Professional and Civic Narratives in the Polyclinic

What underlay the concept of the Polyclinic, and of the clinical museum, was a complex regime of the visible.4 Hutchinson’s writings in this context are padded with a master narrative of visibility that recurs in his work on syphilis.5 The Polyclinic (The Medical Graduate College and Polyclinic) was one of the three postgraduate schools open in London in 1898.6 Like The London Postgraduate Association and The North East London Postgraduate College, it was short-lived on account of, as Charles Newman speculates, its ossified structures (1966: 285). Before it failed, however, it promised to materialize Hutchinson’s ideal of life-long learning, with the training of the faculties of the eye as its core principle.7 Envisioned as the “connecting centre” of many, if not all, metropolitan institutions, it was devised as a space of (inter)national exchange and as a link between more specialized establishments (Hutchinson 1899a: 8). In pursuing three aims - helping the poor, education in “advanced diagnosis” and scientific research - the Polyclinic aspired to “increase the efficiency of the profession as a whole” (Hutchinson 1899a: 12).8 The Polyclinic was thus envisioned as a philanthropic institution, a centre of education and research as well as an arena for civic development.

Most of all, it was a place where the observation skills of medical practitioners were to be trained. In “Clinical Museums in Hospitals” (1901a), Hutchinson bemoans the insufficient development of the clinical aspects of hospital museums, which could otherwise help train the medical gaze. In a speech given during the annual meeting of the British Medical Association, he also made a little flattering comparison, asserting that “[i]nstead of a museum of Clinical Surgery we have a Golgotha of Anthropology” (qtd. in H. Hutchinson 1947: 195). This complaint echoes the address he gave to the medical profession some years earlier in the “Bradshaw Lecture on Museums in their Relation to Medical Education and the Progress of Knowledge” (1888), in which he describes the appalling state of medical museums and in which he advocates the formation of more suitable centres of visual learning. While he acknowledges the existence of advanced clinical collections (for example, the collection at the Hospital St Louis in Paris or at Guy’s Hospital in London), he also points out their limitations, of which the major is a highly restricted access to visual materials: “Most of our hospitals have, more or less considerable stores of valuable drawings, but they are usually stowed away in portfolios, and hardly available excepting to the hospital staff’ (1888: 1262). Such closeted compilations become, in Hutchinson’s writing, dark lands to which he has to bring the light of education and thus afford them sufficient visibility. The history of his collection epitomizes this quest. First exhibited on the premises of 1 Park Crescent, it grew to such proportions that Hutchinson was obliged to search for a new place where it could be adequately displayed. When offered to the College of Surgeons, the collection was declined on grounds of insufficient exhibition space. This failing assistance of medical institutions, symbolizes, in Hutchinson’s narrative, the backwardness and short-sightedness of the medical profession.9

Indeed, Hutchinson’s repetitive return to the issue of clinical museums proves a fertile ground for the exploration of the metaphors of visibility, which serve to legitimate his undertakings in this area and to profile him as a benefactor bringing light to the medical professionals who, it seems, until then, had only with difficulty arrived at a diagnosis:

What I mean by a clinical museum [... ] is a department in which every effort should be made to display in the best possible manner all that can be usefully portrayed by the artist or modeler in illustration of disease during the life of the patient. Its contents should not be hidden away, but exhibited in well arranged order for the ready inspection of all visitors. (Hutchinson 1888: 1262; my emphasis)

Expanding on the regime of the visible, this fragment establishes Hutchinson’s museum as an institution that produces visibility through display and defines it as a complex optical instrument for medical professionals.

