Biomedicine on Display

What role do the senses have in contemporary medicine and how can museums that wish to exhibit the material and visual world of biomedicine make use of sensorial approaches? These are questions that touch upon epistemological and phenomenological questions as well as matters of display and pedagogy. In order to find intellectual inspiration and sharpen our sensibility for biomedical objects, Thomas and I are attending the Five Senses in the Enlightenment conference, which will be held at the Eighteenth Century Centre, University of Birmingham, 17-18 May. As is generally regarded, the Enlightenment was a period in which the senses were given great prominence. Philosophers like John Locke and the abbé Condillac, made sensorial evidence the foundation of knowledge and experience. The sense experience of everyday life was also the core theme in the paintings of Jean-Baptiste Chardin. These examples may indeed seem historically and thematically remote from the molecular, intangible and highly mediated realm of biomedical research and practice. Nevertheless, we still think that a bit of anachronistic juxtaposition can generate questions and ideas of interest to both ourselves and scholars of eighteenth-century history. We therefore thank the organizers of this conference for letting us participate with a paper. The abstract follows here below.

Condillac’s statue re-awakened
Contemporary medical museums are steering a course between what Gumbrecht (2004) calls ’meaning-culture’ and ’presence-culture’, respectively. As curators of the recent medical heritage, including molecular an translational medicine, we wish to display historical artefacts by contextualising and attributing meaning to them; on the other hand we also wish to display them in a way that enhances their immediate presence-effects: interpretation and sensory appearance thus complement each other. To qualify our understanding of the sensory relation between museum visitors and medical artefacts, we are—in a shamelessly non-historicist fashion—turning to 18th century ideas of the senses to cultivate our own curatorial sensibilities (sic!). In Traité des sensations (1754), Condillac illustrates his post-Lockean theory of the senses with the image of a marble statue, which gains knowledge about the exterior world by way of gradual revelation of sensory input. While the sensations of smell, taste, sound and colours, endow the statue with a sense of being, it is only through touching that the statue becomes certain of external objects. If Condillac’s statue were to re-awake from its solipsistic isolation by gradual exposure to the world of contemporary biomedicine and biotechnology, what kind of sensations would it come across? Would it still find certainty in the sense of touch? Unlike the sensations that provided the Enlightenment philosophers with arguments, biomedical objects are not generally
commonsensical. However, despite their intrinsic molecular, digital and intangible structure, they’re not wholly indiscernible either. If airport security allows us, we will try to bring some artefacts to illustrate a 18th and an early 21st century Condillacean statue.

The third Surveillance & Society conference will be held at the Centre for Criminological Research, University of Sheffield, 2nd to 3rd of April 2008. The conference will focus on everyday experiences of surveillance and feature keynote speakers Zygmunt Bauman, David Lyon and John McGrath. As announced on the conference homepage, participants are encouraged to present empirical case studies that document our everyday exposure to the networks of postpanoptic surveillance society, particularly the different technologies and administrative regimes that make us visible in partial and not necessarily oppressive ways.

Susanne and I are giving a joint presentation on the topic of distributed surveillance and digital registries in non-invasive medicine and health policy today. This is an excellent opportunity to get into the anthology co-writing mood, i.e. Curating Biomedicine, which is our current in house project at Medical Museion. Here is our abstract for the forthcoming conference:

Distributed surveillance in biomedicine: Individual bodies and populations as digital registries
This paper addresses the digitisation of biomedicine by exploring recent modes of distributed surveillance. It presents two case studies – 1) on the digital transformation and the data surveillance of the clinical body, and 2) on the production of population data in large scale, sometimes nationwide medical data collecting and tracking projects and on how they transform clinical decision-making. Together these cases illustrate the post-panoptic view of the body in biomedicine, from the patient to the population.
The emergence of non-invasive or minimal invasive techniques in clinical medicine is highly dependent on electro-optical systems and digital networks. Through the use of powerful scanners and miniaturized cameras, bodies undergoing clinical treatment, are spatially disrupted and transformed into electronic sites, which are distributed and monitored inside hospitals as well as outside. The promise of non-invasive, non-painful, almost non-sensible cures has won considerable recognition among patients. However, as much as these techniques tend to minimize the need for larger incisions and painful examinations, they build on an extensive registration of the body, as if distributed surveillance was a counterpart of non-invasive medicine.
Digital databases containing health data of patient populations or the general population constitute another form of distributed surveillance. As flexible ‘surveillant assemblages’, they are continuously monitored for the purpose of health policy. They play a key role in the social management of disease and in prevention, in clinical decision-making of evidence-based medicine. While on the one hand these studies are used for the governance of populations in the tradition of surveillance medicine, individuals take up health statistics in order to make sense of their own bodies; for instance using web-based risk assessment tools. In distributed surveillance, the ‘imaginary of surveillant control’ of governance might be complemented by an ‘imaginary of participation’.

