a particular crease that some humans share with other primate species. Long ago, in embryonic time, the patterns on each of our tiny, clenched palms were formed. For most of us, three main lines were created. For some of us – up to 5 per cent – the so-called head and heart lines fused into a single crease stretching across the palm from one side to the other. Robert De Niro, Hillary Clinton and Benedict Cumberbatch each boast a simian line on their palms. Tony Blair apparently does on both hands, an even rarer distinction. In the 1920s, the London physician Francis Crookshank delighted in announcing that even the Virgin Mary had a simian line, directing people to see for themselves in Renaissance devotional art. To this day, midwives still quickly check neonatal palms, not because the newborn might be divinely conceived, but because a single crease has a high incidence in those of us with a particular chromosomal anomaly known as trisomy 21. Not everyone with this transverse crease has Down’s syndrome. And not everyone with Down’s syndrome has the so-called (still-called) simian crease. And yet, so strong is the correlation that this sign on the hand was a key element of clinical diagnosis until recently. It is fair, if strange, to say that the history of palmistry is the history of medicine. As a rule, physicians relish the weird in their own medical history, but I’ve learned that they don’t appreciate this particular claim. Yet, in turning their backs on the medical history of palmistry, they turn their backs on some towering figures. In the summer of 1663 in Cambridge, young Isaac Newton walked over to the fair on Stourbridge Common and bought himself a new book, Palmistry, the Secrets Thereof Disclosed. It was written by a physician, who instructed that the lines, angles, shapes and hatches on the palm needed to be read strictly and precisely with a measuring compass. Here was a geometry of the hand that needed to be decoded mathematically. No wonder Newton was interested. Yet we also know that Newton attended to ‘occult’ knowledge that purported to be previously unknown or hidden, hence ‘secrets disclosed’. (In fact, physicians still use the word in that plain way: ‘occult pain’, for example, is of unknown or unseen origin.) Newton was exercised by the learned traditions kept in ancient manuscripts and precious early printed books in Arabic, in Hebrew and in Latin, later circulating in vernaculars across Europe, the Middle East and North Africa. He was especially consumed by hermetic natural magic and the mysticism of ancient Jewish Kabbalah that had been Christianised in the Renaissance. This included what was then called ‘chiromancy’, discerning character, health and fortunes from the hand, from the Greek cheir. Medieval and early modern ‘prognostication’ – divining the future – was slowly turning into medical prognostics. Most early chiromantic texts were written by physicians. From Paracelsus to the Paracelsian physician Robert Fludd, Newton had them all in his library. Sometimes the simian line was clearly illustrated, yet this particular sign had not yet been analysed by the comparative anatomists, the biostatisticians or the primatologists who would later name it. Both folk palmistry and learned chiromancy were reference points for a modern anatomy of the hand The hand has a history of natural magic and occult knowledges, but it is also just anatomy, and so it appears in a plainer anatomical canon too. Yet that tradition is enchanted in its own way. One of the 19th century’s most eminent anatomists, Charles Bell, wrote The Hand (1833), a medical text on God’s design. And not long after, humanity’s deep past was being re-told through the human hand. In The Descent of Man (1871), Charles Darwin recounted that, one day, standing upright, the hand of the primate called Homo sapiens was free to grasp and so to evolve differently, uniquely. It is no coincidence that it was in the 1860s that the term ‘haptic’ arose, from the Greek haptikós, not just to touch, but to grasp or perceive. The hand of this new species of primate was set free for matters beyond locomotion, ultimately giving humankind ‘universal dominion’ over all other creatures, as Darwin wrote, quoting Bell. What a revolutionary idea! Friedrich Engels certainly thought so, as he wrangled the human hand into his dialectics of nature, his search for the material drivers of history. Bell’s anatomical textbook had shown the human hand grasping that all-important tool. Both folk palmistry and learned chiromancy were reference points for a modern anatomy of the hand. In the 1820s, the Czech anatomist Jan Evangelista Purkinje – known for his fingerprint studies – also analysed the crease patterns on human as well as monkey palms, specifying new terms: the lines of opposition, abduction, adduction, extension, and flexion. Yet, in order to clarify, he had to explain these as the life line, the line of Mars, the line of matrimony, the table line, the line of Venus, the line of Rascetta, and the lines of honour and fortune. Traditional palmistry, in other words, was his anatomical reference point. Nearly a century later, when a then-obscure English doctor named Reginald Langdon Down admitted a patient to the family’s private asylum, he recorded ‘Hands, no head line’ in the admission