Hutchinson’s vision of a clinical museum is in sync with the newly accorded central role ofthe museum in the propagation of(popular) knowledge. When regarded, after Daniel J. Sherman and Irit Rogoff, as an “intricate amalgam of historical structures and narratives, practices and strategies ofdisplay, and the concerns and imperatives of various governing ideologies” (2000: ix), Hutchinson’s clinical museum is a monument to the professional, civic and national agendas of the time. Tony Bennett famously links the changes in the function of nineteenth-century museums to a transformation in the conceptualization of vision, which, while a matter of “the geometric optics” in the seventeenth and eighteenth centuries, became a domain of “physiological optics” a century later (2006: 275). This repositioning of vision made it both “subjectively” dependent on individual bodily structures and “objectively” reliant on their social conditioning. Within this model, the museum became a space that was to teach not only by displaying new objects but also by training “civic seeing” and thus by forming the characters of the viewing subjects (Bennett 2006: 275). This goal was closely linked to developments in the structuring of the museum and in the arrangement of the exhibited objects. The shift from the Enlightenment to the evolutionary museum involved an activation of the invisible, in-between spaces: “For while the Enlightenment museum ostensibly displayed its logic on the visible surface of things, it was the invisible orders of connection binding things into relations of genealogy and descent that mattered in the evolutionary museum” (Bennett 2004: 161; my emphasis). As the idea of progress became the underlying narrative of the museum, more specialized institutions began to flourish, which promoted knowledge that went beyond the classificatory impulse of the Enlightenment and trained the viewer’s eye to see beneath the obvious structures, thus expanding his/her faculties of “explanation and prediction” (Macdonald 1998: 12; original emphasis).

In keeping with these larger developments, the aim of Hutchinson’s museum was to provide guidance for the student’s eye in the recognition of pathological changes in the living patient:

a clinical museum would teach, so far as the eye is concerned, the great art of diagnosis. It is true that we cannot educate the finger in a museum [... ]. But all that the eye can do, and it comprises by far the largest half of surgical diagnosis, can be learned easily and well from models[,] photographs, and drawings. The trained eye can detect hardness in a chancre without touching it, and many other conditions usually supposed to need the finger, may yet, if the eye be duly educated, be diagnosed at a glance without it. (Hutchinson 1888: 1262)

Acknowledging “the wealth of clinical material [... ] which is buried in the atlases, journals, transactions of societies, and monographs of the past century” (Hutchinson 1888: 1263; my emphasis), Hutchinson calls for their adequate exhibition. The museum would thus foster the skill of differential diagnosis by illustrating and displaying such conditions as are rarely seen in hospital wards (Hutchinson 1888: 1263) and through a specific arrangement of visual materials thanks to which a variety of forms of a given disease would become visibly distinguishable. Such juxtapositions would assist clinical recognition, accelerate the learning process, yield new insights and thus advance medical knowledge. Commenting on his temporary exhibitions in “The Clinical Museum and Syphilis” (1908), Hutchinson relates how an arrangement of about forty drawings of two skin disorders intrinsic to syphilis “enabled [him], when the drawings from various sources were placed in juxtaposition and compared, to recognize several novel and not unimportant features in this group of maladies” (1908: 1592). This combination made it possible for him to see beyond the images and to recognize further variations of the disease.

Hutchinson’s archeologically-driven vocabulary served him to highlight the significance of the museum, in which the dispersed knowledge could be “disentombed,” brought to light and presented to the eye of the student who would now scarcely miss its lesson (1888: 1263). A similar motivation accompanied his assemblage of (about three hundred) extract books consisting of articles and cuttings from a variety of sources, which, compiled under specific headings (for example, syphilis, eye, skin, etc.), classified and indexed, were meant to “save the reader the trouble of referring to the various books in which the original publication occurred, and bring into close and classified juxtaposition the recorded observations of many authors” (Hutchinson 1894: 4). Initially placed on a bench under the portraits of diseases and later in the Council Room of the Polyclinic, these extract books served as sources of reference and self-learning.

