Syphilis, skin, and subjectivity: historical clinical photographs in the Saint surgical pathology collection

Abstract

This study concerns an archive of disused historical clinical photographs within the Saint Surgical Pathology Collection (SSC) that originally served as teaching aids for the benefit of student doctors at the University of Cape Town's (UCT) medical school. Focusing on images of patients diagnosed with syphilis produced between 1920 and 1961, this study represents the first critical visual enquiry of these images and, as such, has directly contributed to their current life within a (publically accessible) learning collection at UCT's Pathology Learning Centre (PLC). Set against a backdrop of psycho-social notions of health and disease, this study engages the visual coding of syphilis in relation to Cape Town's medical history, and the developing conventions of photography within this scientific field. Through close readings of selected images, a critical focus on extra-clinical details, inconsistencies, and emotive qualities within the photographic frame allows a consideration of how these photographs take part in a continuous meaning-making process that troubles any easy, fixed, or disinterested reading. By focusing on concepts of sublimation and projection, I unpack the photographic depiction of ruptured skin in the SSC as an attempt to render the syphilitic patient-body a passive object of medical knowledge. To achieve this the work of Hal Foster, Erin O'Connor, and Jill Bennett form the theoretical foundation to address the affective potential of imaging disease necessarily limited in efforts to secure the diagnostic function of this clinical material. However, while these photographs emerge in this discussion as decisively structured and composed, I likewise address how the 'Syphilis' images offer a way of seeing beyond their institutional use. While acknowledging the disciplinary motivations of the Foucauldian medical gaze, my argument ultimately privileges the subjects of these images while critically considering how the conspicuous nature of this disease may have seen it pose a particular threat to a notion of stable subjecthood. This was especially the case in the context of 20th century South Africa where those most vulnerable to the disease were in many respects second-class citizens. Ultimately, this investigation seeks to (re)address the SSC in an attempt to unpack how these photographs may speak beyond their historical medical purpose. By examining how photographic representations of patients provide a means of seeing beyond their institutional intent, I suggest ways in which these images offer up points of fracture that offset and even resist a medical gaze and instead provide an opportunity for the human subject to be retrieved from the objectifying tendencies of medicine.National Research Foundatio