Visual Culture and Pandemic Disease Since 1750: Capturing Contagion 1032261072, 9781032261072

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Visual Culture and Pandemic Disease since 1750

Through case studies, this book investigates the pictorial imaging of epidemics globally, especially from the late eighteenth century through the 1920s when, amidst expanding Western industrialism, colonialism, and scientific research, the world endured a succession of pandemics in tandem with the rise of popular visual culture and new media. Images discussed range from the depiction of people and places to the invisible realms of pathogens and emotions, while topics include the messaging of disease prevention and containment in public health initiatives, the motivations of governments to ensure control, the criticism of authority in graphic satire, and the private experience of illness in the domestic realm. Essays explore biomedical conditions as well as the recurrent constructed social narratives of bias, blame, and othering regarding race, gender, and class that are frequently highlighted in visual representations. This volume offers a pictured genealogy of pandemic experience that has continuing resonance. The book will be of interest to scholars working in art history, visual studies, history of medicine, and medical humanities. Marsha Morton is Professor of Art History at Pratt Institute. She has published numerous essays and three books on interdisciplinary topics dealing with art, science, anthropology, and music in nineteenth-century German and Austrian cultural history. Ann-Marie Akehurst, PhD, is an independent scholar and a Trustee of the Society of Architectural Historians (GB). She speaks internationally and has published widely on sacred space, urban identity, and the art and architecture of spaces of sickness and wellbeing in early modern Britain and Europe.

Science and the Arts since 1750 Series Editors: Barbara Larson, University of West Florida and Ellen K. Levy, Independent Artist and Writer

This series of monographs and edited volumes explores the arts – painting and s­ culpture, drama, dance, architecture, design, photography, popular culture materials – as they intersect with emergent scientific theories, agendas, and technologies, from any ­ ­geographical area from 1750 to now. Art, Technology and Nature Renaissance to Postmodernity Edited by Camilla Skovbjerg Paldam and Jacob Wamberg The Organic School of the Russian Avant-Garde Nature’s Creative Principles Isabel Wünsche Science, Technology, and Utopias Women Artists and Cold War America Christine Filippone Visualizing the Body in Art, Anatomy, and Medicine since 1800 Models and Modeling Edited by Andrew Graciano Painting, Science, and the Perception of Coloured Shadows ‘The Most Beautiful Blue’ Paul Smith Vitalist Modernism Art, Science, Energy and Creative Evolution Edited by Fae Brauer Visual Culture and Pandemic Disease since 1750 Capturing Contagion Edited by Marsha Morton and Ann-Marie Akehurst

For more information about this series, please visit: https://www.routledge.com/Science-and-the-Arts-since1750/book-series/ASHSER4039

Visual Culture and Pandemic Disease since 1750 Capturing Contagion

Edited by Marsha Morton and Ann-Marie Akehurst

Designed cover image: Attributed to J. W. Gear, The Appearance after Death of a Victim to the Indian Cholera, Who Died at Sunderland, London, 1832. Lithograph with watercolour. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark. First published 2023 by Routledge 605 Third Avenue, New York, NY 10158 and by Routledge 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 selection and editorial matter, Marsha Morton and Ann-Marie Akehurst; individual chapters, the contributors The right of Marsha Morton and Ann-Marie Akehurst to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. ISBN: 978-1-032-26107-2 (hbk) ISBN: 978-1-032-28025-7 (pbk) ISBN: 978-1-003-29497-9 (ebk) DOI: 10.4324/9781003294979 Typeset in Sabon LT Pro by codeMantra

Contents

List of Figures About the Contributors

Introduction: Picturing Pandemics

vii xiii 1

MARSHA MORTON

PART I

Treating and Experiencing Disease: Medicine, Religion, and Myth19   1 The Inception of “Science and Supplication”: Architectural Programs, Devotional Paintings, and Votive Processions in Early Modern Venice

21

ANDREW HOPKINS

  2 Anatomy, Microscopy, and Satire: Looking at Cholera in Early Nineteenth-Century England

41

ANN-MARIE AKEHURST

  3 Combating Cholera: Tanuki Scrotum and the Visual Culture of Disease in Nineteenth-Century Japan

73

SARA K. BERKOWITZ

  4 Jean Geoffroy and the Conflicted Response to Childhood Epidemics in Fin-de-Siècle France

93

BARBARA LARSON

  5 Spaces of Sickness: The Phenomenology of the Sickroom in Nordic Symbolist Art KERSTINA MORTENSEN

116

vi Contents PART II

Reporting, Representing, and Interpreting Disease135   6 “Invisible Destroyers”: Cholera and COVID in British Visual Culture

137

AMANDA SCIAMPACONE

  7 Visualizing Contagion in Colonial India

157

DAVID ARNOLD

  8 Capturing the Invisible Enemy: Photographs of the 1918 Influenza Epidemic

175

LOUISA IAROCCI

  9 Contaminating the “End of AIDS” in Contemporary British AIDS Media

193

CHASE LEDIN

PART III

Public Health: The Politics of Body and State209 10 Plague, Trade, and Governance in Eighteenth-Century Tunisia

211

EDNA BONHOMME

11 Deconstructing the Story of a Contagion: Tuberculosis and Its Representations in Early Republican Turkey

225

ALEV BERBEROĞLU AND CANSU DEĞIRMENCIOĞLU

Index247

Figures

1.1 Titian, Saint Mark Enthroned, c. 1510, oil on canvas, 230 × 149 cm, Sacristy, Santa Maria della Salute, Venice 1.2  St. Roch with a staff resting on rock, with a view of Venice in the distance; at upper left appears an angel, a dog lower left, surrounded with various scenes from his life, 1516, after Titian (1490–1576), woodcut print on paper, 56.3 × 40.4 cm (British Museum) 1.3 Antonio Zanchi, The Virgin Appearing to Plague Victims during the Plague of 1630, 1666, Oil sketch, preparatory composition study, 99 × 135 cm, lent to the Kunsthistorisches Museum by the Friends of the Kunsthistorisches Museum, Vienna. Inv. Nr. Fr 52 1.4 Domenico Tintoretto, Venice Supplicating the Virgin Mary to Intercede with Christ for the Cessation of the Plague, 1630–1631, Oil paint on gray laid paper, 40.3  × 20.1  cm, Princeton University Art Museum. Gift of Frank Jewett Mather Jr 1.5 Bernardino Prudenti, The Virgin and Child, with Saint Mark the Evangelist, the Blessed (later Saint) Lorenzo Giustiniani, Saint Roch, and Saint Sebastian Making the Plague Flee from the City of Venice, 1631–1638, c. 200 × 300 cm, Venice, S. Maria della Salute (photo: Böhm) 1.6 Marco Boschini, The doge Nicolò Contarini visiting S. Maria della Salute in Procession, 1644, etching and engraving, detail, Den Kongelige Kobberstiksamling, Statens Museum for Kunst, Copenhagen 410a, 21 (photo: Hans Petersen) 2.1 Anon., Blue stage of the spasmodic Cholera of a girl who dies in Sunderland, November 1831, published in The Lancet. Credit: Wellcome Collection. Attribution 4.0  International (CC BY 4.0) 2.2 A London Board of Health Hunting after cases like cholera. Lithograph, 1832.  Credit: Wellcome Collection. Public Domain Mark 2.3 J ohn Bull Catching the Cholera, c. 1832.  Lithograph with watercolor, 25 × 19 cm. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark 2.4  The Cholera Morbus!!! John Bull being examined by eight doctors representing ­politicians, who diagnose his illness as cholera. Lithograph, c. 1832.  Credit: Wellcome Collection. Public Domain Mark

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viii Figures 2.5 W  illiam Heath, Microcosm: Monster soup commonly called Thames water, being a correct representation of that precious stuff doled out to us!!! Colored etching by W. Heath, 1828. Wellcome Collection. Credit: Wellcome Collection Attribution-NonCommercial 4.0  International (CC BY-NC 4.0) 2.6 Engraving of a flea in Micrographia, or some physiological descriptions of minute bodies made by magnifying glasses. With observations and inquiries thereupon, 1665, by Robert Hooke. Wellcome Collection. Credit: Wellcome Collection Attribution 4.0  International (CC BY 4.0) 2.7 George Cruickshank, Salus Populi Supreme Lex Esto [Let the health of the people be the supreme law]. 1832.  Header detail…© The Trustees of the British Museum [BM 1862,1217.517] Credit: The British Museum Public domain. 4.0  International (CC BY-NC-SA 4.0) license 2.8 Henry Heath, Sketch from the Central Board of Health. 1832.  Colored ­lithograph. 1832.  Wellcome Library, London. Credit: Wellcome Collection. Attribution 4.0  International (CC BY 4.0) 3.1  Defeating Cholera (korera taiji), woodblock print, 1886.  Courtesy of UCSF Archives and Special Collection, University of California, San Francisco 3.2 Shungyō, Defeating Smallpox (Hōsō taiji no zu), woodblock print, 1890.  Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco 3.3 Utagawa Yoshifuji, Shipping Measles Away (Hashika okuri-dashi no zu), woodblock print, 1868.  Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco 3.4 Tsukioka Yoshitoshi, Illustrated Narrative on Preventing Cholera (Korori fuesgi no etoki) woodblock print, 1877.  Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco 3.5 Tsukioka Yoshitoshi, Rainy Day Tanuki, from the “Comic Pictures of Famous Places in the Early Days of Tokyo Series,” woodblock print, 1881. Public Domain 3.6 Publisher not Identified, Anon., A Young Woman of Vienna Who Died of Cholera, Depicted When Healthy and Four Hours before Death, colored stipple engraving, ca. 1831.  Wellcome Collection: Royal College of Surgeons. Public Doman 4.1 Jean Geoffroy, The Washbasin at the école maternelle (lost), reproduced in Henry Havard, Salon de 1885 (Paris: Baschet, 1885), p. 32.  Library of the Institut national d’histoire de l’art, Jacques Doucet collections, 4 H 8030, Photo credit: Institut national d’histoire de l’art 4.2 Jean Geoffroy, Mothers’ Diploma of Special Merit, nineteenth-century, drawing and watercolor, H. 32 cm × l. 42 cm, Musée de l’Assistance publique—Hôpitaux de Paris, inv. AP 2305.  © AP-HP/Musée—F. Marin 4.3 Jean Geoffroy, La Crèche [The Crib], 1897, 165 × 91 cm, inv. No. 90, oil on canvas, Musée d’Art et d’Histoire, Rochefort. Photo credit: ©Musées-municipaux Rochefort 17

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Figures  ix 4.4 Geoffroy, At the Hospital of Notre-Dame du Perpétuel Bon Secours, 1913, 125 × 100 cm, oil on canvas, Musée de l’Assistance publique— Hôpitaux de Paris. Inv. AP 2266.  Photo credit: AP-HP/Musée—F. Marin 4.5 Jean Geoffroy, The Great Hall of the Poor, 1904, 199.5  × 150 cm, oil on canvas, Musée de Beaux-arts de Beaune, inv. 11-3-1.  En dépôt au Musée de l’Hôtel-Dieu de Beaune depuis 2001.  Photo credit: Illustria 4.6 Jean Geoffroy, Return to Life, 1909, oil on canvas, 107 × 122 cm, Musées d’Art et d’Histoire de La Rochelle. Photo credit: Max Roy 5.1 Ejnar Nielsen, And in His Eyes I Saw Death, 1897, oil on canvas, 137 × 188 cm, Statens Museum for Kunst Copenhagen. Photo credit: Statens Museum for Kunst. © Estate of Ejnar Nielsen, VISDA Copenhagen/IVARO Dublin, 2022 5.2 Edvard Munch, Death Struggle, 1915, oil on canvas, 157.5  × 200 cm, Statens Museum for Kunst Copenhagen. Photo credit: Edvard Munch, Death Struggle. 1915.  Photo credit: Statens Museum for Kunst 5.3 Ejnar Nielsen, The Sick Girl, 1896, oil on canvas, 111 × 164 cm, Statens Museum for Kunst Copenhagen. Photo credit: Statens Museum for Kunst © Estate of Ejnar Nielsen, VISDA Copenhagen/IVARO Dublin, 2022 5.4 Edvard Munch, Spring, 1889, oil on canvas, 169 × 263.5  cm, Nasjonalmuseet Oslo. Photo: Børre Høstland/The National Museum 5.5 Edvard Munch, The Sick Child, 1885, oil on canvas, 120 × 118.5 cm, Nasjonalmuseet Oslo. Photo credit: Børre Høstland/The National Museum 6.1 John Bull Catching the Cholera, c. 1832.  Lithograph with watercolor, 25 × 19 cm. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark 6.2 Attributed to J. W. Gear, The Appearance after Death of a Victim to the Indian Cholera, Who Died at Sunderland, London, 1832.  Lithograph with watercolor. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark 6.3 Robert Seymour, “Cholera ‘Tramples the Victor & Vanquish’d Both’,” McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 October 1832, 2.  Lithograph. British Museum, London. Credit: © The Trustees of the British Museum 6.4 Robert Seymour, “The Dernier Resort,” McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 February 1832, 3.  Lithograph. British Museum, London. Credit: © The Trustees of the British Museum 6.5 Image accompanying “Picturesque Sketches of London, Past and Present. Chapter XVI. The South Districts of London during the Epidemic,” Illustrated London News, 27 October 1849, 285.  The Open University Library, Milton Keynes. Image courtesy of The Open University Library 6.6 “Death’s Dispensary. Open to the Poor, Gratis, by Permission of the Parish,” Fun, 18 August 1866, 233.  National Library of Scotland, Edinburgh. Credit: National Library of Scotland. Attribution 4.0  International (CC BY 4.0) 6.7 “China virus ‘on the way here’,” Metro, 23 January 2020, 1.  Credit: Metro/Will Oliver/EPA-EFE/Shutterstock

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x Figures 6.8 “Virus cases jump in UK,” Metro, 2 March 2020, 1.  Credit: Metro/ Getty Images/WPA Pool 151 6.9  Stop COVID-19 Hanging Around, HM Government and NHS public health ­advertisement in Mile End Underground Station. Photographed by the author on 27 January 2022 153 7.1 Shitala: Kalighat painting, mid- to late nineteenth century. Wikimedia Commons159 7.2 H. Vandyke Carter, Sectional Appearances of the Foot in Mycetoma: Black Variety. From H. Vandyke Carter, On Mycetoma, Or the Fungus Disease of India (1874). Wellcome Collection: Royal College of Surgeons. Public Domain Mark 161 7.3 Bombay Plague Epidemic, 1896–1897: Interior of a Plague Hospital, attributed to Clifton & Co., Wellcome Collection. Public Domain Mark 164 7.4 A Group of Men Lower the Body of a Dead Man on to a Pyre of Logs Prior to a Hindu Cremation Ceremony in Bombay at the Time of Plague, 1896–1897, photographer unknown. Wellcome Collection. Public Domain Mark 165 7.5 Hospital Staff Disinfecting Patients during the Outbreak of Plague in Karachi, 1897, probably by R. Jalbhoy. Wellcome Collection. Public Domain Mark 166 7.6 Bombay Plague Epidemic, 1896–1897: Inoculation against Plague, attributed to Cliftion & Co. Wellcome Collection. Public Domain Mark 168 8.1 “Medical Science’s Newest Discoveries about the ‘Spanish Influenza’,” Richmond Times – Dispatch, October 6, 1918, 2 178 8.2 “Not a Turkish Harem, but Red Cross Workshop Unit Making Flu Masks,” Omaha Daily Bee, October 6, 1918, 20 180 8.3 “Influenza Masks Play Big Part in Curbing Epidemic,” San Francisco Chronicle, October 30, 1918, 11 181 8.4 “Philadelphia Winning the Fight against Influenza,” Evening Public Ledger (Philadelphia, PA), October 9, 1918, np 183 8.5 “‘Give Us Beds, Bedding’ Is the Plea of Flu Hospital,” Oakland Tribune, October 14, 1918, 7 186 8.6 “Preparing to Bury City’s Influenza Victims,” Unidentified Philadelphia newspaper, circa 1918, np 188 9.1 Joe writes a warning on a man’s back. Scene from Luke Davies, The Grass Is Grindr (2018–2019). Image permission via Luke Davies and Patrick Cash 199 9.2 Jill scrubs contaminated dishware. Scene from Russell T. Davies, It’s a Sin (2021). Still © Red Production Company & All3Media International 202 10.1 Jules Marie Vincent De Sinety and Bayot (lithographer), Entrée de S. A. Royale dans le port de la Goulette (Tunis) (Entry of the S.A. Royale into the Port of La Goulette), lithograph, Collection de Vinck. Un siècle d’histoire de France par l’estampe, 1770–1870.  Vol. 103 (pièces 13029–13102), Monarchie de Juillet (July Monarchy) 212 10.2 Jacques-Nicolas Bellin and Jean-Baptiste Croisey, Plan des forts et canal de La Goulette. (Map of the forts and canal of La Goulette) Dépôt des cartes et plans de la marine. 1740–1749 218

Figures  xi 11.1 Dr. Hikmet Hamdi, Illustration, The Atlas, 1926, 37.  Caption reads: “A tubercular man spits on the street. Someone else unwittingly steps on the sputum” 11.2 Dr. Hikmet Hamdi, illustration. The Atlas, 36.  Caption reads: “Dried tuberculosis sputum is scattered with dust and lands on fruits and other food, and those who eat them unwashed are infected with the germs” 11.3 Dr. Hikmet Hamdi, illustration. The Atlas, 38.  Caption reads: “He dirties his home because he enters the room with dirty shoes” 11.4 Dr. Hikmet Hamdi, illustration. The Atlas, 39.  Caption reads: “His child swallows the germs while playing in the dirty room” 11.5 Dr. Hikmet Hamdi, illustration. The Atlas, 40.  Caption reads: “As the child grows up the signs of tuberculosis begin to appear” 11.6 Dr. Hikmet Hamdi, illustration. The Atlas, 41.  Caption reads: “The child falls ill due to his father’s carelessness” 11.7 Photographs from the Hygiene Exhibition (1935) in Ankara that illustrate Dr. Wilhelm Wadler’s essay. La Turquie Kâmaliste 11 (February 1936): 6 11.8 Photograph of the panel explaining tuberculosis in the Izmir Fair (1937). Ahmet Piriştina City Archive and Museum (APIKAM)/İBB İzfaş Endowment Fund

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About the Contributors

Ann-Marie Akehurst is a British art and architectural historian, a Fellow of the Society of Antiquaries of London, a Trustee of the Society of Architectural Historians (GB), and is an occasional adviser to the York Civic Trust. She formerly taught art and architectural history at the University of York and is now an independent researcher with interests in architecture related to place. She speaks internationally and has published on sacred space, on urban identity, and on the art and architecture of health in early modern Britain and Europe. During the coronavirus pandemic she convened an international seminar series for the University of London’s Institute of Historic Research, together with the Wellcome Collections, on spaces of sickness and well-being. David Arnold is Professor Emeritus in the Department of History, University of Warwick, UK, and a Fellow of the British Academy; he previously worked at the School of Oriental and African Studies in London. Closely involved with the Subaltern Studies project in its early years, he contributed to several of its published volumes. He has written extensively on policing, labor, and politics in South India as well as on science, technology, environment, and medicine in India generally. His published work includes Colonizing the Body: State Medicine and Epidemic Disease in NineteenthCentury India (1993), Gandhi (2001), Everyday Technology: Machines and the Making of India’s Modernity (2013), Toxic Histories: Poison and Pollution in Modern India (2016), Burning the Dead: Hindu Nationhood and the Global Construction of Indian Tradition (2021), and Pandemic India: From Cholera to Covid-19 (2022). His current research is on photography and the visual technologies of British India. Alev Berberoğlu is a PhD candidate in the Department of Archaeology and the History of Art at Koç University in Istanbul, Turkey. Her research areas include the history of photography in the Ottoman Empire with a focus on gender, materiality, and multiculturality; Ottoman painting; and the Italian presence in Ottoman Istanbul. Recipient of the French Embassy Research Fellowship in 2021, Berberoğlu currently works on her dissertation entitled “Unwritten Histories of Photography: Elisa Zonaro, an Italian Photographer in Ottoman Istanbul.” Sara K. Berkowitz is Assistant Professor of Art History at Widener University, where she teaches a range of global and thematic courses, including “Picturing Pandemics: The Body, Medicine, and Disease in Art.” She received her PhD from the University of Maryland at College Park in 2020 with a dissertation that explored visual representations of bodily ambiguity and gender transformation as a result of disease, surgical intervention, and spiritual intercession in the seventeenth and eighteenth centuries.

xiv  About the Contributors Her research focuses on the relationship between art, medicine, and gender in the early modern world. Her recent publications include “Unmaking the Masculine Body: Representations of Castrati in the Seventeenth Century” in The Male Body and Social Masculinity in Premodern Europe (2022). Edna Bonhomme is a historian of science, editor, and cultural writer who lives in Berlin, Germany. One of her tasks is to mine through the archives and complicate our understanding of contagion, toxicity, and maladies. Through critical storytelling, Edna narrates how people perceive modern plagues and how they try to escape from them. Her essays have appeared in  Al Jazeera, The Atlantic, The Guardian, The London Review of Books, The Nation,  and elsewhere. Her forthcoming book,  Captive Contagions (One Signal/Simon & Schuster, 2023), examines the role that confinement has played in fostering and hindering epidemics. Cansu Değirmencioğlu is an interior architect, and a PhD candidate at the Technical University of Munich, the Chair of History of Architecture and Curatorial Practice. She received her bachelor’s and master’s degrees at Istanbul Technical University. Her current scholarly research mainly focuses on the cultural modernization of early Republican Turkey, the intertwined histories of medicine and modern architecture, and the history of lighting design. Değirmencioğlu is currently working on her dissertation project, which is funded by DAAD (German Academic Exchange Service). Andrew Hopkins holds the chair in architectural history at the Università degli studi dell’Aquila in Italy and is a recognized authority on Early Modern cities, their architecture, and urbanism. He is the author of numerous articles as well as volumes, including Baldassare Longhena and Venetian Baroque Architecture (Yale University Press 2012) and La città del Seicento (Laterza 2014). Louisa Iarocci is an associate professor in the Department of Architecture at the University of Washington in Seattle, where she teaches architectural history, theory, and design. She is a licensed architect who has worked in architectural firms in Toronto, New York, and Boston. Her publications include the anthology,  Visual Merchandising: The Image of Selling  (2013), and the monograph,  The  Urban Department Store in America (2014). She has recently contributed essays to the anthologies Epidemic Urbanism: Contagious Diseases in Global Cities, edited by Caitlin DeClercq and Mohammad Gharipour (2021), and Building/Object: Shared and Contested Territories of Design and Architecture, edited by Mark Crinson and Charlotte Ashby (2022).  Her current research focuses on the forms and operations of utilitarian architecture with a focus on commerce, storage, and health. Barbara Larson is Professor of Modern European Art at the University of West Florida. She is the author of The Dark Side of Nature: Science, Society, and the Fantastic in the Work of Odilon Redon and a lead editor of The Art of Evolution: Darwin, Darwinisms and Visual Culture and Darwin and Theories of Aesthetics and Cultural History. She is a co-editor along with Marsha Morton of Constructing Race on the Borders of Europe: Ethnography, Anthropology and Visual Culture, 1850–1930. Barbara is an editor of the Routledge/Taylor & Francis, UK series titled “Science and Visual Culture in Great Britain in the Long Nineteenth Century: Sources and Documents.” She has published widely on visual culture and medicine, evolutionism, botany, and anthropology in the nineteenth century. Her fellowships include those

About the Contributors  xv from the National Endowment for Arts, the National Endowment for the Humanities, and the MacGeorge Fund, among others. She is currently working on a book on science and Scottish Symbolism. Chase Ledin is a research fellow at the University of Edinburgh, Scotland. As a sociologist and historian of public health, his research explores the social and cultural dimensions of HIV and STI health promotion in the UK. He is particularly interested in social transformations in STI technological innovation, antimicrobial resistance, and grassroots sexual health movements. Chase has work published in Sociology of Health and Illness; Culture, Health and Sexuality and  The European Journal of Cultural Studies, as well as in a forthcoming edited collection titled Queering STS. Kerstina Mortensen is an art historian specializing in nineteenth- and twentieth-century Nordic art, with an emphasis on Symbolism, word and image, atmosphere, and memory studies. She completed her PhD at Trinity College Dublin in 2019 with a dissertation titled Into the Void: Text and Image in Nordic Art 1890–1915. Her research was funded by the Irish Research Council. Her most recent publication is “Glittering Lights: Nocturnal Atmospheres and the Modern Metropolis” (Periskop no. 28, 2022), and she is currently working on a monograph of her thesis. Kerstina has held teaching positions at Trinity College Dublin and University College Cork. Marsha Morton is Professor of Art History at Pratt Institute in Brooklyn, NY. Her work has centered on German and Austrian cultural history with a focus on the interdisciplinary topics of art, science (Darwin), anthropology, Orientalism, and music. In addition to published essays, her books include Constructing Race on the Borders of Europe: Ethnography, Anthropology, and Visual Culture, 1850–1930 (co-edited with Barbara Larson, Bloomsbury 2021), Max Klinger and Wilhelmine Culture: On the Threshold of German Modernism (Ashgate 2014), The Arts Entwined: Music and Painting in the Nineteenth Century (co-edited with Peter Schmunk, Garland 2000), and the exhibition catalog Pratt and Its Gallery: The Arts & Crafts Years (1999). Her work has been supported by research grants from the National Endowment for the Humanities and DAAD (German Academic Exchange Service). She has served as the president and treasurer of the Historians of German, Scandinavian, and Central European Art (HGSCEA). Amanda Sciampacone is an art historian who explores the intersections between British art, visual culture, medicine, and the environment in the long nineteenth century. She has published articles on Victorian visual culture and medical climatology and on the connections between cholera and empire in nineteenth-century illustrated prints in the Journal of Victorian Culture, and on British representations of the Black Hole Memorial in Third Text. In 2018, she curated the exhibition Art, Air, and Illness at the Lanchester Research Gallery of Coventry University, which explored how art and science shape perceptions of the impact of the environment on health. She is currently a Lecturer and Staff Tutor in Art History at The Open University.

Introduction Picturing Pandemics Marsha Morton

This book originated during the early years of the COVID-19 (SARS-CoV-2) pandemic as a session, “Epidemics of Fear and the History of Medicine,” presented at the College Art Association conference in February 2021, and as a seminar that April in a series sponsored by the Institute of Historical Research, University of London and the Wellcome Collection.1 These “remote” events highlighted one of the most intense antithetical but interrelated experiences of living through the pandemic: the stark isolation of lockdowns offset by a profound sense of community and shared trauma, exemplified by the people singing from windows in North Italian towns and the cheering and banging of pots and pans from New York City balconies every evening to thank healthcare workers. This sense of unity was especially fostered through digital technology, whether social media or Zoom gatherings, and the extensive dissemination of images, both news photos and videos, which made this pandemic more visualized and globally interconnected in the popular imagination than previous ones. It is thus an opportune moment to reconsider the historic role and function of imagery in constructing, responding to, and documenting epidemics, which this book explores in case studies that reflect upon their unique contributions, perspectives, and purposes. In other words, what does a focus on pictures add to our understanding of pandemics that is otherwise muted? What emerges here is a diachronic tale of continuity and change, sameness and otherness, and fracture and cohesion. At the core of this book chronologically is the period between the late eighteenth century and the 1920s when, amidst expanding industrialism, colonialism, and medical research, the world experienced chronic pandemic diseases in tandem with the rise of a public visual culture and new media such as photography. Several decades ago, scholar Sander Gilman speculated on reasons for historians’ image anxiety that had resulted in visual representation remaining “a stepchild in the writing of the history of medicine.”2 So too, Roy Porter confessed to his previous “­blindspot” regarding pictures – a shocking admission considering that he had recently published in 1996 the authoritative Cambridge Illustrated History of Medicine.3 While the situation has considerably improved since the time of Gilman’s writing, the majority of the plethora of books on epidemic disease still contain few to no images, and these largely function as reinforcement of the factual information discussed in the text. This is equally true of illustrated histories of medicine, most of which are essentially picture books with boxed inserts providing descriptions of the relevant scientific material. Art and cultural historians, meanwhile, have written numerous studies of epidemics and art, but these have primarily focused on the periods before 1750 and/or plagues, resulting in an omission of most of the long nineteenth century.4 Exceptions include the anthologies In Sickness and Health: Disease as Metaphor in Art and Popular Wisdom (2004) and DOI: 10.4324/9781003294979-1

2  Marsha Morton Imagining Illness: Public Health and Visual Culture (2010).5 A new area, scholarship on graphic medicine narratives, has arisen since 2007, and provides some of the more thoughtful and stimulating insights on the content, stylistic techniques, and theoretical formulations of illness visualizations.6 Recently, research has been directed toward COVID-19 and, not unexpectedly, utilizes internet sites.7 The chapters in our book present detailed case studies of diverse pandemics in Eastern and Western countries that comprise examples of the four means of transmission: airborne (tuberculosis, influenza, and COVID-19), waterborne (cholera), animals and insects (plague), and human (HIV/AIDS).8 Collectively, they track the etiologies of miasma (foul air from rotting organic material), contagion, genetic predisposition, and germ theory. Chapters explore the picturing of disease through the visual culture of graphic art, painting, photography, film, cartography, and illustrations in brochures, newspapers, and books, though not (apart from a few exceptions) in scientific medical books. Most of these images circulated widely in the public realm but others, such as paintings, were designed for more restricted spaces and audiences. A similar diversity is evident in the multiple purposes for which the pictures were created and the range of situations depicted: the pedagogical messaging of public health that aimed to either stoke or allay fears, the motivations of governments to ensure control, the criticism of authority in graphic satire, and the private experience of illness in the domestic realm by patients, caregivers, and family. Numerous shared themes are interwoven through these chapters, but they have been grouped in three sections according to an emphasis on disease treatment (medical and/or faith-based) and life in the sick room; the impact of media on framing epidemic information and directing behavior; and government efforts to take action for national self-interest. Above all, our authors endeavor not only to interpret the content and context of individual scenes but also to speculate on the larger role played by the picturing of pandemics. Depictions of epidemic disease take numerous forms, from the microcosm of microbes to the macrocosm of people in places, but most all historians agree that the motivation for visualization is a desire to establish order and control, however illusory, in a situation that is chaotic, unknown, and deadly.9 Implicit is the belief in the power of pictures to persuade and convince. Gilman defined art as “an icon of our control of the flux of reality,” while Keir Waddington observed that naming and understanding a disease makes it more manageable.10 The same is equally true of imaging, and, as Louisa Iarocci writes (Chapter 8), visual fact possesses its own unique authority. These initiatives are generally regarded as the first step toward action. According to David Arnold in his discussion of plague photographs in India (Chapter 7), societies feel compelled to “endow contagion with a visible presence, to capture it in corporeal form…that can then be a focus for collective action and a medium for the expression of personal hopes and anxieties.” As analyzed throughout this book, however, those actions and anxieties, and the images that conveyed them, were rarely without social bias. “Seeing,” as Sria Chatterjee has observed, “or the inability to see something, is political.”11 Representing pandemic disease in itself – rather than the suffering sick bodies – requires the ability to visualize the invisible. In Chapter 3 Sara Berkowitz quotes from the statement of the Japanese Home Ministry Bureau of Hygiene (1880) describing cholera and other epidemics as “shapeless enemies” which are “far more threatening than those with shapes…because one’s eyes cannot catch them.” Artists have traditionally resorted to metaphors of embodiment, whether human or animal, such as the Japanese hybrid tanuki (Chapter 3), or microscopic pathogens after the rise of germ theory in the late

Introduction  3 nineteenth century and the development of medical imaging technology. Alev Berberoğlu and Cansu Değirmencioğlu (Chapter 11) examine the large-scale reproduction of the tuberculosis bacillus on an educational panel at the Ankara Hygiene Exhibition (1935), noting that it “give[s] visibility, physicality, and substance to the invisible” and implies “that by isolating and making visible, the disease-causing germs were being taken under control, disciplined, and dominated by the tools of modern medicine.” More often, as the illustrations in this book evidence, the invisibility visualized is that of emotional and psychological states registering, alternatively, disorientation, hope, helplessness, and despair, as in the haunting austerity of Ejnar Nielsen’s painting of a tubercular boy, And in His Eyes I Saw Death (Plate 5.1). In this way, artists center the diverse individual experiences of patients, replacing objective statistical “counting” and classification with the “accounts of direct and indirect human encounters” that social anthropologists have reinserted into medical histories.12 Images of epidemic disease provide an indelible record of past experiences which contribute to ongoing collective memory and function as humanity’s picture album of trauma, survival, and loss. Art, as critic Jason Farago recently wrote with regard to war, allows us to “look and listen in a way that lets thinking and feeling run parallel to each other” and “gives us a view of human suffering and human capability that testimonials, or even our own eyes, are not always able to do.”13 Picturing Pandemics and the New Social History of Medicine The chapters in this book are grounded in the now prevalent principles of the “new” social history of medicine, which supplanted narratives by physicians chronicling the progressive triumph of modern medicine with studies by historians of the social, cultural, political, and economic context of disease, understood as “both a pathological reality and a social construction.”14 Influenced initially by Michel Foucault’s criticism of biomedical authority, as well as the movements of post-structuralism, feminism, and postcolonialism, these writings began to appear in the 1970s and flourished during the later 1980s and 1990s in publications by, among others, Charles Rosenberg, Roy Porter, Sander Gilman, Richard Evans, and David Arnold. This approach to medical history was codified in an anthology edited by Paul Slack and Terence Ranger in 1992 and was applied to a comprehensive study of epidemics by J. N. Hays in 1998.15 More recently, Waddington has penned the most complete history and analysis of these ideas, which are also the subject of the Oxford Handbook of the History of Medicine.16 Authors interpreting the larger context of epidemics have paid close attention to the resulting inequities of race, class, and gender, and they have explored how disease and attempted cures have impacted the pre-existing fault lines of socio-political tensions, such as those related to colonialism, industrialization, poverty, disputes over moral standards, and national identity. This, in turn, has shaped narratives of explanation and blame. These topics are referenced in this book and will be discussed briefly below. Visual images are uniquely suited to encapsulating both the “bio-medical reality” and “human responses,” as observed by Iarocci (Chapter 8). A case in point is the lithograph, The Appearance after Death of a Victim to the Indian Cholera, Who Died at Sunderland (1832, Figure 6.2 and book cover), whose layers of meaning reveal numerous British concerns about the bacterium. On the face of it, we see the physical ravages of a horrific disease, which are enumerated by Amanda Sciampacone (Chapter 6): sunken eyes, lips too dehydrated to close, hands and feet curled and skeletal, and, most notably, flesh

4  Marsha Morton turned dark blue. The soiled dress and mattress hint at the excremental fluids emitted from her body and recall the definition of infection as related to staining or dyeing.17 The blue-gray haze behind the girl materializes both miasma and the “poisonous air” believed to be emitted by cholera patients. It is additionally significant that the victim is probably working class and female, a gender believed to be constitutionally weak and behaviorally passive, as discussed by Ann-Marie Akehurst (Chapter 2). These facts coupled with her darkened skin align her with the racial bodies of “less civilized” colonial subjects, as analyzed by literary historian Anjuli Fatima Raza Kolb, who cites an article on cholera in The Lancet from November 1831 (also examined by Sciampacone) and concludes that “blue and black emphasized cholera’s foreign [Indian] origin by way of its racial otherness.”18 The lithograph thus references the two groups blamed for the ­contagion – Britain’s colonial and urban poor – and conveys fears of national identity, alluded to through the red-white-blue palette, and contemporary concerns about metropolitan sanitation. At the same time, the artist’s attitude toward the dead girl suggests fright but also pity and even respect when seen in the context of the medieval funeral effigies and gisants on which it was based, according to Akehurst (Chapter 2).19 As the medieval reference indicates, pandemics are transhistorical as well as transnational, resulting in a seeming erasure of linear time and belief in the teleological evolution of scientific advances (one of the principal convictions in the new social history of medicine). According to Raza Kolb, disease “surges out of the past as a symbol of barbarism, darkness, and a time before civilization.”20 The conflation of past and present, evident in both public perceptions of disease outbreaks (cholera and influenza as the new plagues) and the work of epidemiologists who build on best past practices, is manifested in various ways in the visual arts. Chase Ledin (Chapter 9) explores the dominance of “previous ideas about contagion and moral disorder” in film representations of life with HIV/AIDS and problematizes interpretations of the earlier history of the disease in order to advocate for present and future gay/bisexual behavior. The most common visual technique to evoke continuity amidst change is through repeated iconographies of illness, or “intertextuality,” as mentioned by Akehurst (Chapter 2) in her discussion of Italian Renaissance and Dutch Golden Age medical imagery, and defined by David Serlin in his book on public health as “the process of borrowing and recycling from a broad variety of sources.”21 This is the subject of Chapter 6, in which Sciampacone explores the imaging of cholera in nineteenth-century Britain and, in some cases, contemporary COVID-19 through adapted scenes of Renaissance plague processions, arrows (emblems of the plague saint Sebastian), the skeletal Dance Macabre, gestures of a “healing touch” by rulers (including prime ministers), and scientific references to visualized miasma and, in the case of cholera, plague pits disturbed by the construction of new sewage lines. Sciampacone concludes that “like microbes, images of cholera and COVID-19 circulate, connecting contemporary outbreaks with a longer history of disease.” Above all, the rejection of a teleological history of medicine replaces the conviction that scientific innovation provides a panacea with the reality that multiple treatments, practices, and beliefs continue and have efficacy. Waddington has suggested the term “blended modernities,” adopted from Carol Gluck, to acknowledge the “plural inflections of the modern experience” and to remove the pejorative connotations of “backward” or “traditional” used in the context of alternative medicine.22 This is a theme that resonates throughout most of the chapters in this book, which explore the continued presence of religious beliefs, folk culture, myths, and home remedies amidst the biomedical era of vaccinations and germ theory. Akehurst (Chapter 2) challenges the binary of

Introduction  5 mythos and logos through examinations of British satirical cartoons of cholera which “fused scientific and rational modes of representation with traditional myths and figures,” such as Aesop’s Golden Goose and Old Father Thames. Berkowitz (Chapter 3) analyzes the Japanese woodblock print, Defeating Cholera, by Kimura Takejiro (1886; Figure 3.1), in which the disease is anthropomorphized in the tradition of Buddhist and Shinto folklore as a fierce animal demon (yōkai), in this case a tanuki (tiger-wolf), who is being battled by an army weaponized with carbolic acid, a Western medical treatment for infection. Additionally, according to the inscription, the army was issued with the native prophylactic of dried plums for consumption. Berkowitz concludes that “these multiple pathways” to combating cholera “reflect the palpable tension, anxiety, and, ultimately, co-existence between them.” Religion and science also continued to flourish in colonial India, as discussed by David Arnold (Chapter 7). Photographs record vaccinations with anti-plague serums, cremations, and microscopic views of the plague bacillus, while imagery and belief in Hindu disease goddesses who could cause and cure illness continued. These, as Arnold reports, were the subject of ethnographic photographs at the turn of the twentieth century and street art during the recent COVID-19 pandemic. In some instances, opposition arose between the secular and sacred, as in late eighteenth-century Tunisia, where the Bey of Tunis (Hammūda Bey) implemented quarantine measures at the port of La Goulette that ran afoul of the mufti (Muslim legal experts) and scholars who sided with religious authorities. As explained by Edna Bonhomme (Chapter 10), Western practices to control the plague did not correspond with the Sunni tradition of Islamic law. Complex and conflicting relations between faith and science in the treatment of illness are the central topic of Barbara Larson’s chapter (Chapter 4) that examines paintings by Henry Jules Jean Geoffroy during the fin-de-siècle. Some of these visualize the medical policies regarding prevention and disease management promoted by the anti-clerical Third Republic government in France that embraced the discoveries of Louis Pasteur; others are images of Catholic nurse-nuns caring for sick children in settings that are religious, such as the medieval Hospices de Beaune in Burgundy (Figure 4.5), built shortly after the Black Death, or mothers at home using popular remedies like castor oil. These were painted at a time when the government was trying to establish nursing as a lay profession. Larson’s chapter confirms Waddington’s conviction that “provisions of medical services from the medieval to the modern period” evidence the greatest continuity of religious presence across centuries.23 Larson concludes that Geoffrey’s pictures “follow a populist attachment to Catholicism and healing” that demonstrates the “conflicted response by France’s working class to a revolution in bacteriology at the center of the state’s late nineteenthcentury attempt to combat contagion.” Because the past history of social and medical responses to epidemics has informed subsequent experiences, this book includes a preliminary chapter by Andrew Hopkins (Chapter 1) on the bubonic plague in early modern Venice where science and faith both thrived and important prototypes originated. Authorities in that city established in the mid-fifteenth century the first island lazarettos as a system of quarantine in reaction to miasma theories of disease, while the earliest theory of contagion was published by the physician Girolamo Fracastoro in 1546. The Venetian government also created one of the first institutions of public health, the Health Office in Venice, which was granted extensive power over civil liberties through regulations that sometimes conflicted with religious authorities. As Hopkins discusses, these included the crowded ritual processions to “demonstrate repentance for ignoring God’s repeated signs of wrath.” While

6  Marsha Morton pioneering scientific and secular policies were implemented, Christian religious belief predicated on providentialism dictated the cause of the plague (sinful behavior) and the cure – the construction of votive churches and painted altarpieces depicting plague saints (especially Sebastian and Roche) and the Madonna, to whom viewers could appeal for heavenly intercession. By the seventeenth century, these pictures included not only supernatural deities but the reality of diseased corpses, undertakers, and boarded-up houses (Figure 1.4). As with later outbreaks, poor people were most adversely affected, the rich fled the cities, and scapegoats were blamed including Jews and women deemed to be witches. Not surprisingly, the personified symbol of the plague in Cesare Ripa’s influential Iconologia (1593; illustrated edition 1603) was an emaciated old woman, thus fusing misogyny and ageism.24 According to the authors Suzanne Hatty and James Hatty, the sexualized bodies of women and homosexual men were especially vilified as sources of pollution and targeted for social control during sixteenth-century epidemics.25 Gender has been figured prominently in images of disease, with the illustrations in this book leaving the impression that illness is largely a matter of women and children, while men do the fighting (as in Figures 3.1 and 6.1). From the print Blue Stage of Spasmodic Cholera (1831; Figure 2.1) to photos of female patients in an influenza ward in Oakland California (1918; Figure 8.5), women assume the prone position of the sick and dead, underscoring Charles Rosenberg’s comment that those perceived to be frail, as well as the poor and immoral, are among the most constitutionally at risk.26 However, while women in the early nineteenth century lacked agency and were pictured as passive victims, as Akehurst discusses (Chapter 2), by the end of the century their portrayal as mothers elevated them to civic guardians responsible for the health of the nation. Paintings such as Ejnar Nielsen’s The Sick Girl, 1896 (Figure 5.3), Edvard Munch’s The Sick Child, 1885 (Figure 5.5) and Spring, 1889 (Figure 5.4), Geoffroy’s Return to Life, 1909 (Figure 4.6), The Crib, 1897 (Figure 4.3), and At the Hospital of Notre-Dame du Perpétuel Bon Secours, 1913 (Figure 4.4), and the bedroom scene in Hikmet Hamdi’s The Atlas, 1926 (Figure 11.6) depict the intimate private spaces, largely domestic, of loving care between mother (or nurse) and child patient. Amidst shadowy darkness or luminous brightness, these works immerse the viewer in the liminal moments of life and death, visualizing the emotional reality of disease and the painful truth, observed by Virginia Wolfe, that “It is only the recumbent who know what, after all, Nature is at no pains to conceal – that she in the end will conquer.”27 The ravages of that conquest are permanently recorded in the paintings of Munch and Nielsen which picture the despair so memorably evoked in Maggie O’Farrell’s Hamnet: A Novel of the Plague (2020) about the death of William Shakespeare’s son. While most of the cases depicted here were tuberculosis, which especially impacted the young and/or female, nonetheless overall childhood mortality statistics were grim. According to Myron Echenberg, who references urban centers internationally, turn-of-the-century epidemiological data revealed that 10 of every 100 children never lived to celebrate their first birthday; 33 did not live to adulthood; and the overall average life expectancy was less than 50 years. Infectious disease accounted for threequarters of all death, with tuberculosis the greatest killer.28 With this in mind it is not surprising that mothers were targeted as responsible for the survival of the state, especially in fledgling governments such as the Third Republic in France (Chapter 4) and the Republic of Turkey under the Kemalist regime (Chapter 11),

Introduction  7 or in nations under stress like the United States during World War I (Chapter 8). This context inserted a social dimension within private relationships and placed the onus of blame on female caregivers in patriarchal societies. Berberoğlu and Değirmencioğlu (Chapter 11) observe that “The child was regarded as the public subject of a national cause, and the person who was primarily responsible for the health and well-being of the child was defined as the mother,” though they also note that Hamdi’s Health Museum Atlas balanced this burden in his narrative scenes of tuberculosis by blaming the father for thoughtlessly tracking germs into the home. In the panels displayed at the Ankara Hygiene Exhibition (1935), infected children were still identified as the worst possible outcome. A similar viewpoint was underscored poignantly in photographs of masked nurses holding influenza-stricken babies in a San Francisco children’s hospital (Figure 8.3). The loss of young girls was especially concerning since, as Kerstina Mortenson remarks (Chapter 5), they represent “future motherhood.” So too, Larson (Chapter 4) concludes that in Geoffrey’s paintings “girls tend to be foregrounded over boys in scenes concerning hygiene and illness in what dovetails with the popularized idea that dutiful and compliant girls will become the primary caretakers of the nation.” Many of the images studied in this book are part of the visual culture of public health, a concept grounded in the relationship between the individual and the state whose origins are intertwined with pandemics, as Foucault observed.29 While the first health bureaus were formed in sixteenth-century Italy, as previously mentioned, the earliest forms of printed material advocating health practices were seventeenth-century broadsides in London, according to Serlin in his book on public health imaging.30 European governments focused more aggressively on public medicine after 1750 when key foundational notions developed (underpinned by an understanding of the economic value of a healthy workforce) such as personal responsibility for health care and the rise of a public social sphere theorized by Jürgen Habermas and discussed by Akehurst (Chapter 2).31 Akehurst also argues that the British satirical prints of this era which critiqued epidemic management and doctors were “in part constitutive of the subsequently emerging notion of public health.” So too, historians Roger Cooter and Claudia Stein locate precedents in cartoons in nineteenth-century magazines and in William Hogarth’s earlier engravings, particularly Gin Lane and Beer Street advocating the Sale of Spirits Act 1751 (24 Geo. II. c 40) that restricted gin sales because of its deleterious effects.32 It was not until later in the nineteenth century that a visual culture of public health was fully formed, following the rise of more inexpensive printing techniques and the first illustrated newspapers. According to Serlin, it “found its most potent manifestation in the late nineteenth century” amidst concerns about overcrowded cities and colonial outposts, simultaneous with, as Waddington notes, “an emphasis…placed on promoting health as a national and moral duty.”33 These facts are exemplified in Larson’s chapter (Chapter 4) discussing the period when French authorities, deeply concerned about a perceived degeneration of the nation especially after a massive smallpox outbreak during the Franco-Prussian War of 1870, promoted visual culture advocating practices of hygiene and disease prevention coupled with health inspectors to ensure implementation. Geoffroy illustrated books on the subject of sanitation and children and completed five commissioned paintings for the Paris Universal Exposition of 1900. Images related to public health messaging are touched upon in many chapters in this book, including the films studied by Ledin (Chapter 9) which invoke a sense of social crisis and advocate hygienic preventive measures (antiretroviral medications) and behavior as part of the “end AIDS” campaign.

8  Marsha Morton Public health, however, is central to three chapters in particular, each of which is concerned with a different pandemic: Arnold’s analysis of plague photography in turnof-the century India (Chapter 7), Iarocci’s evaluation of photojournalism about influenza in the United States in 1918 (Chapter 8), and Berberoğlu and Değirmencioğlu’s study of tuberculosis representations in Republican Turkey during the 1920s and 1930s (Chapter 11). Each chapter deals with public health publications that foreground visual imagery in relation to the text as a pedagogical tool of knowledge about disease etiology, transmission, and treatment together with advocacy of personal practices of hygiene. Compliance is presented as a patriotic duty. Inevitably, medical authority is championed to reassure viewers through pictures of doctors (white males), nurses, labs, and microscopes which are now the new “biomedical God.”34 As Berberoğlu and Değirmencioğlu explain, images of microscopes and x-rays carried the message that “nothing could be hidden from the medical gaze.” Implicit in these publications is the belief in the persuasive power of visual media, as well as its ability to reach uneducated members of the population. Published newspaper photographs, Iarocci concludes, helped to “shape the behavior and environment of the public by serving as a scientific exhibition in explanations of current knowledge about the pathology and geography of the disease.” Arnold discusses a lecture on plague causes and prevention by the bacteriologist W.  Glen Liston from the Indian Medical Service delivered to the Bombay Sanitary Association in 1907. This received widespread circulation when it was published in 1908 by The Times of India with 25 photographs in a 28-page booklet. This publication, as Arnold explains, reflected a change in the public picturing of contagion which now aimed to disseminate practical scientific knowledge and to allay fears. Photos of diseased natives were replaced by images of medical practices such as inoculations and microscope slides, together with scenes of unsanitary urban neighborhoods conducive to the expanding rat population. These pictures of social and environmental conditions were meant to convince his readers that “the idea of contagion [was] an issue of public health, not just of medical science” and that personal “habits” could exacerbate or reduce disease. Through an analysis of Liston’s publication, Arnold substantiates his earlier claim that measures taken during the 1890s marked a transition from enclavism to public health care with the establishment of “the new tropical medicine based on germ theory.”35 The UkrainianFrench bacteriologist Waldemar Haffkine, as Arnold reminds us, developed plague and cholera vaccines aided by his work in India from 1893 to 1896. Following the Turkish War for Independence in 1923, the Republican government was invested in eliminating tuberculosis, which they regarded as an issue of national survival, through public education about sanitation and disease. The aim, according to Berberoğlu and Değirmencioğlu, was to establish a culture of preventive medicine. The authors consider how pictures played a central role in this initiative by examining two different strategies of visualization: the Health Museum Atlas (1926), created by the painter-doctor Hikmet Hamdi, the founding director of the Istanbul Health Museum, and the poster diagrams in the Ankara Hygiene Exhibition (1935), designed by Dr. Wilhelm Wadler (a German-Jewish émigré). The Atlas, an egalitarian venture described by Berberoğlu and Değirmencioğlu as a “portable museum,” delivered color reproductions of paintings in health museums to the public; 5,000 copies were published, and distribution extended to schools throughout the country. In the section on tuberculosis, Hamdi painted six sequential scenes with brief captions to convey a national lesson about contagion and sanitation through the drama of a private family tragedy caused by irresponsible public

Introduction  9 behavior and inattentive parents. The narrative begins with a sick man spitting on the sidewalk of an Istanbul street and ends with a bedridden son near death. By contrast, Wadler’s Ankara panels universalize disease and the physiological response to it in medical portrayals of generic bodies, microscopic pathogens, diagrams charting transmission, pictures of diseased organs, and doctors in labs. The minimalist modern design style reflects a Bauhaus aesthetic by a German physician appropriate to the “rationalist mindset” and scientific presentation of content encouraged by the Turkish government, as the authors note. It is also consistent with the transformation of public health poster design in the post-war period away from “narrative clutter” and realistically portrayed figures to greater simplification and abstraction.36 So too, the Ankara exhibition is clearly the product of an age that glorified doctors and laboratory research, as memorably evoked in Paul de Kruif’s best-selling book Microbe Hunters (1926).37 For the secular Kemalist regime, this exhibition and its visual sensibility culminated a rejection of Ottoman reluctance to implement epidemiological practices (quarantines were not established until the 1830s and 1840s) and the stereotype of Muslim fatalism that embraced martyrdom.38 Iarocci, in her study of photographs of influenza in American mass-circulation ­newspapers, delves beneath the surface to explore the psychology of epidemics, public responses, and the unintended revelation of social and emotional truths. The official agenda in the papers was to reassure readers during wartime and educate them about germ transmission (aerosolization) and safe preventive practices (public sanitation, masks, social distancing, handwashing, and avoiding spitting). But, Iarocci perceptively notices, the new reliance on images with minimal captions resulted in relinquishing control of the message by health authorities. “The capacity of photographs to tell the story without words, rather than just illustrate reporting,” she states, “also meant that they could speak more directly to the public in a revealing way.” The photos disclosed that beneath the positive visual rhetoric could be seen a “rising tide of fear and despair,” flu hospitals that were effectively places of incarceration, and racial prejudices against immigrants and laborers, especially the Chinese and African Americans, whose impoverished urban living conditions were indirectly blamed for the pandemic. People of color were victims “and by implication vectors” of the disease. Blaming other races for disease has been characteristic of pandemic explanations for centuries, enabling a strategy of control which establishes a boundary “between the self and the other.”39 Similar motivations have resulted in the construction of “outbreak narratives,” defined by Priscilla Wald as a formulaic plot in three parts that begins with the identification of the emerging infection, followed by the tracking of the global spread, and concludes with the epidemiological work that contains it. Such narratives, shaped by social, as well as medical, viewpoints and prejudices, have consequences that “promote or mitigate the stigmatizing of individuals, groups, populations, locales (regional or global) [and] behaviors.”40 As Herring and Swedlund have observed, this amounts to medical profiling.41 Repeatedly, this storyline has had a “westward progress” direction in which pandemics have originated in the East and Far East, regions deemed more backward and primitivizing.42 Since the mid-twentieth century, this has come to include African nations. During the long nineteenth century and earlier, contagion was bound up with colonialism, as numerous authors have discussed who also document European culpability by soldiers, explorers, and colonists in spreading diseases such as smallpox, cholera, influenza, and measles to indigenous populations.43 Infamously, typhus killed nearly two million people in the Mexican highlands in the late sixteenth century.44

10  Marsha Morton Our book includes several chapters discussing pandemics in countries other than Europe. These provide an assortment of perspectives that range from colonial experience (India) to nations with greater agency (Turkey, Japan, and Tunisia) whose actions complicate and refute Eurocentric and American stereotypes. The geographic beginning and end of the Western “outbreak narrative” plot is vividly encapsulated in the lithograph John Bull Catching the Cholera, c. 1832 (Figure 6.1) with the confrontation between a stalwart John Bull throttling a scrawny and panicked blue Indian anthropomorphized as cholera and outfitted with a skull and crossed bones turban. British dominance prevails though democratic progress in the form of the Reform Bill has been endangered, as discussed by Akehurst (Chapter 2). Sciampacone (Chapter 6) interprets this image as an instantiation of English attitudes toward the “Asiatic” or “Indian” cholera, citing an article in the medical journal The Lancet (November 1831). This chapter quotes from an account by the surgeon James Kennedy denouncing the swamps and slums of India as the source of contagion, accompanied by a foldout map tracking disease progress through the Empire “from the Gangetic Delta to the River Wear.” Cartography, as Arnold notes in Chapter 7, vividly visualizes “the idea of contagion as movement.” Just as Raza Kolb identified these written sources from the 1830s as initiating the “Orientalizing” racialization of disease leading to subsequent Muslim bias, so too Sciampacone traces a continuation with later attitudes about COVID-19 as the “China virus,” propagated in pictures that have the power to “generate fear and assign blame.”45 A line can be drawn between the blue Cholera figure in the lithograph and the later “icons of corporeal otherness,” such as the abject nude Indian body in a plague photograph of disinfection procedures from the 1890s (Figure 7.5). John Bull has been replaced by the more circumspect pith-helmeted British medical authorities. Arnold, however, chronicles a more nuanced interpretation of Indian plague photos where transformations in attitudes occur before and after the turn of the century. Initially, despite the invention of microscopes, colonial doctors sought disease etiology in climate and miasma, unsanitary urban environments captured by the camera, and native human behavior (“manners and customs”). Race, Arnold concludes, “played so prominent a role in the investigation and understanding of disease in nineteenth-century India that it inevitably informed any visual illustrations of it.” Photos from the 1890s, such as those in the Gatacre Album (1896–1897), still located the plague in the “empire’s non-white subjects,” and championed the efforts of British medical staff to aggressively contain it. As a sign of changing times amidst concern over recent riots, though, Indians were now shown as “members of plague committees, sanitary workers, and medical subordinates.” The final transition to imagery that eliminated the overt racialization of disease was evident in the Liston Album, discussed above, away from pictures of “stricken ‘native’ bodies” toward pedagogical instruction to mobilize Indian agency. Remarkably, Europeans were absent and, as Arnold observes, Indians were foregrounded, whether living in unsanitary poverty or presiding over medical procedures like inoculations. Bonhomme (Chapter 10) discusses the independent actions of the Tunisian government, still a country within the Ottoman Empire, during the 1780s which refute the stereotype of “epidemiological orientalism.” By adopting public health measures, including port city quarantines, practiced in Europe, the local Tunisian elites not only enhanced safety at home but also fostered mercantilism and “the assertion of their power over foreign merchants in a context of nascent Tunisian state formation.” In a reversal of Eurocentric practices and beliefs, it was now frequently the Western merchants placed in quarantine, while contagion was believed to come not only from the East (Egypt) but also

