School of Humanities, Murdoch University
Forthcoming in Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine vol. 1, no. 2 1997
Catherine Waldby teaches in the areas of science and technology as culture, feminist theory and theories of sexuality in the Communications and Cultural Studies program at Murdoch University in Perth, Western Australia. She has published in the areas of feminist theory, sexuality, social aspects of AIDS, and the biopolitics of medicine. Her most recent book is AIDS and the Body Politic (Routledge 1996). She is currently working on a book about the Visible Human Project, entitled Posthuman Medicine: the Visible Human Project and Informatic Bodies, forthcoming with Routledge.
This paper addresses itself to some biopolitical issues raised by the computerisation of medicine. It is now widely accepted in cultural studies and the sociology of medicine that the computer offers a conceptual model to medicine for the organisation of human bodies, and that bodies are increasingly understood as forms of digital archive. However this paper uses one recent development in medical computer imaging, the Visible Human Project, to argue that the computerisation of medicine also involves a material reorganisation of at least some bodies, a reorganisation which reveals a biopolitical hierarchy of more and less valuable bodies within the framework of high-technology medicine.
Medical technologies occupy a peculiarly ambiguous place within the history of technology. On the one hand they can be readily assimilated into the progress narratives through which western cultures tend to represent this history. That is medical technologies can be understood to offer an ever improving contribution to the quality of life, the enhancement of health and knowledge and our control over illness and death. On the other hand, medical technologies do not so readily permit simple fantasies of progressive mastery over nature made available by, say, weather satellites. Medical technologies are peculiarly intimate, in that we, our own bodies, are the material on which they operate. Within the optic of medical technology our bodies are merely matter, no different in kind to other types of matter, subject to predictable organic laws and able to be technically manipulated. Unlike other technical domains it is difficult to sustain a sense that 'we' are the masters of medical technology when 'we' are also its material objects.
It is for this reason that medical technologies can never be understood as simply tools among other tools. Rather medical technologies are better encompassed by Foucault's (1979) term, 'technologies of power', forms of rational, material practice which are indissociable from the exercise of power over embodied subjects. The effect of technologies of power is to organise and exploit the materiality of the body in the interests of both social order and the generation of certain kinds of knowledge, knowledge gained through the observation of bodies in social space, their behaviours and capacities. In this sense medical knowledge is generated through techniques of power and renders bodies available for social use.
If we think about medical technologies in this register it becomes crucial to assess their capacities to manipulate and inscribe bodies, because they tell us something about current forms of biopolitical relations, that is, the power relations which inhere in the social organisation of the bodily capacities of subjects. Changes in medical technologies constitute part of the history of the body and enter into the struggle over the meanings and productiveness of different kinds of bodies.
This paper addresses itself to a particular contemporary moment in the history of medical technologies; the ever-expanding deployment of computers in visualisation, surgery, research and data storage. The computer screen increasingly provides the frame through which bodies are seen and understood within medical practice. In what follows I want to assess some of the effects of this deployment upon current configurations of medicalised embodiment. To do so I will use a recent and startling application of computer technology to the analysis of bodies, an application known as the Visible Human Project. This project is worthy of attention because it demonstrates in an explicit fashion some of the ways that computer technology is working bodies over in its own image. While the conceptual convergence between medically conceived bodies and computers is widely acknowledged in cultural studies and the sociology of medicine and health ( for example in Haraway, 1991; Fox-Keller, 1995; Tomas, 1995) I will argue that this convergence is not only conceptual but also material, involving the literal reorganisation of the flesh.
The computerisation of medicine over the last fifteen years has transformed that field of knowledge in dramatic ways. Computerisation has touched most pedagogical, clinical and research practices. These include:
1) new forms of machine vision - the use of Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and Computed Tomography (CT)-Scans, new modes of seeing the body's interior through rendering non-visual data into visual terms on computer screens; the formulation of three dimensional patient data models based on cross sectional data; the use of computerised, interactive anatomical atlases to teach medical students and surgical simulation programs which allow surgeons and researchers to 'fly through' and interact with a virtual model on the screen.
