Organ Recital

Bodies are capricious. For years mine worked; then it didn’t (and wouldn’t again). “Illness,” Virginia Woolf wrote as she recovered from a faint, “is the great confessional.” Then let me confess that I now wear a pancreas. Sticking onto and into the skin, it is positioned layers of fine tissue above the defunct original, still in there, hiding by the spine.

Anatomists were long curious about this organ. Many thought it not so vital: a bed of flesh to support the stomach or a handful of padding to fill space beside the liver. One Renaissance doctor called it a place of no great repute; another thought it a cesspool of fever and melancholy. The pancreas of chickens is still used for the purpose of divination, but our human gland gives little away. Somehow it both flows with juice and has a neck and tail. It contains a sea dotted with the islets of Langerhans. At the end of the duct that drains it is the sphincter of Oddi. In 1887, the Perugian physiologist Ruggero Oddi compared this circular muscle to a piece of regularly woven fabric, describing its sheen and pale colour as “like that of raw silk.” When things go wrong, the edges of the pancreas are said to turn to lace.

Clothes have much to reveal about our insides. Since antiquity, dress has provided a way of picturing our metaphysical selves and material parts — emotions a cloak that can be thrown on or taken off, the body a cupboard full of garments of various shapes and sizes. Rummaging inside the abdomens of animals, Galen, a Greek physician in ancient Rome, found the stomach to contain a pair of “tunics” layered one over the other, the warp and weft of their fibres pulling against each other to process food. Through his microscope, an eighteenth-century apothecary saw in membranes “innumerable Divisions, Windings, serpentine Progressions, and frequent Inosculations of Veins with Veins, and Arteries with Arteries, [that] make a most agreeable Embroidery.”

The rips and stains in our clothes mark cycles, calamities, and routines. Signs of sickness appear in splotches of sputum on a handkerchief or splashes of urine on stockings and shoes. A top hat might signal other problems. In a satirical print from 1830, Robert Seymour illustrated the idea of “Living Made Easy” with a revolving hat: two smiling men model a newfangled style of topper, its brim arrayed with a set of spectacles, an ear trumpet, an eye glass, a scent box and a cigar, all conveniently dangling around the head. These handsfree dandies look delighted with the ridiculous innovation they’ve adopted.

Now we don a range of “wearables.” Shirts are made to monitor the heart and lungs or to correct bad posture. Your glasses will take pictures while your shoes follow you home. A necklace is to be pressed in case of emergency. The wristwatch has found new rhythms. These electronics are meant to look like familiar attire or are small enough to be worn out of sight as we surveil ourselves. Smart clothes and other adornments contend with any number of modern complaints. Another shirt gives hugs to the lonely. There are neckbands to keep us cool in the heat. Wearables are used by the healthy, the hypochondriacal, and the sick as we come to understand our interiors not in terms of textiles but through numbers shifting on a screen. Like clothes, they serve to protect us or to punish us into shape, encouraging the idle body to push on with the reward of a ring. They reveal our weaknesses and frailties. They may even make us better.

My pancreas is worn on the belly or the limbs, though it can’t really be said to be any sort of accessory, necessary as it is for life. It provides a steady supply of insulin, whose discovery seems itself to have relied on a kind of divination. Without expertise or experience, the surgeon Frederick Banting and the student Charles Best managed to extract and test this hormone over a few months in 1921. Insulin would replace all other treatments for diabetes, including meat or potato cures, sugar, opium, and starvation. It could be infused with a syringe, and short and excruciating lives became longer and easier. Of the change this meant for her feeble patients, the nurse Margate Kienast recounted: “it was a resurrection, a crawling stirring, as of some vague springtime.”

Every few days I inject the peptide into a new insulin pump, as if it were really the one with the disease. The fluid is then administered, in dribs and drabs, from the machine directly into me. The pump isn’t as smart as a top hat, yet it uses an algorithm I hardly understand and is able to speak its own language, clicking as the insulin makes its way into the fascia, and beeping out high and loud cries that call the wearer to action. It is an inconvenient but miraculous lump that must be attached at all times.

In 1654 the English physician Francis Glisson characterised the pancreas as “moist, loose and floppy.” The pump I wear is waterproof and plastic, contains a computer and cannula, and is controlled by a telephone. It is smaller than an egg. Spotted under garments, it has the appearance of a bump (a plague doctor might worry). When it is worn uncovered, the pump looks unmistakeably medical. It is the white of a doctor’s coat or a bandage used to dress to a wound. Strong adhesive tape fastens this tubeless “patch” to the skin. As with any bit of mending, it is made to be as inconspicuous as possible, and just once — while visiting the villa of the psychoanalyst Carl Jung — have I been asked to explain its significance.