Introduction  11 the West (especially France, which had suffered a plague outbreak in Marseilles earlier in the century). Employing Foucault’s concept of biopower, Bonhomme examines how the Tunisian government wielded disease management, paid for by increased taxation, for the purposes of social, political, and economic control. In so doing, they increased their independence from Istanbul, whose Bey opposed quarantine measures. All of this repudiates not only the subaltern status of the country in relation to the Ottoman Empire but also Orientalist configurations of “Eastern” disease formulated at the time. In the late eighteenth-century Encyclopèdie edited by Denis Diderot and Jean le Rond d’Alembert, the entry on plague, written by Louis de Jaucourt, stated: “…for two thousand years all the plagues that have appeared in Europe have been transmitted through the communication of the Saracens, Arabs, Moors or Turks with us, and none of our plagues had any other source.”46 The case of Japan deviates even further from narratives of Asian guilt and Western virtue. Berkowitz (Chapter 3) presents an interpretation of the woodcut Defeating ­ Cholera (1886), mentioned earlier, in which the depiction of both supernatural folkloric elements (the tanuki animal) and modern medicine (carbolic acid) reflect a “critique of the political circumstances that led to cholera’s transmission in Japan in the first place.” Isolated from networks of empire and international trade for the first half of the nineteenth century, the Japanese were especially vulnerable to the cholera pathogen when US Commodore Matthew Perry’s ship arrived in Nagasaki in 1858 carrying infected sailors. The subsequent Meiji Restoration dedicated to modernizing the country in line with Western initiatives including public health practices and institutions led to conflicted attitudes about cholera, with the West as the source and potential cure of the contagion. This situation, according to Berkowitz, resulted in the inclusion in Defeating Cholera of both Western and indigenous medical treatments, which was a departure from the “single beings” (demons, gods, etc.) featured in earlier representations of smallpox and measles, but which still signaled Japanese identity and power through the Samurai-like soldiers who are spraying the formidable foe with acid. Bodies, Embodiment, and Contagion At the center of pandemic pictures is the body under duress: penetrated, contaminated, pricked, peered into in the wake of microscopy and anatomy, and reconstituted as monstrous through metaphoric embodiment. Fear of disease is experienced as the loss of belief in a physical self which is intact, bounded, and protected from outside infiltration. Sciampacone (Chapter 6), for example, referencing the research of fashion historian Karen Harvey, interprets the loose garments worn by the blue Indian cholera figure in John Bull Catching the Cholera (Figure 6.1) as evidence of a sick body without control of its fluid emissions. By contrast, John Bull’s tight-fitting breeches and white hose constitute a “command over one’s bowels” and therefore a “model of masculinity.” So too, later Victorian standards of hetero-normative masculinity were “predicated on the control of a ‘liquid pulpy’ sense of the undisciplined body and on the rigid control of desire.”47 Illnesses such as cholera and plague, as Sciampacone observes, render the body grotesque, a physical form characterized by “excrescences and orifices,” in the words of Mikhail Bakhtin, with unmanageable bodily functions.48 The inverse is essential to achieving a civilized society, as chronicled by sociologist Norbert Elias, and accounts for the fears of devolution and a return to a primitive state by Europeans afflicted with pandemic disease.49

12  Marsha Morton Issues of fluids and their interflow, discipline, and desire are also central to Ledin’s chapter on bodies with HIV/AIDS (Chapter 9), discussed through the lens of contagion and porosity. In an examination of two films, The Grass Is Always Grindr (Luke Davies, 2018–2019) and It’s a Sin (Russell T. Davies, 2021), Ledin defines contagion broadly, influenced by art historian João Florêncio’s theory of porous masculinities, as not only a matter of viruses in liquids but also morals, emotions, and even reconstructions of historical fact. This is also in keeping with Bashford and Hooker’s understanding of contagion as signifying “the dangers circulating in social bodies and in populations – actual viruses and bacteria, [and] ‘contagious’ morals and ideas.”50 Ledin, for example, discusses the character Joe as “a contagious body who overflows with emotions – and later, microorganisms, conflicting intentions, and personality flaws – which threaten to infect other people in his life.” Jill’s form of contagion is moral purification, “grounded in the instinct of cleanliness,” and symbolically enacted in the ritual scrubbing of the kitchen (Figure 9.2).51 In a compelling metaphor of It’s a Sin, Henry compares his illness to kitchen mold, which, Ledin notes, can be regarded as a form of porosity. Like Henry’s own fungal infection, both spread throughout the environment. Ledin’s principal argument is that the two films convey a past (through the mouthpiece of Ritchie in It’s a Sin) tainted by falsified alarmist recollections of the early years of AIDS. This “living contagion” is intended to infect the future with imposed conservative behavioral practices regarding sex that constrain desire in order to “end AIDs.” Worries about porosity and permeability also reflect fears of fusions with “…­people, animals, organic objects, inanimate objects – things with which humans do not know… they are connected.”52 This too relates contagion to the grotesque, predicated on a rupture of boundaries which bind together “the unexpected and disparate.”53 Such a prospect is hilariously illustrated in William Heath’s colored etching Monster Soup Commonly Called Thames Water (1828, Figure 2.5). The woman’s horror on viewing the magnified water drop through a microscope is surely based on her realization that past consumption has rendered her body a habitat for these aquatic creatures. As Akehurst notes (Chapter 2), they convey the “hidden dangers of water” through “open maws, bulbous eyes, and sharp extremities.” They also illustrate the practice of anthropomorphism, central to metaphors of disease. The development of microscopes, beginning in the seventeenth century, cellular microbiology, and anatomy studies (all discussed by Akehurst) had the effect of atomizing conceptions and presentations of the human body. By the late eighteenth century, as historian Barbara Stafford remarked, “the model of the body as an integral whole finally fell apart.”54 After the formulation of germ theory and cellular pathology in the later nineteenth century, disease was no longer located in the environment but in the body, which could be viewed through x-rays. The turn to the corporeal interior is reflected in several pandemic pictures in this book, including microscopic images of tubercular bacillus and photos of diseased lungs (Figures 11.7 and 11.8) and drawings of nasal passages in influenza patients (Figure 8.1). This direction would lead to contemporary abstract paintings of cellular structures, such as the sumptuous decorative patterns of pathogens by biologist David Goodsell, and to “bioart,” begun by Alexander Fleming in his discovery of penicillin, where pictures are made in laboratories using live tissues and bacteria as the medium. The renewed attention to anatomy, pathology, and dissection, beginning in the late eighteenth century in Paris and London, also gave new life to old metaphors of skeletons representing death and disease.55 Cholera and plague were especially visualized

Introduction  13 as crowned and/or weaponized “bone men”; examples in this book include a skyborne enthroned cholera king with an arrow (1849, Figure 6.4) and a regal skeleton pumping contaminated water for impoverished local families in London (1866, Figure 6.6). Among the most famous nineteenth-century graphic depictions of this genre are the wood engravings by the German artist Alfred Rethel: Death as a Strangler/Enemy (1851), inspired by Heinrich Heine’s vivid description of cholera death in Paris in 1832, and the print series Another Dance of Death (1849). His work encourages associations of death by cholera with death by political revolution. In France, representations of cholera, often figured as a skeleton, were even more closely associated with political upheaval since the pandemic arrived two years after the 1830 revolution.56 Robert Seymour’s Cholera Tramples the Victor & Vanquish’d (1832, Figure 6.3) mixes the martial and medical with cholera envisioned as a mysterious shrouded figure with massive skeletal feet and hands flying above an armed battle. Military metaphors are ubiquitous in illness, as is further evidenced by the imagery and information in this book (see Chapters 3, 6, 8, and 11), and famously disparaged by Susan Sontag because “the move from the demonization of illness to the attribution of fault to the patient is an inevitable one, no matter if patients are thought of as victims.”57 Significantly, these martial tropes developed with the study of cellular pathology and the subsequent concept of invasion. Louis Pasteur, according to physician Allan Bleakley, pioneered “biomilitarism” and described germ theory “with a language of invading armies laying siege to the body.”58 Kerstina Mortensen (Chapter 5) foregrounds the body through a novel interpretation of “embodied spaces of sickness” in her study of paintings of tubercular children and women by the Norwegian Symbolist Edvard Munch and the Danish artist Ejnar Nielsen. Mortensen, using Gaston Bachelard’s theorized “psychology of the house,” explores the house as “an anthropomorphic being.” The depicted sickroom is “an extension of bodily experience” through which we move and whose atmosphere is perceived and felt viscerally by the viewer’s physical self. Munch and Nielsen accomplish this stylistically through the construction of space, visible brush work, and paint color. In this, Mortensen’s analysis offers surprising affinities with Elizabeth El Rafaie’s discussion of metaphors of embodiment in graphic illness narratives. She proposed a broader definition of metaphor that is “based on parallels between our sensorimotor experiences and the more intangible areas of our lives” (i.e., ideas and feelings) through “spatial” and “stylistic” visual metaphors (color, light, line, and the “visible traces of the means of production”) in addition to the conventional metaphors based on concrete objects.59 Munch, in paintings such as Sick Child, 1885 (Figure 5.5), applies pigment in a fractured, abstracted manner, signifying, according to Mortensen, “sickness and visual disturbance” as well as decay. Illness is also embodied in the painted surface of Nielsen’s The Sick Girl, 1896 (Figure 5.3), where she fades “into dematerialization.” Munch’s “pallid and pale colors” were described as tubercular by Austrian writer Hermann Bahr, though this comment seems even more pertinent to the palette of Nielsen. The sickroom in Munch’s Death Struggle, 1915 (Figure  5.2) and the mourning figures are on the verge of dissolution into shadows, like the vanished body on the bed, with the “distortions of color and form” serving as a “metaphor for the transition between life and death.” The absence of windows in all of these paintings except for Spring, 1885, coupled with the compressed spaces, which are strikingly vacant in works like Nielsen’s In His Eyes I Saw Death, 1897 (Figure 5.1), evokes an atmosphere of “finality, futility, and the irrevocable.” This book presents a range of diverse images that, though hardly exhaustive, reveal the extensive possibilities for art’s engagement with epidemics, whether visualizing emotional

14  Marsha Morton despair and fear, public health prevention messaging, class and race bias, or the scientific imaging of pathogens, anatomy, or etiologies. These chapters explore the universal concerns that surface during pandemics throughout history, as well as providing further verification that social responses to disease are inevitably “thought through culture.”60 At the same time, authors in this book also identify the unique specifics of time and place in terms of social anxieties, political and economic circumstances, and local cultural and health traditions that impact the framing of illness representations. The chapters examine artistic techniques of realistic representation and metaphoric imagery, while also speculating on motivations, often psychological, for the need to visualize epidemics as a way to bear witness, commemorate through remembrance, or influence behavior. The COVID-19 pandemic, as well as epidemics in the late twentieth century, confirms that their general absence in the West during the middle years of the last century was an aberration. Visual and literary testimonies are therefore essential to contribute to an ongoing genealogy that includes the narratives and experiences of each generation. Acknowledgment I would like to thank several readers for helpful comments. These include Ann-Marie Akehurst and members of the Body Study Workshop: Alice Weinreb, Corinna Treitel, Kathryn Carney, Katherine Sorrels, Heikki Lempa, and Kristen Ehrenberger. Notes 1 The series was titled “Spaces of Sickness and Well-Being: Art, Architecture, and Epidemics.” In this book, the terms epidemic and pandemic appear interchangeably, although pandemic, a word rarely used until the late nineteenth century, specifically indicates the global spread of epidemic disease. It originally referenced only plague. Christos Lynteris, ed., Plague Image and Imagination from Medieval to Modern Time (Basingstoke: Palgrave Macmillan, 2021), 5. 2 Sander L. Gilman, Health and Illness: Images of Difference (London: Reaktion Books, 1995), 9. 3 Roy Porter, Bodies Politic: Disease, Death and Doctors in Britain, 1650-1900 (Ithaca, NY: ­Cornell University Press, 2001), 9. Most of this book concentrates on graphic satire. 4 These include, among others, Millard Meiss, Painting in Florence and Siena after the Black Death (Princeton, NJ: Princeton University Press, 1951); Christine M. Boeckl, Images of Plague and Pestilence: Iconography and Iconology (University Park, PA: Pennsylvania State University Press, 2001); Hope and Healing. Painting in Italy in a Time of Plague 1500–1800, Gauvin Alexander Bailey, Palema M. Jones, Franco Mormando and Thomas W. Worcester, eds. (Worcester Art Museum and the University of Chicago Press, 2005); Franco Morando and Thomas Worcester, eds., Piety and Plague: From Byzantium to the Baroque (Kirksville, MO: Truman State University Press, 2007); Samuel K. Cohn Jr., The Cult of Remembrance and the Black Death: Six Renaissance Cities (Baltimore, MD and London: Johns Hopkins University Press, 1997); Sheila Barker, “Poussin, Plague, and Early Modern Medicine,” The Art Bulletin 86, no. 4, December 2004, 659–689; Alexandra Woolley, “Nicolas Poussin’s Allegories of Charity in The Plague at Ashdod and The Gathering of Manna and Their Influence on Late Seventeenth-Century French Art,” in Medieval and Renaissance Lactations. Images, Rhetorics, Practices, Jutta Gisela Sperling, ed. (London: Routledge, 2013), 165–186; Rinaldo Fernando Canalis and Massimo Ciavolella, eds., Disease and Disability in Mediaeval and Early Modern Art and Literature (Turnhout: Brepols, 2021); and various essays by Louise Marshall, including “Affected Bodies and Bodily Affect: Visualizing Emotion in Renaissance Plague Paintings,” in Performing Emotions in Early Modern Europe, Philippa C. Maddern, Joanne McEwan, Anne M. Scott, eds. (Turnhout, Belgium: Brepols, 2018), 73–103, and “Epidemics and Religion: From Angry Gods and Offended Ancestors to Hungry Ghosts and Hostile Demons,” Socio-Historical Examination of Religion and Ministry 3, no. 1, Summer 2021, 97–117.

Introduction  15 Plague Image and Imagination from Medieval to Modern Times, Christos Lynteris, ed. is a unique contribution. Authored by historians and anthropologists, it is “not a collection of visual analyses of plague,” but a larger examination of the “plague concept,” whether in text or image, that has impacted on the experience of the disease (1–2). Lynteris recently supervised an extensive research project of pandemic photographs of the third plague (1855–1959), whose findings contributed to his book Visual Plague: The Emergence of Epidemic Photography (Cambridge, MA: MIT Press, October 2022). 5 In Sickness and in Health, Laurinda Dixon and Gabriel P. Weisberg, eds. (Newark, NJ: University of Delaware Press, 2004) and Imagining Illness, David Serlin, ed. (Minneapolis: University of Minnesota Press, 2010). Additionally, the essay, “Black Death, Plagues and the Danse Macabre: Depictions of Epidemics in Art,” by Luisa Rittershaus and Kathrin Eschenberg, published in Historical Social Research, no. 33, 2021, 330–341, concentrates on prints from the nineteenth century (primarily Alfred Rethel and James Ensor) taken from the graphic collection Mensch und Tod (Humans and Death) at the Heinrich Heine University, Düsseldorf. Michael Lobel discusses art and the 1918 influenza – John Singer Sargent and Edvard Munch – in “Close Contact,” Artforum, 21 April 2020; https://www.artforum.com/ slant/michael-lobel-on-art-and-the-1918-flu-pandemic-82772. 6 Among others, see especially Graphic Medicine Manifesto, M. K. Czerwiec, et al., eds. (University Park, PA: Pennsylvania State University, 2015), Elizabeth El Rafaie, Visual Metaphor and Embodiment in Graphic Illness Narratives (Oxford: Oxford University Press, 2019), and Meredith Li-Vollmer, Graphic Public Health: A Comics Anthology and Road Map (University Park, PA: Pennsylvania State University Park, 2021). 7 Examples include the interdisciplinary digital project, “Visualizing the Virus” (July 2021), organized by Sria Chatterjee, who contributed the essay “Making the Invisible Visible: How We Depict Covid-19-19).” Also, the Science Gallery Bengaluru’s first digital exhibition-season was CONTAGION, from 30 April 2021 to 31 December 2021. Partly done in collaboration with the Getty, it hosted sixteen interactive exhibits and connected lectures, tutorials, workshops and masterclasses, events, and films. The turn to digital publication during the recent pandemic also led to online curated exhibitions, such as “The Empire’s Physician: Prosperity, Plague, and Healing in Ancient Rome,” curated by Rachel Herschmann for the Institute for the Study of the Ancient World (New York University) in October 2020. For research on COVID-19 and the art of graphic medicine, see Sweetha Saji, Sathyaraj Venkatesan, and Brian Callender, “Comics in the Time of a Pan(dem)ic: Covid-19, Graphic Medicine, and Metaphors,” Perspectives in Biology and Medicine 64, no. 1, Winter 2021, 136–154. 8 These categories were used to organize the material in Sandra Hempel, The Atlas of Disease (London: White Lion Publishing, 2018). 9 Sander L. Gilmann, Disease and Representation: Images of Illness from Madness to AIDS (Ithaca, NY: Cornell University Press, 1988), 2. 10 Keir Waddington, An Introduction to the Social History of Medicine: Europe Since 1500 (London: Palgrave Macmillan, 2011), 32–33. 11 Chatterjee, “Making the Invisible Visible,” 1. https://eprints.lse.ac.uk/105388/1/Chatterjee_ LSE_Covid_19_making_the_invisible_visible_published.pdf 12 D. Ann Herring and Alan C. Swedlund, “Plagues and Epidemics in Anthropological Perspective,” in Plagues and Epidemics: Infected Spaces Past and Present, Herring and Swedlund, eds. (Oxford and New York, NY: Berg, 2010), 4. 13 Jason Farago, “War’s Enormity beyond Words,” The New York Times, 31 July 2022, 10, 11. This article was occasioned by the war in Ukraine. 14 J. N. Hays, The Burdens of Disease: Epidemics and Human Response in Western History (New Brunswick, NJ: Rutgers University Press, 1998), 1. A second edition was published in 2009. 15 Epidemics and Ideas: Essays on the Historical Perception of Pestilence, Paul Slack and Terence Ranger, eds. (Cambridge University Press, 1992). This collection was first presented as papers at a Past and Present conference held in Exeter College, Oxford in September 1989. For Hays, see The Burdens of Disease, 1998. Hays includes topics of poverty and power, imperialism, and the continuation of folk medicine, as well as the discoveries of modern science. 16 Waddington, An Introduction to the Social History of Medicine, 2011, and “Problems of Progress: Modernity and Writing the Social History of Medicine,” The Social History of

16  Marsha Morton Medicine 34, no. 4, November 2021, 1053–1067; The Oxford Handbook of the History of Medicine, Mark Jackson, ed. (Oxford University Press, 2011). 17 Margaret Pelling, “The Meaning of Contagion: Reproduction, Medicine and Metaphor,” in Contagion: Historical and Cultural Studies, Alison Bashford and Claire Hooker, eds. (Milton Park, Abington, Oxfordshire: Routledge, 2001), 20. 18 Anjuli Fatima Raza Kolb, Epidemic Empire: Colonialism, Contagion, and Terror 1817–2020 (Chicago, IL: University of Chicago Press, 2021), 74. Raza Kolb’s comments on “Asiatic cholera” were made within the context of her thesis about the nineteenth-century origins of the conflation of the Muslim insurgent and epidemic disease. 19 The fusion of pity and fear in relation to the economically disadvantaged has roots in the Renaissance. See Brian Pullan, “Plague and Perceptions of the Poor in Early Modern Italy” in Slack and Ranger, Epidemics and Ideas, 101–123. 20 Raza Kolb, Epidemic Empire, 22. 21 Serlin, Imagining Illness, xxv. 22 Waddington, “Problems of Progress,” 12. 23 Waddington, An Introduction to the Social History of Medicine, 51. He also observed that the church especially retained a vital role in health care in France (52). 24 Boeckl, Images of Plague and Pestilence, xi. This reference is taken from her quotations from Jacqueline Brossollet’s “Pioneering Plague Scholarship.” 25 Suzanne E. Hatty and James Hatty, The Disordered Body: Epidemic Disease and Cultural Transformation (Albany, NY: SUNY Press, 1999), 27 and 125. 26 Charles Rosenberg, “Explaining Epidemics,” in Explaining Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge University Press, 1992), 297. Waddington also states that “The idea that women were generally more often ill than men was repeatedly asserted from the seventeenth century onwards. Their biology (reproductive) was associated with weakness, debility and sickness to create a stereotype of the delicate female…” (An Introduction to the Social History of Medicine, 36). 27 Virginia Woolf, On Being Ill (Ashfield, MA: Paris Press, 2012; first published with Hogarth Press, 1930), 16. 28 Myron Echenberg, Plague Ports: The Global Urban Impact of Bubonic Plague, 1894–1901 (New York: New York University Press, 2010), 3. 29 Priscilla Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative (Durham, NC: Duke University Press, 2008), 18. Epidemics, obviously, necessitated the most compelling need for “regimented” and controlled behavior. 30 Serlin, Imagining Illness: Public Health and Visual Culture, xix. 31 For a discussion of self-reform in health maintenance see E. C. Spray, “Health and Medicine in the Enlightenment,” in The Oxford Handbook of the History of Medicine, Jackson ed., 86–87. Spray relates this to patient agency in managing sickness and the rise of the medical marketplace. 32 Roger Cooter and Claudia Stein, “Visual Imagery and Epidemics in the Twentieth-Century,” in Serlin, Imagining Illness: Public Health and Visual Culture, 174. 33 Serlin, Imagining Illness: Public Health and Visual Culture, xx–xxi, and Waddington, An Introduction to the Social History of Medicine, 34. 34 Cooter and Stein, “Visual Imagery and Epidemics in the Twentieth-Century,” 180. 35 Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press, 1993), 13. 36 Cooter and Stein, “Visual Imagery and Epidemics in the Twentieth-Century,” 175–178. According to these authors, this visual turn to simplification began earlier with exhibition design by Karl Lingner, the organizer of the 1911 Dresden International Hygiene Exhibition. 37 The title was additionally stained with colonial associations of big-game hunting. Pratik Chakrabarti mentions microbiologist Robert Koch’s work in Africa, where he also hunted game, and concludes: “Both wild animals and pathogens were seen as part of Africa’s repulsive and dangerous wilderness and needed to be eliminated.” Chakrabarti, Medicine and Empire 1600–1960 (London: Palgrave Macmillan, 2014), 171. 38 For further discussion see Slack, “Introduction,” in Epidemics and Ideas: Essays on the Historical Perception of Pestilence, 17 and Nükhet Varlik, “‘Oriental Plague’ or Epidemiological Orientalism? Revisiting the Plague Episteme of the Early Modern Mediterranean,” in Plague

Introduction  17 and Contagion in the Islamic Mediterranean (Kalamazoo, MI: Arc Humanities Press, 2017), 82–83. 39 Dorothy Nelkin and Sander L. Gilman, “Placing Blame for Devastating Disease,” Social Research: An International Quarterly 87, no. 2, Summer 2020, 337. The authors note that, in addition to particular racial and social groups, categories of blame include individual lifestyles, immoral behavior, and people in positions of power and control. 40 Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative, 2–3. 41 Herring and Swedlund, Plagues and Epidemics: Infected Spaces Past and Present, 1. 42 Raza Kolb, Epidemic Empire, 65. 43 For an examination of the impact of global disease from a medical perspective, see Michael B. A. Oldstone, Viruses, Plagues, & History: Past, Present, and Future (Oxford: Oxford University Press, 2020). Raza Kolb, Epidemic Empire, and Varlik, Plague and Contagion in the Islamic Mediterranean, investigate the association of plague with Muslims, the Ottoman Empire, and Islamic terrorism; studies of colonialism, medicine, and disease include, among many others, Imperial Medicine and Indigenous Societies, David Arnold, ed. (Manchester: Manchester University Press, 1998 and 2021) and Chakrabarti, Medicine and Empire 1600– 1960; other publications include Robert Peckham, ed., Empires of Panic (Hong Kong: Hong Kong University Press, 2015), which focuses primarily on British colonies, and Sheldon Watts, Epidemics and History: Disease, Power and Imperialism (New Haven, CT: Yale University Press, 1999). Contagion is situated within colonial discourse and biomedicine by Bashford and Hooker in Contagion: Historical and Cultural Studies. Recently, authors have sought to retrieve narrative voices previously excluded or stigmatized. Jim Downs, in Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine (Cambridge, MA: Harvard University Press, 2021), “reclaims” marginalized forgotten people (enslaved Africans, Muslim pilgrims, laundresses, soldiers) whose experiences were used but not cited by epidemiologists to advance the discipline. Social anthropologists Melissa Leach and Sarah Dry have edited the anthology Epidemics: Science, Governance and Social Justice (Abingdon and New York, NY: Routledge, 2010), in which they foreground the perspectives of neglected populations suffering from disease (mostly in developing countries in the later twentieth century) whose “alternative stories” counter the dominant “outbreak narrative” of Western science. 44 Kenneth F. Kiple, “The History of Disease,” in The Cambridge Illustrated History of Medicine, 32. 45 Raza Kolb, Epidemic Empire, 63–66. 46 Quoted and translated in Varlik, Plague and Contagion in the Islamic Mediterranean, 63. 47 Pamela K. Gilbert, Cholera and Nation: Doctoring the Social Body in Victorian England (Albany: State University of New York Press, 2008), 122. 48 Mikhail Bakhtin’s comments were contained in his study of the carnivalesque and grotesque in Rabelais and His World (written in 1940 and published in 1965). They are quoted in Frances S. Connelly, The Grotesque in Western Art and Culture: The Image at Play (Cambridge: Cambridge University Press, 2014), 84–85. 49 Norbert Elias, The Civilizing Process: The History of Manners and State Formation and Civilization, translated by Edmund Jephcott (Oxford: Oxford University Press, 1994). The book was originally published in two volumes in 1939. 50 Bashford and Hooker, Contagion: Historical and Cultural Studies, 10. 51 The term “moral contagion” has medical origins. It was coined in 1773 by the French physician Philippe Hecquet to describe collective religious hysteria. See Christopher E. Forth, “Moral Contagion and the Will: The Crisis of Masculinity in Fin-de-siècle France,” in Bashford and Hooker, ed., Contagion: Historical and Cultural Studies, 62. 52 Bashford and Hooker, Contagion: Historical and Cultural Studies, 4. 53 Connelly, The Grotesque in Western Art and Culture, 10. 54 Barbara Maria Stafford, Body Criticism: Imaging the Unseen in Enlightenment Art and Medicine (Cambridge, MA: The MIT Press, 1991), 241. 55 For general accounts of this trend in pathology and anatomy see Waddington, An Introduction to the Social History of Medicine: Europe since 1500, 98–119 and Frank M. Snowden, Epidemics and Society: From the Black Death to the Present (New Haven, CT: Yale University Press, 2020), 168–183.

18  Marsha Morton 56 Gabriel Weisberg, “Cholera as Plague and Pestilence in Nineteenth-Century Art,” in In Sickness and in Health, 2004, 82–100. This focuses almost exclusively on French art. 57 Susan Sontag, “AIDS and Its Metaphors” (1988) in Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York, NY: Picador, 2001), 99. 58 Allan Bleakley, Thinking with Metaphors in Medicine: The State of the Art (Abingdon: Routledge, 2017), 61. The social, political, and cultural ramifications of cell theory are the subject of Laura Otis, Membranes: Metaphors of Invasion in Nineteenth-Century Literature, Science, and Politics (Baltimore, MD: Johns Hopkins University Press, 1999). 59 El Rafaie, Visual Metaphor and Embodiment in Graphic Illness Narratives, 2, 7, and 16. 60 Bashford and Hooker, “Introduction,” Contagion: Historical and Cultural Studies, 3.

Part I

Treating and Experiencing Disease Medicine, Religion, and Myth

1 The Inception of “Science and Supplication” Architectural Programs, Devotional Paintings, and Votive Processions in Early Modern Venice Andrew Hopkins Introduction Outbreaks of plague (Yersinia pestis) occurred regularly in Early Modern Venice, a city whose stagnant waterways came to symbolize the paradox of lurking threats of contagion in developed cultural meccas for centuries to come, as exemplified by Thomas Mann’s Death in Venice (1912). Yet the Venetian Republic was the first official entity on the European continent to establish island-based isolation hospitals to address plagues and to create “plague maps” of advancing disease as well as to establish port quarantines. In addition to traditional recourse to supplication for heavenly intercession, expressed by way of numerous votive processions through the urban fabric of the city, many devotional paintings were commissioned to record these events. However, looking beyond rituals of public devotion and ducal-led processions to terminate plagues, the maritime Republic of Serenissima, inclusive of Venice, precociously adopted techniques of distribution and enclosure on the monastic model as a practical measure to combat contagion, pioneering the development of island lazarettos to isolate the sick and quarantine the suspect in effective, albeit coercive, architecture sited away from public view. This technique of isolation responded to the classical theory of plague generation from ancient Greece, then still current, of the circulation of “corrupt air” or the “miasma theory of disease.” Isolation, a practice initiated in the early fifteenth century, proved to be effective, and the authorities soon devised a more systematic approach made possible through the creation, by government decree of 18 July 1468, of the Lazzaretto Nuovo on an island vineyard five miles from the city, adjacent to the island of S. Erasmo. The more elaborate arrangement here separated the sick not only from each other but also from the convalescent and from those merely suspected of being infected. Venice in the medieval period had become an economic powerhouse through maritime trade and its Arsenal earned its celebrated reputation by being able to build one entire ship each day. The hierarchical structure of government was highly sophisticated with a series of Magistries, including one for health that pioneered the creation of the lazarettos.1 These were, effectively, the first public boards of health. Over the centuries, major outbreaks of contagious illness, such as those of 1576– 1577 and 1630–1631, prompted significant government commissions of the votive churches of Il Redentore by Andrea Palladio (1508–1580) and Santa Maria della Salute by Baldassare Longhena (1597–1682), both of which involved architectural programs, devotional paintings, and votive processions framed as supplication for heavenly intercession.2 The church of Santa Maria della Salute, begun in 1631, was the last great architectural monument of the Republic; it was also the last significant votive procession DOI: 10.4324/9781003294979-3

22  Andrew Hopkins

Figure 1.1 Titian, Saint Mark Enthroned, c. 1510, oil on canvas, 230 × 149 cm, Sacristy, Santa Maria della Salute, Venice.

The Inception of “Science and Supplication”  23 (the andate ducali) to be added to the series which the head of government and his ­highest-ranking ­councilors, the doge and signoria, performed annually. In 1659, the Saint Mark Enthroned ­altarpiece, painted by Titian in 1509, another plague year, was ceremonially installed in the rotunda of the Salute. Dedicated to the patron saint of Venice, St. Mark the Evangelist, it depicts physicians Cosmas and Damian gesturing to the open sore that Roch (a plague saint) fi ­ ngers as he looks to them for help (Figure 1.1). St. Sebastian, another important intercessional saint whose trademark arrows are a symbol of the possibility of surviving massive injuries, became increasingly associated with the plague, and here he turns away from the others, his eyes wistfully lowered, his somber visage contrasting with Titian’s bravura rendition of his nude torso and billowing drapery.3 Originally painted for the island church of Spirito Santo, Titian’s work was relocated in May 1659 to the new votive church then in the middle of construction and fast becoming the Serenissima’s Pantheon.4 This chapter traces the twin developments of science and supplication in Early Modern Venice in the context of contagion, together with the subsequent identification, on the world stage, of this lagoon city with the plague, immortalized in 1912 by Thomas Mann’s Death in Venice and Luchino Visconti’s lush and lavish film version in 1971.5 The Venetian government studiously and strategically had recourse to panem et circenses (“bread and circuses,” or a call to charity and demonstration of pageantry) with their highly visible public votive processions and monumental ecclesiastical commissions aimed at pacifying an angry God, yet authorities also assiduously studied the science, as it was then understood, creating Europe’s first lazzaretto. Not surprisingly, the most innovative literature regarding contagion, referred to below, was published in Venice by doctors from the Veneto, indicating clearly where the forefront of science and medical thinking was, especially in the sixteenth century. This double strategy of science and supplication led to the first serious spatial and medical management of contagion in Europe, as well as some of the greatest architectural achievements of the Serenissima and some of the earliest painted visualizations of pandemic disease, bequeathing a largely successful legacy to European medical strategies. Lazzaretti and Public Health In the fifteenth century the Venetian government extended its power over the unique topography of the city through the creation of island isolation hospitals with stretches of water separating them from the densely populated center.6 The first plague hospital was founded by Senate decree on 28 August 1423 on the small island of S. Maria di Nazareth, just off the Lido.7 The architecture of the lazaretto followed the traditional form of the convent in which it was housed. Dedicated specifically to poor people without fixed abode who were infected with the plague, this hospital with 20 rooms (later 80) enabled individual isolation so that the sick from various places such as the city, the lagoon islands, and incoming ships could be held separately.8 This lazaretto (later the Lazzaretto Vecchio) functioned as a center for quarantine and disinfection and it held in containment those who would otherwise have wandered through the city seeking charity, but also spreading contagion. This technique of isolation responded to the classical theory of plague generation, then still current, of the circulation of “corrupt air” or the “miasma theory” of disease.9 Isolation proved to be effective, and the authorities soon devised a more elaborate arrangement that separated the sick not only from each other but also from the convalescent and from those merely suspected of being infected. This systematic approach

24  Andrew Hopkins was made possible through the creation, by government decree of 18 July 1468, of the Lazzaretto Nuovo on an island vineyard five miles from the city, adjacent to the island of S. Erasmo.10 The Lazzaretto Nuovo was a rectangular cloister-like complex with a church in one corner and two floors containing a succession of wards with numerous entrances that facilitated a strict division between various arriving, convalescing, and suspect groups. In the Lazzaretto Nuovo, patients were held for 40 days’ convalescence; more ­coercively, i sospetti (those in the suspected category), including the families of the sick and those arriving by ship, were detained to ascertain if any latent sickness would manifest itself. A system of isolation wards was devised so that each group would ideally progress over 40 days to a clean bill of health or complete convalescence. By 1503, there were four quarantine wards in which inmates passed ten days each, thereby progressing through the spaces of the lazaretto in separate units, whether the crew of a ship or a group of families admitted together.11 On showing signs of sickness, however, a patient was removed and sent to the Lazaretto Vecchio and the others had to begin quarantine again.12 Each ward was responsible for burying any of its group who died, since the staff had little contact with patients, in accordance with the system devised following the establishment by Senate decree of 20 June 1485 of the Magistrato alla Sanita (Health Office) within the existing Magistrato al Sal (Salt Office). On 7 January 1486 three noblemen were elected as Provveditori (supervisors), initially a temporary and then a permanent office that began with a prior, two doctors, and three servants that grew to 27 staff members by 1541, including two priors with responsibility for the lazarettos.13 The staff included a nodaro (notary), scrivan (book-keeper), capitano (captain), and fanti (servants/infantry). The Provveditori alla Sanità, between 1498 and 1504, also issued other important decrees that recognized the danger of drinking bad water from wells and eating rotten food. The decrees prohibited the emptying of chamber pots from balconies and the discharge of household waste and sewage pipes directly onto the streets, described as “cosa oltra che la sii vergognosa et puvolente e etiam pericolosa de generar vari morbi” (being shameful and even dangerous for generating various mortal diseases). They also insisted on the importance of cleaning by scovadori or mundadori (trash collectors) of scovazze (rubbish) which was to be taken to scovazze (rubbish pits or dumps), although much ended up in the canals.14 These pits were hardly satisfactory as indicated by one Tomitano, …those places called gattoli in Venice. Because at times I have seen them become full of foulness, and stinking from rotting herbs and melon rinds and other putrid things, and I have been taken aback that the air does not change every year and generates pestiferous fevers.15 In Italian cities, unclean workers (the indigent) were designated to remove corpses from the city and infected goods were removed and burnt or looted.16 Though people feared being boarded up in their own homes, removal to a lazaretto was worse. We can contextualize the experience of sufferers and workers through later accounts of varied European examples from the fifteenth to nineteenth centuries. Many Italian cities required doctors to inspect people for plague symptoms. “Plague doctors”—young members of medical guilds who accepted retainers—diagnosed and performed autopsies.17 Responding to a variety of incentives they risked their lives, but over time their experience helped them evolve into specialists. Care was afforded by lay people, porters, and guards

The Inception of “Science and Supplication”  25 for surveillance who were often selected for their physical strength that was assumed to ­confer protection. Some laundry was performed but much clothing was burnt. Priests visited to celebrate Mass. In Milan’s late-fifteenth-century lazaretto—resembling a Carthusian monastery—288 individual cells flanked an octagonal chapel around a vast court segregated by running water for washing and sewerage.18 Comparable to Milan, in the nineteenth-century Spanish lazaretto on an island in Mahón, infected people (patente apestada) occupied individual cells.19 Infected people were admitted separately. Their quarters, dedicated to infected people, had a garden, a kitchen, and a well—it was separately accessed, overlooked by watchtowers, and food was thrown over paired seven-meter-high walls. Inmates witnessed the Mass held in a central tempietto, through grills. Staff were protected behind walls. The air in the interior of lazarettos might be fumigated with vinegar, plague preventives, and wood fires. It was horrific inside: populated with numerous sweating people who were often subject to fleas everywhere, and even occasionally some were subjected to rape.20 Saint Roch In concert with these official strategies of control were parallel efforts encouraging the establishment of popular charitable confraternities. Members of these organizations provided a largely urban focus of relief for the plague-stricken and the poor in order to provide an urban focus for the population’s devotion and manifest a concrete response to the dire situation.21 The body of Saint Roch, who contracted and survived the plague and subsequently ministered to the sick and the poor, was brought from Montpellier to Venice in 1485. The Scuola (confraternity) dedicated to him had been founded some years earlier during the plague epidemic of 1478 and, in just a few years, was the object of a considerable surge of devotion. Thus, already in May 1483 when the landlord of the German friar, Felix Faber, died of suspected plague, he “went by water to the church of S. Roch and invoked the aid of the aforesaid saint, who is the especial helper of those who fear the plague.”22 A year after the return of St. Roch’s body in 1485, his confraternity was elevated to the status of a Scuola Grande, and in 1489 a church was built behind S. Maria Gloriosa dei Frari. Bartolomeo Bon designed the church (later rebuilt) and in 1516, as proto (superintendent of works) to the Scuola, he began a major new building that was completed in 1527–1549 by Antonio Scarpagnino.23 The grandest space of the Scuola, the first-floor sala capitolare (meeting hall), was reached by Scarpagnino’s extravagant “imperial” staircase, with parallel ramps at ground-floor level leading to a broad landing from which a single ramp brings one to the upper hall decorated with Jacopo Tintoretto’s celebrated pictorial cycle of the Life of Saint Roch.24 The Scuola was the locus for ritual processions in which the staircase played an important part in pageantry, as did the richly decorated facade covered with colored marbles and large freestanding columns—its function as a ceremonial backdrop is perfectly captured by Antonio Canaletto’s The Doge Visiting the Church and Scuola di San Rocco of c. 1735 in the National Gallery of London.25 Some members of the confraternity believed that the sumptuous and expensive facade betrayed the role of the Scuola in helping the poor and this led to considerable disagreement, especially with regard to the construction of the staircase, later decorated by Antonio Zanchi in the 1670s with paintings of plague scenes discussed below.26

26  Andrew Hopkins

Figure 1.2 St. Roch with a staff resting on rock, with a view of Venice in the distance; at upper left appears an angel, a dog lower left, surrounded with various scenes from his life, 1516, after Titian (1490–1576), woodcut print on paper, 56.3 × 40.4 cm (British Museum).

Increasing Venetian devotion to St. Roch can be seen in Titian’s Saint Mark altarpiece (see Figure 1.1), painted around the time Giorgione died, probably of plague.27 It also heralds the ascendancy of Titian to the role of foremost artist in Venice. His woodcut Saint Roch and the Story of his Life must have been printed in the 1520s to raise more money for building, as indicated by the collection box above the inscription at the bottom left of the image (Figure 1.2).28 Saint Roch is represented wearing a pilgrim’s dress and carrying a staff, with his upper thigh exposed to show a decorously located plague bubo, while vignettes framing the image illustrate traditional episodes from his life.29 The small votive print depicting Roch’s apparition to a plague victim at bottom right emphasizes the extent to which popular piety was fundamental to the success of the Scuola di S. Rocco (Figure 1.2).30 Devotional images such as Titian’s altarpiece (Figure 1.1) present a typical pairing of the two principal plague saints. Roch, with his traditional beard, hat, and staff, pulls back his cloak to indicate an area of skin in shadow that signifies the presence of a plague buboe, while Sebastian’s chest is pierced by his trademark arrow.31 In another work, Jacopo Bassano’s Saints Sebastian and Roch of c. 1551, a Venetian context is suggested by the verso of the canvas depicting the Madonna of Mercy together with Saint Anthony of Padua whose relics and feast day would be celebrated at S. Maria della Salute from 1656, another plague year albeit significantly milder.32 Roch also appears in Giuseppe

The Inception of “Science and Supplication”  27

Figure 1.3 Antonio Zanchi, The Virgin Appearing to Plague Victims during the Plague of 1630, 1666, Oil sketch, preparatory composition study, 99 × 135 cm, lent to the Kunsthistorisches Museum by the Friends of the Kunsthistorisches Museum, Vienna. Inv. Nr. Fr 52.

Heintz the Younger’s The Parish Priest Pomelli and Saints John the Evangelist, Theodor, and Roch Who Implores the Archangel Saint Michael not to Unsheath His Sword of 1632.33 Pomelli, a canon of S. Marco and parish priest of S. Fantin, appears between a largescale representation of his own parish church and the centrally located view of the piazzetta looking toward the bacino of S. Marco. He represents just one of the numerous religious figures who, during the plague, offered succor to the sick and helped to prevent panic at a local level. Sometimes, however, even the religious fled the city and, following the mid-sixteenth-century change in official policy, during the 1576 epidemic there was a significant exodus of Jesuits to the country villas of Venetian nobles.34 In 1630, the Benedictines at S. Giorgio Maggiore reaffirmed their exemption from administering the sacraments during times of plague, despite a direct request from the patriarch Giovanni Tiepolo.35 Contagion and Poor People In contrast to the predominant belief that plague was sent as a punishment from God for sins, in 1546 the Veronese scholar and physician Girolamo Fracastoro published in Venice his cogent articulation of the theory of contagion, On Contagion, Contagious

28  Andrew Hopkins Diseases, and Their Treatments.36 Although his insight was not immediately understood or accepted, given the mildness of the 1555–1557 plague, the Health Office in Venice was able to examine individual cases, consult doctors, and even hold a meeting with the doge and Senate on 24 August 1556 to examine various theories of causation and begin to posit contagion as the likely etiology. They also began, at least to some degree, to put in place strategies for the examination and documentation of individual cases.37 Notable events during this plague were the deaths of the priors of both lazarettos, confirming the risk people working on the frontline faced in times of plague and pandemic. As was recognized in the sixteenth century, the plague mainly affected the poor: the reduced circumstances of those regarded as respectably poor, such as the massive numbers of urban workers who lived on charitable food donations, deteriorated sharply amid the overall economic chaos in which commerce ceased and the abrupt termination of their employment drove them to starvation.38 But the plight of the poor was attributed not only to inadequate food and small filthy houses—made worse when these abodes were under quarantine or boarded up—but also to their supposedly immoderate sexual habits. Undocumentable sexual promiscuity cannot be accurately assessed as a cause of contagion for this period; certainly, poor families’ inability to establish or maintain “social distancing,” given that they were living in close proximity in hovels, was a clear cause of plague being spread.39 Then there were those regarded as the unrespectable poor, such as vagrants, criminals, and galley slaves, who were even more likely to be infected with the plague because so many of them took employment arising from it as undertakers, fumigators, and cleaners and clearers of plague-stricken houses.40 Those who could fled the chaos of the city but, ethically, if one was a Venetian patrician the proper course of action was to remain. The countryside, in any case, had both strongly positive and negative aspects during periods of plague as it was both a refuge and a blockading force that could withhold supplies and turn back “suspicious” outsiders. It too was the site of thousands of starving peasants, for famine usually preceded plague and eventually drove the rural poor into Venice in search of food, where they often congregated in the courtyard of the Ducal Palace.41 Yet, as Brian Pullan has shown, poor people in cities, such as those who acted as undertakers, were not simply objects of fear as incubators and spreaders of disease, but also the objects of charity directed toward them as a supplication for Christ’s mercy.42 Charity In the context of the plague, the representation of Lazarus, recounted in the Bible by Luke (16:19–31), as the poor, sore-covered beggar who was ignored by the rich man, takes on significant meaning. A number of devotional paintings from this period, including those depicting Lazarus, can be linked to the presence of contagion in Venice.43 In many of these depictions, Lazarus is dragged from a sarcophagus slab by an unidentified young man, and one of Lazarus’s arms is often supported by his sister Martha while his other sister, Mary, turns toward Christ (John 11:39). The miracle of Lazarus’s resurrection is often conveyed by the pristine beauty of his physique, which is in many cases reinforced by the presence of figures who hold handkerchiefs to their noses because of the expected stench of death and decay that, given the miracle, fails to emanate (John 11:39). The smell of death was surely one of the overwhelming urban phenomena during times of plague. Charity for the poor as a gesture of placation is also represented in many other devotional paintings.44 One such subject was the act of feeding the impoverished (Matthew

The Inception of “Science and Supplication”  29

Figure 1.4 Domenico Tintoretto, Venice Supplicating the Virgin Mary to Intercede with Christ for the Cessation of the Plague, 1630–1631, Oil paint on gray laid paper, 40.3  × 20.1  cm, Princeton University Art Museum. Gift of Frank Jewett Mather Jr.

30  Andrew Hopkins 25:35–40). In the seventeenth century, these events were often rendered in pure Caravaggesque mode with dramatic tenebrism, bathing in light figures in the foreground but leaving figures toward the back in shadows.45 The woman pouring water and the elderly man about to receive it are illuminated, while the boy whose cup is being filled and another figure who is drinking from it are set further back in the shadow. Bernardo Strozzi was one artist who had painted this subject. His picture An Act of Mercy was completed around a decade before his transfer to Venice in 1630, the year plague devastated the city. As a former Capuchin dedicated to relieving poverty and suffering, Strozzi must have been particularly attuned to the needs of plague victims, but the horror that would have confronted him there is vividly conveyed by another religious observer, the Jesuit Domenico Cosso, who wrote from Venice on 18 January 1577: Oh, what very great compassion and grief, together with fear, to see the houses, the shops, and the churches closed and barricaded with crossed planks across the doors as a sign and as a barrier! The city was almost deserted, so that it was unusual to see some poor men in a street, each fleeing the others as if they feared their shadows…. So many, many barges full of dead bodies packed like sardines [composti come le sardelle] and so many barges full of infected goods passed by that the wind brought a great stench and stink, even from the lazaretto as a result of the multitude of bodies and the burning of infected goods.46 Something of this horror is evident in Domenico Tintoretto’s preparatory design of 1631, sketch for a plague banner, Venice Supplicating the Virgin Mary to Intercede with Christ for the Cessation of the Plague (Figure 1.4).47 Unlike the final painting, with its pious women, in the modello Tintoretto depicted the reality of undertakers in the middle ground carrying away dead bodies, corpses in the foreground, and the terrifying image of a boarded-up house whose inhabitants were left to their fate.48 Fear and Denial The fear of being boarded up and abandoned (whether individual homes or even the urban port) was one reason any outbreak of plague created such panic throughout the city; often the houses were so tall and narrow that dead bodies could hardly be extracted and were thrown from windows instead.49 Historically, declarations of plague were avoided if at all possible to avoid panic and disruption to everyday life and trade. Governments systematically lied to foreign representatives, not unlike the dissimulation to Gustav von Aschenbach, the  hoteliers, and other authorities in Thomas Mann’s  Death in Venice. Self-serving economic reasons were the basis of this widespread and enduring deceit.50 Once blockades were imposed, fear (paura) would spread through the city faster than the disease itself.51 Denying the existence of the plague, however, seriously delayed effective response, and often resulted in a greater epidemic. This was certainly the case for the 1575–1577 plague that claimed Titian’s son Orazio, along with almost 50,000 other  victims.52 Preceded by years of famine, this plague was one of the worst in Venice’s history. It was thought to be brought to the city by one Matthio from Trent, who died in the parish of S. Basegio in Venice on 2 July 1575. Disastrously, his clothes were sold to pay the expenses of his illness and funeral.53 This lapse—indeed collapse—in the systematic procedures of the

The Inception of “Science and Supplication”  31 Provveditori alla Sanità, designed to prevent the origination, importation, and spread of contagion in Venice, was due to an excessive workload in the 1570s that included duties such as the enforcement of poor laws, taking the census of the city’s population, and policing armed travelers.54 Following the initial declaration of plague, matters were made worse by the Senate, which called for additional testimony from medical experts at the University of Padua. These physicians—Girolamo Mercuriale and Girolamo Capodiva—humiliated the Provveditori by making a public announcement that there was no contagion in the city, so that the shutting up of houses and deployment of lazarettos was severely curtailed.55 The pronouncement by the Paduan medics was well received whereas the Provveditori were considered to be exaggerating the case for their own interests.56 These physicians then proceeded to personally inspect the sick in order to offer reassurance, but eventually the numerous outbreaks became too widespread and subsequently it was recognized that the movement of the Paduan doctors between sick and healthy people probably contributed to the enormous scale of the outbreak.57 Indeed, the practical concern to limit the movement of people and goods repeatedly brought the Provveditori into direct conflict with the religious authorities and the state’s traditional recourse to devotion and supplication. Science and Supplication Science dictated isolation, and in 1576, in addition to the confinement of people in their houses, a plan was hatched for the mass evacuation of 10,000 poor people to tents and barracks at Lizzafusina, a town on the edge of the mainland.58 All assemblies were forbidden and the sestieri of Castello, Cannaregio, and S. Marco were placed under an eight-day quarantine.59 Yet the religious response called for increased numbers of ritual processions through the city to demonstrate repentance for ignoring God’s repeated signs of wrath, which in hindsight were recognized by doge Alvise Mocenigo in the 1569–1570 famine, the Arsenale and Ducal Palace fires of 1569 and 1574, and the Turkish wars of 1570–1573.60 Despite the tight controls on movement and public assembly, an annual votive procession to the Scuola Grande of S. Rocco was instigated by the government in 1576 together with its vow to build a new church and pledge an annual procession to it.61 This was the context in which Il Redentore was commissioned by the Senate on 4 September 1576 and dedicated to Christ the Redeemer.62 After much debate, a site on the Giudecca overlooking the canal was chosen and the architect Andrea Palladio first designed a centralized church.63 During the Renaissance, the centralized plan was deemed appropriate for a church erected as a votive response to a plague. The fifth-century octagonal Baptistry of Sant Giovanni in Laterano in Rome (Saint John Lateran), which was iconographically associated with the fountain of the water of life, signified physical and spiritual cleansing and rebirth. In the case of Il Redentore, it offered a model that perfectly expressed Palladio’s original desire to create architecture based on antique precedent.64 After this was rejected, Palladio designed a longitudinal church that more effectively accommodated the seating arrangements for the annual visit by the doge and government members as well as the ritual processions of clergy and confraternity members.65

32  Andrew Hopkins In the case of Baldassare Longhena’s Santa Maria della Salute, discussed below, centrally planned churches were also deemed most appropriate for churches dedicated to the Virgin Mary—protector of health—who was linked to the founding of Venice. There, the continuous ambulatory—suitable for processions in a votive church—was derived by from other early Christian models as San Vitale in Ravenna and Santa Costanza in Rome. Architectural Programs and Votive Processions Processions were an integral part of the Roman Catholic liturgical calendar. Votive churches, like the Redentore and Santa Maria della Salute, afforded performative spaces where devotional processions—whether penitential or thankful—created a sense of agency in a world where medical interventions were relatively ineffective. Like other ducal visits, there were two distinct parts to the feast-day procession to the Redentore, as represented by Giuseppe Heintz the Younger. The doge and signoria arrived by boat from Piazza S. Marco and processed up the magnificent flight of stairs and through the nave of the church to attend a low Mass in the sanctuary. As this group left the Redentore, the members of the Scuole, the congregations of priests and other religious figures, who had processed over the two votive bridges, respectively traversing the Grand and Giudecca Canals, now processed through the Redentore before returning over the two bridges and passing through the choir of S. Marco before the doge and signoria.66 Similar strategies and ceremonies were adopted to combat the plague of 1630. In 1630, processions were instigated by the zealous patriarch Giovanni Tiepolo even before contagion reached the city.67 The three parishes of S. Marco, S. Rocco, and S. Pietro di Castello were declared to be of special holiness and the “holy ashes” of Lorenzo Giustinian, the first patriarch of Venice and a renowned healer of the sick in the Lazzaretto, were displayed at S. Pietro di Castello, the cathedral of Venice. Patriarch Tiepolo also requested Giustinian’s canonization at this time, an act that foreshadowed the development of his cult in the seventeenth century as an intercessionary figure with respect to the plague. Following initial practical decrees to clear areas of Venice of beggars, the government turned to traditional acts of supplication and, with their decree of 22 October 1630, commissioned the new church of S. Maria della Salute and vowed to hold an annual procession to it.68 From the outset, the vow linked the church to ceremony, as seen in Bernardino Prudenti’s The Virgin and Child, with Saint Mark the Evangelist, the Blessed (later Saint) Lorenzo Giustiniani, Saint Roch, and Saint Sebastian Making the Plague Flee from the City of Venice. Commissioned on 24 November 1631, the painting was completed in just four days so that it could be displayed from a platform located in front of the Procuratie Nuove during processions.69 Apart from the familiar profile of Lorenzo Giustiniani, Prudenti also represented the church of the Salute according to the winning design by Baldassare Longhena (Figure 1.5). After his proposal was selected in June 1631, Longhena revised his design at the request of the deputies appointed to supervise the construction of the building. The church comprises a sequence of interrelated but relatively autonomous spaces including a domed rotunda surrounded by an ambulatory, a domed apsidal sanctuary, and a choir for the

The Inception of “Science and Supplication”  33

Figure 1.5 Bernardino Prudenti, The Virgin and Child, with Saint Mark the Evangelist, the Blessed (later Saint) Lorenzo Giustiniani, Saint Roch, and Saint Sebastian Making the Plague Flee from the City of Venice, 1631–1638, c. 200 × 300 cm, Venice, S. Maria della Salute (photo: Böhm).

conventuals beyond the high altar. Together these fulfilled the complex requirements of the Venetian Senate that commissioned the building, including the need to accommodate participants in the annual ceremony.70 Each year on 21 November, the doge, signoria, and Senate went in boats to the Salute, ascending the magnificent flight of stairs and entering the principal door thrown open to receive the procession. Boschini’s print The doge Nicolò Contarini visiting S. Maria della Salute in Procession captures the view into the building (Figure 1.6). Once inside, this group moved directly through the center of the church and into the sanctuary, attending a low Mass before returning in boats to the piazza and hence to S. Marco. Equally significant was the second processional group that included thousands of members of the Scuole Grandi and the regular clergy who came in procession and most probably entered the Salute by one of the small side doors, proceeded around the ambulatory of the rotunda, thus passing all six altars as well as the high altar, before leaving through the other side door and returning over the pontoon bridge to S. Marco. The ambulatory of the rotunda was designed to accommodate this processional movement through the church on its feast days, as Longhena himself stated in his original memorandum accompanying his design: Between the large nave of the church and the chapels there will be space for being able to go around and around with the processions of the main feast days without the impediment of the people that one finds in the middle of the church.71

34  Andrew Hopkins

Figure 1.6 Marco Boschini, The doge Nicolò Contarini visiting S. Maria della Salute in Procession, 1644, etching and engraving, detail, Den Kongelige Kobberstiksamling, Statens Museum for Kunst, Copenhagen 410a, 21 (photo: Hans Petersen).

