n otes on c ontributors
Bill Ashcroft is a renowned critic and theorist, founding exponent of postcolonial theory and co-author of The Empire Writes Back, the frst text to offer a systematic examination of the feld of postcolonial studies. He is author and co-author of twenty-one books and over 190 articles and chapters, variously translated into six languages, and he is on the editorial boards of ten international journals. His latest work is Utopianism in Postcolonial Literatures. He is Emeritus Professor at the University of NSW and a fellow of the Australian Academy of the Humanities.
Grzegorz Czemiel is Assistant Professor in the Department of AngloIrish Literature at the Maria Curie-Skłodowska University in Lublin, Poland. He received his Ph.D. from the University of Warsaw on the basis of a dissertation on Ciaran Carson’s poetry (Limits of Orality and Textuality in Ciaran Carson’s Poetry, Frankfurt am Main 2014). His academic interests include contemporary poetry, speculative and weird fction, and translation studies, as well as literary theory and philosophy, especially ecopoetics and Speculative Realism. Currently, he is developing the concept of “speculative cartography,” involving poetry as a geophilosophical mode of making cognitive maps. He also translates academic books.
Simon Ferdinand is an interdisciplinary researcher whose interests sit between visual culture, geography, and globalization studies. Having read Theatre and Performance and taught History of Art at the University of Warwick, he received his Ph.D. cum laude from the
University of Amsterdam in 2017. He is the author of Mapping Beyond Measure: Art, Cartography and the Space of Global Modernity, which will appear with the University of Nebraska Press in 2019, as well as of numerous articles and chapters on artistic mapping practices and cultural visions of globalization and the global. Currently, he is co-editing a book named Interrupting Globalization: Heterotopia in the Twenty-First Century.
Patrick D. Flores is Professor of Art Studies in the Department of Art Studies at the University of the Philippines, which he chaired from 1997 to 2003, and Curator of the Vargas Museum in Manila. He was one of the curators of Under Construction: New Dimensions in Asian Art in 2000 and the Gwangju Biennale (Position Papers) in 2008. He was a visiting fellow at the National Gallery of Art in Washington, D.C. in 1999 and an Asian Public Intellectuals Fellow in 2004. Among his publications are Painting History: Revisions in Philippine Colonial Art (1999); Remarkable Collection: Art, History, and the National Museum (2006); and Past Peripheral: Curation in Southeast Asia (2008). He was a grantee of the Asian Cultural Council (2010), a member of the Advisory Board of the exhibition The Global Contemporary: Art Worlds After 1989 (2011), organized by the Center for Art and Media in Karlsruhe, and member of the Guggenheim Museum’s Asian Art Council (2011 and 2014). He co-edited the Southeast Asian issue with Joan Kee for Third Text (2011). He convened in 2013 on behalf of the Clark Institute and the Department of Art Studies of the University of the Philippines the conference “Histories of Art History in Southeast Asia” in Manila. He was a Guest Scholar of the Getty Research Institute in Los Angeles in 2014. He curated an exhibition of contemporary art from Southeast Asia and Southeast Europe titled South by Southeast and the Philippine Pavilion at the Venice Biennale in 2015. He has been appointed the Artistic Director of Singapore Biennale 2019.
Peter Hess is Associate Professor at the University of Texas at Austin. His main research focus has been on early modern German literary and cultural studies (1480–1680) with occasional forays into current issues. His earlier work focused on rhetoric, poetics, and generally on literary studies, with books on the poetics of Georg Philipp Harsdörffer and on the epigram. Recent work has taken a cultural studies perspective. He has just completed a book manuscript entitled Crisis, Transgression,
Discipline, Ordering: Resisting Pluralization and Globalization in German Literature, 1490–1540. Currently, he is preparing a critical English edition of Nikolaus Federmann’s Jndianische Historia, an account of the frst phase of the conquest of Venezuela in 1530–1531.
Peter Hitchcock is Professor of English at the Graduate Center (GC) and Baruch College of the City University of New York. He is also one of the faculty of Women’s Studies and Film Studies at the GC and is currently the Associate Director of the Center for Place, Culture, and Politics. His books include Dialogics of the Oppressed, Oscillate Wildly, Imaginary States, The Long Space, and Labor in Culture. He has also co-edited two collections, on the New Public Intellectual, and The Debt Age. His current research projects include a book on postcoloniality and the state, and another book on critical fnance studies called “Trading Objects.”
Cóilín Parsons is Associate Professor of English at Georgetown University. He is the author of The Ordnance Survey and Modern Irish Literature (Oxford University Press, 2016), and a co-editor of Science, Technology, and Irish Modernism (Syracuse University Press, 2019) and Relocations: Reading Culture in South Africa (University of Cape Town Press, 2015). The Ordnance Survey and Modern Irish Literature was awarded the Robert Rhodes Prize for best book on literature by the American Conference of Irish Studies, and shortlisted for the Modernist Studies Association First Book Prize. He is currently working on a monograph on astronomy, scale, and modernism.
Esther Peeren is Professor of Cultural Analysis at the University of Amsterdam and Director of the Amsterdam School for Cultural Analysis (ASCA). She leads the ERC-funded project “Imagining the Rural in a Globalizing World” (2018–2023). Recent publications include The Spectral Metaphor: Living Ghosts and the Agency of Invisibility (Palgrave, 2014) and the edited volumes Peripheral Visions in the Globalizing Present: Space, Mobility, Aesthetics (Brill, 2016, with Hanneke Stuit and Astrid Van Weyenberg) and Global Cultures of Contestation: Mobility, Sustainability, Aesthetics & Connectivity (Palgrave, 2018, with Robin Celikates, Jeroen de Kloet and Thomas Poell).
Alexis Radisoglou is a fellow of Lincoln College at the University of Oxford, where he teaches German and Comparative Literature. He publishes on twentieth-century and contemporary literature, flm, and visual
art, and is currently working on a book project titled Globe and Planet in Contemporary Aesthetics.
Christoph Schaub received his Ph.D. in Germanic Languages from Columbia University in 2015 and subsequently taught at Columbia University and Duke University. A former fellow of the Fulbright, Whiting, and Rosa Luxemburg Foundations, his research on literary and cultural globalization, labor movement literature, urban culture, modernism, and popular music has been published in such journals as New German Critique, Modernism/modernity, Monatshefte, Weimarer Beiträge, IASL, and Amerikastudien/American Studies.
Robert T. Tally Jr. is the NEH Distinguished Teaching Professor in the Humanities and Professor of English at Texas State University. He is the author of numerous books, including Topophrenia: Place, Narrative, and the Spatial Imagination (2019), Fredric Jameson: The Project of Dialectical Criticism (2014), Poe and the Subversion of American Literature (2014) Utopia in the Age of Globalization (2013), Spatiality (2013), and Melville, Mapping, and Globalization (2009). His edited collections include Teaching Space, Place, and Literature (2018), The Routledge Handbook of Literature and Space (2017), Ecocriticism and Geocriticism (2016), The Geocritical Legacies of Edward W. Said (2015), Literary Cartographies (2014), and Geocritical Explorations (2011). He is also the general editor of “Geocriticism and Spatial Literary Studies,” a Palgrave Macmillan book series.
Miriam Tola is an interdisciplinary scholar of feminist theory, political ecology, social activism, and flm studies. Her work has appeared in Theory & Event, PhaenEx, South Atlantic Quarterly, Feminist Review, and Environmental Humanities. She is an Assistant Teaching Professor in the Media and Screen Studies Program and the Women, Gender and Sexuality Studies Program at Northeastern University.