2) New forms of surgery where computers can be used to set laser beams to finely calibrated co-ordinates.
3) the use of computer screens and the internet to practice clinical and surgical telemedicine, the transmission back and forth of visual, aural and haptic data between patient and physician in separate locations.
4) the increasing use of virtual modelling as in itself a form of medical research, where the model is the experimental object.
5) the storage of huge amounts of data generated in research into DNA structure and the development of on-line archives like GenBank and the Genome Sequence Data Base. (Waldrop, 1995).
These are only a small sample of the ways that all domains of medicine, in the clinic, the surgery, the hospital and the laboratory, have embraced the visualising and analytic capacities of the computer to enhance existing medical practices. This proliferation of computerisation is of course not limited to medicine but rather characterises all aspects of professional and commercial activity and personal life. As Bolter (1989) points out, the computer is such a useful technology precisely because it can be grafted onto existing forms of technology in virtually any domain and used to reorganise them, acting as a command-control system.
Within the medical profession, as elsewhere, this adoption of the computer is generally understood in instrumental, rational terms, an extension of the understanding of computer space as simply another Euclidean space, 'the master-space of Western work-oriented cultures...the space of Western geometry: the geometry of vision, the road, the building, and the machine' (Tomas 1994: 34). The computer space is another rational medical space in which the rational ordering of the material body can be pictured and analysed. New technologies that can be used in this process tend to be represented in progressive terms, qualitative improvements in the ability of medicine to see, measure and represent the 'thing itself' the naturally given organic body. For example, the move from two dimensional, static photographic images of the body used in traditional anatomical texts to three dimensional, dynamic, virtual images are understood as gains in information (Ackerman, 1992) and verisimilitude, the better approximation of the body itself.
This rational, instrumental understanding fails to appreciate much more profound transformations involved in the relationship between medicine and the computer. My argument is that the computer, understood not as tool but as cybernetic philosophy and praxis, is not a better mirror for a pre-existing, natural body but rather participates in an historical transformation of bodies, which is taking place through the discourse of medicine and other social sites1
Rather than providing a mirror for the body the computer has become, over the last forty years or so, the technology which enframes the medical body, the means through which it is re-presented and re-ordered within the terms of biomedical discourse. I am using Heidegger's (1977) term 'enframe' (gestell) here, a term which moves beyond the meaning of the term 'to frame', to passively situate an object within a particular optical field, in this case the computer screen, and takes on a more active and specific sense. 'Enframing' involves the technological production of particular forms of image, a process of representation which is not neutral but which carries particular meanings and consequences within itself, presenting the world to the viewer in a particular way. Heidegger understands technological enframing to involve the representation of the world as essentially mathematical, an ordered entity that is available for technological intervention and appropriation. As an enframing technology the computer sets out the terms in which the body is to be understood, rather than transparently reflecting it in its organic givenness.
This is evident in the way that the computer has becoming the 'defining technology' (Bolter, 1989) for the medical model of the body, providing the primary metaphor through which the organisation of the body is conceived, as well as the instrument through which the body is envisaged. In computerised forms of vision the body is pictured as digital data, that is as an image produced through a mathematical structure of data. This way of seeing works recursively to shore up medicine's growing tendency to understand the body's composition as an archive of DNA 'data' which can be stored, retrieved, and rewritten, or as a system of communication where organism coherence is maintained through the exchange of information (Haraway, 1991). The process of life itself is understood as data, encoded instructions for the ordering of proteins which can be transmitted from the older to the younger generation. Death is, correlatively, a failure of information and diseases like AIDS proceed through viral 'reprogramming' of the body's immune system. The conceptual groundwork for this metaphor precedes the widespread use of computers in medicine, which dates from the early 1980s, gathering momentum throughout the twentieth century, and gaining enormous impetus from the development of the theory of cybernetics in mid-century. As Fox-Keller (1995) argues, the development of models of the organism as data, and the development of the computer were tightly harnessed together from that point onwards.
