Stories of illness: biographies, pathographies and narratives

Back in June 2011 I attended a seminar on the role of biography in the history of psychology and psychiatry. This interesting and informative day raised a lot of questions about the relationship between biography and history. Modern academic historians often have an uneasy relationship with biography, perhaps because of the emphasis on the ‘Lives of the Great and the Good’ in traditional histories, perhaps because of the temptation to subjectivity, so dryly observed by Oscar Wilde:

“Every great man has disciples, and it is always Judas who writes the biography”

One of the consequences of the rise of psychology in the Nineteenth century was that biographers were no longer concerned merely with recording the events in a person’s life. As noted biographer Robert Gittings put it:

“Modern biography aims to take account of every aspect of a man or woman’s life, conscious or unconscious, psychic or physical, public or private, physical states, especially long-term or deeply-laid, must be important to the biographer”

There is no doubt that developments in medicine in the past 200 years have contributed to the evidence available to biographers, not least the death certificate, attesting to the cause of death. You have only to recall how eagerly the media report coroner’s reports on the death of celebrities to see how much medical evidence has become integral to the account of a person’s life. Indeed, there is even a sub-genre of biography that focuses on the medical evidence for the physical and mental state of its subject: the pathography, defined by the Oxford English Dictionary as:

“The study of the life of an individual or the history of a community with regard to the influence of a particular disease or disorder; (as a count noun) a study or biography of this kind.”

Musicians (and composers), genius and power seem to be the most popular subjects for celebrity pathographies. For understandable reasons books such as The Pathology of Leadership raise concerns about the effects of illness and medical disorders on the decision making faculties of great leaders. At the Library, a whole section of the Biographies Collection is dedicated to famous patients (shelf locations BZPX and BZPXA). Here you can find out how a lock of Beethoven’s hair revealed that the likely cause of his many ailments and painful death was lead poisoning (syphilis, another candidate was ruled out because of the absence of mercury - the most common treatment for syphilis in the seventeenth century - in the lock of hair). An absence of traces of opiates suggested that he had not received pain relief during his illness and this may have been the reason why he was able to compose right up to the time of his death.

The latter half of the twentieth century saw the emergence of personal memoirs and autobiographical accounts of illness by ordinary people, as opposed to biographies about celebrity patients. These were usually less concerned with the physical and mental effects of illness and treatment than with the subjective experience of being ill: “the attempts of individuals to orient themselves in the world of sickness….”. as Anne Hawkins put it.

Early patient pathographies such as Anatomy of an Illness helped to address this issue, often expressing frustration with the health system as much as their experience of illness. Under the more general description of patient narratives, they are now relatively commonplace, and to be found in a variety of formats, including biographies, autobiographies, memoirs and graphic novels, and may recount the experience of the carer or family, as well as the patient.

In Reconstructing Illness, Anne Hawkins suggests that one factor in the rise of patient narratives has been the focus of modern medicine on the biophysical aspects of disease at the expense of the patient’s experience of illness. While there have been popular medical accounts about patients, often based on case studies, such as Oliver Sacks’ books, in general, the patient’s voice was missing. It appears the medical establishment are seeking to address this issue, in the relatively recent field of Narrative Medicine :

“A scientifically competent medicine alone cannot help a patient grapple with the loss of health and find meaning in illness and dying. Along with their growing scientific expertise, doctors need the expertise to listen to their patients, to understand as best they can the ordeals of illness, to honor the meanings of their patients’ narratives of illness and to be moved by what they behold so that they can act on their patients’ behalf.”

Medical education programmes have begun to make use of Graphic arts and other patient narratives to train doctors and health professionals in patient relations. And there is another, perhaps just as important function of the patient narrative. Some evidence suggests that writing about their illness may be beneficial to a patient’s well-being.

The proliferation of a more recent form of patient narrative – the online blog - may also testify to the beneficial effects of writing about illness. As one account of blogging during terminal care notes, it can also be a beneficial experience for the community of carers, friends and family around the patient.

Along with published patient narratives, blogs on illness offer a valuable insight into our contemporary cultural and personal experiences of illness and treatment, which will be of interest to historians in the future. It is relatively simple to preserve published materials, but less straightforward for transitory websites. The Library is doing its bit to preserve this material by electronically archiving selected examples of patient blogs, such as My personal journey through depression, and making them available in the Library catalogue.