Irene Villaescusa-Illán has taught Spanish language, literature, and culture in France, Hong Kong, and The Netherlands. Currently, she is a guest researcher at ASCA, the Amsterdam School of Cultural Analysis at the University of Amsterdam, where she completed her Ph.D. dissertation entitled Writing the Nation: Transculturation and Nationalism in Hispano-Filipino Literature from the Early Twentieth Century. She is working on her frst monograph derived from her Ph.D. research. She has published on Philippine literature written in Spanish in the Revista
de Crítica Literaria Lationamericana (2018) and Unitas, the bi-annual journal of the University of Santo Tomás in the Philippines (forthcoming). Her research interests include global Hispanic Studies, world and comparative literatures, globalization studies, and travel writing.
Jennifer Wenzel is a scholar of postcolonial studies and environmental and energy humanities at Columbia University, where she is an Associate Professor in the Department of English and Comparative Literature and the Department of Middle Eastern, South Asian, and African Studies. She is the author of Bulletproof: Afterlives of Anticolonial Prophecy in South Africa and Beyond (Chicago and KwaZulu-Natal, 2009) and co-editor (with Imre Szeman and Patricia Yaeger) of Fueling Culture: 101 Words for Energy and Environment (Fordham, 2017). A new monograph on world literature and environment crisis is forthcoming from Fordham UP in 2019.
l ist of f igures
Fig. 3.1 “The Third Day.” Hieronymus Bosch, The Garden of Earthly Delights, closed state, 1490–1510. Panel Painting, 205.6 × 193 cm. Museo Nacional del Prado (Courtesy of The Print Collector/Alamy Stock Photo)
Fig. 3.2 Detail of “The Third Day”
Fig. 3.3 Detail of “The Third Day”
Fig. 3.4 Children’s drawings of the earth (From Vosniadou and Brewer [1992]. Reprinted with permission from Elsevier [under STM permissions])
Fig. 3.5 Hieronymus Bosch, The Pedlar, 1494–1516. Oil on panel, 71 × 70.6 cm (Courtesy of Peter van Evert/Alamy Stock Photo)
Fig. 3.6 Being in the globe. Detail of Hieronymus Bosch, The Garden of Earthly Delights, central inner panel (Prado Museum)
Fig. 3.7 “Is this a globe or a sphere?” Detail of Hieronymus Bosch, The Garden of Earthly Delights, central inner panel (Prado Museum)
Fig. 4.1 Esteban Villanueva, Basi Revolt, 1821. Oil on canvas, 92 × 92 cm (Photograph by the author)
Fig. 4.2 Esteban Villanueva, Basi Revolt, 1821. Oil on canvas, 92 × 92 cm (Photograph by the author)
Fig. 4.3 Anonymous, Meditation on the Creation of the World, the Life and Sacred Passion of the Lord Jesus Christ, His Glorious Ascension, the Coming of the Holy Spirit, Death, and Assumption of Most Holy Mary Our Lady, 1794. Medium
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unknown, dimensions unknown (Courtesy of the San Agustin Museum, Intramuros, Manila and the Luis Ma. Araneta Gallery)
Fig. 4.4 Anonymous, Meditation on the Creation of the World, the Life and Sacred Passion of the Lord Jesus Christ, His Glorious Ascension, the Coming of the Holy Spirit, Death, and Assumption of Most Holy Mary Our Lady, 1794. Medium unknown, dimensions unknown (Courtesy of the San Agustin Museum, Intramuros, Manila and the Luis Ma. Araneta Gallery)
Fig. 12.1 Dirty Sexecology, Calderwood Pavillion, Boston, 13 November 2009 (Photograph by Mark Snyder, Courtesy of Annie Sprinkle and Beth Stephens)
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Introduction. Other Globes: Past and Peripheral Imaginations of Globalization
Simon Ferdinand, Irene Villaescusa-Illán and Esther Peeren
In the incendiary opening lines of their Dialectic of Enlightenment, Max Horkheimer and Theodor W. Adorno observe how although “the Enlightenment has always aimed at liberating men from fear and establishing their sovereignty,” “the fully enlightened earth radiates disaster triumphant” (2002 [1944], 3). We begin this Introduction with this stark statement on the outcome of the enlightenment, not because we adhere to Horkheimer and Adorno’s gloomy teleologies, which now seem all too transparently overdetermined by the backdrop of exile, genocide, and global war. What interests us, in introducing this volume, is rather how the Dialectic’s grand narrative begins with an image of the earth. Through this image, we approach the disasters of “enlightenment,” which, for Horkheimer and Adorno, describes not just the eighteenth-century hegemony of positivist experimental science, but a deep history of instrumental rationality, culminating in capitalist regimes
S. Ferdinand (*) · I. Villaescusa-Illán · E. Peeren
University of Amsterdam, Amsterdam, The Netherlands
© The Author(s) 2019
S. Ferdinand et al. (eds.), Other Globes, Palgrave Studies in Globalization, Culture and Society, https://doi.org/10.1007/978-3-030-14980-2_1
of enframing and exploiting people, places, and polities. The “earth” is not a neutral backcloth against which this history plays out. Instead, the “fully enlightened earth” can be construed as the specifc conception of Earth produced by enlightenment, that is, the “wholly grasped and mathematized” globe (Horkheimer and Adorno 2002, 25, translation modifed).1 Indeed, the mapped modern globe encapsulates the different characteristics that the Dialectic imputes to instrumental rationality. It reduces nature to the “mere objectivity” of an inert surface; equalizes qualitative differences by asserting general fungibility and calculability; distances the viewing subject from earthbound objects, establishing its mastery over them; and constructs a framework for total knowledge, which curves back on itself in a global rotundity (Horkheimer and Adorno 2002, 3–42). Admittedly, Horkheimer and Adorno write of the “fully enlightened earth” and the “disenchantment of the world” without explicitly theorizing the spatialities of enlightenment. Extrapolating from their analysis, however, we would suggest that instrumental rationality reduces both world and earth—the specifcity of which we go on to discuss—to the reifed framework of a geometrically conceived globe (2002, 3).
Today, advertising and media especially are saturated by fgures of the global, ranging from photographs of the Earth taken from spacecraft or its moon, through daily references to “globalization” or “global issues” in news broadcasting, to the global logos that brand transnational corporations. As Bronislaw Szerszynski has argued, such unobtrusive forms of global imagining have permeated quotidian culture so thoroughly in recent decades as to “constitute an unremarked, all-pervasive background to people’s lives … with the potential to reshape their sense of belonging” (2005, 166). Szerszynski uses the term “banal globalism” to refer to the commonplace condition in which taken-for-granted imaginations of globalization—whether they relate to fnance, environmentalism, news, or tourism—frame identities and experience in inconspicuous ways that escape conscious refection (Szerszynski 2005, 165–167).2 It is important to emphasize that Szerszynski does not invoke banality in the evaluative sense of inconsequential or trite. Rather, banality here signals how global images are so pervasive and familiar in contemporary culture as to evade scrutiny. While some banal global images are much more
idiosyncratic than their commonplace character might frst suggest (Ferdinand 2018b), most reinforce dominant ways of construing globalization and inhabiting the global. In the imagination of globality thus reproduced, the Earth is conceived as a neoliberal globe of frictionless circulation through which fows of commodities, communications, and communities move unimpeded by the constraints of time and geography; and as a calculable geode, available to measurement, management, and manipulation. In a manner consonant with Horkheimer and Adorno’s vision of calamitous totality, critical scholarship has tended to emphasize the deleterious effects of this now pervasive imagination of the global. As we go on to demonstrate below, critics have variously argued that dominant global imaginations estrange people from place; reduce the planet’s ecological and cultural diversity to an objectifed, homogenous system; occasion visions of imperial conquest and mastery; and expedite the exploitation of peoples and environments.