The computer is then, a defining technology for medicine not because of its instrumental proliferation but because the idea of the computer, of an active and interactive complex system of information processing and exchange, has reconfigured the idea of the body. As the primary metaphor for the working of the medically imagined body the computer offers an attractively complex, yet nevertheless circumscribed and comprehensible mathematically based model, which also does the work of making the body and the computer seem to be conceptually compatible, hastening the further computerisation of the medical domain.
However it is important to realise that the medical computer's relations with human bodies is not purely metaphorical and conceptual, but rather extends into practices of material inscription and reordering which work directly onto the bodies, intervening in them in new and profound ways. Medical technologies exercise a certain kind of violence upon the bodies of their subjects, a material transgression which is implied in the idea of 'enframing'. Heidegger (1977) understands the technological enframing of an object as a mode of representation concerned above all to make it appear as a potential use value, an object which can be analysed into component parts as a preliminary to technical intervention and appropriation. To be enframed by technological modes of vision implies that the object has become a target for some kind of material alteration designed to technically 'enhance' its functioning in specific ways.
This point is forcibly demonstrated by Cartwright (1995) in her work on medical imaging technologies and the disciplining of the body. Cartwright demonstrates the extent to which techniques for studying the body's physiology, for example, are only possible with the material alteration of the body studied. Medical practice does not merely study the body, it alters it in ways that suit its purposes. Commenting on laboratory practices in microscopy, she writes that the microscope,
[does not] simply represent nor regulate nature, the organic body...[it is a] privileged mode for generating new configurations of life and subjectivity that conform to the instrument. Forms of life that conform in advance to the conventions of microscopy are favoured as test objects. And when living matter does not readily conform to these conventions it is restructured to suit the means of study (Cartwright, 1995: 90).
Such material interventions are defining features of medical technologies, whose raison d'etre is to provoke alterations in living bodies, in the cause of either experimental or therapeutic ends. Medical technologies are concerned with the inculcation of medical norms in bodies, the therapeutic correction of that which is deemed excessive or deficient in the body's processes (Canguilhem, 1989). However norms are not simply objectively determined values of bodily well-being but are, Cartwright (1995) suggests, to some extent determined by the limitations and demands of medical technologies themselves.
Cartwright makes this point through a number of accounts of medical practice, particularly accounts of the laboratory methods which are used to normalise the body of the research object, both animal and human, according to the dictates and limitations of the instruments used to study them. This normalisation involves technical interventions - the surgical insertion of a viewer 'window' into the body of a rabbit which can be used to film the circulation of its blood, for example - so that the test object is always a technically augmented and altered object, never merely a natural, 'found' object. It is only after this prosthetisation takes place that some productive relation can be set up between organic body to be studied and technology with which it is to be studied. Bodies and body parts are made over in the interests of the machine.
This technical normalisation of the body can, with certain 'defining technologies,' also restage the metaphoric relation between technology and body, not only as a conceptual compatibility but also as a model for material alteration. The medicalised body is not merely rendered compatible with the capacities and limitations of a technology, it is made over in the image of that technology. In this way the body is materially and conceptually assimilated to the technology of which it is the object.
It is in this complex, reciprocal, material and conceptual relation that medical technologies rework, prostheticise and normalise the bodies that they study and treat. Shifts in forms of technology precipitate important changes in these processes, and the subjective experience of the body which is the everyday lived experience of the biopolitical realm. The move to computers as the organising technology of medicine necessarily involves just such a change. The computer brings into being new ways to instrumentalise the body, new ways to work it and analyse it, while at the same time disciplining it in order to render it compatible with its own systems and ways of seeing. Any attempt to generalise too far about the effects generated by the computerisation of medicine seem doomed to failure however, due precisely to the highly varied nature of the computers applications in the field of medicine. Particular applications demand particular studies. Nevertheless the Visible Human Project is, as I claimed earlier, highly suggestive of some more general biopolitical effects generated by the ever intensifying 'convergence' between body and computer which has been taking place over the last forty years.