Plague Concealed and Revealed Some painters chose to focus on these attractive and interesting processions rather than the appalling realities of those suffering the plague. The pontoon bridge became the focus of a splendid large canvas by Luca Carlevarijs, The Feast of S. Maria della Salute. Carlevarijs’s emphasis on the bridge thrown across the Grand Canal foreshadows the entire development of Venetian vedute or view-painting. The Grand Canal

The Inception of “Science and Supplication”  35 and the pontoon bridge occupy the center of the painting, enabling Carlevaris to bring forward the human element in the closely observed genre details, including ladies, nuns, and schoolgirls—all a far cry from the ducal procession with members of the Venetian confraternities represented in Giuseppe Heintz the Younger’s work the Procession to the Church of the Redentore. To the right, Carlevarijs depicts Giuseppe Benoni’s Dogana da Mar (customs house), built after Longhena’s original designs were rejected, with Palladio’s highly recognizable Benedictine church of S. Giorgio Maggiore in the distance.72 Both Carlevarijs’s and Heintz’s canvases focus on S. Maria della Salute, where one of the last works to be executed in the decorative program explicitly refers to plague: Giusto le Court’s High Altar with Saint Mark, Lorenzo Giustiniani and Venetia Who Implore the Virgin and Child to Expel Plague Who Flees Their Attack.73 This sculptural ensemble executed in 1670 is one of le Court’s most powerful works and plague, here depicted traditionally as a withered old woman with swirling drapery, raises her right arm in an attempt to ward off attack.74 In the Serenissima, as in so many early modern societies, many symbolic figures were female: in this case the evil of plague misogynistically anthropomorphized as an ugly old woman is counterbalanced by the presence of Venetia, the powerful female representation of the city who, together with her male counterpart Saint Mark, Venice’s patron saint, and Lorenzo Giustiniani, Venice’s first patriarch, gives a specifically Venetian iconography to this work commemorating the 1630 plague.75 The reality of the 1630 plague depicted by these artists was entirely different: between July 1630 and October 1631 over 30% of Venice’s population died. There were 46,490 deaths among 142,000 residents. The total number of mortalities within the dogado, the cities and towns of the terraferma, and the dominio del mar, including the cities of Murano, Malamocco, and Chioggia, was 93,661. In certain cities of the terraferma, such as Padova, up to 60% of the inhabitants perished: 18,375 deaths among 31,988 residents; 17,700 of Vicenza’s 31,897 residents died; and in the province of Brescia approximately 140,000 people died. Within 15 months between 300,000 and 700,000 inhabitants of Venice and the terraferma perished.76 Later paintings are further testament to the continuing impact of the idea of contagion. Antonio Zanchi’s The Virgin Appearing to Plague Victims during the Plague of 1630 (Figure 1.3) is preparatory to the full-scale works decorating the imperial staircase of the Scuola Grande di S. Rocco, where they would be seen by those processing up to the sala capitolare and Tintoretto’s masterful cycle. Zanchi’s extremely dramatic paintings focus on the horrific results of contagion, including dead bodies being taken away by boats and others being dragged onto the bridge to be lowered onto the boat or simply thrown into the water. The decoration of this staircase complex recalls the conflicts and contradictions inherent in the various responses to contagion. Yet again time and money were dedicated to decoration as a demonstration of devotion in the hope of saving the city and its inhabitants. The celebratory nature of the Scuola Grande di S. Rocco refers not only to depicting the darkest hours of the epidemic but also to its constant recourse to supplication. Diachronically, however, in tandem with supplication, the Serenissima was well on its way to becoming one of the pioneering centers of the Age of Enlightenment (Illuminismo) in which artists such as Giambattista Piranesi would set out a new vision of the world, just as writers across Venice and the Veneto would demonstrate, yet again, a precocious embrace of science.77

36  Andrew Hopkins Epilogue In 2020 in northern Italy, in Brescia, one of the first cities to be greatly afflicted with COVID infections and deaths, the most memorable image was of tents constructed by the army containing the numerous coffins of the deceased. These were loaded onto army transports and taken elsewhere for burial as the city could not cope with the number of people who had perished. This continued over weeks and then months as Brescia and its inhabitants suffered the worst disaster of its post-World War II history. For potentially skeptical viewers and readers of these Early Modern depictions and accounts of plague years, of houses being boarded up and the dead thrown out of upper-story windows or corpses being tossed into the water, one need only look again at those dramatic photos of Brescia in the first months of the 2020–2022 pandemic to understand that these unexpected emergency situations are all too real and all too true, and that no amount of supplication can turn them around. Was this pandemic a situation in which the pursuit of science appears not only to be the solution—through the development of COVID vaccines—but, possibly, also the cause (if the lab leak hypothesis at Wuhan on China is to be believed)? Notes 1 Brian Pullan, Rich and Poor in Renaissance Venice: The Social Institutions of a Catholic State (Oxford: Blackwell, 1971); Richard Palmer, “The Control of Plague in Venice and Northern Italy 1348–1600” (Ph.D. diss., University of Kent, 1978); Paolo Preto, Peste e societa a Venezia (Vicenza: Neri Pozza, 1978); and Venezia e la peste 1348–1797, exh. cat., Orazio Pugliese ed. (Venice: Marsilio, 1979). 2 Wladimir Timofiewitsch, The Chiesa del Redentore (University Park, PA: Pennsylvania State Press, 1971); Andrew, Hopkins, “The influence of ducal ceremony on church design in Venice”, Architectural History, 41 (1998), 30–48; Andrew Hopkins, Santa Maria della Salute: Architecture and Ceremony in Baroque Venice (Cambridge: Cambridge University Press, 2000). 3 Paul Joannides, Titian to 1518: The Assumption of Genius (New Haven, CT and London: Yale University Press, 2001), 148–151. Frank Snowden, Epidemics and Society: From the Black Death to the Present (New Haven, CT and London: Yale University Press, 2020) (with a new preface). 4 Michelangelo Muraro, “Il tempio votivo di Santa Maria della Salute in un poemo del Seicento”, Ateneo Veneto, 11 (1973), 87–119; Michelangelo Muraro, “Iconografia e ideologia del tempio della Salute a Venezia”, in Barocco fra Italia e Polonia, ed. Jan Slaski (Warsaw: Naukowe, 1977), 71–78. Massimo Gemin, La chiesa di Santa Maria della Salute e la Cabala di Paolo Sarpi (Francisci: Abano Terme, 1982); Andrew Hopkins, “Processional pavements for Santa Maria della Salute”, in I Pavimenti Barocchi Veneziani, eds. Lorenzo Lazzarini, Mario Piana and Wolfgang Wolters (Venezia and Verona: Cierre Edizioni/Istituto Veneto di Scienze, Lettere ed Arti, 2018), 93–103. 5 Thomas Mann, Der Tod in Venedig (Berlin: Fischer, 1912). Thomas Mann, Death in Venice, trans. Kenneth Burke (New York, NY: Knopf, 1925). See also Thomas Mann, “Death in Venice” in Complete, Authoritative Text with Biographical and Historical Contexts, Critical History, and Essays from Five Contemporary Critical Perspectives, ed. Naomi Ritter (Boston, MA: Bedford, 1998). Francesco Bono ed., Morte a Venezia – Thomas Mann Luchino Visconti: un confronto (Soveria Mannelli: Rubbettino, 2014). 6 John Howard, An Account of the Principal Lazarettos in Europe (London: Warrington, 1789 (2nd ed. 1791)), 10 “the place where lazarettos were first established”. Paolo Preto, “Peste e demografia: l’età moderna: le due pesti del 1575–77 e 1630–31”, in Venezia e la Peste, 97–98; Paolo Preto, “La societa veneta e le grandi epidemie di peste”, in Storia della Cultura Veneta (II Seicento), eds. Girolamo Arnaldi and Manlio Pastore Stocchi, 4/II (Vicenza: Neri Pozza, 1984), 377–406. Paolo Preto, “Le grandi paure di Venezia nel secondo ‘500: le paure naturali

The Inception of “Science and Supplication”  37 (peste, carestie, incendi, terremoti)”, in Crisi e Rinnovamenti Nell’autunno del Rinascimento a Venezia, eds. Vittore Branca and Carlo Ossola (Florence: Olschki, 1991), 177–192. 7 Archivio di Stato di Venezia, Senato Misti, register 54, c.141v; Venezia e la Peste, 183–186. For a comparable period across the Adriatic, Zlata Blažina Tomić, Expelling the Plague: The Health Office and the Implementation of Quarantine in Dubrovnik, 1377–1533 (Montreal: McGill– Queen’s University Press, 2015). 8 For the architecture see Paolo Morachiello, “Howard e i Lazzaretti da Marsiglia a Venezia: gli spazi della prevenzione”, in Venezia e la peste, 157–164. Nelli-Elena, Vanzan Marchini, Le Leggi di Sanità Della Repubblica di Venezia, 4 vols. (Vicenza: Neri Pozza, 1995–1998). For a much later period Barry Bergdoll, “The architecture of isolation: M.-R. Penchaud’s quarantine hospital in the Mediterranean”, AA files 14 (1987), 3–13. For comparable art and a­ rchitecture in Florence see Giovanni Baldinucci, Quaderno: Peste, Guerra e Carestia Nell’italia del Seicento, ed. Brendan Dooley (Florence: Polistampa, 2001). John Henderson, “Healing the body and saving the soul: Hospitals in Renaissance Florence”, Renaissance Studies 15/2 (2001), 188–216; Idem, Piety and Charity in Late Medieval Florence (Oxford: Clarendon Press, 1994); Giovanni Pagliarulo, “Jacopo Vignali e gli anni della peste”, Artista: Critica dell’arte in toscana (1994), 138–198. For the wider context now see Marina Inì, “The System of Lazzaretti in the Early Modern Mediterranean” (Ph.D. University of Cambridge, 2020); Idem, “Materiality, quarantine and contagion in the early modern Mediterranean”, in Social History of Medicine, 34/4 (2021), 1161–1184; Idem, “Architecture and plague prevention: The development of lazzaretti in the eighteenth-century Mediterranean”, in Public Health in the Early Modern City in Europe, eds. Mohammad Gharipour and Anatole Tchikine (London: Palgrave Macmillan, 2023). 9 Andreina Zitelli and Richard Palmer, “Le teorie mediche sulla peste e il contesto veneziano”, in Venezia e la Peste, 21–28. Other possible causes were noted, including planetary conjunctions or sodomy, the latter being, in theory, controllable. During the 1464 plague the Consiglio di Dieci (Council of Ten) discussed “increasing” the punishment for sodomy from decapitation to death by burning, Palmer, “The Control of Plague”, 291. 10 Archivio di Stato di Venezia, Senato Terra Registro, register 6, c.29r; Venezia e la Peste, 366. 11 Palmer, “The Control of Plague”, 190. 12 Ibid., 189–195; Bergdoll (1987), 5. 13 Archivio di Stato di Venezia, Senato Terra Registro, register 9, c.168r, Senato Terra Registro, register 10, c.189v. Palmer, “The Control of Plague”, 62–64, 73–74. 14 Archivio di Stato di Venezia, Provedditori alla Sanità, register 2, cc. 25v, 27r–28r. “something beyond being ashamed and stinking and dangerous to generate various diseases”. 15 Palmer, “The Control of Plague”, 118: “quei luoghi chiamati in Venetia gattoli. Perciochè io gli ho veduti alle volte si pieni di bruttura, e fetenti per la corruzione delle herbe e scorze di meloni, e alter si fatte cose putride, che io ne ho preso una grande meraviglia, come l’aere ogni anno non venga ad alterarsi e generare delle febbri pestifere”. 16 Guenter Risse, Mending Bodies, Saving Souls: A History of Hospitals (Oxford: Oxford University Press, 1999), 201. 17 Ibid., 206–207. 18 John D. Thompson and Grace Goldin, The Hospital: A Social and Architectural History (New Haven, CT and London: Yale University Press, 1975), 51–52. 19 José L. Terrón Ponce, El Lazareto en el Puerto de Mahón (Mahón: Editorial Menorca, SA, 2003), 86. 20 Risse, Mending Bodies, Saving Souls, 207–208. 21 Pullan (1971); Teresio Pignatti ed., Le scuole di Venezia (Milan: Electa, 1981). 22 Felix Fabri, The Wanderings of Brother Felix Fabri, trans. Aubrey Stewart (London: Palestine Pilgrims’ Text Society, 1892–1893); Kathryne Beebe, Pilgrim and Preacher: The Audiences and Observant Spirituality of Friar Felix Fabri (1437/8–1502) (Oxford: Oxford University Press, 2014). 23 Franco Posocco, Scuola Grande di San Rocco: La Vicenda Urbanisctica e lo Spazio Scenico (Cicadella: Biblos, 1997); Palmer, “The Control of Plague”, 285–286; Gianmario Guidarelli, Una Giogia Ligata in Piombo: La Fabbrica Della Scuola Grande di San Rocco in Venezia 1517–1560 (Venice: Scuola Grande Arciconfraternità di San Rocco, 2002). 24 For the staircase of the Scuola Grande della Misericordia see Guidarelli (2002).

38  Andrew Hopkins 25 Edward Muir, Civic ritual in Renaissance Venice (Princeton, NJ: Princeton University Press, 1981), 216, 227. Analysis of the columns applied to the façade can be found in Manfredo Tafuri, Venezia e il rinascimento: religione, scienza, architettura (Turin: Einaudi, 1985), 125– 154. Martin Gaier, Facciate Sacre a Scopo Profano: Venezia e la Politica dei Monumenti dal Quattrocento al Settecento (Venice: Istituto Veneto, 2002), 76. 26 Tafuri (1985) 125–154. 27 Jaynie Anderson, Giorgione: The Painter of “Poetic Brevity” (Paris: Flammarion, 1997), 284. 28 Exemplum held at the British Museum, London (inv. 1860–4–14–140), woodcut in a single block, 56 × 40.2 cm. See David Rosand and Michelangelo Muraro, Titian and the Venetian Woodcut, exh. cat. (Washington, DC: National Gallery of Art, 1976), 110; Matthias Wivel, “Titian’s St Roch”, Print Quarterly, 29/2 (2012), 131–141; see also Christine Boeckl, Images of Plague and Pestilence: Iconography and Iconology, 2ed. (University Park, PA: Penn State University Press, 2021). 29 For the Cristo Portacroce (Christ carrying the cross), of debated authorship, see Elsje van Kessel, “How to make an image work? The presentation of Giorgione or Titian’s miraculous ‘Christ carrying the cross’ at the Scuola di San Rocco”, Studiolo, 9 (2012), 12–25, 360; Raffaele Paier, “Il ‘Cristo portacroce’ della scuola di S. Rocco a Venezia”, Studi Veneziani, 68 (2013), 375–394. For the symptoms of bubonic plague see Palmer, “The Control of Plague”, ix, xvii, citing Girolamo Mercuriale, Hieronymi Mercurialis Foroliviensis De Peste in Universum, Praesertim Vero de Veneta & Patavina (Basel: Perna, 1577), 2–3 “carbunculi, vibices frequentissimae in dorso, maculae nigrae, violaceae, rubeae”. 30 Venezia e la peste, 240–241. For Roch, see Thomas Worcester, “Saint Roch vs. Plague, Famine, and Fear”, in Bailey et al. eds. (2005), 153–176. For print dissemination and its influence see Pamela Jones, “San Carlo Borromeo and plague imagery in Milan and Rome”, in Bailey et al. eds. (2005), 65–96, here 73–74. 31 Bailey et al. eds. (2005), 200–201, cat. 12. Maria Wyke, “Playing Roman soldiers: The martyred body, Derek Jarman’s Sebastiane and the representation of homosexuality”, in Parchments of Gender: Deciphering the Bodies of Antiquity, ed. Maria Wyke (Oxford: Oxford University Press, 1998), 243–266. Bette Talvacchia, “The double life of Saint Sebastian in Renaissance art”, in The Body in Early Modern Italy, eds. Julia Hairston and Walter Stephens (Baltimore, MD: Johns Hopkins Press, 2010), 226–248. 32 Hopkins (2000), 71–73. 33 Venice, S. Fantin, 350 × 290 cm, signed and dated 1632, inscribed: “Jo. Pomellus pleb(anus) Ducalis Canon(icus) Cong(regation)is S. Paulis arch(ipresbite)r”. 34 A. Lynne Martin, Plague: Jesuit Accounts of Epidemic Disease in the Sixteenth Century (Kirksville: Sixteenth Century Journal, 1996), 120–123. 35 Archivio di Stato di Venezia, San Giorgio Maggiore, busta 53, processo 80, letter from the patriarch, Giovanni Tiepolo, to the Benedictines, “vi facciamo sapere che da noi sieti stati deputati ministrar li sacramenti necessarij nella presente occasione di contaggio in quella parte della Giudecca”, together with other “documenti che stabiliscono li Monaci Cassinense non esser obbligati in tempo di peste alla amministrazione di sacramenti”. 36 Girolamo Fracastoro (Hieronymi Fracastorii), Liber Vnvs, de Sympathia & Antipathia Reru[m]. Item, de Contagione, & Contagiosis Morbis, & Eorum Curatione, Libri III (Lyon: Tornæsium and Gazeium, 1554) (trans. with notes Wilmer Cave Wright (New York, NY: G.P. Putnam’s Sons and The Knickerbocker Press, 1930), 3. Alessandro Massaria, De Peste Libro Duo (Venice: Altobellum Salicatium, 1579); Fynes Morison, An Itinerary (London: Beale, 1617). Palmer, “The Control of Plague”, 91–96; Carlo Cipolla, Public Health and the Medical Profession in the Renaissance (Cambridge: Cambridge University Press, 1976). Franco Mormando, “Introduction: Response to the plague in Early Modern Italy: What the primary sources, printed and painted, reveal”, in Bailey et al. eds. (2005), 7. 37 Palmer (1978), 98–102, 111–112. Michel Foucault, Discipline and Punish: The Birth of the Prison, trans. Alan Sheridan (New York, NY: Pantheon, 1977), for his brilliant analysis. 38 Archivio di Stato di Firenze, Archivio Mediceo del Principato, filza 2971, c. 284, 27, June 1656, citing the ambassador: “tutti questi sono poverissimi”. Bronislaw Geremek, Poverty: A History, trans. Agnieszka Kolakowska (Oxford: Blackwell, 1994), 131–136. 39 Nicolò Massa, “Raggionamento”, cc. 20r–v, “capsule pieno di figliuoli” (“capsules full of children”), which were then shut up, c. 17v, “stando serrati s’infirmano, perché in quel poco di

The Inception of “Science and Supplication”  39 luogo hanno la scaffa, il necessario, et ogni altra sorte d’immonditie della casa, di tal maniera che l’aere è quasi putrido” (“by being tightly enclosed they become infirm, because in that little place they have the shelf, the toilet, and every other kind of filthiness of the house, so that the air is almost putrid”). Archivio di Stato di Venezia, register 3, cc. 29v–30v, “conoscendosi chiaramente dell’esperienza che tal aumento nasce principalmente perché questo afflito populo si trova per lo più habitar in cassette molto ristrette at anguste” (“knowing clearly through experience that this increase arises mainly because the afflicted population is mostly found living in very small, cramped housing”), cited in Palmer “The Control of Plague”, 144. 40 Pullan (1992), 102–103, reprinted in Pullan (1994). 41 Pullan (1992). 42 Pullan (1994), 106–107. 43 Franco Mormando, “Tintoretto’s recently rediscovered raising of Lazarus”, The Burlington Magazine, 144 (2000), 624–629. Maria Elisa Avagnina, “Lazarus and the rich man”, in Jacopo Bassano c. 1510–1592. exh. cat., eds. Beverly Brown and Paola Marini (Bologna: Nuova Alfa Editrice, 1996), 308–310, cat. 24. 44 Michael Milkovich, Bernardo Strozzi: Paintings and Drawings, exh. cat. (Binghamton: State University of New York at Binghamton, 1967), 36, cat. 12. Luisa Mortari, Bernardo Strozzi (Roma: De Luca, 1995), 165–166. cat. 378. 45 For the former see Helen Langdon, Caravaggio: A Life (London: Pimlico, 1998) and the latter pair see Keith Christiansen and Judith Mann, eds. Orazio and Artemisia Gentileschi, exh. cat. (New Haven, CT and London: Yale University Press, 2001). 46 Martin (1996), 51. 47 The modello is at Princeton University Art Museum (inv. 48–1910) and the final oil at S. Francesco della Vigna. Pamela Jones, entry in Bailey (2005), 248–249, cat. 36. 48 Narrow houses were especially a feature of the Ghetto. Ennio Concina et al., La Città degli Ebrei. ll Ghetto di Venezia: Architettura e Urbanistica (Venice: Albrizzi, 1991). Carla Boccato, “La mortalita nel Ghetto di Venezia durante la peste del 1630”, Archivio Veneto 140 (1993), 111–146. 49 Daniel Defoe, A Journal of the Plague Year (London: Nutt, 1722). 50 Mann (1912). Thomas Mann, Death in Venice, trans. Kenneth Burke (New York, NY: Knopf, 1925). Thomas Mann, Death in Venice (Complete, Authoritative Text with Biographical and Historical Contexts, Critical History, and Essays from Five Contemporary Critical Perspectives), ed. Naomi Ritter (Boston, MA: Bedford, 1998). 51 One of the most convincing points made by Samuel Cohn is the rapidity with which the plague spread in the past, compared with the extremely slow spread of bubonic plague, Samuel Cohn, The Black Death Transformed: Disease and Culture in Early Renaissance Europe (London: Arnold, 2002), 1. One suspects that the rapid diffusion of the 1576–1577 and 1630–1631 plagues would indicate fast and widespread conversion from bubonic to pneumonic contagion. 52 Preto (1979), 97–98. Although Titian died during the plague, the cause given on his death certificate was “fever” and he did not die in the lazzaretto, whereas his son Orazio did. Contemporary accounts are Mutio Lumina, “La Liberazione di Vinegia” (Biblioteca Nazionale Marciana, Venice, ms. 2380/21. Archivio di Stato, Venice, Collegio Ceremoniale 1, fols. 47v– 60v) and Rocco Benedetti and Mutio Lumina, Raguaglio Minutissimo del Successo Della Peste di Venetia […] (Tivoli: Domenico Piolato, 1577). 53 Palmer, “The Control of Plague”, 211. 54 Ibid., 123, 213, 219. 55 Ibid., 246. 56 Ibid., 251, 278, noting a similar occurrence in 1630 when Giovanni Battista Fuoli, the physician to the Health Office, was subjected to public hostility and threats to his life when he claimed there was contagion. 57 Ibid., 253, 267. 58 Ibid., 144, citing Archivio di Stato, Venice, Provveditori alla Sanità, register 3, cc. 29v–30v. 59 Ibid., 142–143, 301–302, the Scuola Grande di S. Rocco was closed sometimes during the plague as the conflict between the need for prayer and the danger of congregating was recognized. 60 Ibid., 280–282, 303–304 cites the patriarch Giovanni Trevisan’s recognition of God’s wrath in his 1576 letter to the people of Venice, “afflitioni che giustamente patimo per la moltitudine di

40  Andrew Hopkins peccati nostri”, and further, “per mitigar l’ira del Signor Dio provocato contro questa città per la poca riverentia che si ha alli sacri tempi”, Archivio di Stato, Venice, Secreta, Materie miste notabili, register 95, cc. 67r–68r. 61 Archivio di Stato, Venice, Collegio ceremoniale 1, c. 71r, “Ordine tenuto dal Serenissimo Principe il giorno dell’assontion della Vergine e di S. Rocho quando esce di Palazzo”. 62 Timofiewitsch (1971). 63 Vittorio Pizzigoni, “Tre progetti di Palladio per il Redentore”, Annali di Architettura 15 (2003), 165–178. 64 Staale Sinding-Larsen, “Some functional and iconographic aspects of the centralized church in the Italian Renaissance”, Acta ad Archeologiam et Artium Historiam Pertinentia 2 (1965), 203–252. Antonio Niero, “I templi del Redentore e della Salute: Motivazioni teologiche”, in Venezia e la peste, 294–298. Andrew Hopkins, “Votive Churches, Reliquary Chapels, and Pilgrimage Shrines”, in The Cambridge Guide to the Architecture of Christianity, ed. Richard Etlin (Cambridge: Cambridge University Press, 2022), Chapter 75, 693–701. 65 Hopkins (1998), 30–48. For the contemporary situation in Milan and Rome see Pamela Jones, “San Carlo Borromeo and plague imagery in Milan and Rome”, in Bailey (2005), 65–96. 66 Hopkins (1998), 30–48. For the earliest ground plan of S. Marco see Andrew Hopkins, “Taking in San Marco with John Talman: From the ground up”, in La Basilica di Venezia, San Marco: arte e storia, ed. Ettore Vio (Venice: Marsilio, 2019), Vol. 1, 150–163. 67 Palmer, “The Control of Plague”, 290, 306–309. James Moore, “Venezia favorita da Maria: Music for the Madonna Nicopeia and Santa Maria della Salute”, Journal of the American Musicological Society 37 (1984), 299–355. Pullan (1994). Hopkins (2000), 134–153. 68 Hopkins (2000), 3–4. 69 Venezia e la peste, 263, cat. A37. Hopkins (2000), 9–10, cat. 9. The plague-stricken figures in the lower portion imploring the Virgin are no longer there, indicating the original was later cut down. For the plague in Bologna see Catherine Puglisi, “Guido Reni’s Pallione del Voto and the plague of 1630”, The Art Bulletin 77 (1995), 402–412. For Verona see Venezia e la peste, 270, cat. a45 for Antonio Giarola’s Verona supplicating the Trinity, in the chapel of the Conception of S. Fermo, explicitly depicting a landscape covered with corpses. 70 Hopkins (2000), 134–153. 71 Archivio di Stato, Venice, Senato Terra Filza 326, cc.12r–v. Hopkins (2000), 405–416. 72 Giandomenico Romanelli et al. eds., Dogana da Mar: la punta dell’arte (Milan: Electa, 2010). For earlier examples of views with things “missing” or in the “wrong place”, see Andrew Hopkins, “Sights and Sighs in the Serenissima c. 1610: Built architecture and its depiction”, in The image of Venice: Fialetti’s View and Sir Henry Wotton, eds. Deborah Howard et al. (London: Paul Holberton, 2014), 82–99. 73 Venezia e la Peste, 277–278; Niero (1988), 137–140. 74 Hopkins (2000), 75–81. 75 Preto (1984). Andrew Hopkins, “Venezia e il suo dominio”, in Storia Dell’architettura Italiana: Il Seicento,eds. Aurora Scotti Tosini (Milan: Electa, 2003), Vol. 2, 400–423. Suzanne E. Hatty and James Hatty, The Disordered Body: Epidemic Disease and Cultural Transformation (Albany: State University of New York Press, 1999), Chapter 6 discusses the disparagement of women and the poor during the plague in Florence. 76 Preto (1984). 77 Andreina Griseri ed., Piranesi tra  Venezia  e l’Europa (Firenze: Olschki, 1983). Andrea Gottdang, “Da Tiepolo a Tiepolo: Esperienze visive a  Venezia  tra Barocco e  Illuminismo”, in “La Città dell’occhio”. Dimensioni del Visivo Nella Pittura e Letteratura Veneziane del Settecento: Rappresentazione – Manipolazione – Creazione, eds. Barbara Kuhn and Robert Fajen (Rome: Viella, 2020), 67–102. David T. Gies and Cynthia Wall eds., The Eighteenth Centuries: Global Networks of  Enlightenment (Charlottesville and London: University of Virginia Press, 2018).

2 Anatomy, Microscopy, and Satire Looking at Cholera in Early Nineteenth-Century England Ann-Marie Akehurst

Introduction Originating in India, “Asiatic” cholera spread to Europe early in 1817 in the first of four pandemics. It was only during the second outbreak, which lasted from 1826 to 1837, that it entered Britain late in 1831, reaching London in February 1832 where it claimed between 4,000 and 7,000 lives. The authorities were ill-prepared for this new pathogen and failed to work cooperatively. Physicians disagreed on disease management, and mistrust of the medical profession by poor people generated cholera riots. Though Britain was becoming the world’s first industrialized economy, with a burgeoning international trading empire, it was yet to modify its mediaeval administrative and governance structures. Before modern science and the widespread acceptance of germ theory, populations had few options other than to adopt the containment practices developed in late mediaeval Venice as detailed by Andrew Hopkins in Chapter 1. In the third decade of the nineteenth century, when the benefits of the anatomical and microscopical knowledge, developed from the Renaissance onward, were becoming widely accepted, medicine was still in the early stages of effective disease control. Although faith in science—then called “natural philosophy”—was growing, embedded folk responses to plague were all many had recourse to. While the early modern religious Providentialism that had shaped attitudes to previous epidemics had largely dissolved, the ever-present threat of death loomed over a still Christian country. This chapter discusses graphic satire that addressed the public health crisis of England’s 1831–1832 cholera epidemic. It extends valuable research in the social history of medicine and public health, as recently published by Mark Jackson and Keir Waddington.1 Waddington advocates for the inclusion of subaltern voices in the social history of medicine but much satirical art is produced for and consumed by state agents and elites, and is necessarily occasional, rather than quotidian.2 Nevertheless, pandemic disease is definitionally transnational and inclusive. Moreover, the disciplinary approaches here are explicitly art rather than social historical; despite that, this chapter is well-aligned with Waddington’s historiographical recommendation to avoid narratives of progress, and— since the graphic satire of cholera fused traditional graphic tropes with contemporary cultural references—it illustrates what Waddington calls “blended modernity.”3 Disciplinary perspective is key here: Waddington’s Introduction to the Social History of Medicine includes pertinent themes and flags some historiographical pitfalls, but the images he includes are simply illustrative, demonstrating what Britain’s most prolific socio-cultural historian of medicine, Roy Porter, called his previous personal “blindspot” in his exuberant self-proclaimed epiphany—when he turned to medical art in 2001.4 DOI: 10.4324/9781003294979-4

42  Ann-Marie Akehurst Admitting he had “never seriously examined images or grappled with visual evidence,” Porter’s lavishly illustrated and wide-ranging cultural analysis focuses on eighteenth- and nineteenth-century medicine, politics, medical illustrations, and portraiture.5,6 Detailed analysis such as this treats graphic representations as historical evidence in their own right. Methodologically this chapter sits alongside Porter, and Fiona Haslam’s Hogarth to Rowlandson: Medicine and Art in Eighteenth-Century Britain that looks at the traditions of caricature and medical illustration that employed and subverted traditional ­emblematic images while highlighting their relation to literature and their ­influential longevity. So,  while the prints are set in broad socio-cultural, political, and scien­ tific ­landscapes—and cast light on public responses to the management of contagious ­disease—the focus is on the ways in which epidemic was represented. In the context of satirical prints produced during Britain’s first cholera encounter drawn from London’s Wellcome Collections, particular mention must be made of the medical historian Richard Barnett’s The Sick Rose: Disease and the Art of Medical Illustration, published by the Wellcome Collection in 2014.7 Barnett’s volume showcases over 300 of Wellcome’s vast collection of images. After introductory essays, he divides the survey into clinical categories. This present chapter extends Barnett’s excellent sociocultural description of medical art production by applying the analytical perspectives of art history to excavate the fine-grained and deep historical roots of ways of seeing, and by locating images of cholera in European traditions of art history and contemporary culture they responded to and shaped. This chapter then focuses on prints that circulated in educated circles relating to Britain’s first encounter with the cholera global pandemic. Pandemics are enduring and international, and the art capturing the epidemic parallels these aspects, fusing ancient graphic tropes from continental Europe with indigenous cultural references to challenge the management of a social catastrophe. It sets the prints in the context of medico-scientific knowledge from seventeenth-century New Science to the dawn of nineteenth-century scientific medicine.8 It concentrates on British reactions to this unfamiliar disease, before the emergence of the concept and practice of public health, and the systematic epidemiology that was to shape more effective clinical interventions during the later epidemics of the 1840s and 1850s. The 1831–1832 outbreak occurred at the end of a golden age of British graphic satire that evolved from the work of William Hogarth, through the careers of James Gillray and Thomas Rowlandson, and culminated in that of George Cruickshank.9 The constituent characteristics of that register of engraved prints in eighteenth-century England were succinctly anatomized by art historian Mark Hallett: …graphic satires of the period were critical hybrids that reworked a wide range of literary and pictorial methods circulating in contemporary London, and played them off against each other. The prints we shall be looking at thus need to be understood as active repositories of signs that offered and foreclosed a variety of readings. They are objects whose meanings were generated as much by their engagement with other images and texts as by their self-sufficiency as individual works of art. In graphic satire, it is important to stress, these kinds of exchange were not something to be hidden away or denied. They were an intrinsic part of a satirical engravings cultural and commercial appeal. For the contemporary viewer, graphic satire was appreciated both for the force of wit of its attacks on the figures and fixtures of political and social life, and also for its forms of representational dialogue, appropriation and play.10

Anatomy, Microscopy, and Satire  43 The prints discussed here demonstrate the same breadth of intertextual reference, but while Hallett’s subject matter was largely the social and political culture of eighteenth-century England, this chapter offers close readings related to the culture of science and medicine, supplementing the literature on British visual culture of the late eighteenth and early nineteenth centuries that typically focus on history painting, Neoclassicism, and the rise of Romanticism.11 In tone, this late-golden-age satire offers a visual counterpart to the novels of Jane Austen that were published in the nineteenth century yet adopted the eighteenth-century stance of rational skepticism. Indeed, while Britons’ mastery of science and technology generated far-reaching innovations, they did so while national identity continued to be shaped in large part by a backwardlooking cultural conservatism that valued tradition and history. Not only are they out of time then, but they are also out of place: drawing on European art while the epidemic highlighted the nation’s geographical location that was close to, but distinct from, continental Europe. This chapter is loosely structured following the epidemic timeline, starting in 1831 with the clinical naiveté of the medical profession, authorities’ complacency and political distraction, and the subsequent emergence of conspiracy theories, social unrest, and conflicted attitudes toward the medical profession during the epidemic. It concludes by balancing the emphasis on scientific skeptical rationalism with a reminder of the enduring Christian culture in which these events took place. The chapter traces long-established graphic tropes from the Italian Renaissance and Dutch Golden Age related to the construction of medico-scientific knowledge in the emerging fields of anatomy and microscopy that were to underpin medical progress. It relates the rise of graphic satire to that of scientific skepticism from the late seventeenth century. By excavating the graphic dialects articulated, these close readings offer granular detail of the British response to the epidemic that harnessed the European scientific gaze to indigenous cultural references of folklore, myths, popular ballads, and literary culture. It thus locates this slice of graphic satire in the realm of the art of science and medicine, which they both referenced and subverted to reflect the social chaos cholera engendered. The prints circulated in what Jürgen Habermas designated the public sphere that he argued emerged in the long eighteenth century: the years between the Great Plague of 1665 and the cholera epidemic.12 A highly literate bourgeois class generated a new arena of public opinion shaping their production, composition, and consumption. In England, it was only during and after the 1848 cholera outbreak that problems of transmission were effectively addressed since they necessitated greater epidemiological knowledge, financial and governance reform, and, crucially, political will. These prints, which reflect the earlier outbreak and were circulating in the public sphere, were a platform to critique the shortcomings of epidemic management. It is argued therefore that they were in part constitutive of the subsequently emerging notion of public health.13 It will be argued that Habermas’ public sphere reflected a patriarchal social structure.14 Women were excluded from the coffee houses, clubs, and places of association identified as key spaces for the exchange of ideas. The prints were produced by men, and agency is given to the men depicted while women are represented as passive victims of the disease, reinforcing nineteenth-century gender assumptions. However, one anonymous representation of a female cholera victim titled “The Appearance after Death of a Victim to the Indian Cholera” is located in the dignified complementary graphic tradition of antiquarian recording of funereal monuments, highlighting the enduring importance of Christian values.

44  Ann-Marie Akehurst By doing so they nuance Habermas’ assertions of the secularity of civil society, ­ emonstrating the persistence of religious culture and complicating the simple binary of d science versus religion.15 Recently, the social psychologist Ivana Marková has complicated the historic opposition between mythos—traditional folk narrative—and logos—rational analysis of phenomena—as competing ways of acquiring and processing knowledge.16 She challenges the notion that rational reasoning associated with the Enlightenment replaced mythical thinking. In the context of contagious disease, recent psychological studies have detailed how imagery associated with the treatment of contemporary epidemics such as AIDS/HIV and Ebola has reinforced fears and anxiety as much as offered reassurance. This chapter will demonstrate how the satirical cartoons addressing Britain’s cholera epidemic fused scientific and rational modes of representation with traditional myths and figures and contributed to a wider understanding of the need for public health measures. Cholera, Doctors, and the Public Sphere As Andrew Hopkins has shown, from the fifteenth century, alongside religious votive practices, Venetian authorities identified islands as the safest locales to quarantine victims and those suspected of contagious disease. As an archipelago, nineteenth-century Britain had not suffered pandemic disease since the seventeenth-century outbreaks of bubonic plague (Yestinia pestis), most notably in the 1665 London Great Plague that killed 100,000. In 1720, with that cataclysm still in living memory, fear of its virulent recurrence in Marseilles prompted British quarantine legislation and a flurry of publications from authorized and informal medical quarters giving preventative advice, but the island status kept the nation safe. With the expansion of international travel, a small quarantine or pest house was established in 1764 on the remote island of St. Helen’s, one of 50 uninhabited islands in the archipelago of the Isles of Scilly, in the South West Approaches to England, 300 miles from London. Important naval hospitals were established on peninsulas at Haslar, Gosport, and Stonehouse, near Plymouth.17 Concerns about the infringement of personal liberties through confinement at home or in institutions were compounded by lack of epidemiological consensus between miasmatists and contagionists regarding the efficacy of quarantine. Consequently, the authorities continued to use marshland at Chetney Hill, in Kent, on the Thames estuary to confine suspected ships and cargoes. The lazaretto—taking 50 years to plan and 15 to construct at huge expense— stands as an emblem of the enduring tensions in managing contagious disease in England. As the architectural historians of government building observed: “the combined efforts of Sir John Soane, James Wyatt and John Rennie merely produced a building which was not only never used but was pulled down before it was finished.”18 Britannia ruled the waves and—using quarantine facilities abroad—seemingly kept overseas contagion at bay for over a century. But then it succumbed to the second Asiatic Cholera pandemic originating in “British India” and referred to as “Indian Cholera.” Cholera differed from plague, being transmitted through feces-contaminated foods and river water. It entered northern England at Sunderland in September 1831 and in November news of it reached London.19 The Wellcome Collections hold a drawing they identify as from The Lancet medical journal.20 Though so far not precisely located, the drawing is likely to come from the correspondence series in which the symptoms were shared. In “Blue Stage of the Spasmodic Cholera” (Figure 2.1), the victim’s body is stiffly twisted to face the viewer; her clawed

Anatomy, Microscopy, and Satire  45

Figure 2.1 Anon., Blue stage of the spasmodic Cholera of a girl who dies in Sunderland, November 1831, published in The Lancet. Credit: Wellcome Collection. Attribution 4.0  International (CC BY 4.0).

extremities, leaden-blue pallor, and exophthalmic face characterized cholera in subsequent representations. The hearth and kettle in the background are suggestive of attempts to mitigate perceived chilling. This lithograph probably operated as field notes for physicians anxious to understand the unfamiliar disease. Lithography was an emerging technology enabling artists to swiftly record directly on stone, from which a stereotype mold was made that could be quickly reproduced—an ideal medium for such journalism.21 In style it originated in early modern Netherlandish representation and followed a type of naturalistic descriptive pictorialism associated with the scientific gaze discussed below.22 The embrace of new technology like lithography—though shortly superseded by photography—was characteristic of elite early-nineteenth-century national culture, ­ charged with the optimism of its benefits in contributing to the British Empire. Yet the scientific and technical underpinnings of the progress of medicine were not yet sufficiently manifest, and social attitudes toward the medical profession remained ambivalent. Knowledge construction of the working of the body and its systems—in progress since the sixteenth century—was only slowly shaping medical practice that was still influenced by ancient untested theories. In the context of contagious disease, the miasma theory held—from antiquity—that those epidemics were caused by miasmata, emanating from rotting organic matter and transmitted via foul smelling vitiated—“spent”—air. Buildings housing large numbers of people in close proximity, such as hospitals and prisons, were known to propagate contagious diseases like typhus (gaol fever) and dysentery. They were increasingly designed with opposing windows for through ventilation, or free-standing pavilion blocks. But only in the later eighteenth century had ventilation

46  Ann-Marie Akehurst systems been developed.23 The social reformer John Howard toured Britain and then Europe, critically assessing institutions’ salubrity. Meanwhile, a team of French doctors and engineers, seeking ideas for their new Parisian hospital, toured England in 1780s and settled on the Royal Naval Hospital Stonehouse as their model.24 With increased travel allied to imperial expansion, naval physicians gathered new information and published their observations.25 Late eighteenth-century Britain was in the forefront of institutional infection control, but while interventions addressing acute and traumatic injury were made by architects and military personnel, public health was less a priority: scavenging detritus and street cleaning became essential parts of creating a healthy city, but physicians often kept themselves at arm’s length from their patients. The early modern British medical profession grew in social status. Respectable university-educated physicians—whose theoretical knowledge was validated by the architecturally imposing Royal Colleges of Physicians in London and Edinburgh—attended wealthy patients at home, in their personal apartments, or by visiting local hospital consulting rooms on an honorary basis. Meanwhile, the profession of surgery evolved from its ancient association with butchery to establishing a separate Company of Surgeons in 1745, which was ratified in 1796 by a new modernizing constitution and imposing accommodation it still occupies. Early-nineteenth-century doctors were gentlemen. In discussing their collection of medical portraits, the Royal College of Physicians of Edinburgh affirm: “The unadorned plain black suit with a white shirt and cravat that increasingly became uniform throughout the eighteenth and nineteenth centuries and came to stand for the serious professional.”26 Their smart clothing often remained unruffled as most physicians resisted the haptic aspects of medical practice: it was not uncommon to prescribe remotely, and their practices were effectively small businesses leaving them open to the accusation of self-interest.27 By the early nineteenth century, then, the group of somberly dressed doctors, often carrying a cane of office, were visual clichés, and graphic artists satirically disrupted these dignified compositions during the nineteenth-century cholera pandemic. The criticism that physicians exploited epidemics as personal income generators had been voiced before 1831 in Temple West’s Address of thanks from the faculty to the Right Hon.ble Mr Influenzy for his kind visit to this country (1803) in which sycophantic medics paid court to emaciated Mr. Flu on his close stool, characterized as a Frenchman by his bonnet rouge. The scene is populated with outstretched palms, highlighted in some versions of the print. It plays on the ancient emblem of the College of Physicians: one hand taking the pulse of another, symbolizing the act of diagnosis that is readily conflated with an outstretched—or grasping—hand. Such beliefs were reprised in A London Board of Health Hunting after cases like cholera (Figure 2.2), where the doctors sniffing out cholera reinforce the miasma theory. The cartoonist draws an equivalence between the rounded flanks of the myopic physicians seeking an additional source of income and the pig in its sty. He draws attention to the scatological consequences of cholera infection while the sign advertising Rats’ meat sold here evokes the long-held association of rats with contagious disease. Physicians are drawn away from the ordered and polite surroundings of their consulting room to sniff out disease in the straw-lined spaces of hovel dwellings, motivated not so much by the public good, but by financial self-interest; their sober formal attire jars with the unaccustomed insalubrious environment. In these prints—and many others—physicians are represented as a coherent social group. Underlining their critiques, such satirists simultaneously align with and disrupt an enduring compositional convention that emerged—along with the

Anatomy, Microscopy, and Satire  47

Figure 2.2 A London Board of Health Hunting after cases like cholera. Lithograph, 1832.  Credit: Wellcome Collection. Public Domain Mark.

importance of secular bourgeois civil society—during the Dutch Golden Age: the group portrait, the primary exponents of which were Rembrandt van Rijn and Frans Hals.28 The Wellcome Collections holds copies of Regenten van het Oude Mannenhuis [The Regents of the Old Men’s Almshouse], a group portrait of five regents (public benefactors) and their servant painted by Hals in 1664 for the Oude Mannenhuis in Haarlem. These six half-length portraits capture the regents in three-quarter or full face, which was a moderately expensive format. While their faces reflect individual character and disposition, the uniformity of their pious black and white clothing unifies them as a cohesive social group. Such paintings were hung in the regents’ meeting room or other prominent locations. The representations were coterminous with the rise of bourgeois humanism and the emerging public sphere as characterized by Habermas.29 These dignified group portraits subsequently offered an ideal model for portraying physicians who were effectively small businessmen competing for patients, or, from a cynical perspective, a self-interested social group profiteering from epidemics. So why is seventeenth-century Dutch art relevant in this context? Because the close readings offered here require extensive archaeology and contextualization. The physical and commercial proximity of Britain and the Netherlands—just a short sail across the North Sea—was increasingly cemented by shared Reformed Protestant worship, the development of New Science, and the installation in 1688 of the Dutch Stadtholder as King William III. The visual and social culture of the Netherlands at the height of the Dutch Republic (1588–1795) offered powerful protestant models for the nascent British culture of commercial, empirical, pragmatic skepticism. Margaret Jacob has identified the emergence of a “new public culture found in northern and western Europe,” starting in

48  Ann-Marie Akehurst the seventeenth century, described as “a godly Enlightenment—born out of their r­ eading of the New Science.”30 This fresh mental space, as Jacob characterizes it, was fueled by “global trade, conquest, and colonization; and Newtonian science, which offered an unprecedented body of universally applicable laws of nature subject to mathematical and experimental observation.”31 In the context of medicine, many—if not most—of Britain’s doctors had studied at Leiden, one of Europe’s great centers of medical education.32 Doctors were unusually well-networked internationally; the peregrinatio medica was a kind of medical Grand Tour, with students training in primary European centers, most notably Padua, Bologna, Paris, Montpellier, Göttingen, and Edinburgh. But in society more broadly, Dutch scholars and artists also visited England: in the specific context of the transmission of scientific modes of perception and representation for our purposes were Sir Peter Lely who settled in England, where he became the dominant court portrait painter, and the natural philosopher Christiaan Huygens who was a member of the Royal Society and a regular companion of Robert Hooke as we shall see.33 During the Dutch Republic, social and medical care, which prior to the Protestant Reformation was conducted in monastic houses, was relocated to publicly funded hospitals and alms houses.34 It was an institutional model embraced in mid-eighteenth-century England that eventually saw the founding of provincial corporately-funded voluntary hospitals; physicians who attended there had their names recorded alongside the great and good on subscription boards, advertising their philanthropy and positioning them in the moral ruling elites. We will return to the medical profession later, but the influence of European modes of representation recurs throughout this discussion. Separated by water from the Continent, Britain enjoyed a liminal relationship with its European neighbors. While most Britons may not have traveled across the sea and enjoyed homegrown visual and literary culture, the political elites, artists, physicians, and natural philosophers—the makers, subjects, and consumers of the images under discussion—were internationally sophisticated. The Royal Navy that enabled trade and empire was endlessly celebrated in native culture as a protector in times of war and a symbol of technical progress and mastery of the natural world. Consequently, cartoonists anchored enduring European models to indigenous cultural references, creating distinctively British cartoons that stood at arm’s length to the rest of the world. Rule! Britannia: Patriotism, Hubris, and the Maritime Empire This stance is clearly demonstrated in one particular print. England’s response to the emerging crisis was slow and characterized by complacency, sclerotic lines of authority, and mediaeval administrative systems. Though cholera first appeared in September 1831, it reached London in February 1832 amid a charged political situation alluded to in the ambiguously titled: John Bull Catching the Cholera as discussed by Amanda Sciampacone in Chapter 6 where the print is reproduced in color as Figure 6.1 (Figure 2.3). Here the cadaverous blue personification of cholera—wearing an Indian turban ­surmounted by a death’s head—characterizes the disease. England is protected by Boards of Health and aggressive John Bull, that robust eighteenth-century personification of national character. Bull—a name reflecting the apparent national appetite for roast beef—was popularized by Hogarth and others and is conventionally dressed as a stout, choleric country farmer in red, white, and blue. The confrontation illustrates tensions between a national identity crystalized by William Shakespeare as “this sceptred isle […]

Anatomy, Microscopy, and Satire  49

Figure 2.3 John Bull Catching the Cholera, c. 1832. Lithograph with watercolor, 25 × 19 cm. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark.

50  Ann-Marie Akehurst this fortress built by Nature for herself/Against infection and the hand of war” on the one hand, and Britain’s trading empire, on the other.35 It reflects the misplaced confidence that the “wooden walls of Old England”—a patriotic reference to its fleet—could protect Britain from assault of infection from the colonies.36 Bull throttles Cholera with a club of “hearts of oak” alluding to a lyric of the same name composed by David Garrick for the opera Harlequin’s Invasion (1759). Oak trees were national symbols, associated with the preservation of King Charles II when escaping during the civil wars, and were crucial in the construction of the fleet. The lyrics focus on naval repulsion of foreign invasion, its refrain echoing the assertion in James Thomson and Thomas Arne’s 1740 Rule! Britannia about Britons’ freedom from slavery.37 Repeated appeal to the navy in such patriotic songs reflects embodied pride in Britain’s maritime culture, essential for its intertwined concerns of trade and empire. The insistence upon freedom from slavery is better understood in the context of growing unrest in Britain’s West Indian plantations. The year 1823 saw an uprising of more than 10,000 enslaved people in the British colony of Demerara-Essequibo Guyana, and just months after cholera arrived, the Great Jamaican Slave Rebellion of 27 December 1831 involved more than 60,000 enslaved people, resulting in more than 500 deaths and over 300 executions.38 Maintaining the transatlantic slave trade and the West Indian sugar plantations necessitated long-distance sailing. From the seventeenth century, Britain competed with the Dutch and French for maritime supremacy and by the mid eighteenth century had the world’s most powerful navy. The scientific and technological advances making this ­possible—such as the navigational tools associated with the Royal Greenwich Observatory and the work of the Board of Longitude—underpinned national confidence.39 Not only did horologist John Harrison’s astonishing artisanal skill produce a series of innovative ships’ chronometers that paved the way for faster, more accurate, maritime navigation, but the concomitant mass production shaped processes driving the world’s first Industrial Revolution. In the year of the epidemic, the author of A very brief account of the Chronometer recorded “the very general adoption of the Chronometer, particularly in long voyages, is the best proof of its value; and it is more than probable, that, in a very few years, no vessel will sail without one.”40 This synergy of skills evidenced Britain’s scientific and technological global superiority, licensing the confidence underpinning John Bull Captures the Cholera. The belligerent othering of cholera seen in this and other cartoons as Robert Seymour’s Cholera Tramples the Victor & the Vanquished Both (1831), as discussed by Amanda Sciampacone in Chapter 6, (Figure 6.3) assumed the “sceptred isle” was protected by the sea, navy, and stout national character, reflecting optimistic complacency and exceptionalism that its island status conferred safety. However, that confidence was hubristically misplaced because the pandemic was to demonstrate that Britain’s governance remained mediaeval. In John Bull, Cholera lunges for a rolled-up paper titled Reform Bill but Bull defensively stands astride it. In this significant moment in British constitutional history the Reform Bill extended the political franchise and enlarged units of authority.41 But when cholera assailed national defenses, Britain’s governance apparatus was unfit for purpose. Inflexible legal and financial frameworks were the antithesis of the responsive system necessary for epidemic management, while misplaced belief in Britain’s invulnerability, government resistance to empowering local authorities, and legal and epidemiological confusion wasted vital time.

Anatomy, Microscopy, and Satire  51

Figure 2.4  The Cholera Morbus!!! John Bull being examined by eight doctors representing ­politicians, who diagnose his illness as cholera. Lithograph, c. 1832.  Credit: Wellcome Collection. Public Domain Mark.

Cholera’s ubiquity meant it became a metaphor for social ills. In one anonymous l­ ithograph, The Cholera Morbis (Figure 2.4), John Bull’s scrutinized figure stands for the body politic, his patriotic garb replaced by invalids’ clothing. The flanking team of doctors—now identifiable politicians—interrogate his symptoms, but, in a terrible pun, Bull attributes his weakness not to cholera but to a weak constitution. This was not a new trope: Samuel de Wilde’s John Bull in a Fever (1803) used the personification amid partisan disputes about political reforms.42 It is interesting to compare these with the contemporary but more classical French satire. Le Commerce Attaqué du Choléra Morbis Et Traité Par Le Ministère (c.1832) deploys social stereotypes of the effete diplomat and the finance minister deferring decisions, yet differs in one important respect: here Mercury—the Roman God of commerce limply holding the caduceus in his right hand—denotes the French economy rather than any national personification.43 Though the composition of a patient flanked by a team of advisors—politicians standing in for doctors—is familiar from British examples, its setting is a grand salon illuminated by windows set in classical frames, visible in some versions of the print. By contrast, in John Bull Catching the Cholera the national personification is aggressively active and follows in the tradition of Hogarth. British political satire referenced the wealth of contemporary and elite English drama, literature and popular ballads, indigenous myths, and fairy tales to give voice to a graphic mode that was patriotic, maritime, and scientific, confident, and skeptical at one and the same time.

