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

Afflictions, most of which are now rare in the Western world organize the Sick Rose: cholera, gout, tuberculosis, advanced stages of syphilis. Online, the patients' anguish runs the risk of being seen as vintage"---nearly comical in its horrible extremity and its space from our own time. In a blog post about the process of assembling and later marketing The Sick Rose, Barnett acknowledged to a sense of unease" about sending the images off into the entire world, worrying in regards to 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 images of something that occurred to someone somewhere. They aren't visualized."

As historic medical pictures go digital, scholars and archivists are being forced to weigh the benefits of disseminating the certainly significant and fascinating record of the development of medical practice with issues that the pictures will soon be misused and misunderstood. Making the pictures available will almost surely lead to some tone-deaf uses, lacking empathy and respect at best---manipulating the shock value of a disfigured face or body at worst. On the other hand, digitization of the sorts of pictures which were once accessible only to researchers with the means to travel to archives can do lots of great. Such visibility can raise consciousness about past wrongs, ease the families of former patients and also links between historians , even provide us with a brand new approach to think about our own mortality. (Because there are great arguments on either side, and because these medical images may be disturbing to some readers, we have decided to set the photographs we're publishing with this particular post behind a digital scrim, allowing you, the reader, to choose whether to view them.)

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Here's one case that demonstrates how much such digitized pictures can slip away from their circumstances. Art historian Suzannah Biernoff has written about the destiny of a group of patient images 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 particular unit treating injuries that necessitated maxillofacial surgery. Gillies commissioned photographers and artists to record his patients' presurgical harms, using the images to plan the strategy of his team.

These pictures ended up on the Web as a portion of a mid-2000s exhibit titled Project Faade (now archived via the Wayback Machine ). The job, which was financed by the Wellcome Trust's SciArt Production Award, was a collaboration 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 art that Hartley made from these archives with inspiration after formed the basis of an exhibition at the National Army Museum in London. The endeavor, Hartley writes on his web site , was intended to learn more about the impact of veterans' wartime injuries and subsequent facial operations on their lives.

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After the exhibit had closed, but the digital images had another life. Some pictures from the Job Faade archive ended up used in the design of the genetic mutants (splicers") that players of the videogame BioShock must battle. Henry Lumley, one of the patients in the photographs, a pilot trainee, was injured on the day of his graduation from flying school and lived with his harm for a year before being admitted to Gillies' care. Lumley died at age 26, of postoperative complications. (Here's his page on the Project Faade website And here's a picture of the BioShock character in question) Lumley and his fellow patients are now compelled to wander about in virtual space, made into monsters for the entertainment of gamers.

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Std Test in Belvidere. 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 pictures of soldiers injured in this way were censored, lest they diminish morale. So even if gamers never realize the characters they are seeing on screen were once real men, it can nevertheless feel when they're trotted out as digitized monsters, like these men, ostracized in life, are being wronged again. Belvidere, IL, United States std test. As Wellcome Library archivist Natalie Walters pointed out in a post on the connection between BioShock and also the Gillies Archive: That nearly 100 years later similar pictures are used to frighten folks in a computer game, gives us a glance into what life should have been like for folks who endured such disfiguring injuries." (She adds: How brave these men were to permit themselves to be photographed with extensive injuries, and to get treatments that often made them appear worse before they looked better.")

Std test in Belvidere. Dr. Andrew Bamji, the Gillies Archives' curator, told me over email that he approached the game's programmers after finding out about this use and succeeded in contacting one. I pointed out that the use of identifiable guys in the circumstance of the game was an appalling approach to take care of the memory of veterans," Bamji wrote. He apologized and assured me that no additional such images would be used, and there the matter finished." Where they were disassociated from the names and narratives of the patients, and Hartley's Project Faade Bamji drew a clear distinction between using such pictures in a job like BioShock. Std test nearest Illinois. I have no problem with all the display of images in a historical context, as without this people don't understand what war can do."

