- Facing Pain: Dr. Hans Killian’s Photo Book, Facies Dolorosa
A black and white portrait of a young woman: her round head is propped up on a pillow. The weary face, which is fully turned toward the camera, speaks of profound demoralization. Her overshadowed, strangely commanding eyes draw in the gaze of the onlooker. A thickly swollen throat, a partially exposed chest, and her face fill three quarters of the image, diagonally. In the indistinct white background, one discerns the shadow of a window through which daylight enters—light from the outside world which this woman, stricken with Hodgkin’s disease, might never have seen again. Another image shows the emaciated head of a middle-aged, unshaven man resting on a cushion. With the head turned slightly away, his gaze passes the viewer, deeply absorbed in an inauspicious distance, a realm of pain, desperation, or perchance, expectation of things to come. This man with inoperable stomach cancer is bound to die. Nothing in the neutral, slightly blurry backdrop of hospital linens and cubicle curtains claims the viewer’s attention; her scrutiny is directed exclusively toward the subjects’ faces (See figures 1 and 2).
In 1934, Dr. Hans Killian, one of Germany’s foremost anesthesiologists and surgeons,1 published a volume of patient photographs with the intriguing title Facies Dolorosa: Das schmerzensreiche Antlitz [The Countenance in Pain].2 For this ambiguous enterprise, straddling medical documentation, aesthetic ambition, and an ethical goal to re-figure the patient as a human being in an age of an alienating, faceless medical practice, Killian assembled sixty-four portraits of mostly terminally ill and dying patients. The beautiful edition in quarto, with its glittering gold letters embossed on black cloth binding, is easily identified as Killian’s pet project. Killian was an amateur painter, photographer, and lover of the arts who had previously excelled with purely scientific [End Page 1]
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publications. Multi-talented, Killian generally took precautions to keep his numerous interests neatly separated. His first book of photographs, Farfalla [Butterfly], for example, featured atmospheric images of butterflies that he cultivated himself, and appeared under an alias.3 Intended for doctors as well as the interested lay public, Facies Dolorosa could be read as a medical text or as a coffee-table picture book, and as such, Killian risked endangering his reputation as a stern man of science. Because of its inherent ambiguity, Facies Dolorosa conveys a palpable tension between fulfilling the standards of a scientifically sound presentation and the unfolding of the aesthetic and humanistic dimensions of photographing people in pain.
For his volume, Killian took photographs of children, men, and women of all ages in the Freiburg University hospital where he held the position of senior surgeon. His patients display differing expressions, ranging from almost serene composure to silent suffering, apathy, reproach, struggle, and acute pain. In the foreword, Killian reveals that his main interest in photographing his patients involved not showing the tangible pathological organic alterations and signs of disease, but rather the psychologically remote effects of sickness, the change in the patient as well as the mood at the sickbed (“Stimmung”), which he hoped to capture by the aid of his Rolleiflex camera.4 Photography, he felt, provided him with the means to encapsulate what he was after, namely a unique human essence beyond the quantifiable measurements and data of illness, an essence he later termed “das Unwägbare” [the imponderable] (56). The “imponderable,” vaguely defined as the direct impression at the sickbed, is not only an obscure interest in some mystic quality, but also has a decisive influence on the diagnosis and indication. Results that are only based on lab examinations did not satisfy Killian. For him, “medical art” comprised immeasurable factors such as instinct, fantasy, and even a huntsman-like scent of which biological processes could have taken place in the patient’s body (161).
Killian’s photographic project raises pertinent questions about medical ethics, patient-doctor...