Sir William Batten doth rail still against Mr. Turner and his wife (telling me he is a false fellow, and his wife a false woman and hath rotten teeth and false, set in with wire) and as I know they are so, I am glad he finds it so.

Pepys was peeved to find that he couldn’t discern natural good looks from ones that had been paid for, but the stakes for nose operations were much higher. When a person’s face could be repaired in such a radical way, how could one tell the genuinely healthy apart from the merely wealthy?

Flesh, Spirit, and Sympathy

As the story of the Brussels man who lost his nose reveals, there was another, more serious problem with the nose operation. Several sources alleged that if a patient had their new nose made from the flesh of another person, that nose could drop off when the donor died.

In 1658, for instance, the scientist and courtier Sir Kenelm Digby asserted that:

Artificiall noses that are made of the flesh of other men … do putrifie as soon as those persons out of whose substance they were taken come to die, as if that small parcell of flesh ingrafted upon the face did live by the spirits it drew from its first root, and source.

He was probably thinking back to a story told by the physician-astrologer Robert Fludd, who in 1631 relayed the story of a lord who had a new nose made from the flesh of a slave. All seemed well with the new nose, said Fludd, until “it happened, that the slave fell sicke and dyed, at which instant, the Lords nose did gangrenate and rot”.

What was the cause of this misfortune? Fludd and Digby claimed that the death of the grafted-on noses was proof of a quasi-scientific idea known as the doctrine of sympathy. This theory, which was esoteric even for its own time, held that atoms – a term used in this period to describe small, indivisible particles – had an identity. That is, they were blood atoms, nose atoms, or so on. Each atom had an in-built affinity with others of its own type, meaning that given the chance, atoms would travel through the air to where they were most plentiful (say, transplanted nose atoms travelling back to their original owner).

Proponents of sympathy claimed that using this principle, they could cure wounds at a great distance. For instance, by applying a special “wound-powder” to blood that had dried on a knife, they could cure the wound which the knife had inflicted, even if they had never seen the patient. The atoms of wound-powder would travel with the blood atoms from the knife to the patient’s body. The same principle also applied in reverse; as one anonymous text asserted, grafted-on noses were “nevertheless still animated with the Vitality of [the donor], of whom it was yet truly a part”.

The doctrine of sympathy never gained much credence among the medical establishment, who saw it as at best foolish and at worst evidence of witchcraft. But the idea that noses always “belonged” to their original owner tapped into deeper worries about what “belonged” to any individual body. Most early modern Christians believed that on the day of resurrection, those who were destined for heaven would be raised out of the grave in the same bodies which they had in life. The book of Corinthians reads:

So also is the resurrection of the dead. It is sown in corruption; it is raised in incorruption:
It is sown in dishonour; it is raised in glory: it is sown in weakness; it is raised in power

This was taken to mean that people who died old, sick or disabled would be resurrected strong and healthy, free from the sufferings they had endured on earth.

It was a comforting thought, but in practice, it raised many questions. Even in peacetime, the fate of amputated limbs was uncertain. For instance, in 1720, the London Journal newspaper reported:

On Monday last part of the right Leg of a man was found in a Cellar Window in Bartholomew Close, which probably may have belonged to some Patient in the neighbouring Hospital, that has undergone an Amputation.

The 17th century was far from peaceful, with decades of war at sea and on land, and many soldiers maimed far from home. What happened, then, if one lost a leg in the Atlantic sea and later had one’s nose disintegrate from syphilis? How were those parts to be restored at the resurrection? This wasn’t only a question of finding the missing parts. What happened if the leg lost at sea was eaten by a fish, which was then eaten by a person? The atoms which had made up the leg were now making up that other person, and they couldn’t be restored to both parties at the Last Judgement.

Philosophers and poets agonised over these issues. Some suggested that perhaps not all of the matter that had made up the body needed to be resurrected, and instead it would be enough if just the bones and the major organs were made of the same stuff as in life. Others pointed out that the body produced a lot more matter over the course of a lifetime than it needed, in the form of fingernails, hair and shed skin. Perhaps this superfluous material could make up any shortfall?

For the most part, however, writers on this subject followed the lead of poet and clergyman John Donne, who insisted (though a little too fervently) that God would sort everything out in His own mysterious way. God, preached Donne, “sits in heaven, and spans all this world, and reunites in an instant armes, and legs, bloud, and bones, in what corners so ever they be scattered”. It might seem to mere mortals that resurrection was fraught with problems, but good Christians should have faith that even their “scattered body” would be repaired and recompacted.

While Donne’s advice reflected the religious orthodoxy of the time, the actions of everyday people show that they still worried about these issues. Criminal punishments involving being cut up and one’s parts scattered about struck fear into audiences precisely because they feared that these parts might not be gathered up at the resurrection.

Some law-abiding citizens made efforts to make sure that their bodies stayed intact as much as possible by specifying in their wills that they didn’t want to share a tomb, even with members of their own family. People who had amputations might even bury their lost limbs, ready to be reunited at a later date. At a graveyard in west Wales, there is an 18th-century tombstone with the inscription:

Here lies the Leg of Master Conder:
But he’s alive, and that’s a Wonder.
It was cut off by Dr. Johnson,
The famousest Surgeon of the Nation.

All these controversies centred on the belief that a person’s identity could not be separated from their body. Grafted flesh would always “belong” to its original owner, and keeping one’s body together was important even after death.

To my surprise, a little research into modern transplantation showed that similar impulses still inform amputations and transplant surgeries, and especially hand and face transplants. While most amputated body parts are disposed of as medical waste, both the UK and US now offer patients the chance to preserve their limbs for burial. What is more, the donors of both hands and faces may now receive prostheses that restore them to bodily “wholeness” before they are buried.

Of course, these aren’t driven primarily by religious considerations, but by concern for the families and doctors involved. One 2007 article proposing use of silicone facial prostheses for face donors found that this intervention was welcomed by doctors involved in transplantation. In India, it’s now recommended practice to attach artificial hands to the bodies of deceased hand transplant donors, a step that’s undertaken more patchily in other parts of the world.

The donor of Joe DiMeo’s new face and hands received “replica parts” supplied by New York University’s LaGuardia 3D printing studio. Explaining the decision, DiMeo’s doctor Eduardo Rodriguez told the New York Post: “Despite the fact that they’re now declared deceased […] we still respect the dignity of the donor. It’s important for us to continue to care for the donor because that patient is still our patient.”

DiMeo has gradually regained physical function, but the immunosuppressants he has to take for the rest of his life are a reminder that in one sense at least, his transplants are still “borrowed” flesh. Like Van Helmont’s nose-buying nobleman, 21st-century transplant doctors and patients continue to grapple with the ethics and practicalities of altering the body.

Alanna Skuse is a Lecturer in English Literature at the University of Reading.

This article first appeared at The Conversation and is being republished via a Creative Commons license.