The Body and the Built Environment

written by John Nott

A couple of weeks ago, I was in Durham for a short workshop on the ‘Body and the Built Environment.’  This was an interesting meeting which covered a range of disciplines, including literary studies, medical history and the history of art. I took the opportunity to present a paper on the relationship between the material construction of the medical school and the various biomedical constructions of ‘the body.’ In this paper, I suggested that a theoretical approach to such questions might be achieved by combining ideas drawn from STS and medical anthropology—for their thorough interrogations of ‘the body’—with those philosophical studies of space and rhythm which often leave the body largely untroubled. I proposed testing these ideas using Semmelweis’s Anatomy Institute, a purpose-built, fin-de-siècle anatomy school which epitomises nineteenth-century anatomy. The time of its construction, in 1898, was the middle of Hungary’s golden age, with Budapest one of Europe’s great cultural capitals. The Institute’s heavy use of steel and glass mimics the Eiffel-designed Budapest-Nyugati Railway Terminal only a few miles away. Neo-classical elements of its design also instil a dignity which reflects the symmetry of human anatomy. In many respects, however, what goes on underground is much more interesting. The Institute is built, literally from the ground up, around the use of cadavers. In previous centuries and previous places, education by dissection was undermined by the technical problems surrounding the storage of cadavers as well as moral questions regarding their acquisition. In the Institute, by contrast, unclaimed cadavers were readily obtained from the city’s hospitals and processed by novel, industrial means. Anatomy education at Semmelweis has moved on, although it is one of the last bastions of this dissection-heavy approach to anatomy. The building, however, has remained a constant, which leads to the question; how does the material primacy of cadavers in anatomy education effect student conceptualisations of the body? Unfortunately, you’ll have to wait for my answer to this question, as I haven’t entirely worked it out yet. I would, however, be very grateful for anyone else’s answer in the meantime.

An outbreak of ‘apollo’ recently spread through my friend’s family and their acquaintances in Accra. I didn’t ask who started the whole thing, that could never be polite, but it must have been the baby that spread it to his nanny, and it was surely the nanny who spread it to her unsuspecting family. A little while after this particular outbreak, I happened across the first recorded discussion of epidemic apollo in the March 1970 edition of the Ghana Medical Journal. In the parlance of such a publication—established in the 1960s as an outlet for Ghana’s nascent medical academy—appolo is explained as acute haemorrhagic conjunctivitis. For many other people, however, the causative agents of apollo were germs which had only recently arrived from the moon. This association is still commonly invoked, at least in Accra.

Today appolo is a recurring, seasonal epidemic which usually coincides with the dry air and dust of the Harmattan– the trade wind blowing south from the Sahara—but the first recorded outbreak came in the middle of 1969, the very same time that Neil Armstrong’s cabal first exposed humanity to those virulent moon germs. This should be understood as a fairly significant event in Accra. At the highest ebb of the initial epidemic, the ophthalmology department at Korle Bu, Accra’s primary hospital, registered 1,115 appolo patients in a single day. Somewhat spoiling the moon germ narrative, the Ghana Medical Journal claimed that the first cases were seen in late June, a month before the Apollo XI mission had returned any germs to earth. That said, the epidemic only really took hold in August, so I’m reluctant to entirely dismiss the influence of moon germs in its overall aetiology.

It is difficult to say where rumour ends and humour begins in the history of appolo, I imagine that both elements have contributed to its emergence and endurance in the Ghanaian vernacular. Appolo’s etymology also speaks to the localisation of disease, as well as localised discourses regarding illness. Such specificity is, however, not well catered for in the increasingly international field of medical education. This is something which has come up, time and again, in discussions with doctors in training and in practice in Ghana. The need for translation is an everyday occurrence in the larger hospitals of teeming, multi-ethnic cities like Tamale, where a dozen or more languages might be heard in the waiting rooms on any given day. It is often only by shanghaiing other hospital residents–doctors, nurses, orderlies, other patients or other patient’s visitors—that clinicians at the Tamale Teaching Hospital are able to exchange words with their patients. But effectively understanding symptoms and histories should transcend the workaday translation of words to embrace the coy turns of phrase and anxious untruths which can impede frank discussions of our fragile selves. One doctor recently told me that, in his opinion at least, two thirds of diagnoses can be made solely from a well-taken history. Effective translation is, of course, central to the practice of medicine in multi-lingual environments, how medical students might prepare to meet such challenges is a rather more complex matter.

Our study considers English-language medical training in three countries which are not, predominantly, English speaking. While we have been focussing on the material technologies by which students learn about the body, biology, illness and health, languages might also be understood as pervasive, albeit somewhat conceptual, technologies which lie at the heart of medical education. As has been outlined in postcolonial histories of biomedicine in African contexts, an eagerness to translate complex, socialised understandings of health into a scientific lexicon can actually betray the insights which might have been gleaned from a truer translation. While this has been explored, to some extent, with a mind to twentieth century medicine, these questions should also be asked of contemporary trends. To what degree, for instance, does learning medicine in English promote the development of a medical profession whose use of an English-scientific lexicon jars with the primary language of the patient public? While medical practice grows ever-more global, patient understanding of medicine does not necessarily keep pace. At the same time, although not necessarily in the same places, a growing number of patients are using the internet to research their symptoms and histories prior to any formal interaction with health professionals. The nature or soundness of patient knowledge is largely beside the point here, what is relevant to the training of doctors is that patient experience remains a central part of clinical assessment at the same time as patient knowledge is growing increasingly irregular.

It is probably no surprise that I see the solutions to these questions in clinical engagement with the social study of medicine. Perhaps, one day, recognising the role of moon germs in the popular aetiology of conjunctivitis will bear some relevance to a differential diagnosis. Who knows, it might even have been moon germs all along.

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