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Nov 19, 1999 - Journal of Medical Humanities, Vol. 21, No. 2, 2000. Virtual Anatomy: From the Body in the Text to the Body on the Screen. Catherine Waldby.
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Journal of Medical Humanities, Vol. 21, No. 2, 2000

Virtual Anatomy: From the Body in the Text to the Body on the Screen Catherine Waldby

This paper analyzes the transformations in anatomical representation introduced by the Visible Human Project, the first complete virtual anatomy object. By comparing the process of production of book based classical anatomy with that of the Visible Human Project, the paper identifies the medium specificity of anatomical knowledge, the extent to which its powers of demonstration and analysis are conditioned by the medium in which they take place. The paper argues that anatomy can be productively thought of as a kind of writing practice, in which material flesh is written into different media as traces. Because the production of such traces always involves the destruction of the body involved the paper also interrogates the biopolitical hierarchies involved in anatomical knowledge.

The Visible Human Project (VHP), launched late in 1994, forcibly brought to public attention an old nexus between medicine, violence and punishment. The VHP is the first virtual, three dimensional anatomy “atlas” of entire human bodies, produced, like all anatomical images, through the dissection and rendering of actual, fleshly bodies. The project received extensive public attention in part because the first body to be imaged was that of Joseph Jernigan, a convicted murderer, executed in Texas by lethal injection. A woman’s body was subsequently imaged, but her circumstances and identity remain anonymous. The production of VHP anatomies involves new techniques of dissection, quite unlike the practices associated with classical anatomy. Once a suitable body is selected, it is first fully imaged. The entire body is scanned in Magnetic Resonance Imaging (MRI) and computed tomography (CT) media, making an image template for the intact body. The body is then frozen in gelatin at −85C. Once suitably solid, it is cut into four sections and each section is again scanned in CT and MRI modes. National Centre in HIV Social Research, The University of New South Wales, Australia. 85 ° C

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After this, the body is systematically and very finely sliced into oblivion. Beginning with the feet, the frozen sections are fitted into a cyromacrotome, a dissection device, described by its creators as a “milling device” that planes the body at very fine intervals between .3 and 1 millimeters. This technique effectively obliterates the body’s mass, each planed section dissolving into sawdust due to its extreme desiccation. After each planing the cross section of the remaining body-section is digitally photographed, so that each photograph registers a small move through the body’s mass. Each of these photographs is then converted into a computer data file, and its position in the overall body registered according to the initial template. Through this process the fleshly cadaver is converted into a visual archive that can be downloaded via the Internet after payment of a licensing fee. The files can be viewed one by one, showing highly resolved transverse crosssections through the body in realistic, photographic colour [see Figure 1]. Due to the animating and volume-rendering capacities of computer vision, this archive is not merely an inert series of images. The slices can be re-stacked so that the appearance of volume and solidity is restored to the virtual body [see Figure 2]. Users can isolate and track blood vessels through virtual space, can “travel” the entire length of the spinal cord or the esophagus, and can “open” the body in any direction to be viewed from any angle and at any level of corporeal depth. Users can also move around the body using hypermedia links and “flythroughs” which allow navigation through different points of the body from a vantage point similar to that of a tiny spacecraft. The Visible Human Project is so compelling because it recapitulates an entire spectacular history of anatomy within itself. In using the body of an executed murderer as its first subject, it refers back to a long history in which medical knowledge was intimately bound up with penal and sovereign power. From the fifteenth century until the mid-nineteenth century, scientific anatomists in Europe used the bodies of executed criminals as the raw material for their investigations. Public dissections were frequently performed immediately after public executions, and constituted as extensions of punishment. Barker (1984) describes the annual public dissection of a criminal, held in the dead of winter before the burghers of Amsterdam, as a “drama of retribution” in which the violence of medical dissection and the violence of punishment are indistinguishable, a fusion of punishment and science. As Barker asks, Is not [the anatomist] as much the agent of an older punishment as the representative of a novel science? Does not the annual public dissection, conducted with solemn and awful ritual in the depth of winter, merely extend the execution which immediately preceded it and which provides its patient; and isn’t this . . . performance—which, at most, we might regard as some fusion of punishment and science—then completed by the commemorative banquet for the Guild of surgeons by which it is followed? To execute, to dismember, to eat. It is difficult to imagine how much more than this an act of corporeal punishment might be. (1984, pp. 73–74)

In this sense the VHP Project seems to present us now, at the end of the twentieth century, with the return of the repressed of anatomy, its historical dependence

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Fig. 1. Cross section of skull, Visible Human Male. Reprinted with permission of the Institute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg, Germany.

upon, and resemblance to, the procedures of penal punishment and execution. The fate of Joseph Jernigan demonstrates this historical connection in dramatic terms, and seems to be a restaging of this older, more punitive form of medical power.

