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The experience of looking at The Sick Rose, which is a good-curated print presentation of images that are available digitally on the Wellcome Images site, raises questions about historic medical pictures, and when and in what media it's appropriate to see them. It's one thing to take a beautifully bound book aside into a quiet armchair and have a one-on-one encounter with all the face of a baby wizened by tertiary syphilis, or with a dignified man with a bulbous, untreated pendant tumor. It's another to see the same faces detached from the context 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. Online, the patients' suffering runs the risk of being seen as classic"---almost amusing in its terrible extremity and its distance from our own time. In a blog post about the method of assembling and after marketing The Sick Rose, Barnett acknowledged to a sense of unease" about sending the images off into the planet, worrying in regards to the kitsch, understanding, and emptily ironized attitude" that could greet the images. (When Wired ran a slideshow of photographs from Sick Rose in May, for instance, 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're not visualized."

As historical medical images go archivists, scholars and digital are being forced to weigh the advantages of disseminating the fascinating and unquestionably important record of the development of medical practice with matters the images will soon be misunderstood and misused. Making the pictures available will almost surely result in some tone-deaf uses and regard at best---using the shock value of a disfigured face or body at worst. On the flip side, digitization of the types of images that were once accessible only to researchers with the resources to travel to archives can do lots of good. Such visibility can raise awareness about past wrongs, facilitate the families of former patients as well as connections between historians , even provide us with a brand new method to think about our own mortality. (Because there are good arguments on both sides, and because these medical images may be disturbing to some readers, we have decided to put the photographs we are printing with this specific post behind an electronic scrim, allowing you, the reader, to decide whether to see them.)

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Here's one case that demonstrates how much such digitized pictures 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 specific component treating injuries that required maxillofacial surgery. Gillies commissioned photographers and artists to document his patients' presurgical harms, using the pictures to plan his team's strategy.

These photographs ended up on the Web as a portion 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 visuals that Hartley made from these archives with inspiration later formed the basis of an exhibition at London's National Army Museum. The job, Hartley writes on his website , was intended to explore the effect of veterans' wartime injuries and following facial operations on their lives.

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But the digital images had another life following the exhibit had closed. Some photographs from the Job Faade archive ended up used in the plan of the genetic mutants (splicers") that players of the videogame BioShock must battle. Henry Lumley, one of many patients in the photographs, a pilot trainee, was injured on the day of his graduation from flying school and lived with his injury for a year before being admitted to Gillies' attention. Lumley died of postoperative complications, at age 26. (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 forced to roam around in virtual space, made into monsters for the entertainment of gamers.

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Std Test closest to Leawood. Does this matter, given that many (most?) BioShock players WOn't ever know who these men 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 almost black---a fate worse than death"---and images of soldiers injured in this way were censored, lest they decrease morale. So if gamers never understand the characters they are seeing on screen were once actual men, it can nevertheless feel when they're trotted out as digitized monsters, like these guys, ostracized in life, are being wronged again. Leawood KS 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 images are used to frighten people in a computer game, gives us a peek into what life must have been like for folks who sustained such disfiguring injuries." (She adds: How brave these guys were to let themselves to be photographed with extensive injuries, and to undergo treatments that frequently made them look worse before they seemed better.")

Std test nearest Leawood. 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 context of the game was an appalling approach to take care of the memory of veterans," Bamji wrote. He apologized and assured me that no further such pictures would be used, and there the matter finished." Bamji drew a clear distinction between the utilization of such pictures in a project like BioShock, where they were disassociated from the names and stories of the patients, and the Project Faade of Hartley. Std test nearby Kansas. I don't have any problem with all the display of pictures in a historical context, as without this folks don't comprehend what war can do."

Should we limit access to upsetting digital images to people who we can be certain will perceive them in appropriate context? Michael Sappol , a historian at the U.S. National Library of Medicine who has written about historic and modern medical display, has an argument to the contrary. The NLM's digital sets have lately posted a number of hushed medical pictures from between 1929 and 1945 , a few of which represent 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 children that are dying of rabies. The patients convulse, fight, 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 doesn't think it should be the job of the librarian or archivist to determine 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 would not like to act on behalf of the areas and arrogate to myself the job of being some type of policeman of 'who can view.' " With the NLM's electroshock therapy films from the 1930s, Sappol says, Some of the people in this movie ... look like they surely do not consent to the process, plus it's disturbing to see. I really could say 'This man doesn't desire to be on camera, they are being humiliated.' But this is from. If we never get to see this, who gets to know?" The interest we feel about such images, he contends, is not black, but simply human.

The issue is further complicated by the fact that visibility is preferred by some subjects. This is the situation with all the Thalidomide Trust archive, which features medical case files on people produced withsevere birth defects after their mothers took the drug thalidomide to relieve symptoms of morning sickness in the late 1950s-early-1960s," Wellcome archivist Helen Wakely wrote to me. The views of thalidomiders themselves on what should occur with their case files vary widely, but some definitely need their files and images made available for research as a deliberate act to open up discourse."Of course, there's not any means to ask the patients whose bodies appear in The Sick Rose whether they would prefer to be viewed or remain concealed. But the modern example of thalidomide demonstrates that we shouldn't assume that publication is tantamount to infringement.

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 committed to making her sources freely available. Leawood KS Std Test. In 2010, Posner posted about the ethical quandary she faced when requested to collaborate on a slideshow of lobotomy photographs with a producer at NPR's show Science Friday. Neurologist Walter Freeman, who carried out more than 3,500 of the processes, photographed and patients his filmed before and after their operations.

But Posner finally went ahead with the Science Friday slideshow, reasoning that by asking audiences to take a second look at the before" pictures of patients, which Freeman presented for his own purposes as broken," she may be able to reveal that these faces contain more possibilities than Freeman ever saw." A commenter on the post of Posner wrote that he'd lately discovered that his grandfather, who he had never met, had been institutionalized and lobotomized in West Virginia. The commenter wrote: I don't care if it is a graphic of him having this done I merely desire and desire to see a picture of him so MUCH, and I haven't seen a picture of my grandpa, never, ever. Can you tell me how to get to these archives?" If Posner hadn't gone with Science Friday, it might have been much harder for the commenter to find her; the connection mightn't have been made. Std test in Leawood.

Finally, there is a religious argument for making such pictures accessible. KS United States std test. Even if medical images might be abused, Michael Sappol says, I don't need that possibility to prevent these things that are actually amazing files of the human encounter from being seen. ... We can learn from them, they can redeem us in some way. They could supply us with some form 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 images, there's a power they have over us, and we've got to acknowledge 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 also the conclusion that we all come to."

Still, a vanitas needs space for contemplation---a space the Web seems ill prepared to offer. Susan Sontag's closing book, Regarding the Pain of Others (2003), was written as the Web was in the procedure for scattering photographs 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 may work---or fail to work---in a modern society," where space allowed for being serious is difficult to come by." One wonders what she might have made of Pinterest if she thought that about art galleries, books, and television.

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