Hutchinson’s clinical museum was a space that propagated students’ professional development. Self-study was promoted by a specific classification and grouping of the disorders, detailed labelling and temporal arrangements as well as by the close proximity of the museum to the reading room/library (“The London Polyclinic” 1901: 1218-19). In this sense, then, the museum materialized the ideals of “pristine clarity” and readability that made collections accessible and legible to the visitors (Bennett 1998: 28), and thus followed the educational agenda of the Victorian era. By integrating the museum in the Polyclinic and by its special arrangements, Hutchinson underscored the importance of selfstudy to the development and refinement ofmedical faculties. The journey it promoted was that from the direct visibility of the specimens to a more profound vision of the professional who could distinguish disease variations and recognize, in going beyond the readily visible, its mechanisms.

The formative role of the museum was as much related to the professionalization of individuals as to their civic development. Many museums followed John Ruskin’s aesthetic/ethical programme founded on the premise that “the greatest thing a human soul ever does in this world is to see something,” where seeing “engaged the moral and physical capacities of individuals, who therefore actively experienced and participated in their own education” (Koven 2000: 25). For Ruskin, “[t]he visual sense was paramount to unlocking the visible and invisible truths of God” (Koven 2000: 25). When applied to museums, these postulates transformed them into spaces of civic development:10 they were to constitute the viewer both as the seer and the seen and offered him/her a number of narratives through which to accomplish the aim of this self-educational project. They were convergence spaces in which various narratives of progress and improvement were articulated and performed: narratives of human evolution and of national development (Macdonald 1998: 12). They also offered a social space where the identity of a single viewer was negotiated through interaction with others (Bennett 2009: 28).11 According to Eileen Hooper-Greenhill, the educational function of the museums consisted in three common tendencies: the propensity of Victorian museums to propagate “noble actions,” “good conduct” and “mental exertion,” that is, in the museums’ tendency to highlight the values of the growing middle classes, for whom not nobility through birth was important but nobility through exertion (2000: 40-3). These precepts turned such establishments as the National Portrait Gallery into sites where individual viewers were exposed to and took lessons in civility. The evolutionary trajectory of many such narratives was formative to the self-perception of the viewers and to their recognition of their position within the bounds of society (Bennett 1998: 34). Similarly, the Polyclinic offered specific narratives of identification, which underlay the students’ formation as professionals and citizens.

In the Polyclinic, these narratives pivoted around the ideal ofa progressive gentlemanly doctor, whose work benefited the nation and the empire: an ideal supported by the architectural design of the school and the adjacent museum and by the way in which disease exposition and recognition corroborated in the students’ professional formation.12 Artefacts in the clinical museum offered an illustration ofvisible medical disorders and functioned as signifiers of progress. In his classical study of museums, Collectors and Curiosities (1990), Polish philosopher and historian Krzysztof Pomian inspects the ontologically unstable ground between the visible and invisible as constructed by collectables. He draws a distinction between useful objects and “semiophores, objects which [are] of absolutely no use [... ] but which, being endowed with meaning, [represent] the invisible” (30; original emphasis). “[Intermediaries between the onlooker and the invisible” (23), semiophores help gain access and, at least partially, control the intangible through the production ofmeaning. They also play a crucial role in the construction and maintenance of social hierarchies, with collectors of semi- ophores at the top of the social ladder (36-44). Since the illustrations gathered in the clinical museum can be regarded as semiophores, what is the nature of the invisible that they evoke?13 What stories do they tell?

Numerous Victorian exhibitions transformed the collectibles into “material signifiers of progress - but of progress as a collective national achievement with capital as great co-ordinator” (Bennett 2009: 67). In the same way, the Polyclinic clinical museum can be regarded, at least with reference to the existing materials, as padded with ideals of advancement and improvement, supported by sub-narratives of human evolution. Whereas no generalizations can be made due to the lack of sufficient sources, it is nonetheless possible to distinguish, among Hutchinson’s materials, small-scale narratives of human evolution, evoked by the semi- ophores, which run parallel to the master narrative of progress as embedded in the architecture of the museum.

