Anonymising the Patient: Clinical Photography in the late Nineteenth-Century

"As regards the taking of photographs representing diseased conditions, or natural deformities, it is evident that the first duty of a photographer is to ascertain precisely what points it is most important to represent, and secondly to consider how far it is necessary to retain a tolerably accurate relation between that and other parts. [W]here abdominal tumours are shown, the face is especially thrown out of focus … outline is important, all artistic ideas must give way, and the back-ground be so black as to ensure a rigid line of light."
Henry Wright, 'Address on the Medical Uses of Photography', The Photographic Journal, (1867)
During the mid-to-late nineteenth century, technical advances in photography and printing led to dissemination of clinical photographs into an increasing number of contexts, they included hospital ward journals, pathological reports, teaching collections, medical periodicals and textbooks. Patients were photographed in professional portrait studios, or, by physicians and surgeons within the context of the hospital. Professionals and amateurs alike could consult contemporary medical and photographic periodicals for advice on how to photograph patients. Just what the accepted clinical conventions were at any given time however, was open to the individual photographer's interpretation. Nevertheless, if there was a standard, it was perhaps exemplified by either whole body or cropped shots, taken before and after treatment. The sitter was often photographed while semi-naked, either standing or sitting in front of a backdrop. Props, such as blankets, tables and chairs were sometimes used to introduce an artistic element into the overall composition. The patient's face was however, omnipresent in late nineteenth-century clinical photography. Not only did the face convey specific pathological information, but it also allowed the viewer to see the disease within the context of the individual. The sitter's facial expression could imbue the clinical image with an emotive content. Thus, many clinical photographs were a synthesis of the clinical convention and contemporary portrait. Anonymisation was in part, a consequence of the dissemination of the clinical photograph. The eyes were perceived by many as the key to patient recognition. As a result, medical men devised and utilised a number of techniques, such as the 'black box', to conceal the sitter's eyes. Anonymisation also became part of the composition process, when patients were photographed wearing a blindfold for instance. This paper will begin with an illustrated overview of the methods used to anonymise clinical photographs that featured in a selection of late nineteenth-century medical periodicals and textbooks. Obscuring methods, such as the 'black box', will be contrasted with those used to draw the viewer's attention to a particular detail in an image. For example, 'mapping' was a method employed to demarcate areas of pathological interest that had been identified through auscultation and percussion. Such details were often difficult to photograph, and were therefore clarified through the drawing of a line, circle or cross for example, either on the patient's body, or on the print. Using contemporary contextual sources I shall explore the motives behind the seemingly selective practice of anonymisation, and the importance of the patient's age, status, gender and disease in the decision making process. Many of the symbols used to anonymise and highlight late nineteenth-century clinical photographs are still utilised in modern medical texts. Anonymity and confidentiality are integral to modern clinical photography, what impact will these issues have on the future of patient-image centred research?