Images:
A cholera patient experimenting with remedies. Coloured etching by R.I. Cruikshank, [1832?]. V0011135
Girl aged 12 in bed in a private ward of a hospital. N0012623

Close examination is recommended

Occasionally things like this happen. Christie's South Kensington are having a sale on 30 June 2010 of Victorian and British Impressionist art (mostly paintings and drawings). Lot 159 (see image on left from the sale catalogue) is a small oil painting on wood (17.8 x 14.6 cm., about two-thirds the size of an A4 sheet). It shows a little girl about to have a tooth removed by a dental surgeon who is concealing the dental pincers behind his back for fear of alarming her. It seems unnecessarily melodramatic, as, given her age, her milk teeth would surely come out anyway, but perhaps she is being given a foretaste of adult dentistry? Christie's have given the painting a "title", which is This won't hurt a bit!, though they don't say whether this was a title that they made up (as often happens) or one given by the artist.

Who was the artist? Well, Christie's say the painting is by Thomas Webster RA (1800-1886), and is signed and (indistinctly) dated "T Webster/1835". Thomas Webster is a famous and much-loved painter, a member of the Cranbrook colony of painters in Kent, and a specialist in genre paintings showing children in relation to adults. If this were a finished painting by him, it would be a valuable commodity, but as it is a small sketch, Christie's have published an estimate of only £800-1,200 for it.

However, a finished and large-scale painting of the same composition does exist: it was offered for sale by the rival firm of Sotheby's in the sale which they organized in 2008 of the collection of Victorian paintings built up by the Foreign Office official Sir David Scott. (The sale was mentioned in an earlier posting on this blog.) In that memorable sale of 19 November 2008, lot 118 was a painting on canvas (61 x 51 cm., or larger than A2), signed and dated "Edward Hughes/1866" (illustration right, from Sotheby's catalogue). It sold for £11,875 including the buyer's premium. Hughes, who was born in 1832 and died in 1908, was a High Victorian painter of the generation after Webster. Apart from portrait-painting, which was his bread-and-butter job, his specialty was painting pictures of the misfortunes of the working classes: Sotheby's cited pictures given the titles "Ruinous prices", "Lone and weary" and "Sorrowful tidings". The dental scene would fit into his oeuvre through its class-based subject matter: the little girl and her mother are expensively dressed, but they have come for the operation to a grubby lower-middle class establishment, where the aproned manual operator is concerned not to upset them.

So what is going on here: was the Sotheby's version a copy by Hughes of an earlier painting by Webster? If so, one would have expected Hughes to have signed it "Edward Hughes after T. Webster" (such signatures acknowledging earlier artists do exist). Or is the Christie's picture a copy by Webster after Hughes? That seems improbable as Webster was the senior man, and the date in the Webster inscription would be impossible, as in 1835 Edward Hughes was a little boy younger than the little girl in the painting (but remember that Christie's say the date is indistinct). The costume looks to this writer more characteristic of 1866 than of 1835, and will remind some people of John Everett Millais's My first sermon of 1863 (illustration left: Guildhall Art Gallery, City of London). That would suggest a Hughes composition.

The deeper story has yet to be unravelled, but if I were thinking of buying the Christie's painting on 30 June, I would look very closely at that Webster signature to see whether the signature might have been added to an unsigned picture. That would normally warrant the catalogue statement "Bears signature" rather than "Signed". Added signatures of famous artists are not uncommon: on the same day as the Christie's auction, the National Gallery in London opens its exhibition Close Examination: Fakes, Mistakes and Discoveries (30 June-12 September 2010, admission free), where an array of similar "modifications" will be on display.

Oil painting by Luciano Nezzo. Wellcome Library no. 44610i

As the Hughes/Webster composition shows, the surgeon's bedside manner when dealing with impressionable and vulnerable patients offers wonderful opportunities for a skilful narrative painter, and indeed the Wellcome Library has such a painting by Luciano Nezzo (b. 1856). Here it is not a child but a young woman who is facing the terror of a tooth-extraction. Unlike dealers and auction houses, we do not purport to give titles to paintings, drawings etc., but try to interpret the subject through a description in the catalogue record: in the Wellcome Library catalogue the reader will therefore find an attempt to analyse the various polarities that the artist has set out in the painting. This dramatic painting by an Italian artist of the generation after Hughes makes an interesting contrast with the works of the earlier English genre painter. Nezzo's works are rare, but this painting is signed -- and no reason has been adduced for doubting its authenticity.