52  Ann-Marie Akehurst The Skeptical Concerns of the Scientific Gaze The Royal Society of London for Improving Natural Knowledge, more commonly known as The Royal Society, is the world’s oldest scientific institution and was central to driving Britain’s scientific and technical advancement. It was established in 1660 with a motto that embodied the skepticism of the scientific method adopted by natural philosophers: Nullius in Verba, rendered in English as “take nobody’s word for it.” The members and processes of the Royal Society itself were satirized in Thomas Shadwell’s play The Virtuoso (1676), and later in Jonathan Swift’s novel Gulliver’s Travels (1726). So, long before the cholera epidemic, the Enlightenment emphasis on rationality was a constituent part of a great revival of satire in British visual, literary, and performing arts, often harnessed to partisan politics. As a counterweight to scientific optimism, skepticism was voiced by an extensive list of dramatists, poets, and novelists including well-known exponents John Dryden, Alexander Pope, Samuel Richardson, Henry Fielding, and Laurence Sterne. The integration of the visual and textual is important here as British graphic satire sits somewhere between the two, calling on the visual arts associated with scientific representation as much as poetry, music, and folklore. In the pictorial arts, Hogarth’s agenda to develop a distinctively British voice, allied to his social critique, qualified him to be regarded as a father of English graphic satire; his progeny were James Gillray, Thomas Rowlandson, and George Cruickshank whose biographer calls a “disciple of Hogarth.”44 They were the stars, but less well known today is the work of the Scots illustrator William Heath to whom we now turn. Experimental philosophy and its hands-on partner engineering were drivers of the British industrialization, and scientific exhibitions and displays became popular across the nation, fueled by the expansion of provincial literary and philosophical associations.45 Though the fact that cholera is water-borne was only better understood as an infection vector later, there was a long-held concern among the educated classes about drinking water quality and what it contained. Just a few years before the outbreak, in 1828, William Heath played on elite anxieties about water’s hidden dangers and the fashion for microscopy with his Microcosm—subtitled Monster Soup commonly called Thames Water being a correct representation of that precious stuff dolled out to us (Figure 2.5). Compositionally it is very simple: a well-dressed female viewer holds a small microscope against the circumference of a gigantic circle representing a magnified water droplet filled with grotesque aquatic creatures. Terrified, she drops her teacup. The title evokes Rudolph Ackermann’s The Microcosm of London (1808–1810)—a collaborative collection of luxury prints, based on 104 architectural drawings by the French émigré Auguste Charles Pugin, and populated by figures drawn by Rowlandson. This expensive synoptic series showcased London’s spaces and people to the leisured and wealthy classes and was described by Ackermann in the introduction to the third volume as “A new mode of displaying objects already known, has, in some degree, the merit of discovery; especially when they are not generally accessible.”46 As art historian Jonathan Jones recently observed, “If the scientific revolution taught the British to look, London gave them plenty to look at.”47 Ackermann’s audience was the same as that for the exhibition Microcosm, A Grand Display of the Wonders of Nature responding to an appetite to see, interpret, and understand parts of the natural world inspected through a microscope.48 The exhibition took place in London’s fashionable Regent Street named for George, the Prince Regent, designed by the architect John Nash and newly completed

Anatomy, Microscopy, and Satire  53

Figure 2.5 William Heath, Microcosm: Monster soup commonly called Thames water, being a correct representation of that precious stuff doled out to us!!! Colored etching by W. Heath, 1828. Wellcome Collection. Credit: Wellcome Collection Attribution-NonCommercial 4.0  International (CC BY-NC 4.0).

in 1825.49 The exhibition invited visitors to “look into the secrets of nature” through a microscope. Forty prepared slides revealed parts of the vegetable, animal, and mineral world, including a slice of twig from a lime tree, a louse, and a piece of iron ore. This growing popularity of microscopy was characteristic of Enlightenment science when exponents toured the country demonstrating scientific instruments.50 The exhibition of paintings and scientific experiments was part of the expansion of visual culture associated with increasing urbanism from the late eighteenth century for the educated classes.51 They demonstrate Marková’s argument that “Sciences had a profound effect on public education, but they did not eradicate myth.”52 Rather they were an inspiration for the invention of new myths. Responding to these interests, new types of painting emerged focusing on the public demonstration of experimentation, in particular the extraordinary chiaroscuro works by Joseph Wright such as An Experiment on a Bird in the Air Pump (1768) and A Philosopher Giving That Lecture on the Orrery, in Which a Lamp Is Put in Place of the Sun (1766) that complicate philosophies of air and light related to life. The imagery advertising the exhibition Microcosm, and used by Heath, had been established in the seventeenth century and disseminated in England through Robert Hooke’s monumental Micrographia, published under the imprimatur of the Royal Society.53 It is from the development of optical devices, and the language recording their revelations, that Hooke found his visual vocabulary. An important transitional moment in the history of the art of seeing can be located in the optical concerns of Jan Van Eyck, and became the province of experimental philosophers

54  Ann-Marie Akehurst in the seventeenth century.54 Recently, in his biography of a major figure in the scientific revolution, the Dutch scientist Christiaan Huygens FRS, Hugh Aldersley-Williams has argued that the collocation of fine sand and big skies with a glass-making culture in the Netherlands led to the precocious development of optical instruments and graphic representations of sights they revealed.55 These resonated with British experimental philosophers since they articulated a manner of representation that aligned with religious and cultural preferences. In The Art of Describing: Dutch Art in the Seventeenth Century, Svetlana Alpers distinguished between the classical, perspectival, and narrative styles of graphic realism associated with the Italian Renaissance and those that she associated with the Protestant north-western Europe. She argued, “Perhaps because of the theoretical weight given internationally to disegno (the conceptual role of drawing in the invention of images), the craft and social utility of tekening (the Dutch word for ­drawing) has not been defined.”56 Alpers traced the development of Netherlandish techniques for representing the world without rhetorical or allegorical overlays. She emphasized a d ­ istinctive ethos of praxis she calls techne as key in the development of graphic representation as an epistemic tool. This lack of rhetoric in graphic representation perfectly mapped on to the requirement of the nascent Royal Society that championed the scientific method and established protocols of knowledge dissemination in objective “plain” language, devoid of rhetorical flourishes.57 Its graphic corollary was the new visual grammar, developing across Europe, that held sway until the nineteenth-century invention of stereoscopic visual apparatus.58 Robert Hooke developed that language through his interest in optical devices shared with Huygens.59 One of Europe’s most gifted natural philosophers, and briefly apprenticed to Sir Peter Lely, Hooke was the polymathic Curator of Experiments of the Royal Society. He was an accomplished draftsman and scientific instrument maker, skills perfectly equipping him to represent the objects he viewed. Micrographia—the first important study of microscopy—contains large-scale, finely detailed illustrations of specimens Hooke inspected under the microscopes he designed; the circle of the eyepiece acting as a frame evokes the experience of looking through a lens.60 Micrographia’s immense, wide-ranging “Preface” offers a guide to experimental philosophy and details Hooke’s experience with scientific instruments for recording natural phenomena. As an epistemic tool, in common with anatomy, objects of scrutiny were necessarily dissected, presented in isolation, and considered from multiple perspectives. Objects were multiply reproduced, enabling the viewer to understand the object in three dimensions, revealing the articulation and geometry of the smallest microcosms.61 Megan C. Doherty has recently argued, “Hooke was also aided by the visual ­vocabulary developed by engravers widespread throughout […] London, for translating a three-dimensional world into a two-dimensional representation of it.”62 Demonstrating Hooke’s closeness to London’s artistic community and engagement through print collecting, Doherty argues the illusion of three dimensions is produced through the manipulation of depth and contrast, and the play of light on a three-dimensional object. Hooke selected quotidian objects including disease vectors like the flea and louse, reproduced in monstrous detail (Figure 2.6).63 But despite appearing as real-time sketches, he enhanced flat two-dimensional microscopic images, with shadows, cross-hatching, and details such as Hooke’s own hair across the louse. Ian Lawson’s in-depth discussion compares Hooke’s artistic contribution in the published images to a working drawing of an insect discovered in a Natural History Notebook and Commonplace Book.64 Hooke’s artistic digestion of multiple viewings produced a type of verisimilitude. Replicating the critical gaze of the scientist, such

Anatomy, Microscopy, and Satire  55

Figure 2.6 Engraving of a flea in Micrographia, or some physiological descriptions of minute bodies made by magnifying glasses. With observations and inquiries thereupon, 1665, by Robert Hooke. Wellcome Collection. Credit: Wellcome Collection Attribution 4.0  International (CC BY 4.0).

images focused a monocular beam of scrutiny on a single object, freed from context. It became more widely used in scientific representation and was, for instance, the way physician Martin Lister taught his daughters to represent his studies of mollusks and shells.65 Micrographia was published during the Great Plague in 1665. Though not understood as transmission vectors until the late nineteenth century, plague was spread by lice and rat fleas. Micrographia’s most well-known image is the fold-out plate of a flea the actual size of a cat, simultaneously magnifying its anatomical details and health threat potential (Figure 2.6). Despite the Royal Society’s rejection of rhetoric in favor of plain recording, Hooke’s fusion of the scientific gaze with such artistic ability is a case of the same person producing scientific discovery and myth.66 This digression into seventeenth-century scientific recording becomes relevant when we understand the persistence of those preoccupations of scrutiny in nineteenth-century British visual culture. The role of graphic satire to cast light on, magnify, and critique social behavior was clearly acknowledged in the suggestive titles employed by the author of Microcosm: Monster Soup, Heath, who is best known for producing the world’s first magazine dedicated predominantly to caricatures.67 The Glasgow Looking Glass, later The Northern Looking Glass, was a significant harbinger of the transfer of caricature from prints to journals. In the titles of these, and the later short-lived London magazine,

56  Ann-Marie Akehurst The Looking Glass, Heath extends the optical metaphor of skeptical scrutiny to social and political satire that held a mirror to society. Drawing extensively from British graphic and literary culture, including national poets John Milton and William Shakespeare, was characteristic of Heath’s subsequent satire as we shall see and indicative of the breadth of his cultural references. Microcosm: Monster Soup uses the same language of scientific recording developed by Hooke and, before him, the Dutchman Anthoni Leeuwenhoek’s diertgens—the little animals he discovered by looking through a microscope at lake water.68 Heath’s water droplet contains a range of imaginary creatures, from tiny single-celled organisms to three-dimensional marine life resembling fish, crustacea, cephalopods, and whales. Uniting them are open maws, bulbous eyes, and sharp extremities—all of which imply the infliction of pain and aggressive desire to consume; the hidden dangers of water made manifest to all. The print’s potency comes from the change of scale: what are in life minute organisms are magnified not only so they can be perceived by, and terrify, the viewer, but are amplified to a gigantic scale, echoing the enormity of their presence and threat to the water supply of the metropolis. As with Microgaphia, this fusion of the scientific and imaginative is illustrative of what Marková describes as how: “the scientific process itself often contributes to the creation of myths.”69 “The Health of the People Is the Supreme Law” The first cholera victim died in Sunderland in September 1831, and gradually the English authorities awoke to the necessity of raising public attention to counter the sort of misinformation that spreads during pandemics: even in the august journal The Lancet, an anonymous correspondent called it a “government hoax got up for the purpose of distracting the attention of the people away from the Reform Bill.”70 A handbill addressed the inhabitants of the working-class London Parish of Clerkenwell (across Europe, districts were divided into parishes that were both ecclesiastical and secular jurisdictions). It publicized cholera’s symptoms: giddiness, sickness, nervous agitation, slow pulse, cramp beginning at the fingers and toes and rapidly approaching the trunk; change of colour {sic.] to a leaden blue, purple, black, or brown; the skin dreadfully cold and often damp; the tongue moist and loaded but flabby and chilly; the voice much affected; and respiration quick and irregular.71 The bill bears unwitting testimony to the range of authorities overseeing England’s epidemic management: it is published on the highest authority in the land, the Privy Council, and the content was generated by a regional committee of physicians called the Board of Health. It is signed by the local Churchwardens who had general administrative control over the district. A footnote references Sir Gilbert Blane whose research on cholera reflected his career as a naval physician who engaged in prevention of ill health.72 Blane was consulted by the Home Office on public health matters relating to prisons and convict ships, recommending improved ventilation, decreased crowding, and an adequate diet. He believed cholera was contagious—a view not then universally shared.73 Notwithstanding his recommendations, his wife sadly succumbed to the disease in 1832. Just as the public sphere emerged from social changes concomitant with the early industrial capitalist society, so public health was not yet a fully formed notion, and only truly evolved after this epidemic, crystalizing around the mid-nineteenth-century cholera outbreak. England’s woeful shortage of hospitals had only been addressed in the ­provinces from the 1740s, and they dealt primarily with acute and traumatic problems, not epidemic disease. It was only eighteenth-century political radicalism that engendered community dispensaries.74 For instance, York’s Dispensary for the Poor was established by doctors in 1788 in the medieval Merchant Adventurers’ Hall.75 It supplemented York

Anatomy, Microscopy, and Satire  57 Country Hospital by offering free attention to poor patients and addressing chronic health issues through out-patient surgeries, dental services, domiciliary maternity care, and home visits, treating 17,000 patients between 1788 and 1808. During the 1832 ­cholera epidemic, it freely dispensed advice and medicines.76 Its mission to deliver healthcare in the environment was amplified by its practitioners’ research and publications. But across the nation, controlling a city’s water supply required unified strategic planning. England’s sixteenth-century social policy was administered at a micro-level, and eighteenth-century urban development was generally allied to the profit motive. The demographers Romola Jane Davenport, Max Satchell, and Leigh Shaw-Taylor have recently argued that water supply in the early nineteenth century was a commercial rather than a public health concern.77 They give a detailed description of the problems of waste disposal in an expanding city and the complications attendant on ancient infrastructure and outdated administrative systems, demonstrating the unintended consequences in London of early sanitary innovations.78 During the cholera pandemic, George Cruickshank, then the premier illustrator, attacked profiteers in the shape of John Edwards Vaughan MP, described by his parliamentary biographer as “an unscrupulous demagogue” and “a low lived blackguard.”79 Cruickshank’s Ciceronian title Salus populi suprema lex (The Health of the People Is the Supreme Law) (Figure 2.7) is addressed to Edwards, effecting the moral link

Figure 2.7 George Cruickshank, Salus Populi Supreme Lex Esto [Let the health of the people be the supreme law]. 1832.  Header detail…© The Trustees of the British Museum [BM 1862,1217.517] Credit: The British Museum Public domain. 4.0 International (CC BY-NC-SA 4.0) license.

58  Ann-Marie Akehurst between business and governance embodied in a conflict of interest, for Edwards was the owner of water companies. Rivers were often jurisdictional boundaries, and what happened upstream impacted downstream supplies. Public health necessarily operates on both macro- and micro-scales, but Britain lacked systems for addressing large-scale problems. Cruickshank fused London’s mythical tutelary deity, Old Father Thames—a type of flowing haired Poseidon with a trident—with the classically draped and helmeted national personification, Britannia, to characterize Edwards as the Water King of Southwark. Edwards’ goblet overflows with murky liquid; his trident is impaled with small ­mammals. Wearing an upturned chamber pot helmet, he sits astride a close stool, atop an intake hemisphere inscribed Source of the Southwark Waterworks. Set at London Bridge at Low Water, slicks of raw sewage enter the river from both sides, including the culverted River Walbrook on the Middlesex Bank. Directly opposite, on the Southwark Bank, crowds implore: “Give us pure water!” and “We shall all have the cholera!” Edwards’ Southwark water company drew drinking water directly from a sewage overflow on the Middlesex north bank. Edwards’ liminal position—in the inky river—reflects his ambiguous moral status: Father Thames is contaminating London and England with excrement. His primary responsibility should have been his customers’ health, and that of the nation more broadly, but the thoughtless location of the water inlet spoke rather of self-interested profit. The Body on the Slab: Anatomizing Medical Knowledge While physicians’ authority was derived from their international university education and validated by professional membership in the Royal College of Physicians, theirs was not the only source of advice. Depending upon your degree of skepticism or indeed gullibility, quacks—as they were commonly known—were unregistered practitioners, who ranged from peddlers of traditional knowledge and remedies to acknowledged charlatans.80 Quacks—from the archaic Dutch term kwakzalver, a “seller of salve”—were a common feature of the social intersection of medical entrepreneurship and the consumer society.81 Public unrest in part characterized the national response to the 1831–1832 cholera epidemic, where authorities were too slow to act, physicians were struggling to understand the mode of disease transmission, and science offered no known cure. The therapies recommended on the Clerkenwell parish handbill include palliative domestic remedies of increasing intensity with warming strategies such as friction with flannels and applications of poultices or hot bran, and concluding with tea, spices, or in extremis laudanum (a mix of alcohol and morphine) added to warm drinks. While medical science was slowly advancing, the line between the panaceas and nostrums delivered by quacks and the prescriptions of registered physicians was blurred. Britain was a commercial nation, and quacks and physicians alike used their knowledge to line their pockets in a world where registered physicians (regulars) were no wiser than mountebanks in being able to offer a cure for cholera. George Cruickshank paid anxious attention to the epidemic as his wife was ailing.82 Having previously illustrated many fairy tales, he referenced Æsop’s fable of the Goose that laid the Golden Eggs to criticize quacks peddling alternative therapies in The Sick Goose and the Council of Health (c. 1830–1839). The composition

Anatomy, Microscopy, and Satire  59 is familiar: the seated patient surrounded by physicians, only here the patient is an ­ailing Goose, assailed by patent medicine bottles—standing in for quack doctors—recommending their remedies fearful the goose may die. The quacks/bottles are identifiable as ­registered physicians by their top hats, capes, and especially their canes of office that had become a familiar badge of the medical professional. The diminutive foreground figure of Homeopathy claims, “it’s cholera and I should prescribe a little unripe fruit—the millionth part of a green gooseberry.” Others recommend nostrums like Godfrey’s cordial, Balm of Gilead, or Blair’s Gout Pills. Notoriously divided, medical opinion is aped in a dispute between the two over the efficacy of Life Pills, no doubt a panacea that would be recommended to cure the human condition. But in the context where registered medical authorities did not understand the vectors of contagion and were publicly recommending ingesting dilute sal volatile (ammonium carbonate in alcohol, commonly called smelling salts), there was little to distinguish between them. Despite the Reform Bill’s notionally addressing inequality of political representation, the campaign surrounding its promotion generated class tension for it did not include poor people since there was a property qualification attached to the franchise. Those gentlemanly professional doctors, with their sober dress and canes of office, were obvious targets in class antagonism, and anti-doctor riots occurred during the pandemic in cities like Bristol and Leeds where a terrified mob attacked the cholera hospital.83 In York, doctors were suspected of having a pecuniary interest in promoting the epidemic and the authorities of working with them, targeting the impoverished, and harvesting corpses for dissection. This was an especially sensitive topic in Liverpool, where huge numbers of poor citizens occupied perhaps Britain’s most unsanitary city; the summer of 1832 saw eight separate street riots.84 Such tensions were reflected in Henry Heath’s Sketch from the Central Board of Health 1832 (Figure 2.8) where doctors—no longer dignified self-satisfied regents as represented by Rembrandt or Hals, but a corpulent rabble—brandish a cholera-blue scarecrow at a bewigged cleric and well-dressed valetudinarians. The Central Board of Health was the professional authority charged with public health management. Here, the cynically motivated physicians claim cholera is “Contagious to all but doctors!” and “terrible to silly women and children!” A man regards a collapsed woman as a potential bonus, rejoicing: “we must take her to the cholera hospital, we shall get a premium for this from the doctors.” Playing on the disease’s Asiatic origins, the engraving is subtitled The Real Ass-i-Antic Cholera—denoting the antics of the medical profession in manipulating the population with a disease as fictional as this manufactured scarecrow. And so, as in the case of microscopy and Heath’s Microcosm: Monster Soup we must take a detour to Europe’s long art history of anatomy for a closer reading of this subversive print. Perhaps the best-known European anatomy painting is Rembrandt’s The Anatomy Lesson of Dr Niccolaes Tulp (1632).85 Dr. Tulp was a Doctor of Medicine and Praelector Anatomiae to the Amsterdam Guild of Surgeons of whom this painting is a group portrait—a type of regents’ portrait. There are several important aspects relevant in this context: the large book in the right-hand foreground of the painting, the composition of the group of figures, and the treatment of the body. The book is assumed to be Vesalius’ De humani corporis fabrica of 1543. Andreas Vesal (Vesalius) was a gifted Flemish professor and anatomist at the Padua School of Medicine who challenged long-established anatomical knowledge constructed by Galen in the first century CE.86 In this, Vesalius’

60  Ann-Marie Akehurst

Figure 2.8 Henry Heath, Sketch from the Central Board of Health. 1832. Colored ­lithograph. Wellcome Library, London. Credit: Wellcome Collection. Attribution 1832.  4.0  International (CC BY 4.0).

most famous work, he illustrated human dissection, verifying and disseminating new anatomical knowledge. Human dissection was controversial. For centuries scholarship recycled information from antiquity without challenging its veracity, but it was only by close observation and recording that knowledge of the human body could be constructed.87 As a master of anatomy, Vesalius disseminated his observations in his lavishly illustrated work to demonstrate the isolated various body systems. The Fabrica contained refined woodcut plates, engraved by Steven van Calcar; it became a medical teaching aid ubiquitous in Europe and, in Rembrandt’s painting, it attracts the attention of three of Tulp’s audience. In his reading of the painting, the art historian Martin Kemp identifies a moment of epistemic shift in which the body becomes “the ‘book’ to be read by surgeons, rather than the set text sanctioned by traditional learning.”88 Vesalius’ cadavers are represented as animated flayed musclemen, set in classical landscapes, often adopting allegorical poses and evoking memento mori. Rembrandt’s cadaver is neither posed nor allegorical and can be seen as articulating humanist priorities. Perhaps it was influenced by Hans Holbein’s The Body of the Dead Christ in the Tomb (1521/1522), painted before the Fabrica was printed, but in the same center of humanist scholarship, Basel. Here, Christ’s emaciated body, displaying the stigmata and already corrupting—is presented from the side. Holbein—an associate of the Protestant

Anatomy, Microscopy, and Satire  61 reformer Erasmus—directs our unflinching gaze on this corporeal reality of death, ­stressing the humanity of Christ.89 Holbein’s Christ is understood as deploying the literal representational style associated with Reformed Protestant humanist priorities and the emerging scientific culture as we saw in the discussion of Micrographia. Returning to Dr. Tulp, Rembrandt’s cadaver, which has been slightly rotated toward the viewer, also resists allegory. Placed in the center of the picture plane, light falls on the torso and the surgeons’ faces, foregrounding the anatomy of the hand that is key for anatomists, surgeons, and artists alike. Rembrandt treats the cadaver with great reverence that differs in tone from Vesalius’ playful repertoire of poses. Anatomy combined epistemic enterprise and macabre practice, necessitating firsthand witnessing of choreographed dissections. The frontispiece of Vesalisus’ Fabrica established enduring graphic tropes comprising anatomy theaters’ raked seating—on a circular or elliptical plan—that directed attention to the cadaver in an architecturally ordered space that conferred dignity on the proceedings. Post-Reformation understanding of death focused on the doctrine of two bodies: the natural—biological—and the social body. Legacy and reputation concentrated on the preservation of the social body when the body natural had perished, a mentality shaping funerary monuments.90 The persistence of such concepts into early-nineteenth-century England is attested by the concerns of utilitarian philosopher Jeremy Bentham, who argued, in the year of the 1832 epidemic, that auto-icons—preserved corpses, dressed as in life, like his own preserved cadaver—would in time replace monumental sculpture.91 Consequently, the social body of convicts was deprived of respect at the pronouncement of the sentence, before dissection or display. To conclude his morality narrative The Four Stages of Cruelty, William Hogarth turned to the Fabrica for the Dissection of the Body of Tom Nero (1751). The setting is London’s Cutlerian Anatomy Theatre, then used by the Company of Surgeons (though the image is not architecturally accurate).92 Hogarth’s rendering resembles Charles Harding’s 1762 water-colored cross-sectional view of an anatomy theater, where three skeletons and three other figures—possibly musclemen like those in Vesalius’ Fabrica—are mounted between the windows.93 Hogarth recast the anatomy theater as a site of punishment with dissection as a deterrent against crime. In place of the memento mori skeleton presides the Chief Surgeon who, as Mark Hallett and Christine Riding have recently argued, resembles a High Court Judge emphasizing the process of judicial punishment.94 Above the Chief Surgeon and below the Royal Coat of arms is the familiar emblem of the Royal College of Physicians. The reverence of the proceedings is now undercut by animated jeering flanking skeletons representing named contemporary felons.95 Hogarth secularizes that enduring trope of skulls and crossed bones, in a flaming cauldron, rendering down human flesh.96 Whether or not evidence supports art historian Jonathan Jones’ assertion that “anatomy became one of Georgian England’s favorite blood sports,” it was a practice that remained in the public consciousness.97 With the growth of medical science, dissection became politicized. Surgeons, keen to understand anatomy, generated a demand for corpses. During the 1832 pandemic, political tensions concatenated with the pre-existing lower-class suspicion of doctors relating to cadavers. New medical schools and private anatomy schools required corpses to anatomize and demand outstripped supply, so body snatchers—known colloquially as Resurrectionists—exhumed corpses. High-profile cases captured public attention such as the execution in 1829 of serial killer William Burke who, together with William Hare, murdered people to supply cadavers to anatomists.98 The passing of the Anatomy Act in August 1832, permitting the use of unclaimed bodies from hospitals and workhouses

62  Ann-Marie Akehurst for dissection, in the middle of the cholera pandemic, amplified national hysteria and contributed to anti-authority circulating conspiracy theories. Those eight Liverpool ­ riots were on the back of a case of grave robbing in 1826 that saw 32 cadavers prepared for ­transport to Scotland’s famous medical centers in Edinburgh and Glasgow for dissection. Returning at last to Henry Heath’s Sketch from the Central Board of Health, the dignified interior architecture of the anatomy theater is replaced by the utilitarian block of a cholera hospital—the scene is appropriately outside since the epidemic was an environmental concern that hospitals could do little to contain.99 Heath particularizes the subject by drawing on distinctively English popular culture. A flag above the hospital parodies the patriotic ballad “‘The Roast Beef of Old England’ 10 pounds a week. Huzza!” “The Roast Beef of Old England,” a song originally written by Henry Fielding for The GrubStreet Opera (1731), was commonly sung in inaugural dramatic performances. It was further popularized by Hogarth’s anti-French painting The Gate of Calais or O, the Roast Beef of Old England (1748) that was immediately reproduced as an engraved print.100 In each case, England is xenophobically contrasted with other nations. By replacing “Roast Beef” with “Humbug,” denoting hypocrisy and charlatans, Henry Heath subverts the jingoistic tone of the song, immediately alerting the viewer to a skeptical stance toward the medical profession.101 Heath indicates the overturn of social order by taking the earlier depictions of anatomies and disordering them. Now the doctors hide behind their specialized knowledge to terrify a gullible genteel population. Rather than a skeleton presiding as a memento mori, the skeletal scarecrow is seized by the doctors—no longer witnesses to dissection, but agents in agitating public fear for self-interest. This was not a new notion. Pervasive cholera blue is used not only for the scarecrow and its clothes but also for the hospital patients and the fleeing gentry. A collapsed lady—highlighted in yellow in the center of the picture—is a specimen for exploitation rather than dissection. Distinctively the doctors are uniformly dressed in black and white: while echoing regents’ portraits, the addition of therapeutic impedimenta detracts from their serious professional demeanor. Bottles containing brandy and opium blur the line between efficacious nostrums and epicurean consumption, suggested by their florid complexions and corpulent appearances, and reflect the medical economy where the distinction between authorized treatments and quack nostrums was shifting and uncertain. Second Blue Cholera Girl and Religious Dignity Of course, not all representations of cholera were darkly humorous; some drew on European graphic traditions of respect for the deceased. A second lithograph in the Wellcome Collections, seemingly of the same young woman in Sunderland that was published in The Lancet and titled The appearance after death of a victim to the Indian cholera who died at Sunderland (Figure 6.2) is respectfully placed in the intertwined graphic traditions of the prone, scrutinized corpse discussed above and the memorial effigy. The degree to which Enlightenment science was antithetical to Christian belief has been overstated.102 The new “objective inquiry”—such as anatomy—aimed to uncover the architecture of God’s finest work; the anatomy theater was the formal arena for its display. In representations of corpses, respect for the human body was generally intended. Let us pause momentarily to acknowledge that England’s first cholera victim was male, raising questions regarding representations of those more susceptible to cholera.

Anatomy, Microscopy, and Satire  63 As a caveat we should recall that art historian Ludmilla Jordanovna drew attention to the ways in which females were used in this era either as personifications or as abstractions, while real women were often depicted as someone else, like a goddess.103 Arguing that the association of female form with Nature was very strong, the women themselves were ­rendered as semantically empty, requiring attributes to invest them with ­significance. While wishing to resist accusations of essentialism and ahistoricity, she nevertheless argues, “we cannot infer status from representations.”104 Recent studies suggest that women are more vulnerable to the cholera pathogen than men, though that may reflect the gendered occupation and roles of caring and cleaning and the concomitant greater exposure.105 Moreover, cholera takes an emotional, physical, and socioeconomic toll that may have increased vulnerability, though the statistician and epidemiologist William Farr’s Report on the Mortality of Cholera in England, 1848–49 suggests no gender imbalance.106 All the images discussed here were produced and published by men. In Heath’s chaos outside the cholera hospital, a woman lies in a faint. Cholera is described as “terrible to silly women and children!” and the collapsed woman is seen as an opportunity for financial gain. In Microcosm: Monster Soup, though it is a woman inspecting the water droplet, she is victim to the terrifying sights. While the men in these cartoons represented are active—whether self-interestedly lining their pockets, confronting cholera, or terrifying the public—women lack agency. At this point we can return to Habermas’ public sphere that he identified emerged coterminous with the eighteenth-century rise of bourgeois humanism.107 The extension of literacy, the production of newspapers, and discursive journalism and essay writing created a realm of public opinion separate from the court and traditional centers of power across Europe. Coffee houses, clubs, and polite professional and scholarly societies contributed to a new arena for knowledge exchange and debate, but respectable women were excluded from such spaces.108 The subject matter of these prints concerning governance, social policy, and the emerging notion of public health was essentially a male arena located in the male public sphere. Habermas emphasizes the role of property ownership in admission to the public sphere, a luxury denied women.109 This assertion is confirmed by women writing in the late eighteenth century. The status of the woman represented in Microcosm: Monster Soup might be illuminated by the proto-feminist Mary Wollstonecraft, whose arguments contradict Habermas’ belief that women were included in the public sphere: Nothing, I am sure, calls forth the faculties so much as the being obliged to struggle with the world; and this is not a woman’s province in a married state. Her sphere of action is not large, and if she is taught to look into her own heart, how trivial are her occupations and pursuits!110 Just as the viewer in Microcosm: Monster Soup fears microscopic organisms, Wollstonecraft complained that deficiencies in women’s education left them strangers to reason and prey to imagination.111 Similarly, the passive characterization of women succumbing to cholera illustrates the points made by the poet and novelist Mary Robinson, writing pseudonymously in 1799. She railed against mental subordination, arguing that women were degraded by being called the “defenceless sex” and disempowered by “long established laws of custom [that] have decreed her passive!”112 And in Jane Austen’s Persuasion (1817), Anne Elliot protests women’s lack of authorship and agency in narrative construction: “Men have had every advantage of us in telling their own story.

64  Ann-Marie Akehurst Education has been theirs in so much higher a degree; the pen has been in their hands.”113 As with the pen, so with the burin and the printing press. Moreover, it is significant in this context that the 1832 Great Reform Bill, passed ­during the cholera pandemic, only extended the political franchise to “male persons” and was the first explicit statutory bar to women voting. These cultural attitudes of separate spheres persisted—even increased—well into the nineteenth century; they were crystalized in Coventry Patmore’s poem The Angel in the House (1854) and reflected most strikingly in Henrietta Rae’s painting The Lady with the Lamp that permanently neutralized, domesticated, sanitized, and subverted the reputation of William Farr’s colleague, the epidemiologist and nurse Florence Nightingale.114 However, in historian Linda Colley’s nuanced challenge to the separate spheres analysis of the late eighteenth and early nineteenth centuries, she argued that women were increasingly able to influence political movements. Almost cult-like admiration of the female members of the royal family enabled women of all classes to become acknowledged as arbiters whose moral superiority set them apart from the partisan politics for which they campaigned such as anti-slavery and parliamentary reform.115 Bearing this in mind then, it is useful to contrast the treatment of women satirized as passive victims in the cartoons we have been looking at with that of the second cholera girl. The Sunderland victim is set against a cholera-blue cloud and displays the disease hallmarks as analyzed in detail by Amanda Sciampacone. The unknown artist has placed her on a red-bordered cushioned mattress and bolster, evoking strikingly the actual wax-covered cadaver, said to be the incorruptible body of Santa Victoria in the church of Santa Maria della Vittoria, Rome. This is, however, a mere speculative association. More persuasive as an inspiration in a medical context are the ivory figures circulating in early modern Europe revealing key internal organs and a uterus occupied with a fetus. Anatomically imprecise, rather than clinical, they were domestic teaching aids for young couples. As Martin Kemp and Marina Wallis suggested, they “functioned at the cultural interface between medical professionals and those on the receiving end of their ministrations.”116 Their discussion of this category of objects begins by arguing “the portrayal of the human body, however ostensibly neutral or technical the illustration, always involves a series of choices.” Somewhat echoing the scientific preoccupations of the Royal Society, Kemp and Wallace draw attention to “the technical non-style” increasingly deployed by anatomists to prioritize factual information, but in the context of the wood and ivory figure group they emphasize that these figures were not merely instructional diagrams “but statements about the human being as made by God on the context of the created world as a whole.”117 We have already discussed the relation between art and scientific epistemology, but in concentrating on the cultural aspect of the cholera girl, we see how—whether consciously or internalized—the artist represented her as a medical specimen and dignified example of God’s finest creation. This dual perspective is typical of Northern European Early Modern representations of cadavers. The isolated girl who succumbed to cholera does not occupy an anatomy theater, nor a hospital bed, yet we are scrutinizing her in death—how can this be dignified? Stylistically, the eye-level perspective evokes another tradition of representation: antiquarian recording. The sixteenth-century iconoclasm enacted in England’s parish churches focused on the removal of religious vestments, art works, and sacred impedimenta.118 Many tombs remained intact, however, as directed by the proclamation by Queen Elizabeth I in 1560 prohibiting the destruction of monuments on the basis that they are “set up for the only memory of them to their posterity […] and not for any

Anatomy, Microscopy, and Satire  65 religious honour.” Additional to funerary monuments in cathedrals and private and college chapels, England is home to around 8,000 pre-Reformation parish churches.120 Across the nation, they were familiar to the population worshipping in them, and their fittings, architecture, and graveyards offered a powerful inspiration.121 There, gisants— recumbent effigies—recline on ledger slabs, surmounted by a roll mat, preserving the social body of the deceased. Funerary art continued to be erected throughout the nineteenth century, from wall monuments to family mausolea.122 Such monuments were of interest to fellows of the Society of Antiquaries of London whose membership significantly overlapped with the Royal Society, and who shared the ambition to develop the objective observational techniques generated by natural philosophers.123 In the context of contagious disease, transi effigies became popular after the 1348 Black Death that carried off between one third and one half of the population. These two-effigy stone vanitas monuments typically represented the sleeping recumbent figure as in life, and below, the shrouded corrupted cadaver on a ledger slab. Forty such effigies have been identified and characterized by art historian Nigel Llewellyn as “a representation of a corpse often made more horrifying by being shown crawling with toads, lizards, snakes, snails and other creatures redolent of decomposition and sin.”124 The cholera girl image sits somewhere between the fully realized social body and a transi effigy. Her corpse manifests the signs of the disease to which she fell victim. Whether or not the supposedly incorruptible body of Santa Victoria in Rome was being referenced, in life she is unlikely to have been a member of the elite, but through such graphic treatment the artist confers on her in death the dignity of a monument that historically stimulated remembrance through prayer. So, though the cholera girl is an object of clinical scrutiny and prurient gaze, the familiar mise en scène, perspective, and graphic style respectfully counterpoint her objectification as an example of the terrible symptoms of cholera and its impact on the virtuous sex. 119

Conclusion: Visual Culture and Disease Control Satirical prints drew attention to societal wrongs and scrutinized professional malpractice. Images relating to contagion played a crucial role in managing contagious diseases circulating in the community, prompting legislation and social change regarding sanitation. In the aftermath of the 1832 epidemic, the Municipal Corporations Act (1835) enabled the formation of the Royal Commission for the Health of Towns and Edwin Chadwick’s Report on the Sanitary Condition of the Labouring Population of Great Britain (1842–1843). Chadwick concentrated on water and sewage in extra-metropolitan towns and included sanitary maps of London’s Bethnal Green, and of Leeds, showing disease incidence related to “less clean districts.”125 Subsequently, the Health of Towns Association (1844–1849) was established and physicians’ reports created city portraits of health and disease. This was another custom established in the Venetian Republic: the production of quarantine maps established the progress of the Black Death revealing disease advancement related to trade routes and leading the Government of Venice to halt all trade in its port for 40 days as Andrew Hopkins has discussed.126 England’s Boards of Health produced a map series, enabling authorities to see the distribution of outbreaks and to correlate that information with spaces of poverty and overcrowding.127 The physician John Snow had been a medical student near Sunderland in 1831–1832 and was involved in managing those early cases. After the subsequent outbreak in 1848, Snow, now living in London, observed that fatality rates were particularly

66  Ann-Marie Akehurst high in areas fed by a specific water supply. His treatise On the Mode of Communication of Cholera (1849) received little interest until its second edition, published after a cholera outbreak in Broad Street in 1854 that claimed over 500 lives in ten days. The new edition crucially presented statistical tables of disease prevalence alongside maps, permitting visualization of evidence supporting his theory and demonstrating the relationship between the spread of cholera and contaminated water, thereby validating germ theory.128 Snow then argued for the separation of drinking water from that for water closets.129 Together with William Farr, Snow studied 300,000 London deaths, demonstrating that using water from the Southwark and Vauxhall Water Company—criticized by Cruickshank in 1832 (Figure 2.7)—made cholera deaths 14 times more likely than water from the Lambeth Water Company that withdrew its water miles upstream of the polluted city.130 They advocated water companies filter water, and advised that during cholera outbreaks, water should be boiled before use. While most women’s engagement in the public sphere was indirect, Florence Nightingale’s social privilege endowed her with agency in furthering England’s contagion management. Nightingale’s Notes on Nursing (1859) was shaped by her wartime experience in Turkey, where she reduced the mortality rate from infectious diseases of typhus and dysentery from 42.7% to 3% at Üscüdar (Scutari) field hospital.131 Notes on Nursing is her manifesto for creating a healthy domestic environment; her regime of rigorous cleaning demonstrated the impact of hygienic practice on infection control, and her London nursing school inspired her protégées to establish similar nurse training across Europe and North America.132 Just as the medical knowledge that grappled with contagion was distilled, and experience was constructed internationally, so the visual culture representing that encounter borrowed from and referenced Continental tropes. The art associated with the British cholera outbreaks is significant because it offers granular insights into the attitudes of the day and because print circulation in the public sphere focused on critiques of the authorities charged with epidemic management. The emergence of public health as a category of medicine was a crucial step in cholera eradication, and the health maps enabled those authorities to visualize where the problems lay and to target energies on the management and separation of water supply and sewerage. While women were largely excluded from the public sphere, their reverential representation stimulated sympathy for victims and acknowledgment of the human cost of contagious disease in what remained a Christian country. Notes 1 Mark Jackson (ed), Oxford Handbook of the History of Medicine (Oxford: Oxford University Press, 2013). 2 Keir Waddington, “Problems of Progress: Modernity and Writing in the Social History of Medicine,” Social History of Medicine, 34, 4 (2021), 1053–1067. https://doi.org/10.1093/shm/ hkaa067. 3 Ibid., 1063–1065. 4 Keir Waddington, An Introduction to the Social History of Medicine: Europe since 1500 (2011); Roy Porter, Bodies Politic: Disease, Death and Doctors in Britain, 1650–1900 (Reaktion, 2001, 2nd edition), 9. 5 Porter, Ibid., 9. 6 Porter, op. cit. 7 Richard Barnett, The Sick Rose: Disease and the Art of Medical Illustration (London: Thames and Hudson, 2014).

Anatomy, Microscopy, and Satire  67 8 For a full discussion of these developments in Europe, see Roy Porter’s compendious The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (London: Harper Collins, 1997), 201–347. 9 Patricia Mainardi, Another World: Nineteenth-Century Illustrated Print Culture (New Haven, CT and London: Yale University Press, 2017), 121. 10 Mark Hallett, The Spectacle of Difference: Graphic Satire in the Age of Hogarth (New Haven, CT and London: Yale University Press, 1999), 8–9. 11 Emma Barker (ed), Art and Visual Culture 1600–1850: Academy to Avant-Garde (London: The Open University, 2012). 12 Jürgen Habermas, The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society (Cambridge: Polity Press, 1989; originally published as Strukturwandel der Offenlicheit (Darmstadt and Neuweid: Hermann Luchterhand Verlag, 1962), 14. 13 A really useful introduction to public health history is Christopher Hamlin, “Public Health” in Jackson (ed), History of Medicine, Chapter 23. 14 Habermas, Public Sphere, 43–44. 15 Eduardo Mendieta and Jonathan Vanantwerpen, eds, The Power of Religion in the Public Sphere (New York, NY: Columbia University Press, 2011). 16 Ivana Marková, The Dialogical Mind: Common Sense and Ethics (Cambridge: Cambridge University Press, 2016), 15–19. 17 Ann-Marie Akehurst, “St Bartholomew’s Hospital and Gibb’s Role in Hospital Pavilion Planning,” The Georgian Group Journal, 27 (2019), 91–112, 95; Ann–Marie Akehurst, “‘Private Vices, Public Benefits’: Self-interest and salutogenesis in Early Modern Britain,” in Mohammad Gharipour (ed), Public Health in the Early Modern City in Europe (Palgrave Macmillan, 2023). 18 “The Lazaretto at Chetney Hill, Kent,” in J. Mordaunt Crook and M. H. Port (eds) The History of the King’s Works Volume 6, 1782–1851 (London: HMSO, 1973), 196, 447–451. For details of the site see Peter Froggatt, “The Lazaret on Chetney Hill,” Journal of Medical History, 8, 1 (1964, January), 44–62. https://doi.org/10.1017/s0025727300029082. 19 For a detailed discussion of the cholera pathogen (vibro cholerae) and its transmission related to water purity and urban water supply see Romola Jane Davenport, Max Satchell, and Leigh Matthew William Shaw-Taylor, “Cholera as a ‘sanitary test’ of British cities, 1831–1866,” The History of the Family, 24, 2 (2019), 404–438, published online 3 November 2018. https://doi. org/10.1080/1081602X.2018.1525755. 20 The Wellcome Collections indicate it came from The Lancet medical journal. For the journal’s discussion on the pathogen, see for instance, “Absence of Detailed Reports of the Cases of Cholera at Sunderland,” The Lancet, 17, 434 (1831, December 24), 459–460: https://doi. org/10.1016/S0140-6736(02)94375-8. 21 Barnett, Sick Rose, 34–35; Mainardi, Print Culture, 13–71. 22 Svetlana Alpers, The Art of Describing: Dutch Art in the Seventeenth Century (Chicago, IL: University of Chicago Press, 1983). 23 Christine Stevenson, Medicine and Magnificence: British Hospital and Asylum Architecture, 1660–1815 (New Haven, CT and London: Yale University Press, 2000), 155–172. 24 For an excellent account of the affair in English, see Stevenson, Ibid., 185–194; Jacques Tenon, Mémoires Sur Les Hôpitaux de Paris (Paris, 1816), 386: “que celui de Plymouth, le plus parfait que nous connoissions relativement à sa destination.” [That at Plymouth is the most perfect we know relative to its destination]; Jacques Carré, “Les hôpitaux de marine anglais et la nouvelle architecture de la santé au XVIIIe siècle,” 456 at https://www.academia.edu/12811359/ Les_hôpitaux_de_marine_anglais_et_la_nouvelle_architecture_de_la_santé_au_XVIIIe_siècle? 25 James Lind, Essay on the Most Effectual Means of Preserving the Health of Seamen (London: 1757, 2nd edition, 1762); John Pringle, Observations on the Nature and Cure of Hospital and Jayl Fevers (1750) was highly influential. Stephen Hales responded to concerns that crowded spaces generated vitiated air inimical to good health by designing new technology: a ventilator to draw fresh air into confined spaces. By 1758, when Pringle endorsed Hale’s Treatise on Ventilators, they were already being installed on men-of-war and slave ships, workhouses, jails, and hospitals throughout the country, and as far afield as Naples, St. Petersburg, and Saxony, and at Andrea Orsolino’s Ospedale di Pammatone at Genoa (1758). French prisoners

68  Ann-Marie Akehurst of war held in England benefited from them, and in 1753 Hale was elected a foreign associate of the Académie des Sciences, see Ann-Marie Akehurst, “‘The Body Natural as well as the Body Politic stands indebted’: The hospital – foundation, funding and form,” in Caroline van Eck and Sigrid de Jong (eds), Architectural Theory and Practice, vol. 2, Companion to Architecture in the Age of the Enlightenment (Chichester: Wiley, 2017), Chapter 11, and John Pringle, Observations of the Diseases of the Army in Camp and Garrison (London: 1752); Gilbert Blane, Observations on the Diseases Incident to Seamen (London: 3rd edition, 1799). 2 6 https://www.rcpe.ac.uk/heritage/fashion-and-physician-how-clothing-made-man. 2 7 Porter, Medical History, 358–359. 8 Mariët Westerman, A Wordly Art: The Dutch Republic 1585–1718 (New Haven, CT and 2 London: Yale University Press, 1996), 141–150. 2 9 Habermas, Public Sphere, 14. 30 For a comparative discussion of the European Enlightenment see Margaret C. Jacob, “The Mental Landscape of the Public Sphere: A European Perspective,” Eighteenth–Century Studies, 28, 1 (1994, Autumn), 95–113; 96–98. 1 Ibid., 96–99. 3 32 Ole Peter Grell, Andrew Cunningham, and Jon Arrizabelaga, Centres of Medical Excellence? Medical travel and Education in Europe, 1500–1789 (Farnham: Ashgate, 2010), 4. 3 3 Lisa Jardine, Going Dutch: How England Plundered Holland’s Glory (London: Harper Perennial, 2008). For the English benefits from Dutch science see 263–318. 4 Simon Schama, An Embarrassment of Riches: An Interpretation of Dutch Culture in the 3 Golden Age (London: Fontana Press, 1991). 3 5 William Shakespeare, King Richard II, Act II, sc.i, 40–44. 3 6 Henry Green, The Wooden Walls of Old England. A naval ode. By Henry Green, purser of His Majesty’s ship Ramillies. Most humbly inscribed to His Majesty (Portsmouth: R. Carr, ­MDCCLXXIII. [1773]) 37 They say they’ll invade us, these terrible foes, They frighten our women, our children, our beaus, But if they in their flat-bottoms, in darkness set oar, Still Britons they’ll find to receive them on shore. 38 Mary Reckord, “The Jamaica Slave Rebellion of 1831,” Past & Present, 40 (1968, July), 108– 125. See also Barry W. Higman, “Slave Populations of the British Caribbean, 1807–1834,” Journal of Interdisciplinary History, 16, 2 (1985, Autumn), 365–367. 39 https://cudl.lib.cam.ac.uk/collections/longitude. 40 Parkinson and Frodsham, A Brief Account of the Chronometer (London: M.A. Pittman, 1832), 1–2. 41 https://www.parliament.uk/about/living-heritage/evolutionofparliament/houseofcommons/ reformacts/overview/reformact1832/. 42 Samuel de Wilde, John Bull in a Fever (Wellcome Library 12204i, 1809). 43 [n.p.], [1832] Wellcome Library no. 16429i. 44 Robert L. Patten, George Cruickshank’s Life, Times and Art, vol. 1 1792–1835 (London: The Lutterworth Press, 1992), 357–358. 45 Peter Borsay, The English Urban Renaissance: Culture and Society in the Provincial Town, 1660–1770, (Oxford: Oxford University Press, 1989), 136–137. 46 Rudolph Ackermann, Microcosm of London, vol. 3, 9. Introduction at: http://www.romanticlondon.org/microcosm-intro/. 47 Jonathan Jones, Sensations: The Story of British Art from Hogarth to Banksy (London: Laurence King Publishing, 2018), 48. 48 https://collection.sciencemuseumgroup.org.uk/objects/co65710/microcosm-a-grand-displayof-the-wonders-of-nature-advertisement-for-microscopes-london-england-1827-print. 49 John Summerson, The Life and Work of John Nash, Architect (London: Allen and Unwin, 1980), 75–89. 50 Borsay, Urban Renaissance, 136–137; Roy Porter, Enlightenment: Britain and the Creation of the Modern World (London: Allen Lane Press, 2000), 142–155. 51 Emma Barker, “Painting for the Public,” 188–189. 52 Marková, Dialogical Mind, 17.

Anatomy, Microscopy, and Satire  69 53 Patri J. Pugliese, “Hooke, Robert (1635–1703), Natural Philosopher,” Oxford Dictionary of National Biography, 23 September 2004. https://www-oxforddnb-com.sheffield.idm.oclc.org/ view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-13693 (accessed 27 September 2020). 54 Stephen Hanley, “Optical Symbolism as Optical Description: A Case Study of Canon Van der Paele,” Journal of Historians of Netherlandish Art, 1, 1 (2009, Winter). See also his “The Optical Concerns of Jan van Eyck’s Painting Practice,” PhD diss. (University of York, 2007). https://etheses.whiterose.ac.uk/11052/. 55 This observation arises in the context of discussing the gifted figure of Constantijn Huygens, nephew of the artist Joris Hofnagel and father of the famous mathematician, physicist, astronomer, and inventor Christiaan Huygens FRS. For an engaging biography of the three generations of Huygens family see Hugh Aldersley-Williams, Dutch Light: Christiaan Huygens and the Making of Science in Europe (London: Picador, 2020). 56 Alpers, Art of Describing, 26. 57 Thomas Sprat, The History of the Royal Society (London: 1667), 111–115. 58 Denis Pellerin, “Two eyes are better than one,” in Daryl Green and Laura Moretti (eds), Thinking 3D: Books, Images and Ideas from Leonardo to the Present exh. cat. (Oxford: Bodleian Library, University of Oxford, 2019), 186. 59 Robert Hooke, The Diary of Robert Hooke, M.A., M.D., FRS, 1672–1680, transcribed from the original in the possession of the Corporation of the City of London (Guildhall Library), eds. Henry W. Robinson and Walter Adams, (London: Taylor and Francis, 1935). For a readable biography see Lisa Jardine, The Curious Life of Robert Hooke: The Man Who Measured London (London: Harper Collins, 2003). 60 For a rich and engaging account see Matthew C. Hunter, Wicked Intelligence: Visual Art and the Science of Experiment in Restoration London (Chicago, IL: University of Chicago Press, 2013). 61 Hooke demonstrates that far from the engravings being simple records of observed materials they are the distillation of a series of observations during which lenses were used in varying combinations. Hooke saw microscopes as furthering the natural philosophical enquiry and intending to offer a corrective against false representations; see his Micrographia, Physiological Descriptions of Minute Bodies Made by Magnifying Glasses, with Observations and Inquiries Thereupon (London: The Royal Society, 1665), Preface: “by the help of Microscopes, there is nothing so small, as to escape our inquiry; hence there is a new visible World discovered to the understanding.” Hooke suggests, “the images are the product of as a sincere Hand, and a faithful Eye, to examine, and to record, the things themselves as they appear […] expressions of our own misguided apprehensions then of the true nature of the things themselves.” But that process was not unmediated; he outlined his method, indicating the engravers followed his directions closely: “by the help of Microscopes, there is nothing so small, as to escape our inquiry; hence there is a new visible World discovered to the understanding.” 62 Meghan C. Doherty, “Discovering the ‘true form’: Hooke’s Micrographia and the visual vocabulary of engraved portraits,” Notes and Records of the Royal Society of London, 66 (2012), 211–234, 212. https://doi.org/10.1098/rsnr.2012.0031. 63 Hooke, Micrographia, plate 34: Microscopic study of a flea, showing one eye, its antenna, genal comb, palpus, thorax, legs, planar bristles, abdomen, and sternite. 64 Robert Hooke, Drawing of an Insect from John Covel, Natural History Notebook and Commonplace Book, 1660–1713. Copyright British Library Board (Add. MSS 47495); Ian Lawson, “Crafting the microworld: How Robert Hooke constructed knowledge about small things,” Notes and Records of the Royal Society of London, 70, 1, (2016), 23–44, 36–38, https://royalsocietypublishing.org/doi/10.1098/rsnr.2015.0057. 65 Anna Marie Roos, Martin Lister and His Remarkable Daughters: The Art of Science on the Seventeenth Century (Oxford: Bodleian Library, University of Oxford, 2019). 66 Marková, Dialogical Mind, 18. 67 Simon Heneage, “Heath, William [pseud. Paul Pry] (1794/5–1840), caricaturist and illustrator,” Oxford Dictionary of National Biography, 23 September 2004. https://wwwoxforddnb-com.sheffield.idm.oclc.org/view/10.1093/ref:odnb/9780198614128.001.0001/ odnb-9780198614128-e-66123 (accessed 12 May 2021). 68 Aldersley-Williams, Dutch Light, 310.

70  Ann-Marie Akehurst 69 Marková, Dialogical Mind, 17. 70 Anonymous, “Cholera or No Cholera—Tricks of Some Governments,” The Lancet, 1831, J. 37 cited in Sean Burrell and Geoffrey Gill, “The Liverpool Cholera Epidemic of 1832 and Anatomical Dissection: Medical Mistrust and Civil Unrest,” Journal of the History of Medicine and Allied Sciences, 60, 4 (2005, October), 478–498. 71 “A notice about Indian cholera issued to the inhabitants of the Parish of Clerkenwell in 1831. With His Majesty’s Privy Council having approved of precautions proposed by the Board of Health in London, the notice describes symptoms of Indian cholera and remedies for this disorder,” Wellcome Collections at https://wellcomecollection.org/works/gvhdvb66. 72 J. Wallace, “Blane, Sir Gilbert, first baronet (1749–1834), physician,” Oxford Dictionary of National Biography, 23 September 2004. https://www-oxforddnb-com.sheffield.idm.oclc.org/ view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-2621 (accessed 4 May 2021). 73 Gilbert Blane, “On the Epidemic Cholera as it has appeared in the territory subject to the presidency of Fort St George drawn up by order of the government and the superintendent for the medical board by William Scott surgeon and secretary to the board,” in The Philadelphia Journal of the Medical and Physical Sciences, II, Issue, 4. Blane is cited from where he proposes “that those who advocate the doctrine of non-contagion appear to me to lay too much stress on the circumstances of great numbers escaping the disease, who have been exposed to it by near approach or contact of the sick” and accounts for their escape on the supposition of “variety of predisposition and original constitution without the intervention of which preservative circumstances during epidemics the whole human race must long since of perished by contagious affections.” 74 Harriet Richardson, English Hospitals: A Survey of their Architecture and Design (London: Royal Commission on the Historical Monuments of England, 1998), 23. 75 Katherine A. Webb, “One of the Most Useful Charities in the City: York Dispensary 1788– 1988,” Borthwick Paper 74 (York: St. Anthony’s Press, 1988); P. M. Tillott (ed), A History of the Country of York, City of York, Victoria County History (Oxford: Oxford University Press, 1961), 470. 76 Webb, “Dispensary,” 17. 77 For an assessment of British water supply during the nineteenth century see Davenport et al. “Cholera,” 404–438. 78 Op. cit., 405–409. 79 https://www.historyofparliamentonline.org/volume/1820–1832/member/edwardsvaughan-john-1772–1833. https://www.historyofparliamentonline.org/volume/1820-1832/ member/edwards-vaughan-john-1772-1833. 80 Roy Porter, Quacks: Fakers and Charlatans in Medicine (Stroud: Tempus Publishing, 2000, this edition 2003). 81 Ibid., 41–92. For a narrative account of one particular quack, see David Paton-Williams, Katterfelto, Prince of Puff (Leicester: Matador, 2008). 82 Patten, Cruickshank, 357–358. 83 Michael Durey, The First Spasmodic Cholera Epidemic in York, 1832 (York: St Anthony’s Press, 1974), 24–25; Sue Hardiman, The 1832 Cholera Epidemic and its impact on the City of Bristol (Bristol: 1981). 84 Burrell and Gill, “Liverpool Cholera Epidemic,” 478. 85 Jonathan Bikker, Gregor J. M. Weber, Marjorie E. Weiseman, and Erik Hinterding, Rembrandt: The Late Work, exh. cat. (London and Amsterdam: The National Gallery and Rijksmuseum, 2014), 86–89. 86 Mark Somos, “The Embodiment of anatomical education,” in Green and Moretti, 3D, 170–175; Andrew Cunningham, The Anatomists Anatomis’d: An Experimental Discipline in Enlightenment Europe (Farnham: Ashgate, 2010), Chapter 1. 87 Cunningham, Ibid., 1–15. 88 Martin Kemp and Marina Wallace, Spectacular Bodies: The Art and Science of the Human body from Leonardo to Now, exh. cat. (Berkley, Los Angeles, CA and London, 2000), 23. 89 Pál Ács, “Holbein’s ‘Dead Christ’ in Basel and the Radical Reformation,” The Hungarian Historical Review, 2, 1 (2013), 68–84; on Holbein related to science, observation, and manipulation, see Jeanne Nuechterlein, Hans Holbein: The Artist in a Changing World (London: Reaktion Books, 2020), 139–180.

Anatomy, Microscopy, and Satire  71 90 Nigel Llewellyn, The Art of Death: Visual Culture in The English Death Ritual, c. 1500–c. 1800 (London: Reaktion Books, 1991), 46–49. 91 Ibid., 53. Figure 34, 52. 92 The Company of Surgeons had built a new hall with an anatomy theater near Newgate Gaol so it could teach and dissect the bodies of executed criminals: https://www.rcseng.ac.uk/ about-the-rcs/history-of-the-rcs/. 93 Wellcome Library no. 25372i. 94 Mark Hallett and Christine Riding, Hogarth, exh. cat. (London: Tate Publishing, 2006), 194. 95 Ibid.,192–194. 96 There was an increasingly direct relation between anatomy and art. George Stubbs (1724– 1806) is known primarily for his astonishing equine portraits. He spent time studying anatomy at York County Hospital where he was eventually permitted to lecture on the subject; see Jones, Sensations, 68–69. Subsequently Stubbs retired to the country to dissect 12 horses that informed his naturalistic representations of them, most notably Whistlejacket c.1762, now at London’s National Gallery, TNG NG6569. 97 Jones, Sensations, 86. 98 J. Gilliland, “Burke, William (1792–1829), murderer,” Oxford Dictionary of Biography, 2004. 99 In scale and plainness, it resembles the cholera hospital in Thomas Taylor and Joseph Fisher’s contemporary line engraving of a small detached structure in an isolated setting three miles from the center of Oxford: https://historicengland.org.uk/listing/the-list/list-entry/1016177. The isolation hospital, known as the “Pest House,” is at the foot of the island’s southern rocky spur and is a roofless single-story building with rubble walls faced externally by neat coursed slabs called ashlar; traces of plaster survive inside. It has a main room, 4.9 m square internally, and an extension with a lean-to roof on the southeast, later subdivided into two rooms. 100 Hallett and Riding, Hogarth, 216, plate 112. 101 An anonymous etching of 1799 in the Wellcome Collection depicts a mountebank selling nostrums described as “The noted Dr Humbug cures all disorders incident to the human body,” Wellcome Library no. 20883i. 102 Mendieta and Vanantwerpen, Public Sphere, 34–59. 103 Ludmilla Jordanovna, Nature Display’d: Gender, Science and Medicine 1760–1820 (London: Longman, 1999), 22. 104 Ibid., 46. 105 UNICEF, Strategy for Integrating a Gendered Response in Haiti’s Cholera Epidemic UNICEF  Haiti Child Protection Section/GBV Program, 2 December 2010. https:// ­g bvguidelines.org/wp/wp-content/uploads/2020/03/29_Haiti_UNICEF_Briefing_Note_ Gender_Cholera.pdf. 106 William Farr, Report on the Mortality of Cholera in England, 1848–49 (London: HMSO, 1852). 107 Habermas, Public Sphere, 14. 108 Markman Ellis, The Coffee House: A Cultural History (London: Weidenfeld and Nicholson, 2004), 66–68. 109 Habermas, Public Sphere, 46–47. 110 Mary Wollstonecraft, Thoughts on the Education of Daughters: With Reflections on Female Conduct, in the More Important Duties of Life (1787): “Matrimony,” 100. 111 Ibid., 99. 112 Robinson Mary, A Letter to the Women of England, on the Injustice of Mental Subordination. With Anecdotes. By Anne Frances Randall (London: T.N. Longman, and O. Rees, 1799) 4; 8. 113 Jane Austen, Persuasion (London, 1818), Vol. 2, Chapter 11. 114 Coventry Patmore, “The Angel in the House” (1854). For a broader discussion see Walter E. Houghton, The Victorian Frame of Mind, 1830–1870 (New Haven, CT and London: Yale University Press, 1957), 341–343. 115 Linda Colley, Britons: Forging the Nation 1707–1837 (London: Yale University Press, 1992, this edition. Vintage, 1996), 276–296. 116 Kemp and Wallace (2000), Chapter 2. 117 Ibid., 68.

