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The Manufacture of Bodies in Surgery Author(S): Stefan Hirschauer Source: Social Studies of Science, Vol

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The Manufacture of Bodies in Surgery Author(S): Stefan Hirschauer Source: Social Studies of Science, Vol The Manufacture of Bodies in Surgery Author(s): Stefan Hirschauer Source: Social Studies of Science, Vol. 21, No. 2 (May, 1991), pp. 279-319 Published by: Sage Publications, Ltd. Stable URL: https://www.jstor.org/stable/285264 Accessed: 16-09-2019 07:19 UTC REFERENCES Linked references are available on JSTOR for this article: https://www.jstor.org/stable/285264?seq=1&cid=pdf-reference#references_tab_contents You may need to log in to JSTOR to access the linked references. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at https://about.jstor.org/terms Sage Publications, Ltd. is collaborating with JSTOR to digitize, preserve and extend access to Social Studies of Science This content downloaded from 134.93.236.161 on Mon, 16 Sep 2019 07:19:06 UTC All use subject to https://about.jstor.org/terms * ABSTRACT This paper presents an ethnographic account of surgical operations as encounters of two disciplined bodies - a parcelled 'patient-body" and an aggregated 'surgeon-body'. It describes the practices of making bodies operable, of cooperating and of creating anatomical visibility by means of highly skilled manipulations and optical technology. The discussion relates features of surgical practice to two issues raised in science studies: (1) Ritual aspects of scientific work; how does a medical science deal with the life- world esteem for its object?; and (2) The relation of experience and representation; how do patients' bodies come to embody the properties of anatomical pictures? A constructivist interpretation is offered: the anatomical body is an accomplishment of the sculptural practice of operations. The Manufacture of Bodies in Surgery Stefan Hirschauer The ethnographic and constructivist approach in social studies of science has so far mainly dealt with experimental natural sciences.1 Observational studies have investigated scientific practice within its social situatedness in the laboratory. This article focuses on an applied science which studies and treats human beings: surgery.2 It presents empirical results of an ethnographic study of surgical operations,3 in the form of a 'thick description'.4 This description tries to provide an insight into a situation in which a subtle manipulation of a material object (the human body) is accomplished in a close cooperation of highly skilled and technologically supported specialists, who together aim to enhance the visibility of the object. The description brings several points into focus which can be compared to features of experimental sciences. One question con- cerns ritual aspects of scientific work: how does a medical science deal with the life-world esteem for its object, which precludes that 'sacrifice' of bodies, which has been described for experimental Social Studies of Science (SAG E, London, Newbury Park and New Del hi), Vol. 21 (1991), 279-319 This content downloaded from 134.93.236.161 on Mon, 16 Sep 2019 07:19:06 UTC All use subject to https://about.jstor.org/terms 280 Social Studies of Science sciences?' The handling of human bodies should require more continuity and more discontinuity to practices in everyday life. Another point concerns perception in surgery. In a recent article, Bryan Turner attributes the historical growth of anatomical know- ledge to the empiricist rigour of Vesalius and his followers: 'a revolt against Galenic deductivism'.6 In contrast, to Bruno Latour, 'science' begins with a turning away from direct observation to a preoccu- pation with extracted representations: 'If scientists were looking at nature, at economics, at stars, at organs, they would not see anything.'7 Instead of choosing one of these alternatives, we can better approach surgical perception by taking up a question Michael Lynch has raised: 'How do graphic properties merge with and come to embody the "natural object"?'8 Lynch describes how in the laboratory 'natural objects' (rats) are assimilated to the properties of an image-medium by making these properties crucial for the selective perception and manipulation of 'natural objects'. In surgery, of course, it is not 'docile images' (that is, data), but the practical use of images (anatomical drawings) in the production of 'docile bodies', that is at stake. So one has to follow another aspect of 'merging': the re-assimilation of 'natural objects' to images already produced. How do patients' bodies come to embody the properties of anatomical pictures? Concerning this question I propose that the authoritative facticity of the anatomy atlas is an accomplishment of the sculptural practice of surgery. Approaching Surgery through Discursive Phenomena A first way to approach