Medical Museion has recently acquired four different models of the wireless capsule endoscope, more commonly known as the pill camera. Shortly after its announcement in 2000, capsule endoscopy was introduced in clinical medicine as a non-invasive technique for visualizing the gastrointestinal tract. Instead of having a flexible endoscope inserted through the mouth or the rectum, the patient swallows the capsule endoscope, which measures about 26 mm in length, 11 mm in diameter, weighs 3.7 grams and is equipped with lens, image sensor, transmitter and batteries.

As it makes its way through the alimentary canal, the capsule endoscope takes up to 14 images per second, approximately 60.000 images all in all. The images are first transmitted to a portable receiver attached to the patient’s waist. They are then downloaded on a computer and processed into an endoscopic film, which is analyzed with the aid of special software.

Miniaturization and digitization are characteristic features of this new diagnostic technique. So is mediation. Besides its clinical recognition, capsule endoscopy has aroused extramural curiosity for its science fiction-like connections to popular culture and high-tech research. Whereas the 1966 motion picture Fantastic Voyage, depicting a manned submarine shrunk to microscopic size and injected into the blood vessels of an unconscious scientist, constitutes a point of historical reference, scientific reports on microrobots, which will travel through the cerebral spinal fluid, underline the futuristic aspects of the pillcamera. Nevertheless, for a miniaturized, digitized and disembodied technology of vision, the pill camera certainly provokes gory reactions. On Youtube it is turned into a spectacle, an electronic simulacrum of the messy body, repelling yet at the same time highly controlled. The capsule endoscope has been developed by the Israelian/North American company Given Imaging. These particular models have been generously given to Medical Museion by gastroenterologist Ervin Toth, head of the Endoscopy Unit, University Hospital Malmö, Sweden.

Thomas and I have written this abstract for the “Sculpture and Touch” symposium to be held at the Courtauld Art Institute, London, 16-17 May next year (see earlier post here).

Due to the profound impact of vision on modern Western culture, the history of medicine has mostly been conceived in ocular terms. This is true both for medical historiography and the way that medical collections, no matter how object dominated, are exhibited in museums. However, given the crucial role of touch in medical practice as well as the abundance of three-dimensional objects in medical museum collections, the emphasis on the visual neglects an essential aspect of medical history and medical objects.

In this paper, we will focus on the tactile dimensions of medicine as manifested in medical museum collections. Whereas many of these objects are visually evocative, they were made, or preserved, to fulfil other purposes then the pure visual. Even objects intended for the enhancement of vision, bear witness through their very forms and materials, of a sculptural function that had to do as much with the sense of touch. The question is of course, whether this lost sensorial dimension can be brought back into historiographical and museological awareness without taking recourse into metaphors and representation. If only indirectly, medical objects do tell us something about the role that touch had in different historical periods. Besides giving concrete examples of such objects, we will suggest ways in which the sense of touch can be employed to reinvent curatorial and display practices in museums. We will also suggest how current theoretical reflections such as “production of presence” and “haptic vision” can be used to approach the history of medicine through the sense of touch.

All critical responses are welcome — to jan-eric.olsen@mm.ku.dk

Our panel proposal for next years SLSA conference, “Figurations of Knowledge”, which will be held in Berlin from the 2nd to the 8th of June, has been accepted. Here follows our general outline and individual abstracts.