72  Ann-Marie Akehurst 118 Eamon Duffy, The Stripping of the Altars: Traditional Religion in England 1400–1580 (New Haven, CT and London: Yale University Press, 1992, 2nd edition, 2005), Chapter 14. For the impact of reform on parishes see 478–503. 119 Eliz. Vol. XIII, 32, Proclamation against Breaking or Defacing Monuments of Antiquity Set Up in Churches, Calendar of State Papers, Domestic Series, of the Reigns of Edward VI, Mary, Elizabeth, 1547–1580. ed. R. Lemon (London: Longman, Brown, Green, Longmans, & Roberts, 1856) 158. Document Ref. SP 12/13; 19 September 1560. 120 Simon Jenkins, England’s Thousand Best Churches (London: Allen Lane, Penguin, 1999), xx. 121 The alabaster figures of a knight and his lady lie together with three other effigies in a side aisle at the Church of Saint Nicholas, West Tanfield, Yorkshire; see John Goodall, Parish Church Treasures: The Nation’s Greatest Art Collection (London: Bloomsbury, 2015), 85. A splendid transi monument is that of Alice de la Pole, Duchess of Suffolk, at The Church of Saint Mary the Virgin, Ewelme, Oxfordshire; see Goodall, op. cit., 88; 105. 122 Benedict Read, Victorian Sculpture (New Haven, CT and London: Yale University Press, 1982), 186–214. 123 Sam Smiles, “The Art of Recording,” in David Gamister, Sarah McCarthy, and Bernard Nurse (eds), Making History: Antiquaries in Britain 1707–2007, exh. cat. (London, 2007), 123–140. 124 Llewellyn, Death, 46; see also Christina Welch, “Exploring Late-Medieval English Memento Mori Carved Cadaver Sculptures,” in Dealing with the Dead: Mortality and Community in Medieval and Early Modern Europe (Leiden, NV: Brill, 2018), https://doi. org/10.1163/9789004358331_015; and Jakov Đorđević “Made in the Skull’s Likeness: Of Transi Tombs, Identity and Memento Mori,” Journal of Art Historiography, 17 (2017, December). https://arthistoriography.files.wordpress.com/2017/11/djordjevic.pdf. 125 Peter Mandler, “Chadwick, Sir Edwin (1800–1890), social reformer and civil servant,” Oxford Dictionary of National Biography, 2004; Arthur H. Robinson, Early Thematic Mapping in the History of Cartography (Chicago, IL and London: University of Chicago Press, 1982), 187, Figure 95. 126 Laura Vaughan, Mapping Society: The Spatial Dimensions of Social Cartography (London: University College London Press, 2018, Kindle Edition). 127 Ibid., Chapter 4; Robinson, Mapping, 170–188. For a longer discussion see Akehurst (forthcoming 2023). 128 Stephanie J. Snow, “Snow, John (1813–1858), anaesthetist and epidemiologist,” Oxford Dictionary of National Biography, 2004; Vaughan (2018), Figure 2.8: J. Snow, Street Map of Soho, around Golden Square, Illustrating Incidences of Cholera Deaths during the Period of the Cholera Epidemic,1853. For a full account of Snow’s mapping see Robinson, Mapping, 176–179. 129 John Snow, Medical Times and Gazette, 1858, 191. 130 John Snow, “Cholera and the Water Supply in the Southern Districts of London,” British Medical Journal, 2 (1857), 864; P. Bingham, N. Q. Verlander, and M. J. Cheal, “John Snow, William Farr and the 1849 Outbreak of Cholera that Affected London: A Reworking of the Data Highlights the Importance of the Water Supply,” Public Health, 118, 6 (2004, September), 387–394. https://doi.org/10.1016/j.puhe.2004.05.007. For Snow’s 1855 map relating to the two water companies see Robinson, Mapping, 179, Figure 89. 131 Grace Goldin, “Building a Hospital of Air: The Victorian Pavilions of St Thomas’ Hospital,” Bulletin of the History of Medicine, 49, 4 (1975), 512–535; Monica E. Baly and H. C. G. Matthew, “Nightingale, Florence (1820–1910), Reformer of Army Medical Services and of Nursing Organization,” Oxford Dictionary of National Biography, 2004. 132 Florence Nightingale, Notes on Nursing (London, 1859), Chapter 1.

3 Combating Cholera Tanuki Scrotum and the Visual Culture of Disease in Nineteenth-Century Japan1 Sara K. Berkowitz

In 1880 Japan’s Home Ministry Bureau of Hygiene published the following description of the highly infectious cholera virus: In this world, there are enemies with shapes (katachi aru) and enemies without shapes (katachi naki). They consistently threaten people’s lives and harm people’s health, even stealing their lives once in a while… Wars, floods, droughts, storms, fires, earthquakes are mostly those with shapes… However, shapeless enemies are far more threatening than those with shapes… They are not detected by people’s ears or eyes and one can know their horror only after they have already done damage. These enemies are cholera and other epidemics… I call them “enemies without shapes” because one’s eyes cannot catch them.2 The Home Ministry’s portrayal of cholera as an enemy to be feared more than physically recognizable threats such as war and natural disasters reflects the critical necessity of seeing the enemy not only to combat it but to understand it.3 As discussed in chapters by Akehurst (Chapter 2) and Sciampacone (Chapter 6), cholera’s emergence in the nineteenth century sparked fear and chaos around the world. Doctors and government officials from both the West and the East struggled to determine the disease’s etiology and mode of transmission and to develop measures to treat and contain its spread that could be applied on a mass scale. These difficulties were exacerbated in Japan when “Asiatic cholera,” as it was often called by Euro-American writers, spread rapidly following the forced opening of the country’s ports to foreign trade in 1854.4 While epidemic cholera’s staggering effects on human populations transcended geopolitical boundaries—with the cause, symptoms, and often untimely deaths of its victims unchanged from East to West—the means by which different cultures attempted to make sense of this “enemy without shape” varied drastically across social, political, and religious boundaries. These differences are significant within the realm of visual culture, which challenged artists to ascribe physical form to a disease whose means of transmission and contraction were untraceable and, thus, invisible to the naked eye. Literary scholars, anthropologists, and social and medical historians, among others, have often turned to contemporaneous images to examine the impact of cholera during the nineteenth century and to understand contagion across time and space. Recently, scholars working in an interdisciplinary global framework have studied images of disease from cross-cultural and transnational perspectives, reflecting on the effect of colonialism, trade, and travel on the porosity of boundaries between countries and regions. An important example is Mary Louise Pratt and her concept of a contact zone, which she defines as DOI: 10.4324/9781003294979-5

74  Sara K. Berkowitz a “social space where cultures meet, clash, and grapple with each other, often in contexts of highly asymmetrical relations of power…”5 Pratt’s and others’ studies offer critical perspectives on the transmissibility of not only contagion but also visual media and cultural attitudes toward disease, which were often simultaneously informed by local and foreign influences.6 Indeed, if the COVID-19 pandemic starting in 2020 has taught us anything, it is that contagion’s visual documentation is one of the most defining methods through which vastly different regions of the world are connected over a shared experience of fear, chaos, and sometimes even hope. One need only recall the worldwide profusion of photographs picturing crowded hospital wards, empty supermarket shelves, deserted city streets, and perhaps the most unforgettable image: the digital microscopic rendering of the virus to be reminded that images not only document but also deeply shape our reaction to and experience with disease.7 Yet, the primacy of images of contagion and the visual strategies artists embed in their work to communicate messages remain an unstudied area of inquiry in the history of medicine. Art historians’ contributions to this topic and expertise in visual and iconographic analyses of images is one area that remains underrepresented in the scholarship.8 Additionally, many studies engaging with visual media still rely on images as merely illustrations of medical or social phenomena and not as case studies or sites of inquiry in their own right.9 As a result, the specific role that visual elements such as material, scale, composition, color, and line play in reflecting—and shaping—culturally diverse experiences of disease is underexamined. This chapter aims to extend recent work on the visual culture of contagion to a single case study of an extraordinary woodblock print from 1886 entitled Defeating Cholera (korera taiji), where a group of military men aim a bottle affixed to a cannon spewing liquid at a ferocious beast lunging toward them, with four victims already lying beneath it (Figure 3.1). The beast’s head and arms reference the color and texture of a tiger’s stripes, while the remainder of its body is covered in the gray fur of a wolf. The text above the scene identifies the hybrid animal as an embodiment of cholera, which swept through nineteenth-century Japan, killing thousands. It does not take the viewer long, however, to notice a third, conspicuously out-of-place element on the cholera beast’s body: a gargantuan scrotum, poised directly above three of the victims, moments away from crushing them with the force of its weight. The artist’s articulation of cholera in the form of a monstrous chimera follows a broader visual strategy in Japanese print culture whereby monsters, demons, and supernatural animals from traditional folklore—broadly defined as yōkai—were repurposed as villainous anthropomorphized contagious diseases.10 The tiger and wolf portrayed in the print not only recall two actual creatures renowned for their predatory nature in the animal kingdom, but they also repeatedly appear as characters associated with strength and swiftness in folklore stories. Combining these two elements to create a hybrid monster reflects the severity of cholera, which could dramatically lead to death from dehydration in a manner of hours after contraction.11 And yet, the beast’s pendulous scrotum belies easy categorization as it is associated with neither tigers nor wolves, in life or in popular culture. Scholars have convincingly argued that the scrotum refers to a third animal, the tanuki, a canine indigenous to Japan who is sometimes referred to as a “racoon dog” or “badger” in English. In popular texts and prints, the tanuki is often pictured with an exaggerated scrotum. Unlike the tiger or wolf’s clear association with speed and ferocity, the tanuki is a trickster who is capable of both deception and transformation, resulting in either humorous or disastrous ends for its unsuspecting human victims.12

Figure 3.1 Defeating Cholera (korera taiji), woodblock print, 1886.  Courtesy of UCSF Archives and Special Collection, University of California, San Francisco.

Combating Cholera  75

76  Sara K. Berkowitz A secondary association of the tanuki’s scrotum was its use in the crafting of gold leaf, whereby practitioners would use skin from a tanuki scrotum as a buffer between the gold leaf and the hammer used to create thin sheets that could be applied to another surface. The scrotum skin’s ability to stretch to great lengths enabled artists to flatten the gold leaf into as thin a sheet as possible, while also protecting it from breaking under the weight of the hammer. As a result of this common use, the scrotum skin was considered a good luck totem and was often refashioned into wallets, leading to the notion that it could “stretch one’s money.”13 While anthropologists and art historians of Japanese visual culture have long acknowledged the visual strategy of anthropomorphizing contagious diseases into ferocious animals and other supernatural figures from folklore, few have devoted significant attention to unpacking the curious addition—and prominence—of the tanuki’s scrotum in this print.14 The scrotum’s stark, visual discordance with the remainder of the animal’s body in the print is arguably the element that most immediately strikes viewers—past and present. In this chapter, I recenter the tanuki scrotum as the primary focus to investigate how its multilayered cultural and symbolic associations inside and outside of the print may reshape our understanding of contagion in Defeating Cholera. Coupled with an exploration of the larger social and medical impact of cholera in nineteenth-century Japan, the tanuki scrotum complicates an interpretation of the cholera beast as solely a ferocious monster. The tanuki’s association with trickery, transformation, and, in some cases, humor directly contributes to the overall meaning of the print and, therefore, must be taken into consideration. In so doing, I argue that Defeating Cholera cannot just be read as a straightforward warning of the dangers of the disease but may also reflect a critique of the political circumstances leading to cholera’s introduction to Japan in the first place. The composition combines multifarious references to wartime and heroic imagery with supernatural elements from traditional folklore and modern medicine to figure cholera as a complicated disease that was as fierce and fearsome as it was mysterious. The references to both traditional belief systems that preceded the nineteenth century and the use of modern medicine promoted by Japan’s Meiji government demonstrate the idea that to combat cholera, Japanese citizens must look to both the past and the present.15 This perspective opens the possibility that the addition of the curiously enlarged scrotum to the hybrid monster and its interaction with the other figures in the print were intended to function as a deliberate focal point with the purpose of drawing the viewer’s attention deeper into the print and into Japan’s complicated history with cholera. For while cholera’s initial infiltration into Japan was understood as a byproduct of the West forcing Japan to open its ports to trade, the post-isolationist Meiji government now ironically found itself looking to Europe and the United States for medical research to quickly understand and combat this foreign disease, which had infiltrated the West as early as the late 1820s.16 I suggest, then, that Japan’s “double misfortune” of being compelled to seek aid from the same forces that introduced this highly infectious disease to its shores provides a new context to interpret the addition of the tanuki scrotum to this otherwise conventional representation of cholera as a ferocious animal and may function on a secondary level as a reclamation of Japanese identity and its place on the world stage in opposition to Western imperialism. As the print shows, it was the Japanese martial heroes at the front line who combatted cholera, providing an example to the public on how to prevent the disease from spreading while the presumably male patient accompanied by female attendants lay trapped under the pendulous weight of the tanuki scrotum, moments from impending demise.

Combating Cholera  77 Through a close examination of the print’s content and the scientific, social, and ­ olitical factors that informed its design, this chapter contextualizes Defeating Cholera p within larger artistic trends for representing disease, both in Japan and in the West.17 In so doing, it provides an in-depth study of the tension between its visual components and the main subject, an anthropomorphized hybrid monster embodying cholera. By studying an East Asian example, I hope to contribute to a growing body of literature on nonWestern art by Anglophone scholars with the aim of reaching wider audiences.18 Drawing from Homi Bhabha’s writings on hybridity and the third space, this study also further complicates the false narrative of Western colonial dominance in the region that scholars continue to dismantle.19 Two limitations in this approach should be noted. One concerns the lack of extant data on the major case study’s provenance. And the other concerns the print’s commission, how widely it circulated, and its original audience. I contend, however, that these limitations should not prevent investigation into the print’s potential meaning and significance as the medical and cultural context of cholera, coupled with the known symbolism behind its subject matter, provides a starting point for future examinations as more information is uncovered. Contracting Cholera Unlike other past outbreaks of infectious diseases documented in historical records for centuries, such as the bubonic plague and smallpox, cholera was only identified as what would be referred to today as a novel pathogen in the 1800s. It was first detected in 1817 along the Ganges River in India before spreading globally.20 Today, cholera is classified as a highly transmissible waterborne, bacterial disease contracted through direct contact with the bacillus Vibrio cholerae. It enters the body through the ingestion of water or food contaminated with the bacteria—often through water carrying infected human waste—which then passes through the digestive system. Prior to the nineteenth-century development of centralized public health initiatives and systematized plumbing and sewage removal, the disease spread rapidly once a communal water source was contaminated through direct contact with an infected person’s feces.21 Within hours after initially becoming infected, a series of symptoms developed, including nausea, vomiting, fever, headache, chills, and diarrhea as outlined elsewhere in this volume by Akehurst and Sciampacone. If left untreated, these symptoms often worsen, causing extreme dehydration and culminating in a quick and painful death anytime between three hours and three days after contraction.22 The disease posed a critical threat to all those who contracted it (as it still does today if left untreated). The understanding of cholera’s cause and transmission remained unsolved far into the 1850s, inciting fear and panic on a global scale. The most well-known hypothesis was the miasma theory, or the belief that it was contracted through bad air. Eventually during an outbreak in 1854, British doctor John Snow attributed the disease to a polluted communal water pump, demonstrating that it spread not through contaminated air but “through contact with an infectious agent.”23 This important discovery signaled one of the earliest applications of what would eventually become germ theory, but it was initially overlooked by the international medical community. Only after the research of German doctor Robert Koch in the 1890s, as William Johnston notes, “did a single, bacteriological explanation of cholera’s etiology begin to dominate the discourses of medicine and public health.”24 With no clear path toward understanding the cause

78  Sara K. Berkowitz and treatment prior to the 1890s on a global scale, physicians, government officials, and ­laypersons sought a wide range of different cures and therapies, including alcohol, opium, a diet of ­moderation, and potions.25 Following cholera’s initial detection in India in 1817, it subsequently spread across Asia, eventually making its way to Europe and the Americas as a byproduct of Western ­colonialism.26 Japan remained untouched during these first years of the disease’s ­transmission due to the country’s policy of isolationism under the Tokugawa Shogunate (1603–1867), whereby international trade outside of Asia was severely limited. During this time, however, Japan conducted trade with China and Korea, in addition to the Dutch. It is possible that tensions with China may also be embedded in Japanese prints on cholera; however, the scope of this chapter does not permit a deeper exploration into this issue.27 Cholera made its first appearance in Japanese historical records in 1822, where it was generally described as a product of foreign intervention and, thus, was labeled a “foreign disease.”28 The cause of this epidemic outbreak is unclear, but it likely spread from China to the ports of Nagasaki.29 After killing several thousand people over the course of the year, it then subsided for approximately 36 years. A second and more deadly wave began in 1858, when the U.S.S. Mississippi, an American ship under the command of Commodore Matthew Perry, following travel to China, docked in Nagasaki carrying infected sailors.30 The disease spread rapidly and widely, reaching the metropolitan capital of Edo (present-day Tokyo) in a month, culminating in an estimate of over 100,000 deaths in the first two months of the outbreak.31 Once cholera became a consistent presence on Japanese shores, epidemic outbreaks continued until around 1886, marking the single deadliest year with over 530,000 recorded deaths.32 The disease subsequently became endemic, continuing to impact Japanese life until the 1920s. Prior to cholera’s introduction in Japan, the country remained relatively untouched by many of the infectious diseases that wreaked international havoc for centuries, such as the Bubonic Plague. This stemmed, in part, from a wariness of foreign contact that led to a policy of isolationism instituted under the dynastic rule of the Tokugawa Shogunate (also known as the Edo period), which closed most of Japan to foreign trade and colonialism rather than an inherent natural immunity.33 The shogunate’s focus on primarily domestic issues also led to several restrictions on Japanese citizens, including on social behavior deemed immoral or outside the bounds of one’s class, or gender, and the censoring of texts considered blasphemous, especially against the shogun and his family.34 And yet, local culture and art flourished, in part, as reactions against these prescriptive measures, including the rise of urban pleasure quarters for kabuki theater, tea houses, and brothels. In response to these sites’ popularity, especially among the middle class, artists began executing woodblock prints of famous actors, courtesans, humorous stories, and graphic scenes of war and violence.35 These subjects, known as ukiyo-e prints for their depiction of the “floating world,” a phrase appropriated from Buddhist philosophy on the ephemerality of life, were widely circulated and accessible to the public.36 This era of political isolation ended in the 1850s with what is often referred to as the “unequal treaties,” whereby several Western nations, headed by the United States, imposed unfavorable trade agreements on Japan. The Treaty of Kanagawa, Japan’s first treaty with a Western country, forced its ports to open to American trade. Following these external pressures, in addition to domestic unrest, political revolution ensued leading to the collapse of the Tokugawa Shogunate in 1868, and the restoration of the authority of the emperor. Commonly referred to as the Meiji Restoration, this era ushered in a

Combating Cholera  79 transformation of Japan’s governing policies and position on the world stage.37 No longer enforcing a policy of relative isolation, the emperor and his government swiftly turned to “modernizing” the country in line with Western countries’ industrialization initiatives including the development of textile and machinery production industries, the construction of railways, and the institutionalization of public health.38 It was during this period of rapid change that Japan experienced the highest infection rates and death tolls of epidemic cholera, suggesting that the government’s motivation to rapidly industrialize also stemmed from an urgency to control the spread of this “modern” disease by combating it with whatever means necessary, including collaborating with the West to develop potential treatments. Thus, the correlation between Japan’s trade opening and the aggressive spread of cholera was undeniable. And yet, as the country contended with what may be interpreted as a “second invasion” of a virulent nature—one, that along with the forced opening, was also transmitted through waterborne agents—doctors and politicians desperate to find a cure and control its spread also sought advice for diagnostic and treatment options from the same forces that brought the disease to its shores. From this perspective, the devastation caused by cholera’s transmission in Japan represents one of the most lasting consequences of Western expansionist and imperialist policies. Embodying an Invisible Foe: Cholera in Japanese Visual Culture Cholera’s unprecedented appearance in Japan necessitated the creation of a new local word.39 The designated term korori carried several connotations; not only was it a phonetic transliteration of the Western word “cholera” into Kanji, but the three characters used for the transliteration, 虎狼狸, also mean tiger (ko), wolf (ro), and tanuki (ri), respectively.40 The word, likewise, reflected a clever use of onomatopoeia, which, when spoken, signified the sound of a “thump.”41 Korori, then, became synonymous with the hybrid monster and the “sudden death” or “three-day collapse” that often led to the quick demise of its victims.42 The transformation of this originally foreign disease into a naturalized, multilayered lexis had an undeniable effect on how the subject was anthropomorphized in art. In addition to codifying a recognizable name for the new disease, cholera’s sudden rise during the Meiji era prompted a proliferation of written and visual materials addressing the subject, from medical pamphlets for specialist audiences to nishiki-e, or illustrations printed in popular newspapers.43 These images were executed as polychrome woodblock prints following the popular ukiyo-e style from the Edo period. In keeping with Japan’s rich and distinctive print culture, their production was a multi-stage process involving several makers, including an artist who conceives the initial design on paper; a carver who cuts a separate woodblock for each color; a printer who applies ink to each block, carefully layering each color on top of one another; and a publisher who disseminated the final product.44 Contrary to the number of specialized individuals required to execute and publish a multi-colored woodblock print, new technology developed in the 1760s enabled prints to be rapidly reproduced at a surprisingly low cost, thereby making them the ideal medium for circulating educational materials on infectious disease for a wide audience.45 Compared to writers, however, visual artists had the particularly difficult task of formally representing a disease that was ostensibly invisible, both in contraction and transmission. To do this, artists turned to earlier images of infectious diseases that afflicted

80  Sara K. Berkowitz Japan, including pictures of smallpox (hōsō-e) and measles (hashika-e). These prints reflected an established visual language of disease blending the teachings of traditional medical treatments with Buddhist and Shinto beliefs, realized by anthropomorphizing illnesses in the form of demons and animals central to these spiritual practices. The visual conventions and iconography previously established in these works often transformed the spirits, monsters, demons, and ghosts from written accounts of these beliefs into physical embodiments of the disease itself. For example, in Defeating Smallpox from 1890 (Figure 3.2), a humanoid black demon with a bow and arrow stands over two red figures covered in pockmarks, their arms stretched out in horror as they run in the opposite direction of the demon.46 Interestingly, this print was published after the development of a smallpox vaccine, suggesting the persistence of faith and its utility as a recognizable form for communicating to the public. The trope of escaping a vilified disease in physical form carried over to other examples where protagonists—often smaller in scale—directly fought the monster. In Shipping Measles Away, 1862 (Figure 3.3), the artist portrays measles in the form of a rash marked Shūtendōji, a large demonic ogre from popular culture, well known for his physical might and grimacing visage. Laura W. Allen notes that the portrayal of Shūtendōji, as seen here atop a cart carried by a chaotic and overabundant group of smaller human bodies with food packages in place of heads, references Shinto festivals, where spirits (kami)

Figure 3.2 Shungyō, Defeating Smallpox (Hōsō taiji no zu), woodblock print, 1890.  Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco.

Combating Cholera  81

Figure 3.3 Utagawa Yoshifuji, Shipping Measles Away (Hashika okuri-dashi no zu), woodblock print, 1868. Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco.

are processed through village streets.47 The addition of rice cakes surrounding the ogre also foregrounds one of the government’s primary directives to the public to maintain a healthy diet to prevent disease.48 By transforming the enemy into a tangible and recognizable form derived from popular culture, artists prompted viewers to readily understand the immediate threat that measles posed, encouraging the general public to fight the disease through such methods as sanitary health and proper diet.49 It is also possible that artists deliberately portrayed such figures as Shūtendōji as a rash-laden reincarnation of measles to induce fear in the public.50 The strategy of placing the measles ogre atop cart about to be sent away, as the title also indicates, further suggests that through collective following of government guidance, even the most threatening of villains could potentially be overcome. This trope of a seemingly insurmountable foe on the brink of expulsion, as we shall see, will also inform later portrayals of cholera. The depiction of cholera, however, presented artists with multiple unprecedented visual problems. Unlike the highly recognizable external markings on a smallpox or measles victim’s skin, cholera’s most common symptoms of diarrhea and dehydration and their often-rapid progression leading to death challenged Japanese artists to develop visual strategies to explicitly signal the presence of cholera in a manner that fit within

82  Sara K. Berkowitz the established convention of embodying a monster with the hallmarks of the disease. In addition, artists had to contend with the problem of figuring a disease in a distinctly Japanese form when it was not only widely known to have originally been brought on by a Western intruder but also had the potential to be cured through the Japanese government’s collaboration with Western medical researchers’ practices.51 As a result, Defeating Cholera reflects a deliberate departure from the “single beings/identities” of demons, gods, and ogres that often embodied other previous infectious diseases such as smallpox and measles, signaling cholera’s complicated status. Before turning to the hybrid cholera beast, this section will first elucidate key elements of the composition that contribute to the print’s broader meaning. The horizontal woodblock print is divided into two sheets, with only subtle delineations of space marked by a band of red ink that gradually fades and two isolated clusters of green shading underneath the two separate groups of figures, alluding to a ground line. An inscription occupies the upper third of the composition. In sum, the text describes doctors’ potential cures against the cholera pathogen. It advises the use of phenol (also called carbolic acid), a popular remedy first prescribed by American doctor D. B. Simmons, who was a resident at the Yokohama Medical College in Kanagawa.52 It also notes that the Japanese army was issued dried plums and that the public was also encouraged to obtain them as a prophylactic measure.53 The inscription, then, functions both as an historical record of doctors’ experiments and as an instructive guide to the populace set forth by the army. The text also interacts with the scene below, especially on the right sheet where it forms a partial outline around the monster, creating a barrier of negative space and drawing the viewer’s gaze to the actions of each group. The military men labeled “Hygiene Army” occupy the left side of the composition.54 Like martial figures from other cholera prints such as Tsukioka’s Illustrated Narrative on Preventing Cholera, they appear to be dressed in modern soldiers’ uniforms while the central figure seems to be wearing garments akin to a traditional Samurai or marshal hero (Figure 3.4).55 The soldiers aim the cannon of plum vinegar or carbolic acid toward the center of the composition, just slightly out of reach of the hybrid beast, whose body occupies a majority of the right sheet. The tripartite monster and its interaction with both the military figures at left and the victims beneath its body play a key role in producing a palpable tension between the visual elements of so-called “modern” Western medicine and traditional Japanese folklore. Starting from the viewer’s left, the first third of the beast resembles a tiger; its head and front legs articulated with yellow fur and characteristic stripes. In addition to tigers’ prominence as one of the ancient Chinese calendar’s 12 zodiacal animals— which was believed to be adopted in Japan as early as the late seventh century—they were also associated with courage and strength, and were often carved into amulets to ward off diseases in general.56 Interestingly, the gray striations and their subtle red shading diverge from their appearance in life, perhaps alluding to the protrusion of one’s veins that likely accompanied choleretic dehydration. A clear change from yellow to gray marks the ­transition from tiger to wolf and continues up to the animal’s outstretched hindlegs, which almost reach the text at the upper right, giving visual form to the powerful and swift movement of cholera’s progression from infection to death.57 Like the tiger, the wolf is also associated with ferocity and strength in Japanese folklore, where it often appears as a mountain-dwelling protector of both farmers’ crops and Shinto shrines.58 Yet, while the tiger and wolf derive from nature and were found in Japan, it is worth noting that contrary to the tanuki, they were not originally native to Japan and were imported.59

Combating Cholera  83

Figure 3.4 Tsukioka Yoshitoshi, Illustrated Narrative on Preventing Cholera (Korori fuesgi no etoki) woodblock print, 1877.  Courtesy of UCSF Japanese Woodblock Print Collection. Archives & Special Collections, University of California, San Francisco.

The monster’s tripartite form culminates in the grotesquely large tanuki scrotum moments away from crushing what appears to be three female caretakers and their accoutrements, including a bottle and a fan. Kimura depicts the scrotum with as much textural detail as the tiger’s veiny stripes and the wolf’s fur, complete with delineations of hair and shading to suggest not only depth but also the magnitude of its scale and weight. The tanuki, a species of wild canine, has been a widespread figure in traditional folklore since the fourteenth century and continues to occupy popular imagination today with appearances in the 1994 film Pom Poko and its inspiration for the character “Tanooki Mario,” which debuted in the Super Mario Brothers video game in 1988. The Incredible Weight of Disease: Monsters and the Tanuki Scrotum Within the broad category of yōkai, tanuki are described as tricksters who deceive humans, often causing them to make either humorous or disastrous mistakes. The scrotum’s prominence in Defeating Cholera is consistent with other representations of tanuki where the scrotum functions as the principal means through which it shapeshifts and tricks humans. These multilayered associations with trickery and good luck carried into images of tanuki in popular prints. In contrast to Defeating Cholera where only the scrotum of the tanuki was incorporated, Edo-era prints of tanuki portrayed them as full-­bodied bipedal beings who stretched their scrota into a variety of shapes and sizes

84  Sara K. Berkowitz

Figure 3.5 Tsukioka Yoshitoshi, Rainy Day Tanuki, from the “Comic Pictures of Famous Places in the Early Days of Tokyo Series,” woodblock print, 1881.  Public Domain.

to perform human-like activities such as pitching a tent or clobbering a human, often with a satirical connotation, as seen here in Tsukioka’s Rainy Day Tanuki (Figure 3.5).60 Interestingly, and perhaps contrary to how viewers today might interpret this subject within a Western paradigm of sex and gender, previous scholars have contended that the emphasis on the tanuki’s gargantuan scrotum in visual and literary sources is not intended to be read as erotic.61 Nor does its humorously disproportionate scale in relation to the rest of its body, and its interaction with the victims below, imply a hypersexuality, like Western examples of ithyphallic gods such as Priapus from Roman mythology.62 When combined with the tiger and wolf motif in Defeating Cholera, the tanuki scrotum takes on new meaning beyond its earlier associations with trickery and auspiciousness to portray a sinister and fierce opponent, necessitating military intervention to defeat it. The dramatic battle of two opposing forces recalls both sensationalized subjects from theater and the shocking and graphic images of war that were equally prevalent in Japanese ukiyo-e prints.63 According to Alicia Volk, it did not matter that the subjects of these prints were often fabricated, noting that there is “beauty [sic] in these spectacular war images…”64 Likewise, the design for the vibrantly colored hybrid monster and its spatial relationship with the other figures, offset by deliberate negative space and text, in Defeating Cholera surely attracted attention and visually absorbed the viewer in the dynamic scene. In particular, the positioning of the scrotum on the right sheet directly contrasts with the cannon firing medicinal liquid, drawing the viewer to the cluster of figures at left.

Combating Cholera  85 While other prints depicting cholera as a hybrid monster survive today, no example exists, to my knowledge, that visualizes the tanuki scrotum on such a large scale and is as visually prominent as Defeating Cholera.65 In so doing, it also highlights an important facet of disease visual culture that has yet to receive extensive scholarly attention: the role of sexual identity and gender, both in a Japanese and global context. Interestingly, most prints picturing embodied demonic or monstrous diseases from this era appear to either possess male anatomy or hold objects such as a weapon that suggest a masculine attribution. That is not to say that there are no examples of female or gender ambiguous supernatural characters in Japanese folklore but, rather, that artists and the government likely asserted that messages warning the public about highly infectious and fear-provoking illnesses would be more effective in male form. The prominence of the tanuki scrotum is also significant when read through the broader interactions between the two opposing groups flanking the monster. The Samurai-like warrior and accompanying members of the hygiene army are deliberately dressed in clothing recognizable for its associations with masculine strength. Indeed, the two partial figures behind the warrior appear to be wearing military uniforms and Western-style hats. Their collective gesture of advancing toward the enemy with standards raised, and the wide-spread stance of the warrior also suggest a performance of masculine military might.66 This cluster of cropped, almost disembodied figures with the warrior as their leader appears in stark contrast to the chaotic group at the mercy of the beast and its pendulous scrotum at far right. The clothing and hair styles of these three figures suggest they are women, while scholars such as Allen have identified the fourth figure on the sick bed as male.67 Taken together, these gender assignments are far from accidental. The ­juxtaposition of the male monster and its combatants against the female c­ aretakers, in particular, reveals an aspect of the patriarchal system that governed behavior and ­occupation in much of Japanese society during this time.68 The deliberate gendering of these subjects also reveals how the same disease could be experienced and pictured differently across cultures and geographic regions. For example, Western images depicting the impact of cholera in England and Europe are often more broadly focused on the physical side effects and symptoms of the disease on single victims, such as portraying a sufferer’s sallow skin dramatically tinted with blue, alluding to the dehydration that would ultimately lead to death. Notably, several examples portray the subject as a once beautiful female youth, as seen in a two-part colored engraving of a Viennese woman that shows her as beautiful and healthy on the left and hours away from death with ragged clothes and blue skin on the right (Figure 3.6). Defeating Cholera, in contrast, suggests an outward, collective experience of the disease that must be read within the print’s function as a directive to ward off infection rather than mourn the loss of a victim. Conclusion What began as a disease initially brought to Japanese shores through the forced opening of its ports by Western imperialists eventually became one of the defining impetuses for the Meiji government’s swiftly enacted policies of modernization, including centralizing public health and institutionalizing state-run hospitals and medical treatment directives, culminating in the country’s elevated geopolitical status on the world stage.69 The visual culture of Japanese woodblock prints of cholera represents one of the most critical and effective means through which artists and government officials circulated health

86  Sara K. Berkowitz

Figure 3.6 Publisher not Identified, Anon., A Young Woman of Vienna Who Died of Cholera, Depicted When Healthy and Four Hours before Death, colored stipple engraving, ca. 1831.  Wellcome Collection: Royal College of Surgeons. Public Doman.

directives and inspired compliance through the adoption of dramatic, eye-catching, and recognizable imagery from popular culture and Buddhist and Shinto practices. Defeating Cholera and the other prints discussed here function less as straightforward reactions to a foreign disease and instead reflect Japanese society’s looking to both the past and the present to understand and give visual form to a disease “without shape.” What this brief survey of images demonstrates is the cultural relativity we must bring to any examination of the visual culture of contagion. For while the symptoms of cholera and the very real corporeal experiences of its victims were surely felt on a consistent, if not, universal level, the conceptualization of its cause, spread, and treatment remained inextricably tied to the distinctly Japanese cultural factors that arguably shaped the experiences of both the public and medical community. The Japanese government’s engagement with Western medical theories and practices to control the spread of cholera did not mean a complete revocation of previous popular beliefs, however. Following Mary Louise Pratt’s use of the contact zone as a dynamic space of overlapping and reciprocal exchange, I argue it reflected an integration of these diverse cultures and systems of thought, permitting their co-existence on the printed sheet, rather than blending or diluting the references to indigenous Japan.70 For while Defeating Cholera incorporates an American doctor’s promotion of carbolic acid as a disinfectant, the hybrid cholera monster is a distinctly Japanese phenomenon that is combated—and presumed eventually defeated—by Japanese martial heroes dressed in a combination of modern and

Combating Cholera  87 t­ raditional military uniforms. The prominence of the tanuki’s scrotum, both regarding its scale and placement within the composition and the critical part it plays in the trampling of the beast’s victims, recalls earlier Edo-era prints of tanuki which visually emphasized the scrotum’s role in shapeshifting. The undeniable visual attention the scrotum solicits, arguably above all other references to spiritually endowed animal appendages in the print, demonstrates an intentional highlighting of the tanuki’s past associations with transformation, trickery, and potentially even humor, which likely carried through to its new role as an agent of surprise for the monster’s victims. The print’s alignment with famed ukiyo-e woodblock techniques and subjects, which, in turn, were highly sought after and collected by Westerners, also underscores a distinctly Japanese interpretation of the disease and its ultimate defeat by Japan. In conclusion, this chapter has attempted to move away from previous linear narratives that privilege a neat, teleological evolution from the reliance on local traditions of healing and popular belief to privileging Western techniques of so-called modern medical innovations. Rather than revealing a complete transition—or even integration—of these multiple pathways toward understanding and combating contagion, I argue Defeating Cholera reflects the palpable tension, anxiety, and, ultimately, co-existence among them.71 It is also important to note that Japan’s experience with cholera throughout the epidemic outbreaks of the nineteenth century was not exceptional but instead existed within a larger, globalized context whereby Eastern and Western nations sought to quell the fear surrounding this new invisible threat through medical research and public health initiatives. As the irrevocable toll of epidemic disease continues into the twenty-first century with the COVID-19 pandemic, the importance of reviving hybrid monsters from the past to make sense of the unfathomable continues in Japanese culture. For instance, images of Amabie, a multi-legged sea yōkai, have experienced a resurgence in popular culture due to the creature’s potential to ward off sickness. One need only look to online platforms like Twitter and Instagram to discover a plethora of posts by multiple generations of users to recognize the power of belief in times of chaos.72 Notes 1 I would like to thank Marsha Morton and Ann-Marie Akehurst for their thoughtful feedback on this chapter. I would also like to thank Yui Suzuki, who first brought the primary study under consideration to my attention when I was teaching a class entitled “Picturing Pandemics” at Auburn University in 2020, in addition to Alicia Volk for bibliographic suggestions and Yufeng Mao for her feedback on the historical context and translation of important terminology. 2 Home Ministry Bureau of Hygiene and Bureau of Shrines and Temples, Korera yobō no satoi (Shajikyoku Shuppan, 1880). This quote is published in Miri Nakamura, “Monstrous Language: The Translation of Hygienic Discourse in Izumi Kyoka’s The Holy Man of Mount Kōya,” Review of Japanese Culture and Society 20 (2008): 157–177; 161. 3 In some cases, the link between natural disasters and the spread of infectious disease was explicitly articulated in art. Gregory Smits, for instance, has discussed the relationship between the Ansei Edo earthquake of 1855 and its visualization in catfish prints, or namazu-e, and the measles outbreak of 1862 and its visualization in prints of deities and demons, or hashikae. See Gregory Smits, “Warding off Calamity in Japan: A Comparison of the 1855 Catfish Prints  and  the 1862 Measles Prints,” East Asian Science, Technology, and Medicine 30 (2009), 9–31. 4 Charles S. Braddock, “Asiatic Cholera, Its Prevention and Treatment,” JAMA 24 (1907): 2027– 2028 and Edward S. Morse, Japan Day by Day (Boston, MA and New York, NY: Houghton Mufflin Company, 1917), 336.

88  Sara K. Berkowitz 5 See Mary Louise Pratt, “Arts of the Contact Zone,” Profession (1991): 33–40, especially 34. For its application in Japan, see Laurence Williams, “Revising the ‘Contact Zone’: William Adams, Reception History and the Opening of Japan, 1600–1860” in J. Kuehn et al. (eds.), New Directions in Travel Writing Studies (London: Palgrave Macmillan), 297–312. 6 For a recent example that examines disease from a colonial perspective, albeit only engaging visual culture indirectly, see Jim Downs, Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine (Cambridge: The Belknap Press of Harvard University Press, 2021). 7 The US Centers for Disease Control and Prevention (CDC) commissioned the three-dimensional visual rendering of SARS-CoV-2 in January 2020 with the aim of increasing public awareness on the severity of the disease. The image was designed by Alissa Eckert and Dan Higgins, both of whom are trained as medical illustrators and have Bachelor of Fine Arts degrees. The image won a Beazley Designs of the Year award from the Design Museum in the category of Graphics for 2020, which noted the image depicts the virus viewed through a microscope: a speckled grey sphere with bright red spikes that create the now infamous crown-like appearance of the virus. Using lighting, texture, contrast, and color, Eckert and Higgins give the virus a beautiful yet threatening form. See “3D rendering of SARS-CoV-2,” https://designmuseum.org/exhibitions/beazley-designs-ofthe-year/graphics/3d-rendering-of-sars-cov-2 (accessed October 7, 2022). 8 See Andrew T. Kamei-Dyche, “The History of Books and Print Culture in Japan: The State of the Discipline,” Book History 14 (2011): 270–304. 9 For example, see Richard Barnett, The Sick Rose or Disease and the Art of Medical Illustration (London: Thames & Hudson Ltd., 2014). 10 Michael Dylan Foster, The Book of Yōkai: Mysterious Creatures of Japanese Folklore (Berkeley: University of California Press, 2015), especially 186–193. 11 Frank M. Snowden, Epidemics and Society: From the Black Death to the Present (New Haven, CT: Yale University Press, 2019). 12 Dylan Foster, The Book of Yōkai, 186. 13 The scholarship on tanuki in folklore is extensive. For select examples, see U. A. Casal, “The Goblin Fox and Badger and Other Witch Animals of Japan,” Folklore Studies 19 (1959), 1–93, Violet H. Harada, “The Badger in Japanese Folklore,” Asian Folklore Studies 35, no. 1 (1976): 1–6, and Michael Dylan Foster, “Haunting Modernity: Tanuki, Trains, and Transformation in Japan,” Asian Ethnology 71, no. 1 (2012): 3–29. 14 Nicholas Epley, et al., “On Seeing Human: A Three-Factor Theory of Anthropomorphism,” Psychological Review 114 (2007), 864–886. 15 It is important to note that the move toward a model of Western modernization did not result in a complete rebuke of previous indigenous traditions, nor was it a smooth or straightforward transition. For a complication of the problematic “tradition/modern” dichotomy, see Akihito Suzuki and Mika Suzuki, “Cholera, Consumer, and Citizenship: Modernisations of Medicine in Japan” in Hormoz Ebrahimnejad (ed.), The Development of Modern Medicine in NonWestern Countries (London: Routledge, 2012), 184–203, especially 185 and 188. Pratt, “Arts of the Contact Zone,” 33–40. 16 Tom Koch, Disease Maps: Epidemics on the Ground (Chicago, IL: The University of Chicago Press, 2011), 125–135. 17 Hereafter referred to as Defeating Cholera. 18 Kamei-Dyche, “The History of Books and Print Culture in Japan,” 285–291. 19 Of relevance to this study is Bhabha’s contention that hybridity and hybrid identity resist the previously strict boundaries between colonizer and colonized. See Homi Bhabha, “The Third Space” in J. Rutherfod (ed.), Identity: Community, Culture, Difference (London: Lawrence & Wishart), 207–221. It should be noted that Japan’s interactions with the imperial powers of the West were different from other territories in the East that came under the direct rule of EuroAmerican colonizers. See Rumi Sakamoto, “Japan, Hybridity and the Creation of Colonialist Discourse,” Theory, Culture & Society 13 (1996): 113–128. 20 Other diseases with dysenteric symptoms have long existed in the historical record, but it is not until the 1800s that cholera is named. See Julie Anderson, Emm Barnes, and Emma Shackleton, The Art of Medicine: Wellcome Collection (Chicago, IL: The University of Chicago Press, 2011), 128.

Combating Cholera  89 21 “Cholera” from https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc20355287#:~:text=Cholera%20is%20a%20bacterial%20disease,eliminated%20­cholera%20 in%20industrialized%20countries (accessed December 29, 2020). See also William Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822–1900),” Extreme-Orient Extreme Occident 37 (2014): 171–196, especially 174–175. 22 Anderson, Barnes, and Shackleton, The Art of Medicine, 129. 23 Ibid., 128. 24 Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822– 1900),” 187–188. 25 Anderson, Barnes, and Shackleton, The Art of Medicine, 128. 26 Susan Burns refers to cholera as the “child of imperialism,” in her lecture “The Cholera Pandemic and 19th Century Japanese Culture” for the “Epidemics Then and Now: Infectious Diseases around the World,” University of Chicago Summer Institute for Educators, 2006. https://www.youtube.com/watch?v=AaO1QwSVWg8 (accessed December 29, 2020). 27 A sentiment developed in Japan following the Opium War of 1839–42 and China’s defeat in the Sino-Japanese War of 1894–1895 that China was an inferior civilization, a reversal of previous attitudes. I thank Yufeng Mao for sharing this point. See also Frederick R. Dickinson, “External Relations” in William M. Tsutsui (ed.), A Companion to Japanese History (Oxford: Blackwell Publishing, 2007), 207–223, especially 209. The Defeat of Epidemic is a cholera print from 1880 that directly references the disease’s association with China with an inscription below the hybrid cholera monster reading “I’m going to China,” suggesting the monster is leaving the superior Japan to wreak havoc in China. Notably, the monster’s head and body reference the tiger and wolf, but its genitals are not discernable. See Miri Nakamura “Monstrous Language: The Translation of Hygienic Discourse in Izumi Kyōka’s ‘The Holy Man of Mount Kōya’,” Review of Japanese Culture and Society (2008): 157–177, especially 157. 28 Suzuki et al., “Cholera, Consumer, and Citizenship: Modernisations of Medicine in Japan,” 186. 29 Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822– 1900),” 174–176. 30 Although this event is one of the most well-known and highly documented, other examples also contributed to the disease’s spread—and the transmission of ideas for treatment—such as the influx of Buddhists from China. See William D. Johnston, “Buddhism Contra Cholera: How the Meiji State Recruited Religion Against Epidemic Disease” in David G. Wittner and Philip C. Brown (eds.), Science, Technology, and Medicine in the Modern Japanese Empire (London: Routledge, 2016), 62–79. 31 By 1721, Edo’s population is estimated at 1,000,000 residents, making it the highest populated city on a global scale. See Gilbert Rozman, “Edo’s Importance in the Changing Tokugawa Society,” The Journal of Japanese Studies 1 (1974): 91–112, especially 91. 32 Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822– 1900),” 171. The Satsuma Rebellion of 1877, a revolt led by disenfranchised Samurai against the Meiji government, was one such factor. See Suzuki et al., “Cholera, consumer, and citizenship: Modernisations of medicine in Japan,” 187. 33 Trade routes between Japan and China and Japan and the Dutch were still open. See Suzuki et al., “Cholera, Consumer, and Citizenship: Modernisations of Medicine in Japan,” 186. 34 For censorship policies during the Tokugawa Shogunate, see Sarah E. Thompson and H. D. Harootunian, Undercurrents in the Floating World: Censorship and Japanese Prints (New York, NY: The Asia Society Galleries, 1991), 72. 35 Kamei-Dyche, “The History of Books and Print Culture in Japan,” 274–277. 36 Ibid., 275. 37 James L. Huffman, “Restoration and Revolution” in William M. Tsutsui (ed.), A Companion to Japanese History (Oxford: Blackwell Publishing, 2007), 139–155. 38 “Modernizing” is presented in quotation marks to signal the complicated and problematic associations with this word when placed in opposition to “traditional.” It is used here for clarity purposes and to denote the institutionalization of medicine in what is commonly referred to as the era of modern history. See Keir Waddington, “Problems of Progress: Modernity and Writing the Society History of Medicine,” Social History of Medicine (2021): 1–15. 39 Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822– 1900),” 173.

90  Sara K. Berkowitz 40 Miri Nakamura, “Monstrous Language: The Translation of Hygienic Discourse in Izumi Kyōka’s ‘The Holy Man of Mount Kōya,’ ” 157. 41 Laura W. Allen, “Contagious Disease,” UCSF Japanese Woodblock Print Collection, https:// japanesewoodblockprints.library.ucsf.edu/contag1.html (accessed November 1, 2020). 42 Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822– 1900),” 178. 43 Hayari Yamai No Nishiki-e: Color Prints of Infections (Japan: Naito Museum of Pharmaceutical Science & Industry, 2001). 44 Thompson and Harootunian, Undercurrents in the Floating World: Censorship and Japanese Prints, 72. 45 Thompson and Harootunian, Undercurrents in the Floating World, 72. 46 For the role of color—especially the significance of red—see Allen “Contagious Disease,” UCSF Japanese Woodblock Print Collection, https://japanesewoodblockprints.library.ucsf. edu/contag3.html (accessed November 1, 2020). 47 For more information on deities, see Johnston, “The Shifting Epistemological Foundations of Cholera Control in Japan (1822–1900),” 183. 48 Allen, “Contagious Disease.” 49 While the government’s role in the design and dissemination of these prints is yet to be fully determined, numerous scholars have noted that a private commercial printing sector developed in Japan around the 1700s. Although the printing of books and visual media was supported under both the Tokugawa Shogunate and the Meiji Empire, censorship restrictions prohibited the publication of material deemed slanderous against the government. See Kamei-Dyche, “The History of Books and Print Culture in Japan,” 274–275. Thompson and Harootunian note that by 1875 the Meiji emperor required the publication of the full name and address of both artist and publisher, in addition to the date of publication on each print, which likely dissuaded the publishing of explicitly anti-government material. See Thompson and Harootunian, Undercurrents in the Floating World, 88. 50 Shūtendōji is notably gendered male, a point that, when coupled with the undeniable malepresenting anatomy of the hybrid monster in Defeating Cholera, necessitates further exploration into the potential relationship between gender and anthropomorphized representations of disease that is beyond the scope of the present study. Female monsters in the form of witches, ogresses, and old crones did exist in Japanese yōkai culture, however. See Michael Dylan Foster, The Book of Yōkai, 144–149. 51 The incorporation of Western medicine and vaccination is not isolated to cholera. For example, Japan previously incorporated Western medical research and early attempts at vaccination during the influx of smallpox in the Edo period. Philip F. B. von Siebold, a German physician, transported cowpox vaccine from England to Japan but it was unsuccessful as it was a live vaccine and did not withstand the long travel. Japanese physicians eventually turned to variolation, or the deliberate infecting of a patient with smallpox to induce a mild reaction through blowing dried smallpox scabs into the nose. This technique was also transnational by way of Lady Mary Wortley Montagu, the wife of the British ambassador to the Ottoman Empire. See Tetsuo Nakayama, “Vaccine Chronicle in Japan,” Journal of Infection and Chemotherapy 19 (2013): 787–798. 52 Today, the CDC describes phenol’s chemical structure as a “crystalline solid with a sweet, acrid odor.” It also warns that exposure to direct phenol could “cause irritation to the skin, eyes, nose, throat, and nervous system.” It is still used, however, in the manufacturing sector and as an antimicrobial pesticide, antiseptic, and disinfectant. See “Phenol” The National Institute for Occupational Safety and Health (NIOSH) from Centers for Disease Control and Prevention, https://www.cdc.gov/niosh/topics/phenol/default.html, June 22, 2019 (accessed September 1, 2022). For Japan’s adoption of D. B. Simmons’ promotion of phenol as a medicinal preventative against cholera, see T. Otaki, “Cholera Epidemics in Kanagawa,” Nihon Ishigaku Zasshi [Journal of Japanese History of Medicine] 38 (1992): 5–24. 53 For a more thorough discussion of the text, see William D. Johnston, “Buddhism Contra Cholera: How the Meiji State Recruited Religion against Epidemic Disease” in David G. Wittner and Philip C. Brown (eds.), Science, Technology, and Medicine in the Modern Japanese Empire (London and New York, NY: Routledge, 2016), 68. 54 Johnston, “Buddhism Contra Cholera: How the Meiji State Recruited Religion against Epidemic Disease,” 68.

Combating Cholera  91 55 In Tsukioka Yoshitoshi’s example, cholera takes the form of a humanoid demon rather than an animal hybrid. 56 Singer and Masatomo (eds.), The Life of Animals in Japanese Art, 45–57. 57 I thank Ann-Marie Akehurst for initially equating the tiger’s dynamic movement with cholera’s expediency. 58 For wolf as a protector from cholera, see Bettina Gramlich-Oka, “The Body Economic: Japan’s Cholera Epidemic of 1858 in Popular Discourse,” East Asian Science, Technology and Medicine 30 (2009): 32–73, esp. 51. 59 The exotic animal trade in Asia was extensive in the eighteenth and nineteenth centuries and was largely facilitated by Dutch merchants who controlled key trade routes in the Indian Ocean. Notably, tigers are native to China, and were likely transported from China to Japan through the Dutch, suggesting an additional geopolitical layer to the integration of foreign animals in Japanese art. See Robert T. Singer and Kawai Masatomo (eds.), The Life of Animals in Japanese Art, National Gallery of Art Exhibition (Princeton, NJ and Oxford: Princeton University Press, 2019): 29–30. The wolf likely appeared in Japan around 1777, also through the Dutch animal trade. For the presence of a small gray “wolf-like” dog (ōkami), in Japan see John Knight, “On the Extinction of the Japanese Wolf,” Asian Folklore Studies 56, no. 1 (1997): 129–159, especially 135–137. 60 On humor, see Gramlich-Oka, “The Body Economic: Japan’s Cholera Epidemic of 1858 in Popular Discourse,” 57–65. 61 Few scholars have remarked on the conspicuous absence of a phallus in visual representations of tanuki. For two exceptions, see U. A. Casal, “The Goblin Fox and Badger and Other Witch Animals of Japan,” 57, and Harada “The Badger in Japanese Folklore,” 2. 62 While scrotal swelling due to any number of conditions from kidney stones to a bacterial infection can cause an enlarging of the scrotum in humans, it does not appear to be a side effect of cholera or dehydration caused by cholera. Veterinary scientists have noted its appearance, however, as a side effect in classical swine fever (CSF), also referred to as “hog cholera.” See Agricultural Research Service, U.S. Department of Agriculture “Cholera,” 2019. https://www. ars.usda.gov/oc/timeline/cholera/ (accessed March 10, 2022). 63 Tsukioka Yoshitoshi, the artist of the Illustrated Narrative on Preventing Cholera, for example, was famous for disturbingly violent scenes of bodily harm like Picture of the Lonely House at Adachigahara in Ōshū, 1885 (Minneapolis Institute of Art), where a pregnant woman, nude from the waist up, is hung from the ceiling of a house with rope while an elder woman sits below, ready to assault her. 64 Alicia Volk, “Beauty and Violence, Art and War: Some Reflections on the Visual Cultures of Imperial Japan,” Cross-Currents: East Asian History and Culture Review 31 (2019): 231–243, especially 235. 65 For instance, Toyohara Chikanobu’s Mr. Saigō’s Amazing Charm to Ward of Off? Cholera, 1877 (IHL Cat. #777) from the Irwin Lavenberg Collection of Japanese Prints portrays the tripartite monster already defeated with a human fighter standing on top of it. The tiger stripes and body of the wolf are clearly identifiable, but the transition from the wolf to the tanuki is difficult to discern, nor is the scrotum visible, if pictured at all. For information on the Irwin Lavenberg Collection, see the Portland Japanese Garden’s exhibition “Ukiyo-e to Sin Hanga: Changing Tastes in Japanese Woodblock Prints,” https://www.japanesegarden.com/2021/10/06/ukiyo-eto-shin-hanga/. Another example, a diptych entitled Defeat of Epidemic, 1880 portrays the same ferocious tiger body, but with the head of a lion. Miri Nakamura discusses this print within the context of the word korori’s breakdown of ko (head of a tiger), ro (torso of a wolf), and ri (genitals of a badger), but only one of the two sheets is published. As a result, the monster’s body is cropped, leaving the viewer to wonder how prominent the tanuki’s scrotum would appear, if included at all. See Miri Nakamura, Monstrous Bodies: The Rise of the Uncanny in Modern Japan (Cambridge: Harvard University Press, 2015), 13–15. 66 The attire’s reference to a specific military rank as opposed to generalized representation is too subtle to discern. 67 Allen, “Contagious Disease.” https://japanesewoodblockprints.library.ucsf.edu/contag3.html. 68 Like the United States’ promotion of a “cult of domesticity” aimed at women in the 1950s, the Meiji government’s Education Ministry propagandized the concept of “Good Wife, Wise Mother” (ryosai kenbo), popularized as a “cult of productivity.” It encouraged women to assume the roles of child-rearing and household management, while also emphasizing hard

92  Sara K. Berkowitz work, frugality, and caring for the sick, as visualized in the female attendants to the male victim in Defeating Cholera. See Sharon H. Nolte and Sally Ann Hastings, “The Meiji State’s Policy toward Women, 1890–1910” in Gail Lee Berstein (ed.), Recreating Japanese Women, 1600– 1945 (Berkeley: University of California Press, 1991), 151–153. For women who challenged these norms and fought for representation in the public sphere, see Mara Patessio, Women and Public Life in Early Meiji Japan: The Development of the Feminist Movement (Ann Arbor: University of Michigan Center for Japanese Studies, 2011). 69 For the use of public isolation hospitals, see Suzuki et al., “Cholera, Consumer, and Citizenship: Modernisations of Medicine in Japan,” especially 188–189. 70 Pratt, “Arts of the Contact Zone,” 33–40. 71 This mode of interpretation is not exclusive to Japan but could also be applied to medical images from other cultures as evidenced by the wide scope of contributors to this current volume. 72 Yuki Furukawa, et al., “Amabie: A Japanese Symbol of the COVID-19 Pandemic,” JAMA 324, no. 6 (2020): 531–533.

