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Home arrow Language & Literature arrow Syphilis in Victorian Literature and Culture: Medicine, Knowledge and the Spectacle of Victorian Invisibility

Media Production and Dissemination of Knowledge about Syphilis: A Case Study

The extent to which visual information is integral to nineteenth-century medical industry is pertinently shown in Hutchinson’s discovery of the patterns of teeth malformation in the subjects of inherited syphilis. In the second volume of Illustrations of Clinical Surgery, Hutchinson reports:

About the year 1857 [... ] I stumbled upon the observation that many of those in whom there seemed reason to suspect syphilis had very peculiar teeth. With the assistance of my friend Mr. Alfred Coleman I soon collected a large number of models, drawings, and photographs, by the comparison of which we were able to describe definitely the peculiarities in question, and also to assert that they did not occur in other cases [... ]. (1878-88: 9; my emphasis)

Two interdependent developments are striking in this account: Hutchinson’ s cooperation with a colleague on the identification of teeth malformations and the recognition of their patterns through media comparison. This narrative is particularly relevant in delineating the social and media-based character of knowledge construction, which results in a creation of a referent that is here the malformation of teeth as a symptom of inherited syphilis.

It is especially the medical atlases of the late nineteenth century which illustrate the various media processes that were part and parcel of the medical production of knowledge about syphilis and which help address broader questions concerning its social construction. In their classical study of the mid-nineteenth-century birth of objectivity as an “epistemic virtue” (2010: 40), Lorainne Daston and Peter Galison regard scientific atlases as “dictionaries of the sciences of the eye” and put forth their character as compendia of genealogical knowledge of given disciplines and as registers of their evolutions (22). Images “[n]ot only [ ... ] make the atlas” but also “make the science” as they set out to establish the epistemological principles of the time (22). Although they regard atlases as a form of “collective empiricism” and highlight the necessary repetitiveness of atlas authors (26), Daston and Galison pay little attention to the visual citationality of many such publications. Despite the insistence of many compilers on the exclusivity of their prints, intermediality appears to have been widespread. In Skin Diseases: 5 Centuries of Scientific Illustration (1989), Franz Ehring notes that reusing prints in pedagogical collections was increasingly common throughout the nineteenth century. Pictures being expensive, they were often reprinted or copied in and outside their country of origin and irrespective of the author’s agreement or knowledge of their reuse (Ehring 1989: 19-20).

Exchanging (visual) materials was certainly common among the specialists of the esoteric circle. A Descriptive Catalogue of the New Sydenham Society’s Atlas of Portraits of Diseases of the Skin (1869a), for instance, includes many prints compiled by Ferdinand Hebra for his Atlas der Hautkrankheiten 1856, reproduced in a lithographic process. Devoted to “Framboesial Syphilis,” the XIV Fasciculus of An Atlas of Illustrations of Clinical Medicine, Surgery and Pathology (1902) includes lithographs based on photographs by Dr Corney, Mr Crossley Wright of Halifax, Dr Numa Rat and one Dr Powell, along with photographs “executed in Ceylon under the direction of Sir William Kynsey,” reproductions of images already included in Hutchinson’s journal Archives of Surgery and other, earlier sources, such as a photograph of an illustration from Nicholls’s “Report on Yaws” (Hutchinson 1902: 3) (Fig. 2.2). Atlas of Skin and Venereal Diseases (1889) compiled and purveyed with the text by Prince A. Morrow, a New York dermatologist, is arguably the finest monument to

Examples of (visual) sources and techniques combined in An Atlas of Illustrations of Clinical Medicine, Surgery and Pathology. London

Fig. 2.2 Examples of (visual) sources and techniques combined in An Atlas of Illustrations of Clinical Medicine, Surgery and Pathology. London: New Sydenham Society, 1902-04. Fasciculus 14. Bernard Becker Medical Library, Washington University School of Medicine the referential character of such works. It is advertised as including (visual) materials from over a dozen named and many unnamed sources, and compiles illustrations previously published, among others, by Hutchinson, Kaposi, Ricord, Cullerrier and Fournier. This circulation of prints added to the dissemination of knowledge, but it was also a good vehicle for the exchange of criticism. Hutchinson annotates one of the prints commissioned by Alfred Fournier, which allegedly shows a case of hereditary syphilis, with “No proof.”16 He also puts various prints from diverse atlases next to one another as a didactic tool in training future practitioners in the art of diagnosis.