Recent biomedicine and vitality
This panel addresses different emergences of ‘vitality’ in recent biomedicine. It brings together diverse case studies – from embryonic practices between clinical waste and ‘personhood’, laboratory animals to preventive risk assessment software and medical simulations. Recent biomedicine is a key contemporary site in which boundaries of life and death are negotiated. While ‘health’ has been construed in opposition to ‘disease’, in recent biomedicine these categories have become less and less clear. Depending on practices, the same fetal material can be enacted with different meanings, biomedical objects are more often rather multiples than clear categories. Engineered laboratory animals are endowed with vitality and designed to mimick the human body for research purposes. In preventive medicine, health and disease are located on a continuum, where preventive risk management is used to treat symptomless risk factors. In medical simulations the signs of health and disease are recast in software and borrow much of their plots from the game industry. This rematerialization of the life/death tension, does not only entail a new aesthetic perception of the vital body. Framed in the pedagogy of simulation, the issue of vitality is presented as something that is performed and therefore, following the logics of games, open in its outcome.

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Pillcam chic

Whether one has undergone a gastrointestinal examination or not, most of us would agree that there’s nothing particularly cool about having your stomach examined by means of long tubes. Rather, we tend to find such exams unpleasant, distressing and embarrassing, not to mention what we think of the close-ups of our exposed bowels. However, thanks to capsule endoscopy, gastroenterology may be on the verge of becoming hip. At least that’s the message behind this advertising video for the next generation of pill cameras. Catchy disco, smart graphics and laid-back instructions, makes it hard to believe that the pill camera actually is modelled on the missile technology that was used in the Persian Gulf War. Okay, it’s plain to see that images of flying missiles and ruined cities won’t promote medical technology. But it’s just as evident that all the fleshy parts – malignant outgrowths, inner bleedings, inflammations etc. – have been deliberately left out. In this slick version, capsule endoscopy is presented as a lifestyle product, something to go along with your new espresso machine, flat screen or other wearable computing.

A notice in the September issue of the Economist, reminds us of the impact of biotechnology on contemporary culture. With the global spread of genetic information and steadily falling prices on computers and other hardware devices, biotech is finding new user groups among biology graduates and computer aficionados who turn their living rooms into veritable dry labs and carry out experiments in silico. Basic biotechnological aid is already out there on the web, check websites like www.dnahack.com, and magazines such as Biotech Hobbyist, report on amateur attempts at creating skin-tissue cultures and cloning trees. Seen from a historical viewpoint, the emergence of biotech hobbyists is not surprising. As the amalgamation of two revolutions, the scientific and the industrial, once gave rise to amateur scientists in redingotes, toy steam engines and chemistry chests, so is the networked society and biomedicine, providing amateurs with the means to conduct biotechnical investigations on their own. Hobby anatomists are already dissecting the human body virtually and kids can map the DNA in the form of games such as Discovery DNA Explorer. What will come next? Toy PET-scanners, the teeny-weeny laparoscope or the youngsters portable biobank?

Our session proposal “Scientific Visualisations in Disturbance” for the above conference has been accepted. Here are the abstracts.
Session organisers: Susanne Bauer, Christine Hanke, Jan Eric Olsén
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The so called I-space is a virtual reality system for clinical and research applications. It's a physical room where three-dimensional models can be performed so that one can almost literally enter the heart or, as seen in the picture, the human genome. The I-space has recently been installed at the Erasmus Medical Center in Rotterdam. See http://www.erasmusmc.nl/bioinformatics/home/index.php?content=virtual

Last Friday, the 10th of February, I and some other forty curious spectators, gathered at the Institute of Contemporary Arts, London, to witness the artist Phillip Warnell swallow a pill camera and discuss the view of his belly with consultant gastroenterologist Dr. Simon Anderson.

The event took place between 3.00pm and 8.00pm, which was approximately the time needed for the pill camera to make its way through Warnell’s digestive tract and transmit images, via sensors attached to the artist’s body, to a computer which downloaded them for us to see on a screen. While waiting for the pill camera to do its job, curator Lisa Le Feuvre led us through a series of papers given by historian of science Bettyann Holtzmann Kevles, marine biologist Anne-Sophie Cussatlegras and cultural theorist Ric Allsopp. Film clips were also shown, for example of The Man with the X-Ray Eyes, and a practical demonstration of the phenomenon of bioluminescence – glass tubes containing luminous marine organisms – provided a congenial complement to the sight of Warnell’s pinkish intestines.

