There is a stark contrast between the many volumes on the history of anatomical illustration and the relative dearth of book-length studies dedicated to the history of pathological illustration; just scan the relevant sections of Morton’s Medical Bibliography for proof. Domenico Bertoloni Meli’s Visualizing Disease is an important step in reducing this disparity. His book attempts ‘to document key stages in the development of pathological illustrations’ (p. xiii). To show how illustrated pathological treatises became a ‘new medical genre’ (p. xi), Meli explores an impressive range of materials – from occasional woodcuts adorning sixteenth-century surgery texts to early nineteenth-century pathology tomes replete with numerous costly coloured plates. Meli concedes that his is ‘not a comprehensive study of independent treatises’ (p. 54). Rather, Visualizing Disease is a knowledgeable and authoritative survey of many of the most historically significant early works of pathological illustration. The book’s crowning glory (and testament to Meli’s curatorial efforts for the Visualizing Disease exhibition at Indiana University’s Lilly Library in 2013) is the 72 stunning illustrations that richly demonstrate this historical account.
In his preface, Meli emphasises that certain ‘key concepts and issues’ run throughout this book, including the availability of cadavers, use of pathological specimens, shifts in nosology, different visual strategies and changing printing techniques. Another uniting – if somewhat formulaic and limiting – feature is the consistent use of ‘a thematic and a biographical approach’ (p. 23). Chapter 1 explores three related early modern developments crucial to the production of pathological treatises: the formation of the Observationes genre, which featured surgical case histories and often illustrations; the proliferation of pathological collections, especially in anatomical museums; and the growing influence of surgeons’ perspectives on disease, and particularly their focus on localisation. In a similar fashion to the subsequent chapters, this first chapter’s narrative relies on a chronology of select historical figures and their influential productions. In this case, the discussion spans from Guilhelmus Fabricius Hildanus (1560–1634) to Frederik Ruysch (1638–1731) with a spate of surgeons and their publications filling the intervening years. Chapter 2 specifically considers bone pathologies. As Meli contends, the relative ease in preserving bone specimens made them ideal subjects for artists to draw. The key figures examined here include William Cheselden (1688–1752), Cornelis Trioen (1686–1746), Christian Gottlieb Ludwig (1709–73), Andreas Bonn (1738–1818), Johann Peter Weidmann (1751–1819) and Eduard Sandifort (1742–1814); a wide selection that covers several European centres of medicine and nearly the whole length of the eighteenth century. The third chapter, ‘Preserved Specimens and Comprehensive Treatises’, moves to the decades around the beginning of the nineteenth century and the publication of comprehensive pathology treatises ambitiously undertaken by the likes of Matthew Baillie (1761–1823), Johann Friedrich Meckel the Younger (1781–1833) and Jan Bleuland (1756–1838). The examination here is on the theoretical and practical considerations in producing these treatises, such as the use of pathological specimens, the work of illustrators and the thematic structure of the texts.
In Chapter 4, Meli considers works from the same period but those that specifically focus on ‘a disease, an organ, or a system’ (p. 107). The topics here include: James Wardrop (1782–1869) and his study of fungus hæmatodes; Everard Home (1756–1832) and his two volumes about diseases of the prostate; and René–Théophile–Hyacinthe Laennec (1781–1826) and his work on lung diseases in De l’auscultation médiate (1819). The fifth chapter examines the visual representation of cutaneous diseases in the publications of Robert Willan (1757–1812), Thomas Bateman (1778–1821), Wilhelm Gottlieb Tilesius (1769–1857), Jean-Louis-Marc Alibert (1768–1837) and Pierre Franc˛ois Olive Rayer (1793–1867). As Meli observes, a common feature among these authorities on skin diseases is their connection to ‘large dispensaries and hospitals’, which provided them ready access to patients as study subjects (p. 153). Chapter 6 surveys the propagation of coloured pathology treatises in the early nineteenth century as exemplified by the publications of John Richard Farre (1775–1862), Robert Hooper (1773–1835), Thomas Fawdington (1795–1843), Richard Bright (1789–1858), Astley Cooper (1768–1841), James Annesley (1774–1847) and John Armstrong (1784–1829). The seventh chapter brings the themes of Chapters 3 and 6 together by examining coloured comprehensive pathological treatises produced by Jean Cruveilhier (1791–1874), James Hope (1801–41) and Robert Carswell (1793–1857). The progress across these discrete chapter themes provides much of the argument about how pathological illustration developed.
In Visualizing Disease, the careful selection of historic figures, books and images is often unequal to the choice of words and visual analysis. For example, the writing is occasionally clunky and repetitive (the phrase ‘for example’ appears no fewer than thirty-one times in the Introduction); many sentences are a jumble of information hastily spliced together by semicolons. You see my meaning. The analysis of images tends to remain superficial. In discussing the engraved prints of bone pathologies found in Cheselden’s The Anatomy of the Humane Body (1713), Trioen’s Observationum medico chirurgicarum fasciculus (1743) and Sandifort’s multi-volume Museum anatomicum (1793–1835), Meli remains fixed on technical issues, such as the size of the prints, the use of pathological subjects, production costs and the quality of cross-hatching (p. 115). Reference to wider visual cultures and aesthetic concerns are noticeably scarce. This shortcoming is partly due to an inadequate engagement with secondary literature, a problem further compounded by the clumping of citations into single notes at the ends of paragraphs, which frustrates any attempt to attribute references and claims. For a study about ‘Art and History’, there is a paucity of art history scholarship. The result is a too-brief critical attention given to visualisation, and particularly the epistemological function of illustrations in pathology. Meli’s Preface includes a short comment about how ‘visualizing’ is used in this book as meaning ’making visible to the eye through several means, including technical devices’ (p. xii). Not only is this equivocal definition wanting, but so is further comment about such issues as how visual observation relates to medical knowledge and the different kinds of authority assigned to images. The closing pages of the book begins to unpack these issues, but those comments are too slight and too late. As it is, this book leaves the reader wondering what is at stake in this history.
Where Meli’s book truly succeeds is in mapping the development of illustrated pathological treatises in terms of the lives and goals of their authors, their collaborations with artists, the changes in nosology and the technical innovations in printing images. It is a wonderfully illustrated and much-needed study that will be an essential reference for many historians of medicine, and especially those working on pathology, medical illustrations, representations of disease and any of the several historical figures featured among its pages. Visualizing Disease will inspire pathologists interested in the history of their discipline and, hopefully, future scholars exploring the history of pathology.
