The Hidden Wonders of Your Lungs with Dr. Jonathan Reisman

November 9, 2021

Congratulations to my friend, Jonathan Reisman, on his book, The Unseen Body, which publishes today, Nov 9, 2021!

We met in India during Allahabad Kumbh Mela when according to Wikipedia: “An estimated 120 million people visited Maha Kumbh Mela in 2013 in Allahabad over a two-month period including over 30 million on a single day, on 10 February 2013.”

I am honored to share this excerpt from his book, The Unseen Body, “Lungs,” with permission from his publisher, Flatiron Books:

Early on in anatomy lab, as I was first getting elbow deep in my cadaver’s abdominal fat and neck deep in the Latin names of body parts, I decided to visit a slaughterhouse. I wanted to learn more about how cuts of beef compare to human muscles. I found a kosher slaughterhouse in central New Jersey, deep in the state’s industrial heart, and I called up the owner. After expressing surprise at my request and asking a few questions to convince himself that I was not “some crazy vegan or something,” he agreed to let me visit on the next slaughtering day. And while I had muscles on the mind, the theme of my visit would turn out to be all about lungs. On a crisp autumn morning, I drove along the New Jersey Turnpike past oil refineries, gas stations, and tractor-trailers to the slaughterhouse. When I opened the heavy metal door to the building, I could hear the rattling of chains, the booming sounds of chain saws, and a chorus of cattle mooing. The scent of barnyard hung in the cold air as I walked through the front office toward the dreadful sounds coming from beyond. The slaughtering had already begun. I saw rabbis with long gray beards and thigh-high rubber boots standing around a large wooden table, examining mounds of shiny flesh. Workers, primarily Black and Hispanic, wielded huge motorized butchering saws and moved hanging quarter-cows along tracks in the ceiling. Each steer was led into the building from the outside lot through a narrow chute leading directly onto the slaughtering platform. Chains were then fastened to its back legs and used to slowly lift the animal off the ground. Just as the front hooves left the concrete floor, a long, final moo built in volume and echoed off the grimy industrial walls. With one swift slice of the rabbi’s knife to the animal’s neck, a slick of blood hit the floor with a loud splash, and the animal was dead before the echoes of that last moo had finally faded. I walked among the hanging slabs of beef and saw quarter-cadavers, recognizing the same orthopedics of muscle and bone that I had seen in anatomy lab. Underneath our skins, humans and cattle are both glistening red outlined in white, strung like puppets by the names of a dead language. The rabbi actually doing the slaughtering seemed less busy than the others—in between animals, he mostly stood around cleaning the blood off his long knife. His beard was neatly cropped, and his yarmulke held tightly to his short brown hair. I asked him about what the other rabbis were doing. He explained that Jewish traditional dietary law, or kashrut, provides a guide to the proper dissection of meat and diagnosis of its cleanliness. I knew the basic rules of kashrut: keep milk and meat separate, and avoid shellfish and pork. But there is another criterion that is less well known, he explained: severe pneumonia during an animal’s life can make an animal no longer kosher.
Dr. Jonathan Reisman, photo by Olaf Starorypinski
In healthy animals and humans, as the lungs expand and contract with each breath, they slide freely against the pleura, a layer of membrane surrounding the lungs and lining the inner side of the chest wall. But when the two surfaces are inflamed by a bad bout of pneumonia, they stick together like an unlubricated piston in its shaft. As the pneumonia heals, a scar forms at the spot where the lung got stuck—a band of white fibrous tissue attaching the two surfaces. The shochets—those trained in kashrut’s version of a USDA inspection—were carefully examining the animals’ lungs and looking for these telltale signs of pneumonia. Called adhesions, these scars were the footprint of past disease, and each was a potential degradation of kashrut. According to Ashkenazi Jewish tradition, the number and size of these adhesions determine the grade of kosher, with the highest level called glatt, meaning “smooth,” a description of the surface of an animal’s lungs that are free of the roughened scars. Most important, the shochets must determine whether there is a hole hidden within a scar that reaches straight through the lung. As a carcass hung freshly killed and cut open, a shochet slid the lungs out of the chest cavity. He walked back over to the examining table, his hand grasping the trachea as two fleshy lungs dangled below. He placed an air hose into the animal’s trachea and inflated the lungs with a rush of air. They doubled in size like two large loaves of bread rising abruptly. The shochet then cupped his hands around one of the scar tufts on the lung and filled his hands with water, being careful not to let any drain out. If there was a hole within the scar, air from inside the lungs would bubble up through the water, as when a mechanic investigates a flat tire for the puncture site. Such a hole from the outside into the body’s inside proves the animal is not intact and therefore its entire body is not kosher, with bubbles as the definitive diagnostic criteria. Kashrut’s concept of cleanliness and health seemed to rely on the sanctity of a barrier between the inside of the body and the outside world. Maintaining cleanliness means keeping the outside out, much as people in many cultures remove their shoes before entering a house or a place of worship. When animals or humans breathe in air and atmospheric schmutz, they enter our lungs and whoosh all the way down to the alveoli—but this is not truly inside the body. The air in the lungs is still continuous with the external atmosphere. The real threshold of the physical self is the lining of those deep alveoli, and a hole connecting the inside of the lungs to the pleura is a way for the dirt of the outside world to get in, truly inside, the body, and once that sacred barrier has been breached, innocence and purity are soiled. For the kosher postmortem inspection of an animal, the lungs have a unique primacy—they hold the singular key to the purity of every part of an animal’s body, even its rump roast. In the past, shochets examined eighteen different body parts to make a determination of kashrut, looking for defects of all kinds, but experience over centuries showed that the lungs offered by far the most bang for the buck [Shulchan Aruch]. A large enough proportion of all defects found were in the lungs, obviating the practicality of examining the other seventeen body parts, except in special circumstances. It made anatomical sense: as the organ standing guard at the body’s entrance and suffering the microbial blows of an outside world teeming with infection, the lungs serve as a proxy. The kosher version of dissection exalts the lungs above all other organs, and when they show signs of disease, the animal’s entire body is considered unfit for human consumption. Excerpted THE UNSEEN BODY: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy by Jonathan Reisman. Copyright © 2021 by Jonathan Reisman. Reprinted with permission from Flatiron Books. All rights reserved.  

More about Jonathan Reisman and his organization:

I wrote about him in 2013 for Huffington Post.

The Bodies that Guard our Secrets” in The New York Times, Sunday Review section. April 26, 2014. Kosher meat and the diagnosis of cancer meet in this medical student’s trip to a slaughterhouse.

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