Cape Town, South Africa
|Image courtesy of the Pathology Learning Centre, University of Cape Town|
Looking into the face of a patient is a necessary part of the clinical experience. Yet despite the physical proximity achieved in the doctor’s office, on the operating table, or in the petri dish, it is only when patients are perceived as legible objects that their bodies can be impartially scrutinized, deciphered, and ultimately cured. Part and parcel to what it means to be a medical practitioner is to see patients as puzzles to be solved, as questions to be answered. This, in the words of neurosurgeon Henry Marsh, is what allows dread to be replaced with the kind of “fierce and happy concentration”1 necessary to practice medicine; it is what turns assault into treatment.
The necessary objectification of the clinically unwell is understood within the humanities to be a consequence of the “medical gaze” – a mode of perception that allows for the human body of another to be impartially investigated and handled. A term coined and theorized by philosopher Michel Foucault,2 the medical gaze describes the transformation of the patient as a human being into a medically legible thing – a process that sees the human subject turned object, a “he” or “she” turned into an “it.”
Nowhere is this transformation more acute than when the sick are photographed. Put on display, fixed in time, and rendered little more than a representation, the patient is literally turned into an entity that can be stored, passed around, inspected, and mulled over. And yet, despite these characteristics, clinical images often trouble the clear-cut divide of subject and object; while they aim to aid a detached reading of the human body, patient photographs rarely succeed in wholly doing away with the person behind the pathology.
Historically clinical photographs have typically donned a portrait-like aesthetic. Particularly during the nineteenth century, they see the patient depicted as head-and-shoulders, often dressed in their own clothes, and looking directly into the camera. While the traditional painted or photographic portrait aimed to put an individual’s physical as well as social, economic, spiritual, and emotional essence on display,3 clinical portraits do something else. These depictions serve to capture the features not of the human subject but of disease; they merge personhood and illness, identity and pathology.4
But photography itself conducts a strange merging – even beyond its clinical use. It is a merging less of subject and object than of then and now, of present as past. This medium, more than any other, forces a viewer to face a past moment made alive in the present: of something or someone that once was but likely is no more. Yet there they are in the photograph. For Roland Barthes, every photograph of a person is thus perpetually haunted by what he calls a “future anterior” or “death in the future.”5
It is in his quest to find an image that truly captures his mother (her essence, her “air”) that Barthes uncovers this haunting quality of photography. And it is in stumbling on an image he calls the “Winter Garden Photograph” that he finally recognizes her.6 Yet it is a tragic recognition, for, at the very same moment, he is reminded of the tragedy of her passing – not depicted and yet somehow present.
Barthes’ contention is that photographs of people confront us with the inevitable loss of human life. But it is photography’s potential to usher in a sense of deep connection (as well as death) that sees Judith Butler identify this medium as a powerful ethical prompt. Photographs, in her mind, can make us see the humanness of those otherwise dehumanized, dismissed, and objectified because they make us take note of, and even mourn those they depict.7
While photography is thus inherently haunted by both loss and recognition, it is photographs of the visibly unwell that seem doubly troubled by death – by mortality made manifest in both the physical body and its representation. Such images, more than any other, offer an overt reminder of the fragility of human life and the longing that accompanies the loss thereof.
It is this experience that I have forcefully encountered upon my own engagement with a particular historical collection of clinical or, more specifically, patient photographs. Produced in the city of Cape Town during the twentieth century, the collection was generated to serve as clinical teaching aids at the University of Cape Town’s medical school. Yet despite the collection’s educational origins and empirical aims, there is little about the photographs that leave one, as a contemporary viewer, untouched.
Beyond the fact that they depict symptomatic and often broken bodies, these historical images penetrate one’s vision, and, at times, wholly disrupt the objectifying gaze and disinterested viewing required for them to be clinically useful. Nowhere else does the clash of subject and object, of then and now, appear within the collection more clearly than in an image of a young girl suffering the lurid effects of congenital syphilis.
Like many undated photographs in the collection, this one bears little information about either the patient or her care. She is pictured from the chest up, dressed in a lightly colored, almost apron-like overshirt made from a stiff, pleated, and heavily creased fabric. Her dark long-sleeved undergarment disappears into the background – merging seamlessly, invisibly, into the rounded shape of what I presume to be the chair on which she sits. From the depths of this form her thin neck juts forward, awkwardly pushing her incredibly pale and heavily freckled face towards the viewer.