Should we confine access to upsetting digital images to folks who we can be sure will perceive them in proper context? Michael Sappol , a historian at the U.S. National Library of Medicine who has written about historic and contemporary medical display, has an argument to the contrary. The NLM's digital collections have lately posted a string of hushed medical movies from between 1929 and 1945 , some of which symbolize what Sappol calls challenging issues": leprosy, electroshock, schizophrenia. Sappol mentions, in particular, this 1929 film made at Cook County Hospital in Chicago , which shows four kids who are dying of rabies. Struggle, the patients convulse, bleed from the mouth; they're inconsolable, even as gloved adult hands reach from off screen to hold them or offer them water.

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Sappol does not think it should be the job of the librarian or archivist to decide that the public can not handle looking at pictures that are such. We're stewards of these historical materials," he told me. They don't belong to us. They belong to everybody. ... I would not like to act on behalf of the subjects and arrogate to myself the job of being some sort of cop of 'who can view.' " With the NLM's electroshock therapy movies from the 1930s, Sappol says, Some of the people in this picture ... look like they definitely do not consent to the process, plus it is disturbing to see. I could say 'This person does not need to be on camera, they are being humiliated.' But this is from. If we never get to see this, who gets to understand?" The fascination we feel about such images, he contends, isn't shameful, but only human.

The problem is further complicated by the fact that some subjects prefer visibility. This really 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 occur with their case files fluctuate widely, but some undoubtedly need their files and images made accessible for research as a willful act to open up debate."Of course, there's not any method to ask the patients whose bodies appear in The Sick Rose whether they would prefer to be viewed or remain hidden. But the modern case of thalidomide reveals that we shouldn't assume that publication is tantamount to violation.

Nor should we suppose the Web is a less serious medium than the bound-and- printed book. Historian Miriam Posner, who wrote her dissertation on medical filmmaking, is also a digital historian dedicated to making her sources publicly available. Belvidere, IL std test. In 2010, Posner posted about the ethical quandary she faced when requested to collaborate with a producer at NPR's show Science Friday on a slideshow of photos that were lobotomy. Neurologist Walter Freeman, who carried out more than 3,500 of the processes, photographed and filmed his patients before and after their operations.

But Posner ultimately went ahead with the Science Friday slideshow, reasoning that by asking audiences to choose a second look at the before" images of patients, which Freeman presented for his own motives as broken," she might have the capacity to reveal that these faces comprise more possibilities than Freeman ever saw." A commenter on the post of Posner wrote that he'd lately learned 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 grandfather, never, ever, and I don't care if it is an image of him having this done I need and only want to see a picture of him so MUCH. Can you tell me how to get to these archives?" It might have been much harder for the commenter to find her if Posner hadn't gone ahead with Science Friday; the link might not have been made. Std test near Belvidere.

Eventually, there is a spiritual argument for making such images available. IL, United States Std Test. Even if medical images may be misused, Michael Sappol says, I really don't want that possibility to prevent these things that are really amazing documents of the human encounter from being seen. ... We can learn from them, they are able to redeem us in some way. They are able to supply us with some sort of curriculum of human suffering. ... Looking at them makes life richer and deeper." Barnett, despite his misgivings, agrees on this point: There is a power behind these pictures, there's a power they have over us, and we've got to recognize or respect this at some point." He compares the images to a lay 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, images like those in the Sick Rose might remind us: This Is Actually the body, along with the conclusion that we all come to."

Still, a vanitas demands space for contemplation---a space the Web appears ill prepared to offer. Susan Sontag's final book, Regarding the Pain of Others (2003), was composed as the Web was in the procedure for scattering pictures to the four winds. Sontag wrote that photographs of suffering might be a memento mori " and serve as a still point around which to contemplate mortality. But she wondered how this could work---or fail to work---in a modern society," where space reserved for being serious is difficult to come by." One wonders what she might have made of Pinterest if she thought that about television, publications, and art galleries.

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