The Visible Human Project (VHP) is a recent innovation in computerised medical vision developed by researchers at the National Library of Medicine (NLM) in Baltimore, USA, which, in effect, takes actual human bodies and renders them as visual digital data. It represents the most recent and thorough attempt to enframe the body within the logic of the computer.
The VHP moves anatomy, the medical representation of the body's structure, out of two-dimensional text based media and into the three dimensional medium of digital reproduction on the screen. In 1988 a consortium of US based academic medical centres called upon the NLM to turn its attention to the growing centrality of computer based three dimensional imaging techniques in medical practice.
Each of the University groups presented an overview of the types of activities at its own centre. ..it became clear that the power, graphic display capabilities, and affordability of current computers are sufficient for many educational and research applications in 3-D anatomical imaging, and that there are unique merits to images rendered from digitised anatomic databases. The most dramatic of these is the ability to isolate, highlight, 'reversibly dissect', rotate, and view from multiple angles single and grouped tissues, organs, body regions, and physiological systems. (Ackerman, 1992: 367).
While computer imaging was already in extensive use at that time, the consortium was concerned that no standardised digital anatomical 'atlas' was available to serve as a reference point for the proliferating range of medical practices which utilised such imaging. Anatomical texts serve the function of standardised reference points, representations of normal anatomy against which individual pathology can be measured 3. For a detailed argument about the normalising operations of anatomical texts see Waldby (1996a).
The group made a recommendation to the NLM that it '[support] the development of an image data set of an entire human male and female'(Ackerman 1992: 367).
This recommendation marked the beginning of the Project, a quest to create digital image 'atlases' of entire human bodies which could be manipulated in the space of the computer screen. These atlases were to be, like all anatomical atlases, not merely displays of the body's surface morphology but also representations of the body's interior, a project to precisely make that interior 'visible'.
As the request of the consortium indicates, the VHP was intended , among other functions3, to assist in the interpretation of existing and developing forms of computerised vision of the body's interior. Part of the drive to computerisation in medicine arises because of the computer's abilities to render all information as visual data. It can thus be used to convert a wide variety of electromagnetic, sonographic and radiation-based techniques into ways of 'seeing' aspects of the corporeal interior. The most commonly used forms of computer vision are computed tomography (CT-scan) and magnetic resonance imaging (MRI), both techniques which rely on this visualising ability. CT scans are based on the technique of the X-ray, but rather than providing a 'shot' from just one angle, as conventional radiography does, the scan uses a thin beam which rotates around the entire body and takes a 'slice' right through a cross section of the body. The radiological information, instead of being developed on a photographic medium as with radiography, is translated into digital data which is then translated into visual data on a video screen, displaying a colour coded and enhanced cross section of the body. MRI is an electro-magnetic technique which surrounds the body with a powerful magnet which affects the alignment of hydrogen atoms in the body in such a way that they emit a small electric current. A computer translates this current into an image of the area scanned (Sochurek, 1987).
These are only two of a battery of relatively recent forms of computer vision used within medicine. Others include digital subtraction angiography, radioisotope imaging, sonography, and positron emission tomography. Each of these techniques anatomise the body in a particular way. The CT scan produces a detailed colour enhanced cross sectional image, good for the imaging of small bones and soft tissue, while MRI produces ghostly, aqueous images which do not register bone and hence are useful for seeing tissue like the spinal cord within the spinal column (Sochurek, 1987). Furthermore several of these imaging methods are designed to eliminate certain kinds of unwanted detail from the image, either through the registration of a contrast agent injected into the body, or as with CT scans the elimination of all information outside the 1 millimetre depth of the scan.