4 Jean Geoffroy and the Conflicted Response to Childhood Epidemics in Fin-de-Siècle France Barbara Larson

Henry Jules Jean Geoffroy (1853–1924) was one of the leading French Third Republic painters of children of the working class. Like other artists who worked in the dominant aesthetic of the early years of the Republic, he was a Naturalist—making use of a flexible, descriptive style that often foregrounded the here and now in the life of the lower classes. Naturalism, with its emphasis on observation and accuracy, suited the rise of a political state that found its footing in egalitarian values after the devastating loss of the Franco-Prussian War (1870–1871) and in a rejection of the hierarchical societal controls exercised by Napoleon’s nephew under the Second Empire, the deeply rooted traditions of the Catholic Church, and ongoing sympathies for monarchies of the past. Despite an initial backlash in support of the Church in the 1870s among conservative administrators, by the final year of the decade an anticlerical government dedicated to scientific progress and communal welfare had consolidated. After 1880, Geoffroy was sometimes hired through official government channels to create paintings of children that celebrated initiatives in education or collective hygiene.1 A close friend of the Pasteurian pediatrician Gaston Variot, whom he frequently visited at his clinic in the working-class Paris neighborhood of Belleville, Geoffroy’s subjects included the necessary hospitalization of the child sick with a possible contagious illness or the baby whose health was dependent upon a mother’s awareness of preventative care in avoiding the effects of disease or bacteria from an unsanitary environment. Louis Pasteur’s ideas on the microbial origins of contagious ­illness such as those put forward in his La Théorie des germes et ses applications à la médecine et à la chirurgie (The Germ Theory and Its Applications to Medicine and Surgery) (1878) constituted a central driving force behind Republican health initiatives.2 Geoffroy would seem to be squarely within the camp of new medical treatments and aggressive hygienic interventions based on the discoveries of Pasteur were it not for his many lesser-known paintings and drawings that dwelled on the near-miraculous recovery of homebound children in less-than-pristine environments that have been treated with folk remedies or who are surrounded by markers of Catholic faith. In some cases, his sick children are tended to in both religious and secular settings by seemingly competent nuns at a time when Third Republic officials attempted to curtail sisterhoods devoted to nursing. Geoffroy even painted at the still active late medieval Hospices de Beaune in Burgundy, built shortly after the bubonic plague wiped out three-quarters of the local population in the fifteenth century. In his paintings at the Hospices, sick children in the care of nun-nurses convalesce, leave their beds, and begin to traverse the Hall of the Poor with its gothic windows and stained-glass illumination, and Rogier Van der Weyden’s fifteenth-century nine-panel Last Judgment nearby.3 Geoffroy’s secular hygiene paintings DOI: 10.4324/9781003294979-6

94  Barbara Larson were initiated in the mid-1880s, while the “Catholic” medical paintings begin to appear approximately a decade later, though many of Geoffroy’s paintings are undated. This chapter explores the political, social, and religious response to modern medicine and contagious illness during childhood in fin-de-siècle France and Geoffroy’s seemingly conflicted depictions of means of cure. Having first been schooled in academic art at the École des Beaux-Arts under Léon Bonnat, Eugène Levasseur, and Adolphe Yvon, Geoffroy found early and consistent employment as an illustrator of children’s books in the mid-1870s. He had shown an interest in the subject of the disadvantaged child along with humorous and anecdotal scenes of the daily life of children in the streets in his paintings of the same period, which were exhibited at the Paris salon and the Salon des artistes français. Among his earliest medical paintings are hygiene scenes of children gathered around newly instituted communal washbasins in schoolrooms and teachers inspecting young children for any apparent lack of cleanliness, followed by family visits to sick children in the hospital. Hygiene and the case of children’s health was not an unusual subject in visual culture in the last two decades of the century. We find references to a range of health initiatives in advertisements, including in the new arena of poster art as well as postcards, universal expositions, popular scientific journals, and what was called scientific vulgarization—entertaining imagery (and literature) aimed at the masses. For example, when artist Théophile Steinlen, like Geoffroy a painter and a graphic artist, was hired to create an advertisement for a dairy in Burgundy, he chose an image of a healthy, young girl drinking pasteurized milk for the poster Lait pur sterilisé de la Vingeanne (1894). Such responses in mass culture were the result of hygienists, doctors, and government officials harnessing the power of the image. Business and institution owners and others whose livelihoods were influenced by hygiene such as the Quillot brothers who commissioned Steinlen’s poster or hospitals that produced postcards showing off new rooms separating the contagious from the non-contagious participated in these initiatives. In the 1890s, when Geoffroy moved to Belleville from his shared apartment above a school on the Rue du Faubourg Faubourg-du-Temple Street, he was hired to depict the Goutte de Lait or the puericulture clinic there by the pediatrician who would soon become a close companion and inspiration in the production of a growing number of medical paintings and illustrations of compromised or robust children over the next 30 years. However, the lack of full commitment to medicalized spaces with innovations that seemed to promise a healthful future to France’s children in Geoffroy’s work may owe to the reality that statistics of death from a wide variety of illnesses, pandemics included, were exacting a significant toll on infants and children in the final decades of the nineteenth century. Vaccines for common contagious illnesses were in the early stages of development or not widely employed, and water filtration systems to keep out bacteria were only beginning to be used. Antibiotics, necessary for the treatment of tuberculosis, were not available until the 1930s. For some, religion held out the ultimate promise of hope where science appeared to fail. Geoffroy himself never commented on his position regarding faith, but an early hint of a conflicted attitude or a targeted effort to appeal on a popular level occurs not in a medical painting but one concerning congregational students or perhaps orphans. Ralph Gibson has maintained that a government worker (or perhaps a close affiliate as in the case of the artist) risked their career by taking Easter communion in the early years of the Republic.4 Yet in Palm Sunday (Les Rameaux) of 1887 (lost) Geoffroy depicts a related Church holy day with a seemingly determined nun wearing a prominent coif leading a large group of young girls from the Church of Saint

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  95 Sulpice, eliciting the response of salon critic François Bournand, “Bravo master! You are not afraid to show us a painting of the good sisters so maligned by the tyrants of today!”5 On the one hand, an image of entirely females involved in religious pursuits is consistent with studies on gender and Catholicism foregrounding women’s perceived continued association with the Church during an otherwise divisive period;6 on the other, it demonstrates the complex relationship with religion experienced by many in late-nineteenthcentury France. Hygiene in the Classroom As a young artist in Paris, Geoffroy boarded with a pair of schoolteachers who may have influenced his interest in the life of children. It was a timely subject that offered a lucrative niche for a novice illustrator and painter since France’s new Republican government concerned itself with the education and welfare of children as a primary initiative. Having recently lost a major war along with two of its provinces and suffering the effects of waves of contagious illness including typhoid fever, smallpox, diphtheria, croup, and measles in crowded recently industrialized cities, France appeared to many to be weakened. Indeed, more soldiers died of smallpox during the Franco-Prussian War than from war wounds; given the fact that a vaccine against smallpox had been available in the prePasteurian period but was not used on soldiers, the defeat was partly blamed on medical neglect. When Paris itself was under siege, cut off from the rest of the country, and surrounded by Prussians, many inhabitants died of a typhoid epidemic. The language of recovery now focused in part on a younger generation who might be the hope of France’s future, in terms of both knowledge and health. New legislation attempted to change the landscape of education and hygiene.7 Secular education for the masses would help turn the country away from the power of the Church, which had been in charge of education before 1880, and an emphasis on hygiene, on the agenda in all public schools beginning in the 1880s, would teach children the value of responsibility to themselves and others and would helpfully bolster the sagging number of French citizens.8 The rise of a public health movement in France wherein the state took responsibility for health initiatives can be dated back to the 1820s and 1830s in the modern period as a response to industrialization. Increasingly congested cities seemed to result in serious outbreaks of infectious diseases, especially among members of the working class. As in the early nineteenth century, in the later decades the social etiology of disease was attached to disorders of society such as poverty, and a similar intersection of hygienists, administrators, lawmakers, statisticians, and doctors strove to deal effectively with epidemic disease. Committees and boards of health made recommendations to the state in both periods, but by the late nineteenth century these became increasingly interventionist.9 The discourse of morals (lower class lifestyles) and miasmas (noxious and disease-ridden odors) present in the earlier period was replaced with the new theories of contagion and prevention. As the locus of contagious disease sharpened to bodies over spaces the state also emphasized to its citizens individual responsibility for the collective good, even among the very young. In 1882, primary school education was made obligatory for children of all classes. The sheer number of working-class children now entering the classroom was facilitated by the law of 19 May 1874 which raised the working age to 13, with some exceptions.10 However, the influx of children into public classrooms brought with it sometimes deadly contagious illness. Cholera entered France via Egypt in 1884 and again in 1892 (both

96  Barbara Larson considered part of the fifth cholera pandemic) and typhoid menaced the country from 1881 to 1886. In terms of the latter disease, while its potential water-borne nature was already known and its bacillus isolated by the German bacteriologist Karl Eberth in 1880, it was only in 1886 when the French Secretary of the Academy of Sciences lost three daughters to it that a connection with urban drinking water was confirmed; leading Pasteurian hygienist Paul Brouardel set about locating the presence of the typhoid bacillus in the public water system.11 Another common contagious illness (formerly thought to be hereditary) that affected children as well as adults was tuberculosis.12 Health activist Dr. Edouard Vaillant claimed that at least one member of half of all working-class ­families was infected by tuberculosis.13 While Geoffroy’s Obligatory Education (n.d., private collection) with its mother pulling her recalcitrant son by the ear to the classroom door was clearly meant to find a humorous side to the transition to mandatory public education many parents now faced, his paintings of younger children washing their hands or having their ears inspected by teachers seemed to be geared toward reassurance of the safety in access to schoolrooms even for France’s youngest citizens (Figure 4.1). A single washbasin with multiple sinks also functioned as a symbol of national unity; the language of solidarity and moral correct action for the greater good was part of the messaging in hygiene manuals and instructions now given to teachers within the public school system.14 Instructors were to conduct inspections of ears, hands, and faces of children both in the écoles maternelles

Figure 4.1 Jean Geoffroy, The Washbasin at the école maternelle (lost), reproduced in Henry Havard, Salon de 1885 (Paris: Baschet, 1885), p. 32.  Library of the Institut national d’histoire de l’art, Jacques Doucet collections, 4 H 8030, Photo credit: Institut national d’histoire de l’art.

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  97 (schools for ages two to six) and in primary schools outside the door of the classroom— a subject Geoffroy also took up—and to insist on the washing of hands before classes. Through a legislative act of 1882 communal washbasins were required at all state-run écoles maternelles.15 Given the frequent outbreaks of typhus, cholera, and other diseases, the chaotic and crowded scene and shared damp towels in The Washbasin at the école maternelle (1885) might send an alarm signal to the viewer today; however, it is unlikely that the nineteenth-century artist and viewer were fully aware of the limits and, indeed, threats of the intended hygienic use of the communal washbasin. Instead, the scene would have conveyed the idea of a protected environment and social betterment enacted even among the youngest of students. The active children in their simple working-class dress described as “children of the people” by historian and critic Joseph Noulens are individualized and offer a range of emotions from joy to tears in an approach that typifies Geoffroy’s seeming intention to underscore the importance of each child and everyday experiences of the younger members of the lower class.16 Given the extreme youth of those it served, the écoles maternelles were encouraged but not mandatory. They were largely used by the working class who were especially considered to be carriers of disease;17 younger children of the middle and upper classes often stayed home with mothers or nursemaids before attending primary school. Beginning with this salon entry of 1885 Geoffroy created at least a dozen scenes of washbasins or inspections of cleanliness by teachers. In 1892 he illustrated Léo Claretié’s L’Université moderne, which traced the history of educational advances in France, culminating with the Third Republic, and covered methods and subjects to be implemented at all levels of education. Claretié included a discussion of the washbasin in pre-school, pictured in a full-page illustration by Geoffroy, to be used at the beginning of the day before children were divided into groups based on age. According to the manual, the communal washbasin was to be “so perfectly at their [children’s] height and so appealing” that it invited good health.18 When Geoffroy was commissioned by the state to create a series of five paintings of initiatives in education and health for the universal exposition of 1900, one of these was of the communal washbasin.19 For the entire series he was awarded a gold medal. When outbreaks of epidemic disease occurred during the Third Republic, schools at all educational levels were to be closed for a time. Sanitary police began inspecting classrooms starting in 1879 when all hygienic services, including initiatives to filter water, were first concentrated under the Ministry of the Interior. Yet despite precautions and interventions epidemic disease continued to menace children. For example, in 1901, following a diphtheria outbreak, 30 children reportedly died weekly of this disease for 12 weeks in a row in Paris alone.20 The diphtheria bacillus had been isolated in 1888 and a serum subsequently developed, but treatment was not uniformly instituted.21 Even where the smallpox vaccine was concerned, this was not a national requirement until 1902. In the late-nineteenth-century battle against epidemic disease, France turned to the popularization of hygiene, the gradual institution of filtration systems (though this would not be complete until the twentieth century), mopping rather than sweeping dusty floors in public buildings, including schools, and changes in building construction. Ferdinand Buisson’s Nouveau dictionnaire de pédagogie et d’instruction primaire of 1911 (first published in 1897) laid out the mandatory program for teaching hygiene in schools. Along with teachers inspecting faces, necks, hands, and ears among the youngest students, washing was to be reinforced as in previous years, and students were to be taught

98  Barbara Larson that cleanliness was a moral obligation. Washing hands before eating was obligatory. Nearly 30 years after the first washbasin was installed in a public pre-school, washing one’s hands and face regularly had become a more familiar activity, not only at school but at home as well. Julia Csergo credits the internalization of lessons learned at school with increased attention paid to washing as instrumental in changing personal habits.22 Hygiene had transformed urban infrastructure, with more buildings created with modern plumbing and many insalubrious houses destroyed. In 1880 over half of Parisians lacked running water to their homes, but by 1887 this had already dropped to 20%.23 However, into the early twentieth century, water for the urban working class was normally supplied to courtyards, not individual apartments, and did not consistently run. Tubs or showers remained a luxury and washbasins were used to scrub hands and face. Thus, regular partial bathing was the norm, with doctors recommending that the face, neck, and ears be washed morning and night with greater attention paid to hands—scrubbing should take place upon arising, before bedtime, before eating, and after returning from the out of doors.24 As a result of the emphasis on frequent washing during the final decades of the century, soap production trebled in France.25 The skin itself was increasingly seen as the potential enemy of health as manuals of the 1890s made clear.26 According to Buisson’s Nouveau Dictionnaire, primary school students were obligated to take a test on hygiene in their third year at the age of eight or nine. This exam would be given in the context of the course “Man,” within the natural sciences curriculum. In this class, children learned about rudimentary aspects of the body’s systems, such as the nervous or digestive systems, along with lessons in hygiene including dangers lurking in the air, food, or water. The girls, who attended their own schools, followed a program that differed in that they also were taught about hygiene and infants, the dangers of cosmetics, and disease-carrying dust associated with different types of clothing. Given the accelerating importance placed on hygiene in the classroom Geoffroy’s initial emphasis on initiatives for children is unsurprising.27 Depopulation and Disease in Infants Geoffroy also depicted the washing of infants. Given the promotion of healthful benefits of cleansing with water, scenes of mothers bathing infants in a basin proliferated in the late nineteenth century. We see this in the work of modernists such as American Mary Cassatt, who was living in France, traditional salon painters such as Norbert Goeneutte, and Naturalists like Geoffroy. There was a growing emphasis on infant health and survival in paintings by Geoffroy by the 1890s when we can document his friendship with the pediatrician Variot. Geoffroy was not the only artist Variot hired, but he seemed to be his favorite. Variot was a doctor of puericulture—a term coined in France in the 1850s in reference to the hygienic and scientific care and raising of children.28 A highly respected doctor and administrator, Variot had served as Chief Physician at the Herold Hospital, followed by the Trousseau and Necker, all in Paris. Eventually, he assumed the same role at the Hôpital des EnfantsAssistés (originally the city’s foundling hospital) in Belleville.29 Variot’s work in puericulture was central to state initiatives having to do with fears of depopulation in general as well as disease specifically. In 1897 a national census revealed that in four of the six years from 1890 to 1896 there had been more deaths than births.30 Between 1850 and 1910 the entire population of France grew only by a million-and-ahalf.31 Dr. Jacques Bertillon started the National Alliance for the Growth of the French

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  99 Population in 1896;32 Théodore Roussel started the League against Infant Mortality in 1902; and Geoffroy’s friend Dr. Variot joined the Commission against Depopulation, presiding over its subcommission concerning childhood survival up to age 14. He was a founder of the League against Infant Mortality. The novelist Emile Zola joined Bertillon’s Alliance and published the novel Fecundity on French depopulation. Variot initiated a “Goutte de Lait” clinic in Belleville in 1892, the first of which had been introduced by Dr. Léon Dufour in 1890. These clinics were used in the distribution of sterilized milk, the promotion of hygienically cleaned baby bottles, and monitoring the weight and growth of infants. Geoffroy’s 1903 Triptyque de la Goutte de Lait de Belleville is his best-known painting of Variot’s clinic (Musée de l’Assistance publique, Paris). It was engraved two years later and became popularized through its reproduction in journals and postcards. The use of three panels with a major central one flanked by smaller paintings evokes a religious format; a mother weighs her baby at left, another mother picks up sterilized milk at right, and Variot himself appears in the center panel “Consultation” as a kind of secular saint surrounded by women and other doctors. Secular paintings with religious resonance might have mass appeal to those raised on Catholic imagery without offending Republican sensibilities, and Geoffroy was not alone among Naturalists to draw from such traditions.33 Over 200 additional Goutte de Lait clinics were created across France between 1895 and 1914. By 1911 the Hôpital des Enfants-Assistés housed three labs and became a center for the distribution of tracts on infant hygiene. Variot’s La Puériculture pratique gave specific feeding times and offered height and weight charts. Only glass bottles were to be used by those who could not breastfeed and these had to be sterilized.34 Breastfeeding one’s own child was encouraged above any other means of infant feeding. Variot awarded diplomas to mothers, including one designed by Geoffroy (originally intended as an illustration for La Puériculture pratique), where we see breastfeeding, bottle feeding, and the results: several healthy children playing, including a little girl with a doll, suggesting her own future role as a good mother (Figure 4.2). Breastfeeding for mothers was taken so seriously that Pierre Budin created École des mères specifically to teach mothers lactation techniques. He also developed a machine to sterilize baby bottles. In 1904 a legislative act officially established maisons maternelles as centers to ensure access to prenatal care. Despite these initiatives in puericulture, the issue of just who would be caring for the infants of working-class mothers who could not afford to stay home with their babies and how this might take place in order to avoid disease remained unresolved. One solution for infant care might be found in public nurseries or crèches. Charity-sponsored public nurseries had been established as early as 1844 and physicians were to visit them regularly, but infants in urban nurseries did not fare well. During the cholera epidemic of 1849, 22 out of 31 babies died at Paris’s St. Ambroise crèche.35 In 1852 all 20 of the babies then at the same crèche died of the measles or the croup.36 Crèches were subject to poor ventilation as well as crowded conditions. Public crèches came under the jurisdiction of the Department of Public Assistance under the Third Republic, but circumstances did not necessarily improve. Variot wrote about their deplorable conditions.37 In 1897 a law was instituted to allow doctors to inspect these nurseries on a more regular basis, though this proved to be less than adequate in terms of both cleanliness and staffing. Under the early Third Republic, working-class mothers were encouraged to use any break available to return and breastfeed their babies as a means of avoiding contagion. Geoffroy’s painting of a crèche scene in 1897 seems to represent this space in a positive

100  Barbara Larson

Figure 4.2 Jean Geoffroy, Mothers’ Diploma of Special Merit, nineteenth-century, drawing and watercolor, H. 32 cm × l. 42 cm, Musée de l’Assistance publique—Hôpitaux de Paris, inv. AP 2305.  © AP-HP/Musée—F. Marin.

light, one that anticipated potential gains of Republican laws (Figure 4.3). A somewhat thin, careworn mother in working-class clothing whose bodice is loosened appears to have just breastfed her chubby child, and the white linen and generous windows suggest cleanliness and sufficient ventilation. The hopeful painting, whose general positive spirit follows that of the hygiene campaign, masked fears as well as the familiar reality that most working-class mothers did not even work near the crèches in their neighborhoods and, therefore, did not use them, let alone have the ability to take breaks from their jobs to breastfeed.38 While it might seem as if the infants of the middle and upper classes would have fared better, France’s continued historical relationship with the wet-nursing industry well into the 1870s and beyond complicated the situation.39 Though breastfeeding in general may have seemed a positive alternative to potentially contaminated milk from other sources or potential diseases in public spaces, many wet nurses took care of middle- and even upper-class children in their own homes where conditions were not closely monitored, often in the countryside.40 There were wet-nursing agencies or Bureau des Nourrices in most large cities in nineteenth-century France where these women would meet potential clients before returning to their homes. An inventory of 1871–1874 revealed that over 40% of infants sent either to the peasant wet nurse or to “dry nurses” who used animal milk perished.41 As a result of this, the Roussel Law of 1874 mandated that all babies taken to homes of wet nurses needed to be officially registered and subject to inspections.

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  101

Figure 4.3 Jean Geoffroy, La Crèche [The Crib], 1897, 165 × 91 cm, inv. No. 90, oil on canvas, Musée d’Art et d’Histoire, Rochefort. Photo credit: ©Musées-municipaux Rochefort 17.

The implementation of this law in terms of the entire country was slow, and it was not until 1897 that all wet nurses and their wards were accounted for. Both babies and nourrices were to pass an initial health inspection and then be subject to monthly reviews of the general health of both infants and wet nurses, means of feeding, and cleanliness of the home. The inspections were organized by the departmental prefects of police with the assistance of medical inspectors who were designated by the Ministry of the Interior.42 However, the statistics regarding survival remained grim. Despite this, for the middle class and even some members of the lower classes (those who could afford minimal payment), the preference was to send infants outside the city. As late as 1908 Variot complained that out of 50,000 children born in Paris every year, 16,000 were sent to live with a wet nurse.43 The myth that the country child was a healthy child was not easily undercut despite the reality of lurking disease often far from the eye of hygienists. Alfred Roll’s well-fed peasant Louise Cattel: Wet Nurse (Musée des Beaux-Arts, Lille, 1892) is an example of the visual culture that contributed to this idea. The country idyll in the nineteenth century in terms of health had emerged from reactions to early industrialization and the older belief that air that lacked the stench of the city was healthful, part of the lingering notion of the miasma theory of disease. However, many wealthy families employed wet nurses who lived with them and here the outcome was more successful. Berthe Morisot’s The Wet Nurse Angèle Feeding Julie Manet (the artist’s own daughter) of 1880 (private collection) is an example of the ongoing tradition of using a wet nurse

102  Barbara Larson perceived as positive. However, the pressure on women of all classes to breastfeed their own children and avoid the potential disadvantages of bringing third parties into infant care can be seen in the proliferation of paintings of even wealthy women nursing their own babies. Examples include those by academic painter Edouard Debat-Ponsan, whose refined mother in Before the Ball (Musée des Beaux-Arts, Toulouse, 1886) breastfeeds her baby in an elegant gown, or works of art that feature women of the middle and lower classes breastfeeding, such as images by the Naturalist Georges Moreau de Tours or modernists Auguste Renoir, Eugène Carrière, and Maurce Denis. Nursing Sick Children The new laïc (secular) laws instituted by the Third Republic banned priests from teaching in public schools in 1879 and removed all remaining congregational personnel from public classrooms in the law of 30 October 1886 (to be carried out over a five-year period). Nuns persisted as teachers in private schools though they were now required to possess the brevet de capacité (official credential), and in 1901 a law was passed encouraging the dissolution of all Catholic orders involved in teaching. Despite this, private Catholic schools were responsible for the education of approximately 40% of children in the late nineteenth century.44 However, the majority of the private Catholic schools in France (over 10,000) were closed by the first decade of the twentieth century. The case of nuns as nurses was somewhat different. Despite a precarious legal status, 314 care-giving congregations operated in late-nineteenth-century France.45 In 1896 a government decree did end the practice of nuns as nurses in public city hospitals. However, this was rife with problems. Professional nursing schools were instituted in 1878, but they foundered and had high attrition rates. The secular nursing staff often lived in dormitories, which caused health problems in and of itself. In one year, from May 1895 to May 1896, 13% of the nursing staff of Paris who lived in communal spaces died, many of tuberculosis.46 And this did not include those who withdrew ill to their homes and died there. Further, the secular nursing staff was often illiterate, and training had to begin with rudimentary schooling and literacy.47 However, the last Catholic nursing staff in a public hospital in Paris, the sisters of St. Augustine, was forced to leave the Hôpital Hôtel-Dieu to enter the private Catholic hospital Notre Dame de Perpetual Bon Secours in 1908. Several years later, Geoffroy painted one of the sisters and a sick child in the Hôpital de Notre Dame de Perpetual Bon Secours (Figure 4.4). The young girl may be suffering from tuberculosis as she sits upright in a chair, a common, traditional intervention into the progress of the disease. Tuberculosis affected all levels of society, but it was thought of as a poor person’s disease since there were more cases among the lower classes due to time spent in dank, slum housing where the bacillus was found. The population of Geoffroy’s Belleville was the worst hit in Paris with a statistical probability of anyone from this neighborhood having a six times greater likelihood of contracting tuberculosis than someone from a medium-income neighborhood of Paris.48 However, tuberculosis had had a Romantic fictional attachment to the idea of the spiritual and redemption in terms of sick girls as it was also a wasting disease where the corporeal self became seemingly less present and vital. As in Geoffroy’s painting, the trope of the pale, thin ethereal young girl whose very sensitive nature had even predisposed her to this disease had been a popular one in nineteenth-century France.49 Henri Murger’s Francine in Scènes de la Vie de Bohème was referred to as “pale as an angel of phithisis [pulmonary tuberculosis].” Most recently, it had acquired a specific Catholic dimension. In the final years of the

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  103

Figure 4.4 Geoffroy, At the Hospital of Notre-Dame du Perpétuel Bon Secours, 1913, 125 × 100 cm, oil on canvas, Musée de l’Assistance publique—Hôpitaux de Paris. Inv. AP 2266.  Photo credit: AP-HP/Musée—F. Marin.

104  Barbara Larson nineteenth century, a young woman who had spent nearly a decade with Carmelite nuns in Lisieux died of tuberculosis. This would have been unremarkable for the time period were it not for the fact that her diary was published as The Story of a Soul (1898) one year after her death, creating such a sensation that “Thérèse de Lisieux,” despite having lived a simple life, was posthumously credited with miraculous healing abilities. A pilgrimage to Lisieux was second only to one to Lourdes, another site of miraculous healing popular with the working class.50 A young girl with tuberculosis in France in the early years of the twentieth century would almost certainly know the story of Thérèse and a viewer seeing a young tubercular girl with a nun in a painting like Geoffroy’s might have been reminded of Thérèse de Lisieux.51 In the year in which this painting was done, 1913, a more conservative municipal board encouraged a measure to bring about the reintegration of nuns as nurses in public hospitals, but the war ended these discussions. Nuns persisted as nurses in public spaces for care of the ill far longer in the countryside than in the city. In fact, in an 1861 census, a decade before the beginning of the Third Republic, there were 10,000 nun-nurses working in hospices and hospitals throughout the country and by 1912 there were nearly 13,000 such personnel.52 Though not formally trained, nuns ran their own pharmacies, sanatoria, and home nursing operations along with social services that had overlapping functions such as soup kitchens, homes for the deaf and mute, and orphanages. Geoffroy’s integration of Catholic references in medical spaces is part of the backdrop of perceived competence of nun-nurses by the public at large if not government officials. Although many of Geoffroy’s paintings are undated, those containing nun-nurses that do bear dates were created at the turn of the century or later. By this time, the politics of Catholicism had shifted. Leo XIII, pope since 1878, favored a conciliatory attitude with France’s Third Republic and embraced Neo-Thomism (a revival of the scholasticism of Thomas Aquinas which, in part, sought to reconcile science and faith). In 1891 the encyclical Rerum novarum was issued, calling for the Church to recognize social change, and a year later, the encyclical Au milieu des solicitudes was specifically concerned with the acceptance of the Republic by French Catholics. By the 1890s the Republic responded at least in some quarters and took a more nuanced position toward the Church. Unlike the determined nun who commands our attention in Geoffroy’s 1887 Palm Sunday, the artist’s nun-nurses are dutiful and modest as if they fit into their roles without any apparent issue. Nor was Geoffroy the only artist who credited the importance of the care of nuns to the healing of children’s diseases. Albert Besnard, himself an artist known to embrace new scientific methodologies, seemed to believe that his son was cured of tuberculosis at the Franciscan Institute Cazin-Perrochaud as much by faith as medicine. He painted for the hospital a mural in which a nun and a doctor preside over a young boy, a vision of the risen Christ appearing at the head of the table that bears the frail body of the barely conscious young man (Faith, 1898, Chapel, Institut Cazin-Perrochaud, ­Beck-sur-Mer).53 However, despite a greater conciliatory attitude toward the actual practice of Catholicism, the state remained resolute in its determination that when it came to body and mind if not spirit, those considered representatives of the Church were to be held in suspicion. Laws established in the early twentieth century closed down a number of the Catholic orders and seized property. Many nuns and priests left France. With an official separation of Church and State in 1905 the Republic no longer paid salaries to priests or nuns. Despite this show of power, many congregations were allowed to continue their practices of worship as a means of pacifying voting Catholics. As for the position of the Church

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  105 where French politics were concerned, unlike Leo XIII who died in 1903, Pius X did not reach out to France in a spirit of compromise. Along with nuns administering to children in hospitals, Geoffroy took up the subject of the family visit to the hospitalized child, beginning in the 1880s. The thin, workingclass father who visits his pale son in Visit to the Hospital (1889, Musée d’Orsay) is tragic on more than one level. Despite children now being encouraged to be cared for in hospitals rather than at home such as at the Hôpital Trousseau or the Hôpital des Enfants Malades, open rooms with multiple beds were a seedbed of contagion. Dr. Variot found the situation so alarming that he claimed in one report that half of all children who died in Paris did so in the hospital.54 A targeted attempt to improve the outcomes of hospitalized children included the construction of new children’s hospitals with isolation units, an increased number of interior rooms divided from one another with particular diseases separated, and specific room for consultation—three of which opened in 1901—the Bretonneau, the Herold, and a reconfigured Trousseau.55 The names of these hospitals were taken from celebrated doctors whose findings preceded Pasteur and foreshadowed his discoveries. For example, Pierre-Fidèle Bretonneau had identified typhoid and named diphtheria, distinguishing it from scarlet fever, and his student Arman Trousseau all but identified bacteria, referring to it as “morbid seeds.” Nevertheless, wards with multiple beds remained the norm rather than the exception into the twentieth century. Geoffroy firmly tied faith, nurse-nuns, and hospitals together in his choice to paint scenes in the Hall of the Poor at the Hospices de Beaune in Burgundy with its indigent young patients in 1904 (Figure 4.5). The hospital had functioned as a place of respite for the poor and gravely ill since the fifteenth century; a religious community was established specifically to tend to the sick here.56 In certain paintings, Geoffroy focused on the placement of beds, 15 lined up on either side of the great hall, which were made nearly private through thick drapery separating one from another. It should be noted that aging drapery around the sickbed often contained disease-carrying dust, recognized by Pasteurian hygienists, but here again, not all citizens or nurses were compliant with or even aware of such specifics of recent discoveries. The heavy red bedding that Geoffroy chose to incorporate indicates that the season is winter (one of these is visible at far right in The Great Hall of the Poor); traditionally, in warmer months lighter white cotton curtains were used.57 In some paintings, Geoffroy shows convalescing young girls accompanied by nuns out of their beds as in the image illustrated here in the great room of the hospice, the interior bathed with the colored light of stained glass. Historically, the beds had all faced a chapel at the end of the Hall, and Rogier van der Weyden’s Last Judgement polyptych had been displayed here for centuries before its relocation to the Hospices’ museum. The scenes that would have been observed in the stained glass included two saints attached to medical conditions or miraculous interventions: St. Anthony and St. Nicolas.58 St. Anthony, known for healing diseases of the skin, appears again in the van der Weyden polyptych along with another healer saint, St. Sebastien, associated with the plague since the seventh century, in the central outside panels. These could be observed when closed over the interior painting which, in fact, was the majority of the time. The kneeling and prayerful patrons, Nicolas Rolin and his wife, regard the two large-scale grisaille figures from either side. The Hall of the Poor and the van der Weyden painting had recently been restored to what they regarded as full medieval splendor when Geoffroy was present. The restoration work of the great hall was done between 1875 and 1878, those final years of the first

106  Barbara Larson

Figure 4.5 Jean Geoffroy, The Great Hall of the Poor, 1904, 199.5 × 150 cm, oil on canvas, Musée de Beaux-arts de Beaune, inv. 11-3-1.  En dépôt au Musée de l’Hôtel-Dieu de Beaune depuis 2001.  Photo credit: Illustria.

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  107 decade of the Third Republic when religious revivalism was still on the agenda.59 The architect in charge of the project was Maurice Ouradou, who had assisted his father-inlaw Viollet-le-Duc in the restoration of Notre Dame in Paris. In addition to preserving the artistic detail of the room and chapel, Ouradou added a heating system to the floor.60 Van der Weyden’s polyptych was sent to the Louvre for restoration and returned in 1878, immediately after being exhibited at the universal exposition that year. Other rooms at the hospital had been added through time as places to care for the ill with a total of 140 beds at the institution, though the great hall remained the most iconic. New structures had been created on or near the hospice property as well. In 1902 a state-of-the-art surgery pavilion making use of antiseptics, progressive operating techniques, and improvements to anesthesia had opened just behind the hospital, but Geoffroy chose not to paint in this modern space.61 The Pasteurian revolution had barely reached the old building of the Hospices itself, at least not according to Doctors Octave Sirot and Amédée Vesoux who issued a report in 1903 complaining that the hospital did not have so much as a microscope, let alone a lab to be able to examine blood and urine for bacteria, and there were no isolation rooms.62 Those with tuberculosis were placed with the non-contagious, and a birthing room was dangerously close to a room with diphtheria patients.63 From the time it opened its doors to the poor in the fifteenth century, a decree forbade those with contagious illnesses to enter the Hospices, though this proved to be untenable through the centuries. Reports that have survived from 1891 to 1893 include cases of typhoid, smallpox, diphtheria, measles, and whooping cough, among other infectious diseases.64 An average of 600 patients a year were admitted in those years, one third of which were women, and just under a tenth children.65 Some hygienic measures had been gradually instituted. Showers and baths were added in 1881 with an additional pressurized water supply by 1891. The sisters themselves were gifted a copper tub in 1888. New patients were to be bathed and clothing disinfected. Bedding was disinfected as well and there was an attempt to fumigate rooms from time to time with sulfur. However, Sirot and Vesoux’s report claimed many insalubrious spaces continued to exist.66 The nuns continued to oversee the pharmacy, but followed the prescriptions of doctors, which included such advances as an anti-diphtheria serum used after 1894.67 The great hall had been specifically designed from the beginning to combine nursing and religious faith, but the sisters had come under pressure by a local anticlerical administrative commission around the time we can first document Geoffroy’s presence. The soeurs hospitalières were required to stop morning and evening prayers in the hospital rooms in 1905.68 Following protests by the mother superior who indicated the sisters would suffer psychologically, the practice was reinstated the following year, but only in wards of women patients and only until 1909 (in reality the practice continued until World War II).69 In 1907 the same commission pressured the Hospices to laicize its nursing staff as had been the case with the hospital at nearby Dijon in 1905.70 Here an early edict issued by founder Nicolas Rolin himself was invoked by Arthur Montoy, vice president of the administration of the Hospices de Beaune (and subject of a portrait by Geoffroy). The sisterhood had been established as a community, but not as a formal order. The emphasis was on care for the ill rather than institutionalization. The sisters were able to take the veil, but they could also leave the community at any time. The sisters had chaffed at this through time, but in this case it was used to their advantage. Montoy responded that the nuns’ habits were not that at all and, in fact, merely imitated the dress of the fifteenth century worn by the founder’s wife; moreover, these women had never constituted an official congregation.71 The issue of laicization was thereby avoided.

108  Barbara Larson The case of nursing at Beaune had set an example dating back centuries for other independent communities of sisters who worked at small regional hospitals.72 This represented an alternative pattern to the case of nuns as nurses at large urban hospitals; here, independent communities were perceived as deeply attached to their locale with greater stability in terms of retention. In his 1906 Young Girls in Procession at the Feast of Corpus Christi at the Hospices de Beaune (private collection), Geoffroy shows a celebration with cheerful young local girls that was sponsored yearly by the sisters at Beaune. Protected by hospital administrators to whom they answered (as opposed to heads of congregations), soeurs hospitalières in general were better insulated against laicization. In 1910 when Geoffroy returned to the subject of nuns as nurses and sick girls in the Great Hall of the Poor, the emphasis was not on spectacular architecture, stained glass, and recovery but on intimacy between nurses and patients (The Convalescent, Musée de l’Hôtel-Dieu, Beaune). Timothy Smith has argued that small, regional hospitals like Beaune wherein local officials had long taken pride in municipal or Church-driven charitable support of the poor have been overlooked as important oppositional elements to the idea of organized national social assistance and ultimately the rise of the welfare state and national health reforms in France.73 Thus, while Beaune is a clear site of Catholicism, it is also one that placed value on localism. The patients that Geoffroy depicted at the Hospices de Beaune were invariably older girls, despite the fact that the Hall of the Poor was reserved mainly for women, with men and younger children separated. These paintings may indicate a common trope in the still unsettled culture of late-nineteenth-century France concerning obvious Catholic references and a moral order in which women, girls, and religion were interrelated.74 While we see both male and female children in Geoffroy’s paintings in general, girls tend to be foregrounded over boys in scenes concerning hygiene and illness in what dovetails with the popularized idea that dutiful and compliant girls will become the primary caretakers of the nation, and they must survive to become mothers—it is they who are on the front line to guard against disease. Brouardel promoted the hygiene of the home and the creation of a salubrious environment specifically to women and girls who were tasked with the very survival of the family.75 In some paintings by Geoffroy done for Variot involving women and young girls we find secular interpretations of what might have reminded the audience of religious scenes and settings, once again hinting at familiar moralizing spiritual iconography. The painting Christmas Tree at the Goutte de Lait (Musée de l’assistance publique, 1908) presents the secular side of a religious holiday, but in this painting a baby sits in its mother’s lap evoking a Madonna and Child composition, its tiny hand kissed in near reverence by a young girl. The scene is crowded with admirers of all ages each eager to look at this one child as if we are witnessing a recast nativity with the only hint of a pagan Christmas celebration in barely visible boughs above the heads of the hushed crowd. The young girl, a sister perhaps, who kisses the baby’s hand serves to underscore her important future role as loving mother and caretaker. This scene of near reverence would have resonated with Catholics at a time of ascendency of the cult of the Virgin Mary in her role as patron saint of France.76 Despite advances in hygiene and medicine along with welfare programs in late-nineteenth-century France, the outcome of social safeguards instituted under the early Third Republic did not necessarily bring about improvements in the control of disease, as we have seen, nor was poverty alleviated; in some cases, the matter of survival seemed to have worsened. The reluctance to dismiss a spiritual component from healing and welfare functioned on different levels, including the idea that spiritual distress and pain were

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  109 not necessarily separate from one another. And when it comes to relocating sick children away from the home, if children often did not return from hospitals, might the home be a safer space of healing? Physicians themselves colluded in this mindset. Nearly two-thirds of French doctors, mainly those in rural or small-town locations, organized themselves into the Union des syndicats médicaux as early as 1881; they advocated traditional athome visits to the ill.77 Geoffroy painted scenes of recovery at home in a positive light. In his Return to Life of 1909 a young girl who takes Castor Oil sits upright in her bed with religious prints and a boxwood twig, a Catholic symbol of blessing, on the wall above her (Figure 4.6).78 A print of Geoffroy’s The Great Hall of the Poor appears to be affixed to the wall as well. The plain, working-class room is somewhat claustrophobic with multiple items in a relatively small space. Dishes are scattered about and a cat laps milk from a dish on the floor. Light streams in from the small window at upper left as if to underscore the positive outcome and what may well be a future mother to help replenish the French population. In this painting we see what appears to be a mother administering the liquid, while in other paintings of illness affecting young children in their home by Geoffroy, older sisters appear to be the caregivers of both younger sisters and brothers, again underscoring current and future roles in national health and survival along with the reference to working-class mothers who cannot always be present to be the primary caregiver.

Figure 4.6 Jean Geoffroy, Return to Life, 1909, oil on canvas, 107 × 122 cm, Musées d’Art et d’Histoire de La Rochelle. Photo credit: Max Roy.

110  Barbara Larson The era in which Geoffroy created his medical genre paintings has often been discussed within Foucauldian theories of social control of the masses by an authoritarian, interventionist state through the vehicle of doctors, hygienists, educators, and politicians. Indeed, Gal Ventura discusses Variot’s work in this way.79 According to Ventura, he participated in attempts to establish a “normative” society with controlling mechanisms of medical administration such as data, statistics, and even the appropriation of the bottle industry. Ventura states that he was part of a transition from an approach to disease that went from what Foucault referred to as “being essentially clinical to being social.”80 This model of medicine eliminates the individual who becomes subsumed within statistical categories. Within a Foucauldian framework there is often a system of rewards (such as the certificate of merit designed by Geoffroy) and punishments (for example, mothers could not pick up milk at the Goutte de Lait clinic without first weighing their babies), just as there is an overarching system of control (such as authorized inspections of homes of nourrices). Foucault often points out class difference between authorities and those controlled. Geoffroy’s emphasis on individuality and a hint at personal relationships between nun-nurses and children in his paintings, if not all of his illustrations, puts him essentially at odds with authority and compliance where this model is concerned. His brand of Naturalism at times borders on the sentimental, with the working-class child or children appealing through individualized emotive states even if withdrawn and cheerless as in the case of those with advanced disease. We find him drawn to workingclass experiences in spaces of public assistance for the poor (whether at Beaune, the government-subsidized Goutte de Lait clinics, or the free écoles maternelles) or to spaces of resistance, such as at home or in a gothic setting, where he often represents children in relatively unguarded moments or where the only real authority seems to be divine or personal (mothers and other family members). Geoffroy was able to satisfy Republican doctors and educators with his imagery, which appears to have drawn little if any negative response and indeed to have been highly valued for its messaging and at the same time to effectively reference traditional Catholic values. His “Catholic” medical paintings are devoid of irony and follow a populist attachment to Catholicism and healing, albeit from a “safer” political perspective of underscoring the world of women and children within that sphere. Geoffroy foregrounds the reaction of the working class to new medical and hygienic initiatives under the early Third Republic, not all of which are compliant. His imagery demonstrates the conflicted response by France’s working class to a revolution in bacteriology at the center of the state’s late-nineteenth-century attempt to combat contagion. Acknowledgment An earlier version of this chapter was given as a keynote lecture at the conference “Sick Girls in European Visual Art, Literature, Medical Science, and Popular Culture in the Nineteenth Century” at Aarhus University in 2019. The chapter benefits from the suggestions of Marsha Morton and Ann-Marie Akehurst. Notes 1 In addition to specific state commissions, Geoffroy became an official member of the Commission de l’Imagerie Scolaire in 1893, a group under the presidency of art historian Henri Havard that

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  111 was devoted to secular education and Republican values. In 1895 he was named Chevalier de la Légion d’honneur. 2 On Pasteur and medicine in late-nineteenth-century France see David Barnes, The Great Stink of Paris and the Nineteenth-Century Struggle against Filth and Germs (Baltimore, MD: Johns Hopkins University Press, 2006); Lion Murard and Patrick Zylberman, La Hygiène dans la République: La Santé Publique en France ou l’utopie Contrariée, 1870–1918 (Paris: Fayard, 1986); and Andrew Aisenberg, Contagion: Disease, Government, and the “Social Question” in Nineteenth-Century France (Stanford, CA: Stanford University Press, 1999). Also see Bruno Latour, The Pasteurization of France, trans. Alan Sheridan and John Law (Cambridge, MA: Harvard University Press, 1988) and Claire Salomon-Bayet, ed., Pasteur et la Révolution Pastorienne (Paris: Payot, 1986). 3 Its original placement in the chapel at the end of the great hall would have been well known, but the enormous polyptych had been moved to the museum by mid-century. Bruno François, “De l’hôpital au musée, histoire du musée de l’Hôtel-Dieu de Beaune,” Revue de la Société Française d’histoire des Hôpitaux, 165:5 (2021), 15. 4 Gibson, A Social History of French Catholicism, 1789–1914 (London and New York, NY: Routledge, 1989), 231. 5 François Bournand, Paris-Salon 1887 (Paris: E. Bernard & Cie, 1887), 52. 6 Caroline Ford, Divided Houses: Religion and Gender in Modern France (Ithaca, NY: Cornell University Press, 2005) and Ralph Gibson, A Social History of French Catholicism, 152–192. Also see James McMillan, France and Women, 1789–1914, Gender, Society and Politics (New York, NY and London: Routledge, 2000). 7 For a history of hygiene in these years see Gérard Jorland, Une Société à Soigner: Hygiène et Salubrité Publiques en France au XIXe Siècle (Paris: Albin Michel, 1988); and Jean-Pierre Goubert, Une Histoire de L’hygiène: Eau et Salubrité dans la France Contemporaine (Paris: Pluriel, 2010). In 1879 Pasteur organized and presided over the Council on Hygiene for the Department of the Seine, and from 1879 to 1898 municipal bureaus of hygiene were ­instituted in 20 cities in the provinces. In the 1880s, the Ministry of the Interior began to institute measures for the filtration of local water though this would not be completed until the early ­twentieth century. On legislation and hygiene see Jack Ellis, The Physician-Legislators of France: Medicine and Politics in the Early Third Republic, 1870–1914 (Cambridge: Cambridge University Press, 1990) and Olivier Faure, “Révolution pastorienne et revolution républicaine,” in Histoire Sociale de la Médecine 18-19e siècles (Paris: Anthropos-Economica, 1994), 177–198. 8 Goubert, Une histoire de l’hygiène, 145 and Julia Csergo, “Propreté et enfance au XIXe siècle,” in Education à la Santé , XIXe-XXe Siècle, ed. Didier Nourrisson (Rennes: Ed. de l’Ecole Nationale de la Santé Publique, 2002), 49. 9 For example, the Commission des logements insalubres (1850) became the powerful Casier sanitaire des maisons in 1893. Armed with data on epidemics it could recommend tearing down slum neighborhoods. On the earlier public health movement see Ann La Berge, Mission and Method: The Early Nineteenth-Century Public Health Movement (Cambridge: Cambridge University Press, 1992) and William Coleman, Death Is a Social Disease: Public Health and Political Economy in Early Industrial France (Madison: University of Wisconsin Press, 1982). On the later nineteenth century see Barnes, The Great Stink of Paris, 65–104; Murard and Zylberman, La Hygiène dans la République, 87–201; and Ann-Louise Shapiro, Housing the Poor of Paris, 1850–1902 (Madison: University of Wisconsin Press, 1985), 134–158. 10 Thirteen was the very age when children were no longer required to be in school after 1882. Exceptions to child labor included the textile industry, where children could be employed from 10 to 12, but hours were limited to six per day and school remained mandatory. See Colin Heywood, Childhood in Nineteenth Century France: Work, Health and Education among the “Classes Populaires” (Cambridge: Cambridge University Press, 1988) on children and labor. 11 Theodore Zeldin, A History of French Passions: Ambition, Love, and Politics (Oxford: Clarendon Press), 1973, I: 396. Also see Paul Brouardel and Pierre Chantemesse, Enquiête sur les causes de l’épidémie de fièvre typhoid qui a règne à Clermont-Ferrand pedant les mois de Septembre, Octobre, Novembre et Décembre 1886 (Paris: J.-B. Ballière et fils, 1887) and A. Durand-Claye, “L’épidémie de fièvre typhöide à Paris en 1882,” Journal de la Société

112  Barbara Larson Statistique de Paris, 24 (1883), 458–474. On epidemic disease in Paris, see Jacques Bertillon, De la Fréquence des principals causes de décès à Paris pendant la seconde moitié du XIXe siècle et notamment pendant la période 1886–1905 (Paris: Imp. Municipal), 1906. 12 Tuberculosis was officially declared to be contagious at the Academy of Medicine in 1889. Yvonne Knibiehler, “La lutte anti-tuberculeuse: Instrument de la médicalisation des classes populaires (1870-1930),” in Annales de Bretagne et de Pays de l’Ouest, 86:2 (1979, June), 321–336. 13 Ellis, Physician-Legislators of France, 204. 14 Aimé Riant’s Hygiène scolaire, influence de l’école sur la santé des enfants (Paris: Hachette, 1874) was foundational and inspired many other hygiene manuals, including A. E. Breucq and C. Delvaille, La Santé de l’écolier, guide hygiènique et médicale des maîtres, des mères de famille, des Médecins, d’établissements scolaires, des proviseurs, chefs d’institutions et d’usines, de délégués cantonaux… (Paris: F. Nathans, 1902); P. Degrave, Manuel d’hygiène élémentaire, à l’usage des écoles et des familles (Paris: A. Maloine, 1903); Ernest Monin, La propreté de l’individu et da la maison (Paris: Bureau de la Société Française d’Hygine, 1884); Ephrem Aubert and A. Lapresté, Cours élémentaire d’hygiène, rédigé conformément aux programmes officiels des écoles normales primaires (Paris: E. André fils, 1893); Frédéric Mane and P. Pugnière, 40 leçons sur l’hygiène, antialcoolisme, l’épargne et la mutualité (Paris: Gedalge, 1911); and Louis Dufestel, L’Hygiène à l’école maternelle, 1912. 15 Jean-Noel Luc, ed., La petite enfance à l’école, XIXe-XXe siècles (Paris: Economica, Institute national de recherche pédagogique, 1982), 167–172. 16 Joseph Noulens, Artistes français et étrangers au Salon [1885, 1886] ranges et appréciés dans l’ordre alphabétique (Paris: E. Dentu, 1886), 88. 17 On the older notion of fetid working-class populations and the miasmatic theory of disease, which did not immediately disappear, see Louis Chevalier, Classes laborieuses et classes dangereuses à Paris pendant la première moitié du XIXe siècle (Paris: Plon, 1958) and Alain Corbin, The Foul and the Fragrant: Odor and the French Social Imagination (Cambridge: Harvard University Press, 1986). Chevalier’s classic book connects urban neighborhoods of lower classes as suspects of disease and crime. Corbin first called scholarly attention to the importance of smell, including foul odors as indicative of disease (miasmas). On miasma also see André Guillerme, La Naissance de l’industrie à Paris, Entre seuers et vapeurs, 1780–1830 (Paris: Anthropos, 2001). On the continued fear of the working class as primary carriers of disease such as the bourgeois fear of their maids and the connection between urban development, prostitution, tuberculosis, and hygiene before and during the Pasteurian period see Alain Corbin, Le Temps, le désir et l’horreur: Essais sur le XIXe siècle (Paris: Aubier, 1991). Georges Vigarello describes the changing notion of what is dirty and what is clean in Le Sain et le Malsain: Santè et mieux-être depuis le moyen age (Paris: Seuil, 1993) and Jacques Léonard details a history of concepts of health and the relationship with air and water along with changing medical doctrines in Archives du corps: La Santé au XIXe siècle (Rennes: OeustFrance, 1986). Ann-Louise Shapiro discusses architectural reforms in Housing the Poor of Paris, 1850–1902. The écoles maternelles originated as salles d’asile in the first part of the century. Conceived as a Christian charitable asylum and supported by philanthropists, the teachers were mainly nuns who ensured the children received Catholic moral precepts. On this history see Jean-Nöel Luc, L’Invention du jeune enfant au XIXe siècle: de la salle d’asile à l’école maternelle, (Paris: Belin, 1977). 18 Leo Claretié, L’Université Moderne (Paris: Delgrave, 1892), 8. 19 The universal exposition also displayed a new kind of sink that was rectangular and often affixed to the wall, making the exchange of germs less likely. By this time, some écoles maternelles also had showers. Anon., Exposition universelle international de 1900 à Paris. Rapports du jury international France. Minstère du commerce, de l’industrie, des postes et des télégraphes Groupe I. Education et enseignement. Première Partie. Classe I (Paris: Imprimerie Nationale, 1902), 27–33. 20 P. Brouardel, “Discours d’ouverture,” Revue D’hygiène et de Médecine Preventative, 24 (1901), 443. 21 By the turn of the century, international teams of bacteriologists had identified the germs that caused typhoid, cholera, diphtheria, tuberculosis, and pneumonia. 22 Julia Csergo, “Propreté et enfance au XIXe siècle,” 43–56.

