Pathology and Visual Culture: The Scientific Artworks of Dr. Jean-Martin Charcot and the Salpêtrière School is an example of the increasing contemporary awareness of the value in addressing subjects from an interdisciplinary perspective. Describing the project, Ruiz-Gómez says,

“The Salpêtrière presents a rich and complex case study because its clinicians saw art and medical science participating equally in the construction of knowledge, the results of which were disseminated in an increasingly global scientific network. This has also been the challenge of this project, … Pathology and Visual Culture has been my way of thinking through images and objects that occupy an intellectual space somewhere between the hospital and the Salon, between medical objectivity and individual artistry.” (p. 152)

The book successfully interweaves what Natasha Ruiz-Gómez calls “scientific artworks” with art history, visual culture, and studies exploring the medical humanities. Yet, and despite the extensive research that was obviously put into the project, the text seems to underemphasize the long, robust, and influential tradition of art and medicine. Therefore, this publication seemed somewhat removed from the collaborative teams that historically created images, made models, and developed an array of visual tools while working on projects that included artistic practices, scientific reasoning, and clinical methodology. As a result, the analysis frequently reads more like a hagiographic study celebrating Jean-Martin Charcot, Paul Richer, and the Salpêtrière School than a balanced overview.

Chapter 1, “Curating Pathology at the Musée Charcot,” opens with André Brouillet’s famous painting, A Clinical Lesson at the Salpêtrière (1887). Commissioned by the neurologist Charcot himself, it shows him giving a clinical demonstration with Marie “Blanche” Wittman, one of his hysteria patients. Using it as a springboard, the author introduces Charcot’s background in art, his love of art, his art collection, his inclination to hire those with artistic backgrounds, and some of the pathological/anatomical artworks that reside within his museum and resemble objects found throughout the history of art. A key focus in this chapter is on the albums of drawings, photographs, charts, and graphs of the Salpêtrière. These albums, discussed in detail throughout the book, included images that frequently lacked significant explanatory text. The author sees them as repositories of memory, points out that many of the images in them seem to have nothing in common, and that they convey a strong sense of inner life. As Ruiz-Gómez put it, “[i]n the Musée Charcot, then, the human body was simultaneously absent and ubiquitous, except when the patients themselves were ‘displayed’” (p. 28).

We first meet artist/physician Paul Richer in this chapter. His contributions are a large part of the study, and his later career as an artist and a professor of art are presented in Chapter 4. We learn here that, with Richer’s hiring in 1878, Charcot asserted that with him on the staff he “could revive a medico-artistic practice in the tradition of Adriaan van den Spiegel, Thomas Bartholin, and Andreas Vesalius, ‘whose magnificent plates remain famous’” (p. 42). Given Charcot’s aspiration to be a part of this tradition, it is a pity that Pathology and Visual Culture missed the opportunity to integrate Charcot’s work with it. As the catalogue for the Spectacular Bodies exhibition at the Hayward Gallery (2000-2001) points out [1], there was a robust conversation between art and anatomy/medicine from about Leonardo da Vinci’s work in 1500 to about 1880. The curators, Martin Kemp and Marina Wallace, included Charcot and emphasized that these collaborations were built on a shared a mutual interest in direct, sensory knowledge of the human body.  By contrast, Ruiz-Gómez’ focus explores the idea that imagination and creativity are the connective tissue between art and medicine, “essential conceptual tools for all artists and scientists” (p. 152).

Chapter 2, “The Art of Retouching at the Salpêtrière,” is centered on how images were produced at the mental hospital. This chapter treats patient photography as a form of portraiture, probes photographic accuracy, examines their indexicality, and raises questions about the “truthfulness” of the clinical photograph (her quotes) and agency. Admittedly, at times I found myself unsure about what she was saying. The language used aligns more with art history and the humanities than with traditional art and medicine practices analyses. Suffice it to say that the author writes that these photographs, needing to compete with the written word, “raise questions about agency, ethics, and the unequal power dynamics at play between patient and clinician-photographer” (p. 68). Furthermore, “[t]he manipulation evident in the retouched photographs diminish the agency of the Salpêtrière patients by imposing an aestheticizing veil over scenes of medical phenomena” (p. 81-82).