Behold the man: a painting in Perth

Christ displaying his wounds. Oil painting on canvas 132.1 x 99 cm.
Perth Museum and Art Gallery, Scotland.

This painting of Christ showing to the viewer the wound in his side has belonged to the town of Perth, Scotland, since around 1862, when it was presented by a local resident, Colonel William Macdonald Farquharson Colquhoun Macdonald (1822-1893). Until recently it was hardly known to anyone, but in November 2007 it became available on the web in the British online database National Inventory of Continental European Paintings, in which it appears with a catalogue record by Dr Claudia Heide. (A small selection of the Wellcome Library's more problematic oil paintings--164 items--are also included in the same database.)

However, though databases may be accessed on the Internet through what is called a "browser" (such as Internet Explorer, Netscape or Firefox), they, unlike ordinary web-pages, do not usually expose their contents for browsing, and the painting did not come to wide public attention until it was published in the pages of a journal in October 2009, when it was the subject of a thorough and expert study by John Gash of the University of Aberdeen [1]. Such an exceptional painting raises several inter-related questions about its authorship, iconography, and function, which are discussed in Mr Gash's article.

First, who painted it? It is a Caravaggesque painting, and although there are features that suggest an attribution to the artist called Caravaggio (Michelangelo Merisi, il Caravaggio, 1571-1610), the odds are that the painting is "a stupendous act of homage by an early follower" of Caravaggio. Gash mentions as the possible author of the painting no fewer than eight such followers, all of them well known to students of the international Caravaggesque movement, and all of whom worked in Rome at some time: Bartolomeo Manfredi, a master of half-length compositions; the elusive Giovanni Antonio Galli, il Spadarino; G.B. Caracciolo, il Battistello, of Naples; Valentin de Boulogne; Gérard Douffet from Liège; the Venetian Carlo Saraceni; Antiveduto Gramatica from Siena; and Alessandro Turchi from Verona. Unable to fix on a definitive attribution, especially in the painting's uncleaned state, Gash concludes by designating the author as The Perth Master. One of the small unusual features that might prove to be a clincher of the attribution is the fact that the outer contour of Christ's halo follows the irregular contour of his hair, instead of being a perfect circle.

The iconography is also unusual. Pictures of Christ showing his wounds are usually narratives of Christ showing his wounds to the doubting Saint Thomas, called by art-historians the ostentatio vulnerum [2]. In the Perth painting, Christ is showing his wounds to us as the viewers of the painting; or to us as contemporary doubting St Thomases. Works showing this subject tend to be mediaeval rather than early modern: the closest parallel cited by Gash is a Florentine sculpture (left) from the early 15th century, which happens to be prominently displayed in the Medieval and Renaissance Galleries at the Victoria and Albert Museum--the new galleries which opened on 2 December 2009 (below right). [3] It is displayed rather high on the wall in the V&A because it is thought to have been placed originally above the cloister doorway in the hospital of Santa Maria Nuova in Florence. [4]









This provides Gash with a clue to the function of the painting:
"Sculptures and paintings of this subject were traditionally located in hospitals, as reminders of Christ's compassion for, and identification with, sick and suffering humanity, and it may be that the sculptural qualities of the Perth painting reflect that tradition and were devised for such a location." Paintings for such a setting are documented as having been painted by Caravaggio himself. During his time in Rome, one of his patrons was the prior of the hospital of Santa Maria della Consolazione: as Gash remarks, "none of these pictures has ever been identified, and the subject of the Perth canvas would make it an ideal contender".