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Fig. 2. Volume rendering of head, Visible Human Male. Reprinted with permission of the Institute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg, Germany.

At the same time the project moves us forward to an imagined future where forms of technoscientific expertise will shape the new millennium. The anatomy theater in this case is not an actual public space but the virtual media space of the Internet, and where the Visible Human data’s dissection is not a single event to be witnessed in real time but a simulated event to be endlessly repeated at innumerable workstations around the globe. Nevertheless, a similar sensibility and set of institutional power relationships seem to be at work here, a confluence of penal and scientific power that designates Jernigan’s dead body as a legitimate object of spectacular and public violence.

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What concerns me in this paper is the relationship between the forms of analytic violence involved in the production of anatomical knowledge, and whose, or what kinds of, bodies can be used as the object of this violence—the raw matter for knowledge production. I will investigate two issues in the following pages. First, I will examine the relationship between anatomisation and the medium in which it takes place. In conventional empiricist terms, the transformation of the body into knowledge is carried out through procedures of observation and illustration, into accurate visual and narrative information that simply transposes the organic structure of the fleshly body into a textual register. To think of this as a procedure for the production of scientific resemblance is quite inadequate to the task of accounting for the violence inherent in the practice of anatomy. Thus, I propose that anatomy is not a process of illustration but a way of spatialising flesh as communicable knowledge. As flesh, the body remains incommunicable; it is opaque, singular and specifically located. The spatialisation of flesh that takes place in anatomy involves the destruction of this local entity in favour of its trace—writing of the body as intelligible, communicable terrain, and hence useful for medicine. Here, the idea of writing and the trace clearly owes much to a deconstructionist use of these terms. According to Latour (1990), the scientific trace describes the inscriptions (drawings, photographs, spectrographs, x-rays, etc.) used in scientific practice to summarize and stand in for natural phenomena in a systematic and recognizable way. To suggest that in anatomy the body is written is to refer to how the fleshly body is worked over to produce intelligible and reproducible traces, anatomical drawings and diagrams. In a deconstructionist use of the term, such inscriptions count as writing insofar as they mediate between authors and readers across distance and absence, and stand in for absent things. My claim is that the violence of anatomy is the violence of a particular kind of writing practice, a set of techniques that destroy the fleshly body along particular analytic lines in order to inscribe its trace in various knowledge media. The development of the VHP has foregrounded the fact that anatomy’s methods of writing the body are medium specific, and that the move from a text based to a virtual economy of representation involves working over this materiality in a new way, to bring it into line with the demands and limitations of the medium. Second, I will examine the ways in which this spatialisation relates to the biopolitical hierarchies evident in the production and consumption of the Visible Human Project. How does the practice of anatomy relate to broader questions of power relationships in the production of biomedical knowledge, and to the construction of sacrificial orders of bodily matter?1 If anatomisation resembles punishment, their respective kinds of violence are dedicated toward different ends. The penal execution pursues the derangement of the body, its pain, humiliation and death, the maximum demonstration of power over flesh. The anatomical dissection, however, is concerned not with the extraction of pain but of knowledge. Its violence is analytic, propelled by the logic of systematic scientific procedure. It pursues not

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disorganisation or the extinction of vitality but rather the explication of what it takes to be the inherent order of the body, its anatomy. Nevertheless, this order cannot be discovered without the death and dis-integration of the body concerned. Throughout the history of anatomy, “worthless” bodies—not only criminals but also prostitutes, suicides, orphans, the indigent, slaves and the insane—have posthumously redeemed their debt to the social order through furnishing the raw material for anatomical knowledge production (Richardson, 1988), knowledge that can then be used to preserve other more worthy and valuable bodies, elsewhere and later. In what follows, I want first to sketch out some aspects of the representational practice developed in sixteenth century anatomy texts as a way of thinking about the medium specificity of the book-based anatomical atlas. I will then consider the shift in these practices inaugurated by the move into the virtual domain. This is not to undertake an historical argument per se, in the sense of providing a systematic account of the VHP’s precursors and their social context. Rather, by comparing the moment of the emergence of the anatomical text with that of the virtual anatomy, I will demonstrate the ways in which the media of anatomical demonstration condition anatomical knowledge and practice. Medium specificity can only be considered differentially, as a relative question of comparison between medium and medium, rather than treated as a positive essence (Weber, 1996). Thus, it requires a comparative methodology. Moreover, if the emergence of the book-based anatomy seems to occupy a distant historical point, it should be remembered that until the very recent advent of virtual anatomies, all anatomical atlases have taken the form of the book, even when the book incorporates new imaging modalities like x-ray atlases. THE BODY IN THE BOOK AND THE BOOK OF THE BODY Anatomical knowledge is medium dependent, developed by mapping the resistant three dimensional bulk of the material, fleshly body into a more compliant and reproducible space of representation. Thus, the beginning of modern anatomical practice, conventionally dated from the anatomical texts produced by Vesalius in the sixteenth century (Harcourt, 1987), is inextricable from the coming of the mechanically printed book. The printed book was crucial in the development of anatomy because mechanical printing provided a method of preservation, circulation and reproduction of the knowledge gained from particular dissections, a way to move that knowledge away from local conditions and create a public readership for it. As Eisenstein (1979) demonstrates in her history of the printing press, the technical conditions of medieval scribal culture were antithetical to the development of visual forms of knowledge. Scribal illustration and copying could only be carried out on a very small scale with very limited circulation, and were subject to constant degradation of the original image, a constant loss of accuracy and quality. Under these conditions intellectual discoveries and observations could be, and were made. But, as

