Disease and the Art of Medical Illustration – An Interview with Richard Barnett

Frankie Kubicki and Georgia Lauren Cherry


A young woman, aged 23, depicted before and after contracting cholera, Coloured stipple engraving, © Wellcome Library, London.

A young woman, aged 23, depicted before and after contracting cholera, Coloured stipple engraving, © Wellcome Library, London.

Dr Richard Barnett is a historian of medicine, a writer and broadcaster, and an award-winning poet. As one of the first Wellcome Trust Engagement Fellows he has spent the past few years encouraging many different groups to explore medicine’s past. His latest book is the lavishly-illustrated The Sick Rose: or, Disease and the Art of Medical Illustration – a collaboration with Thames & Hudson and Wellcome Collection. The Sick Rose draws on the rich collections of the Wellcome Library, highlighting the ‘new kinds of power and vision’ which characterised nineteenth-century medicine. We spoke to Richard earlier this week, and this article transcribes some highlights of our conversation.

Watercolour illustration from a Japanese work on smallpox entitled Toshin seiyo [The essentials of smallpox] consisting of a manuscript in two volumes. © Wellcome Library, London.

Watercolour illustration from a Japanese work on smallpox entitled Toshin seiyo [The essentials of smallpox] consisting of a manuscript in two volumes. © Wellcome Library, London.



Material Matter: Ok, so we have six questions, and the first one is: why did you become interested in the topic of medical illustration, and what drew you to write this book?

Richard Barnett: Over the past decade or so the Wellcome Library has been digitising its remarkable collection of historical images, making it available online to the public in new ways. One of the things the Wellcome wanted to do was to mark this with a new series of books that drew out different strands of the collection. My own interest in this is that the images illustrate the remarkable transformation in Western medicine and ideas about the body, but also about the importance of medicine in culture and society. It was in the long nineteenth century, from the French revolution to the First World War, that medicine became scientific, adopting the practices and the rhetoric of science. Doctors donned white coats and put microscopes on their desks, even if they never touched them throughout their careers! So there’s a new kind of scientific gaze that medicine acquires, and a new progressive orientation. But at the same time medicine is taking on new kinds of social and political power. So it’s all about new kinds of power and vision, and this book seemed a way to reflect that. What’s also here, and what really interests me, is the idea of reading these images against the grain as a genre of portraiture. There are some stunning and uncanny portraits in this book, and I love the juxtaposition of the very ‘traditional’ portraits with the illustrations of different parts of the body. It’s fascinating how often we talk metaphorically about the heart, the gut, or the brain; and here we have portraits literally of hearts, guts and various other organs. So for me it’s historically fascinating as a document of medical transformation, but it’s also fascinating as a genre of portraiture.

MM: One of the things that we really enjoyed about your book was that it wasn’t restricted to medical portraiture, it looks at illustration but includes photography, and what you might refer to as ‘still lifes’ as well as portraits.

RB: It’s interesting you say that because it is possible to think of medical illustration as a completely separate world, divorced from art, but you can see the influence of the vanitas and various genres of Western art. Through the nineteenth century they do gradually become less painterly – there’s less attention to composition and symbolism, and a greater emphasis on what would become known as ‘photographic realism’, which I think is tied up with scientific medicine self-consciously rejecting its past as a Classical learned art.

MM: Following on from that, in his review for the Guardian, Will Self commented that the style of the illustrations may have influenced the style of fine art movements. Would you agree with that, or do you think there’s evidence to suggest that the medical illustrations responded to various artistic styles?

RB: I think it’s clearly both. These images are the result of extended collaborations between physicians or anatomists and draughtsman, engravers, colourists, publishers – workers whom the sociologist Steven Shapin has described as ‘invisible technicians’. I think there’s an obvious connection with the nineteenth century realist tradition, but you can certainly see the influence of medical illustration in twentieth-century art. Francis Bacon is often noted for his anatomical references and of course he took the screaming mouth that featured in so many of his paintings from a textbook of dentistry. More generally, when artists came to respond to the bodily horrors of the twentieth century, most obviously the Holocaust, I think this genre of art, sorry, this genre of medical illustration provided a kind of ‘ready-made’ for artists to deploy, deconstruct and react against.