However, Caravaggio was not the only painter to receive such commissions. Another of the candidates, Bartolomeo Manfredi, was patronised by Pope Paul V's physician, the connoisseur and critic Giulio Mancini, who had links with the two Roman hospitals Santa Maria della Consolazione and Santa Maria della Scala. Manfredi also made paintings for the rector of the Hospital of Santa Maria Della Scala in Siena. Another Caravaggesque painter, the Fleming Louis Finson, painted an allegory of the four humours and other subjects for the hospital of the Jesuits at Sant'Andrea della Valle in Rome before 1612. [5]

The Perth painting gains in force if we imagine that we are not just doubting St Thomases to be won over intellectually to the possibility of resurrection, we are also vulnerable, ailing hospital patients with painful ulcers, bubos, and aposthumes, to be comforted by this vision of Christ appearing, as if in living reality, before us, and demonstrating his own trauma. Christ tilts his head, raises his eyebrows and furrows his forehead in a combined questioning, pained and resigned expression in response to our presence before him: "What do you expect? I went through this—-you can endure it too". The contour of the halo also emphasizes his physical humanity.

So—a remarkable discovery, obscure even in Perth, even more so elsewhere until now, and one which enlarges our insight into the minds and sufferings of early modern people.

[1] John Gash, 'A Caravaggesque "Christ" in Scotland', The Burlington magazine, October 2009, 151: 682-690

[2] Sabine Schunk-Heller, Die Darstellung des ungläubigen Thomas in der italienischen Kunst bis um 1500 unter Berücksichtigung der lukanischen ostentatio vulnerum, München: scaneg, 1995

[3] Anna Somers Cocks, 'How the Victoria and Albert Museum dealt with the dying of Christianity: the redisplay of the museum's Medieval and Renaissance Galleries' The art newspaper, December 2009, http://tinyurl.com/yzjfawm

[4] "Tentatively identified as the figure of Christ once situated over the now-destroyed small doorway leading into the Chiostro delle Ossa, next to the church of Sant'Egidio within the hospital of Santa Maria Nuova in Florence. Christ's wounds were a focus for devotion. His side wound was especially venerated, and in prayers it was evoked as a refuge for sinners. No. A43-1937 artist unidentified" (V&A exhibition label)

[5] Louis Finson, The four elements, Milano: Rob Smeets, 2007

The Exhibition of Living Patients, 1881

A man with Lupus erythematosus. Watercolour by Mabel Green, 1902.
Wellcome Library no. 672807i

The International Medical Congress which took place in London in 1881 was the seventh in the series, sandwiched between the sixth congress in Amsterdam and the eighth in Copenhagen. It was a crystallization of the medical knowledge of the time. Some 3,000 people attended from every continent. The four massive volumes of its Transactions make fascinating reading for the historian, and no doubt also for the historically-minded clinician.

The organizers of the Congress decided to include among the attractions a museum in which specimens of one sort or another could be shown. These were mainly drawings, photographs and casts, but in addition there were two special exhibits. The renowned neurologist Jean-Martin Charcot (1825-1893) brought over from Paris a life-size wax model of a recumbent woman with locomotor ataxy and disordered joints, together with her preserved skeleton, illustrating one of Charcot's many clinical discoveries; and Jonathan Hutchinson, the chairman of the Museum Committee, organized an "Exhibition of Living Patients".

The Exhibition of Living Patients was something of an experiment, and it turned out to be a victim of its own success. It was allotted one of two rooms (the museum room and the boardroom) of the Geological Society, one of the Learned Societies which have been housed since 1874 in magnificent buildings around the courtyard of Burlington House on Piccadilly.

Right: Burlington House and Piccadilly. Wood engraving, Illustrated London news, 1873. The Geological Society's rooms are on the right of the entrance archway.

According to Hutchinson there was "confusion and crowding … Our exhibition was more popular than we had expected: every morning at the hour announced, the room filled. The weather chanced to be very hot [this was the first week of August], and as the room looked into Piccadilly, it was exceedingly noisy." One of the reasons for the noise was that, while the hubbub of Piccadilly entered through the open windows, not only did the doctors presenting their patients have to speak over it but at the same time visitors were continually jostling in and out of the crowded room. [1]

Left: Jonathan Hutchinson. Oil painting by W. Swainson, one of the artists who produced pathological illustrations for Hutchinson. Wellcome Library no. 45691i