Each of these imaging methods has specific clinical uses, but they also foreground the extent to which they can only be produced through extensive amounts of technical mediation. The price paid by transparency technologies is that they cannot image the body's interior as it might look to a classical anatomist dissecting a corpse. They cannot simply see the 'thing in itself' and their use in surgery or clinical settings present multiple problems of interpretation before they can be applied to particular human bodies.
The technique of the VHP is designed to overcome this necessity for interpretation, to generate an imagery of the body's interior which dispenses with a sense of mediated vision, yet which can still be used as a benchmark in relation to other forms of computerised vision. In order to do this however it must literally cut open the body, make its interior amenable to light spectra and the technology of (now digitalised) photography, so that images produced seem 'natural' to our eyes. It does this through a microsectioning of the body, a cutting into very fine cross sectional segments. The technique involves first of all freezing the bodies in gel at about -70C, as soon after death as possible. Once frozen the bodies are fitted into a laser dissection device called a cryomacrotome, which planes the body at very fine intervals, between 1 and .3 mms, transversely from head to foot. After each planing the cross section of the body is digitally photographed, so that each photograph registers a small move through the body's mass. This technique effectively obliterates the body's mass, each planed section dissolving into sawdust due to its extreme desiccation.
Each digital image of the slices forms a separate data file, which is registered so that its position in the overall taxonomy is known. Thus the total images of the body can be stored as a complete archive, in which each file is specified in relation to all the others, a methodical visual taxonomy which records the body's volume in digital form. The files can be viewed one by one, showing highly resolved transverse cross-sections through the body [ figure 1]. More importantly they can be restacked, so that the appearance of volume and solidity is restored to the virtual body [figure 2]. This restacking capacity enables unlimited manipulation of the virtual corpse. As one commentator describes it,
The ...data set allows [the body] to be taken apart and put back together. Organs can be isolated, dissected, orbited; sheets of muscle and layers of fat and skin can lift away; and bone structures can offer landmarks for a new kind of leisurely touring (Ellison, 1995: 24).
Blood vessels can be isolated and tracked through virtual space, and the body can be opened out in any direction, viewed from any angle and at any level of corporeal depth. The virtual corpse can also be animated and programmed for interactive simulations of trauma, of human movement, and of surgery, to mention a few of its proposed uses.
Hence the images produced by the VHP seem unmediated. They have the documentary realism of photographic aesthetics at their disposal, the realistic colour of anatomical photography as opposed to the purely conventional colour-coding found in CT scans for example, colour which is all too clearly an aide to the eye and nothing else. Unlike tomography images these images are inclusive, no feature of tissue or bone is selectively forgrounded. They look like the 'real thing', the way a body would look if sliced into across its breadth. Once restacked the slices can be reformulated into the simulacrum of a whole body, a body which looks opaque and self-enclosed but which can be opened out at will in any way desired, to any depth, and then re-enclosed, completely at the disposal of vision.
The VHP is a dramatic example of the ways in which bodies are worked over in the interests of technological frames of reference, treated as objects within a technological optic. We can see that the VHP is a visual text produced by literally reworking the body's materiality according to the logics of computer storage and computer vision.
This is evident first of all in the way that the VHP converts the body's volume and density, its material coherence and self-enclosure into a series of archivable planes. As material opaque volume it is resistant to computerisation but as a series of flat cross-sections it can be both serially visualised and 'stored'. The body is exhaustively taxonomised in files, the flesh serially sliced so that each paper thin move through the body's volume constitutes a separate file. This archival trope is found in other technologies that assimilate the body to the computer, particularly in the Human Genome Project, an attempt within molecular biology to exhaustively sequence all genetic data within the human genome. As Marchessault (1996) points out, contemporary molecular biology conceives of the human body as itself an archive, a mode of storage for a vast yet limited set of genetic information. She writes,
Unlike the body of Frankenstein's [monster] constructed out of recycled parts that never add up to a seamless whole, genetics conceives of the body in bits as an archive of interconnected codes to be deciphered. The Human Genome Project in the US and its international counterpart the Human Genome Organisation involves the scientific community around the globe in piecing together a genetic map of the human body...The DNA body is not simply a book but a library of information whose textual production extends backwards to the origins and totality of creation (Marchessault, 1996: 121).