MM: You just described medical illustration as a ‘genre’ of art but then corrected yourself. Do you think it is an art genre?

RB: Oddly enough I’ve recently been reading a book on Grinling Gibbons, and the interesting question with him is whether his work should be seen as architecture, decoration, art, or craft. But of course the answer is why worry about these disciplinary distinctions. He’s all of these things, and that’s joyous. I’d say the same for these illustrations. To me the distinction between art and craft and science is something that is really in the mind of the viewer. So I think it’s certainly possible to see these images as a technical resource for learning the skills of a profession, which is what they were created for, but I think you can view them very profitably as art. As I write in the introduction to the book, a very appealing way of looking at these is as a kind of secular vanitas, but you could also read them with respect to the Gothic, to Romanticism, to the nineteenth-century realist tradition, and so on.

MM: So we were just talking a little about audience, how do you think the audiences of these illustrations change over the chronology of the text, and who do you identify as the audience for your text today?

RB: To take the first question, obviously these were made in a fairly narrow clinical context. They were not made as works of art for a wider audience. We don’t know very much about who read these illustrated books, but I think it’s fairly safe to assume that the initial audience would have been medical students – the kind of people who buy medical textbooks today. There’s a fascinating tension in the history of these images because on the one hand they were on sale in public bookshops, so in theory they were available to everybody – so long as you could afford the book. But what is interesting is that from the late nineteenth century through to the late twentieth century there was a move for these images to be restricted. It was not necessarily a terribly deliberate move, but if you think about the sorts of places where these illustrations were held, medical libraries and so on, these were the sorts of places from which the public was very often excluded. Often the rhetoric was about protecting the public in some way from these disturbing images. But of course there’s also an aspect of maintaining the boundaries of the profession, rather like the medieval Catholic Church preventing translations of the Latin Bible languages that the laity could understand.

As to the second question, I think it’s very telling that the current move to digitisation has come exactly when it has, as we’ve moved into this very, very visual digital culture. There’s a new fascination with this material, and I think audiences are engaging with these images in very different ways. This takes me back to some of the ethical considerations I addressed in my blog post for the Wellcome Library. Gory or lurid pictures are often taken out of context online and used merely for their shock value. Of course these are shocking and fascinating images, and I wouldn’t want to stop anybody from looking at them, but I do think there’s a power that these images have, and like all forms of power, we need to be careful in what we do with it. It’s not that we shouldn’t look at all, and I think it would be very wrong if we were to put these images away and returned to that sort of mid-twentieth century idea of restricting access to a few professionals. But I think that it’s very easy to turn these images into kitsch, or emptily ironized takes on death, and I think that’s a great pity. These images are far, far richer than that, and they deserve far better treatment.

MM: The book is an interesting collaboration as Thames & Hudson are more of an arts publisher, so in terms of audience, do you want to open these images up to an artistic audience?

RB: I’d love to. I come from a medical historical background myself, I’m not part of the art world, but it does seem to me that the power and the beauty, and also the technique that goes into these illustrations could have real resonances. So I love the idea of an artist getting hold of this and responding to it in their own way, it’s a fascinating idea.

MM: It struck us that some of the illustrations are clearly by the same hand or artist, did you have the opportunity to research the artists and their training, background, or careers?

RB: This is difficult. Part of the ‘objectivity effect’ these images possess is achieved by concealing the art and craft that goes into them. Very often the greatest way in which the artist figures in these images is in a very small signature, so it can be very, very difficult to get into these stories. We can tell a more general story, which I outline in my introduction. We can certainly say there are connections between art and anatomy, and that artists and anatomists shared a concern over how to represent the body realistically. More than that, it’s usually quite difficult to be specific. As you might expect, the draughtsmen and engravers were typically journeymen, some specialising in anatomical or pathological work. Books like William Hunter’s Anatomy of the Human Gravid Uterus show us that many artists might be involved in a single publication, and that we see these specimens through many pairs of eyes.

MM: That’s really interesting because in the book you highlight how collaboration challenges notions of objectivity, but it’s also worth thinking about the significance of collaboration in the production of the images.