For those who could get near it, the exhibition was evidently quite a sight. Beneath the chandeliers in the fine rooms sat seven patients with leprosy, four of them supplied by Hutchinson. Six patients with diseases designated as myxoedema sat in a row and "the peculiarities of their features, and the sameness in their peculiarities, became very conspicuous". There were also many cases diagnosed as Lupus, a disease which fascinated connoisseurs of clinical conundrums. In Hutchinson's words:

All the varieties of Lupus Erythematosus were plentifully illustrated by cases produced by Mr Malcolm Morris, Mr James Startin, Mr Waren Tay, and myself. Some of the cases were very exceptional ones. Several were of the form known as lupus sebaceus; and of these, two showed the remarkable tendency to occur in the concha of the ear (symmetrically) just where a group of glands is placed, which are often the site of comedones. Other exceptional forms of Lupus, especially Lupus of Mucous Membranes, and the punctate form known as Acne Lupus, were also illustrated. In several of these cases, portraits showing the state of the disease several years before were placed by the side of the patient, thus making the cases more than doubly instructive.

One of the visitors to the museum was the young Professor William Osler from McGill University in Montreal, who recorded his experience of the congress in the Canada medical and surgical journal [2]. Osler described the museum as follows:

For working purposes the Congress divided into fifteen sections, the meetings of which took place in the rooms of the various learned societies at Burlington House and of London University, and one or two other contiguous institutions. One of the most instructive parts of the congress was the Museum, held in the Geological Society's rooms. This consisted of illustrations of disease in the living subject, as well as a large assortment of rare and interesting prepared specimens. … Mr Jonathan Hutchinson had a number of cases each morning, and his demonstrations on leprosy, rheumatic arthritis and inherited syphilis attracted large audiences. Rare forms of skin diseases were exhibited by many of the leading dermatologists. The museum of specimens contained about 700 examples of interesting and rare illustrations of morbid anatomy. … The walls of the rooms in which the specimens were collected were covered with coloured drawings. Among the most remarkable of these was a set of watercolours by Sir Chas. Bell, illustrating gunshot and other wounds seen by him after Waterloo. Mr Hutchinson's enormous collection attracted particular attention, and illustrated most of the special departments in which he has become so famous. What struck me as most remarkable among them was a set illustrating eruptions due to iodide and bromide of potassium, particularly two portraits of a man, the subject of an extensive eruption of tuberous masses on the skin, many of them ulcerated. … Several beautiful coloured drawings by Raphael of Montreal were exhibited by our townsman, Dr Roddick. An excellent catalogue greatly facilitated the inspection of the specimens, and perhaps as much direct benefit to the working members of congress was obtained during the time spent in the museum as in any of the other departments.

The watercolour of a man with Lupus erythematosus shown above is one of twenty-six watercolours which have recently been acquired by the Wellcome Library and which are believed to be strays from Jonathan Hutchinson's "Clinical Museum", though their connection with Hutchinson is at present only circumstantial. The Oxford dictionary of national biography says of Hutchinson "His vast collection of pathological drawings was probably unequalled." The artist of this watercolour, Mabel Green, was one of the small band of artists who worked for Hutchinson. After Hutchinson's death in 1913 most of his watercolours were sold, and they were acquired in 1915 for the Hospital of Johns Hopkins University in Baltimore: the acquisition was celebrated by William Osler (by now Regius Professor of Medicine at Oxford) some thirty years after his first sight of them in Piccadilly. [3] They are now in the Institute of the History of Medicine at Johns Hopkins. The reason why the Wellcome watercolours did not join them is currently obscure. Another of them, also by Mabel Green, is shown below, and the catalogue records for all the 26 drawings in the Wellcome Library will be found in the Wellcome Library catalogue.

Watercolour by Mabel Green, 20 May 1896. Wellcome Library no. 675950i

[1] Transactions of the International Medical Congress, 7th session, London 1881, vol. 1, pp. 109-132

[2] Digital page-images of the Canada medical and surgical journal are available free online in the corpus Early Canadiana Online (ECO, http://www.canadiana.org/ECO ), produced by Canadiana.org. Osler's paper describing the Congress is at http://www.canadiana.org/view/8_05177_110/58

[3] William Osler, 'The Jonathan Hutchinson iconography: a preliminary note', The Johns Hopkins Hospital bulletin, vol. 26 (1915), no. 289, pp. 82-83