The citational character of the aforementioned atlases is responsible for their overwhelming multimediality. While others extolled their publications for the beautiful execution of the plates, Hutchinson’s Illustrations of Clinical Surgery (1878-88) spotlights the diversity of illustration techniques already in its full-blown title: Illustrations of Clinical Surgery Consisting of Plates, Photographs, Woodcuts, Diagrams, etc. In the first volume, a chromolithograph of Burgess’s drawing from life of the “Nodes from Hereditary Syphilis” follows graphs in which syphilis is produced in terms of its pathological stages as in “Scheme of the course, stages, and sequel of acquired syphilis” or in “Chronological treatment of events during the first year of acquired syphilis” (n. pag.). An Atlas of Illustrations of Clinical Medicine, Surgery and Pathology (1902) also contains instances of radiographs and microphotographs. In many atlases, lithographically reproduced plates are accompanied by woodcuts from original drawings or photographs, which, frequently embedded in the text, serve a detailed explanatory function (for example, Pringle 1895). On close comparison, the uniformity of lithographic prints, most readily used in the production of detailed plates (Hill 1915: 10), reveals the multilayered processes of media transfer. “Syphilis Chancre of the Face” from John James Pringle’s A Pictorial Atlas of Skin Diseases and Syphilitic Affections in Photo-Lithochromes (1895) affords a fine example of this layering of cross-media translations (Fig. 2.3). The final photo-litochrome print is a product of successive media conversions that start with a wax moulage of a living patient. The wax model had been executed by M. Baretta, famous for the application of colour to successive layers of wax, which created an “effect of transparency” characteristic of the human skin (Ehring 1989: 177). The moulage was then photographed; afterwards its image was transferred onto the lithographic stone and

“Syphilitic Chancre of the Face” and two examples of “Syphilitic

Fig. 2.3 “Syphilitic Chancre of the Face” and two examples of “Syphilitic

Chancre of the Breast.” John James Pringle. A Pictorial Atlas of Skin Diseases and Syphilitic Affections in Photo-Lithochromes from Models in the Museum of the Saint Louis Hospital, Paris. London: Rebman, 1895. Plate 40. Bernard Becker Medical Library, Washington University School of Medicine

finally printed as a lithograph (Ehring 1989: 5).17 Hutchinson’s collection affords numerous examples that show the various stages of such media transformations.

The multimedia character of medical atlases along with the multilayered processes of media transfer that underlie it add to the stylistic eclecticism of the works. Many of the atlases show adherence to the changing principles of scientific illustration; even these, though, occasionally resurrect the relics of older, often outdated, anatomical imagery. Plate LXV from Fasciculus XII of An Atlas of Illustrations of Pathology (1898a) - “Infective Disease of the Lymphatic System” - which reproduces a drawing of a dissected upper body with enlarged glands, is highly reminiscent of the plates in popular Surgical Anatomy (1851) prepared by Joseph Maclise, a West-End physician. It follows the tradition of an idealized depiction of the human body, which, although anatomically correct, was, as K. B. Roberts notices, clearly independent of the dissection room’s realities: “The faces of his subjects are mostly handsome; their perfection, nobility and cleanliness are characteristic of much of the art of the great expansionist phase of industrial Britain - an age of squalor, degradation and dirt for many of the people” (1981: n. pag.). These studies inhabit a quizzically liminal state between the living and the dead: while the dissected bodies lie open to inspection, their faces bear an expression of dreaming or thoughtful consideration (especially in Plate 11) and their stylized poses are full of grace and animation, not unlike the poses of Vesalius’s anatomical studies published four centuries earlier. Whereas the aforementioned plate from An Atlas of Illustrations of Pathology (1898a) has nothing to do with harmony and grace, it depicts the body in an equally peripheral state: dissected, the male cadaver writhes in a spasm, his face as if deformed by a silent scream. As these examples make clear, the visual material of the atlases also often offers a compendium of changing illustration practices.

