Picturing Medicine: visual and material culture as historical source

Researchers in the medical humanities are becoming increasingly alert to the potential of visual sources and visual culture. Here Dr Katherine Rawling, Dr Harriet Palfreyman, and Dr Beatriz Pichel discuss their research into medical photography to reflect on their practice and draw attention to possible new directions in the history of science and medicine.

KR: As a group we have different disciplinary backgrounds – history, philosophy, and fine art, but all three of us place visual culture at the centre of our historical research. For me it’s about treating medical photographs carefully and analytically, just as I would a textual source – too often images, and especially photos, are taken at face value and under-analysed, if commented on at all. My approach demands that we take visual culture seriously and consider it as something that was fully part of discourse, not an addition or side issue, or as an exception. Visual sources are everywhere in the history of medicine and they can change established narratives and interpretations.

HP: It’s not just about reintroducing images into established historical narratives or as additional material, but revisiting subjects from the starting point of their visual cultures and asking questions that begin from the images or artefacts.

BP: For me, the advantage of using photographic material is that, in one source, you get images, objects and texts. There are not that many sources that are so complete. We can use visual sources to explore issues that do not have to do with visual culture. If we use photographs, the subject of our book or article doesn’t need to be ‘medical photography’; we can study the history of a medical topic (surgery, the asylum, emotions, etc.) through photographic sources.

KR: But I think we’ve all encountered a reluctance from some to consider the visual, whether that’s from unfamiliarity, or assumed knowledge – often images are considered so straightforward, it’s thought they’re not worth including, or only as illustrative material.

HP: True, and ironically, there’s also a common assumption that images are somehow inherently ambiguous and therefore harder to interpret. If the history of medicine is going to embrace the ‘visual turn’ and all it has to offer then there should be better training for dealing with non-textual sources, one that takes students beyond a basic visual analysis.

KR: I think there’s a real desire amongst historians of medicine to fully engage with visual archives, but anecdotally I know colleagues who’ve come across images in their research but simply not known what to do with them – they simply don’t feel equipped to write about them in a meaningful way.

HP: My undergrads sometimes ask if they can include images and are completely shocked when I say ‘yes’, as long as they are relevant and not just illustration. If we started to train students that images are sources too from their first years, we might get a new generation of historians for whom visual analysis is as second nature as textual.

BP: We’re doing that at De Montfort University, and it’s hard for them because they never thought that they could ask so many questions in social history or the history of medicine through visual sources. But they eventually come around, and it’s amazing to see the transformation! What I find most interesting about using photographs is that you have to actively use your imagination to take you beyond what you see in an image. To help me focus on material practices I imagine in my mind everything that was happening when the photograph was taken, or when someone was reading a journal and saw the photograph. This might not be a conventional method, but I find it very inspiring for my writing and for understanding medical and social practices.

HP: That’s interesting because one of the things I often end up doing when working with illustrations is drawing things myself and trying to get at the practice and materiality of image creation through that. I think you’re right that visual history can lend itself to a more creative and imaginative interaction with our sources. Maybe then, instead of training people in rigid ways of interpreting visual sources we should be encouraging a more creative/imaginative attitude towards all our sources and allowing ourselves to play a little more with things?

BP: This is why I always make my students take photographs during seminars. You need to get used to holding the objects, understanding how a camera works, how long it takes to take an image under certain light conditions, try on poses, etc. We’re talking about visual and material culture here. It’s not just that images are everywhere, it’s that the taking of photographs, the circulation, and the consumption of them does something.

HP: I think that’s what I first really liked about yours and Kat’s work. That you don’t just treat the photos like images, but look at their materiality, for example, where they are placed in patient records and the situation of their creation in asylums.

KR: It’s an approach that I’ve found really inspiring and productive. In order for a patient photograph to be pasted inside a case book ledger it needed to be printed or reprinted, handled, cropped, annotated, framed, and so on. If we were to just look at photographic sources as simply representations, or reflections, we would lose that really important context. So, I tend to consider not only what the photo may ‘show’ (as I do think that analysis of content, style, pose and so on is very important) but also what the object does and how it was produced. I’ve found that considering the visual archive can help historians rethink or change the narrative. Leafing through asylum case books stuffed with photographs in which patients are just as likely to pose happily for the camera, as they are to look away, should prompt us to question the related issues of power, control, and agency in the history of mental ill-health. Viewing patient photographs has helped me think about relationships in an institution – the daily interactions between staff and patients, and the dialogue and negotiation that was necessary for an asylum to function, were also needed for successful photography – whether that takes the form of cooperation and complicity or discipline and coercion.

HP: Visual sources can certainly provoke the same kind of reassessment in the history of medical education. Education, especially in disciplines like surgery, has long been based on visual and material cultures – think of the use of images, models, recreations and simulation, which is only getting more complex now with the use of VR and haptic tech. But the history of medical education has never really grappled with the intense visuality of training. Take for example one of the images I’m looking at in my work on medical illustration in the twentieth-century. First and foremost, this is an instructional image demonstrating the appearance of a Gigli saw, an instrument for making a cut through the skull. In terms of medical education, it begs numerous questions. For example, what are students supposed to learn from this image? It tells us little about how to position the saw in this way or how to use it to make the cut, both elements of practice that are difficult to visualise or verbalise and must be taught in person. However, the image also demonstrates that a part of medical education is learning how to understand the visual language of these images; the meaning of the dotted lines and shading for instance.

BP: For me, it’s all down to practices. What I’m interested in is what doing photography did. What were the effects of taking photographs in a medical institution or reproducing images in scientific journals? In my new project, Photography and the Making of the Medical Sciences in France (1860-1914), I examine photographic practices in different institutions, medical specialisms and publications, and I argue that photographic practices contributed to the making of medical knowledge, the shaping of medical specialisms and the communication of scientific ideas. When I talk about practices, I refer to the actions of the production, examination, display, circulation and consumption of photographs, so it includes both the visual and the material. I believe that we can retell important episodes of French medical history, such as the birth of experimental psychology or the development of specialised medical journals, from a photographic point of view.

We all agree that visuality is unavoidably connected to materiality. Visual archives offer rich, varied, and extensive sources for the historian, but researchers should be properly trained so that we do more than simply introduce visual evidence into established historical narratives. More exciting and meaningful work can be produced when we revisit subjects from the starting point of their visual cultures and ask questions that begin with the image-objects themselves.

Dr Harriet Palfreyman is a Research Fellow at the Centre for the History of Science, Technology and Medicine at the University of Manchester. Her research explores the visual cultures of pathology and surgery in the nineteenth and twentieth-centuries and her current focus is on medical illustration in the twentieth-century. Her previous work has looked at the history of minimally invasive surgery in the late twentieth-century and visual representations of venereal disease in the nineteenth-century.

Dr Beatriz Pichel is Research Fellow at the Photographic History Research Centre, de Montfort University, Leicester. She is a specialist in photographic history, the history of medicine and the history of emotions. Her new project explores the role of photography in the making of medical specialities in France in the nineteenth-century. Her work has been/will be published in History of the Human Science, Journal of War and Culture Studies, and Media History among others.

Dr Katherine Rawling is Visiting Fellow in the School of History at the University of Leeds. Her research explores the ways in which photography interacted with medical knowledge and practice and experiences of patients and practitioners. Her book The Institutional Eye: Photography in the Asylum 1850-1914, will analyze photographs of asylum patients and the varied photographic practices behind them. Katherine’s postdoctoral project, Photomania: Anxiety, The Camera and Diseases of Modernity, 1850-1914, examines the connections between nineteenth-century and present-day anxieties over the photographic image and health and well-being.