1.4.1: Doctors at Work

The previous two case studies (1.2.1; 1.3.1) have looked at tuberculosis and its influence on culture at different scales, with a focus on architecture and hygiene. What is absent from both of these case studies is the figure of medical professionals—especially white male doctors—even in contexts where the inclusions of these doctors and nurses in the frame might be beneficial.

Figure 1. Nurses particularly are visible doing the care work with patients. In this example the care for children is folded into a discussion of the cleanliness of the spaces. City of Chicago Municipal Tuberculosis Sanatorium Monthly Bulletin. 1917-1924.

Figure 2. The most often nurses are caught in photographs are as part of sanatoria materials. Bonney, Sherman G.. Pulmonary Tuberculosis and its Complications: With Special Reference to Diagnosis and Treatment for General Practitioners and Students. Philadelphia & London: W. B. Saunders Company, 1910.

One of the important aspects when it comes to clinical vision is its unidirectional nature: doctors look at their patients, defining symptoms and pathologies, but the gaze is never returned.¹ There is power in being behind the camera, being the person who illustrates a body or organ, being the radiologist and not the one whose body is photographed, illustrated, or x-rayed. Medical professionals seem adept, consciously or otherwise, at not being captured in the visual rhetoric of their arguments. Their gaze looks outward, and even when medical personnel are in line of sight of the camera, usually it is nurses whose bodies and faces are displayed in these images (figs. 1 & 2). The power of absence—to see and not be seen—positions doctors especially as impervious to the criticism levied at their patients.²

It is hard to find doctors in the tuberculosis corpus and image dataset (X.1.1; X.1.3). They appear in two prominent contexts: the first is in the professional headshot. When these images are used in an argument, and not in the frontmatter of a book or as part of an obituary, those moments are often reserved for the most prominent and influential scientists, with Robert Koch (figs. 3 & 13) and E. L. Trudeau (fig. 4) being the most common figures. The other context in which doctors appear is in more candid shots, where they are shown treating patients or doing laboratory work. These photographs are not as common as many of the other images, and these depictions tend to appear in promotional contexts or in publications that describe daily operations of a hospital or sanatorium. There is also a notable difference in their mise en scene, with doctors treating patients in more sparse exam rooms or hospital rooms (figs. 5 - 7), or with doctors being caught in semi-candid or posed stances in laboratory rooms or pharmacy/dispensary rooms (figs. 8 & 9).

Figure 3. Robert Koch’s portrait is the most popularly reproduced one in the literature of the period, with many different photographs and illustrations appearing in the text. Knopf, S. Adolphus. Tuberculosis: A Preventable and Curable Disease: Modern Methods for the Solution of the Tuberculosis Problem. New York: Moffat, Yard and Company, 1916.

Figure 4. A photograph of Edward Livingston Trudeau as it was published in a tritise on tuberculosis. Huber, John Bessner. Consumption: Its Relation to Man and His Civilization Its Prevention and Cure. Philadelphia & London: J. B. Lippincott Company, 1906.

Figure 7. Bellevue, a prominent hospital in New York City, had a tuberculosis clinic. The doctors working are centrally framed, but also seem to be smaller as compared to the group of patients and the space of the clinic itself. Image courtesy of the New York Academy of Medicine.

Figure 8. This image shows a doctor sitting in front of a testing apparatus. This image was used as part of an essay trying to determine the amount of oxygen that is taken in each human breath. City of Chicago Municipal Tuberculosis Sanatorium Monthly Bulletin. 1917-1924.

The professional image of medical scientists is instead bound to these clinical spaces, with the accoutrements of the most advanced, scientific practices surrounding them. Often doctors are posed around their equipment (fig. 10 & 12); other times, there are human remains in frame (fig. 11). These images are coded with the technical iconography of modern science—pharmaceuticals, microscopes.³ Often the doctor is framed in a candid, unassuming way, often doing some kind of beneficial work—caring for children, attending to a patient, doing surgery. The context here is important, because the images seem more associated with facilities and the institution and not people, not even the doctors themselves.

A model of this practice can be seen in the ways Robert Koch was framed in the tuberculosis discourse. The German bacteriologist had been the subject of a prominent profile in Harper’s Weekly,⁴ and the images made for that profile were commonly reproduced: both his portrait (fig. 13) and the drawing of the scientist in his lab appeared multiple times in my research (fig 14). Koch’s framing includes a detail to another space in the lab, presumably cabinets with equipment, that are associated with his authority as a man of science. In all of these images the figure of the doctor is dwarfed by the tools of the medical trade, or by a clean, exquisitely furnished laboratory space. These images convey what was a cutting-edge approach to tuberculosis, something which sanatoria would use in their promotional materials (1.2.2). It also conveys a kind of labor that is separate from but intrinsic to the act of curing; these spaces, so advanced in their processes, were also distinctly separate from the patient’s bodies.