If it is meant to be worn, like clothing, the pump is a rather extreme sort of innerwear. If instead it is a replacement piece of the body, then the brand names and numbers printed on its side are a reminder that this apparatus doesn’t exactly belong to you. The businesses that have developed and sold these items since the 1970s like to keep their secrets, and their devices too are designed to be discreet, growing ever smaller. In a photograph from around 1978, the reporter Patrick Connolly adjusts the dial of the Autosyringe hanging like a large medieval belt buckle from his waist. At the 1999 Miss America pageant in Atlantic City, Miss Virginia Nicole Johnson had a pump the size of a pager concealed inside her evening gown. She detached her MiniMed 507C only to wear an electric blue bikini for the swimsuit segment, and won the crown.

There is little glamour in this condition that must be managed like a job or it will come for the eyes and feet and heart. We form a company of nervous accountants, always following the numbers as our number grows by hundreds of thousands with each year. “I anticipate each update. Recheck my phone. Recheck my / daughter a graph of plotted data points constructed in real time,” Dave Brennan writes in his book A Cyborg’s Father. Brennan finds hope in Donna Haraway’s enduring image of the cyborg, “a kind of disassembled and reassembled, postmodern collective and personal self.” The future in which most of us find ourselves seems far from this liberatory socialist vision, with the creators of my expensive swelling — and many other machines for organisms — so litigious over patent infringement.

In the midst of chemotherapy, Susan Sontag took issue with the metaphors of war associated with cancer that are “so much a vehicle for the large insufficiencies of this culture.” Diabetes and its types have their own set of myths that portion out blame and contribute to disparity in care (pumps and even insulin remain unaffordable for many). This is a malady that can’t be battled or beaten and is simply to be controlled. In “The Song of Diabetes,” the doctor Cecil Striker advises the diabetic patient to work “with it, not against it, / Thus avoiding psychic conflict.” Or as the doctor Wilhelm Jaenecke put it in another questionable poem: “He who’s stuck with insulin is helped the most by discipline.” The weak-willed old senator in Thomas Mann’s Buddenbrooks has neither. He rents a shabby room to eat his cakes in secret and dies there of a stroke with “crumbs upon his coat.”

This ailment was never fashionable like tuberculosis. In the nineteenth century, when beautifully delicate consumptives took themselves to sanatoriums in the high mountains, diabetes was thought to be caused by dirty laundry or a lesion in the brain. In 1884, Dr. Harvey J. Philpot explained that it was the result of “too long a strain upon the intellectual powers, prolonged anxiety in business, intense suspense while great danger is threatening, excessive sexual indulgence, and dissipation long continued.” Those with the affliction were advised not to work or travel. We diabetics have no Katherine Mansfield, coughing from house to hotel across the continent, consoling herself with the tubercular example of John Keats, writing stories and poetry still.

As I type this there is the promise of a thought-to-text cap, a beanie fitted with tens of thousands of sensors to find and write out the words in your brain, as though our heads contained a conveyor belt of finished text. While we extend ourselves with wearables and medical equipment is worn both to aid the chronically ill and to augment the optimally fit, we remain the bewildering body — filled with ancient tunics and curious embroidery, unprintable thoughts, and unpredictable cells.

Beatrice Radden Keefe is an art historian and writer.

1. Virginia Woolf, “On Being Ill,” The New Criterion IV: 32-45, 1926, p. 36.
2. The French original is Ruggero Oddi, “D’une disposition a sphinctèr spéciale de l’ouverture du canal cholédoque,” Arch. Ital. Biol. 8: 1887, pp. 317-322. The English translation is in John M. Howard and Walter Hess, History of the Pancreas: Mysteries of a Hidden Organ, 2002, p. 43.
3. John Quincy, Lexicon Physico-Medicum: Or, A New Medical Dictionary, 1730, p. 273.
4. Howard and Hess, History of the Pancreas, p. 123. They cite Michael Bliss, The Discovery of Insulin, 1982.
5. Glisson’s Anatomia hepatis: “…humida, laxa, flaccid…”. It is quoted and translated in Paraskevas et al. 2018, “Historical considerations regarding the first description of pancreas’ anatomy,” Ital. J. Anat. Embryol. 123: 257-262, p. 260.
6. Dave Brennan, A Cyborg’s Father: Misreading Donna Haraway, 2025, p. 22.
7. Susan Sontag, “Disease as Political Metaphor,” New York Review of Books February 23, 1978. I quote from Susan Sontag, Illness as Metaphor, 1988, p. 87.
8. Dietrich von Engelhardt, ed., Diabetes: Its Medical and Cultural History, p. 27.
9. von Engelhardt, Diabetes, p. 10
10. Harvey J. Philpot, Diabetes Mellitus: A Synposis of its Pathology, Physiology, Etiology, Incipient and Progressive Symptoms, Causes of Death, Sugar Tests, and Treatment, 1884, p. 41.