Against this backdrop, Other Globes sets out to show how the prevailing vision of the capitalist and calculable globe represents only one among many possible ways in which the global has been—and might be—articulated. Although the volume draws extensively on scholarship critical of dominant global discourses, our intention is less to enlarge this critical mass than to highlight the abundance and variety of alternative imaginations of globalization and the global. Whether before the historical ascendance of the capitalist and calculable globe in the early modern period or at its fringes today, cultural practice brims with different, imaginative ways of narrating and representing the global. In the contemporary context of intensive capitalist globalization, ruthless geopolitics, and unabated environmental exploitation, these various “other globes” offer paths for thinking beyond the globality we have—paradigms for alternative relations among people, polities, and the planet. Accordingly, the chapters in this volume present a collection of case studies of diverse cultural imaginations of the globe, the earth, the world, and the planet in works of art, literature, performance, flm, and music, emphasizing how they emerge or can be mobilized as counterpoints to hegemonic representations of globes and globalization. Derived from, among others, the disparate historical and cultural contexts of the Holy Roman Empire (Hess); late Medieval Brabant (Ferdinand); the colonial and postcolonial
Philippines (Flores; Villaescusa-Illán); early twentieth-century Britain (Parsons); contemporary Puerto Rico (Hitchcock); occupied Palestine (Hitchcock); postcolonial South Africa (Ashcroft) and Chile (Radisoglu); and California (Tola), these alternative articulations of the global often contradict one another. Nonetheless, their diversity emphasizes how there is no single, transparent way in which to imagine globalization—no neutral or natural way to inhabit the global. A renewed cognizance of the rich multiplicity of global imaginations underlines the contingency and constructedness of the supposedly fully mapped and spanned modern globe, and interrupts the cultural work of naturalization through which dominant imaginations fade into the taken-for-granted background of everyday life.
The volume collects an archive of qualitatively different ways of conceiving and approaching the global. To avoid establishing new hierarchies among diverse global imaginations, it is largely organized chronologically. Though the counter-imaginations analyzed are specifc to each case study and must be grasped on their own terms, overall they tend to emphasize relationality and heterogeneity, while challenging detached, dominative, and homogenizing global representations. Besides showing how they dispel the global’s dominant associations with transcendence, objectivity, and mastery, the contributions underline how “other globes” are themselves emplaced and entangled in the power and politics of globalization processes, and participate in shaping them. As a result, there can be no absolute distinction between dominant and alternative global imaginations: hidden complexities may inhabit dominant global imaginations, while alternative global imaginations may exhibit forms of ideological reduction.
The remainder of this Introduction is structured as follows. We begin with a discussion of the divergent meanings of the words “globe,” “world,” “earth,” and “planet,” highlighting how each preconditions distinct perceptions of and practices toward what is currently named “the global.” Subsequently, we explain how the volume situates global imaginations, describing what we mean by central and peripheral, and elaborating a genealogy of global imaginations focusing on how the opposition between dominant and alternative imaginations emerged in and through modern terrestrial globalism’s rise to hegemony. After surveying some major theoretical critiques of dominant global imaginations, and explaining how the volume’s contributions relate to them, we close this Introduction with a chapter outline.
globe, eArth, world, And PlAnet
In attending to different cultural imaginations of globalization, this volume insists from the outset on the importance of the globe embedded in its very name. Although this may seem obvious, the presence of the globe in globalization—or, alternatively, the monde in the French mondialisation and Dutch mondialisering—is seldom refected upon explicitly. As W. J. T. Mitchell has written, even when scholars set out to actively scrutinize prevalent understandings of globalization, “the general tendency has been to talk about the global distribution” of its various products, fows, risks, and rewards, while allowing globalization as an idea—a culturally mediated imagination, grounded in specifc “images of the world and the global as such”—to proceed unexamined (2007, 50, emphasis in text). And yet, to speak about globalization, whether extolling its virtues or bemoaning its consequences, entails grasping and inhabiting social reality in and through a specifc thought-image that is, ultimately, cartographic and astronomical: the spherical globe—whether measured and visually mapped, or photographed from afar against a backdrop of stars and void. If, as Denis Cosgrove has argued, it is from this global fgure “that ideas of globalization draw their expressive and political force” (2001, ix), then exploring alternative words for the global might destabilize and reconfgure our ideas of globalization. Accordingly, we will proceed to offer a partial taxonomy of ostensible synonyms for the globe, emphasizing their different histories, cultural associations, and socialpolitical implications. By attending to the notions of globe, earth, world, and planet, we mean to unpack some of the alternative conceptual bases through which the case studies in this volume approach globalization processes.
The modern word globe denotes “a spherical or rounded body”; “the earth” itself; or “a spherical representation of the earth” (OED). It derives from the classical Latin globus, which means the “sphere of a celestial object,” but also a “dense mass,” such as a “closely packed throng of soldiers” (OED).3 Since antiquity, the globe has been associated with the arts of geometry and metaphysical refection (Sloterdijk 2014, 13–43). As the “most geometrically perfect three-dimensional body,” it was a key conceptual fgure in Neoplatonic thought, for which the globe signifed the “incorruptible perfection of mathematical relations and forms” held to lie behind given appearances (Cosgrove 2001, 10). As such, the globe is abstract, detached, and artifcial. It emphasizes
“volume and surface over material constitution”; is observed from without by a distant calculative gaze; and reduces environmental diversity to geometrical regularity (Cosgrove 2001, 8). The globe has also signifed territorial dominion. An especially infuential early example is the medieval and early modern iconography of the globus cruciger: a globe, often trisected to connote the three continents known to medieval European cultures, to which a Christian cross is affxed (Cosgrove 2001, 10–11; Sloterdijk 2014, 53–57). In its metaphysical mode, then, the globe is associated with an impulse to transcend and rationalize the given world. In its political mode, it signifes unbounded dominion. Together, these connotations indicate a mastering, “implicitly imperial” vision of the globe as a “geometric surface to be explored and mapped, inscribed with content, knowledge, and authority” (Cosgrove 2001, 15–16).
Although often used interchangeably with globe, the term earth has a very different cultural signifcance. Notions of the globe emphasize dimensionality; earth, in contrast, connotes materiality and substantiality. It names both “the planet Earth” (OED) and the “nourishing, fertile and fecund substance … which covers its surface” (Mitchell 2007, 54). Earth denotes the substance common to different terrestrial scales, encompassing both planetary immensity and the ground beneath one’s feet. It fgures centrally across historical understandings of physics, from the fve agents (wu xing) of ancient Chinese philosophy to the four elements of Platonic and Aristotelian thought. A feminine noun in Germanic and Latin languages, earth has been personifed or referred to as a woman in numerous cultures. As Miriam Tola shows in her contribution to this volume, in patriarchal contexts, such imaginations of earth reduce women’s possible social roles to a “natural” realm of earthly fertility, immanence, and reproduction, in contrast to the masculine, historical space of the global. Above all, writes Cosgrove, “Earth is organic” (2001, 7). Whereas the globe is associated with artifciality and geometrical order, earth, as the nourishing soil of agriculture and horticulture, “denotes rootedness, nurture, and dwelling for living things: earth is the ground from which life springs, is lived, and returns at death” (Cosgrove 2001, 7). Through burial practices and cultural modes of being toward buried ancestors, as Robert Pogue Harrison has emphasized, the earth becomes a medium through which cultural legacies are interred and retrieved—or “unearthed” (2003, x–xi). If the globe implies extraterrestrial detachment, for Harrison the earth provides the “humic foundations” in the absence of which notions of “humanity” lose their meaning (2003, x).
