«The Rise of Pathological Illustrations: Baillie, Bleuland, and Their Collections DOMENICO BERTOLONI MELI SUMMARY: This essay examines the illustrated ...»
The Rise of Pathological Illustrations:
Baillie, Bleuland, and Their Collections
DOMENICO BERTOLONI MELISUMMARY: This essay examines the illustrated pathological works by Matthew Baillie (London, 1799–1803) and Jan Bleuland (Utrecht, 1826–28). Both works relied on extensive collections of specimens preserved in London and Utrecht, respectively. The essay discusses changing notions of disease, the erosion of the boundaries between surgeons and physicians, the role and significance of pathological collections, and the relations between preserved specimens and their representations.
KEYWORDS: pathological anatomy, visual representations, collections, surgery This is a preprint of an accepted article scheduled to appear in the Bulletin of the 2 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. In the avant-propos to his monumental Anatomie pathologique (1829–42)—the first treatise on the diseases of the entire human body based on recent postmortems and illustrated in color—Paris pathologist Jean Cruveilhier argued that images were indispensible to pathological anatomy. Yet just a few decades earlier, Giovanni Battista Morgagni’s seminal treatise, De sedibus et causis morborum per anatomen indagatis (1761), contained not a single illustration besides his portrait. Nor were treatises in pathological anatomy an exception: also the taxonomy of diseases outlined by the Montpellier physician and botanist François Boissier de Sauvages in Nosologia methodica ( 1763) contained no relevant illustrations. Thus arguably perceptions changed between the 1760s and the 1820s, a period that also witnessed major transformations both in medicine—involving notions of disease, hospital medicine, and clinical training—and in visual representations—with the rise of tonal printing processes and lithography.1 Unlike Cruveilhier’s work, not all illustrated treatises in pathology relied on recent postmortems: in the decades around 1800 several extensive treatises relying on specimens preserved in collections and museums saw the light. Such works usually involved black-and-white representations and posed specific problems deserving close attention. Examples includes Tabulae ossium morbosorum (1785–88) by the Amsterdam anatomist Andreas Bonn; the magnum opus by Leiden anatomist Eduard Sandifort, Museum anatomicum (1793–1835); A Series of Engravings (1799–1803) by the London physician Matthew Baillie; Tabulae anatomico-pathologicae (1817–24) by the Halle anatomist Johann Friedrich Meckel the Younger; and Icones anatomico-pathologicae This is a preprint of an accepted article scheduled to appear in the Bulletin of the 3 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. ( 1826–28) by the Dutch physician Jan Bleuland.2 These works occupy a significant role in the history of medicine: they reflected crucial transformations in the notion of disease, and, at the same time, played a key cognitive and heuristic role in those transformations by focusing on local lesions and structural changes.
In order to set the scene, I raise some preliminary issues related to the availability of specimens, changing notions of disease, and specific features of pathological illustrations. However, I also discuss concrete examples of illustrated publications on pathology; to this end I have chosen two medical men, Baillie and Bleuland, whose careers, practices, and publications present useful material for reflection. I am especially interested in the interplay between specimens preserved in collections and museums, and the images produced from them, as well as the roles of surgeons, physicians, anatomists, and artists responsible for drawings, watercolors, engravings, and lithographs. Unlike Bonn and Sandifort, who focused on osteology, Baillie and Bleuland focused on the soft parts, which involved a much wider spectrum of organs and diseases and posed a different set of problems to technicians in the preparation of the specimens. Since this journal does not publish images in color, I have focused overwhelmingly on black-andwhite illustrations.
Changing Horizons in Pathological Collections and Iconography Specimens pertinent to morbid or pathological anatomy could come in different forms: as London physician Matthew Baillie put it in the preface to his Morbid Anatomy (1793), he had extensive access to relevant material because he was physician to a large hospital (St.