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Latour (1990) puts it, each achievement stayed local and temporary just because there was no way to move their results elsewhere and to bring in those of others without new corruptions or errors being introduced. For instance, each carefully amended version of an old author was, after a few copies, again adulterated. No irreversible gains could be made, and so no large-scale, long-term capitalisation was possible. (p. 34)

In contrast to this situation of image-entropy, Latour describes the printing press as a means of preserving and improving on visual knowledge, a mechanism to irreversibly capture accuracy in the reproduction of images, a mechanism for the production of reliable, because falsifiable and verifiable, demonstrative visual knowledge. Certain kinds of writing—diagrammatic, visual and graphic forms of meaning—can only develop as forms of systematic knowledge production and mediation once they can be reliably and identically reproduced, and can circulate at a certain critical mass. From this point onward, scientific anatomy developed through the medium of the anatomical atlas. The anatomical atlas is a particular kind of book devoted to the visual representation of the anatomised body, which aspires to a high degree of technical realism. As Daston and Galison (1992) observe, the scientific atlas is devoted to graphic forms of knowledge, where the images (of flowers, shells, bodily organs, etc.) are understood to be mimetic images—“the closest possible rendering of what truly is”—that strive to crystallise the essential nature of the object, to effectively re-present the object, making it appear as the thing-in-itself (p. 84). This understanding of the relationship of atlas to object is, in the case of anatomy, far too passive, seriously misunderstanding the kinds of demands that the atlas places on the body that it depicts. The atlas is not so much illustrative as demonstrative. It is, in itself, a medical technology for laying bodies out in particular ways, for making them conform to the demands of anatomical truth and proof through certain kinds of display. Unlike the public execution that lays out bodies according to logics of pain with a maximum demonstration of the flesh’s vulnerability to bloody, brutal disorganisation, the atlas lays out bodies according to the analytic logics of knowledge, cutting them up so that they conform to the spatiality and intelligibility of the atlas. That is, there is nothing straightforward or transparent about how bodies can be dissected and turned into atlas illustrations. Sawday (1995) describes an interregnum in the early sixteenth century during which the early anatomists, faced with the wet, bloody mess of the cadaver’s interior, were at a loss as to how to proceed to order and represent this amorphous mass. Dissection clearly involved opening up the body, but the ways to open it up were not self evident. The creation of visual conventions for the rendering of bodies as visual text was part of the means whereby a logic could be imposed upon the flesh, a process whereby the body became intelligible as a structure or system. In this sense the “anatomical” body and the anatomical text were “co-emergent,” coming into being only in relationship to each other. Moreover, the anatomical body is produced only in the

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act of dis-integration, becoming fully anatomical only in the acts of surgery or anatomical dissection, that is, in the act of being anatomically “written.”2 But of what does this anatomisation consist? I propose three epistemological moves through which the anatomical body was achieved, acknowledging that this may not be an exhaustive list.

The Privileging of Vision Numerous commentators have analysed medicine’s privileging of visual over other kinds of knowledge, its desire to transform all forms knowledge into graphic forms (e.g. Stafford, 1993; Cartwright, 1995). The institutionalisation of dissection and the creation of the first anatomical atlases mark the threshold where medieval medicine gave way to this preference for visual forms of knowledge over analogical or humoral systems. As Harcourt (1987) argues, the reason that Vesalius’ volumes of anatomical text, the De Humani Corporis Fabrica (1543), are conventionally celebrated as the moment when modern medicine was inaugurated is because “it established anatomy once and for all as a discipline absolutely dependent on a system of visual representation” (p. 53). The corollary here is that anatomy also became a discipline absolutely dependent on dissection, on cutting into the body in order to bring its opague interior to light and to vision. The anatomical dissection treats the body according to the demands of a science which, as Foucault (1973) puts it, is ordered on the “exercise and decisions of the gaze,” that is, around the logics of visual identification and recognition of bodily organisation. Rather than utilising the explanations of heat, cold, wetness and dryness used, for example, in medieval humoral medicine, anatomy was premised on the discernment of visible characteristics, forms, structures, surfaces and lesions. Hence the anatomical dissection opened out the opaque volume of the body in such a way that these visualisable features were abstracted into a visual text, displayed so that its interior forms were captured by the art of the atlas. This demand can be discerned in Vesalius’ captions to some of his images (see Figure 3), such as the following: “In this figure . . . we have fractured some ribs so that the entire hollow of the liver could be drawn more conveniently. Then the orifices of the stomach are seen since it, as well as the intestine, have been pushed to the left in order to bring into view the whole of the mesentery” (cited in Saunders & O’Malley, 1950, p. 3). The ways in which the body is dissected are here clearly determined by the necessity for the complex depth of the interior to be displayed in ways which are amenable to being rendered as image on a page.