RB: I think it reminds us that objectivity is not an abstract, universal or eternal thing. The meaning of objectivity, how we define it and what we’ve tried to make it has changed radically over the centuries. In this sense it’s entirely appropriate that The Sick Rose itself is a collaboration, a product of the combined expertise of the Wellcome Library and Thames & Hudson. I’ve been lucky enough to bring these things together in one book with my name on the spine.

MM: A key debate within the history of medical illustration is what is lost through the illustration and what illustrations fail to capture, but is there anything which you feel has been lost through the reproduction of the images you were working with?

RB: To address the first point, illustrations made for teaching are almost by definition leaving things out. What’s going on here is an attempt to reduce mess, the kind of mess that results from opening up a sick body, to some kind of comprehensible order that can be taught and understood. And this is a process in which the important details must be highlighted and the irrelevant details downplayed or left out. One of the problems with early photography, at least in science and medicine, is that photographs give near-equal emphasis to everything in their field of view, so even with this apparently more objective medium the viewer’s eye had to be guided with interventions from artists or anatomists. So the idea that photography is a somehow more objective medium actually doesn’t work, and it’s fascinating that in response to photography you actually get this far more simplified style of illustration exemplified in Gray’s Anatomy – more like engineering blueprints than realist paintings.

As far as losing things in the reproduction of these images, I think obviously you’re losing the original context – the book in which it was first published and read. But what you gain is an ability to hold the image up to the light and turn it around and see it from a greater variety of perspectives. I think it’s very important to walk that tightrope between respecting the original purpose, and on the other hand recognising that you can read a whole cultural and intellectual world into them – and of course turn them to new kinds of historical and artistic purpose.

MM: So, finally, your emphasis on the ethics of using these images in your Wellcome library blog article is particularly noteworthy. In the Guardian review, Will Self commented that the text highlights the ‘horror show (…) Britain’s cities must have provided when so many of the untreated were wandering its (…) pathways’. Do you think the book’s illustrations provide an accurate and representative depiction of suffering patients, and do you think they would have been perceived as a horror shows?

RB: Accurate and representative … accurate and representative is difficult. Obviously any medical textbook is not trying to give a statistically average portrayal of what you might see on the street. It’s portraying ‘types’ and distinctive cases, sometimes extreme examples of what you might see. The thing that struck me most forcibly about these images is an old point about realist art: that this is something that happened to someone somewhere. It is real, it is not fantasy. So I think a lot of their power comes from that reality effect, it is a representation of a real person who may well have walked the streets and been shunned from society or cast into a workhouse. So, of course I want to fight shy of language like ‘horror show’, that’s not how I want this book to be seen. But what I think it is a representation of the frailty of human existence. We inhabit these strange and beautiful and ugly and infuriating lumps of flesh and they can go wrong in hideous ways. One way of reading this book is to say ‘Aren’t we lucky to have modern medicine?’, but you could then say that in poorer parts of the world people still do suffer in these ways. So as ever with this book I’m finding it difficult to come to a single conclusion about it. It’s a depiction of human suffering and the extremes of human suffering in some ways, but it’s also a record of attempts to relieve that, and attempts to represent it in new ways as well.

A final thought: I think these images also remind us that medicine and anatomy have always been a kind of spectacle. It’s no coincidence that places where surgery and anatomy are carried out are called ‘theatres’, anatomy theatres and operating theatres. So I think it does remind us that so much of the history of medicine and surgery has been about the performance of knowledge and treatment, and the illustrations remind us that the human body can still be the greatest and most intriguing show on earth in lots of different ways.

MM: Great way to end (laughter).




Frankie Kubicki –

Frankie previously studied History at King’s College, London. She has a keen interest in museology and has previously worked at Somerset House, Wellcome Collection and Two Temple Place. Her MA thesis examines paper disposable products from the early twentieth century and aims to question wider ideas of what makes a thing, ‘rubbish’.

Georgia Lauren Cherry –

Georgia joined the V&A/RCA MA in 2012 following her degree in History and Art History at the University of Nottingham. Interested in the history and material culture of medicine, socially responsive design and interdisciplinary practice, she is currently assisting projects at the Helen Hamlyn Centre and the Science Museum. Her thesis considers the dissemination and application of early x-ray technology as a case study of processes of ‘closure’ and ‘stabilisation’.


© Frankie Kubicki and Georgia Lauren Cherry, 2014. All Rights Reserved.

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