Syphilis visualizations supported such narratives. The grouping of yaws, a disease Hutchinson regarded as a tropical variation of syphilis, is a vivid example of such a tendency.14 Positioned in one frame, images of an English boy are contrasted with photographs of “a negro” acquired from Dr Daniels from Georgetown (then British Guiana) (Hutchinson 1901b: 180). From this juxtaposition Hutchinson concludes that:

[a]s regards climate both these patients were under the same conditions, and it is not unfair to suggest that difference in race may explain the minor severity in the European [... ]. At any rate we may remark that no portrait or patient illustrating yaws in a severe and persistent form in a person of European descent has ever been brought under our notice. (180)

Through this contrast, the ‘lower’ status of the non-Europeans - evident in their inefficient immunity to the disease - is emphasized. Hutchinson’s conclusions are in keeping with professional convictions at the time, which often allied the incidence and severity of diseases with climatic conditions and racial predispositions. In this context, the bodies of the viewers - the healers - seem to be positioned even higher on the evolutionary scale.

Similar sub-narratives found in many groupings of particular diseases were supported by the overall arrangement of the exhibits. According to the existing sources, the lower entrance of the museum was ornamented by the images of foreigners suffering from skin diseases:

The large coloured portraits five in number, all representing Negroes, which are to be seen over the door in the lower museum, have been copied by Burgess from photographs. The originals were Negroes in the West Indian Islands under the observation of Dr. Alford Nicholls. [... ] The close resemblance of the eruption [... ] to that of syphilis must strike every one. (Hutchinson 1901b: 181)

It seems as though this arrangement, repeatedly re-envisioned in smaller groupings of diseases, tells the story of the ascent of man - from diseased “Negros” to English medical men who reside in the upper rooms of the Polyclinic. In this way, the visitor did not only see the evolutionary progress in diseases but also in their classification and ordering and hence was confronted with “a spatial realization of the relationship between progress and differentiation,” and offered “props for a performance in which a progressive, civilizing relationship to the self might be formed and worked upon” (Bennett 2009: 182, 186). Small-scale narratives, exemplified by the grouping of yaws and the narrative beginning of the collection with the set ofimages oftropical diseases illustrate the extent to which the Polyclinic museum followed the then ostensible goal of reiterating the evolutionary narrative in terms of nationalistic, if not imperial, progressivism. The arrangement of the semiophores evoked the fictions of Britain’s power and superiority.

The architecture of the Polyclinic was optimized for this grand narrative of education and enlightenment. Its design, initiated by Hutchinson’s son Herbert and executed by the architects Marshall and Vickers, marked an ascendance to knowledge. The original plans (Fig. 3.2) foresaw that the Medical Graduates’ College and Polyclinic at 22, Chennies Street would have two entries, one in the basement, through the Curator’s room, and

The plans of the Polyclinic. “The New Museum.” The Polyclinic 2.1 (1899b)

Fig. 3.2 The plans of the Polyclinic. “The New Museum.” The Polyclinic 2.1 (1899b): 50-61. Wellcome Library one on the ground floor, adjacent to the clinical museum. The museum room, with “a broad gallery running around it, and a staircase and landing platform in its centre” (Hutchinson 1899b: 59), was to be thoroughly lit by two large skylight windows and to afford about 3,000 feet wall space for the display of illustrative material (Hutchinson 1899b: 62). It was to be accompanied by other functional rooms such as the dark room in the basement and lecture rooms on the ground floor. This functional arrangement can be seen in rhetorical terms. Already the 1901 article “The London Polyclinic” conceives of the visitor’s path in the Polyclinic in terms of professional ascendance and improvement. The ensuing passage can be read as a metaphorical ascent from the daily routine of observation to the elevated premises of esoteric circles, where only the learned and the experts preside (1218-19). A parallel is drawn between the progress of the British Empire and ascendance in medicine.