The Body as a Terrain to be Mapped The central problem of anatomy is the incommensurability between the opaque volume of the body and the flat, clean surface of the page. By what means

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Fig. 3. Plates of the Muscles, De Humani Corporus Fabrica. In Saunders, M. and O’Malley, C. (eds.) (1950). The illustrations from the works of Andreas Vesalius of Brussels. Cleveland: World Publishing Company.

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could this bulk be transposed onto this two-dimensional surface? This problem was resolved to some extent through the creation of analogies between anatomical and cartographic space, analogies evident in the fact that the book of anatomy is known as an atlas. If the interior of the body could be thought of as space, rather than as a self-enclosed and continuous, solid volume, then it could be laid out in ways which were amenable to a form of mapping, just as the navigators of the time were mapping the new world. Moreover, to write the body as anatomical space was to mark it as a space controlled by medical logic and under medical fiat, rather than other possible systems of meaning. This analogy between corporeal and cartographic space simplified the problem of how to translate the three-dimensional volume of the body onto the space of the page, because it conceptualised the body as an accretion of laminar “surfaces,” as landscapes to be traversed by the eye, a volume composed of layers and systems of tissue which are laid one upon the other. Hence the anatomical demonstration proceeded, ideally at least, as a flaying. The e´ corch´e figures of classical anatomy were produced through the peeling away of first skin, then successive layers of muscle, to work through the body’s volume as if through the layers of an onion, from outer surface to bone (see Figures 4–6). As exposed surfaces these anatomical features could then be mapped in succession. Clearly this graduated abolition of depth is continuous with the necessity to render the body demonstrable in a visual mode. This topographical or laminar spatialisation of the body was also precipitated by the spatiality specific to the book, another laminar volume. The body’s volume could be laid out sequentially in the book’s volume, and the reader could traverse the former by flipping through the latter. Furthermore, the form of the book suggests both a spatiality and a temporality, insofar as one reads and turns its pages in a sequence. Hence this form lends itself to a spatialised narrative about the body’s constitution, an ordering which reverses the ideal spatial order in which the cadaver is dissected. By narrating the body as a sequence of systems and an assemblage of organs, the anatomical atlas creates the sense of a body which is always/already only the sum of its essentially discrete parts. The Body as Readable If it is possible to think of anatomy as a kind of writing practice, a disintegration of the flesh in order to produce a coherent system of reproducible and communicable traces, then it must be a writing-for, involving the participation of readers. The anatomical atlas is a technology for transforming private flesh into public, medical knowledge and putting that knowledge into circulation, creating an audience for what it conveys. In keeping with its claim to simply display the preexisting organisation of the body, classical anatomical discourse troped the body as itself a book whose meaning and coherence was the result of divine authorship.

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Fig. 4. Plates of the Muscles, De Humani Corporus Fabrica. In Saunders, M. and O’Malley, C. (eds.) (1950). The illustrations from the works of Andreas Vesalius of Brussels. Cleveland: World Publishing Company.

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Fig. 5. Plates of the Muscles, De Humani Corporus Fabrica. In Saunders, M. and O’Malley, C. (eds.) (1950). The illustrations from the works of Andreas Vesalius of Brussels. Cleveland: World Publishing Company.

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Fig. 6. Plates of the Muscles, De Humani Corporus Fabrica. In Saunders, M. and O’Malley, C. (eds.) (1950). The illustrations from the works of Andreas Vesalius of Brussels. Cleveland: World Publishing Company.