The debates surrounding retouching photography are presented primarily through those surrounding the first of the Iconographie photographique de la Salpêtrière (IPS), an 1878 album put together by Désiré-Magloire Bourneville and Paul Regnard under Charcot’s direction. Ruiz-Gómez’ argument is that the clinicians’ use of retouching of photographs implies that they have art-historical derivations and aspirations. This work is also used to cast in high relief what the author perceives as the issues surrounding the purported objectivity of the photograph, for in most cases the retouches added nothing to the medical meaning of an image.

Given the divergent perspectives on retouching, I found myself wishing she had emphasized that the task at hand with re-touching was to address what the camera missed or distorted. Over time, through their experiences working with various cases and conditions, specialists learn to perceive conditions broadly. While Ruiz-Gómez recognizes that the aim was not to simply provide either an imitative or an aesthetized copy because they were striving to also represent a “type,” she didn’t firmly address how even a reworked copy could aid in learning to see, comprehend, and communicate about the pathology being studied. Also, “medical objectivity,” a term used frequently in the book, doesn’t seem to fully encompass the various and even competing points of view within a medical setting. Chapter 2 ends by with the insight that Charcot was disappointed with the reach of his photographic results, “photography’s promise of transparency utterly failed him” (p. 87).

Integrating the contemporaneous neurological discussions on the pros and cons of using photographic images might have aided in tightening Ruiz-Gómez’ critical examination. For example, one unmentioned individual was Jules Bernard Luys (1828–1897), who worked in Charcot’s shadow at the Salpêtrière from 1862-1886. As pointed out by de Rijcke [2], in 1873 Luys published the first photographic atlas on the brain and nervous system, Iconographie Photographique des Centres Nerveux (Photographic Iconography of the Nervous Centers), which contained seventy albumen prints of frontal, sagittal, and horizontal sections of the brain. It also included beautiful drawings identifying the various structures seen on each photomicrograph. This pairing of the hand drawn images with the photographs in the volume led many practitioners to conclude that the drawings communicated conditions more effectively than the mechanical photographic representations. Debates about the value and use of photography in macroscopic neuroanatomy ensued, with many in the field concluding that the mechanical renditions failed to offer a satisfactory alternative to drawing or engraving in terms of facilitating research and communication goals.

Chapter 3, “The Ataxic Venus: Between Portraits and Specimen” focuses in on the most famous object in the Musée Charcot:

“The Ataxic Venus implicates not only the patient and the clinician(s)/artist(s) but also the beholder’s understanding of and empathy with Western depictions of human suffering. It epitomizes scientific inquiry, but it also evokes Christian faith. It portrays an individual, yet it triggers countless associations in a shared visual culture. The Ataxic Venus acts as a medical memento mori and shocks us in part through its ‘mimesis of physical misery.’” (p. 114)

This sculpture is defined as “a portrait of a patient who had locomotor ataxia” (p. 92), the inability to precisely control one's own bodily movements, and as “the portrait of an individual and the portrait of an illness” (p. 97). Inspired by the Hellenistic Medici Venus in the Uffizi Gallery, and although fully secular, the addition of real hair on the piece intensifies the wax’s relic-like status. Ruiz-Gómez tells us this “scientific artwork” was intended to represent a “type” and to serve as a “textbook example” of this condition (p. 92). Berthelot was the patient depicted; her full name is never given. Her locomotor ataxia was caused by tertiary syphilis, and she was about sixty years old at the time the object was made. Ruiz-Gómez compares the sculpture’s tortured body, her term, to images of martyred saints and the ultimate martyr, the dead Christ, telling us that, “the contoured body of the Ataxic Venus should be read through the codes of pain that have a long lineage in Christian and classical imagery” (p. 107).