In this way, a professional hierarchy is established on grounds of the practitioners’ seeing abilities. The article starts with a description of two basement rooms with ophthalmoscopic, laryngoscopic and stereoscopic equipment. Functionally and metaphorically, they constitute the basis of clinical knowledge of the time and refer to the mechanisms of knowledge acquisition. From there, the author takes the reader to the three rooms on the ground floor, which represent a further step in clinical ascendancy and education: the classroom with a Roentgen ray-plant, the photographic dark room and the Council room used as a library and reference room. Whereas the mechanical means that enhance clinical vision in the basement area - the opthalmoscope and the laryngoscope - are devices that facilitate medical looking ‘at’ chosen areas, Roentgen symbolizes a further initiation into the process of medical seeing by looking through and laying bare the internal, invisible crevices of the body. The recognition of the palpably invisible areas is also related to intensive medical study, accomplished through self-learning in the library and the reference area. The lecture and council rooms, connected to the museum, link the clinical study of disease recognition to the social character of medical knowledge. The consultation theatre, situated next to the library, is a site where knowledge can be extended and shared through demonstration, discussion and joint diagnosis. Above this area, “The London Polyclinic” notes, there is a laboratory equipped with “microscopes, microtromes, incubators, sterilisers, chemical balances, and fume chamber” (1901: 1219). Such an ascending arrangement of the Polyclinic highlights the stages of professional development: from the darkness of the basement and first lessons in medical seeing, to the learning to see with the help of new technologies, educational procedures and further selfstudy, to the joint analysis of the cases and ‘live’ classes in diagnosis and on to a further specialization in the seeing of the invisible in the laboratory space.

The design of the Polyclinic offers a peripatetic ‘regime of truth’, a route of professional and, most of all, civic development. What transpires from the writings, lectures and meetings is that both goals were subordinated to the philanthropic character of the institution. “London Medical Graduates’ College and Polyclinic” cites the words of Arthur J. Balfour, the chairman of the Polyclinic:

[The Polyclinic] brought directly home to those most in need of it medical assistance, medical advice, and medical knowledge, that would not under other circumstances be at their command. For the Polyclinic did something which the great hospitals could not do, and did not attempt to do. (1901: 1293).

The educational and scientific goals of the Polyclinic were thus linked to its philanthropic mission, which is also instantiated by clinical demonstrations in the lecture area, where diagnosis was given to the deserving free of charge. The immediate effect of this instructive act - the help for those who could not afford medical consultation - was simultaneously a didactic demonstration, which offered a platform for professional discussion. Together with army doctors and other visitors, this knowledge would be spread throughout the British Empire. The doctor, envisioned as “an angel of mercy to thousands and tens of thousands” (“London Medical Graduates’ College and Polyclinic” 1900: 1432), could learn from the best in the Polyclinic and be helpful all around the globe. In his “An Address on the Uses of Knowledge,” Hutchinson compares the medical profession to a “Church of Science, sending its pastors and teachers to reside in the most various and distant parts of the world, and become bearers of the torch of knowledge wherever they may go” (1885: 634). In these accounts, the Polyclinic forms doctors into missionaries and pastors of knowledge, whose role it is to heal and to spread knowledge and, by that, to add their share to the shaping of the social order.

Professional progress and evolutionary development were central to the spatial and practical design of the Polyclinic. Practitioners were led along the path of professional enlightenment: from the early darkness and confusion, trough the initiation into specialized and technologized processes of recognition to the final and joint enlightenment in the diagnostic rooms, where they could share their knowledge. At the end of this journey was the activity of public diagnosis, which, like the underlying evolutionary sub-narratives, sustained the belief in the beneficence of the medical profession and its importance for the prosperity of the whole nation: practitioners were initiated into specialized knowledge not only to advance their profession but also to cure patients. However noble, the aspirations voiced here were also an integral part of justification narratives, which granted medical men a more esteemed position in society.

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