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As Sawday (1995) writes, the anatomical body is constituted as text—as the liber corporum—the book of the body written by God. . . . The anatomist, then, who “read” the anatomy (relating body and text together in the anatomy theatre) was reading two different kinds of text: a text written by human agency (the observations of his predecessors) and a text written by God, comprised of all the different members, sections, subsections, and partitions revealed in dissection. The task was to recreate, in order to read, the precise system of division by which the body-book had originally been composed by the divine author. (p. 135)

Within the confines of this conceit, the anatomical atlas functions as a kind of primer, a secondary text which instructs the reader in the art of interpreting the primary text, the body. This is why the atlas is so concerned with schematisation, with the development of a simplified visual field in order to educate the eye of the anatomist. Its purpose is to standardise both the vision and interpretation of scientific objects. The atlas eliminates what it considers superfluous detail in order to maximise intelligibility, so that it can mediate between raw, material objects and communities of scientific interpretation. Hence the anatomical atlas developed a repertoire of graphic conventions that helped to schematise the representation of the body on the page. These include the use of perspective, the hard-edged, crisp delineation of organs and tissue, the designation of particular functional systems through colour coding, the isolation of particular body parts in the space of the page, and the exclusion of blood or other body fluids from the image. The anatomical atlas inscribes the trace of the dissected body through the aesthetics of the technical artifact, a systematic machine whose parts are discrete, interchangeable and arranged according to a functional teleology.3 These practices of rendering provide the user of the atlas with reading procedures that produce legitimately medical interpretations of the cadaver in the anatomy theatre, or the living body in surgical or clinical space. The atlas produces medicalised legibility, as Armstrong (1983) indicates when he describes his induction into ways of seeing bodies under the tutelage of the anatomical atlas. As a medical student dissecting and examining bodies, he writes, “I had come to take for granted that what I saw was obvious. I had thought that medical knowledge simply described the body.” He subsequently revises this assumption: The anatomical atlas directs attention to certain structures, certain similarities, certain systems and not others, and in so doing forms a set of rules for reading the body and making it intelligible. In this sense the reality of the body is only established by the observing eye that reads it. The atlas enables the anatomy student, when faced with the undifferentiated amorphous mass of the body, to see certain things and ignore others. In effect what the student sees is not the atlas as a representation of the body but the body as a representation of the atlas. (Armstrong, 1983, p. 2)

Armstrong contests the classical assertion that the body is always/already a legible text, one whose coherence pre-exists any reader. If the body seems coherent and legible, this is the effect of certain obedient and active kinds of reading that participate in this process of production. This idea of anatomical reading is close to

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the idea of bio-technical writing that I have made use of here, in that both suggest an active production of flesh along normative medical lines.4 Armstrong’s idea of reading suggests a practice inseparable from writing, a kind of reading that itself inscribes in a certain fashion. Through these techniques, and no doubt others, the anatomical atlas works as a technology that textualises flesh, ordering the body’s volume according to the demands of the book’s volume. The dis-integrated flesh of the cadaver is marked into the communicable space of the book as anatomical trace, and these graphic traces can be deployed as frameworks to decipher living bodies. By ordering anatomical traces in the space of the page, the atlas provides a means for practitioners to order the material space of three dimensional bodies, to dissect cadavers, to perform surgery, to set bones and rectify deformities. In this sense the atlas is deeply tied to the coherence and intelligibility of the body as scientific object. By writing it in particular ways in the space of representation, the atlas enables clinical medicine to rewrite bodily flesh in clinical space through its repertoire of surgical and therapeutic techniques. To contend that anatomy is medium specific is to consider the constitutive part played by the materiality of the anatomical trace and its particular modes of reproduction and circulation. I have argued that the coming of the book allowed modern medical knowledge to take form, but the particular form it took depended on the possibilities presented by the book. The book determined what kinds of traces of the material body could be deployed in medical knowledge, how these traces were to stand in relation to that body, and what problems and opportunities of interpretation, accumulation and circulation they presented in the complex task of moving from body to book and back again. These conditions are radically transformed by the advent of virtual anatomy.

VIRTUAL VISION: FROM MAP TO MODEL As the first virtual anatomical atlas of an entire human body, the Visible Human Project moves anatomy into a new theatre of representation, and a new space for the public spectacle of medicine’s mastery. The VHP is the first attempt to move a totalised representation of the body out of the economy of representation created by the book and into one created by the computer and computer mediated communication (CMC). While other virtual atlases have been created since the late 1980s, the VHP is the first to image entire bodies rather than specific body parts or structures. The VHP is, like the book-based atlas, a technology for both spatially ordering and reading the material body, but this analysis is now carried out in the media of virtual space (the space proper to the computer screen) and cyberspace (the space of computer mediated communication) rather than in the space of the page and the volume. This move from the space of the page to the space of the screen was precipitated by the fact that so many forms of medical imaging

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now utilise computers and work through digitising various forms of information from the bodies of patients. Thus, VHP is a new technology for writing the space of the body in tandem with these other diagnostic screen technologies. It writes this space according to the logic of the screen and the computer rather than the logic of page and the book, and according to the new modes of visualisation, distribution, replication and collaboration made possible by the computer and CMC. In doing so it provides medicine with a new form of “working object” whose performative power is dramatically greater than, and different from, that provided by the book. I will first describe three of these performative qualities, and then return to the question of the disintegration of flesh that underwrites the production of the anatomical trace, and the biopolitical implications of this mode of production.