The treatment of the body as an archive of DNA information in the Human Genome Project involves the recording of gene sequence data for each gene in the human body, an enterprise which has produced over 200 million base pairs to date (Kevles and Hood 1992). The production of this archive is, like the production of the VHP visual archive of the body, indissociable from the archival capacities of the computer technology which furnishes both model and instrument for these enterprises. That is the sequencing of the human genome, and that of other species, is only possible and usable because of the storage, retrieval, and cross-linking capabilities of the large computers which are used by the scientific community to record their findings (Waldorp 1995). In the same way the VHP is only possible because of the advent of super-computers. It detailed visual data files are very large, so that the VHP male comprises about 30 gigabytes, a volume of data only able to be handled by recent computers. Here it is evident that the computer is both the instrumental frame for this idea of the body, and its primary trope.
By making the body conform to the spatiality of the file the VHP enables the body data to be manipulated in the space of the screen in particular ways which are specific to the simulational capacities of the computer. Because the files are registered with regard to their position in the whole body schema, they can, as was described earlier, be reformed to make a totalised image of the body. This totalised image gives an impression of solidity and depth but because it is constituted in the first instance by methodically cutting and moving through the body's volume it enables the viewer, with the right software, to 'fly-thru' the body's interior as if through, or above, a landscape. In a more prosaic mode it enables the viewer to carry out reversible dissections, cutting into the body in any way and then reformulating the image's integrity, overcoming the non-reversibility which characterises material medical practice on bodies.
The second way in which the VHP makes the body's materiality over in the image of the computer is its transformation of flesh into data, rather than into the text based media of photography or line diagram used in anatomical text books. By moving from the continuous, analog realm of the book into the discreet, digital realm of the computer, the VHP produces a visual text of the body which is also a structure of mathematical data, digital code. As Marchessault (1996) observes, medicine has sought since the nineteenth century to render the body in mathematical terms, an attempt which since the advent of cybernetics after world war two has been assimilated into the cybernetic notion of code, an idea of information which is purely quantifiable, having no concern for the meaning of what is coded (Fox-Keller 1995: 82). Again an equivalence can be found in the Human Genome Project and other domains of genetics which seek to exhaustively translate the body's fleshly organisation into sequences of code. As digital code the VHP partakes of all the qualities specific to virtual objects - it can be flawlessly and endlessly replicated without loss of information, it can be manipulated, subdivided and scaled to any extent, it can be transmitted on the internet, thus making it a highly useful object of international medical collaboration and distribution. For more on this point see Waldby (1996b)..
The third way the VHP makes the body a computer compatible text is by rendering it according to the spatiality favoured in the CT-scan. As was described earlier, the CT-scan works by imaging a 1 millimetre 'slice' of the body using radiation, and the images produced by CT-scan are a series of such slices which move gradually through the body's length. The VHP effectively substitutes a material incision for the radiation 'incision' used by the CT-scan. Like the VHP these 'slices of life' can also be restacked to provide as three dimensional image of sections of the patient's body. Hence the VHP can be seen to materially cut up the corpse according to the spatial logic of the CT-Scan file, a mapping procedure which allows the photographic 'real' quality of the VHP images to be readily used in the interpretation of the scan data.
