This blog post includes images of pregnancy and nudity, which some readers might find uncomfortable.
Dr Christine Slobogin, Visiting Early Career Research Fellow in 2021-22, writes:
My fellowship at the Rylands, from January 2022 to April 2022, allowed me to gather primary source material for my second major research project, titled “Anonymous Anatomies: A Critical History of Visual Anonymity in Britain and America, 1870-1955.” There has been no critical history written on anonymity in medical imagery, perhaps because it is in part a history of what is not visualized.
My PhD research also focused on the visual material of medicine, but in a very different capacity. My thesis was on drawings and photographs of facial injury and plastic surgery during the Second World War in Britain. It was through this research that I alighted upon the “Anonymous Anatomies” topic.
Fixating as I was on the face during my PhD, I often came across difficulties with when and how to show patient images. The rules of archives, journals, and publishers often contradicted one another. “Anonymous Anatomies” comes from my desire to get to the bottom of the historical precedents for how we think about patient anonymity in imagery, and how the ethics around the display of patients’ faces developed from the nineteenth century onwards.
Since I study the modern period, most of the material that I combed through during my fellowship is held at the Main Library. As expected, the scope of the medical publications at Manchester did not disappoint, and I now have an Excel spreadsheet containing details for almost four hundred images that will eventually be used to write the “Anonymous Anatomies” monograph.
When I first started this project, I thought that I would be looking at prints and drawings, as well as photographs. But the deeper that I went into the image sources, the more I realized that it is really photographs that pose the most complex ethical and aesthetic dilemmas.
Photographs serve as representative indices of the patient, rather than as interpretations (although there is theory that complicates and nuances this statement). And it is when photographs start to be used more often in medical publications that the question of patient recognizability is grappled with through anonymization tactics.
Anonymization Tactics
The question of patient display is dealt with in many different ways. Before starting this fellowship, I knew of black bars placed over faces, or eyes excised from photographs – these are among the most common ways in which publishers and practitioners anonymize their subjects. But the sources at the Rylands showed me that the visual conventions that were improvised to provide solutions to patient recognizability went far beyond these two tactics.
I found many strange and creative instances of anonymization in medical photography. In a 1901 book on the diseases of the thyroid gland, I found some approaches to anonymity that I had not found anywhere else. Thyroid diseases proved to be particularly rich pathologies for this project, as these illnesses are most obviously shown in the neck and eyes, so they offer difficulties to practitioners wanting to anonymize.
The diversity of the images in this book by James Berry show the ad hoc nature in which anonymity was dealt with in this period. Berry’s publication uses some more conventional tactics, such as cropping the image below the eyes. But several patients were given more fashionable, delicate anonymization treatments.
One is covering her eyes (or is a doctor, out of frame, covering them for her?) with a round, decorative fan. Another has had a layer of lace cloth placed over her face – a softer tactic than the cutting or scratching or blurring of the eyes that often accompanied depictions of thyroid diseases. Another patient in this book – not shown here because the anonymization is not very effective – is “anonymized” by a diaphanous black veil, like one that a widow might wear.
Hooding the Patient
Beyond these fascinating examples of aestheticized anonymization, there is one tactic that particularly interests me intellectually. I found many women who were anonymized with a sack placed over their head. The sack over the patient’s face offers perhaps one of the most compelling narratives of anonymity as it relates to the overlap of the histories of medicine and of photography – the two fields with which I am most concerned.
This stereoscopic image, found in the medical museum collection, shows a heavily pregnant woman diagnosed with a “pendulous belly” with a cloth sack placed over her head. This image inspired me to look for more of this type of anonymization, and I found several others examples in the Rylands collection.
I am working on an article about these images tentatively titled “Hooding the Patient: Early-Twentieth-Century Medical Anonymization and Visualizations of Torture.” Using these extraordinary pictures, I am couching this type of medical imagery within the context and theory of photographs of torture and execution, in particular the Abu Ghraib prisoner abuse images of 2003.
In this research, inspired directly by my Rylands fellowship findings, I intend to build upon the work on affect and photography that I began in my PhD, interrogating what Judith Butler terms “the way in which suffering is presented to us, and how that presentation affects our responsiveness.”
In these medical photographs, women’s bodies (it is always women) are lined up for the “shooting” of the camera, as if prepared stoically and nakedly (they are always nude) for an execution. Some of them even hold out their arms like the most famous Abu Ghraib photograph of a hooded prisoner.
By asking “What are the visual similarities between images of torture and images of diagnosis?”, I will aim with this research – one facet of the larger “Anonymous Anatomies” project – to articulate the visual and ethical power dynamics of early-twentieth-century medicine and anonymity.
Questions for the Future
Even just in this blog post, I have had to grapple with which images I can show, and which to hold back. This is especially important when writing a piece like this that will be published online for all to see and to potentially reuse. Working with medical images, even when they are of patients from a hundred years ago, brings with it complicated ethical quagmires.
I do not want to reify the pain and exposure that these patients may have felt when their pictures were being taken, but I also think that it is important to chart who was deemed worthy of anonymization in medical journals and books, and why. Ethics of display and publication form the backbone of “Anonymous Anatomies”.
My time at the Rylands ended up raising more questions than it answered – but that is exactly what I was looking for with this fellowship. I am grateful to the Rylands for funding this period of research that completely shifted how I am thinking about this project. I will continue to develop this work as a Postdoctoral Fellow in the History of Medicine and the Center for Medical Humanities & Social Medicine at Johns Hopkins University, starting this summer.
Dr Christine Slobogin
Image references
- James Berry, Diseases of the Thyroid Gland and Their Surgical Treatment (London: J. & A. Churchill, 1901), 281 and 340-341. Manchester Main Library Archives. K11.51 B26.
- G. F. Barbour Simpson and Edward Burnet, eds., The Edinburgh Stereoscopic Atlas of Obstetrics, section IV (London: The Caxton Publishing House, 1909), no. 82. From the collection of the Museum of Medicine and Health, Faculty of Biology, Medicine and Health (found with help from Stephanie Seville)
Fascinating post and an astute perspective. The Berry book is on-line at the Welcome Institute and is in Public Domain. Do rules about patient imagery and privacy extend to those in a book in public domain? Or does one still have to seek permissions? As it is, I would suggest that the “widow” was not trying to hide behind her veil but actually lifting it up so that the subject of the photograph could be seen better. The vast majority of the photographs in Berry are not anonymised and whilst those that are framed so the top of the face and eyes are not shown do achieve anonymity, I would suggest the cropping is done solely to show the condition more clearly.
re. “hooding”, F A Hornibrook’s ‘The Culture of the Abdomen’ has some patient photographs with the anonymity technique of a simple white blindfold – as if they were in front of a firing squad.
A very interesting subject. I have worked on Scottish 18th and 19th century engravings of anatomical subjects and it struck me that there was often little care to conceal identity, to the point where I became uncomfortable that I could see this was a ‘real’ person. I wondered if the attitude came from the fact that some (many?) of the bodies used for disection were of executed people. It seemed odd that in order to make an engraving at least three people were invovled; the dissector, the artist and the engraver and all three had accepted this method of working and the engravings were published. I wonder at what point this attitude changed – was it the camera that made the difference, in the same way that you don’t take a camera into a life class… so many questions.