Spatial Complexity Much of the appeal of the VHP for medicine and the biotechnology industries resides in the form of spatial “capture” that virtual space is understood to involve. As was discussed earlier, the space of the page and the book can only render the density of the body with great difficulty. It can only represent the volumetric nature of the body, the relationship between its inside and its outside, as a sequence of surfaces successively laid out. By comparison, the VHP is able to register volumetric space with much more complexity. It makes not a map of the body, a surface rendition, but a model, a spatial homolog, one that reproduces the inside/outside volume of the material body in itself. It can demonstrate this inside/outside as a simultaneity rather than a sequence, holding together surface and depth in a single image.

Point of View and Animation This copied space is not static, like a hologram, but can rather be traversed from mobile points of view, rotated and animated in a number of ways. The VHP visually replicates bodily organisation without presenting any of its material intransigence, its fleshly weight and dense opacity. The interior flesh can be visually traversed in any fashion, the point of view literally moving through the virtual flesh at will, constituting flesh as pure spectacle without density, pain, tangibility, recalcitrance, material consistency or self-enclosure. Hence, interior structures like the skeleton, the colon, the esophagus, and the arteries can be navigated using “flythrough” software, which visualises the data “as if the viewers eyes were freely mobile inside the . . . lumen” (Hong et al., 1995, p. 26). The point of view is that of a pilot in a tiny space ship, looping and zooming through the enclosed spaces of the body’s interior with a complete mobility, able to “land on an object in order to

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understand its surface structure, or to enter an object in order to understand its internal structure” (Ackerman, 1991, p. 14). If the Renaissance anatomists imagined the body as a new world to be mapped, virtual anatomists imagine it through the history of space exploration, inner space to be traversed by miniaturised bionauts, and through the swooping, vertiginous optics of flight simulation. The interior space of the body is treated as empty and inertia-less space, an “outer space” within the corporeal envelope. In addition to these mobile points of view, the body image itself can be animated, providing body movements and fluid dynamics so that blood can flow in the arteries, the body can bleed, the limbs can flex. Attempts are also being made to add in muscle torsion to make human movement more plausible, and to give the user the feeling of tissue resistance in the image. A virtual scalpel cuts into a rotatable image that registers different degrees and kinds of drag, resistance and texture to the user through a haptic5 feedback system. Photorealism The VHP bodies are “photorealistic” in the sense that they are imaged in the light spectrum rather than in the range of other spectra and kinds of information used to image bodies in other forms of computer based three-dimensional imaging. Computer tomography works through the conversion of a wide variety of electromagnetic (MRI), sonographic (ultrasound) and radiation based (CT-scan, radioisotope imaging) information into ways of “seeing” aspects of the corporeal interior. Each of these techniques anatomise the body in a particular way and each has specific clinical uses, but they also make clear the extent to which they can only be produced through extensive amounts of technical mediation. The images they produce are partial, specific, noisy—sometimes ghostly or aqueous, as with MRI, or sometimes grainy, as with sonography. Moreover, the use of such images in surgery or clinical settings presents 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 that dispenses with a sense of mediated vision, yet which can still be used as a benchmark in relation to other forms of computerised vision.

THE VIRTUAL TRACE The VHP data-body can perform in these spectacular ways because it is written into the space of the digital, and so partakes of the qualities specific to virtual space and digital data. As with book-based anatomy, this writing-into takes place through death and violent spatialisation. Just as text-based anatomy involves spatialising material bodies in a particular way, cutting into them and opening them

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out so that they can be exposed to the gaze of the anatomist and their contours mapped as text, so too, the bodies imaged for VHP involve a particular kind of spatialisation enabling their volume to be recorded as digital data. If the modern anatomical body is treated as a volume, an intelligible book, the posthuman body of virtual anatomy is treated as an archive of data. The VHP is a visual text produced by literally reworking the body’s materiality according to the logics of computer storage and computer vision, and so rendering it as a system of traces workable and readable through the medium of computed space. This is evident 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. While book-based anatomy requires the body to be anatomised as an accretion of laminar surfaces, computer-based anatomy demands that it be reduced to a series of flat cross-sections that can be both serially visualised and “stored” as discrete digital files. 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. Just as book-based anatomy enframed the anatomised body as itself a book, a legible volume, so computer-based anatomy enframes it as an archive of digital data. 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 analog media of photography or line diagram used in anatomical text books. The anatomised body is cut up in order that it can be digitally photographed in light spectra. All information manipulated by computer must be rendered as data, as binary code that mathematicises all forms of phenomena—numbers, text, images, sound, radiation—as strings of bits, combinations of zeros and ones. The VHP data body is produced through the conversion of photographic data into digital data, through the allocation of a set of quantitative values to different qualities of colour, lightness, darkness and texture. Once the data have been scanned into a computer, these mathematical codes can be reconstituted as visual text through visual interface software, which reverses the process, transforming quantitative codes into pixels and voxels, the light units of the virtual screen. By moving from the continuous analog realm of the book into the discrete, digital realm of the computer, the VHP produces a visual text of the body, which is also a structure of mathematical data and digital code.6 A third way the VHP makes the body a computer compatible text is by rendering it according to the spatiality favoured in the CT-scan, the most widely used clinical procedure for registering flesh as data. The CT-scan works by imaging a 1 millimeter “slice” of the patient’s body using radiation, with the images as a series of such slices moving 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 a three-dimensional image of sections of the patient’s body. Hence the VHP can be seen to cut up the cadaver according to the spatial logic of the CT-Scan file, a