The event, which revolved around Warnell’s performance titled Endo/Ecto, gave rise to a number of interesting topics such as the role of self-experimentation in science, the collaboration between art and science, the wish to make the opaque body transparent, visibility and invisibility, material and immaterial representations of the body and technology versus living organisms. Whereas self-experimentation has a genuine place in the history of science – a history which both includes heroes such as the German surgeon and laureate Werner Forsmann, known for his self-experimentation with cardiac catheterization in 1929, and stereotypes like the protagonist in The Man with the X-Ray Eyes, dropping X-ray tincture into his own eyes – artists making use of their own bodies are of a more recent date. Although Warnell’s interdisciplinary art is very much in tune with issues concerning the significance of mediated images in postmodern society, his method, as suggested by Bettyann Kevles, has more in common with scientists who pursue knowledge by way of self-experimentation. Certainly, the quest for unrefutable truth isn’t Warnells. Still, his performance evokes uncertain feelings towards the body, usually associated with questions of medical, scientific and ethical nature.

Besides blurring the borders between art and medicine, Warnell’s performance also raised questions about the issue of authorship in art. The Endo/Ecto couldn’t have come about, if it hadn’t been for the companies that deviced the endoscopical capsule and the sensors, the supercomputer which was used to download the images and Dr. Simon Anderson, who had previously performed an endoscopical examination of Warnell’s abdomen and who was our medical cicerone this afternoon. In this regard, Warnell shares a similar interest in artworks as research projects, with for example, the French artist Matthieu Briand, who makes use of a wide range of digital techniques in his exhibitions. The encounter between art and science is also something that is being explored by the The ArtsCatalyst, an agency dedicated to projects which bring art and science together in new and unforeseen ways. Not surprisingly, Warnell sees himself more as an interdisciplinary artist and researcher than as an artist in the traditional sense of the word. Like a laboratory scientist he is dependent on other people who he either collaborates with directly (Dr. Simon Anderson), or indirectly (the company behind the pill camera).

The main attraction this afternoon at the ICA was of course the images of Warnell’s stomach, which were projected on a screen as the artist and Dr. Simon Anderson discussed what we actually saw. I believe I was not the only one in the audience who had expected more of this conversation. Actually it was more of a chat, as if the two men were still in Andersons consulting room back at St. Thomas Hospital. Maybe they were just too shy to talk about such personal matters in public; Warnell did indeed seem rather uncomfortable, walking around with a belt of sensors strapped around his waist. Anyhow, the whole thing was quite impressive, especially when the pill camera located an E or a C, paste letters spelling the title of the performance, which Warnell had swallowed along with the camera. After having illuminated the walls of the stomach for us, the camera continued on to the sturdy intestines and we all felt like the crew members of the Fantastic Voyage film, voyaging into unknown space, only the destination of this unmanned spacecraft was not so spectacular and we weren’t invited to see the end of the film. Still, what we saw was enough to stir up questions regarding the function of medical images and how they can be charged with different meanings and interpreted in different ways, depending on where they are shown and on who does the talk.

For me, the strongest impression with Endo/Ecto was simply the fact that art as well as medicine depends on technology in order to achieve corporeal transparency. Bioluminescent organisms on the other hand, are capable of achieving transparency by themselves. This was very well illustrated when the glass tubes containing bioluminescent organisms, were passed around among the audience. When shaken, the glass tubes were illuminated with a green phosphoric light which lit up the dark auditorium. For Warnell and Anderson, the transparent body can only be achieved via compact and solid technology, the pill camera, the sensors, the computer, and even then one can wonder whether the accomplished effect has anything to do with transparency at all. Probably more with the opaque body, be it the stomach of Warnell or the deep dark see where bioluminescence has evolved. By then, for some reason, I had become thirsty, so I wandered off in the London night, in search for Guinness.