Until the eighteenth century, the Latin mundus was often used to signify totality: the “agglomeration of all totality of existent things” (Leibniz, qtd. in David 2014, 1220). Since then, however, that meaning has been taken up by universe, with world dissociated into different meanings. In current usage, world refers to “the earth and everything on it, the globe,” but also to a “state or realm of human existence on earth” (OED). As such, it is a distinctly more anthropocentric and conceptual term than earth, which connotes the organic reciprocity of life as such. “Consciousness alone can constitute the world,” writes Cosgrove, for whom “world implies cognition and agency” (2001, 7). A world indicates a domain of human activity in its spatial and experiential dimensions. It can form at individual, collective, and universal scales. We speak of someone being in “their own world”; entering the “business world”; or fret that “the whole world knows.” A world’s geographical dimension does not necessarily coincide with the entire physical earth, but rather indicates the scope of particular cultural domains. In foregrounding the domain of lived experience, world has been an important concept in phenomenology and existential philosophy.4 For Martin Heidegger, world was among the three “fundamental concepts of metaphysics” (1995, title). In his famous analysis of an ancient Greek temple, Heidegger defnes world as the “open relational context” of a “historical people” (1992, 167). It is the existential space in which a given culture’s understanding of existence unfolds: “a horizon of disclosure” or “horizon of intelligibility” within the bounds of which particular beings take on particular purposes and meanings, and possibilities for relating to them are determined (Young 2001, 23, 104). This Heideggerian concept of world stands in stark contrast with earth, for a world establishes what the earth is and means, and the possible ways of relating to it, in the frst place. As such, this notion of world opens up a wider taxonomy, in that various cultural worlds might each contain further specifc ways of naming the global.5
Two senses of worldliness are also pertinent to this volume. The frst has to do with cosmopolitanism. To say that a person is worldly is to suggest that they have experience of, or familiarity with, wide-ranging cultural contexts, and have adopted variously fexible, realistic, or openminded attitudes as a result. To be worldly in this sense—to “know the world” or the “ways of the world”—may also connote “sexual experience, a certain feshy materialism” (David 2014, 1221). The second sense relates to Christianity, which, in its several traditions, has opposed
a transcendental and eternal heavenly realm to all that is temporal, fallen, appetitive, and profane—in a word, all that is worldly. Here, the worldly “takes on a negative connotation, even one of damnation” (David 2014, 1218). Worldliness in this sense aligns closely with the idea of the mundane; as Mitchell points out, this implies that the French mondialisation comes “close to equating globalization with an epidemic of boredom and inanity” (2007, 53).6
Set in the context of extraterrestrial space, the world, earth, or globe becomes a planet, derived from the ancient Greek word for “wanderer” (OED). A cosmic body among innumerable others in a largely barren and ancient universe, the planet is not constructed, controlled, and contemplated like a globe: it preceded (and will succeed) human life by many billions of years. Unlike a world, the planet exceeds the domain of specifcally human experience and meaning. Given the planet’s resistance to anthropocentrism and control, concepts of “planetarity” or “the planetary” have been mobilized as conceptual alternatives to globality and the global. Although Amy J. Elias and Christian Moraru, in their survey of the planetary “structure of awareness” in culture and theory, indicate diverse precedents and infuences for the contemporary “planetary turn” (2015, xi), work by the literary theorist Gayatri Chakravorty Spivak remains its central point of reference.7
Spivak emphasizes how “the ‘global’ notion allows us to think that we can aim to control globality,” while “planetarity … is not susceptible to the subject’s grasp” (2014, 1223). Her concept of planetarity remains explorative; the “motif of the planet,” as Satoshi Ukai picturesquely puts it, “like a so-called comet … cast a streak of light through [Spivak’s] works and then vanished” (2017, 27). Still, Spivak’s remarks on planetarity, above all in Death of a Discipline (2003), have become touchstones across contemporary reconsiderations of the global:
I propose the planet to overwrite the globe. Globalization is the imposition of the same system of exchange everywhere. In the grillwork of electronic capital, we achieve that abstract ball covered in latitudes and longitudes, cut by vertical lines, once the equator and the tropics and so on, now drawn by the requirements of Geographical Information Systems. … The globe is on our computers. No one lives there. It allows us to think that we can aim to control it. The planet is in the species of alterity, belonging to another system; and yet we inhabit it, on loan. (2003, 72)
To be human is to be intended towards the other. We provide for ourselves transcendental fgurations of what we think is the origin of this animating gift: mother, nation, god, nature. These are names of alterity, some more radical than others. Planet thought opens up to embrace an inexhaustible taxonomy of such names. (2003, 73)
Several aspects of Spivak’s formulation warrant emphasis in introducing this volume.8 First, she conceives the planetary in opposition to the distance and disengagement imputed to global overviews: even as we are confronted by the planet’s alterity, its startling strangeness, humans inhabit and participate in it as “planetary creatures” (Spivak 1999, 46).9 Against the detached modern globe’s attempted severing of all earthly ties, then, planetary thought is distinguished by a heightened consciousness of relationality, a recognition of our thrownness among “inexhaustible” species of planetary difference. It is on the basis of this relationality that Elias and Moraru write that planetarity’s “preeminent thrust is ethical” (2015, xii). Second, the planetary indicates an alternative subjective stance toward beings and the world. In a 2006 essay, Spivak conveys humanity’s planetary condition by quoting the musician Laurie Anderson, for whom “the scale of space” invites “thinking about human beings and what worms we are” (108). We are, Spivak expands elsewhere, “a glitch/blip on the cycle that pushes up the daisies” (2012, 495). In his analysis of interplanetary travel in H. G. Wells’s First Men in the Moon in this volume, Cóilín Parsons refects at length on this “humbling” of humanity before the planetary. In Wells’s imagination of space travel, Parsons demonstrates, imperial attitudes of global mastery and Apollonian composure disintegrate before the disorienting, vertiginous spatialities and undifferentiated temporalities of the planetary scale. Third, Spivak suggests that planetarity “is perhaps best imagined from the precapitalist cultures of the planet,” yet does not develop the thought (2003, 101). Other Globes picks up this orphaned suggestion, which resonates complexly with Peter Hess’s discussion of reactions to the onset of capitalist globalization in the sixteenth-century Holy Roman Empire; Simon Ferdinand’s analysis of late medieval paintings by Hieronymus Bosch, which depict the created world “from within”; and Patrick Flores’s account of Filipino naturalesa.
In discriminating different ways of naming the global, this discussion has shown how there is no neutral terminology with which to refer to the object of the narratives and representations explored in this volume.
All of the available terms—globe, earth, world, planet—are laden with specifc cultural associations and historical baggage. Thus, although in introducing this volume we refer to “global” imaginations, and to the “earth” as their object, we do so under erasure, acknowledging how these terms are differently constituted, mediated, and contested by the narratives and representations discussed in the contributions.
situAting globAl imAginAtions
In focusing on past and peripheral global imaginations, the contributions to this volume not only attend to visions of the global, but also refect on how these visions are positioned within a global feld of shifting political fortunes and cultural hegemonies. This emphasis on the situatedness of global imaginations dispels the aura of transcendence and objectivity that often surrounds global views. Visions and discourses that imagine the whole Earth from an unidentifable perspective are an extreme example of what Donna Haraway has infuentially termed the “God’s eye trick” of “seeing everything from nowhere” (1988, 581). Through this rhetorical strategy, masculinist discourses of control claim to rise above the distorting effects of value-laden earthbound vantage points and subject positions, purportedly being able to fully access, grasp, and manipulate situated objects. This same trick is played by global views, which assume the “appearance of worldless neutrality, purged of all residues of situation and subjectivity” (Ferdinand 2019, n.p.). The intellectual historian Lorraine Daston has termed this denial of positionality “aperspectival objectivity,” showing how it emerged with the development of an international scientifc community in the nineteenth century (1992, 599). Aperspectival objectivity, Daston explains, was constructed around the elimination of contextual infuences and personal characteristics from experimental inquiry, such that scientists came to see the knowledge they produced as escaping perspective, context, and embodiment altogether. Although it is now possible to see the whole earth from spacecraft, throughout history, imaginations of the earth seen from an unmarked, seemingly impersonal, and contextless extraterrestrial gaze have been culturally associated with fantasies of a “view from nowhere” (Nagel 1986; see also Bonneuil and Fressoz 2017, 62–63).
