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The experience of looking at The Sick Rose, which is a well-curated print presentation of images that are freely available on the Wellcome Images website, raises questions about medical pictures that are historical, and when and in what media it's proper to see them. It is one thing to take a beautifully bound book aside into a silent armchair and have a one-on-one encounter with all with a dignified man with a bulbous, untreated pendant tumour, or the face of an infant wizened by tertiary syphilis. It's another to see the same faces detached from the circumstance of Barnett and flit by on Pinterest, Tumblr, or Twitter, in a jumble of other unrelated images -providing scholarship.

The Sick Rose is organized by afflictions, the majority of which are now rare in the Western world: cholera, gout, tuberculosis, advanced stages of syphilis. On the Internet, the patients' suffering runs the risk of being seen as classic"---almost comical in its awful extremity and its space from our own time. In a blog post about the process of assembling and later promoting The Sick Rose, Barnett admitted to a sense of unease" about sending the pictures off into the world, worrying about the kitsch, knowing, and emptily ironized approach" that could greet the images. (When Wired ran a slideshow of photos from Sick Rose in May, for example, it was headlined Awesomely Gross Medical Illustrations From the 19th Century") Over Skype, Barnett told me: These are all pictures of something that happened to someone somewhere. They aren't pictured."

As historic medical images go archivists, scholars and digital are being compelled to consider the benefits of disseminating the fascinating and undoubtedly important record of the evolution of medical practice with issues that the pictures will be misused and misunderstood. Making the images accessible will almost certainly cause some tone-deaf uses, lacking empathy and respect at best---exploiting the shock value of a disfigured face or body at worst. On the other hand, digitization of the types of images that were once available only to researchers with the resources to travel to archives can do plenty of great. Such visibility can raise consciousness about past wrongs, ease the families of former patients and also connections between historians , even supply us with a fresh strategy to think about our own mortality. (Because there are good arguments on both sides, and because these medical images could be upsetting to some readers, we've decided to place the photographs we're printing with this article behind a digital scrim, which allows you, the reader, to choose whether to view them.)

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Here's one instance that shows how much such digitized photographs can steal from their contexts. Art historian Suzannah Biernoff has written about the destiny of a group of patient pictures from the Gillies Archives These are the World War I-era records of Queen Mary's Hospital, Sidcup, in the U.K., where plastic surgeon Harold Gillies headed a special component treating injuries that necessitated maxillofacial surgery. Gillies commissioned photographers and artists to document his patients' presurgical injuries, using the pictures to plan his team's strategy.

These photos ended up on the Web as part of a mid-2000s exhibition titled Project Faade (now archived via the Wayback Machine ). The job, which was financed by the Wellcome Trust's SciArt Production Award, was a cooperation among artist Paddy Hartley; Dr. Andrew Bamji, a rheumatologist who acts as curator of the Gillies Archives; and Dr. Ian Thompson, a surgeon and designer of facial implants. The graphics that Hartley made with inspiration from these archives later formed the foundation of an exhibition at the National Army Museum in London. The endeavor, Hartley writes on his site , was meant to explore the effect of veterans' wartime injuries and subsequent facial operations on their lives.

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But the digital images had another life following the exhibit had closed. Some photos from the Job Faade archive ended up used in the plan of the genetic mutants (splicers") that players of the videogame BioShock must battle. One of the patients in the pictures, Henry Lumley, a pilot trainee, lived with his harm for a year and was injured on the day of his graduation from flying school before being declared to Gillies' attention. Lumley died at age 26, of postoperative complications. (Here's his page on the Project Faade website And here's an image of the BioShock character in question) Lumley and his fellow patients are now forced to wander around in virtual space, made into monsters for the amusement of gamers.

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Std test nearby Lula. Does this issue, given that many (most?) BioShock players will never understand who these guys were in real life? Biernoff writes that British culture during the World War I perceived departure in battle as glorious, but facial mutilation was seen as nearly black---a fate worse than death"---and images of soldiers injured in this way were censored, lest they diminish morale. So even if gamers never realize that the characters they're seeing on screen were once actual guys, it can nevertheless feel like these guys, ostracized in life, are being wronged again when they are trotted out as digitized monsters. Lula, GA United States Std Test. As Wellcome Library archivist Natalie Walters pointed out in a post on the connection between BioShock and the Gillies Archive: That nearly 100 years later comparable pictures are used to frighten people in a computer game, gives us a glance into what life should have been like for folks who sustained such disfiguring injuries." (She includes: How brave these guys were to allow themselves to be photographed with extensive injuries, and to undergo treatments that frequently made them appear worse before they appeared better.")

