The Hand How Its Use Shapes the Brain, Language, and Human Culture By Frank R. Wilson Pantheon. 396 pp. $30 Reviewed by F. Gonzalez-Crussi, a pathologist who lives in Chicago. His latest book, "Suspended Animation," was nominated for the PEN Faulkner Award. Sunday, July 19, 1998; Page X01

Nor are the hand's contributions purely material; they extend to the realm of abstract ideas. Language evolved with the help of the hand, whose gestures served to point to the objects named. Similarly, all philosophical concepts of reality, even the subtlest, started off with elementary, tactile sensations collected by human hands. To touch with one's own hands is, after all, the ultimate proof of reality: a test that Saint Thomas the Incredulous did not hesitate to apply.

Pondering all this, the French poet-philosopher Paul Valery once expressed his amazement that no one had written a "Treatise of the Hand," which, as he put it, ought to be "an in-depth study of the innumerable virtualities of this prodigious machine, which joins the most nuanced sensitivity to the freest of strengths." "But," he added, "this would be a limitless study." Well, if Valery were alive today, he would wonder no more. The treatise has been written. It is The Hand, by Frank R. Wilson, a neurologist who, possibly on account of his experience in treating the various hand ailments of performing musicians, grew especially sensitive to all matters manual. If not exactly "a limitless study," it is a vast undertaking. The author duly acknowledges that each chapter raises more questions than it answers. But this, incidentally, ought to be reckoned a mark of the book's excellence, for it makes the reader aware of the wonder in trivial, everyday acts, and reveals the complexity behind the simplest manipulation.

There are 15 chapters, plus epilogue and appendix, all copiously annotated and fortified with allusions to the biomedical literature in addition to a bibliography of more than 200 entries. The author's gift for narrative is much in evidence. When the going turns wearisome – and, alas, it inevitably does when there are substantial amounts of technical information to convey – the narrator's talent comes to the rescue. The movement of tendons and muscles invites a comparison with string-pulled marionettes and a glance at the art of puppetry. A ponderous discussion of delicate and forceful grips leads to a lively account of a craftsman who succeeds as jewelry designer despite the accidental amputation of four of his fingers, and then to an engaging sketch of a precocious mountain climber who must hang on for dear life with unusually strong digits. The connection sometimes seems tenuous, as in a chapter that tries to link handiwork, gastronomy and evolution. But no matter: A foray into the virtuosity of the hand in Mexican cuisine cannot help but maintain the reader's interest.

Medicine and the hand share an age-long relationship, one that goes from the laying on of hands to contemporary surgical prowess and its quasi-miraculous limb reconstructions and organ transplants. Indeed, the pristine, etymological sense of the word "surgery" is to "work with one's hands" (Greek cheirourgia, from cheir, hand, and ergein, work). It is thus not surprising to find a chapter that discusses overlapping features of surgery, medicine and magic. Yet, as the book's strongest section explains, the hand is no passive executor of the brain's crafty schemes or programs of action; the brain itself owes the unfolding of its intellectual powers to the hands' sensorimotor input. It is through feeling, touching and manually exploring the world, as much as through other sense perception, that the human brain acquires its identity and perfects its exquisite neuronal circuitry.

The hand, Wilson's thoughtful book makes us realize, is the most versatile of organs. Through its agency we lift, pinch, squeeze, explore, feel, learn, discriminate, repulse, caress, aggress. We also communicate, for its gestures represent an embryonic form of speech (for the deaf, hands represent language itself); and we philosophize, since all language is symbolic. But if philosophy bores you, remember this: The quickest way to communicate frustration is manual. Just make a fist and hit the table.