files. Palmists’ terms were his clinical referents too. That was in 1907, just after his own beloved son was born with the syndrome that was yet to be named for his family. In France, the anatomist Paul Broca had for some time researched palm creases comparatively across humans and other primates, identifying ‘la disposition simienne du pli palmaire’. Over time, le seul pli – the single fold – was the term used in French scholarship, while German anatomists and clinicians referred to vierfingerfurche, the four-finger crease. In English and American studies ‘the simian line’ proved to be an enduring designation. In 1924, an anatomist employed by the London Zoological Society showed clearly that the orangutan had this single transverse line, and sometimes even two in parallel, both running right across the palm. This was all on Wolff’s mind when she entered the morgue at London Zoo in 1938. Indeed, she had for some time been climbing into the primate cages taking the prints of every live simian she safely could: those of lemurs, spider monkeys, baboons, chimpanzees, orangutans and more. She even took the delicate prints of a hedgehog. Of more stature, perhaps, were the palms of human primates she collected and then interpreted. These were not any old Homo sapiens but very special specimens indeed. As I opened more manila folders in the Wellcome Collection, London, there were the intimate hand-portraits of every interwar cultural luminary imaginable: Aldous Huxley, Virginia Woolf, Vaslav Nijinsky, Maurice Ravel and so many more. Yet the most haunting remained Mok, the dead lowland gorilla. It’s a delicate history to tell, this comparative anatomy across primate palms that gave rise to the offensive term ‘simian line’. Yet, before we object, sneer, mock, judge or even just enjoy this as the quirky business of early misguided medicine, or worse dismiss it as ‘pseudoscience’, we should note that this is not only an antique history. It tracks right up to our own present, involving some of the most distinguished researchers of the 20th century, Newton’s worthy intellectual descendants. Around the same time that Wolff was taking Mok’s palm print, in another part of London the medical geneticist Lionel Penrose was beginning a lifetime assessing human palms and finger patterns. He was doing so both geometrically and statistically in a manner more sophisticated than, but not unlike, Francis Galton’s late-19th-century work on fingerprints. It is little known that Galton – often called the ‘father of fingerprinting’– took palm prints too, occasionally wondering if his hypothesis on the individuality of the fingerprint was also discernible in palm lines. This was a tradition of medical and genetic hand-reading that came to be called ‘dermatoglyphics’. As late as 1990, the simian crease was even sought, detected and analysed prenatally, via ultrasound In this context, it was the fortune of the so-called simian line to become the perfect exemplar of a classic modern biomedical pair, the visible ‘phenotype’ and its hidden twin, the ‘genotype’. The former is an observable physical trait; the latter is that trait’s unique DNA code or sequence. Sorting out the connection between them was a great driver of mid-20th-century genetics. Over the 1930s and ’40s, before the chromosomal cause of Down’s syndrome was known, clever Penrose could work only with the phenotype – the physical expression – and he was able to statistically correlate the simian line with the syndrome. And then, in the late 1950s, a Paris-based team discovered the genotype that was trisomy 21, the additional chromosome. It was a massive breakthrough, the long-invisible genotype (an extra chromosome) was now visible, a match with its long-visible phenotype (the simian line, le seul pli, vierfingerfurche). We might well say that an occult sign had been revealed. I expected the medical palmistry – so to say – to then dissipate, to become antiquated, yet to my utter surprise it did not. For decades after the extraordinary chromosomal discovery, these world-leading Paris and London-based geneticists continued to exchange letters with diagrams of hand patterns, still drawing those three – and in some humans, just two – main lines on the palm. In the 1960s, paediatricians added another palm crease of note, dubbing it the ‘Sydney line’, or sometimes ‘the simian-like line’. As late as 1990, the simian crease was even sought, detected and analysed prenatally, via ultrasound. One study showed that, in seven foetuses with this sign, four had no chromosomal anomaly, and three had trisomy 21. And even today, some of the most prestigious research hospitals in the world explain to parents that their neonatal physician may check the newborn palm, still nominating the ‘simian crease’. We all know that a straight line can be drawn between any two points. But as a medical historian, can I really draw a line from Newton’s book Palmistry, the Secrets Thereof Disclosed to the prenatal detection of the simian line in the Journal of Ultrasound in Medicine? The first was built from knowledge that is far remote from our own comprehension of the human body. That was a world in which it made every sense that the planet Jupiter and the finger of Jupiter would be connected, a ‘sympathetic’ relation between a celestial macrocosm