Critical feminist standpoint theory has mounted a thoroughgoing critique of the “God’s eye trick” or “view from nowhere” evoked by modern representations of the globe. In allowing, as Marianne Janack
puts it, “the views of some-people-in-particular” to pass as “the view of no-one-in-particular,” the construction of a positionality amounts to a power-laden rhetorical strategy, endowing some knowledge claims with (false) epistemic authority over others (2002, 273). Other Globes extends standpoint theory’s critique of the rhetorics of objectivity and insistence on the “radical historical contingency of all knowledge claims and knowing subjects” (Haraway 1988, 579) to the study of global imaginations. By emphasizing the situatedness of global discourses, our aim is to dismantle received epistemological hierarchies through which capitalist and colonial, masculinist and measurable articulations of the global have prevailed over other imaginations, historically and today. This focus on grounding ostensibly transcendental global imaginations comes across strongly in Grzegorz Czemiel’s contribution to this volume, which explores new “speculative cartographies” as alternatives to detached global visions. Drawing on the work of the ecocritic Timothy Clark, Czemiel emphasizes how extraterrestrial views, even though they look back on the Earth from geostationary orbits or still greater distances, can never truly “server the cords”—material, cultural, political— connecting them to earthbound institutions, concerns, and perspectives. “No matter from how far away or ‘high up’ it is perceived or imagined,” writes Clark, the Earth “is always something we remain ‘inside’ and cannot genuinely perceive from elsewhere” (2015, 33). In insisting on the dependency of global views on terrestrial institutions and frames of understanding, Czemiel and Clark undercut the basis of their association with a transcendent, unmarked “outside.”
Even when people physically escape earth’s gravitational pull through spacefight, they remain caught ineluctability within the intellectual force feld of earthbound cultural imaginations. The pathos of this inescapability is explored in this volume in Alexis Radisoglou’s analysis of planetary visions in Patricio Guzmán’s documentaries, which explore traditions and practices of astronomy in the deserts of northern Chile. As the flms trace the astronomers’ ostensibly transcendental narrations of star formation and intergalactic distances, Guzman’s presentation of planetarity becomes inexorably bound up with Chile’s all-too earthly histories of colonialism and dictatorship. Calcium released from exploding stars becomes the bones of “the disappeared;” the crystal-blue ocean water, which, in the image of earth seen from space, we admire as a miraculous and precious force for life, is also the medium that frst brought colonizers to Chile and where the Pinochet regime disposed of its victims.
“The planetary,” Radisoglou writes, offers “no escape from the exigencies of history” (this volume).
The work of situating global imaginations in sociohistorical contexts has a double signifcance in this volume. First, it annuls received hierarchies among global imaginations, undercutting the way certain conceptions of the global have been valorized, often on account of their imputed objectivity, and prompting a reappraisal of the myriad narratives and representations disprivileged because of their perceived partiality or parochialism. Second, it emphasizes that, far from being immaterial abstractions, the ways in which the global has been imagined are implicated and entangled in the very globalizing processes they represent or describe. In particular, several contributions to this volume highlight how different ways of perceiving, depicting, and narrating the global are imbricated in histories of capitalism and colonialism, which have also played a crucial role in drawing center–periphery distinctions. Signifcant here is Bill Ashcroft’s contribution, which shows how African literatures have narrated global connections and spaces by describing all-too earthbound processes of diaspora, migration, and enslavement. It is precisely because of its status as the exploited periphery of colonial empires that Africa has played a constitutive role in sustaining the capitalist world system and global modernity.
At this point, it is important to pin down what we mean by “peripherality” in the context of shifting historical imaginations of the global. Numerous critics have problematized this loaded term. Some, like Katherine McKittrick, argue that, in calling on a spatial metaphor “to name difference” in the feld of social relations, discourses on peripherality and marginality are often inattentive to “actual geographic displacements”—“material realities of spaces unheard, silenced, and erased” that exist outside a metaphorical register (2006, 57–56). Others suggest that critical references to peripherality might reproduce hierarchical designations of power and cultural value. Denis Cosgrove, for example, writes that “core and periphery … depended upon an imperial and Eurocentric vision” (2001, 15). Still, while we would agree that it is of paramount importance to contest the dubious justifcations adduced by colonial powers to posit and rationalize their centrality, which have included protestations of ethnic superiority and civilizing missions, the language of centrality and peripherality remains indispensable in grasping the power relations that inhere between different global imaginations: “to reject the terminology [of centers and peripheries] as outdated
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distended almost to its bursting point still free or but slightly attached by exudate. In the milder cases there may be found strictures indicating the site of previous lesions. Again, aside from pus, there may be more or less fluid or semisolid fecal matter or dense concretions, in addition to the possible foreign bodies whose presence has been elsewhere considered. In the more subacute or chronic forms there will be found relics of previous rather than active expressions of present trouble, such as strictures, thickenings, contortions, old adhesions, sometimes quite dense, and contained concretions, or other foreign bodies, or one may find appendices shrivelled up or more or less obliterated (appendicitis obliterans).
The role of the omentum has elsewhere been mentioned, but must be alluded to again at this point, since it participates more or less in almost every case of acute appendicitis. The moment the appendix is acutely inflamed the omentum tends to shift itself over toward it and finally around it, and it is not uncommon to find a gangrenous appendix wrapped in a roll of this kindly disposed fatty apron. In fact this may constitute the tumor which may have been already discovered and found to be fixed or movable. The inner surface at least of the omentum thus applied will nearly always have sacrificed itself and one has need usually to remove a considerable area of gangrenous omentum, as well as the appendix itself, feeling as he does it that he is necessarily sacrificing the best friend that the incriminated appendix has had.
Aside from what may concern the appendix itself the two most serious complicating local conditions are abscess and gangrene with perforation. Abscess is not necessarily the result of perforation, at least at first, but may be due to infection by continuity, the sequence of events being acute appendicitis, with exudation, fixation, and adhesion of surrounding tissues, followed by pus formation, perhaps first within the appendix and then perforating, or perhaps having its origin in the infected exudate exterior to it. So long as this process is localized by a protective barrier of surrounding lymph, with intestinal adhesions and the assistance of the omentum, there is to be dealt with a more or less complicated peri-appendicular abscess, such as in the past was frequently seen and spoken of as perityphlitic. Concerning the frequency of perityphlitic abscess in days gone by
the literature of the previous century will afford ample illustration, but in spite of the surgical acumen and advice of Willard Parker, who taught the profession how to deal with it, its proper explanation did not come until the researches of Fitz, alluded to at the beginning of this chapter. Even now it is perhaps not quite correct to say that every typhlitic abscess, i. e., every collection of pus around the typhlon or head of the large intestine, is of appendicular origin, for the tendency has been to forget the possibility of phlegmonous cellulitis about any part of the bowel without reference to the appendix.
Such a peri-appendicular abscess may be small, containing but a few drops of pus, or extensive, even to the degree of holding a pint or more. The pus is usually offensive and sometimes one will find floating in it shreds of tissue, or even a completely separated and sloughed-off gangrenous appendix. According to the original location of the appendix, and the disposition of the adjoining parts, such a collection of pus may form a tumor in the iliac fossa, which may also fill the pelvis, or may present in the loin, closely simulating a perinephritic abscess.
