Flesh and Concrete: A Creative Dissection

Novelist Mara Dougall reflects on touch and the sensory experience of dissection

I hadn’t even thought about fainting until he mentioned it.  But the professor was right, the room was very warm – and the smell was brutal.  Strong chemicals and degrading flesh.  I breathed it in all the same, trying to notice every aspect, to remember.  I would need this.

There was an agitated sort of energy as we listened to the instructions; all standing with our recently washed hands held slightly away from our bodies.  Nobody told us to do that.  The flesh we would be cutting was already dead.  We were only playing, but it was funny how well we took to the role.  As soon as they gave us those white coats.  Bright and stiff, and I knew I wouldn’t faint after all.

It was May, 2018.  I’d come to Edinburgh’s Surgeons’ Hall to look at the collections – rows of specimens in jars, portraits of distinguished gentlemen, surgical instruments in display cabinets – but also to touch.  In fact, I’d mainly come to dissect a pig heart and I was looking forward to it more than any decent vegan should.  Not even Dr Nicolaes Tulp’s students got as hands on as I was about to; Rembrandt’s famous painting of his anatomy lesson shows several craned necks and eager eyes, but only Tulp is engaging directly with the cadaver, plucking the flexor digitorum superficialis from the midst of the stripped back forearm.  The focus is deeply symbolic.  It was through the mastery of such muscles that the surgeon set himself apart, and hands were already becoming a trope in anatomical art. Vesalius, father of modern anatomy, described the hand and forearm as ‘the physician’s chief instrument’ (Masquelet 2004, 381).   Charles Bell, the Scottish surgeon and anatomist, echoed these sentiments in an 1833 treatise, which ‘valued the hand as a necessary expression and extension of the eye in building knowledge’ (Berkowitz 2014, 382).

The idea of a ‘seeing’ hand particularly appealed to me because I needed to know textures as well as structures. To feel the organ’s temperature and heaviness.   This all mattered because of a story I was writing; about a girl and a guy and their patients and, I suppose somewhere down the line, a pig.

My novel, Unity, is set in 1948, in the months leading up to the birth of the NHS.  The main character is a theatre nurse who wants to be a surgeon.  She knows things I don’t, like the intricate functions of bodies and hospitals, and the weight and feel of surgical instruments in gloved hands.  For the sort of narrative I was aiming to produce, the latter mattered as much as the former.  Reading would only get me so far in terms of building robust and specific historical settings and persons, so I was in the market for some embodied knowledge – something surgeons have specialised in for centuries.  For a curiously long time, physicians sought to elevate their professional standing by elevating themselves clean away from the bodies of their patients.  The comparatively manual nature of the surgeon’s craft, which had seen them historically dismissed as ‘sawbones’ tradesmen,  produced a particular type of embodied knowledge  that was eventually seen as an integral part of any medical education (Brown 2018, 23).  Whilst my medical education wouldn’t equip me to treat even a pig, it would give me the sensory detail I needed so I could have my protagonist repeat the procedure, and bring that to life on the page.

A sculpture outside Surgeons’ Hall depicts a giant hand, clutching a giant blade.  The metal material and its circular motif merges fingers and knife; it has a whiff of art deco about it, and the distinct threat of violence.  It made me think about Freud’s vision of Man as ‘prosthetic god’, and of how objects can, and in the case of the surgeon, must, be incorporated into a person’s body image – all of which is discussed in Elizabeth Grosz’s Volatile Bodies (1994).  Of course, aside from having my own volatile body to contend with, I wasn’t under any illusions as to the skills I was bringing to the dissecting room.  Squeamish.  Ham-fisted.  Too squeamish even to think the word ham without wincing; it conjured the butchered women splayed across the pages of Hunter’s Gravid Uterus.  Our too porcine flesh.  A pig heart was as close to human as a layman could hope to get.  So even if me and the scalpel weren’t about to become one, I was at least getting to try it out and look the part.

Each person’s heart sat in a grey tray in front of them, so that despite the faint forensic feel, it was in some ways quite like being back at school.  A lot of the gear was familiar.  I had envisioned a series of precise incisions but the heart, it turned out, was as tough as old boots.  It was a plain pair of scissors that the professor pointed us towards first, and there was a fair bit of fleshy resistance before the metal snipped all the way through.  Even the daintier parts proved surprisingly strong.

‘That’s the heart strings.’  The professor held his up and pointed.

I looked for the thin threads, scooping another slimy black clot out the way and catching the metallic tang of it.