The transference of these various visual contents oftentimes testifies to the ways in which original images were adjusted in subsequent publications. Erasure, cropping, recoloration and rearrangement are just a few of the characteristic procedures involved in the circulation ofvisual material. Prince Morrow’s Atlas offers a number of exemplary cases. Plate XII (Fig. 2.4a) reframes Kaposi’s Plate XXII (Fig. 2.4b) and erases the idiosyncrasies of the previous illustration by removing both the string of pearls and the contours of the patient’s facial features. On closer inspection, it becomes clear that the prints in the atlas have been redrawn rather than simply copied: not only do the scale and the colouring differ but also the facial features of the redrawn figures.18 Unlike these individual images, Plate XXXII has been created through a rearrangement of Hutchinson’s and Kaposi’s earlier plates showing various changes to the mouth. These numerous images, now mounted side by side on one plate, serve as a means of differential diagnosis; they emphasize the nuanced differences in syphilis symptoms.

Hutchinson’s collection at Welch Medical Library bears witness to the ways in which photographs were adjusted by overdrawing before they were used as blueprints for lithographic prints. Figure 2.5 shows a prominent

Examples showing various practices of appropriation. (a) Prince A. Morrow. Atlas of Skin and Venereal Diseases. New York

Fig. 2.4 Examples showing various practices of appropriation. (a) Prince A. Morrow. Atlas of Skin and Venereal Diseases. New York: William Wood & Company, 1889. (b) Moriz Kaposi. Die Syphilis der Haut. Vienna: W. Braumdller, 1882. Bernard Becker Medical Library, Washington University School of Medicine example of such an adjustment. Mounted on a cardboard plate are two albumen prints which show that symptoms have been added to and accentuated on the photograph.19 The background was inked out and a layer of pink wash added. After that, various colours were used to highlight individual eruptions, especially in the lower part of the beard. Other items in the collection instantiate a series of transformations that a photograph would undergo before it was publishable. Their comparison shows the extent to which visual information was simplified and only essential details retained.

A lot has been written about the traditions of medical illustration and about the ways in which photography and other optical technologies have influenced the way medical subjects have been manufactured within broader cultural frameworks (K. Arnold 1993, 2001, Thomas 1997, Cazort, Kornell and Roberts 1996, Roberts 1981,

A case of symptomatology added to an albumen print. Verso

Fig. 2.5 A case of symptomatology added to an albumen print. Verso: “Probably syphilis.” John Ross, J. Wood, Lambeth Infirmary, Polyclinic 1907. Sir Jonathan Hutchinson Collection, Institute of the History of Medicine, The Johns Hopkins University, Baltimore, MD

Doby and Alker 1997, Ehring 1989). While it was the Renaissance that put “visual depictions of the body at the heart of medical inquiry and instruction” (K. Arnold 2001: n. pag.), since that time a number of new genres in medical representation have been actively pursued, developed, modernized or made obsolete due to an ever growing number of new visual technologies, itineraries of representation (hospitals, asylums, medical laboratories, etc.) and ways of dissemination. These developments, as Ken Arnold contends, “have all expanded the album of medicine’s visual surface” (2001: n. pag.). Importantly, the nineteenth century brought a shift from a holistic view of illness to an emphasis on particular pathologies and symptomatologies. It also witnessed an increasing tendency to “widen” and “deepen” the scope of traditional depiction of diseases by the use of photography and X-ray (K. Arnold, 1993: 14). Developments in the medical laboratory, sketched in Chapter 1, brought with themselves the invention and modernization of laboratory equipment, such as Carl Ludwig’s kymograph, which allowed a novel representation of the body, unlike the traditional naturalistic aesthetics that had hitherto dominated medical illustration (17). A parallel study of cellular biology gradually contributed to a transformation in thinking about the human body. The extension of microbiology to include the study of bacteriology, based on the work of Robert Koch, Louis Pasteur and Rudolf Virchow, was accompanied by an early appearance of invisible worlds which now could be sighted under the microscopic glass. Gilman considers Virchow’s Cellular Pathology (1858) as a testimony to the transition in the wake of which the physician’s gaze shifted from patients to symptoms (1989: 231). This movement was accompanied by another vector: from “microscopic-but-normal” to “micro- scopic-but-degenerate” (Gilman 1989: 235). With reference to venereal disease, Gilman detects a nineteenth-century tendency to exchange the overt signs of the disease for suggestive symbols that stress its sexual provenance (238). All this shows that pathological illustration cannot be seen as changing due to the modification in medical practices only; the significance of technological processes must be taken into consideration as well.