It is unfortunate when the natural walling off process has failed and we have to deal with a spreading, generalized, septic peritonitis. A partial compromise between these conditions sometimes appears as a widespread yet practically localized peritonitis, in which several loops of bowel have become affixed, and, what is worse, infected to such an extent that they are themselves breaking down, so that there may be impending or actual gangrene of the intestine. Such a condition bespeaks the intensity of the infection and the destructiveness of the infectious process, and produces a condition which may appall the operator. The result is not only acute obstruction of the bowel but such a local condition that one scarcely knows where to begin or terminate his operative efforts. It was in such a case as this that I removed eight feet and nine inches of bowel, the last nine inches including the colon, turning in both ends and making a lateral anastomosis, because of multiple gangrenous patches, each of which taken alone would have required a distinct and laborious intestinal resection, it seeming better to remove the entire amount involved. This patient recovered and was well years
after the operation. Still other complications may disturb the surgeon’s calculations. Thus fecal fistula may have already occurred, or suppurative thrombophlebitis may have already produced the beginnings or an hepatic abscess, while septic expressions within the lungs, the heart, or elsewhere may have also occurred. In addition to this general peritonitis, with all of its terrors, may put a hopeless aspect upon the case.
Treatment.
—Viewed in the above light it will be seen that appendicitis is essentially a surgical disease, and that while mild attacks may at times be successfully conducted to resolution, or tend in that direction without treatment, the danger of spreading infection with all its possible disasters is ever present, and even a mild case is at no moment free from the danger of becoming acute. Considering its widest relations, and believing in the greatest good to the greatest number, the surgeon may easily maintain that, save when it is too late, it is never a mistake to operate, providing operation be properly performed. This, however, is sometimes out of the question, and the laity occasionally assume responsibility for a decision against the better judgment of the profession. We have to accept, then, the fact that, no matter what the theory may be, we are not always allowed to operate when we desire. Nevertheless if a universal rule could be established it could be laid down in terms such as these, that more lives would be saved by operating upon every case of appendicitis as soon as the diagnosis has been made or even in the presence of good reason for suspicion.
With conditions such as they are, and the fact that these cases are usually first seen by general practitioners whose surgical judgment has not been cultivated, and whose prejudices often actuate them, it may be said that every case should be seen early by a surgeon, no layman and no ordinary practitioner of small experience being in position to assume responsibility for delay. It then remains for the judicious and competent operator who may see such a case early, as thus advised, to study it carefully in order to convince himself whether there be about it good and sufficient reasons for not operating. The most honest operator does not gainsay the possibility of mild cases recovering without operation. He does, however, question by which course they run greater risk.
The following may serve as a brief summary of conditions which justify waiting:
1. When symptoms are mild and not increasing in severity;
2. When pain and tenderness are not pronounced and gradually subside;
3. When the pulse rate does not exceed 100;
4. When temperature is not rising nor showing abrupt changes, especially if during the first thirty-six hours there have been no rise. (Murphy states that if there has been no temperature during the first thirty-six hours he begins to doubt the diagnosis.)
5. When the belly is not distending;
6. When rigidity is not increasing and there is no evidence of peritonitis;
7. When nausea is not increasing;
8. When neither in facial expression nor elsewhere are there evidences of septic infection;
9. When there is no perceptible tumor in the right iliac fossa. Under the above conditions the conservative surgeon will be justified in waiting; being prompt, however, to intervene, should there be change for the worse in any one of the features specified. Even here it may be said that with conditions all as favorable as above represented pus may be present (in small quantity) and the whole picture may suddenly change into one of local disaster. Finally it may be summed up in these words: When there is no doubt as to the advisability of waiting, then wait; but in case of doubt operate, i. e., give the patient the benefit of the doubt, which he in this way the more certainly obtains.
Non-operative Treatment.
—While thus waiting in cases which justify it, what should be done? Absolute rest in bed, even to the extent of using bedpan instead of commode, is the first essential. The second comprises abstention from all food, and practically the temporary starvation of the patient, who may be allowed water in abundance and nothing else. Altogether too much stress has been placed upon the so-called starvation treatment as “saving patients from operation.” Active therapeutic treatment is limited mainly to the use of cathartics and of anodynes, according to reason therefor. On one
hand it is not advisable to rudely stir up the large intestine, one part of whose structure is already involved in a serious and questionable inflammatory process; on the other hand it is not for the general welfare of the patient to permit him to continue with a condition of coprostasis and the ever-increasing stercoremia which it encourages. On the whole it would seem better to clean out the lower bowel at the earliest possible moment, after which if the patient be properly starved there will be less necessity for subsequent active catharsis. The question of anodynes is one of equal importance. Those who bear pain badly, or those who suffer intensely, will demand anodynes, which every physician knows both help to mask the symptoms and interfere with elimination; but such cases seem to be of themselves so violent that the extreme expression of pain should of itself be regarded as an indication for operation. It should be held, then, that cases which demand opiates for relief of pain demand operation even more strongly. In the mild cases, expectantly treated, the local application of ice may be of some value. In effect these cases are to be treated expectantly, and, while expectant treatment is a confession of weakness or of ignorance, it may be unavoidable because early operation is flatly refused.
Indications for Operation.
—Sufficient reasons for not operating being absent or having passed, the following may be considered among the more urgent indications for immediate surgical attack:
1. Continued and especially increasing pain and tenderness;
2. A rapid pulse (110 or over) tending to increase in rapidity;
3. Any rapid change in the temperature, either a sudden rise or a drop to the normal or subnormal, without corresponding improvement in every other particular;
4. Increasing or widespread abdominal rigidity; when the right side of the abdomen of a sensible and non-neurotic subject is rigid this of itself should be sufficient to justify operation;
5. The appearance of tumor in the right iliac fossa;
6. Recurring and especially constant vomiting;
7. Any indication of septic infection, local or general. Such are the indications by which the surgeon may say upon the instant of their recognition that a given case requires immediate operation. Fortunate are both he and the patient if the case be seen
early, when these conditions have but lately shown themselves, and before it be too late. It has been said that almost every death from appendicitis means the loss of a life that might have been saved and for which someone is responsible, this responsibility being divisible among the patient, the parents or family, and the general practitioner who first saw the case and was tardy in recognizing its essential features. While patients die after late operations the surgeon himself is rarely censurable, it not being his fault that he was called in too late, and the patient dying of the progress of the disease in spite of an operation and not because of it.
Operation for appendicitis may be one of the simplest and easiest of the abdominal operations, especially when the acutely infectious element be not present, or it may be one of the most trying and difficult of all possible surgical procedures, taxing alike the judgment of the experienced operator and the resources of the clinic. Much will depend upon the time at which it is performed. If within the first fortyeight hours the surgeon may expect to find but a small amount of pus; if from the second to the fifth day, he may find a well-marked collection, while later he may have not only localized abscess but extensive complications. Again, he who operates between attacks, during the interval or interim stage, will find conditions of adhesion and results of old disease rather than its active products.
