Visualizing Disease: The Art and History of Pathological Illustrations by Domenico Bertoloni Meli (review)

There is a long and distinguished tradition of scholarship on the history of anatomical illustration, Domenico Bertoloni Meli rightly observes, but somehow scholars have scanted what is perhaps an even larger category of medical image production—pathological illustration. Visualizing Disease, erudite, profusely illustrated, richly documented, begins to rectify that omission.

Meli starts with the early modern origins of what came to be designated morbid anatomy, pathological anatomy, nosology, dermatology, venereology, before there existed any formal disciplines of pathology or genres of pathological illustration. He ends around 1850, when new and expanding medical institutions, and continually improving specimen-making and media technologies such as chromolithography and photography, led to the proliferation of pathological objects, images, publications and displays. Even so, Meli has to pack a lot in: surgery vs physic; text vs image; monochrome vs color; woodcut vs intaglio vs lithography; ideal vs particular; the case history vs taxonomy and “lesions”; anomalous vs typical; Parisian vs German vs British medicine; dissected cadavers vs preserved specimens; and much much more.

Meli is an expert guide, gives readers the basics and the topic a useable history. Centuries ago, diseases were not easy to understand and treat. Some diseases may appear in different sites in the body, affect different people in different ways. Some go through a metamorphosis, look entirely different in beginning, middle and end stages. Others stay consistent in time, place and manifestation. Another problem: the most acute cases are the most visible and dramatic, but often the most idiosyncratic.

Over the course of the eighteenth and nineteenth century, surgeons and physicians who studied disease tried to bring order to the chaos, to stabilize disease entities and categories, create taxonomies, nomenclatures and theories, not just compile reports and views of cases and freaky anomalies. And so they collected specimens, made field and laboratory observations, and published illustrated books, articles and journals, for reference, discussion and debate.

The struggle to understand was intimately bound up with the struggle to collect. At first this took the form of unillustrated collections of written cases. Then collections of specimens taken from the autopsied bodies of the afflicted, kept in “cabinets” and museums. And collections of images based on specimens or, where possible, on views of living patients (where signs of disease were manifest on the outside of the body). Illustrations were increasingly thought to be essential to the understanding of disease.

But the viewing of “figures” wasn’t merely the end-product. The very making of them, Meli tells us, had “epistemic aspects” (p.14). Specimen and image production produced new knowledge, a heuristic device that Eva Åhrén in a recent article on scientific visualization, elegantly calls “figuring,” a dynamic multimodal process of “figuring out” through specimen making and illustration.¹

What emerges from Meli’s account is the key role of the museum. Eduard Sandifort and other founders called their illustrated books “paper museums” (Meli, 30 et passim), a complement to, or substitute for, the three-dimensional pathological collection. The printed book of pathological images was promoted as an aid to students and practitioners who lacked easy access to specimen collections (and to large hospitals where cases aggregated). Visualization involved more than just the making of images: preparation, display and exchange of specimens was crucial.

If so, Meli’s treatment of the traffic between illustrated pathology and the pathological cabinet is a bit of a missed opportunity. Visualizing Disease is lopsidedly bibliographic and lopsidedly empirical. The cultural logic of pathological illustration was precisely an imperative to visualize. Pathologists argued over and over: you can’t just describe it in words, you have to see and show it — in the flesh, the specimen, the wax or plaster cast, the model, handmade drawings and watercolors and oil paintings. But none of those things appear in Meli’s illustrations, which are entirely allocated to showing printed images. Visualizing Disease does not visualize the whole ensemble of visual materials, the representational chain from...