Std Test closest to Lula. Dr. Andrew Bamji, the Gillies Archives' curator, told me over email that he approached the game's developers after finding out about this use and succeeded in contacting one. I pointed out that using identifiable men in the circumstance of the game was an appalling approach to treat the memory of veterans," Bamji wrote. He apologized and assured me that no additional such images would be used, and there the matter ended." Bamji drew a clear distinction between the usage of such images in a project like BioShock, where they were disassociated from the names and narratives of the patients, and the Project Faade of Hartley. Std test near me Georgia. I don't have any issue with all the display of images in a historic context, as without this folks don't understand what war can do."

Should we confine accessibility to upsetting digital images to individuals who we can be certain will see them in appropriate context? Michael Sappol , a historian at the U.S. National Library of Medicine who has written about historical and modern medical display, has an argument to the contrary. The NLM's digital groups have recently posted a series of quiet medical films from between 1929 and 1945 , some of which represent what Sappol calls challenging subjects": leprosy, electroshock, schizophrenia. Sappol mentions, in particular, this 1929 movie made at Cook County Hospital in Chicago , which shows four kids that are dying of rabies. Struggle, the patients convulse, bleed from the mouth; they are inconsolable, even as offer them water or gloved adult hands reach from off screen to hold them.

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Sappol doesn't think it should be the job of the librarian or archivist to decide that the people can't handle looking at such images. We are stewards of these historical materials," he told me. They don't belong to us. They belong to everybody. ... I wouldn't like to play on behalf of the subjects and arrogate to myself the occupation of being some sort of officer of 'who can view.' " With the NLM's electroshock therapy movies from the 1930s, Sappol says, Some of the folks in this film ... appear like they definitely do not consent to the process, plus it is disturbing to see. I really could say 'This individual does not desire to be on camera, they're being humiliated.' But this is something we can learn from. If we never get to see this, who gets to understand?" The interest we feel about such pictures, he contends, is not black, but only human.

The problem is further complicated by the fact that a few subjects favor visibility. This is the situation with all the Thalidomide Trust archive, which includes medical case files on folks produced withsevere birth defects after their mothers took the drug thalidomide to ease symptoms of morning sickness in the late 1950s-early-1960s," Wellcome archivist Helen Wakely wrote to me. The perspectives of thalidomiders themselves on what should happen with their case files vary widely, but some definitely want their files and images made available for research as a deliberate act to open up discussion."Of course, there is no way to ask the patients whose bodies appear in The Sick Rose whether they would prefer to be seen or remain concealed. But the modern example of thalidomide shows that we shouldn't assume that publication is tantamount to breach.

Nor should we presume that the Web is a less serious medium than the bound-and- printed book. Historian Miriam Posner, who wrote her dissertation on medical filmmaking, is additionally a digital historian dedicated to making her sources freely accessible. Lula GA Std Test. In 2010, Posner posted about the ethical quandary she faced when requested to collaborate on a slideshow of lobotomy pictures with a producer at NPR's show Science Friday. Neurologist Walter Freeman, who carried out more than 3,500 of the procedures, photographed and patients his filmed before and after their surgeries.

But Posner finally went ahead with the Science Friday slideshow, reasoning that by asking viewers to take a second look at the before" pictures of patients, which Freeman presented for his own purposes as broken," she may have the ability to show that these faces include more options than Freeman ever saw." A commenter on the post of Posner wrote that he'd recently discovered that his grandfather, lobotomized and who he had never met, had been institutionalized in West Virginia. The commenter wrote: I have not seen an image of my grandpa, never, ever, and I do not care if it's an image of him having this done I just desire and desire to see a picture of him so MUCH. Can you tell me the best way to get to these archives?" It might have been considerably more difficult for the commenter to locate her if Posner had not gone with Science Friday; the link might not have been made. Std Test closest to Lula.

Finally, there's a spiritual argument for making such images available. GA, United States Std Test. Even if medical images might be misused, Michael Sappol says, I don't desire that possibility to prevent these things that are really amazing files of the human encounter from being seen. ... We can learn from them, they can redeem us in some way. They are able to provide us with some sort of program of human suffering. ... Looking at them makes life richer and deeper." Barnett, despite his misgivings, concurs on this particular point: There's a power behind these images, there's a power they have over us, and we've got to recognize or respect this at some point." He compares the pictures to a secular vanitas ," referring to the 17th-century Dutch paintings of skulls and other symbols of decay that were meant to remind the viewer of human mortality. For modern viewers, Barnett says, pictures like those in the Sick Rose might remind us: This Is Actually the body, and the end that we all come to."

However, a vanitas needs space for contemplation---a space the Web looks ill prepared to offer. Susan Sontag's closing book, Regarding the Pain of Others (2003), was composed as the Web was in the process of scattering photos to the four winds. Sontag wrote that photos of suffering might be a memento mori " and function as a still point around which to consider mortality. But she wondered how this might function---or fail to work---in a modern society," where space allowed for being serious is hard to come by." One wonders what she may have made of Pinterest if she believed that about publications, art galleries, and television.

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