These operations should then be considered under these different headings:
1. Early operations in acute cases, where there is little or no tumor;
2. Operations in cases where abscess is present;
3. Operations in cases of more or less peritoneal involvement, with obstruction;
4. Interval operations.
Under the above headings conditions vary so widely that they can scarcely be spoken of or described under the same name. The seat of the disease should first be approached. Here there is wide range for choice of location of incision and even the method of its performance. Some prefer the outer border of the rectus, others go through the rectus muscle proper by an incision parallel to its fibers, which when exposed are separated, its sheath both anteriorly and
posteriorly being divided separately Others go through the abdominal wall by incisions more or less oblique, and made near the anterior superior spine, where are found the different layers of the abdominal muscles arranged in proper order, their fibers being disposed at right angles to each other. That incision is best in each case which affords the shortest and easiest route to the site of the lesion when it can be located. If tumor be present it is ordinarily best to go in directly over it. In the absence of tumor the point of greatest tenderness is the best guide. The possibility of subsequent hernia at the site which is weakened by operation should be taken into account. If it be possible to avoid drainage hernia may usually be avoided. When drainage is necessary hernia is sometimes unavoidable. The advantage of operation through the rectus is that the muscle fibers can be separated without dividing them. Incision here may, however, carry the operator so far from the site of the appendix that he must necessarily disturb the interior arrangement more than is advisable, and thus increase the danger of infection. The oblique exterior incisions near the ilium always permit of separation of the fibers of the external oblique. The deeper muscle fibers which cross at nearly a right angle may sometimes be nicked and widely separated by firm traction, as in the so-called “gridiron method,” or they may require division. A short external incision is desirable when it suffices for the purpose. Considerations of safety (i. e., the better exposure and easier removal of the appendix) may call in some instances for long incisions, and they should be made sufficiently long for his purpose.
It will often happen that as the surgeon passes more deeply toward the peritoneum he will find the tissues more or less edematous. This is a reliable indication of the presence of pus beneath, and should make him open the peritoneum with care and then use extreme caution in his further manipulation, lest by separating recent adhesions he permit pus to escape. The peritoneum being opened sufficiently the finger is gently insinuated, and thus the first orientation concerning internal conditions is obtained. With the exploring finger there should be ascertained, first, the existence of any adhesions; second, their location and relative firmness, and, third, in a general way, the amount of surrounding
disturbance. With an appendix placed anteriorly we may thus come directly upon it, while when placed deeply and posteriorly we may have much to do before reaching it. After the first general exploration the next procedure should be to protect and wall off the region involved from the rest of the abdominal cavity by strips of gauze. These should be long and so secured that none may be lost by being left within the abdomen. The introduction of gauze for this purpose will sometimes increase depression and decrease blood pressure, but it is a necessary procedure in nearly every instance. Moreover, several strips may be needed, and the incision may have to be extended to a limit of two or three inches, according as further exploration reveals a more complicated situation. The fluid pus which may escape should be gently removed with dry gauze, or, if present in considerable amount, be carefully conducted toward the surface. Loops of bowel or tissue bound together by lymph should be gently separated, as they may easily tear, or since imprisoned between them there may be found small collections of pus. If found gangrenous the situation is thereby seriously complicated, and it is advisable not to restore such a loop to the abdominal cavity.
The omentum, as already indicated, may serve as a valuable guide to the location of the appendix, which may be found wrapped within it. It should be handled with great caution, while, at the same time, it is made to reveal the desired information. When the omentum is infiltrated, contorted, and adherent we may be sure of finding pus concealed within the cavity which it helps to wall off. That which is already gangrenous should be removed, with use of sutures in such a way that there shall be no subsequent bleeding. It may be found easily, or not until many other details have been mastered. The involved appendix, when found, may be in one of the conditions described above, all of which demand its removal save those where this has been already accomplished by violence of the disease, in which case the opening in the cecum may have to be closed, or one may employ it for the purpose of an artificial anus. The appendix is often so hard to find that any reliable guide will be welcomed. Such a guide may be found, first, in the location and relation of the omentum, and, secondly, in the cecum if this can be exposed, or in either one of its firm, longitudinal, white tissue bands, which, leading
down on either side of the colon, meet and blend at the point of origin of the appendix. Either of these followed in the right direction leads to this spot. Conditions may be such, however, as to obscure both of these guides, and then the colon should be followed downward toward the ileocecal valve, or the small intestine up toward it, in the belief that in this vicinity, and probably in the centre of the tumor, the appendix will be found. What the surgeon shall next do depends on the details of each case. He has not only to remove the diseased appendix, but to ligate and separate from it its mesentery; furthermore to separate either or both of these from surrounding tissues or organs, e. g., the wall of the pelvis, the ovary, the bladder, the retroperitoneal tissue above the sacrum, or from the lateral or anterior abdominal wall. This separation may be easy, or in its performance the tube may rupture and both pus and fecal matter escape; or perforation may have already occurred and the operator will be conducted into a cavity containing matter, pus and fecal mixed, in which perhaps fecal concretions of considerable size will be found loose. He is fortunate who, finding a condition of this kind, finds at the same time that he is still within a circumscribed cavity. This he should respect, and, while endeavoring to clean it thoroughly and drain it, he will avoid doing further harm by breaking down its walls.
Another condition which may arise after the peritoneum is opened is that of escape of a quantity of seropurulent fluid or of almost clear pus which is free within the abdominal cavity. There may be little or much of this. When present it should be removed by gentle sponging before the gauze packing is introduced. Some operators are inclined to irrigate freely and endeavor to wash out all this contained fluid. Others are opposed to this method and believe that gentle dry sponging is preferable. When the appendix is found free and movable, and when the tissues in previous contact with it are free from evidences of destructive infection (as, for instance, when peritoneal surfaces have not lost all their glimmer or sheen), one should carefully remove it, cauterizing its stump, burying it beneath the surrounding peritoneum, and close the abdomen without drainage. In spite, however, of the assertions and actions of some operators, I believe it to be the wisest rule to lay down for general
application that it is safer to drain in every case where free pus or breaking down exudate is discovered.
The question of drainage thus raised is as important as any connected with this subject. When and how shall one drain is a question upon which hundreds of pages have been written by various operators, and one which, while settled for individuals, can hardly be settled for the profession at large by any brief statement. Inefficient drainage is almost as bad as none. Efficient drainage may call for the insertion of a tube into the depths of the pelvis, even for counteropening in the cul-de-sac, or for additional opening in the loin, or for the employment of two or three tubes and drains of various kinds. A large tube loosely packed with gauze, perhaps split through its length and abundantly provided with openings, is probably the most effectual drain for most purposes. The cigarette drain, of gauze wrapped in oiled silk, or a few folds of oiled silk loosely tied together, along which fluid may percolate, may be sufficient for cases of lesser extent. Large foul cavities are better left more widely open, and abundantly drained with gauze packing, in spite of the humorous stigma which has been cast upon some of these methods by Morris with his expression “committing taxidermy upon patients.” The depressing reflex influence of such packing being readily conceded it may be regarded as the lesser of two evils.
Another almost equally important question is that of treatment of the peritoneal cavity when involved. Here methods and opinions have varied widely. A peritoneal cavity once inflamed cannot be made absolutely clean in any way, and much reliance should be placed on the properties of the membrane itself, which, to a large extent, should act as its own scavenger. When, however, by removing the parts evidently diseased we have taken away the main source of infection we may feel like relying upon the natural protective forces of the human body; still even here opinions differ. Thus some would flush the abdomen with hot saline solution and even leave some portion of it there, closing the external wound, while others would carefully avoid the introduction of anything by which infectious material may be spread; and while each method has much to justify it one is scarcely found preferable to the other. I believe, however, in thoroughly cleaning out any distinct abscess
cavity, and if the pelvis be such then I would irrigate it. I would also thoroughly drain it.
The attention of the reader is here directed to the general considerations found earlier in this work concerning the general technique of abdominal operations, and the matters of drainage and after-care, it being scarcely necessary to reiterate what has been there said regarding the general use of saline solution locally and by the rectum, the advantage of the Fowler position, or of Murphy’s method of slow and gentle introduction of saline solution into the rectum, providing for its continuous absorption, etc.