Ruiz-Gómez also develops the view that this object offers a painful impression of a debilitating illness, and thus of pain itself. Furthermore, it is important because it brings pain and portraiture together.  Within this, she interweaves descriptions of cabinet of curiosities and thoughts on how deformities, monstrosities, and errors of nature come together in Charcot’s depictures of pain and portraiture. One fascinating element of the chapter points out that Berthelot did not leave behind any verbal or written trace so we can only characterize her condition through others such Alphonse Daudet, who also developed locomotor ataxia. In his novels, Daudet compares the pain he experienced to crucifixion.

Here, too, the history of wax that combines art and medicine tradition is largely unmentioned, although she notes that waxes are found in medical museums such as the La Specola in Florence. Rather than taking the opportunity to discuss how artists and clinicians often learned wax modeling in shared educational venues and the many historical collaborative projects that fit well with the Salpêtrière School’s emphasis, she turns to metaphor. She describes the medium as one tied to the processes of life: birth, metamorphosis, and dissolution. She tells us that the Ataxic Venus figure also embodies the paradoxes of wax: it is clearly dead, but its colors suggest life. The body is petrified, yet it radiates pain. In addition, the trope of the old woman in art and literature is incorporated, as is sexuality.

“This anxiety about the aging female body was only heightened by contemporary fears of hereditary degeneration, a theory expounded by Charcot and many others who did not believe that syphilis caused tabes dorsalis [a form of neurosyphilis]. ‘Sexual excess,’ a ‘symptom’ of degeneration, was thought to be a possible cause of the disease. The inclusion of hair on the crown and on the mons veneris helps make the wax ‘as lifelike as possible’ and highlights the ‘individuality’ of a particular patient.’ But it also sexualizes this body, that is, of course, both culturally produced and socially constructed.” (p. 101)

As noted earlier, Chapter 4 turns to Paul Richer with a focus on his career as an artist after he left the Salpêtrière. We learn more about how Richter’s work engages with the conventions of portraiture. Realism and objectivity are discussed here too in terms of the individual and a type. She characterizes this tension as an oscillation between portrait and specimen. An elasticity that, in her view, speaks to the artistry of medical images. Furthermore, she tells us, the gaps in scientific artworks in some sense resemble the way traditional portraiture might present either a clear resemblance or an ideal representation of a sitter. Other topics include expression, type, and morphology. At times Ruiz-Gómez claims that Richer’s representations of disease are more accurate or “truthful” because of his medical background and at times she says that he creates a resemblance that does not match the patient. To reconcile the two, she again references the tension between the individual and the type, saying that these portraits allowed him to employ artistic license to open the door to empathy.

It was with the final section, “CODA: The Salpêtrière at the École des Beaux-Arts,” that it becomes clear that the sketchiness of Pathology and Visual Culture’s integration with the medicine and art tradition was by design. Ruiz-Gómez wraps up the book by saying that within the book she has both used and contested the binaries of objectivity and subjectivity, as well as the “scientific self” and “artistic self” to probe an area that is yet to be explored: “[I]t seems to me that the clinicians working at the Salpetriere redefined the relationship between the two through their scientific artworks. That there were scientists in France and elsewhere whose work pushed and pulled at these binaries in other ways is yet to be explored” (p. 152).

She brings this home with a painting of Paul Richer by one of his students at the École des Beaux-Arts, Georges Leroux (1877-1957). This work depicts Richer demonstrating over a human cadaver. Because the book opened with Brouillet’s 1887 painting, A Clinical Lesson at the Salpêtrière and a quote by the art critic and novelist Octave Mirbeau that compared it to Rembrandt’s Anatomy Lesson of Doctor Nicolaes Tulp (1632), it seems this painting of Richer teaching is used by the author as a device to bring this publication full circle, and to suggest that it marks a revolutionary change. This point is underscored when she emphasizes that in the Leroux painting Richer is standing is like a modern-day Doctor Tulp, but the doctor here is teaching artists rather than surgeons.