and a bodily microcosm. Yet I’ve come to appreciate that this apparently magical chiromancy is an archaic version of what modern clinicians do all the time and every day. They read bodily signs. Medical students are routinely taught the distinction between a symptom felt by the patient, and a sign observed and interpreted by the clinician. This sign (a rash, the colour of nails, a black spot, a pattern in the palm) has that meaning (measles, liver disease, melanoma, Down’s syndrome). And so, all physicians are foundationally schooled in the interpretation of somatic signs. They are medical semioticians, whether or not they would put it that way. All physicians are medical semioticians, professional and trained readers of bodily signs The surprising thing is that some physicians put it precisely that way. It was initially strange to me that the London physician who observed the simian line on the Virgin Mary’s palm in the 1920s – Francis Crookshank – was also deeply schooled in the complexities of contemporary linguistics. Pondering the meaning of the simian line that some of his professional colleagues, as well as his patients, displayed, Crookshank began to insist that medicine desperately needed a ‘theory of signs’. One winter’s evening in 1926, he lectured on just that to the Royal College of Physicians and couldn’t understand why his medical brethren first rolled their eyes, and then closed their eyes, falling asleep with boredom. The connection he drew between clinical sign-reading and highly abstract semiotics was just too much. In so many ways, he was speaking a different language, and certainly his essay’s publication in the specialist book The Meaning of Meaning (1923) – to be read mainly by philosophers of language and Oxbridge cultural anthropologists – did nothing to persuade his medical colleagues. It may have been ill-delivered and badly pitched, but the fact is this palm-reading physician was theorising not just the simian line, but everyday clinical business: how signs on the human body are observed, named, and then ascribed meaning. He did so, not only, but not least for the simian line. All physicians are medical semioticians, professional and trained readers of bodily signs. In his 16th-century treatise on chiromancy, Paracelsus claimed that ‘nothing is so secret in a human being that it does not have an outward sign’. Indeed, a whole language of the hand is discernible within the medical past. It was the 17th-century doctor John Bulwer who set out the origins of sign language in his enchanting book Chirologia, or the Naturall Language of the Hand (1644). He conceptualised the hand as a second mouth, so keen is its capacity to communicate by gesture and by sign. For Bulwer, it was the hand, not the mouth, that could speak a universal language, the ‘chiefest instrument of eloquence’. Two hundred years later, Bell, one of the greatest anatomists of his day, also wrote of the ‘eloquent’ hand. And a century after that, Wolff wrote about the psychoanalytic body that speaks, in A Psychology of Gesture (1945), placing her work on primate hands in just this tradition. Today, some adventurous and imaginative medical schools take the connection between somatic signs, language and interpretation very seriously indeed, teaching physical examination through the idea of ‘The Body as Text’. ‘Every patient’s body tells a story,’ Stanford’s medical students are instructed. ‘The narrative includes the past and present of a person’s social and medical condition.’ Bulwer, Bell, Crookshank and Wolff would have added ‘and the future’: signs on the hand were not just diagnostic, but prognostic. The Stanford School of Medicine frames the physical examination as an old-school art that needs to be retained, not superseded, by various technologies that ‘see’ inside. This is the art, science and language of decoding the phenotype. It is quite right that Stanford explains this ‘body as text’ method as the interpretation of the phenotype. Yet when their clinicians teach this language of the body, they are perhaps unaware of just how long and distinguished the tradition of decoding somatic signs is. When dead Mok’s hand first reached out to me – far more than a ghost – I was culturally cornered, stuck thinking that the palm was relevant only to palmistry. Yet of course the hand – including the fingerprints, the palm and its folds, creases and patterns – is plain human anatomy made semiotically and phenotypically meaningful. For centuries, fortune-telling palmists have studied the hand to unlock the future and the past, health and character, but so too have other experts in bodies and minds: physicians, psychologists, psychiatrists, embryologists, anatomists, endocrinologists, primatologists and physical anthropologists. Having followed a language of the hand both backwards and forwards in time from Mok’s poignant print, it was especially affecting to learn that, as a medical elder in the 1970s, Penrose the curious geneticist was himself pursuing the history of palmistry: one of the final publications of his stellar career was on fingerprints and palmistry, published in The Lancet, no less. For me, Mok’s print became slowly unveiled from its occult state, no longer inscrutable and mysterious, but now known, legible, and clear, a historical secret disclosed.