The possibility of appendicitis leading to general peritonitis, this to acute obstruction of the bowel, and this possibly even to multiple gangrene, has been mentioned. What should best be done under these circumstances must depend upon the patient and upon the surroundings. With a patient too much reduced to justify any prolonged operation the surgeon would probably content himself with evacuation of pus which may be readily reached, and then perhaps by the formation of an artificial anus. Cases which will justify such extensive operation as that above reported by myself in this connection, where it was possible to successfully remove nearly nine feet of intestine, will be exceedingly rare, as well as impracticable in the ordinary private house.
A condition perhaps a little less serious but always perplexing is that of gangrene of a limited area of cecum around a gangrenous appendix. To remove the appendix alone in this condition is to accomplish nothing, while to meet the indication may require the exsection of a small area of cecal wall or the resection of the entire cecum, or perhaps in cases of limited extent the enfolding of the gangrenous area and the suture of its edges in such a manner that when it sloughs it may slough into the bowel cavity.
When the surgeon sees a case of peri-appendicular (the old perityphlitic) abscess late, and after it is easily recognized, he should operate according to the local indication, making incision perhaps short and placing it at a point where pus will apparently be most easily reached and best drained. Most of these instances present rather on the side or even in the loin behind the colon, and here a posterior incision might be sufficient. This may here be more liberal,
since there is little danger of postoperative hernia, while through it one may possibly expose the cecum freely and often reach even the appendix itself. In making this opening it is well, if possible, to separate the fibers of the transversalis by blunt dissection. Here, as in all of the other incisions made toward the outer side of the body, the opening should be made, if possible, obliquely and parallel to the branches of the iliohypogastric nerves, which are thereby avoided and loss of sensation thus prevented. In fact this posterior method is sometimes even more rapid, and preferable in exceedingly fat patients, while it will always cause less shock and abdominal distress than does an anterior section; moreover, drainage takes place in the most desirable direction.
Fecal fistula is sometimes the immediate and unavoidable, sometimes a more or less delayed and apparently inevitable, result or complication of some of these operations. In the former instance it will be because of more or less gangrene or the necessity for an immediate enterostomy. In the latter case it results from conditions which are concealed, but may be imagined, comprising the giving way of tissues already compromised or else being a continuation of the ulcerative or gangrenous process. These complications are always unpleasant and untoward, though they rarely reflect upon the method or judgment of the operator, being essentially inevitable. If only the fecal outflow escape externally the condition may be regarded as inconvenient and temporary. Only in those instances in which the peritoneal cavity is contaminated does septic peritonitis ensue. The majority of these fecal fistulas close spontaneously by granulation tissue. Sometimes closure is rapid, sometimes delayed, in which latter case it may be stimulated by the use of silver nitrate, as already indicated above. In a few instances the condition is so extensive or so permanent as to justify or require further operation, which may be in the nature of a curettement of the fistulous tract, a slight plastic procedure, including a buttonhole suture about the opening, or possibly a complete intestinal resection. I have seen small, fistulous tracts discharge occasionally, even for years, and then finally close spontaneously, and have far oftener seen some form of spontaneous closure than necessity for operative intervention. The danger of infection around any such fistulous tract
is ever present, and when it has occurred the fact will be made known by increase of edematous granulations, with swelling and tendency to breaking down. In every such case active cauterization, or, better still, the use of the curette, will be required.
A tuberculous form of chronic appendicitis, as well as tuberculous infection of a subacute exudate, is possible, the case being converted into one of greater chronicity, with more or less mild but constant septic features (hectic). In any event, so soon as the tuberculous element can be recognized radical measures should be instituted.
F 583
Omentum being gently lifted in order to uncover the appendix enclosed with its fold (Lejars )
F 584
Appendix delivered from the abdominal cavity and brought to view (Lejars )
Operation for Chronic or Recurring Appendicitis; Internal Operations.
Separation of the meso-appendix. (Gosset.) —
Other things being equal the most favorable time at which to remove the appendix is that when pathological processes are least active. If, therefore, there be a choice the interval of quiescence rather than the stage of active infection would be chosen. Interval operations, so called, are usually comparatively simple, both in principle and technique. There are times, however, when it is difficult to find a partially obliterated appendix which has been covered up in thickened peritoneum or partially organized exudate. In such a case considerable blunt dissection or separation may have to be done before it can be removed. In those instances is this particularly true where it had originally a retroperitoneal location, and at no time a free or movable position. When difficult of recognition we may be unerringly led to it if we but follow the bands of white fibrous tissue on either side of the cecum to their junction.
The opening by which the appendix should, under these circumstances, be reached may again be made at the point of election, and should best be located over the area of greatest tenderness. Whatever incision is selected we should endeavor to separate muscle bundles as much and incise as little as possible. The appendix being delivered through the wound, either before or after ligation of its mesentery, and being thus completely isolated, is removed close to the large intestine, its base being tied and its structure being seized within the blades of a forceps in such a way that none of its contents may escape. The scissors with which it is divided are contaminated by its contents and should not be used again until cleansed. The stump on the proximal side may be touched with the actual cautery, or scraped and then cauterized with pure carbolic acid or formalin solution in order to thoroughly disinfect it. Subsequent treatment of this stump differs with different operators. Some are satisfied to leave it thus cauterized, while others cover it with the adjoining peritoneum, which is brought together over the stump end by either a purse-string or a continuous suture. Yet others have been satisfied to invert the ends of the stump into the cecum and thus leave it with or without further protection. It seems to make
really very little difference how the stump is treated, providing only it be disinfected and prevented from leaking. Nevertheless it would appear preferable to give it at least a peritoneal covering to prevent adhesions (Figs. 583 to 588).
F 586
The base of the appendix is tied with silk. The meso-appendix is being tied in sections with the Cleveland needle. (Richardson.)
F . 587
Appendix surrounded with ligature at its base, after its isolation from its mesentery. Purse-string suture in place. (Gosset.)
F . 588
Complete detachment of appendix (Gosset.)
In the subsequent closure of the external wound drainage is not made, there having been no pus to call for it; while the more perfectly the wound layers be closed, each with a row of chromicized catgut sutures, the peritoneal incision being first carefully approximated and over it the muscle and aponeurotic layers, each by itself, the less the tendency to subsequent postoperative hernia. On general principles, also, the shorter the incision the less the danger of this undesirable event. Nevertheless other considerations should not be sacrificed to shortness and beauty of the cutaneous scar.
The essentials of after-treatment of these cases have been already summarized in the previous section, and to these little exception may be taken in cases such as those above described.
Every precaution should be taken to prevent vomiting, as every muscular effort involved in the act tends to disturb a freshly sutured wound. While violent muscular efforts of defecation are also to be deprecated, there is perhaps as much or more to be dreaded from the abdominal distention which may result from inattention to free intestinal elimination. Until the bowels have been moved it is best to restrain the diet to the simplest fluid nourishment. So soon as elimination becomes free more liberality in diet may be allowed. There is the same liability to and danger from other possible complications, such as postanesthetic pneumonia, anuria, or lack of expulsive power of the bladder, which requires the use of the catheter, in these as in other abdominal cases. Principles of treatment, however, do not vary, and the reader is referred to the previous section already indicated.
Paratyphlitic abscesses are to be distinguished from perityphlitic or peri-appendicular abscesses in that they arise from a phlegmonous process in the cellular tissue around the colon not due to intraappendicular infection. In consequence of such a cellulitis more or less considerable collections of pus may form, which are most likely to present either in the loin or just in front of the cecum, which may burrow either upward or downward, or appear elsewhere. They are mentioned here, not because they are to be differently treated or surgically regarded, but because it is worth while to remember that here about the cecum and ascending colon, as on the left side, such pericolic abscesses may form without reference to the appendix.