Here the VHP can be seen to enact Heidegger's (1977) propositions about technological ways of seeing. While seeming to replicate the analog, material and qualitative aspects of the body represented, the VHP is a purely mathematical object, an data set, able to be manipulated and formed into economies and equivalence in ways which material objects cannot. At the same time, as a text of 'normal' anatomy it can act as a map for intervention into material bodies.
Most forms of computer imaging can readily be described in the progressive terms alluded to at the outset of this article. Sochurek (1987) in his article 'Medicine's New Vision' for National Geographic, writes, for example,
Changing the face of medicine, a new breed of imaging devices enables doctors to watch vital organs at work, identify blockages and growths, and even detect warning signs of diseases not yet present - all without exploratory surgery (Sochurek, 1987: 2).
The beneficence of computer imaging derives, according to Sochurek, from its ability to see into the body without touching it, to envision it without the material transgression involved in surgery. It is not however true to say that the techniques of computer imaging leave the body untouched. The condition of their visual access to the body's interior is precisely the introduction of some change into the body, 'shooting' it with X-rays, injecting it with radioactive substances, changing its magnetic field, and so on, as I described earlier. In other words the body has to be 'touched' or transgressed in some way so that it can be envisaged.
These material alterations are necessary in order for the body's interior to be imaged as a useful, digitised trace, a trace which is amenable to manipulation by computer. I am using the term 'trace' in Latour's (1990) sense, to mean a particular form of abstract, scientific representation which summarises a material phenomenon in a systematic and recognisable way, a kind of map which designates an absent, possibly lost, object and which acts as its surrogate. In medicine the gathering and ordering of traces is necessary before diagnosis can be made, and in the case of computerised visual traces, is a way to make decisions about the necessity or otherwise of surgery, and to plan the trajectory of such surgery. Hence the material transgression of bodies involved in computer imaging is one designed to preserve it from a greater transgression, that of unnecessary or inappropriate surgery. This move from a greater to a lesser transgression lends itself readily to progress narratives, part of medicine's heroic attempt to preserve the integrity of the body.
However the VHP, also a kind of computer imaging, plays out the violence of bodily transgression disavowed in the rhetoric of computerised vision, and in the process makes some of the bio-political issues involved in the use of high-end visualising technologies more visible. It inverts the logic of preservation of the body's integrity, involving as it does the exercise of extraordinary violence on the body anatomised, its material effacement in an act of spectacular medical mastery. As Alan Sekula, in his article about the formation of photographic police archives during the nineteenth century The Body in the Archive, points out, the rendering of bodies as traces may have not only an epistemological but also a political function. Writing of the system of photographic identification of criminals created by the french police, he states,
For [the police] the mastery of the criminal body necessitated a massive campaign of inscription, a transformation of the body's signs into text...Thus [they] arrested the criminal body, determined its identity as a body that had already been defined as criminal (Sekula, 1986: 33).
Rendering bodies as traces involves not only a technical but also, at least potentially, a political form of mastery, as Sekula puts it a kind of 'arrest'. My point here is that the material transgression involved in rendering bodies as traces can readily become implicated in power relations of various kinds, and the violence involved in this transgression cannot be reliably separated out from other, social kinds of violence.
In the case of the VHP a configuration of biopolitical relations can be detected in the distinction between whose body is being sacrificed in order to render it as trace, and whose bodies will be preserved and enhanced by the existence of this new imaging method. What kind of body can be legitimately cast as the object of such violence? Within the history of anatomy the answer to this question has been found in the bodies of the 'worthless' -the poor, orphans, the insane, foundlings, suicides and above all in the body of the criminal, deemed, as Sekula suggests above, to be in need of textual 'arrest' and punishment, but whose sacrifice to medical knowledge confers a posthumous redemption (Sawday, 1995).
