4.2.4: Opacity in the History of Medicine

I have foregrounded this chapter with the theoretical formulations which have informed the design of the OOPP’s features. I did this partly because so much of this dissertation is about the value of specimens in biomedical research (0.1.4), and the rights of historical research subjects (4.1.3). I wanted to demarcate my ideas before talking directly about the image opacity function on the platform. What I need to make clear, however, is that the OOPP is responding to a very specific problem in the history of medicine, and medical librarianship/archival practice: the materials produced before the codification of informed consent were regularly made from people who did not want their bodies or remains used for research (0.1.5; 2.1.3).¹

As I described in the introduction, modern medicine was defined by posthumous theft: the best example of this is in the practice of grave robbing that corresponded with the adoption of the Parisian anatomical method (0.1.3; 0.1.4; 2.1.4).² Medical science depends on the bodies of their research subjects, and there are explicit and implicit value structures which are associated with specimens. The value of the cadaver in medical research needs more critical examination, because once that object is imbued with epistemic value, then it cannot easily be removed from academic contexts. The commodified corpse,³ the value of the patient’s body in this system, and the material, social, and epistemic value of specimens, are things that if lost will produce a loss for the organizations which own them (0.1.4).

More important than the corpse as commodity is the ways this framework becomes entwined in the corpse’s supposed epistemic utility. It would be shameful to sell these remains,⁴ but it is entirely acceptable to continue to use these materials to further research—to publish papers, write monographs, create museum displays and so on. This work produced value, and continues to produce value, for knowledge institutions, which all depends on the primary referent needed for the argument: the person from which the specimen, organ, image, or data point was originally extracted (0.1.4; 2.3.1; 5.1.2).

To explain what I mean, I want to turn to an example illustrated by Megan Rosenbloom. Rosenbloom’s work is especially influential for this project, as her engagement with the often awful history of medicine is both critical and caring. She summarizes the issue described above succinctly, when describing a book challenge levied at USC’s Norris Medical Library. The challenge, brought against Édouard Pernkoft’s Topographische Anatomie des Menschen (also known as Pernkopf’s Atlas) raised an issue with the book’s original anatomical material. This challenge was centered around an issue of establishing consent: Pernkoft made the atlas as a doctor in Nazi Germany, and the research subjects whose bodies were used for the illustrations may have been victims of the Nazi regime and may have been anatomized without consent. Rosenbloom and her colleagues decided to keep the book, adding a detailed description to the book’s digital catalog entry.

This practice is, in many senses, completely correct, especially considering Pernkoft’s Atlas’ lack of specific provenance and the ways the book could be used as a teaching tool to describe the pernicious ways fascism harms and continues to harm human subjects it deems as other. The problem is that, while it addresses so many concerns, it maintains a relation between knowledge worker and exploited medical patient where the knowledge worker produces new knowledge from the body of the subject (0.1.5; 2.1.4). Rosenbloom’s response corresponds with a will to produce new knowledge from the same subjects whose rights were ignored in order to include them in medical research. Earlier on in the book, Rosenbloom makes a convincing plea to the value of her research, writing,

To learn about the people whose bodies make up these books, we must rely on the stories that accompany the objects through the decades, allowing for the generational game of telephone that plays out as stories change to suit the times in which they are told, or disappear altogether. There is no way to change how these people were treated in their deaths, but I can restore some respect to their humanity by uncovering their stories, separating the myths from the facts, and exploring the contexts in which such treatment of the dead could be remotely acceptable.⁵

The production of knowledge becomes a liberatory practice, which repairs the historical record in such a way as to better know that past. Increasing the visibility of the history, while productive in its own right, further denies the research subject’s right to opacity (4.1.3; 4.2.3), while further entrenching the disciplinary and institutional value of the objects which have been examined. My challenge to Rosenbloom, and those who work in the medical libraries, archives, and museums, is to ask, at what point does the harm preserved, indexed, and reproduced in these collections outweigh the potential value produced by the maintenance of unethically produced material? My concern echoes the counterintuitive ways materials may be recovered under the Native American Graves Protection and Repatriation Act (NAGPRA), where the communities, whose objects, information, and literal bodies were stolen, have to articulate the value of those materials in court in order to request their return (4.1.4; 5.1.4).⁶

While iconoclastic in framing, my interest is not in the utter dissolution and dispersal of biomedical materials in libraries, museums, and archives. One of the biggest gaps in this research project is the absence of community interlocutors. Rather than assuming institutional and disciplinary value inherent in these materials, knowledge workers in the history of medicine should consult with and listen to the communities who were harmed in the production of medical knowledge. The final decision for the inclusion of any specimen, book, or object in these collections should be decided in concert with these communities, where their refusal overrides institutional incentives for the maintenance, inclusion, or preservation of stolen materials (5.2.3).

The absence of a community to work with for this project presents a difficult problem,⁷ and so I built the OOPP with twin goals in mind. First, reflecting on the anonymity of much of my materials,⁸ I wondered what would happen to my argument should I follow through on the erasure of the primary source. While I still use these images and texts, and thus fall into the same disciplinary and academic traps which I criticized above, my interest is in speculatively imagining how a history might be told should it be bound to the ethical standards for which I am calling (4.2.1). Part of this makes me a hypocrite, to which I will admit, but my reasoning for this is intentional, if in the reverse of this method: to show how much of my argument actually depends on the research subjects I examine. My suspicion is that the history of medicine might not be as poorly affected by the loss of some of these materials as suspected.⁹

Second, the Opaque Online Publishing Platform (OOPP) was developed to show differing levels of opacity. I wanted to perform a kind of scaled opacity, which would show the limitations of our contemporary ethical standards. These protocols tend to prioritize the needs of the institution and the abstract possibility for new knowledge (4.1.3); moreover, outside the scope of ethics, I hoped that the differing approaches to opacity might be applicable for scholars working with sensitive subject matter, or subject matter that might require trigger warnings. The production of this platform meant that it could be shared, remixed, and made to continue reparative work, beyond the contradictions that limit my own intervention. More than a speculative imagination of an ethical approach to the history of medicine (4.2.1), I wanted these tools and methods to be applicable for a range of scholars who want to present their work in ways that care for both the scholar’s research subjects and their readers (4.3.4).

In the next section, I will focus on the affordances of opacity, and the code Kalani Craig and Sagar Prabhu wrote to make the platform function. This section will get more technical, looking at the code explicitly. For those curious about the more specific affordances of the Jekyll-based GitHub site, please view the associated appendix (X.2.2; X.2.3; X.2.4).