The images of patients seem almost staged (figs. 6, 8, & 10). I address this to think about how the careful framing, and the detail in exposure, would imply a kind of consent, at least from the doctor. Inviting a photographer into the space, having them set up their equipment, and posing for the image all require a kind of acceptance that this work will be done. These are not doctors caught in the act unaware. Very rarely do they return their gaze to the camera (fig. 15). The authority of medical scientists in these spaces make these images most likely consensual, at least for the professionals caught in frame.

Figure 10. This picture, while being quite charming, displays how the spaces around medical researchers are framed in these images. They are usually around these objects of work---dyes and microscopes. Lovell, R. Goulburn. Why Tuberculosis Exists: How it may be and has been Cured and Prevented. London: John Bale, Sons & Danielsson, LTD., ~1927. Image Courtesy of the New York Academy of Medicine.

Figure 11. When pictured in the laboratory doctors are often overshadowed by the tools of their trade. In this case it is human material which has been framed in the foreground, with the doctors hiding further in the background (0.1.1). City of Chicago Municipal Tuberculosis Sanatarium Bulletin. 1925-26.

Figure 12. Radiography is prominent in tuberculosis discourses at the turn of the twentieth century, with hundreds of examples in the image dataset. City of Chicago Municipal Tuberculosis Sanatorium Monthly Bulletin. 1917-1924.

Figure 13. A portrait of Robert Koch that was regularly reprinted. Birnbaum, Max. Prof. Koch's Method to Cure Tuberculosis Popularly Treated. Translated by Fr. Brendecke. Milwaukee: H. E. Haferkorn, 1891.

Figure 14. Often reprinted with the image of Koch above, this image shows both Koch posing with what appears to be a dyed specimen, but it also inclludes a specific detail of his equipment cabinets. Birnbaum, Max. Prof. Koch's Method to Cure Tuberculosis Popularly Treated. Translated by Fr. Brendecke. Milwaukee: H. E. Haferkorn, 1891.

For the patients though, even those that were caught in a more posed exposure, consent is more fraught. To think this through, I want to look at a photograph where a doctor and a patient were framed together (fig. 16). The doctor, whose face is visible, and who is working in a professional manner probably consented to the photographer taking the picture. I am less convinced that the subject, whose back is turned away in this photograph had the same ability to consent. The image of the doctor at work, whether doing treatments, research, or other aspects of their jobs (figs. 17 - 19), depends on the figure of a patient whose consent is forced or coerced. Moreover, as consent can be taken through coercive or punitive force,[^fn5] the power dynamic between patient and doctor makes any presumed agreement to and acceptance of the photographic act almost impossible. I stress consent because it is an important concept in this dissertation, which I will address in the fourth chapter (4.1.2; 4.1.4), and because it stresses a power differential between subject and researcher (0.1.4; 2.1.4). Moreover, consent, codified as it was in the post-war period, was a concept that was not dominant in medical practice: doctors did not regularly tell patients what their illness was upon diagnosis, and did not always tell patients that they were part of an experimental study.[^fn6] For doctors to be able to say ‘no’ at any point in an imaging process implies some agency over the image itself. Doctors may not expose the film in the camera, but they can say whether they should be photographed in the first place.

There is a consciousness about the operation of these images: they are documents, specimens, things that convey a message to the public. The absence of medical staff throughout the corpus speaks to a reticence to being shown in these contexts. This implicit sense of how and in what context an image operates is not conveyed to the patients who were posed without their consent.

As I finish this chapter, I will look at this strange omission in the materials, and try to glimpse the medical professionals in the moments where their presence is less obvious, but equally manufactured. I will look at the doctors when they hold their patients in place, when their hands display not just a professional touch, but also a disciplining one: one to hold the patient still for the camera, to hold the patient in place for a procedure, to hold the patient in such a way so their body may be caught for medical knowledge work (2.1.3).

Figure 17. This figure shows the process of heliotherapy as a treatment of tuberculosis. I am unsure if the patient’s face is covered because of the bright light, or because the doctor wanted to hide their face. Monell, S. H.. Electricity in Health and Disease. New York: McGraw Publishing Company, 1907.

Figure 18. This image was found in the same issue as the study of respiration shown above (fig. 9). City of Chicago Municipal Tuberculosis Sanatorium Monthly Bulletin. 1917-1924.

Figure 19. How might a black patient have refused to be included in a shot like this one? Could they have? Did they benefit at all from this image being taken? Crowell, F. Elisabeth. The Work of New York's Tuberculosis Clinics. 1910. Image courtesy of the New York Academy of Medicine.