The Visible Human Project found a similar answer to this question. The first body to be microsectioned, digitised and made available on the internet is that of a criminal. In 1993 a 39 year old white male prisoner in a Texas prison, one Joseph Jernigan, was executed by lethal injection for a murder he had committed some twelve years earlier. He had, prior to his execution, signed a consent form donating his body to science, thus making his corpse available to those various medical institutions which use body parts for organ transplants and medical school dissections. Jernigan's body could not be used to harvest organs due to poisoning, but his cadaver met all of the specifications of the Denver search team, and his institutionalised death ensured that his corpse could be processed very quickly after the moment of death. Jernigan became the first subject to be imaged for the Visible Human Project. Cross sections of his body can be viewed on the Web, or the entire data set which has been extracted from his body can be downloaded through the internet.
Jernigan thus joined a centuries old fraternity of male criminals whose bodies have served as pre-texts for the production of medicine's anatomical texts. In doing so he is also assimilated into an economy of biopolitical worth which operates implicitly within medicine. Certain kinds of bodies are legitimate sacrifices in the production of knowledge, knowledge which can be used to intensify the life force of others. As Sawday (1995) puts it,
In medicine anatomisation takes place so that, in lieu of a formally complete 'body', a new 'body' of knowledge and understanding can be created. As the physical body is fragmented, so the body of understanding is held to be shaped and formed. In medicine, too, anatomisation takes place in order that the integrity and health of other bodies can be preserved. The anatomist, then, is the person who has reduced one body in order to understand its morphology, and thus to preserve morphology at a later date, in other bodies, elsewhere (Sawday, 1995:2).
Jernigan's body is rendered as digital trace to act as a globally available norm against which other kinds of digital medical imaging can be measured and interpreted. However the VHP is produced through the abolition of bodily integrity, while these other methods of medical imaging are designed precisely to maximise the preservation of the integrity of the body's imaged, to preserve them against exploratory surgery and ensure that any surgery performed will be accurately planned, processes which will be greatly assisted by the VHP data. As Sawday points out, one body has been sacrificed to preserve others, elsewhere. The development of medical technologies has often involved a similar sacrifice of bodies, as the history of medical use of X-rays attests (Cartwright, 1995). It is precisely because 'non-invasive' modes of medical vision must always alter the body's material organisation as a condition of seeing the interior that they are all potentially dangerous, and each requires processes of standardisation and experimentation to make them safe which may involve risk to human subjects. In other words the capacity of benign enhancement made available by imaging technologies is often bought at the expense of a prior or supplementary violence, a relationship clearly demonstrated by the VHP.
There are, furthermore, other ways in which computerised forms of vision and the material enhancements they can provide are caught up in hierarchies of bodily value. After all, not all bodies have equal access to computerised medical vision, not all bodies can be pictured within the terms of the high technology biomedical body politic. For a development of the idea that medical visualising technologies constitute a body politic see Cartwright (1995).. The benefits of computerised medicine are restricted to a relatively small number of valuable bodies, white, urban, middle class bodies in the industrial democracies, while other kinds of bodies are excluded from these modes of visualisation by the cost of their development and use. The sacrifice of Jernigan's body serves to remind us that only bodies deemed already valuable have the right to the bodily enhancements made available through computerised medicine.
This research was made possible by a special research grant from the School of Humanities, Murdoch University. The author would like to thank Thomas Schiemann and the staff at the Institute for Mathematics and Computer Science in Medicine at the University Hospital Eppendorf, Hamburg for their generosity in demonstrating the Visible Human Project to me.
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1. Hayles (1993) argues that a new normative body is being generated in informatic culture, a body which can live itself as code. This normativity emerges at all points where bodies and computers come into relation, within medical practice but also in the workplace, the home computer, and so on. For a more personal account of this process see Lupton (1995).
2. The consortium listed possible uses as: the study of anatomy by health professions students; patient education; normal reference for interpretation of diagnostic images; treatment planning; trauma modelling; prosthesis design; reference for normal growth and development; research data sets and forensic medicine (Ackerman 1992).
New: 3 July, 1997 | Now: 11 May, 2015