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  113 23 Peter Ward, The Clean Body: A Modern History (Montreal: McGill-Queen’s University Press, 2019), 69–70. On the changing urban infrastructure and plumbing see Fabienne Chevallier, Le Paris Moderne: Histoire des politiques d’hygiène, 1855–98 (Rennes: Presses Universitaires de Rennes, 2010). 24 Csergo, “Propreté et enfance,” 47. 25 Ward, The Clean Body, 107–110. 26 Aubert and Lapresté, 46–48. On the history of hygiene and the transformation of school ­buildings with hygiene in mind see Chevalier, Le Paris Moderne, 187–228. For official contemporary recommendations on hygiene in the pre-schools see Ministère de l’Instruction publique, Hygiène du premier âge scolaire, Rapport de M. le docteur Henri Napias, secretaire general de la Société de médecine publique et d’Hygiène professionnelle (Paris: Imprimerie Nationale, 1884). 27 Buisson, Nouveau Dictionnaire de Pédagogie et d’instruction Primarie, V (Paris: Hachette, 1911 [2011]), 248–256. 28 Paul Strauss, Dépopulation et Puériculture (Paris: E. Fasquelle, 1901). 29 On Variot see Nadine Simon Dhouailly and Nicolas Sainte-Fare Garnot, Un patriote aux Origines de la Puériculture: Gaston Variot, Médecin et Mécène: 1855–1930, exh. cat. (Paris: Musée de l’assistance publique, Hôpitaux de Paris, 1984). 30 Richard Tomlinson, “The ‘Disappearance’ of France, 1896–1940: French Politics and the Birth Rate,” The Historical Journal, 28:2 (1985), 405. 31 Karen Offen, “Depopulation, Nationalism and Feminism in Fin-de-Siècle France,” American Historical Review, 3:89 (1984, June), 651. 32 Bertillon was a physician and a statistician who helped clarify the results of medical progress by dedicating his work to an analysis of numbers of cases of diseases and causes of death from contagious illness. The Bertillon Classification of Causes of Death was adopted elsewhere, allowing for international comparisons. 33 Richard Thomson explores overlapping meanings between secular imagery and Catholic iconography in Naturalist painting in his The Troubled Republic: Visual Culture and Social Debate in France, 1889–1900 (New Haven, CT: Yale University Press, 2004), 135–139. 34 The use of glass bottles in infant feeding did not immediately offer a perfect solution to infant survival even where pasteurized milk was concerned. Of the various bottle types, one with a lengthy rubber tube was a particular danger in the proliferation of bacteria and was not discontinued until 1910. 35 Ann La Berge, “Medicalization and Moralization: The Crèches of Nineteenth-Century Paris,” Journal of Social History, 25:1 (1991, Autumn), 74. 36 Ibid., 75. 37 Dhouailly and Sainte-Fare Garnot, Un patriote, 10. 38 La Berge, “Medicalization and Moralization,” 74. 39 On this history see Gal Ventura, Maternal Breast-Feeding and Its Substitutes in NineteenthCentury French Art, trans. Merav Fima (Leiden and Boston, MA: Brill, 2008); George Sussman, Selling Mother’s Milk: The Wet-Nursing Business in France, 1715–1914 (Chicago: University of Illinois Press, 1982); and Fanny Fay-Sallois, Les Nourrices à Paris au XIXe Siècle (Paris: Payot), 1980. 40 On persistent issues of germs and dirt among peasants as well as lingering notions of filth as protective see Steve Zdatny, “The Old Regime of Hygiene: Life in the Nineteenth Century French Countryside,” Rural History, 30 (2019), 17–36. 41 George Sussman, “The Wet-Nursing Business in Nineteenth-Century France,” French Historical Studies, 9:2 (1975, Autumn), 321. 42 George Sussman, Selling Mother’s Milk, 166–167. 43 Gaston Variot, L’Hygiène infantile, allaitement maternel et artificial (Paris: Hachette, 1908), 9. 44 Private Catholic schools actually increased in popularity in the late nineteenth century, notably for girls. See Sarah Curtis, Educating the Faithful: Religion, Schooling, and Society in Nineteenth-Century France (Dekalb: Northern Illinois University Press, 2000); Isabelle Bricard, Saintes ou pouliches: L’éducation des jeunes filles au XIXe siècle (Paris: France Loisirs, 1985); and especially Linda Clark, Schooling the Daughters of Marianne: Textbooks and the Socialization of Girls in Modern French Primary Schools (Albany, NY: SUNY, 1984). Country towns had proven resistant to removing sisters from their roles in teaching and nursing. For

114  Barbara Larson example, the Law of Associations (1901) required municipalities to supply the government with an opinion about local religious communities and many did, in fact, write in support of them. Judith Stone, “Anticlericals and Bonnes Soeurs: The Rhetroric of the 1901 Law of Associations,” French Historical Studies, 23:1 (2000, Winter), 103–128. 45 Claude Langlois’ magisterial study on nineteenth-century congregations sees 1880 as the apex of numbers of nuns in “action-oriented” societies representing in all approximately 1% of the female population in France. He argues that in the nineteenth century these congregations were not interested in a cloistered life, but instead were socially involved. Le Catholicisme au féminin: Les Congrégationes françaises à supérieure générales au XIXe siècle (Paris: Cerf, 1984). 46 Katrin Schultheiss, Bodies and Souls: Politics and the Professionalization of Nursing in France, 1880-1922 (Cambridge, MA: Harvard University Press, 2001), 38. 47 Ibid. Not all urban doctors had been opposed to the use of nuns as nurses at hospitals not run by the Church. For example, Drs. Emile Roux and Louis Martin appointed sisters of Saint-Joseph de Cluny as nurses at the Pasteur Hospital in 1900 (Schultheiss, 25). Others were concerned a secular nursing staff would bring disease home to families, including children (Schultheiss, 27). 48 David Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995), 99. 49 Sharon Hirsh has explored this history in visual culture in depth. See Hirsch, “Codes of Consumption: Tuberculosis and Body Image in the Fin de Siècle,” in In Sickness and in Health: Disease as Metaphor in Art and Popular Wisdom, eds. L. Dixon and G. Weisberg (Newark, NJ: University of Delaware Press, 2004), 144–165. 50 On Lourdes see Ruth Harris, Lourdes: La Grande Histoire des apparitions des pèlerinages, et des guérisons (Paris: J. C. Lattès, 2001), 385–490. Ruth Cranston, The Miracle of Lourdes (New York, NY: Doubleday, 1988), and Philippe Aziz, Les Miracles des Lourdes: La science face a la foi (Paris: Robert Lafont, 1981), 201–221. Beginning in 1883 a medical bureau to investigate the cures at Lourdes was established, but the opinion of the cures given by the Bureau des Constatations Médicales was not respected by all Catholics or anticlerical Republicans. Considered too restrictive by the faithful, others believed that spontaneous cures were merely psychological. This debate was well known; in his novel Lourdes (1894) Emile Zola poked fun at the current head of the Bureau Gustave Boissarie, who had portrayed Lourdes in a positive light in his book L’Histoire Médicale de Lourdes (1891). 51 Thérèse de Lisieux was eventually named patron saint of missions and was canonized in 1925. 52 Gibson, A Social History of French Catholicism, 125. 53 Thomson, The Troubled Republic, 157–158. 54 Dhouailly and Sainte-Fare Garnot, Un patriote, 16. The situation at the Hôpital des EnfantsMalades began to improve after 1885 following measures instituted by the pediatrician Jacques-Joseph Grancher. He founded a lab to examine microorganisms at the hospital in the saliva and blood of admitted children. He advocated for isolation units and divided spaces with glass walls. Even in the open halls of the infirmary he had isolation boxes constructed. He insisted doctors dip their hands frequently in antibacterial solution. He experimented with a small hospital annex for children at the Pasteur Institute with only one bed to a room and a near moratorium on visitors. Grancher was known for his pioneering work on tuberculosis; in 1897 he published the much consulted Treatise on Illnesses in Childhood. 55 Pierre-Louis Laget, “L’architecture hospitalière à Paris: depuis le projet modèle propose par le chirurgien Tenon Jusqu’à l’inauguration du nouvel hôpital Beaujon (1788–1935),” in Les Maux et les soins: Médecins et malades dans les hôpitaux parisiens au XIXe siècles, ed. Francis Démier (Paris: Maisons des Sciences de l’homme, 2007), 175–189. 56 These were the soeurs hospitalières of Beaune. 57 I thank Hospices’ collections curator Bruno François for pointing out this detail. 58 The stained glass had been damaged during the French Revolution, but had been reconstituted by Léon-Auguste Ottin in 1877, based on a description of 1653. 59 The year 1875 is the same year the construction of the great church of Sacré-Coeur was initiated in northern Paris. 60 For a discussion on the restoration see Abbé Boudrot, L’Hôtel Dieu de Beaune, 1443–1880. (Beaune, 1881, reissued Marseille: Laffitte Reprints, 1979), 330–337.

Jean Geoffroy and the Conflicted Response to Childhood Epidemics  115 1 This was the Bahèzre de Lanlay block. 6 62 Georges Chevaillier, Du Quinquina à la Cortisone: L’Hôtel Dieu de Beaune (Beaune: Centre Beaunois d’Etudes Historiques, 1871–1971, 1994), 28–29. 63 Ibid. 64 Ibid., 22. 65 Ibid. 66 Ibid., 21. A device with steam heat was used to disinfect clothing and bedding. 67 Ibid., 35. 68 Georges Chevaillier, Histoire des Religieuses hospitalières de Beaune des origines au XXe s­ iècle. (Beaune: Centre Beaunois d’Études Historiques, 2006), 61. 69 Ibid., 62. 70 Ibid. 71 Ibid. 72 Oliver Faure built upon the example of Marie-Claude Dinet-Lecomte who had traced the growth of independent communities of sisters at small regional hospitals with Beaune as an influence in the seventeenth and eighteenth centuries in her Les soeurs hospitalières en France aux XVII et XVIII siècles,(Paris: Champion, 2005), extending it into the nineteenth century. See Oliver Faure, “Les religieuses dans les Petit Hôpitaux en France au XIXe siècle,” in L’Hôpital entre Religions et Laïcité, du moyen âge à nos jours, ed. Jacqueline Lalouette (Paris: Letouzey & Ané, 2006), 59–85. 73 Timothy Smith, Creating the Welfare State in France, 1880-1940 (Montreal: McGill-Queens’s University Press, 2003). 74 On the “feminization” of Catholicism see Ralph Gibson, “Le Catholicisme et les femmes en France au XIXe siècle,” Revue de l’histoire de l’Église de France, 79:202 (1993), 63–93. 75 Aisenberg, Contagion, 94. 76 Barbara Corrado Pope, “Immaculate and Powerful: The Marian Revival in the Nineteenth Century,” in Immaculate and Powerful: The Female in Sacred Imagery and Social Reality, eds. Clarissa Atkinson, Constance Buchanan and Margaret Miles (Boston, MA: Beacon Press, 1985), 173–200. 77 Philip Nord, “The Welfare State in France, 1870–1914,” French Historical Studies, 18:3 (1994, Spring), 835. This powerful group helped to bring about an 1893 national law making health care free to the poor, whether in the hospital or at home. 78 A strikingly similar painting with what appears to be an older sister and her young brother entitled Castor Oil was reproduced in Figaro Illustré in May 1901, no. 13, 8. That painting (now lost) is most likely the 1894 Castor Oil painting listed as no. 804 in the salon livret of the year. Fernand Bougerat, Salon de 1894. Société des artistes français et société nationale des beaux-arts (Paris: L. Baschet, 1894), 55. 79 Gal Ventura, Maternal Breast-Feeding and its Substitutes, 74–75. 80 Michel Foucault, “The Crisis of Medicine or the Crisis of Anti-Medcine?” (1976). Trans. Edgar Knowlton et al., Foucault Studies 1 (2004, December), 13.

5 Spaces of Sickness The Phenomenology of the Sickroom in Nordic Symbolist Art Kerstina Mortensen

Precariously situated between life and death, the sickroom is a space of existential ­liminality. Its location in the home suggests spatial intimacy, yet its designation as a “sick room” simultaneously marks its otherness within the domestic interior. A protective shell against external contaminants, the sickroom also functions as a quarantine against the contagion of others. Walter Benjamin writes “the traces of the inhabitant are imprinted in the interior,”1 and so too the traces of illness imprint themselves on visualizations of the sickroom, inviting a phenomenological perspective on the “sick space” at the very threshold of existence. Taking a Bachelardian (Gaston Bachelard) approach to the interior space and “psychology of the house,” this chapter examines the phenomenology of the sickroom as depicted in Nordic Symbolist art with a focus on the Danish painter Ejnar Nielsen (1872–1956) and the Norwegian Edvard Munch (1863–1944), whose oeuvres are marked by imagery pertaining to tuberculosis and the sickroom. Nielsen arrived in the remote Jutland town of Gjern to paint the picturesque landscape, only to become preoccupied with painting the consumptive residents. Works such as And in His Eyes I Saw Death (1897, Figure 5.1) and Death and the Cripple (1899) depict a young local man Erik Kjærsgaard before and after his death from tuberculosis. The desolate sickroom is replaced by the rolling Gjern landscape, and the deathbed becomes an allegory of life’s injustice: the young die, while the old prevail. Where Nielsen bears witness, Munch presents memory. Repeated sickroom motifs become a means of recovery from the traumatic loss of his mother and sisters to tuberculosis, from the dreamlike evocation of space in The Sick Child (1885) to the feverish fury of Death Struggle (1915). Nielsen’s focus on the individual is expanded by Munch to include familial figures in distress or mourning, their presence further marking the sickroom. The inheritance of illness haunts Munch’s outlook on life and approach to art, describing in his notebooks a family history of tuberculosis and lung infections that intensified with his generation.2 The interiority of the sickroom is aligned with the interiority of the mind, imagination, and memory. Rather than romanticizing, Nielsen and Munch embrace emotional sensitivity to poeticize illness through the paradigm of the private, interior space. With particular emphasis on atmosphere, the corner, and the shadow, the works by Nielsen and Munch are analysed as embodied spaces of sickness, in which the sickroom ultimately becomes the waiting room of death.

DOI: 10.4324/9781003294979-7

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Figure 5.1 Ejnar Nielsen, And in His Eyes I Saw Death, 1897, oil on canvas, 137 × 188 cm, Statens Museum for Kunst Copenhagen. Photo credit: Statens Museum for Kunst. © Estate of Ejnar Nielsen, VISDA Copenhagen/IVARO Dublin, 2022.

The Sickroom as Space What is a sickroom? A cell-like space that isolates the patient, the sickroom functions as shelter for the convalescent and defence against the transmission of disease. Primarily located in a private, domestic dwelling, the sickroom is a separate space of treatment than the hospital ward. This intimacy removes the sickroom from the sterile surgical environment and prompts consideration of a number of social factors, including poverty, geographical remoteness, convalescence, or, indeed, palliative care. At a time rife with sickness and communicable disease, the nineteenth century saw surging interest in depictions of the ill and dying. Among the range of diseases, tuberculosis is one of the most voracious, with the tubercle bacillus physically “consuming” the body. The symptoms of tuberculosis range widely, and include a debilitating cough and hemoptysis, persistent fatigue, high fever, and tachycardia. As it progresses, the disease “wastes” the body to the point of emaciation, with normal nutrition becoming increasingly difficult. Together with the physical symptoms is the phenomenon of spes phthisica among tuberculosis ­sufferers, a euphoric state of passion suggestive of a final blooming.3 However, the space in which these individuals are situated – the sickroom – remains an under-investigated area.

118  Kerstina Mortensen The sickroom, positioned at the confluence of space and sickness, becomes a metaphor for existence. The phenomenology of the sickroom examines the space as a container of illness but also as the most basic and primitive of spaces, the shelter. Bachelard writes a house constitutes a body of images that give mankind proofs or illusions of stability. We are constantly re-imagining its reality: to distinguish all these images would be to describe the soul of the house; it would mean developing a veritable psychology of the house.4 The nineteenth-century alignment of art and disease poses an interesting perspective in the context of the sickroom. The abstracted connection between the perceived physical, psychological, and cultural degeneration of the fin-de-siècle resonates with Bachelard’s use of such terms as “body,” “soul,” and “psychology” to present the house as an anthropomorphic being, in which the sickroom becomes an extension of bodily experience. Architecture has long been considered in light of human proportion, encasing the body as a space for living. This is true not only of the architectural skin but also of the furnishings contained within the house, which, given the tactile interaction between user and possession, demands haptic perception. The link between the body and the house can be extrapolated to such a degree that the sickroom becomes an extension of the body, meaning that the space too is embodied and therefore ill; this concept finds reflection in Munch’s By the Deathbed (Fever) (1895) and Death Struggle (1915) (Figure 5.2), in which the room itself becomes distorted by color and texture, as though absorbing the atmosphere of illness. Art, Degeneration, and Illness Illness and death: these are not merely existential processes but cultural motifs of the fin de siècle (1890s), framed by the pessimism and perceived moral degeneration of modern European society, all of which pointed to a supposed decline of Western civilization. The subject of sickness transcends the Symbolist predilection for melancholia as a sobering reflection of fin-de-siècle society, ravaged by communicable diseases amidst growing populations and poor sanitation.5 The tubercle bacillus (Mycobacterium tuberculosis), first discovered by Robert Koch in 1882, pinpointed the root of the disease, but until the introduction of antibiotic therapy (streptomycin) and vaccination programmes in the twentieth century after the Second World War, treatment continued to be sought in the fresh air and bedrest of sanatoria. Accounting for 33% of adult deaths in Denmark and 20% in Norway around 1900, the contagion spread across social strata, particularly affecting younger people.6 However, sanatoria were often the preserve of the elite, and so the domestic sickroom becomes a microcosm of the epidemic, the private stage upon which collective reality plays out. A report in the Danish journal Nationaløkonomisk Tidsskrift (1912) provides statistical analysis on the ubiquity of tuberculosis in the 1890s, but these numbers are countered by the rapid decrease in deaths by 1909. In 1890, tuberculosis caused 302 deaths per 100,000 people in urban populations, compared to 155 in 1909.7 The report further details the decrease in tuberculosis deaths across all age groups, with the number of children under 15 years old dying from the disease reducing from 7,200 in the 1890s to 4,700 in the decade up to 1909.8 The combined efforts of the Nationalforening til Tuberkulosens Bekæmpelse (National Society for Tuberculosis Control) and Tuberkuloselovene

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Figure 5.2 Edvard Munch, Death Struggle, 1915, oil on canvas, 157.5  × 200 cm, Statens Museum for Kunst Copenhagen. Photo credit: Edvard Munch, Death Struggle. 1915. Photo credit: Statens Museum for Kunst.

(Tuberculosis Laws) of 1905 are credited with this decrease, with treatment of the disease also eased by an increase in sanatoria and tuberculosis hospitals in Denmark in the period 1900–1909. While illness and death strike indiscriminately, a further report published in 1908 indicates several clear social divisions of tuberculosis, with significantly higher instances of seamstresses and the lowest service class (tyendeklassen) contracting the disease; it is also reported that more women in rural areas suffered from tuberculosis, while in urban areas more men were affected.9 Denmark’s Tuberculosis Laws were a government mandate to track tuberculosis numbers in the state, ensuring doctors would report each tuberculosis patient they had in their treatment from 1905 onwards.10 This data, assembled by the State Statistics Bureau and Health Service, was made public to monitor the outbreak of disease among various demographics. While aimed at medical professionals in the treatment of tuberculosis patients, the law also indicates some best practice for containing the illness in the context of the sickroom. The law specifies the room used by the patient, whether deceased or relocated, should be thoroughly disinfected prior to further use or sale, including bed clothes and personal clothing.11 The Epidemic Commission was further empowered to take necessary precautions if patients were found to be living in conditions conducive to the transmission of tuberculosis, including the voluntary relocation of patients to tuberculosis hospitals at the state’s expense.12 Norway’s first public sanatorium was opened

120  Kerstina Mortensen in 1897, and by 1900 the government introduced Tuberculosis Laws in a global first ­initiative to tackle the spread of disease, similar to those that followed in Denmark five years later. These efforts demonstrate the progress made by Nordic states in the early years of the twentieth century to democratize medical care in the face of more costly private sanatorium treatments. The surging cases of disease, including tuberculosis, during the 1890s directly intersects with the momentum of Symbolist art, which turned from depicting the social realities of Realism and Naturalism to interpreting these experiences through the inner psychological landscape. The breathless acceleration of modern life had fomented disillusionment and pessimism throughout European society. In an apparent foreshadowing of the horrors of the First World War, this sensation of decay was rooted in urban expansion, alienation, industrialization, and rapidly increasing birth and death rates.13 In response, Symbolist artists sought to convey ideas around existence and humanity through representational, yet highly personal, visual idioms. Discarding the verisimilitude of the academic tradition, Symbolists and other “odd aesthetic fashions” were moving incrementally towards abstraction, with many artists including Nielsen and Munch focusing on death, illness, emptiness, and dream-like scenes.14 Furthermore, the dematerialized and fragmented application of paint that characterizes the avant-garde was especially troubling to critics, with the tache or “mark” signifying sickness and visual disturbance.15 This is especially true of Munch, with the Austrian writer Hermann Bahr decrying the artist’s use of “pallid and pale colours, just as washed out and wiped over as the undercoat on a house wall – tubercular colours, real consumptive patients of colours that never knew the nourishment of blood and the light of day.”16 Many in both cultural and medical circles identified these new techniques of the avant-garde as symptoms of a sick degenerate society. The wider social debate around physical sickness and the “sick art” of the avant-garde is rooted in the perceived decline of Western civilization during the fin de siècle. This pervading sense of decay is encapsulated in Max Nordau’s Degeneration (1892), in which he claims that the poisoning of the body by addiction, malnutrition, and disease, including tuberculosis, only “begets degenerate descendants.”17 He heralded the Völkerdämmerung (“twilight of the nations”), condemning the new artistic tendencies of the avant-garde, which were favored by intellectuals rather than the lower classes, most of whom were conservative, as if an elite minority bore responsibility for the sweeping social decline. For Decadents and Symbolists, however, decay and sickness, rather than health and vitality, were qualities to be embraced in order to be “of one’s own time,” in the sense of Charles Baudelaire.18 With the distance of time, Ejnar Nielsen remarked in 1927 that his interest in death and decay was partly a symptom of the fin de siècle: “I don’t understand that people cannot see death with the same majestic beauty as life. There was perhaps also something in the time I belonged to, […] the Symbolist trend around the turn of the century.”19 This attitude to beauty and death prevailed through the nineteenth-century trope of the tuberculosis patient as a “romantic personality” whose youth and vitality is ravaged by illness only to become mythically aligned with creativity, art, and passion.20 Koch’s 1882 breakthrough in germ theory had identified tuberculosis as a contagious bacterial disease, scientifically shattering the earlier romanticized history of tuberculosis as consumption, from c. 1750 to 1882.21 Before Koch, the French physician René Laënnec (1781–1826) had maintained the disease was not contagious but a hereditary condition to which the body was predisposed; thus, fate intervened as consumption emerged in the individual,

Spaces of Sickness  121 while environmental factors such as excitement, stress, and overwork – all associated with modern urban society – exacerbated susceptibility to the disease.22 This paved the way for the “pale and interesting” tubercular idols, perceived as sensitive and intellectual, to become the ultimate symbol of modernity. The prevalence of the sick girl as a motif in the latter half of the nineteenth century has been recently theorized by Mette Bøgh Jensen as an image of sentimentality to evoke the viewer’s emotional response, but there is also a latent symbolism in the sick girl as society’s collective loss.23 She represents future motherhood, and if the future mother is ill, then what is to become of human civilization? Inevitably there were sick women, men, and boys, but none appear as closely linked to the concept of decline and degeneration as the girl. Where Christian Krohg’s Sick Girl (1881) appeals directly to the ­viewer’s sensibilities, Ane Dorthea, the young sitter for Ejnar Nielsen’s The Sick Girl (1896, Figure 5.3), is almost entirely consumed by her sickroom, her personhood effectively erased by tuberculosis. Nielsen depicted the girl on her deathbed, with permission from her parents.24 Innocent and blameless for society’s decline, sick girls appear to suffer the consequences of a degenerate world in sharp contrast to the depictions of athletic and active boys. This culminates in Vitalism’s cult of the body and the Lebensreform movement, which prized health and beauty as an antidote to degeneration.25 Such movements emerged during the nineteenth century, but by 1900 they had become distinct themes in art, with links to national socialist ideologies.

Figure 5.3 Ejnar Nielsen, The Sick Girl, 1896, oil on canvas, 111 × 164 cm, Statens Museum for Kunst Copenhagen. Photo credit: Statens Museum for Kunst © Estate of Ejnar Nielsen, VISDA Copenhagen/IVARO Dublin, 2022.

122  Kerstina Mortensen The Atmosphere of the Sickroom Consider a room in a private domestic dwelling. It is a section of space, typically with a designated function in daily life – for cooking, relaxation, or sleep. These rooms allow for the primal needs to be met; they are at the root of existence and constitute a home. Those without this basic shelter are termed “homeless,” stripped of the security and protection the dwelling provides. As a subsection within the dwelling, the space which becomes the sickroom has been repurposed from its original function. Often a space of solitude and isolation, the sickroom in Munch’s art is frequently depicted as a populated space with family members or attendant doctors. In Nielsen, only the most essential component – the patient – remains. As an embodied space inhabited by the imagination of the ill individual, the sickroom possesses a dream-like quality. Bachelard writes that “the house shelters day-dreaming, the house protects the dreamer, the house allows one to dream in peace.”26 The act of daydreaming is present in many sickroom scenes by Munch and Nielsen – more clearly, it can also be defined as abstracted or detached thinking, or figures in deep contemplation. In these states of introspective repose, certain types of brain activity, known as the “Default Mode Network,” actually increase.27 The role of DMN in disease is believed to be significant and has become a subject of research.28 The presence of the sitter in Nielsen’s And in His Eyes I Saw Death (Figure 5.1) presents a duality of daydreaming, one in which the distracted gaze of the sitter implies remoteness of thought, but also on the part of the title as uttered by the artist or viewer, in which the act of daydreaming shifts from subject to object. Bachelard further concludes that “the house is one of greatest powers of integration for the thoughts, memories, and dreams of mankind. The binding principle in this integration is the daydream.”29 If the house encompasses the mind, the sickroom becomes a site of psychological contemplation, a liminal space between health and illness, existence and death. Munch’s Self Portrait with the Spanish Flu (1919) presents the artist convalescing in his sickroom dominated by putrid greens and yellows. Some doubt lingers over whether Munch actually contracted the Spanish flu, suggesting a potentially performative aspect to these works in which the artist embodies illness.30 With his head turned to the viewer, his skin imitates the surface of the wall as patient and sickroom meld as one, while closer inspection reveals white patches in place of his eyes. The erasure of the eye suggests the glazed state of a daydream, a type of blindness and “­looking beyond” from the protection of the sickroom. However, Munch regains agency in Self Portrait after the Spanish Flu (1919), where the “lost” abstracted vision of his illness now confronts the viewer at the edge of the picture plane. The room as liminal space between life and death is also explored explicitly in Harald Slott-Møller’s painting The Poor: The Waiting Room of Death (1888), in which society’s most impoverished await their fate. The daydream is the result of unspecified automatic thinking, a response to free association and the peripheral vision of the imagination. Atmospheric potential is present in depictions of the sickroom by Munch and Nielsen, both of whom represent the domestic space as a site of illness, daydreaming, and medical containment. If we understand interior scenes from an architectural perspective, as spaces through which the body enters and circulates, then we can begin to comprehend the unique atmosphere created by the artist within the illusionism of the two-dimensional plane. Through various spatial devices, Munch and Nielsen create deeply evocative scenes with implications beyond external appearances by utilizing the compositional structures within the pictorial space:

Spaces of Sickness  123 these include the corner, the placement of furniture, and arrangement of fenestration and doorways (and thereby light), but also the texture of surfaces including walls or textiles. The term “atmosphere” has entered recent scholarship as a phenomenological and spatial concern.31 At once evocative of air and light, atmosphere also speaks of quality and feeling: we measure social festivities by their “good” atmosphere, while “bad” atmosphere is lacking and is often the preserve of volatile or precarious situations. In all instances, we gauge the atmosphere of a space, and this conclusion becomes integral to our recollection of the experience, consigned to memory. Atmosphere comes in many nuanced guises, ranging from Alois Riegl’s Stimmung to Walter Benjamin’s aura.32 While atmosphere is a significant architectural consideration, it also has profound resonance in the art historical context. Atmospheres can be likened to the immersive quality of a space, perceived bodily. Munch and Nielsen depict spaces of sickness, but how do we understand the atmosphere of these flat spaces, unreachable within the pictorial plane? Paintings are spatial illusions in two-dimensional, fictive worlds which the eye observes, but the body feels. The architect Juhani Pallasmaa eloquently conceptualizes the nebulous idea of atmosphere in the study of visual culture, primarily architecture, and notes its relevance to other arts: “even the imagery of a painting is integrated by an overall atmosphere or feeling – the most important unifying factor in a painting is usually its specific feel for illumination and colour.”33 The unifying factor is reflected in earlier writings of the sociologist Georg Simmel, in which he discusses mood, a cognate of atmosphere: the mood of a landscape permeates all its separate components, frequently without it being attributable to any one of them. In a way that is difficult to specify, each component partakes in it, but a mood prevails which is neither external to these constituents, nor is composed of them.34 The sense of unity and oneness derived from grasping a landscape as a whole, rather than discerning individual elements, directly relates to the phenomenology of atmosphere. Measured by the body, atmosphere is often a sensation reduced to a single adjective, such as “melancholic,” “introspective,” or even “atmospheric.” Breaking down into its constituent parts reveals a tessellated picture, but also the very production of that mood in an artistically rendered work of art. Gernot Böhme’s assertion that all art is engaged in the “production of atmospheres” suggests our participation not only in regarding the interior, but inhabiting it as a bodily experience.35 Considering the air or atmosphere of a space is all the more pertinent in the context of tuberculosis. Composed of the Greek atmos (vapours) and sphaira (globe), we comprehend atmosphere as the air surrounding us, inhaled and exhaled with the body as a barrier in a porous relationship between self and environment. From Antiquity to the advent of germ theory in the 1880s, diseases were thought to spread from air polluted by decaying organic matter or miasma, which was also linked to climatic changes in atmosphere.36 This rendering of atmosphere can be equated to a climate contained within the sickroom. Eva Horn discusses the early nineteenth-century concept of circumfusa, the climate that immerses the plant, animal, or human body as a medium, which could comprise “the beneficial effects of ‘good air’ (e.g., in mountain resorts or by the coast), or [the] deleterious emanations that bring diseases and epidemics.”37 Air is both the medium for disease, through which the tubercle bacillus is inhaled into the lungs, and the remedy in the treatment of tuberculosis before vaccination and antibiotics. In this sense, the sickroom is a

124  Kerstina Mortensen microclimate, one in which the very air of the space is linked to health, but also to the emotional perception of the space. Understanding the “atmosphere” of the space is integral to our perception of the sickroom. Böhme defines atmosphere as a phenomenon positioned between subject and object, positioned on the threshold of this co-dependent dynamic.38 He further maintains that the particular quality of a story, whether read or heard, lies in the fact that it not only communicates to us that a certain atmosphere prevailed somewhere else, but that it conjures up this atmosphere itself. Similarly, paintings which depict a melancholy scene are not just signs for this scene but produce this scene itself.39 This thinking places equal burden – and meaning – on the reception of a work and its aesthetic orchestration. The artist creates the work, but the viewer perceives it; artistic intentionality directs the compositional arrangement, but the viewer embodies it. Böhme defines the “ecstasies of things” as a visual presence in which “the thing asserts its presence in space and radiates into it.”40 If the qualities of a thing, such as its color, form, or scent, can “tinge” the surrounding space,41 then the atmosphere of the sickroom is physically marked by the presence of sickness as “thing.” In this manner, the visual aspects of colour, light, and composition form what we ascribe as the “atmosphere” of a work, paradoxically echoing Nordau’s denunciation of the avant-garde’s proclivity for emotion and imagination.42 In 1887 the Swedish Decadent writer Ola Hansson described a fictive toxic plant in Sensitiva Amorosa as possessing the same color as the “daylight in a sick room.”43 The toxicity of this herb to society is aligned with the putrid excesses of Baudelaire’s Les Fleurs du Mal (1861), but light also embodies the function of the sickroom.44 Light shapes space, and its use is a significant architectural consideration that is typically considered in terms of the atmosphere of space. In Munch’s Spring (Figure 5.4), daylight streams into the sickroom, but in Nielsen the sickrooms appear sequestered from light. Reinhold Heller also highlights the “dank atmosphere of the darkened sickroom” present in Munch’s autobiographical writings, in which the artist recollects how close he too came to dying from tuberculosis as a child.45 The passage alternates between first- and third-person narratives and, dated to when he was living in St Cloud in 1890, outlines the sickroom not from the perspective of the observer but the patient. The text offers poignant insight into the experience of the sickroom by the primary user: the darkness of the room requires Munch’s father, a physician, to reach for a candle in order to examine the blood his son has coughed up, an act made all the more significant by his medical profession. Munch is told to stay still for the day, and with nothing to do “he stared quietly into space,”46 an image which instantly conjures the dejected, vacant gaze of Erik Kjærsgaard awaiting his fate in Nielsen’s And in His Eyes I Saw Death (Figure 5.1). However, the notion that the sickroom functions as a quarantine is refuted here, demonstrated by the comings and goings of Munch’s father, doctor, siblings, and aunt, all of whom are ­present in the home.47 Even a visitor can be heard in the kitchen inquiring about Munch’s c­ ondition: “my son is also ill, it will be either him or my son – can you hear how the dog is barking – it is not a good sign.”48 The atmosphere of this sickroom as described by Munch is a fluid communal space, in which the family ebbs and flows around the patient.

Spaces of Sickness  125

Figure 5.4 Edvard Munch, Spring, 1889, oil on canvas, 169 × 263.5  cm, Nasjonalmuseet Oslo. Photo: Børre Høstland/The National Museum.

Corners of Space The sickroom of Nielsen’s painting And in His Eyes I Saw Death (1897) is barren and white-washed, a low-ceilinged space with a large black chest set into the corner. With plaster peeling in the lower sections, the decay has already begun. Positioned directly against the wall, the sitter Erik Kjærsgaard sits at the foot of this chest, with hands clasped. The sickroom is designated as the space in which the confined patient rests, occupying a bed or a wheelchair. There are no attendant family members, the medical accoutrements of illness are missing, and the patient is sitting up, not in bed. The man is upright and, to some degree, mobile; he is dressed in a black suit, not pajamas or nightclothes. Further to this, the title alters our perception of this man; rather than being labelled “the sick man” or “illness,” Nielsen endows the sitter with a nuanced, existential narrative, g­ ranting Kjærsgaard a heightened sense of purpose and agency than other images of invalids through the expansiveness of the title. This fact is cemented by the inscription of the title on the surface of the picture plane.49 The title places the man firmly in the grips of illness, a fact compounded by Nielsen’s Death and the Cripple (1899) completed just two years later, in which the confinement of the sickroom is displaced by the rolling hills of Gjern. Erik Kjærsgaard is laid out beneath a shroud, his emaciated body a poignant counterpoint to the elderly yet still-living man tending to his side.50 The man’s physical deformity emphasizes the injustice of tuberculosis, a disease in which the young had the highest infection rates.51 The work also displays a monistic perspective of life: Kjærsgaard’s death forms part of the circle of existence, and his return to the soil will feed the subsequent

126  Kerstina Mortensen flourishing of nature. Nielsen wrote of the beauty of the Gjern landscape upon his arrival in the early 1890s: When I arrived there, walking on foot from Silkeborg – this was before the time of the railway, you know – it struck me clearly, that this was the place for me, here were the subjects I wanted to paint. And soon it proved to be the same case with many of the people I got to know. Strange though, that in such beautiful surrounds there  was  so much illness and misery – amidst the hills, tuberculosis was ravaging terribly.52 That beauty and nature can also give rise to destruction is a paradox Nielsen grapples with in Gjern when faced with life and death, the twin facets of existence. The concealment of contagion in the lush and fertile landscape is mirrored in the prevalence of ­tuberculosis among the young, dying before their time. The corner is present in many sickroom scenes by Nielsen and Munch, namely as a regular architectural feature as a right angle in an interior space. However, the phenomenology of the corner enriches our understanding of the architectural corner – from the interior rather than the exterior – as a mode of dwelling: “every corner in a house, every angle in a room, every inch of secluded space in which we like to hide, or withdraw into ourselves, is a symbol of solitude for the imagination.”53 Though present in all rooms, the sickroom corner is one such secluded space into which one retreats both physically and psychologically. The corner implies vulnerability, the individual seeking a protective encasing while inhabiting the corner in a gesture of defense. The corner enhances the sense of claustrophobia – but is this truly a fear of enclosed spaces or a desire for them? The claustrophobia relates to the suffocating feeling of being quarantined in a space, as though imprisoned. However, the safety and security of this feeling can be questioned as to whether these scenes instead embrace a claustrophilia, offering the sitter privacy and protection, a refuge within the house.54 The Sickroom as Shadow of the Self The shadow is a phenomenon of light. It is detached from its source, yet simultaneously fixed to it as both fragment and whole. As light sources move, the shadow distorts, and the object and its shadow can align to appear fused together. The shadow itself ­disappears. Dark, dusty, dusky – the shadow mimics its object, a distortion of the object. As the antagonist of the reflection, the shadow absorbs light, rather than reflecting it.55 To shadow someone is to follow closely, tracing their steps as an extension of their being. The “shadows” are areas beyond the reach of light, ambiguous forms shrouded by darkness. Persistently two-dimensional, the presence of shadows denotes the volumetric dimensionality of their object. Silhouettes are shadows, an erosion of the self, with the characteristic profile reduced to intimate anonymity. To live in the shadows is to exist on the fringes of society, cast out between worlds, while shadows gather and deepen at dusk. To be a shadow of one’s former self is to be a mere husk depleted of content, while an x-ray will reveal a shadow on the lung of a tuberculosis patient. The symbolism of the shadow marks each of these sickroom depictions. A looming presence bears witness in these scenes, a symbol of darkness absorbing light and functioning as a counterpoint to the sick individual. Shadows are dominant and encroach upon the scene in Munch’s Death Struggle (Figure 5.2) but are also present in the

Spaces of Sickness  127

Figure 5.5 Edvard Munch, The Sick Child, 1885, oil on canvas, 120 × 118.5 cm, Nasjonalmuseet Oslo. Photo credit: Børre Høstland/The National Museum.

poignant breakthrough work The Sick Child (1885) (Figure 5.5) in the form of the curtain drawn back, forming a vertical counterpoint to the girl.56 The solidity of the object and dark green coloration is offset by the scratch-like, diaphanous quality of the fabric, creating a shadowy presence in the room. The shadow denotes the object from which it is cast, but also possesses connotations of its own. Dark, absorbing light, and in outline or silhouette against the surface, the shadow does not reveal detail but only contour. In Nielsen’s And in His Eyes I Saw Death the shadow of the sitter is traced in faint outline against the wall in a doubling of the self, just as Sjöstrom aligns this shadow to the shadow on the lung of tuberculosis.57 The man in Death and the Cripple, dressed all in black, adopts the position of a shadow, as does the black chest sofa set into the corner of And in His Eyes I Saw Death. The coffin-like chest can be read as an allusion to the sitter’s impending death, but also as an anthropomorphic symbol of the act of dreaming. Its horizontality echoes the reclining dreamer, but its form conveys many Bachelardian oneiric ideals – the nest, the corner, the shell, the shelter. The sitter at the base of the chest is occupied in the act of daydreaming, his line of sight falling beyond the viewer’s gaze. This item of furniture becomes a “model” in the scene, and together with the cryptic title, it invites our intellectual engagement with what is contained within. The shadow is also a double or Doppelgänger, an optical effect both attached to the figure and detached from their physicality. The shadow motif is found throughout Munch’s

128  Kerstina Mortensen oeuvre, but takes on particular resonance in the sickroom scenes. In The Uncanny (1919), Freud discusses the Doppelgänger through the prism of German Romanticism in E. T. A. Hoffman’s short story The Sandman, in which the double becomes uncanny as a marker of “mirror-images, shadows, guardian spirits, the doctrine of the soul and the fear of death.”58 The shadow is said by psychoanalyst Otto Rank to be an extension of the immortal self, one which has its roots in humanity’s primitive belief systems: From a symbol of eternal life in the primitive, the double developed into an omen of death in the self-conscious individual of modern civilisation. This revaluation, ­however, is not merely due to the fact that death no longer could be denied as the end of the individual existence but was prompted by the permeation of the whole subject of immortality with the idea of evil.59 In Death in the Sickroom (1893), the shadow has a curious function. As a further rendering of Sophie Munch’s death, the dead girl is concealed from the viewer and our focus shifts from death to its immediate aftermath. Here, the sickroom becomes a stage for the unravelling of grief. The shadows around Munch’s father and brother (on the left) are further exaggerated in other iterations of the motif: in charcoal, these shadows take on a spectral appearance, as though the self has splintered. The presence of shadows in these paintings suggests a quantity at once terrible and unknown, invoking a reaction similar to the sublime.60 Just as the sickroom functions as a threshold on the edge of existence, so too the shadow becomes the liminal self, an in-between state through which one must cross. The sickroom becomes a site of dematerialization, in which the self deteriorates to the point of decay, as visualized in Death Struggle. In this manner, these looming objects become disembodied elements of the individual, in which the self is separated from its body and takes on symbolic function in the context of the sickroom. If we understand geographer Yi-Fu Tuan’s definition of space as possessing the ability of movement and place as “an object in which one can dwell,”61 then it can be said that the sickroom is a space composed of and governed by a number of places, or objects, within the scene that convey meaning. However, the sickroom by its definition suggests an enclosure, more specifically within the object of the bed or chair in which the patient is confined during their illness. The objects within the represented sickroom then acquire value within the space. The accoutrements of illness are evident in Munch’s Death Struggle – the emptied medicinal bottles by the bedside indicate the futile efforts against the disease (Figure 5.2). The term “death struggle” or “dødskamp” presents further semantic dimensions to the sickroom – is this a fight for life or the release of death? The struggle for – or against – death is absorbed in the bloodied, claw-like patterns imprinted on the walls.62 Most striking in this scene is the dark blue-grey shadow that looms above the ancillary figures like a wave, almost consuming their forms. The patient is subsumed in the grief and fear of death that envelops the space, so that the surrounding figures and forms instead become the primary focus. The sickroom here becomes a nightmarish, immersive experience with distortions of color and form as a metaphor for the transition between life and death. The Air of the Sickroom An interesting counterpoint to Munch’s image of The Sick Child (Figure 5.5) is a slightly later work titled Spring (1889) (Figure 5.4). Munch draws again on the memory of his sister Sophie, with her characteristic red hair, before her death from tuberculosis. In The

Spaces of Sickness  129 Origins of the Frieze of Life (1890), Munch writes that “with Spring – the sick girl and the mother by the open window with the sun pouring in I said farewell to Impressionism and Realism.”63 The oscillation between styles is evident in these related works, and this final ­departure from representing the social realities of illness marks a turning point in the artist’s career. Spring is a variation of the same theme but replaces the cropped composition of earlier work with a panoramic view of the sickroom, almost as though inhabiting the space of the Sick Child from a new angle. Here, the girl’s head is turned to the viewer, with her attendant mother by her side. Again, the details that were reduced to singular strokes in the earlier work are articulated in Spring with clarity and structure. In all, Spring appears to be a more conventionally finished work than The Sick Child, certainly in the eyes of contemporary critics. Most striking however is the disruptive paradox of the title and the subject matter. The allegory of spring symbolizes rejuvenation: new life, rebirth, and fertility, as emphasized by the blooming plants along the windowsill and golden sunlight through the curtains in almost heavenly rays. The breeze billowing through the light curtains of the sickroom suggests that the clear air will help the girl in her recovery, as typical of tuberculosis treatment. The air of the sickroom is not close, but fresh and alive with the breeze. Given the title, flowers, and circulation of fresh air through the room, it is tempting to read this sickroom as one of convalescence and recovery. Further to this, she is not bedbound, but fully dressed in the space of a living room. However, the girl’s head is turned from the world beyond the window in a deliberate shunning of beauty and revitalization. There is no longing in her expression, but resignation and withdrawal from her environment. This insight is a stark contrast to The Sick Child, in which the girl appears to look towards the window, curtain pulled back. The presence of external reality is implied, but the blinding visibility of sunlight in Spring forces the viewer to confront the juxtaposition of sickness and vitality. The spring is further linked to the age of the girl: though in the spring of her life, her youth is suppressed by illness, as was the reality for the inordinate number of young people who had contracted tuberculosis. The title Spring again implies a hidden contagion in nature and appears to foreshadow Nielsen’s words “amidst the hills tuberculosis was ravaging terribly,” a theme Nielsen explores with far greater ­explication in Death and the Cripple.64 The Sick Child is painted from memory, in an effort to represent the deep grief Munch felt at the death of his sister Sophie in 1877; the artist proclaimed about his artistic practice, “I paint, not what I see, but what I saw.”65 In his art and writing, Munch revisited certain motifs throughout his career, including that of his sister’s death, to the extent that each self-contained iteration can be also situated in a broader, self-citing narrative.66 Spring presents a more fully formed pictorialization of the scene with the viewer at a remove, quietly observing the resting girl from another room. Though both are rooted in his personal memory, the shift in perspective from emotion to visualization is tangible in Munch’s technique. Where The Sick Girl conveys “the atmosphere of the sickroom”67 in which the girl fades into dematerialization with her illness embodied in the painted surface, Spring recreates the reality of disease and its presence in the domestic interior space. Coda: The Window Just as the body contracts infection, the sickroom also possesses the potential to harbor bacterial infection. The Swedish town of Antnäs near Luleå was razed by tuberculosis

130  Kerstina Mortensen in the late nineteenth century; however, historian Neil Kent indicates its virulence in the town was likely due to the “sealed windows of the houses, which prevented the circulation of fresh air.”68 The window that cannot be opened is a barrier to the external, but also incubates the disease. Given the significance of fresh air in the treatment of tuberculosis, it is remarkable that with the exception of Spring, few sickroom depictions include the window. According to the adage, the eyes are the “windows to the soul”; however, this link is more than just proverbial. Etymologically, window is derived from the Old Norse ­vindauga, as a composite of vindr or “wind,” and auga, “eye.” This derivation implies the interconnectedness of windows and vision that alludes to the primacy of the window as a shelter, but simultaneously to its potential to see out from within, a primal need for security and survival. This “looking out” from within seems to reinforce an ocularcentric viewpoint. However, the root word also implies the circulation of air, or “wind,” and the concept of ventilation to cleanse the atmosphere of the enclosed space against airborne disease. The window is both a barrier against the elements and also the senses: the closed window suppresses perception of external sound, touch, taste, odor, and sometimes sight. The primacy of vision is inverted by Pallasmaa’s call for bodily perception, so that “all the senses, including vision, can be regarded as extensions of the sense of touch – as specialisations of the skin.”69 The link to the tactile is in closer alignment with its Latin cognate, fenestration, from fenestratus, which describes something provided with openings. Apertures or orifices suggest the inside/outside dialectic, and a transition from one spatial body to another. Returning to the adage, “if the eye is a window,” then in architectural terms the window is also an eye, and the house is both body and soul.70 Only Munch’s Spring depicts the wafting curtains as indexical of air currents in the sickroom. All other scenes are set within enclosed spaces – perhaps a door opens into another room, as in Death in the Sickroom, but both Nielsen’s And in His Eyes I Saw Death and The Sick Girl play out against the confinement of the interior corner. The shut window can be further likened to the shut chest and cabinet in these works. Where openness suggests possibility, the closedness conveys finality, futility, and the irrevocable. The distinctly non-medical representations of tuberculosis in Nielsen convey a distance from the individual, and foreground instead the transcendent experience of existence. Where in Munch’s sickroom there is a deeply personal excavation of memory populated by the artist’s family in a replaying of trauma, Nielsen’s sicknesses represent the universality of death, the devastation of illness, and the death of youth as the elderly bear witness. The phenomenology of the sickroom as a space of sickness opens the viewer to a bodily perception of tuberculosis visualizations through the spatiality of windows, corners, shadows, and air – the very atmosphere of the sickroom. Notes 1 Walter Benjamin, The Arcades Project, trans. Howard Eiland and Kevin McLaughlin (Cambridge, MA: The Belknap Press of Harvard University Press, 2003), 9. 2 Edvard Munch, Undated Sketchbook (MM T 2794, Munch Museum Oslo), 3. https://emunch. no/HYBRIDNo-MM_T2794.xhtml#ENo-MM_T2794-19r. 3 Frank M. Snowden, Epidemics and Society: From the Black Death to the Present (New Haven, CT and London: Yale University Press, 2020), 275–276. 4 Gaston Bachelard, The Poetics of Space (Boston, MA: Beacon Press, 1994), 17. 5 For further detail on the disease, decline, and degeneration in the nineteenth century, see “The Sick City” in Sharon L. Hirsh, ed. Symbolism and Modern Urban Society (Cambridge: Cambridge University Press, 2004), 103–162; and Sharon L. Hirsh, “Codes of Consumption:

Spaces of Sickness  131 Tuberculosis and Body Image at the Fin-de-Siècle,” in In Sickness and in Health: Disease as Metaphor in Art and Popular Wisdom, eds. Laurinda S. Dixon and Gabriel P. Weisberg (Newark, NJ: University of Delaware Press, 2004). 6 For detailed statistical information in Norway, see Knut Liestøl et al., “Hvem fikk tuberkulose – og var de generelt skrøpelige?” in På liv og død: Helsestatistikk i 150 år, ed. Ragnhild Rein Bore (Oslo-Kongsvinger: Statistisk sentralbyrå, 2007), 120–134; “Døden skifter årsag – fra de store epidemier til de nyefolkesygdomme” (Copenhagen: Dansk Sygeplejehistorisk Museum, 2017), 8. 7 Editorial, “Den Aftagende Tuberkulose-Dødelighed,” Nationaløkonomisk Tidsskrift, vol. 3. 20 (1912), 596. 8 Editorial, “Den Aftagende Tuberkulose-Dødelighed,” 596. 9 Editorial, “Tuberkulosen i Danmark,” Nationaløkonomisk Tidsskrift, vol. 3, 16 (1908), 542–543. 10 Editorial, “Tuberkulosen i Danmark,” 542. 11 “Tuberkuloselovene, 14. April 1905: §4 and §5,” Danmarkshistorien.dk, Aarhus Universitet. https://danmarkshistorien.dk/vis/materiale/tuberkuloselovene-af-1905/. 12 “Tuberkuloselovene, 14. April 1905: §6,” Danmarkshistorien.dk, Aarhus Universitet. https:// danmarkshistorien.dk/vis/materiale/tuberkuloselovene-af-1905/. 13 Michelle Facos, Symbolist Art in Context (Berkeley, CA and Los Angeles, CA: University of California Press, 2009), 65. 14 Max Nordau describes Realism, Symbolism, and Decadence as “odd aesthetic fashions.” Max Nordau, Degeneration (London: William Heinemann, 1898), 43. 15 Sjåstad aligns the tache (a blot, stain, or mark) with illness, quoting from Nordau’s Degeneration, in which artists working in Impressionism and its associated movements are described as suffering from a “trembling of the eyeball” or nystagnus. Thus, in both medical and aesthetic discourse of the later nineteenth century, the meaning of the tache is explored as a marker of disease and degeneration. By this reasoning, contemporary audiences would have viewed Munch’s The Sick Child as a “sick painting.” Øystein Sjåstad, A Theory of the Tache in Nineteenth-Century Painting (Farnham, Burlington: Ashgate, 2014), 17–18. 16 Hermann Bahr, “Die Décadence,” Studien zur Kritik der Moderne (Frankfurt am Main, 1894), 20–21. Quoted in Reinhold Heller, Munch: His Life and Work (London: John Murray, 1984), 98. It is also worth noting that the Swiss critic William Ritter labelled Munch a “hospital Velázquez” for his depictions of modern (and arguably “degenerate”) society with unvarnished truth in 1906 – see Allison Morehead, “Munch: A Modern Velázquez?” Kunst og Kritik, vol. 100, 1–2 (2017), 6–19. 17 Max Nordau, Degeneration (London: William Heinemann, 1898), 34. 18 Like Symbolism, Decadence is characterized by an inward turn and pessimistic worldview, but may to some extent be differentiated by a predilection for the hedonism and perversity of modern life. See Pirjo Lyytikäinen, “Decadent Tropologies of Sickness,” in Decadence, Degeneration, and the End: Studies in the European Fin de Siècle, eds. Marja Härmänmaa and Christopher Nissen (New York, NY: Palgrave Macmillan, 2014), 85–102. 19 “Jeg forstaar ikke, at Mennesker ikke kan se paa Døden med dens majestætiske Skønhed som paa Livet. Nu laa det maaske ogsaa noget i Tiden, jeg tilhørte…hele den symbolistiske Mode, der var omkring Aarhundredskiftet,” translated by the author from “Ejnar Nielsen om Kunsten og Døden,” interview with the artist, Nationaltidende, February 1, 1927, 7. 20 Susan Sontag, Illness as Metaphor (New York, NY: Farrar, Straus, & Giroux, 1978), 30. 21 Snowden, Epidemics and Society: From the Black Death to the Present, 271. 22 Snowden, Epidemics and Society: From the Black Death to the Present, 279. 23 Mette Bøgh Jensen, “Raske Drenge og Syge Piger,” Kultur & Klasse: Sygdom, vol. 131 (2021), 83. See also Mette Bøgh Jensen, “Sickness, Sentimentality, and Sympathy: Sick Girls in Nordic Art 1850-1900,” in An Angel’s Kiss: Sick Girls in Nordic Art, eds. Camilla Klitgaard Laursen and Mette Bøgh Jensen (Copenhagen: Rosendahls, 2021). 24 Ulla Sjöström, Maleren Ejnar Nielsen (Copenhagen: Christian Ejlers’ Forlag, 2000), 16. 25 For Vitalist tendencies in Danish art, see Gertrud Hvidberg-Hansen and Gertrud Oelsner, Spirit of Vitalism: Health, Beauty and Strength in Danish Art 1890-1940 (Museum Tusculanum, 2011).

132  Kerstina Mortensen 26 Bachelard, The Poetics of Space, 6. 27 Marcus E. Raichle et al., “A Default Mode of Brain Function,” PNAS (Proceedings of the National Academy of Science), vol. 98, 2 (2001, January 16), 676–682. 28 Marcus E. Raichle, “The Brain’s Default Mode Network,” Annual Review of Neurosciences, vol. 38 (2015, July), 443–447, see especially 444. 29 Bachelard, The Poetics of Space, 6. 30 Patricia G. Berman, “Self-Portraits ‘As’: Expressionist Embodiments,” in Munch and Expressionism, eds. Jill Lloyd and Reinhold Heller (Munich: Prestel, 2016), 92–93. 31 Selected scholarship on atmosphere includes Gernot Böhme, Atmospheric Architectures: The Aesthetics of Felt Spaces (London: Bloomsbury, 2020), Tonino Griffero and Giampiero Moretti, eds. Atmosphere/Atmospheres: Testing a New Paradigm (Milan: Mimesis International, 2018), and Juhani Pallasmaa, The Eyes of the Skin: Architecture of the Senses (Chichester: WileyAcademy, 2007). 32 Walter Benjamin, The Work of Art in the Age of Its Technological Reproducibility, and Other Writings on Media (Cambridge, MA and London: The Belknap Press of Harvard University Press, 2008) and Alois Riegl, “Die Stimmung als Inhalt der modernen Kunst,” in Die ­graphischen Künste, 22 (1899), 47–56. 33 Juhani Pallasmaa, “Space, Place, and Atmosphere: Peripheral Perception in Existential Experience” in Architectural Atmospheres: On the Experience and Politics of Architecture, ed. Christian Borch (Basel: Birkhäuser, 2014), 20. 34 Georg Simmel, “The Philosophy of Landscape,” in Georg Simmel: Essays on Art and Aesthetics, ed. Austin Harrington (Chicago, IL: University of Chicago Press, 2020), 224. 35 Gernot Böhme, The Aesthetics of Atmospheres, ed. Jean-Paul Thibaud (Abingdon: Routledge, 2017), 21. 36 Snowden, Epidemics and Society: From the Black Death to the Present, 190. 37 Eva Horn, “Air as Medium,” Grey Room 73 (2018, Fall), 13. 38 Böhme, The Aesthetics of Atmospheres, 25. 39 Böhme, The Aesthetics of Atmospheres, 21–22. 40 Gernot Böhme, Atmospheric Architectures: The Aesthetics of Felt Spaces (London: Bloomsbury, 2020), 51. 41 Böhme, Atmospheric Architectures: The Aesthetics of Felt Spaces, 22. 42 Among thoroughly sane individuals the emotions originate almost solely from impressions of the external world; among those whose nervous life is more or less diseased, namely, among the hysterical, neurasthenic, and degenerate subjects, and every kind of lunatic, they originate much more frequently in internal organic processes. Sane artists will produce works, as a rule, in which perception will predominate; artists unhealthily emotional will produce works in which the play of association of ideas predominates – in other words, imagination working principally on memory-images. Max Nordau, Degeneration, 476. 43 Ola Hansson, Sensitiva Amorosa (1887). Quoted in “Decadence in Nordic Literature: An Overview,” in Nordic Literature of Decadence, eds. Pirjo Lyytikäinen, Riikka Rossi, Viola Parente-Čapková, and Mirjam Hinrikus (New York, NY: Routledge, 2021), 3. 44 Charles Baudelaire, Les Fleurs du Mal (Paris: Calman-Lévy, 1868). 45 Heller, Munch: His Life and Work, 19. 46 Edvard Munch, MM T 2771, fol. 02v. https://emunch.no/TRANS_HYBRIDMM_T2771. xhtml. 47 The recollection from the artist’s childhood naturally pre-dates the 1889 tuberculosis poster campaign in Norway (Tuberkuloseplakaten) aimed at curbing the transmission of the disease. 48 Edvard Munch, MM T 2771, fol. 04r. https://emunch.no/TRANS_HYBRIDMM_T2771. xhtml. 49 For a semiotic analysis of the artwork title in relation to Nielsen’s And in his Eyes I Saw Death, see Kerstina Mortensen, Into the Void: Text and Image in Nordic Art 1890-1915 (PhD Dissertation, Trinity College Dublin, 2019). 50 Ulla Sjöström, Maleren Ejnar Nielsen 1872–1956 (Copenhagen: Christian Ejlers Forlag, 2000), 21. 51 The highest numbers of tuberculosis infections in Denmark occurred in 25–30 year olds. Editorial, “Tuberkulosen i Danmark,” Nationaløkonomisk Tidsskrift, vol. 3, 16 (1908), 542.

