Heidi Katherine Knoblauch (Author)
Warner, John Harley (Advisor)
Yale University
Warner, John Harley
The role of patients has been minimalized in previous studies of the clinical case record. Yet, as this dissertation shows, patients collaborated with physicians and photographers to collect photographs for the purpose of documenting disease. Patients' Posture uses private casebooks, hospital records, medical journals, popular periodicals, photograph guidebooks, and legal cases to argue that patients played a large role in shaping the newly conceived clinical record that appeared in the late 1870s and early 1880s. While patient photographs represented a new type of scientific aesthetic practice, as did graphs and charts, the way photographs were collected during the nineteenth century mirrored more sentimental and intimate practices such as scrapbooks and albums. During the 1850s, physicians began collecting photographs of their patients. This practice coincided with the emergence of new types of photograph collection that offered scripted ways of creating objects of remembrance. Through the mail, physicians received hinged gold frames that housed daguerreotypes and painted tintypes of patients, along with notes from patients about their current condition. This epistolary practice, where patients sent photographic images of themselves to physicians, continued unabated until the 1890s, when a new conception of a "right to privacy"–catalyzed in large part by the emergence of amateur photographic technologies–caused patients to distrust photography in the clinic. This dissertation is as much a history of privacy in the clinic as it is of technologies of collection. Photography emerged at the same time as other clinical recording devices. Unlike other recording devices, however, clinical photographs are necessarily bound up in privacy. Many other recording technologies necessarily mediate potential privacy concerns. While temperature charts hold data about patients, they do not reveal the identity of a patient in the way a photograph of someone's face inescapably does. As a mechanical technology, photography simultaneously served natural history practices and new standardization practices. This particular technology, however, was unlike similar tools for three reasons. First, photographs were often collected from outside the clinic, whereas other recording technologies, such as casebooks, primarily recorded data from within the practice walls. Second, photographs necessarily introduced issues of privacy in a way that other technologies, like temperature charts, did not. Finally, portrait artists and patients mediated photograph collection until the late 1880s. These differences make the exploration of clinical photography an interesting case for elucidating changes in the doctor-patient relationship, understanding the incorporation of collection technologies, and tracing the rise of privacy concerns in the clinic. Chapter 1 of this dissertation analyzes photographs that doctors, patients, and photographers contributed to the Army Medical Museum between 1862 and 1912. These photograph collecting practices show that patients played a large role in constructing their visual case record. Chapter 2 looks at the creation of a photographic department at Bellevue Hospital in New York City to illustrate the way physicians used photographs to abbreviate clinical narratives in similar ways to graphs and diagrams. Physicians who used the photographic department, though, often collected portraits of patients taken in the official photographic department alongside portraits taken by studio photographers outside the hospital to build illustrated case histories. Chapter 3 looks at published photographs and amateur medical photographs taken by physicians to show how, in the late nineteenth century and early twentieth century, physicians conceived of photographing patients as a form of recreation. By the 1880s, most photographs of patients were vernacular photographs taken by physicians. Chapter 4 uses legal decisions to show that new conceptions of privacy and new photographic technologies aimed at amateur photographers dramatically diminished collaboration between patients and physicians and, in fact, led to legal disputes over photograph collection. Chapter 5 examines the rise of professional clinical photographers and the standardization of medical photographs during the 1920s.
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