‘If you slide the side of your tweezers underneath one, you’ll find you can lift the whole organ.’

Right enough, it took the strain no bother.  I watched the organ slowly swing for a moment in front of my face, thoroughly impressed, but also thinking – well, the tired metaphors pretty much write themselves.  Later though, poking about inside my heart, I was struck by glistening tuberculae carnea, spread out like a dense and tiny forest.  Sleek bare winter branches, reaching up and out and all intertwined.  All appallingly sentimental.  Was a medical gaze allowed to be this sentimental?  According to Foucault it was a ‘gaze that burns’, but is at the same time the ‘gaze of concrete sensibility’ (1973, 147/148) – cold and hard.  At first I tried imagining how my protagonist would see it; how would I frame the observations as hers?  But then I wondered what it would feel like for a 1940s woman, in a male domain, to go about cultivating a concrete gaze.  What might the potential side-effects be?  This question implanted itself in both the creative and critical components of my PhD.

Touch is a crucial part of the plurisensorial medical gaze which can be objectifying and/or constitutive, depending on the levels of empathy employed.  Fictional narratives encourage empathic engagement – so creative writing seemed a fitting tool with which to examine bodies that had been problematised in the past: transgressive, ambitious, female bodies.

As a writer rooted in realism, with particular visceral interests, my research often gravitates towards the material, the sensory, the psychogeographic.  Engaging with historical objects offers a corporeal connection to the past.  Fortunately, my period of inquiry lends itself particularly well to this; the 1940s are so relatively close you can often reach out and touch them.  Even within my own home I’ve accrued books printed on rationed paper and pre-war medical paraphernalia.  The thinness of a novel’s pages, or a stethoscope’s cracked rubber tubing are themselves interesting things – but the factuality of the people that handled them first gives any engagement an almost mimetic quality.  Touch instigates creative connections and cultivates knowledge.

In the archives too, objects from the period of inquiry offer an open line through which we can trace the emotional echoes of historical persons.  At the Royal College of Nursing archive I leafed through carefully kept exercise books, with anatomical diagrams sketched in colour pencil, and lines of handwritten hospital rules.  This helped foster a deeper empathic connection than the infirmary histories alone would allow.  By using specific sensory detail in my narratives, particularly the tactile and the textural, I hope to extend this connection to the reader – as they process the information through their own body (something cognitive scientists are increasingly researching).  Yet, the more specific detail becomes, the greater the pressure to get things right, especially when dealing with a period within living memory and loaded with national and personal significance.  Even when going the extra mile in terms of experiential research, doubts abound.  Back then, were the surgical gloves (repeatedly boiled and powdered) much thicker?  Did that change the feel of the scalpel, or how cold the flesh felt?  And even more vitally – would my characters, trained in specialist skills, and practised in detachment, notice the same things as me at all?

I was still thinking about this, peering at the intricate pink layers, when I clocked another white coat pause by my elbow.  As I looked up to meet the professor’s eye, I don’t know whether it was the state-sanctioned looking scissors, or the plastic trays, or the poetic thoughts – but I had the distinct sensation of being caught.  He just smiled though.  Gave a slight nod.

‘They look like little trees don’t they.’

Mara Dougall is currently in the third year of her PhD in creative writing and history of medicine at the University of Strathclyde.  Her interdisciplinary project explores embodied narratives, female sexuality, and the history of contraception, in early 20^th century Britain. Twitter handle: @dougallmara

Notes: With thanks to Surgeons’ Hall Museums, and in particular Senior Research Fellow, Professor Ken Donaldson.

Works Cited:

Berkowitz, Carin. 2014. “Charles Bell’s Seeing Hand: Teaching Anatomy to the Senses in Britain, 1750–1840.” History of Science 52 (4): 377-400. https://doi.org/10.1177/0073275314559334

Brown, Michael. 2018. “Surgery, Identity and Embodied Emotion: John Bell, James Gregory and the Edinburgh ‘Medical War’.” History 104 (359): 19-41. https://doi.org/10.1111/1468-229X.12720

Foucault, Michel. 2008. The Birth of the Clinic: An Archaeology of Medical Perception. Translated by A. M. Sheridan. London and New York: Routledge.

Grosz, Elizabeth. 1994. Volatile BodiesL Towards a Corporeal Feminism. Bloomington and Indianapolis:  Indiana University Press.

Masquelet, A. C. 2005. “The Anatomy Lesson of Dr Tulp.” Journal of Hand Surgery: British and European Volume 30 (4): 379-381. https://doi.org/10.1016/j.jhsb.2004.11.005