Media technologies, like the processes of media transference, are intertwined with scientific epistemologies, even ifthere is no unison concerning the character ofthis interweaving. For instance, Daston and Galison do not regard photography as provoking the epistemological upheaval that put objectivity on the scientific landscape previously dominated by the “truth- to-nature” approach: “Photography did not create this drive to mechanical objectivity; rather, photography joined this upheaval in the ethics and epistemology of the image” (2010: 161). Nonetheless, they acknowledge this technology to have become the primary trope for scientific objectivity, the latter denoting a progression from the virtues ofinterpretation to those of “noninvolvement” (187). Photography promised to expunge the interpretative factor in knowledge production. Albert Londe, practitioner and photographer of the Salpetriere, is reported as saying that “the photographic plate is the scientist’s true retina” (Didi-Huberman 2003: 32). Yet the new technology brought other problems. Ann Thomas notes its inadequacy to signpost depicted phenomena and thus to offer a tool for the recognition of certain physical states and stresses the necessary “manipulative” and “selective” use of the medium in medicine

(1997: 122). Not only were the results far from satisfactory, the sole process of “shadow fixation” appeared problematic, especially in case of clinical studies, which seldom provided ideal environs for photographic processes. To this must be added specific technical decisions, preparation of the specimen, and the environment in which they had been photographed (122-23).20 Despite the technical inadequacy of early photography, medical publications soon made use of it through recourse to the processes of lithography, woodcutting, etc., which facilitated the reproduction of photographically-won images.

Although, as Hutchinson’s tinkering with albumen prints shows, photography proved particularly problematic in recording skin diseases, this branch of medicine very early turned to mechanical means of observation. Advertising his publication of Photographs (Colored from Life) of Diseases of the Skin (1865), Alexander Balmanno Squire, surgeon to the West London dispensary for the diseases of the skin and lecturer at St Mary’s Hospital Medical School, offers a rationale behind the publication, which, ensuing from his own experience, has been devised for those with little direct access to the diseased:

My original object in making the experiment was to assist myself in researches into the pathology and treatment of the diseases of the skin. I was thus enabled, by securing accurate representations of remarkable cases, to compare them with other similar cases that subsequently came under my care. It soon became evident that excellent results were to be obtained by this means, and that they might be rendered more widely available by publication. (n. pag.)

Squire’s comparative study encompasses extraordinary cases rather than the usual conditions one was likely to see even with little clinical experience. His emphasis on the positive results of research conducted in this way justifies the publication and foretells its expediency to expert surgeons. Although withholding the manner of his undertaking, Squire reassures the reader of the accuracy of the prints he gathered, which have been “obtained by means of photographs of the disease coloured from life by one of the best artists” (1865: n. pag.). Whereas the valorisation of the artist’s skill undoubtedly serves to emphasize the exactness of illustration, it, at the same time, undermines Squire’s statement by establishing associations with artistic imagination. Ann Thomas brings up the issue of such cooperation by highlighting the fact that each commissioned artist, unless he is a doctor himself, is

“confronted with deeper internal structures for which he d[oes] not possess established criteria for viewing and affective schemata for portraying” (1997: 121). To ensure the compatibility of the artistic product with the vision, gaze and touch of the doctor, the latter has to “subordinate his artists’ vision to his own” (121). Despite that, illustration will always retain at least the debris of the standard thought style in which the artist is embedded. Confronted with the lithographic prints, one cannot but regard with admiration the artist who, under Squire’s aegis, produced the photographs and hand coloured the faces of the subjects suffering from cutaneous diseases, and who remains unacknowledged.