Yet, there are many precursors and similar paintings that show this is not exceptional terrain at all. For example, in my book on Art and the Brain [3] I examined the painting of The Academicians of the Royal Academy (1771-72) executed in 1771–72 by Johan Zoffany. This work, or one of many similar paintings, could have provided a starting point for placing the study within the larger art and medicine tradition and to show how artists and scientists learned in shared venues and often collaborated on projects. The Zoffany group portrait was produced shortly after the foundation of the Royal Academy of Arts in London in 1769. Zoffany’s painting includes the Royal Academy’s Professor of Anatomy, physician William Hunter, demonstrating to a class of artists, with Joshua Reynolds looking on. Hunter’s appointment reminds us that from the mid-16th century and even into the 20th century, European art academies included specialist Professors of Anatomy generally appointed from the medical world. Moreover, the debates between Reynolds and Hunter demonstrate that ideas about truth often differ between disciplines and even within them.

Of course, not all the examples of this shared tradition involve teaching. As noted, Ruiz-Gómez mentions that Charcot saw the hiring of Richer as a move toward placing himself within the medico-artistic tradition of Andreas Vesalius. Though unnamed in his epochal De Humani Corporis Fabrica (On the Fabric of the Human Body) (1543), Vesalius collaborated with the artist Jan Stefan van Calcar (1499–1546/1550) in producing it. Calcar was a Flemish painter, and possibly a student of the great Venetian painter Titian. In the seventeenth century, artist/architect Christopher Wren, while working as a part of neurologist Thomas Willis’ team, created the magnificent drawings for Willis’ Cerebri Anatome (1664). Others, like artist/neurologist Charles Bell (1774–1842), offer a broader window into the tradition. Bell studied both medicine and art and he aspired to become the Professor of Anatomy at the Royal Academy. He turned to neurology after he was unsuccessful in receiving the position. Later he taught both physicians and artists when he ran the Great Windmill Street School of Anatomy. A short review cannot detail the many ways in which his neurological research and drawings may have influenced Charcot’s trajectory. Briefly, Charcot studied with Guillaume Duchenne de Boulogne (1806-1875), who drew heavily on the work of Charles Bell. In addition, Charcot’s work often drew upon Bell’s earlier contributions to neurology.

In summary, fitting Pathology and Visual Culture into the medicine and art tradition, where Charcot aspired to place himself, would have made the analysis more compelling. The book does ably demonstrate that the author has looked closely at the pathological drawings, photographs, sculptures, and casts created at Paris’s Hôpital de la Salpêtrière in the nineteenth century. What does not come across is how the use of artists materials and practices in clinical work and independent art projects are a part of neurology’s history. The blurb for the book says that Natasha Ruiz-Gómez challenges conventional interpretations of visual media in medicine. Since she only vaguely touches on collaborative practices within art and medicine historically, it seems she is challenging general theoretical interpretations rather than the widespread custom of interweaving the two approaches. It is likely this book will appeal more to people in the arts and humanities although there are many details from the Charcot archives that will no doubt fascinate scientists and neurologists.

References

[1] Kemp, Martin, Wallace, Marina. Spectacular Bodies: The Art and Science of the Human Body from Leonardo to Now: Hayward Gallery; 2000

[2] de Rijcke, Sarah. Light Tries the Expert Eye: The Introduction of Photography in Nineteenth-Century Macroscopic Neuroanatomy. Journal of the History of the Neurosciences. 2008;17(3):349-66.

[3] Ione Amy. Art and the Brain: Embodiment, Plasticity, and the Unclosed Circle. Amsterdam: Rodopi Brill; 2016.