the events in operating theatres is to look at the topics of the most important studies.9 Observational studies of operating theatres are surprisingly rare. In the context of his theory of role distance, Erving Goffman studied the operating surgeon's jocular presentation of self as a means of making subordinate members of the team accept the surgical hierarchy, and thus become part of an 'activity system'. J. Cassell, too, dealt with the relationship of the surgical profession to the surgeon as a person. She analyzed the personality traits and the professional 'ethos', the standardized emotional stances which the surgeons' work requires: certitude, resolve, arrogance and courage. Finally, Pearl Katz approached the operating theatre from an ethnological point of view and studied in great detail sterility procedures as rituals, which contribute to the This content downloaded from 134.93.236.161 on Mon, 16 Sep 2019 07:19:06 UTC All use subject to https://about.jstor.org/terms Hirschauer: Manufacture of Bodies in Surgery 281 technical functioning of operations by clarifying the categories clean'/'dirty'. A second way of approaching the events in operating theatres is to look for surgical self-descriptions in books and articles or in interviews. Most written texts describe operating methods. In these descriptions, the persons of patient and surgeon seem to be absent from the events: in place of the patient, there are terms for organs, and instead of the surgeon a multitude of practices, which 'take place' or are 'carried out' in a particular sequence and with particular instruments: Access is achieved via the perineum by means of a longitudinal incision in the raphe of scrotum. Both testicles are exposed and, after following the spermatic cord up to the anulus inguinalis superficialis, they are severed using clamps, with ligation of the spermatic cords The anonymity of these practices, and the exclusive appeal to technical rationality, stand in contrast to the topics of the observa- tional studies: rituals and persons. In interviews I conducted with surgeons, the personality also appeared to be of only some anecdotal interest. It is, from the point of view of surgeons, a marginal topic. Two types of metaphors, which frequently appear in surgical self- descriptions, indicate surgical relevances. In a historical account, a surgeon describes four prerequisites of surgery as science: 1. anaesthetics, operating in an area free of pain; 2. asepsis, surgical action in a sterile field; 3. stypsis, and thus intervention in a preferably bloodless space; 4. strictly detailed systems of localization and a wide-ranging topographical anatomy, which enabled us to have a new overall view of the ground, the terrain of the operation." The author writes that when asepsis had been established historically, 'the departure was sounded for the general attack on the large cavities of the body: truly a storm on heart, belly, brain! The heroic age of surgery had begun'.'2 Such affinities to military language are also present in basic terms of surgery such as 'tactics', 'invasive methods', 'invasion of germs'. And, of course, an 'operation' is also a 'planned movement of one side, limited in its goal, duration and space, mostly related to fighting'.'3 Another range of metaphors is derived from sports. In interviews, surgeons talked of the 'operating team', which should have the right 'team spirit', and of their 'daily form', which could depend on the amount of sleep they had had. Smirking, a surgeon assured me that a This content downloaded from 134.93.236.161 on Mon, 16 Sep 2019 07:19:06 UTC All use subject to https://about.jstor.org/terms 282 Social Studies of Science five-hour operation was definitely a 'marathon'. An assistant was complaining of aching muscles: 'And then you're hanging on such a retractor for eight hours'. But she also said, 'That gives you some idea of what a body can endure'. Cassell quotes one surgeon as saying that 'surgery is a body contact sport', and another compared the permanent need for decision-making during an operation to a cyclist's need to keep in motion.'4 Cassell also refers to the specific 'thrill' of an operation: as during a match, the pulse-rate goes up and then falls again. The limitations of these metaphors are immediately obvious. Even though surgical, like military, operations are a matter of life and death, in surgery both sides agree that the patient's body shall be kept alive. The patient's consent in writing is not a declaration of war, and the 'invasion' is not a sudden attack but a controlled advance, trying to grasp organs as selectively as possible, especially in 'sparing' (schonendem), operating in the right layers. But the metaphors also have a core which can be of use for an apt sociological description of operations: it is the antagonism of bodies and the relation offorces of two sides which they emphasize.
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