‘The Sick Rose: Or; Disease and the Art of Medical Illustration’ reviewed by Professor Shelley Wall

‘The Sick Rose: Or; Disease and the Art of Medical Illustration’ by Richard Barnett (Thames & Hudson, 2014).

Following our initial call for a clinical and artist’s review of ‘The Sick Rose,’ Professor Shelley Wall offers her perspective as a medical illustrator and lecturer of ‘pathology illustration’.

Sick Rose JktRichard Barnett’s magnificent book, The Sick Rose, brings together 354 images from The Wellcome Library with a suite of informative and lyrical essays, all centred on the state of human disease, medicine, and medical art in the long nineteenth century (1789-1914). It is an intellectual and aesthetic delight. It is also deeply disturbing, and not recommended for reading on public transport.

The introduction situates the book’s contents within the intertwined histories of European medical practice and education, anatomical study, medical illustration, publishing, print technology, and changing conceptions of the human body—both living and dead. The subsequent ten chapters address specific types of disease: skin diseases, leprosy, smallpox, tuberculosis, cholera, cancer, heart disease, venereal diseases, parasites, and gout. A short text introduces each chapter, supported by images of artifacts, historical public health posters, editorial cartoons, and early examples of information graphics. These are followed by a gallery of full-colour pathology illustrations from the period, including portraits, isolated body parts, autopsied or biopsied organs and tissues, and hand-drawn microscope field views.

The ‘disenchanted flesh’ of the diseased body, and its representation in pathological art, represent a significant strand in what Barnett calls the ‘conversation’ between western medicine and modernity. The contexts and meanings of disease were transformed as the emerging fields of scientific medicine (physiology, epidemiology, bacteriology, cell theory) encountered shifting political and cultural landscapes and the forces of industrialization, imperialism, and global trade. Each chapter — and essentially each disease —brings out a different facet of this conversation. The chapters on leprosy and venereal disease, for example, reflect the persistent ‘moral framing’ of disease. The chapter entitled ‘Smallpox: Blistered by Act of Parliament’ illuminates not only the limitations of nineteenth-century microscopy but also the history of struggles over the state’s role in public health. ‘Cancer: The claws of the crab’ articulates the power of metaphor in conceptions of disease and cure, while ‘Gout: Fashionable agony’ highlights, as do other chapters, the central role of class in the understanding of disease.

Barnett’s text provides a setting for the gems that are the priceless bookplates, paintings, and drawings from the Wellcome’s collection. Many of the images are strangely beautiful. The skill of the illustrators comes through in the detailed, finely-observed nuances of colour, texture, and form that are critical to identification and diagnosis. The clinical portraits often look like—well, like delicate, lifelike portraits—were it not for the presence of a tumour, a rash, or some other disfiguring sign of disease. As a medical illustrator, I’m thrilled by the sheer craft on display in the collection. Beyond that déformation professionnelle, as a human reader vulnerable to disease, I find myself caught between attraction and repulsion, between morbid curiosity and overwhelming pathos.

The complex experience of reading this book is captured in the very first image in the volume—a hand-coloured etching of William Blake’s poem ‘The Sick Rose’ from his Songs of Innocence and of Experience (ca. 1789-94).

O Rose thou art sick.

The invisible worm,

That flies in the night

In the howling storm:

Has found out thy bed

Of crimson joy:

And his dark secret love

Does thy life destroy.

As both book title and illuminated epigraph, the choice is masterful. The poem, one of the ‘Songs of Experience,’ evokes an unsettling conjunction of beauty and disease, of sensuality and stigma, against the turbulent background (the ‘howling storm’) of the Revolutionary era that marks the start of The Sick Rose’s historical period. A central tension throughout Barnett’s book is that between the undeniable aesthetic appeal of these pathology illustrations, and the profound distress they engender as images of human suffering and abject bodily fragments. In his introduction, Barnett asks how we might make sense of this tension: ‘Should we seek to resolve or “overcome” it, or should we practise what […] the medical-student-turned-poet John Keats […] called negative capability — the capacity to be “in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason?” The images in this volume embody one kind of answer to this question’ (p. 21).

The structure and design of the book encourage ‘negative capability’. At my first encounter with The Sick Rose, I was unsettled by the difficulty of locating detailed information about the images. Captions are minimal, discreet, and do not appear on every page. Individual sources are, of course, scrupulously identified — but for the most part only in the back matter, where they are ganged into four dense pages of text. I found myself repeatedly looking at an image, glancing to the place where I might expect to find an explanatory caption, not finding it, and then flipping to the back of the book. It was only after a period of such ‘irritable reaching after fact and reason’ that I realized the problem lay, not with the book design, but with my approach as a reader. In the absence of a detailed caption to categorise and explain a disturbing image, the reader is forced to spend time with the image itself, to listen to what it has to say.

The book’s layout helps to cultivate these silent encounters: pathological tissues are sometimes arranged in groupings or extreme close-ups that promote contemplation of them as pure pattern. Many individual portraits occupy full pages; as in Henry Tonks’s Great War portraits of wounded servicemen, the subjects possess a calm dignity that mitigates their status as medical objects. The textual portions of each chapter provide a context for the illustrations, but do not ‘explain’ them. Instead, as with Blake’s illuminated poetry, the reader is left to fill in the conversation between image and text.

For those interested in the medical humanities, The Sick Rose provides a compelling lesson in de-objectifying medical imagery. It reminds us that, at its root, pathology is not the study of specimens, but the study of suffering.

Reviewed by Professor Shelley Wall, who is a medical illustrator and assistant professor in the Biomedical Communications program, University of Toronto, Canada where she teaches, among other things, pathology illustration. She holds a PhD in Romantic literature, a four-year diploma in studio art, and a Master of Science in Biomedical Communications.

Correspondence to Professor Shelley Wall.

Shelley’s academic profile can be found here, and her personal webpage here

Works cited:

Barnett, Richard. 2014. The Sick Rose or; Disease and the Art of Medical Illustration. London: Thames & Hudson, in partnership with Wellcome Collection and the Wellcome Library.

Blake, William. 1982. The Complete Poetry and Prose of William Blake, Newly Revised Edition. Ed. David V. Erdman. Berkeley: University of California Press.

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