Perfectly centered within the photograph, this face is framed by straight but slightly tousled dark hair, swept away from her forehead and adorned with a dishevelled bow. The depth of field is so narrow that, besides her face, the rest of her – her hair, her clothes, her surroundings – blur into obscurity. Forming a dark halo, her hair accentuates the whiteness of her skin, heightening the visual and spatial contrast between the light, unfocused background and her brightly illuminated face. Punctuated with delicate dark freckles, wide-set eyebrows, and an open soft-lipped mouth, this face is the focal point of clinical interest: it bares the disastrous evidence of her pathological condition – one that overcomes her most distinctive features.
Wracked by dark, wet, irregular eruptions, her eyes, nose, and mouth are distorted by the effects of disease. Eroded down to raw, moist flesh, her nose appears simultaneously flattened and puckered. But it her eyes that prove most affected and challenging to decipher. Oozing, wet, dripping, and seemingly overcome by the effects of the disease, they are surrounded by dark, waste-like masses that appear to bubble and blister. Surrounding one eye completely, almost filling up the space between eyelid and cheek and brow, the glistening mess of it captures the extremity of tones within the photograph – of deep black and most bright white.
She emerges as something monstrous – something not wholly human. And it is impossible to imagine her in a state of health prior to this distortion. Indeed, it is arguably this ability of syphilis to quite literally “deface” the human body that saw the disease emerge as a particularly dreaded affliction during the nineteenth century.8 As James Elkins suggests, without a recognizable face there is no person, there is no recognizable life.9
And yet, despite this destruction, there appears to be a paradox at work in clinical photographs of this kind. I cannot help but realize that this young girl is looking at me, her pupils just discernible among the dark mess that surrounds them. Her unblinking gaze meets my own through time and space as I look at this photograph of her. Her eyes catch me in my tenuous yet oddly comfortable perusal of her face, her features, her symptoms. In this image I experience a strange tension between vulnerability and knowing presentation: her widely-parted lips show large, child-like teeth – a gesture that somehow speaks to an offering up, as if this pose was requested, as a physician might prompt one to “say ah.” There she is, looking back, positioned for the camera and for me.
There is a tension here between seeing her and seeing the disease. Indeed, it is, as Erin O’Connor suggests, that this photograph allows the person to emerge at the moment they are annihilated;10 it is through the recognition of a subject lost – of someone that once was and is no more – that a disinterested reading of the patient as body, as object, as mere site of disease may be upended.
It is in her erasure that this young girl emerges, her humanity hovering on the edges of her representation. Her crumpled clothes, the ribbon, and those eyes – they offer a semblance of someone left in the wake of both disease and depiction. Rendered for clinical eyes and diagnostic purposes, the photograph is haunted by this co-presence of person and pathology, of subject and object, of past and present, and of death in the future. Such images remind us of how fragile both our own lives and the lives of others are. They allow us to practice a search for humanity when that which is recognizably human has been lost. And yet, like Barthes’s Winter Garden Photograph, this photograph “exists only for me.”11 Fearing indifference, his crucial photograph (mused over at length in the seminal Camera Lucida) was never reproduced, never printed. And, fearing indifference, this photograph, my photograph, shall similarly remain in words only.
- Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, London & New York: Routledge, 2003(1963).
- Henry Marsh, Do No Harm: Stories of Life, Death and Brain Surgery, London: Weidenfeld & Nicolson, 2015, 40.
- Graham Clarke, The Photograph, Oxford & New York: Oxford University Press, 1997, 101-103.
- Erin O’Connor, “Camera Medica,” History of Photography, Vol. 23, No. 3, Autumn 1999, 234.
- Roland Barthes, Camera Lucida: Reflections on Photography, New York: Hill & Wang, 1982, 96.
- Barthes, Camera Lucida, 109.
- Judith Butler, Frames of War: When is Life Grievable? London & New York: Verso, 2009, 14, 42-43, 96.
- Harriet Palfreyman, Visualising Venereal Disease in London c.1780–1860, University of Warwick: PhD Thesis, 2012, 244-246.
- James Elkins, The Object Stares Back: On the Nature of Seeing, San Diego, New York, & London: Harcourt Inc., 1996, 192.
- O’Connor, “Camera Medica,” 234.
- Barthes, Camera Lucida, 73.
MICHAELA CLARK works as a part-time lecturer in Visual Studies at Stellenbosch University’s Visual Arts Department. Her research focus lies in the history and politics of medical representation, particularly clinical photographic practices as they relate to the depiction of conspicuous and stigmatizing disease. She is currently part of a digital curation project for the University of Cape Town’s Pathology Learning Centre to describe the institution’s collection of twentieth century clinical photographs.