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mapping procedure that allows the photographic “real” quality of the VHP images to be readily used in the interpretation of the scanned data. By spatialising the material body in this way, it provides an anatomical text that can be mapped onto other visual texts produced through the computerised envisioning of the body. By writing the space of the material body along these lines, the VHP produces a virtual anatomical image, a simulation that mimics an appearance of the body’s volumetric quality. While book-based anatomy can only work in the domain of surfaces, virtual anatomy enables the rendering of structured depth. It can thus produce an image that medicine can use, not only (as with earlier book-based anatomy) as a map of actual bodies, but also as a surrogate for actual bodies. One of the primary uses for the VHP is as a virtual object upon which students and surgeons can enact forms of dissection or surgical procedure (Hohne et al., 1996). Students or surgeons can “cut” into the flesh of the body with a cursor/scalpel in a fashion that mimics the spatiality of classical anatomy, treating the body as a series of layered structures that can be revealed as surfaces, or discrete organs that can be removed from the body cavity and themselves dissected. Their photorealistic, volumetric quality means that such incisions produce views of interior structure that resemble those produced by a similar procedure in actual space on a material body. Surgical simulation involves the rehearsal of certain techniques, the use of probes and catheters, endoscopes and the like, as preparation for working on an actual body. Users, for example, can rehearse a craniotomy by cutting arbitrarily shaped holes and removing tissue layer by layer from the virtual skull, plotting an access path to be followed by a probe (Hohne et al., 1996, p. 29). Because the VHP data body is produced through a slicing technique that mimics the spatiality of the CT-scan, visual data from actual patients’ bodies can be lined up with analogous sections of the data-body, mapping virtual to clinical space. The VHP data is, for example, being used to model fly-throughs of the colon. Rather than subjecting patients to the invasive practices of colonoscopy and barium enema to detect polyps in the colon, a research team based at SUNY is developing a procedure they call a 3D virtual colonoscopy that utilises computer graphics technology to visualise the inner surface of the colon based on CT images of the abdomen. The Visible Human Male data have been used to help develop the fly-through algorithms and colour information used in the development of this software (Hong et al., 1996). In making use of the VHP as a surrogate for the bodies of patients, the biomedical imagination understands the VHP data-body as a “copy” of an original fleshly body. As I have already noted, the logic of the scientific atlas is one of striving for resemblance, the re-presentation of the object in the space of knowledge, rather than the space of nature (Daston & Cialison, 1992). The entire methodology of the VHP is designed to create a point-to-point reproduction of the actual body in virtual space, to preserve the integral, organic geometry of the actual body in a digital form, so that relations of outside to inside, and organ to organ, are

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reproduced without distortion. This technical resemblance drives the appeal of the VHP as demonstrative object for so many domains of medicine and biotechnology. As trace it is understood to be exhaustive, to leave behind no significant residue, capturing all that is essential for a medical vision of the body. Medicine’s desire to “copy” bodies through technical reproduction is one of its most enduring fantasies. I would discern this fantasy in all its attempts to model flesh as (digital or genetic) code, insofar as code is by definition both interpretable and reproducible. However, to think of the VHP as a copy implies a particular relationship between the original and its reproduction, a relationship that the VHP’s process of production demonstrates to be inapplicable. To copy is to undertake a benign process of replication that leaves the original intact as the first, the master-model whose presence guarantees the integrity and value of the copy. To copy is to leave the presence of the original untouched, even if a perfect copy undermines its status as original. Hence these images cannot be copies, precisely because their process of production involves the destruction of flesh, of the presence of both being and matter. The condition of possibility of the VHP data-body is precisely the abolition and absence of the body that it must use up in the process of its creation. The VHP is, at bottom, a mathematical description of space that does not record a body’s disposition in space but rather the process of its abolition. The sequential destruction of the actual flesh is what makes the virtual flesh traversable, mutable, and reproducible, because its abolition is the sacrifice necessary for its transubstantiation into visual data and mathematical code. As a mathematical description of space, the VHP is, unlike the material intransigence and resistant inertia of the cadaver, or the subjective complexity of the patient, a perfectly cooperative, perfectly transparent and perfectly traversable object. The virtual anatomy is open to almost any kind of manipulation, because any action performed upon the body is reversible and free of consequences. As mathematical data it can be almost infinitely segmented and then reformulated. The body can be repeatedly dissected or penetrated, and each time reformulated, organs and other structures can be removed and then seamlessly replaced. Its spatiality can be endlessly deformed and then returned to an appearance that mimics the appearance of bodies in actual space, without loss of image quality. It can present the “look” of flesh without any of the resistance and opacity of flesh, virtual flesh that acts as empty, abstract space. Thus, all the performative qualities of the VHP data-bodies derive from the destruction of the bodies imaged. Yet these performative qualities are being used in ways that enhance the integrity and preserve the health of at least some patients’ bodies. Book-based anatomy, by visualising the body as an accretion of planes, produces surgical techniques that open the body, cut into its depth and bring it to the surface. The VHP contributes to the effort in computer-mediated medicine to treat patients’ bodies as enclosed envelopes, to work them in three dimensions without cutting through key-hole surgery, or through the deferral or reduction of cutting, as in the example of the virtual colonoscopy already described. Hence such