The tendency to move away from individual interpretation towards the mechanics of objectivity was accompanied by a shift in depiction: from typical to individual and from interpretative to “ procedural” (Daston and Galison 2010: 185). The reader was now left to interpret what was earlier read through the prism of the cooperation between practitioners and artists; yet this shift can in no way be regarded as linear or as eradicating the earlier discourses of truthfulness to nature. This development is also visible in Hutchinson’s publications. In A Descriptive Catalogue of the New Sydenham Society’s Atlas of Portraits of Diseases of the Skin, Hutchinson insists on the mimetic character of the amassed images, ensured by a close supervision of the artist:

The original portraits have been done from nature with the most exact attention to fidelity, and have been supervised by a committee appointed by the Council. All other considerations have been sacrificed to the accurate delineation of the morbid appearances, and the artist has been strictly prohibited from taking any liberties with his subjects, such as altering the position of patches, or introducing or omitting details for the sake of effect. Not a few of the published illustrations of skin-diseases bear proof that they have been constructed in parts, that is, from several different cases. This practice, although temptingly convenient, is unsafe, and has in our Atlas been scrupulously avoided. Our plates are, therefore, not only illustrations of typical varieties of disease, but faithful portraits of individual patients. (Hutchinson 1869b: vi-vii; my emphasis)

Here, Hutchinson still subscribes to the ideal of cooperation which was considered the best means of producing “synthetic” types that were both characteristic and ideal (Daston and Galison 2010: 70-82). In his

1902 paper “A Resume of Present Knowledge as to Framboesial Syphilis, &c,” which uses lithographs of drawings and photographs, on the other hand, Hutchinson no longer offers an interpretation of the presented materials but leaves this task to the public. Although he shows similarities in the lesions produced by syphilis and by the disease variously named “Yaws, Framboesia, Framboesia tropica, Framboesial Syphilis” (1902: 3), he leaves their interpretation almost entirely to the readers:

To those who are convinced that Syphilis is Yaws and Yaws is Syphilis, the present collection of illustrations will be interesting, as exhibiting certain modifications of the latter, which are common in coloured races and not unknown amongst Europeans. To those who accept Yaws as a distinct malady, the plates will be of great value as fixing the type of that disease. (3)21

Here, the imagery “becomes an archive” (Daston and Galison 2010: 178) and is regarded as able to warrant two divergent and incompatible views concerning the disease.22

This overview shows that the visual production of knowledge about syphilis cannot be regarded as a simple economy of representation but should be taken to encompass a variety of cognitive, social, cultural, technological, economic and political processes. Technological constraints, financial considerations, the status of the commissioner, his choice ofmaterials, his networking possibilities, the governmental readiness to acknowledge and facilitate his work, the availability of skilled artists: all this should be taken into consideration in this discussion. The visual industry that syphilis produced (and which produced syphilis) encompasses more than just images: it includes the mechanisms of fact construction, knowledge dissemination and discursive maintenance of epistemic virtues.

In view of the overwhelming multiplicity of trans-, inter- and intramedial processes inextricable from the practices ofknowledge production at the time, it is disquieting that the majority of works on syphilis have focussed solely on the written text. Textual narratives produced by medical practitioners cannot be read at the expense of the imagery that accompanied them. These two registers were complementary in building an argument. Adhering to an exclusive analysis of either clearly misses the complexity of the rhetoric used in the construction and dissemination of a particular understanding of the disease. One of the factors responsible for this proclivity may be that, as I will argue later, the visibility of syphilis was clearly hampered in exoteric circles.

Travelling of the images of syphilis outside the esoteric circle can be instantiated by a passage from Upton Sinclair’s novelization of Eugene Brieux’s Les Avaries (1902), a play that dramatizes the consequences of conscious choices to ensconce the disease:

The disturbing symptom still continued, and so at last George purchased a medical book, dealing with the subject of the disease. Then, indeed, he opened up a chamber of horrors; he made his mind an abiding place of ghastly images. In the book there were pictures of things so awful that he turned white, and trembled like a leaf, and had to close the volume and hide it in the bottom of his trunk. But he could not banish the pictures from his mind. (Sinclair 1913: 40)

The travelling of knowledge outside the esoteric groups could be regarded analogously to George’s disposal of the volume: it required a hiding place where such knowledge could be buried and dissipated in small dozes to the ones who needed this medicine. It meant a translation from the highly complex and infinitely layered multimediality to a seemingly straightforward verbalization or painterly depiction. These two most frequently registered modes of syphilis dissemination among the members of the exoteric circle changed the character of its visibility and, while allowing for spaces of its articulation, shifted the emphasis from seeing to imagining.23

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