This is a preprint of an accepted article scheduled to appear in the Bulletin of the 4 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. George’s), because he lectured at an anatomy school, and because he could rely on the large collection of preparations assembled by his uncle William Hunter. It is useful to take Baillie’s claim as a starting point to review the situation of bodies available for clinical teaching and for inspection at postmortems in large hospitals, anatomy schools, and museums.3 It is not easy to determine how many diseased bodies were available to medical men for postmortem investigation at different European locations: traditional scholarship identified a quantum leap with the French Revolution, and indeed at the end of the Napoleonic Wars Paris was a magnet for medical students from different counties in search for clinical experiences and opportunities for dissections. More recent research, however, has pointed to more continuous changes both within France and in several European countries, with a growing trend across the eighteenth century; in 1781 London surgeon John Hunter stated that he had dissected some thousands of animal and human bodies, no doubt some of them diseased; the Berlin professor of anatomy Johann Gottlieb Walter had dissected several thousand bodies by the turn of the century; by the early 1800s Aloys Vettel in Vienna had dissected several thousand bodies by the age of thirtysix; and in 1828—four years before the anatomy act that regularized the practice of dissection and greatly increased the number of bodies available in the United Kingdom— Robert Hooper claimed that he had dissected over four thousand specimens over thirty years of investigations, leading to Morbid Anatomy of the Human Brain (London, 1828);
Hooper was first apothecary and then physician to the Marylebone Infirmary in London.
Clearly Paris was not the only place were extensive postmortems could be performed.
This is a preprint of an accepted article scheduled to appear in the Bulletin of the 5 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. Moreover, pathological researches have a broad scope, and while in many regards, such as with René Laennec’s stethoscope and auscultation, the French were in the vanguard, with regard to pathological illustrations they lagged behind, as Cruveilhier admitted in 1829, either because of the difficulties involved, or because the abundance of corpses made their visual representations less crucial.4 Anatomy schools, especially very popular ones like that established by William Hunter at Windmill Street in London and inherited by Baillie, provided extensive opportunities for investigating diseased states. At the turn of the century, London, which lacked a university until well into the nineteenth century, had several such schools that served a large number of students by providing extensive theoretical and practical instruction in a number of subjects ranging from chemistry to surgery. In Edinburgh too, despite the presence of one of the most distinguished universities of the time, students could attend extramural lectures.5 Last, several private and university anatomical collections including pathological specimens were available in late eighteenth-century Europe, indeed too many to enumerate; such collections relied on a range of preservation techniques developed at the end of the seventeenth century, such as injections with a number of substances and immersion in alcohol. Injection techniques were especially prominent in the Netherlands, Amsterdam anatomist Frederik Ruysch being the recognized master. Some of the most prominent collections were located at Leiden and Utrecht in the Netherlands, Halle and Berlin in Germany, Edinburgh and London in Britain. They often started as private enterprises, grew over decades, frequently were donated to or acquired by universities This is a preprint of an accepted article scheduled to appear in the Bulletin of the 6 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. directly or through state officials, and were increasingly enshrined in printed catalogues, at times with illustrations. In Berlin, for example, Walter had a notable collection of several thousand specimens, which he described in part in a catalogue in 1796, and which was purchased by the state in 1803. Thus besides postmortems of recently deceased patients, museums and collections of pathological specimens played a key role in the study of disease.6 The issue, however, was not simply one of numbers. Specimens and diseases were seen and conceptualized in different ways at different times. According to still influential but problematic views, notions of disease changed suddenly and dramatically through developments occurring in France, and especially Paris, from around 1800, especially the medical reforms of 1794 that instituted a largely common training for surgeons and physicians and emphasized practical clinical training. According to those Paris-centered accounts, before that time diseases were identified overwhelmingly through patients’ narratives and subjective feelings, while physical examinations were performed cursorily and anatomy had little to do with medicine and especially disease.
These accounts are problematic at many levels: what should one make of the thousand reports Geneva physician Théophile Bonet had collected in his Sepulchretum ( 1679), and of Morgagni’s seminal work, for example, which relied on the correlation between patient’s symptoms and postmortems for thousand of patients?7 The reception of Morgagni’s work is a complex issue, though the existence of many Latin editions appearing across Europe before 1800, and of the 1769 English translation as well as of the 1771–76 German one, suggest that De sedibus was widely This is a preprint of an accepted article scheduled to appear in the Bulletin of the 7 History of Medicine, vol. 89, no. 2 (Summer 2015). It has been copyedited but not paginated. Further edits are possible. Please check back for final article publication details. influential.8 In the early 1700s, as Maria Pia Donato has recently argued, pontifical archiater Giovanni Maria Lancisi’s work on sudden deaths relied on extensive and systematic dissections aiming at establishing patterns and analogies among cases.