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patients can be relatively protected against the risks of pain, perforation, infection and hemorrhage, which are attendant on older diagnostic and surgical techniques.

THE MEDIUM OF FLESH Within itself, the VHP is a technology for the reproduction of a certain hierarchy of biopolitical value. As I have demonstrated, all anatomical production is based on sacrifice, the death and disintegration of some in order to enhance the health of others. The history of anatomy is a history of the sacrifice of the poor, the criminalised, and the abandoned in order to preserve the health of the more valuable. The VHP reiterates rather than disturbs this economy within the new clinical space of virtual medicine. While the VHP is itself in the public domain, many of its users are focused on the development of new markets for privatised medicine, markets which high-end medical imaging is designed to secure (Howell, 1995). To this extent the bodies of Joseph Jernigan, a poor, white, executed criminal, along with an anonymous “housewife,” have provided the raw matter that will enable the preservation of the lives of those who can benefit from high technology medicine—the heavily insured in the increasingly privatised medical systems of the industrialised democracies. It is also a technology that demonstrates the medium specificity of flesh, when considered in relation to the medium of data. The process of production of the VHP and its subsequent form provide clues to ways in which flesh and code cannot be subsumed one into the other. The VHP data-bodies are seductive for medicine precisely because of their endless mutability. Like all data objects, they are morphable, reversible, and indestructible. They can sustain transformation without loss; they can change without cost or labour. Nothing done to them has consequence because everything can be returned to initial conditions. These qualities are so prized because they are not qualities of actual, vulnerable flesh. The bodies destroyed to make the VHP bear witness to the non-reversibility of flesh. Once it is marked, the body’s marks cannot be erased. All pain, all experience, all illness, and all violence leave a trace in flesh, changing it forever. In this sense flesh is historical, conditioned by the passing of time that eventually brings its death and dissolution. If flesh can be said to be a medium, it is marked through and by loss, and by the prospect of a final disappearance.

ACKNOWLEDGMENTS The author would like to thanks the Institute of Mathematics and Computer Science in Medicine at the University Hospital Eppendorf, Hamburg, Germany, for the use of their images. This research was supported by a grant from the Australian Research Council. Earlier versions of this paper were presented to the Research

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Symposium, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, U.S.A., November 25th, 1997, and to the Cultural Studies Seminar, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A., November 19th, 1997. ENDNOTES 1. The question of biopolitical hierarchies in the production of medical knowledge has been addressed in a wide range of literature. Two recent texts that discuss this question are Kapsalis (1997) and Treichler et al. (1998). 2. As Hirschhauer (1991) demonstrates, in surgery the surgeon carves tissue up according to the lineaments of the anatomical atlas. 3. As Harcourt argues, the rendering of the bodily interior as artefact helps to dissipate any sense of the violence that necessarily precedes the production of the image, “bracketing in representation the simple fact that anatomical knowledge is constituted through the violation and destruction of its proper object in practice” because the images “do not read as actual cadavers” but rather as synthetic objects that have been assembled, and that can therefore be harmlessly disassembled (Harcourt, 1987, p. 341). 4. I have discussed the implications of anatomy’s normative constitution elsewhere (Waldby, 1996). 5. Haptic technologies are those that address the hand. 6. As Marchessault (1996) observes, medicine has sought since the nineteenth century to render the body in mathematical terms, an attempt that since the advent of cybernetics after World War II has been assimilated into the cybernetic notion of code, an idea of information that is purely quantifiable, having no concern for the meaning of what is coded (Fox-Keller, 1995, p. 82).

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