Spaces of Sickness  133 52 Da jeg kom dertil, vandrede på min fod fra Silkeborg – det var før jernbanens tid, må De vide – stod det mig med det same klart, at det var stedet for mig, at her fandtes de motiver, jeg brød mig om at male. Og snart viste det sig, at det samme var tilfældet med mange af de mennesker, jeg efterhånden lærte at kende. Mærkelig blot, at der i så smukke omgivelser fandtes så megen sygdom og elendighed – mellem bakkerne hærgede navnlig tuberkulosen frygteligt. Steffen Lange, Eneren — Maleren Ejnar Nielsen (Herning: Poul Kristensen Forlag, 1998), 15. From Nielsen’s 80th birthday interview in Silkeborg Avis, 4 March 1952. Translated from Danish by the author. 53 Bachelard, The Poetics of Space, 136. 54 For a psychoanalytical approach to this phenomenon, see Elvio Facchinelli, Claustrophilia (Milan: Adelphi, 1983). 55 Sorensen writes that shadows “require light sources plus transparent or translucent regions where light would have entered were it not for objects that block the source.” Roy Sorensen, Seeing Dark Things: The Philosophy of Shadows (Oxford and New York, NY: Oxford University Press, 2008), 26–27. 56 The Sick Child marks a turning point in Munch’s career, which he describes as his first break from Impressionism (MM N 122). The sketchiness and scratched surface of the canvas shocked critics, with the artist later recalling The Sick Child had been “vilified worse than any cubist picture” (MM N 318). See the vast digital archive of Edvard Munch’s Writings www.emunch. no for further statements by the artist. 57 Sjöström, Maleren Ejnar Nielsen, 19–20. 58 Sigmund Freud, The Uncanny, trans. David McLintock (London: Penguin Books, 2003), 142. Freud’s essay responds in part to Ernst Jentsch’s On the Psychology of the Uncanny (1906) which also theorizes the uncanny as a form of aesthetically derived anxiety, but the topic received relatively little attention following its publication in psychoanalytical circles until Lacan’s approach to the Freudian uncanny in the 1960s – see Anneleen Masschelein, “A  Homeless Concept: Shapes of the Uncanny in Twentieth Century Theory and Culture,” Image & Narrative 5 (Jan 2003 online). 59 Otto Rank, “The Double as Immortal Self” in Beyond Psychology, ed. Otto Rank (New York, NY: Dover Publications, 1958 [1914]), 76. Stoichita’s text offers complex readings of the shadow through art, history, and philosophy, including the double: Victor I. Stoichita, A Short History of the Shadow (London: Reaktion Books, 1997). 60 Burke’s discussion indicates the sublime power of darkness and, by extension, shadows: “A quick transition from light to darkness, or from darkness to light, has yet greater effect. But darkness is more productive of sublime ideas than light.” Edmund Burke, A Philosophical Enquiry into the Sublime and Beautiful (Oxford: Oxford University Press, 2015 [1757]), 65. 61 Yi-Fu Tuan, Space and Place: The Perspective of Experience (Minneapolis: University of Minnesota Press, 2001), 12. 62 Berman offers insight regarding the haptic and optic qualities of the surface in relation to Munch: Patricia Berman, “Scratching the Surface: On and In Self Portrait (1895),” Kunst og Kultur vol. 100, 1–2 (2017), 78. 63 Edvard Munch, The Origins of the Frieze of Life MM UT 13 (Oslo, 1928), 10. https://emunch. no/TRANS_HYBRIDMM_UT0013.xhtml. 64 Steffen Lange, Eneren – Maleren Ejnar Nielsen (Herning: Poul Kristensen Forlag, 1998), 15. 65 Reinhold Heller, Edvard Munch: The Scream (London: Allen Lane, The Penguin Press, 1973), 27. 66 Mai-Britt Guleng, “Edvard Munch – The Narrator” in eMunch.no – Text and Image, ed. MaiBritt Guleng (Oslo: Munch Museum, 2011), 232. 67 Michelle Facos, Symbolist Art in Context, 74. 68 Neil Kent, The Soul of the North: A Social, Architectural and Cultural History of the Nordic Countries 1700–1940 (London: Reaktion Books, 2000), 141. 69 Pallasmaa discusses hapticity, atmosphere, and the senses in The Eyes of the Skin (Chichester: Wiley-Academy, 2005) and The Embodied Image (Chichester: Wiley-Academy, 2011). Juhani Pallasmaa, The Eyes of the Skin (Chichester: Wiley-Academy, 2005), 42. 70 This recalls Bachelard’s call for a “psychology of the house.” Gaston Bachelard, The Poetics of Space (Boston, MA: Beacon Press, 1994), 17.

Part II

Reporting, Representing, and Interpreting Disease

6 “Invisible Destroyers” Cholera and COVID in British Visual Culture Amanda Sciampacone

The COVID-19 pandemic has brought to the fore the continued associations between epidemic disease and fears of both the unknown and the Other. This chapter will explore how the representation of COVID-19 in the British press, particularly in the Metro, recalls a longer visual history of the iconography of epidemics from plague to cholera. More than most diseases of the nineteenth century, cholera inspired fear in Victorian society, because of its seemingly enigmatic nature.1 European physicians claimed that a new epidemic form of cholera had apparently emerged in Bengal in 1817, naming it “Asiatic cholera” or “Indian cholera” to distinguish it from the violent intestinal disorder known as “English cholera” or cholera nostra that had existed prior to the nineteenth century.2 Cholera pandemics were regularly represented in text and image as plague and through racial bodies. Bringing cholera to bear on coronavirus, my chapter will draw parallels with present-day invocations of the state of war against what has been described as “this invisible killer stalking the whole world,” controversies around calling SARSCoV-2 the “China virus,” and images in the British press that conflate COVID-19 with Chinese bodies. Through a selective comparison of this longer visual history, my chapter will demonstrate how epidemics of new diseases are pictured through established ­iconographies of illness as a method of comprehension and offer a broader consideration of the role played by visual depictions of the pandemic in generating fear and assigning blame. Portraying Cholera as an “Indian” Disease Nineteenth-century European physicians claimed that the first cholera pandemic began in Jessore, India, in August 1817, from what they described as the fetid jungles of the Ganges Delta. British surgeons stationed in India, such as James Jameson, James Annesley, and Reginald Orton, claimed that cholera emerged from the climatic and insalubrious conditions of the Indian territories.3 With the first cases of cholera in Britain appearing in the city of Sunderland in 1831, texts and images were published to provide information about this seemingly new foreign disease to Britons within the dominant center of the empire. A broadsheet circulated by the churchwardens of Clerkenwell in November 1831 boldly announces the “alarming approach of the INDIAN CHOLERA” (Figure 2.1). It further outlines the symptoms of the disease, including how it changed the color of sufferers “to a leaden blue, purple, black or brown,” and potential remedies in order to prepare

DOI: 10.4324/9781003294979-9

138  Amanda Sciampacone the parish’s inhabitants.4 In the first of two articles offering a history and overview of cholera, the Lancet explained: how all the orders and regularity of the climate were reversed, and how […] the tanks and ponds of the Gangetic Delta and the swampy surfaces of the Sunderbunds were converted into apparent spiracles of poison. Never perhaps was there, in the history of the world, a more close and abundant concatenation of the causes, which transmute the decay of vegetable life into the pestilence of the living animal; and never perhaps was a malady thus produced which swept the world with more destructive virulence than that which we are about to consider.5 Describing Jessore, the Lancet reiterated the account provided by the surgeon James Kennedy in his history of cholera, stating that the town was “a crowded, filthy place, surrounded by impenetrable and marshy jungles, and consequently exposed to all the horrors of a malarious and ill-ventilated atmosphere.”6 British physicians claimed that the ostensibly stagnant and insanitary environment of an Indian town situated in the forests of Bengal gave rise to a deadly new form of cholera. Beliefs about the disease’s apparently Asiatic origins would continue to be perpetuated throughout the nineteenth century as subsequent cholera epidemics broke out in Britain in 1848–1849, 1853–1854, and 1866.7 In fact, British physicians claimed that the various epidemic diseases that afflicted Europe were “imported from the East” or originated elsewhere.8 To emphasize cholera’s foreign origins, the Lancet published a foldout map alongside its article.9 It is centered on Europe, with England at the top left and India squeezed into the bottom-right corner, while the north-eastern regions of India, where Jessore is located, are cut off by the edge of the image. To picture this missing area, the map includes a close-up inset of Jessore and the Ganges Delta over the ocean space between Arabia and the subcontinent. The map indicates that cholera came from the landscape enclosed in the inset (and described as “impenetrable and marshy jungles” in the accompanying article), spreading from here through Europe and striking the cities marked with a black dot surrounded by a circle. The map does not provide any dates of outbreaks or routes of spread, giving the impression that cholera has erupted everywhere almost simultaneously. The disease appears to be a pervasive force. The map demonstrates that not even England is safe, as a black dot enclosed in a circle has been marked on Sunderland. The article confirmed that cholera “has now made in one direction an uninterrupted tour from the Gangetic Delta to the river Wear.”10 The gap between Britain and India has been reduced by the cartographic space and by cholera’s ability to traverse the vast expanses of Western Asia, North Africa, and Europe rendered in the image. The Lancet chided its readers for not seriously considering that cholera would spread. “Misled by the identity of a name of hurried and almost popular imposition,” the Lancet argued, the cholera of India was confusedly deemed identical with the disease of that title familiar to the English practitioner; and arguing from the rare mortality, and the evidently non-contagious nature of the latter, the public erroneously flattered themselves with the notion, that the Indian pestilence had received exaggerated attributes, and that it would doubtless remain within the cradle of its birth, and never manifest the power of extending its virulence to other climates.11

“Invisible Destroyers”  139 Through both text and image, the Lancet stressed that this was a new disease, c­ laiming that it began in India and was distinct from the English cholera with which physicians were already familiar. This new cholera had now arrived in the United Kingdom (UK), where it threatened to spread to other key cities identified on the map: Dublin, Edinburgh, and London. Cholera’s alleged Indian origins are vividly portrayed in the colored lithograph John Bull Catching the Cholera (Figure 6.1). Cholera is visually personified as a foreign agent caught by John Bull as it attempts to sneak into the nation through a gap in the patchedup fence marked “the Wooden Walls of Old England” to steal the Reform Bill, which Ann-Marie Akehurst also discusses in Chapter 2. Bull straddles the Reform Bill lying on the grass and brandishes a “Heart of Oak” stick at Cholera, which he has firmly seized by the neck. Bull asks Cholera “Now you rascal where are you going to,” to which Cholera replies “I am going back again.” In the print, Cholera is represented as an orientalized blue figure. It has blue skin, jaundiced eyes, thin limbs, pointed ears, and sunken cheeks, and wears a turban adorned with a skull and crossbones pendant and a loose white garment seen as characteristic of Indian clothing.12 Cholera contrasts with Bull, whose face is plump and ruddy with health, and who is fully dressed in bright, tailored European clothing. In her article on eighteenth-century men’s clothing, historian Karen Harvey argues that fitted breeches signaled the transition from boyhood to manhood by indicating one’s command over one’s bowels, while loose stockings suggested a concerning regression from self-control. By the nineteenth century, Harvey points out, “tight-fitting breeches had become the model for ‘modern masculinity’,” with snug pale legwear highlighting the fighting strength and whiteness of European men.13 While Cholera’s loose garments reflect a body that is uncontrolled (a body tainted and made grotesque by the purging effects of the disease), Bull’s fitted clothing signifies his bounded English masculinity. Bull’s body is not the cholera body. Although Bull has Cholera by the neck, it may still pose a danger to him. As Cholera steps over the fence, its leg appears to be twice the length of the stout legs of Bull, which indicates that Cholera could dwarf Bull if it stood up straight. Appearing at a time when the government was debating the Reform Bill, which called for the modernization and democratization of the English electoral system, cholera, as the image implies, seemingly emerged from the subcontinent to interfere with the political progress of Britain. With news of cases of a deadly form of cholera in Sunderland in 1831, British physicians and the public came into contact with a disease about which they had little knowledge. Many theories were put forth to try to explain cholera, with initial assumptions that it was a contagion carried by travelers and goods.14 The contagion theory, however, soon gave way to what would become the dominant theory for how cholera propagated: the miasma theory. Supported by the Board of Health, which included prominent sanitarians such as Edwin Chadwick and Thomas Southwood Smith, the theory asserted that cholera was generated from the emanations, or miasmas, of decomposing organic matter.15 Despite the acceptance of the miasma theory, cholera remained a mysterious and troubling disease. Following further cholera epidemics in the middle of the nineteenth century, the Board of Health admitted that cholera remained an “impenetrable mystery,” while the Lancet lamented that “the question, What is cholera? is left unsolved. Concerning this, the fundamental point, all is darkness and confusion, vague theory, and a vain speculation. […] We know nothing; we are at sea, in a whirlpool of conjecture.”16 Cholera appeared to evade explanation.

140  Amanda Sciampacone

Figure 6.1 John Bull Catching the Cholera, c. 1832. Lithograph with watercolor, 25 × 19 cm. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark.

“Invisible Destroyers”  141

Figure 6.2 Attributed to J. W. Gear, The Appearance after Death of a Victim to the Indian Cholera, Who Died at Sunderland, London, 1832. Lithograph with watercolor. Wellcome Library, London. Credit: Wellcome Collection. Public Domain Mark.

Illustrations of cholera’s bodily symptoms were created to help identify the new disease. In Appearance after Death of a Victim to the Indian Cholera, who died at Sunderland (Figure 6.2), the female victim, wearing a white nightcap and gown, lays across a bare mattress with her head propped up by a bolster. Her eyes are sunken and closed, her lips are pulled back revealing her teeth, and her hands and feet are curled and skeletal. Her skin is saturated blue. She has been represented with what physicians identified as some of the characteristic symptoms of the disease.17 The print expresses how cholera has transformed a healthy English body into a corpse. Although another key symptom, purging, is not illustrated through the patient, it does not escape representation completely. The mattress and pillow that the girl lays on are prominent features of the scene. Their folds and creases look dark with collected matter. Even the shadows on the girl’s gown give the garment a dirty and stained appearance. The image implies that the gown and mattress have become saturated with the excremental fluid of the girl’s body, which was forced out of her by the disease. The transformation of the European body was a particularly troubling aspect of cholera, because it revealed that it could be corrupted. As literary scholar Pamela K. Gilbert explains, in mid-nineteenth-century Britain, the ideal body was English, male, imperial, active, and closed.18 Cholera, however, altered this ideal body into a grotesque body; that is, a body not closed and bounded, but with orifices and openings. The disease represented a loss of control over the boundaries of the civilized body.19 Britons suffering from cholera were no longer able to control the functions of their bodies; instead, their orifices were thrown open by cholera so that their bodily waste (which would later be identified by John Snow as the cause of cholera) could flow freely and visibly. As this print reveals, the “Indian Cholera” did not provide sufferers with a dignified death;20 instead, it reduced the patient’s body to a cadaverous, uncontrollable leaking mess. Further, the lithograph also depicts the

142  Amanda Sciampacone cholera victim surrounded by a blue and grey haze, which becomes thicker as it gets closer to her body. Physicians claimed that there seemed to be “poisonous air” and a “disagreeable odour” around a cholera sufferer that became “the most poisoned the nearer it is to the sick person” and contaminated “the atmosphere around the sick.”21 Here, the cholera body has become a source of pollution, radiating a sickly blue haze that fills the top portion of the page. Cholera as the Plague of the Nineteenth Century While physicians attempted to comprehend cholera through its symptoms, texts and images also framed the disease as a living entity of foreign, biblical, and historical origins. Cholera was described as a malignant entity that “creeps,” “moves,” “migrates,” “advances,” and “invades.”22 It was, according to the Lancet, an “invisible destroyer.”23 In response to an outbreak in the southern districts of London, the author and poet Thomas Miller wrote of cholera in the Illustrated London News as “the pestilence [that] stalked like a Destroying Angel,” while the statistician William Farr opened his report on the second epidemic by comparing cholera to “a foreign army that had landed on the coast of England [… and] ravaged the population.”24 According to the medical inspector R. D. Grainger, the devastation and terror created by cholera “had no parallel save in the great pestilences and plagues of former ages.”25 In the rhetoric of physicians, sanitarians, and social commentators, cholera was a military invader or invisible force that brought destruction to the nation not seen since the plague epidemics of the medieval and early modern periods. As cholera began to spread through England, an older form of epidemic i­ conography— the art that emerged from the Black Death of 1347—would be utilized to visualize the new disease. An early image by Robert Seymour, Cholera “Tramples the Victor & the Vanquish’d Both” (Figure 6.3), printed in the October 1831 issue of McLean’s Monthly Sheet of Caricatures, or the Looking Glass, the first caricature magazine in England, depicts cholera as a force of destruction. Personified as a gigantic, shrouded skeleton, the figure of Cholera recalls the images of the corpses of plague victims that began to appear in art from 1347, the year of the Black Death. According to Christine M. Boeckl, an iconography for plague began to develop across Western Europe during and following the Black Death. Familiar symbols of death, such as skulls and skeletons, served as metaphors for plague and figural motifs, such as corpses, signified that the subject of an artwork was pestilence.26 Scenes from the lives of ecclesiastical figures and saints associated with plague, such as the illustrations of Pope Gregory the Great’s litany procession in the Belles Heures of Jean de France, duc de Berry (1405–1408/1409) and Josse Lieferinxe’s painting Saint Sebastian Interceding for the Plague Stricken (1497–1499), include representations of cadavers being taken for burial as part of their visual narratives about the devastating effects of the disease. In Seymour’s lithograph, however, cholera is pictured as an animated corpse, actively crushing two armies with the large bones of its feet as a fortress burns in the background. Striding over the soldiers and horses, Cholera is unaffected by the cannon and gunfire. A black and blue cloud reminiscent of the portentous clouds found in medieval plague imagery,27 as well as the cloud that seemed to emanate from the female victim from Sunderland, surrounds Cholera’s head. Given pictorial form in Seymour’s illustration, cholera is no longer an invisible disease; it is a deathly entity, reminiscent of the great plagues of the past, which exerts real, unstoppable destruction.

“Invisible Destroyers”  143

Figure 6.3 Robert Seymour, “Cholera ‘Tramples the Victor & Vanquish’d Both’,” McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 October 1832, 2.  Lithograph. British Museum, London. Credit: © The Trustees of the British Museum.

Plague iconography would also be referenced to satirically criticize the measures adopted to stop the spread of cholera. An untitled illustration by Seymour in the January 1832 edition of McLean’s represents cholera in the form of skeletons travelling on a coach. The caption states that, without “making too light of a grave subject,” the sketch aims “to exemplify the late curious policy of our Official medical authorities.”28 As Smith explained, “when cholera first invaded Europe in 1831, the belief in its contagious nature was almost universal,” leading public health officials to enact quarantine measures to stop the spread of the disease. The measures, Smith cited, included the prohibition of movement between towns by sea, but permitted unrestricted travel by land.29 Seymour’s illustration shows a Royal Mail coach racing by a port. The word Sunderland is written on the side of the coach, the name of the city where the first cholera cases had been found in England. Ships’ masts can be seen in the background next to a wall pasted with two bills. The first bill states that the ships are under quarantine and the second bill announces that coaches to all parts leave daily from the Red Lion Inn on the High Street. One skeleton carries a large parcel over his shoulder. Straddling the horses, it points with its arrow at the lower bill. The skeleton has something to deliver to the rest of England. Another skeleton on the roof of the coach puts one hand on the head of a passenger seated by the frightened guard, while it prods an ailing man next to the horrified driver. As the image

144  Amanda Sciampacone makes clear, cholera is not only being transported by goods; it is also p ­ otentially being spread by sick individuals travelling along land routes across the country. The representation of cholera as a pair of seemingly jovial skeletons holding arrows is a direct reference to the iconography of the Danse Macabre (Dance of Death) and the plague. Following the Black Death, visual representations of the Danse Macabre emerged in the fifteenth century, depicting skeletons compelling the living to dance with them as a reminder of the fragility of life and the universality of death. For instance, the Nuremberg Chronicle by Hartmann Schedel from 1493 features a scene of two skeletons and a cadaver (its intestines trailing out of its abdominal cavity) dancing joyfully to music from a wind instrument played by another cadaver as a corpse rises from an open grave.30 Personifications of death were also combined with other symbols of plague, such as arrows, which were associated with the imagery of Saint Sebastian.31 The saint was seen as a protector of the plague-stricken in the medieval period and arrows referenced his martyrdom. A French Book of Hours from c. 1473 illuminated by Jean Colombe depicts Death as a skeletal cadaver holding an arrow in its right hand as it rises from a sarcophagus.32 A shroud is loosely draped around its shoulders and its skin is a wizened brown stretched across bone. Seymour’s caricature not only uses Black Death iconography to portray cholera as a new plague, its evocation of wizened cadavers and skeletal bodies also evokes the transformative symptoms of cholera. Visualizing cholera as plague in a critique of the ineffectiveness of quarantine measures, the image suggests that the poorly conceived decisions of health authorities were setting Britain up to dance for its mortality. Plague iconography was further invoked in Seymour’s The Dernier Resort (Figure 6.4), from the February 1832 issue of McLean’s, to connect cholera with opposition to the Reform Bill. The title is a reference to the French phrase “en dernier ressort,” which translates to a last resort when all other methods have failed. The caption states: It is recommended to the anti-reformers to go up to His Majesty in procession as above represented and throwing themselves entirely on the Royal mercy with tears and prayers implore the withdrawing of the reform Bill, candidly acknowledging what they ask is for their own good alone, for if they pretend to seek the good of the country His Majesty, like His Grace of Sussex, may call it all Humbug.33 Seymour depicts a winding procession of opponents of the Reform Bill spread over three registers. The procession consists of clergymen, politicians, landowners, editors of Tory newspapers, and other groups of people who were believed to be anti-reformers. The last member of the procession, at the top left, is a figure signifying cholera. Labelled “Figure to Misrepresent the Cholera,” the sketch depicts the disease through the plague figure of the corpse holding an arrow. Here the skeleton is seated on a wheeled block being pulled by two parsons. During the epidemic, clergymen preached that the arrival of cholera marked the sinfulness of the British nation and called for official days of prayer to atone.34 The depiction of a procession further connected cholera to the plague through the visual iconography of plague processions, such as representations of the Great Litany Process of Gregory the Great (who survived a plague epidemic in the sixth century and organized the first procession recorded in Christian literature) and the Great Plague of London from 1665 to 1666.35 Illuminations, like those in the Limbourg Brothers’ Belles Heures from 1405 to 1408/1409, emphasized Gregory’s devotion to the spiritual and

“Invisible Destroyers”  145

Figure 6.4 Robert Seymour, “The Dernier Resort,” McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 February 1832, 3. Lithograph. British Museum, London. Credit: © The Trustees of the British Museum.

physical health of his flock by depicting him praying as he leads a procession of clergy and laypeople through a plague-stricken Rome.36 Over two centuries later, John Dunstall created a broadsheet containing nine illustrations chronicling the 1665 outbreak of plague in London, with scenes of processions of wealthy citizens fleeing the city, the dead being removed and buried, funerals, and, finally, people returning to London as deaths declined.37 Evoking visual representations of medieval and early modern religious and civic plague processions, Seymour’s caricature stresses that in nineteenth-century Britain, certain public leaders have abandoned their duty to the nation; they process for a selfserving outcome. Moreover, physicians and sanitarians, in an effort to combat cholera, called for the quick removal of the sick to cholera hospitals, rapid burial of the dead, and the cleansing of poor areas—all of which met resistance from the lower classes, who believed these measures did nothing to help them and only served to make physicians wealthy. For those who were disenfranchised, cholera was a lie—a fabrication created by religious and medical authorities that supported conservative and capitalist interests— used to distract from the Reform Bill and control the populace through fear.38 The illustration alludes to the skepticism around cholera, though it is unclear where it positions itself in the debate. As part of the procession, cholera could be seen as either a false figure concocted by anti-reformers or a real illness they have co-opted to use as a last resort to frighten the King and the British public into withdrawing the Bill. Seymour satirizes the claim by the procession that cholera and, by extension, the Reform Bill will be just as lethal a threat to the nation as the great plagues of the past.

146  Amanda Sciampacone With the outbreak of a second epidemic of cholera in Britain between 1848 and 1849, the disease was again visually connected to past illnesses through the subversion of the theme of the king’s touch. Beginning in the Middle Ages, English and French monarchs claimed they possessed the divine gift to cure disease through the laying of hands on the sufferer. A seventeenth-century engraving of Charles II curing scrofula (a form of tuberculosis) by placing his hands on the head of a subject—as courtiers, clergymen, royal guards, and commoners who have come to be healed look on—portrays the English monarch as a benevolent healer and protector of his people.39 With the overthrowing of the monarchy in the French Revolution and subsequent establishment of Napoleon Bonaparte as Emperor of the French, paintings such as Antoine-Jean Gros’s Bonaparte Visiting the Plague Victims of Jaffa of 1804 depict a statesman, not a monarch, wielding the same divine power as he touches the body of one of his soldiers suffering from plague in Egypt. According to the art historian Darcy Grimaldo Grigsby, Gros destabilized the Western nude body, a sign of civilization, by depicting the body contaminated by Egyptian plague. What is most terrifying, according to Grigsby, is that this foreign corruption is invisible, and transforms the European body into something between ­“classical hero and degraded spectre.”40 Although Gros “relegates the heroic male nude to the passive, expressive role,” Grigsby explains, the artist replaces it with the clothed, upright bodies of Napoleon and his officers. The metaphors of illness used by Revolutionaries to comment on the state of the body politic are manifested in the plague-ravaged nude bodies, while the uniformed Napoleon is posited as the entity that will regenerate the state.41 During the second cholera epidemic, the disease itself would be portrayed as possessing the opposite power—killing, rather than healing, with a touch. In a picture that accompanied Miller’s Illustrated London News article, a menacing crowned specter looms over a shrouded woman (Figure 6.5). Framed under an arch and illuminated by a low moon, it emerges from the dark clouds. Its head is a skull, with a menacing look, and its upper body is fleshy and corporeal. Recalling images of skeletal plague figures holding arrows and memento mori of crowned cadavers in verdant landscapes from the fifteenth century,42 this being holds a spear and wears a crown covered with a veil. Juxtaposed with an article on the second epidemic’s effects in London, the figure represented here is a material and visible manifestation of the disease. Surrounded by ominous clouds, another feature of plague imagery, cholera is the embodiment of the invisible miasmas blamed for propagating the malady. Cholera haunts London silently and invisibly, striking down its victims from the dark ether with its pointing gesture. Similarly, Death’s Dispensary. Open to the Poor, Gratis, by Permission of the Parish (Figure 6.6), published in the satirical magazine Fun during the fourth epidemic in 1866, portrays cholera as the crowned skeleton Death. Here, a poor family has gathered around a pump to collect water for their home. Holding the pump’s handle is a skeleton wearing a crown and dressed in a hooded robe. He dispenses water into a jug held by one of the daughters, as her father drinks from a cup attached to the pump. Printed during the fourth epidemic, when Snow’s theory that the disease was spread by ingesting water containing the waste of cholera sufferers was gaining acceptance, the illustration expresses how contaminated water threatened the lives of the city’s inhabitants, particularly poor people. Furthermore, the title points out that parish authorities aided in spreading pestilence by providing impoverished communities with this polluted drinking water. Combining a recent epidemiological discovery with an older tradition of picturing pestilence, Fun portrays Death infecting the lives

“Invisible Destroyers”  147

Figure 6.5 Image accompanying “Picturesque Sketches of London, Past and Present. Chapter XVI. The South Districts of London during the Epidemic,” Illustrated London News, 27 October 1849, 285.  The Open University Library, Milton Keynes. Image courtesy of The Open University Library.

of London’s poor with cholera. Yet, it is not simply any death that is being dispensed through the pump; the crown on the skull marks out this figure as the monarch of death. The utmost of death is, thus, cholera. Plague and cholera were not only connected through iconography in popular media, but they were also linked in scientific images. In his diagram Plagues of London for his report on the second epidemic, Farr compares the average weekly mortality of cholera in London in the year 1849 with the mortality of several years of plague epidemics in the seventeenth century.43 Seven circles are arranged in two rows on the page. The first is for 1849, the second is for the average mortality between the years 1640 and 1646, and the rest are for the outbreaks of plague in 1593, 1603, 1625, 1636, and 1665. According to Farr, the inner circle represents the average weekly deaths of the period. […] The numbers of the weeks are arranged round the outer circle. The number of deaths in any particular week is shown by the length of the radial outer circle.44 By comparing each circle, the viewer sees that the mortality of cholera in 1849 was nowhere near as deadly as the plagues of the seventeenth century. Cholera’s mortality remains within the innermost circle of 500 deaths per week, just like the circle showing

148  Amanda Sciampacone

Figure 6.6 “Death’s Dispensary. Open to the Poor, Gratis, by Permission of the Parish,” Fun, 18 August 1866, 233.  National Library of Scotland, Edinburgh. Credit: National Library of Scotland. Attribution 4.0  International (CC BY 4.0).

the average mortality in the seemingly healthy years of 1640–1646. It was not even as fatal as the plague year of 1636, which had the lowest plague mortality (around 1,000 deaths per week) of all the years represented. The mortality of every other plague year radiates beyond the outer circle of 1,500 deaths per week. The plagues of 1625 and 1665 were far deadlier than cholera, as their radial lines of weekly deaths extended well beyond the outer circle—to circumferences designating over 6,000 and 8,000 deaths per week, respectively—and on to the white background of the page. The contrast between plague mortality and cholera mortality highlighted, according to Farr: “how much London in the nineteenth century is less fatal to its inhabitants than London in the seventeenth century.”45 The clean, regular circumferences give order to the mortality of cholera and plague. The juxtaposition of these circles also demonstrated that cholera and plague epidemics generally occurred around the same time of year, between the months of July and October. For Farr, this similarity demonstrated that the harvest months were historically deadly months.46 By comparing cholera to the plague, Farr also implied that like the plague, cholera struck London during the warm season and shared a similar, though less deadly, nature. Therefore, the viewer could suppose that, like the plague, cholera was a disease imported from an apparently tropical climate.47 London may have been healthier in the nineteenth century compared to the seventeenth century, but the city still experienced epidemics of what were perceived as foreign diseases and was seemingly even more exposed to them through the routes of empire.

“Invisible Destroyers”  149 The British, moreover, believed that cholera was death infecting life, as they linked cholera to London’s graveyards and plague pits. According to Grainger, “the most offensive putrid effluvia escape from the burial grounds.” He continued, “these are ­predisposing causes of disease, and especially of fever, […] and that in the houses immediately adjoining these places cholera was observed to prevail.”48 As another sanitarian explained, parts of a “dead body must dissipate and mix with the air we breathe, which is thus made the vehicle of invisible and subtle poisons.”49 Concerns that cholera was a new form of the plague—which had emerged from old plague pits disturbed by the construction of new sewage lines—were addressed by the Board of Health in their report on the outbreak of cholera in Soho in 1854. Based on engineer Edmund Cooper’s map of the outbreak for the Metropolitan Commission of Sewers–which used a thick black bar to mark homes of cholera victims, thin black bars for mortality within each home, black lines to mark the sewer lines, and a shaded oval to indicate the supposed location of the plague pit—the Board of Health’s map adopts this structure to represent the possible miasmatic sources of cholera.50 New and old sewer lines are picked out with black lines running along the streets. Black squares mark sewer grates and black dots the pumps. The numbers of houses and the walls between buildings have also been included. Black bars mark the number of cholera deaths in each house, with the orientation of the bars indicating whether the person who died was a resident of the district or not. The site of the plague pit has been corrected, with a grey oval representing the incorrect spot and a grey rectangle showing its new location. According to the accompanying text: In reference to these opinions, we may observe, that no case of Cholera occurred in Little Marlborough Street, through which a new sewer was constructed last year, and which street is represented by the Commissioners of Sewers to be the centre of the plague pit; but we believe it is not, as Mr. York, Clerk to the Paving Commissioners, and who is evidently well acquainted with the antiquities of the neighbourhood, assured us that he had seen old plans of the ground, of an authentic character and of a date anterior to the present houses, which represented the pest field as extending considerably to the south and east of that stated by the Commissioners of Sewers; […] nevertheless, from the facts above stated, we consider that the outbreak of Cholera cannot be specially attributed to the disturbance of the old burial ground, the construction of any one sewer, or drainage of a nuisance into any particular portion of the sewerage of the district.51 Juxtaposing both the earlier assumed location of the plague pit and its corrected position with the black bars of mortality, the map demonstrates that the concentration of cholera deaths is around the area of Broad Street and not directly over the old burial site. Although the map and report conclude that miasmas from sewers, improper house drainage, and impure water produced cholera, the investigation and visualization of the plague pit in Soho revealed broader fears of the return of epidemic diseases that were thought to have been long buried. COVID-19 and the Visual Return to Past Pandemics The martial references and racial representations of the visual culture of the cholera epidemics of the nineteenth century re-emerged in press portrayals of COVID-19. On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of viral pneumonia cases “of an unknown cause” detected in Wuhan, China, and launched

150  Amanda Sciampacone an investigation on 1 January 2020.52 Results of laboratory tests showed a new coronavirus causing severe acute respiratory syndrome. As confirmed cases were reported outside China, the WHO declared “the novel coronavirus outbreak a public health emergency of international concern” on 30 January 2020.53 As this new disease spread through Asia and Europe, the front pages of British newspapers, such as those published on 24 January 2020 by the Daily Mail, Metro, and The Times, speculated about when it would arrive in the UK. As with cholera in the nineteenth century, early visual representations of COVID-19 in the press pictured the illness as foreign to Britain. Newspapers labelled the new disease the “China virus” or “killer virus” and visualized it through the bodies of masked East Asian people, with a particular emphasis on those travelling into the UK. The Metro, the UK’s highest-circulation print newspaper, is distributed freely on weekday mornings on public transport across London and selected urban centers in Great Britain. Freely accessible and mainly consumed by readers on their morning commute, the Metro’s front pages stressed the foreign origins of the coronavirus through the juxtaposition of bold headlines and Chinese bodies. The Metro’s 23 January 2020 front page proclaimed that the “China virus” was “on the way here” over a photograph of a masked East Asian man arriving at Heathrow airport (Figure 6.7).54 Like the “Indian” figure of Cholera traversing the wooden walls of England, the Metro implies that the coronavirus lurks in racialized and foreign bodies—here the body of what is assumed to be an international traveler of Chinese descent—crossing the borders of the nation (marked by the name of the well-known airport in the background) and bringing the illness into the UK. Unlike the lithograph, there is no John Bull to defend the nation’s boundaries. Seemingly emerging from what was believed to be the insanitary conditions of a wet market in Wuhan,55 COVID, like cholera, is represented as a foreign body that enters the UK unchecked. Twenty-four hours after its front page suggested the coronavirus may be “on its way to Britain and may even have arrived already,”56 the Metro’s 24 January front page implied the virus was already in the UK through the juxtaposition of text and image. Readers were confronted with the headline “Killer Virus: UK Patients in Isolation” over photographs of the Health Secretary Matt Hancock set against a black background and a Chinese patient “feared to have the virus” being attended by medics.57 Both the patient

Figure 6.7 “China virus ‘on the way here’,” Metro, 23 January 2020, 1. Credit: Metro/Will Oliver/EPA-EFE/Shutterstock.

“Invisible Destroyers”  151 and medics are wearing personal protective equipment—including hairnets, face shields, surgical masks, long-sleeved gowns, and gloves—to provide a protective barrier against infection. The immediate idea conjured by text and image is that the deadly new virus has entered the UK and is already infecting the British populace. It is only through a closer inspection of the image caption that the reader learns that the patient in the photograph was not in the UK; instead, he was being transported at a hospital in Hong Kong.58 The Metro’s misleading combination of headline and image stoked fears about the presence of the virus in the country and assigned blame on who could be transmitting it. The UK would not record its first confirmed cases of coronavirus until 31 January, when it was reported that two Chinese nationals tested positive in York, and its first confirmed case of community spread on 28 February 2020.59 However, in British newspapers, particularly in a newspaper that circulates freely and widely to commuters, the new coronavirus is racialized as a Chinese and foreign entity. In an October 2020 House of Commons debate on the increased racism experienced by Asian people in the UK during the pandemic, the Labour MP Sarah Owen, who is of Chinese decent, referenced a petition that she stated “revealed that some 33% of images used to report covid-19 in the British media have used the image of someone who looks like me, completely unnecessarily and unrelated to the story.”60 Like cholera, COVID-19 was visually identified as a disease of the Other. With cases rising and the first deaths reported at the beginning of March 2020, the Metro printed an image of Prime Minister Boris Johnson wearing a protective yellow Public Health England coat next to an article about how the government was handling the situation (Figure 6.8). The article began by stating that the “fight against coronavirus will be led from a dedicated war room inside the Cabinet Office.” It went on to explain that the Health Secretary, Matt Hancock, admitted that the “spread of the infection across the country cannot be stopped” and that COVID-19 “will become ‘endemic’ here.”61 Similar to the iconography of Charles II curing scrofula and the painting of Napoleon touching a plague sufferer, pictured at left is the person who would lead the UK in the fight against the pandemic. Johnson, photographed during a visit to an infection laboratory, points decisively at the bold white text “Coronavirus Crisis” in the red box (the second “o” of ­coronavirus replaced with a simplified graphic of the COVID-19 pathogen based on

Figure 6.8 “Virus cases jump in UK,” Metro, 2 March 2020, 1. Credit: Metro/Getty Images/ WPA Pool.

152  Amanda Sciampacone electron ­microscope images released a month earlier). Wearing a uniform that marks him out as managing public health for the nation, Johnson appears to gesture decisively at the virus. Like John Bull grasping Cholera by the neck and in the face of a seemingly impossible task, it appears as if Johnson, leader of the nation, will check COVID’s progress. Further front pages of the Metro from the 17th and 20th of March place that same “Coronavirus Crisis” logo and microbe symbol over photos of Johnson speaking and gesturing confidently as he explained the public health guidance that was meant to help Britain “turn the tide” and “beat [the] virus.”62 On 27 March, however, Johnson announced that he tested positive for coronavirus and was self-isolating. By the afternoon of 6 April, he was admitted to hospital for routine tests and by the evening it was reported that “the prime minister’s condition had ‘worsened’” and he was “moved into the intensive care unit of the hospital.” He spent seven nights in St. Thomas’s Hospital being treated for COVID-19 before being released on 12 April to recover at home.63 Continuing the martial rhetoric of nineteenth-century tropes of cholera, the Health Secretary Matt Hancock spoke of how “we are in a war against an invisible killer” and described COVID-19 as “this invisible killer stalking the whole world.”64 Having recovered, Johnson explained that “if this virus were a physical assailant, an unexpected and invisible mugger—which I can tell you from personal experience, it is—then this is the moment when we have begun together to wrestle it to the floor.”65 Recalling Seymour’s illustration of cholera trampling armies, in political rhetoric, COVID-19 was similarly described as a malevolent entity that had to be fought by men of state. In hindsight, can the images of the former Prime Minister that appeared on the front pages of the Metro in March 2020 confidently and dynamically gesturing against the coronavirus be reconsidered? As of 19 September 2022, the WHO reports that the UK has had over 23 million confirmed cases of COVID-19 and 189,484 deaths.66 Looking back on the photograph of Johnson in the laboratory, his pose may also recall the crowned skeletal figure of Cholera that signaled death. Images, like pathogens, are elusive, and what were once clear photographs of a confident leader ready to combat (to borrow the martial language used by politicians and the press) a deadly pandemic have potentially become opaque and allow for a more critical reading of Johnson’s handling of the pandemic. As with the cholera epidemics, visual representations of the COVID-19 pandemic referenced previous pandemic imagery to make the new disease visible and understandable. With the spread of the Omicron variant in the winter of 2021–2022, the UK government reintroduced mandates for wearing face coverings indoors. To encourage people to follow the guidance, the government and National Health Service produced a series of images for their “Stop COVID-19 Hanging Around” campaign, which not only appeared on social media and websites of various health organizations but were also displayed on bus shelters and public transport stations. One example from the Mile End Underground station in London (Figure 6.9) shows black coronavirus particles emerging from the mouth of an unmasked woman standing in the background of a grocery shop to demonstrate the importance of wearing a mask in public to protect the health of others and stop the spread of the virus. As with the lithograph of the Sunderland cholera victim, here, COVID-19 is visualized as a miasma that emerges from the body and contaminates the air and the unsuspecting masked shoppers. Filling the top of the image and seemingly pressing against the foreground, all that appears to be stopping the virus from escaping into the station is the glass and frame of the digital display. Yet, like the images on the front pages of the Metro, this scene confronts viewers with representations of COVID-19 in the very spaces in which the virus could be circulating. Indeed, a Metro article from November 2019 reported the

“Invisible Destroyers”  153

Figure 6.9  Stop COVID-19 Hanging Around, HM Government and NHS public health advertisement in Mile End Underground Station. Photographed by the author on ­ 27 January 2022.

results of a poll that showed two-thirds of commuters believed public transport was “a major cause of maladies” and “a breeding ground for catching viruses.”67 While viewers were encouraged to protect themselves from the virus by socially distancing and wearing masks, depictions of COVID-19 as a racialized, martial, and miasmic entity were transmitted across the same spaces into the British social body, infecting it with harmful ideas about the pandemic. Conclusion The portrayal of COVID-19 through martial language as an embodied, invisible, and racialized agent moving across the world, to be combated with seemingly decisive and masculine leadership, is not new; it recalls depictions of cholera in the nineteenth century and plague in the medieval and early modern periods. Images of cholera as a pestilential specter and Indian entity that invaded Britain suggested this disease would bring the same terror and devastation as the great plagues of the past. Illustrated newspaper articles on the COVID-19 pandemic in Britain evoked a similar visual rhetoric of sensationalism and fear to capture the attention of readers. In particular, the Metro newspaper, distributed freely in major urban centers, represented this new virus in similar terms to cholera, as a foreign disease and “invisible killer” that entered the UK, ostensibly through Chinese bodies, to bring

154  Amanda Sciampacone devastation to the health of the nation. In the face of coronavirus, photos in the British press that referenced imagery of the royal touch put forth Prime Minister Johnson as a national leader metaphorically capable, like monarchs and statesmen of the past, of willing this deadly pandemic away with his gesture. The progress of the pandemic and Johnson’s own behavior would, however, undermine this portrayal.68 Like pathogens, images of cholera and COVID-19 circulate. They connect contemporary outbreaks with a longer history of disease and disseminate inaccurate understandings of pandemics as embodied, foreign, and racialized threats that defer blame onto the Other with deadly consequences. Notes 1 Anthony S. Wohl, Endangered Lives: Public Health in Victorian Britain (Cambridge, MA: Harvard University Press, 1983), 118; and Margaret Pelling, Cholera, Fever and English Medicine, 1825–1865 (Oxford: Oxford University Press, 1978), 3–4. 2 See Norman Longmate, King Cholera: The Biography of a Disease (London: Hamish Hamilton, 1966), 1–2; and R. J. Morris, Cholera, 1832: The Social Response to an Epidemic (London: Croom Helm, 1976), 21. For the purposes of my chapter, I will be using the term cholera to refer to the epidemic form of cholera that European medics classified as “Asiatic cholera,” “Indian cholera,” and “cholera morbus.” 3 James Jameson, Report on the Epidemick Cholera Morbus as It Visited the Territories Subject to the Presidency of Bengal in the Years 1817, 1818, and 1819 (Calcutta: Government Gazette Press, 1820), lxviii; James Annesley, Sketches of the Most Prevalent Diseases of India: Comprising a Treatise on the Epidemic Cholera of the East (London: Thomas and George Underwood, 1825), 4–5; Reginald Orton, An Essay on the Epidemic Cholera of India, 2nd ed. (London: Burgess and Hill, 1831), v. 4 Thomas Key and George Tindall, “To the inhabitants of the parish of Clerkenwell,” broadsheet, 1 November 1831. 5 “History of the Rise, Progress, Ravages, etc. of the Blue Cholera of India,” Lancet 17, no. 429 (1831): 242. 6 “History…Blue Cholera,” Lancet, 242. For Kennedy’s account, see James Kennedy, The History of the Contagious Cholera; with Facts Explanatory of Its Origin and Laws, and of a Rational Method of Cure, 2nd ed. (London: James Cochrane and Co., 1832), 20. Similar accounts of Jessore appear in Orton, Essay, 402, who quotes Jameson; and the Society for the Diffusion of Useful Knowledge (SDUK), The Working-Man’s Companion. The Physician: I. The Cholera (London: Charles Knight, 1832), 89 and 106. 7 General Board of Health, Report of the General Board of Health on the Epidemic Cholera of 1848–1849 (London: W. Clowes and Sons, 1850), 2; William Farr, Report on the Mortality of Cholera in England, 1848–49 (London: W. Clowes and Sons, 1852), xc; and John Simon, Public Health Reports, ed. Edward Seaton (London: Offices of the Sanitary Institute, 1887) 1: 102. 8 Kennedy, History, 2nd ed., 13. The statistician William Farr explained that “the human race is now destroyed periodically by five pestilences: cholera, remittent fever, yellow fever, glandular plague, and influenza. The origin or chief seat of the first is in the Delta of the Ganges; of the second, the African and other tropical coats; of the third, the low west coast round the Gulf of Mexico or the Delta of the Mississippi, and the West Indian Islands; of the fourth, the Delta of the Nile and the low sea-side cities of the Mediterranean: of the generating field of influenza nothing certain is known, but from the course of its epidemics one might be disposed to look for it in Russia” (Farr, Report…1848–49, xc). 9 The map can be found facing page 241 in “History…Blue Cholera,” Lancet. 10 Ibid., 242. 11 Ibid., 241. 12 See Bernard S. Cohn, “Cloth, Clothes, and Colonialism: India in the Nineteenth Century,” in Cloth and Human Experience, eds. Annette B. Weiner and Jane Schneider (Washington, DC: Smithsonian Institution Press, 1989), 304–348 for how the British perceived Indian clothing in the nineteenth century. 13 Karen Harvey, “Men of Parts: Masculine Embodiment and the Male Leg in Eighteenth-Century England,” Journal of British Studies, 54, no. 4 (2015): 805–806 and 810–811.

“Invisible Destroyers”  155 14 “History…Blue Cholera,” Lancet, 261 and 267. 15 General Board, Report…1849, 32, 36, 73, 81–82, and 146–147; and Edwin Chadwick, Report on the Sanitary Conditions of the Labouring Population of Great Britain, ed. M. W. Flinn (1842; repr. Edinburgh: Edinburgh University Press, 1965), 422. 16 General Board, Report…1849, 143; and “London: Saturday, October 22, 1853,” Lancet 62, no. 1573 (1853): 393. 17 Both the Lancet and Kennedy provide detailed summaries of cholera’s symptoms, including the change of colour to the skin and the cadaverous appearance of sufferers (see “History…Blue Cholera,” Lancet, 253 and Kennedy, History, 2nd ed., 262). 18 Pamela K. Gilbert, Cholera and Nation: Doctoring the Social Body in Victorian England (Albany, NY: SUNY Press, 2008), 103. 19 Gilbert, Cholera and Nation, 104 and 122. 20 Orton, Essay, v; and “History…Blue Cholera,” Lancet, 241–242 and 253–254. See also Susan Sontag’s discussion of how certain illnesses, such as tuberculosis, were perceived to provide a romantic death in Susan Sontag, “Illness as Metaphor,” 1977; repr. in Illness as Metaphor and AIDS and Its Metaphors (London: Penguin Books, 1991), 28–29. 21 SDUK, Working-Man’s Companion, 177; and Orton, Essay, 4 and 327. 22 SDUK, Working-Man’s Companion, 162; Simon, Public Health, 1: 113; and Farr, Report…1848–49, lxxi. 23 “History…Blue Cholera,” Lancet, 247. Cholera was also described as a “destroyer” in the Board of Health’s report on the third epidemic; see General Board of Health, Medical Council, Report of the Committee for Scientific Inquiries in Relation to the Cholera-Epidemic of 1854 (London: George E. Eyre and William Spottiswoode, 1855), 182. 24 Thomas Miller, “Picturesque Sketches of London, Past and Present. Chapter XVI. The South Districts of London during the Epidemic,” Illustrated London News, 27 October 1849, 286; and Farr, Report…1848–49, i. 25 R. D. Grainger, Appendix (B) to the Report of the General Board of Health on the Epidemic Cholera of 1848 and 1849 (London: W. Clowes and Sons, 1850), 130. 26 Christine M. Boeckl, Images of Plague and Pestilence: Iconography and Iconology (Kirksville, MO: Truman State University Press, 2000), 45, 47, and 48. 27 See the discussion of cloud iconography in Boeckl, Images of Plague, 65. 28 Robert Seymour, untitled, McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 January 1832, 3. 29 Thomas Southwood Smith, “Quarantine and Contagion,” in The Common Nature of Epidemics, and Their Relation to Climate and Civilisation. Also Remarks on Contagion and Quarantine. From Writings and Official Reports by Southwood Smith, M.D., ed. T. Baker (London: N. Trübner and Co, 1866), 63 and 67. 30 See the Dance of Death illustration in Hartmann Schedel, Liber Chronicarum (Nuremburg: A. Koberger, 1493), folio CCLXIIII, recto. Wellcome Collection, London. For the connections between danse macabre imagery and the Black Death, see Paul Binski, “The Macabre,” ch. 3 in Medieval Death: Ritual and Representation (London: British Museum Press, 1996), 126–134. 31 For further information about the association between plague and arrows, see Boeckl, Images of Plague, 46–47. 32 See Hours of Anne of France, Bourges, France, c.1473, MS M.677, fol. 245r. Pierpont Morgan Library, New York. MS M.677. 33 Robert Seymour, The Dernier Resort, McLean’s Monthly Sheet of Caricatures, or the Looking Glass, 1 February 1832, 3. 34 Gilbert, Cholera and Nation, 18 and 21–22; and Robert Saunders, “God and the Great Reform Act: Preaching against Reform, 1831–32,” Journal of British Studies 53, no. 2 (2014): 382. 35 Boeckl, Images of Plague, 81. 36 See the “Great Litany Process” and “End of the Plague” in the Limbourg Brothers, Belles Heures of Jean de France, duc de Berry, Paris, 1405–08/09, bifolium 73–74r. Metropolitan Museum of Art, New York. 37 See John Dunstall, Plague broadsheet, 1666. Museum of London, London. 38 Morris, Cholera, 1832, 101–114; and Gilbert, Cholera and Nation, 18 and 50–56. 39 For an example, see the engraving Charles II touching a patient for the king’s evil (scrofula) surrounded by courtiers, clergy and general public by Robert White (1645–1703). Wellcome Collection, London.

156  Amanda Sciampacone 40 Darcy Grimaldo Grigsby, Extremities: Painting Empire in Post-Revolutionary France (New Haven, CT: Yale University Press, 2002), 88. 41 Grigsby, Extremities, 76 and 101–102. 42 For an example of the latter, see the image of a crowned king cadaver in Book of Hours, Use of Paris (“The Hours of René of Anjou”), 1405–1410. Egerton MS 1070, f53r. British Library, London. 43 Farr, Report…1848–49, Plate 5. 44 Ibid. 45 Ibid., xlviii. 46 Ibid, xlix. 47 See Grigsby, Extremities, 89–90 for an example of how Europeans, in this case the French, perceived plague in the early nineteenth century. 48 Grainger, Appendix (B), 57. 49 Mr. Walker quoted in National Philanthropic Association, Sanatory Progress: Being the Fifth Report of the National Philanthropic Association, 2nd ed. (London: J. Hatchard and Son, 1850), 75. 50 General Board of Health, Medical Council, Appendix to the Report of the Committee for Scientific Inquiries in Relation to the Cholera-Epidemic of 1854 (London: George E. Eyre and William Spottiswoode, 1855), foldout following p. 322. 51 General Board, Appendix, 151–152. 52 “Novel Coronavirus,” World Health Organization, accessed 9 January 2021, archived from the original on 22 January 2020, https://web.archive.org/web/20200122103944/https://www. who.int/westernpacific/emergencies/novel-coronavirus. 53 “COVID-19 timeline in the Western Pacific,” World Health Organization, accessed 9 January 2021, archived from the original on 23 May 2020, https://web.archive.org/web/20200523183 143/https://www.who.int/westernpacific/news/detail/18-05-2020-covid-19-timeline-in-thewestern-pacific. 54 Aidan Radnedge, “China Virus ‘On the Way Here’,” Metro, 23 January 2020, 1. 55 Michael Worobey, “Dissecting the early COVID-19 cases in Wuhan,” Science 374, no. 6572 (2021): 1204. 56 Radnedge, “China Virus,” 1. 57 Daniel Binns, “Killer Virus: UK Patients in Isolation,” Metro, 24 January 2020, 1. 58 Binns, “Killer Virus,” 1. 59 “Coronavirus: Two cases confirmed in UK,” BBC News, 31 January 2020, accessed 9 August 2022, https://www.bbc.co.uk/news/health-51325192; and Evie Aspinall, “08 Apr COVID-19 Timeline,” British Foreign Policy Group, accessed 9 January 2021, https://bfpg.co.uk/2020/04/ covid-19-timeline/. 60 Sarah Owen, “Chinese and East Asian Communities: Racism during Covid-19,” 13 October 2020, Hansard Parliamentary Debates, Commons, 6th ser., vol. 682 (2020) col. 114WH. 61 Dominic Yeatman, “Virus Cases Jump in UK,” Metro, 2 March 2020, 1. 62 Daniel Binns, “Time to Get Anti-Social,” Metro, 17 March 2020, 1; and Dominic Yeatman, “We Can Turn the Tide in 12 Weeks,” Metro, 20 March 2020, 1. 63 Guardian Staff, “PM’s COVID-19 timeline; from ‘mild symptoms’ to a brush with death,” The Guardian, 12 April 2020, accessed 10 January 2021, https://www.theguardian.com/ world/2020/apr/05/timeline-boris-johnson-and-coronavirus. 64 Matt Hancock, The Secretary of State for Health and Social Care, “Covid-19,” 16 March 2020, Hansard Parliamentary Debates, Commons, 6th ser., vol. 673 (2020) col. 698; Matt Hancock quoted in “Coronavirus: Nightingale Hospital opens at London’s ExCel centre,” BBC News, 3 April 2020, accessed 10 January 2021, https://www.bbc.co.uk/news/uk-52150598. 65 Boris Johnson quoted in “Coronavirus: Boris Johnson says this is moment of maximum risk,” BBC News, 27 April 2020, accessed 10 January 2021, https://www.bbc.co.uk/news/ uk-52439348. 66 “The United Kingdom: WHO Coronavirus Disease,” World Health Organization, accessed 20 September 2022, https://covid19.who.int/region/euro/country/gb. 67 “Commuters convinced public transport is making them ill,” Metro, 22 November 2019, 4. 68 “Partygate: Boris Johnson facing questions after photos emerge,” BBC News, 24 May 2022, accessed 10 August 2022, https://www.bbc.co.uk/news/uk-politics-61560535.

7 Visualizing Contagion in Colonial India David Arnold

Contagions require to be seen as well as suffered. The means by which disease was ­rendered visible in the Western world is a subject that has been extensively explored, from antiquity to modern times. Considerably less has been written about how contagious disease was represented in the visual cultures of non-Western societies and the colonial world.1 This chapter accordingly considers the multi-stranded and rapidly evolving relationship between different modes of visual representation of contagious disease in British India from the early nineteenth century through the 1920s. The underlying concern is with what, in a visual sense, contagion signified and for whom; how disease could (or could not) be represented through graphic illustration and pictorial art; and the emerging role of microscopy in informing disease imagery and the pathogenic imagination. This chapter tracks the rise of photography as a primary means of visualizing contagion and the increasing use of photography as both a scientific medium and a pedagogic device for communicating modern ideas about contagion. Documenting the Medical Gaze Medical texts produced in (or even about) colonial India in the first half of the nineteenth century seldom incorporated visual images, or, at least, far fewer than one might find in comparable works produced in Europe at the time.2 Thus, from the 1830s, cholera in the Western world was widely depicted in visual form, whether in maps to illustrate its inexorable advance or through sketches (some in color) showing the horrific effects of the disease on the human body.3 But there were remarkably few such illustrations in the dozens of medical treatises published on cholera in India, despite that country being the acknowledged source of a disease commonly designated “Indian” or “Asiatic cholera.” When contemporary medical works in India referred to “sketches” or “illustrations,” it almost invariably signified a textual discussion supported by case studies and statistics, not visual content.4 A rare example of a color plate, showing an inflamed spinal column, appeared in J. G. Malcolmson’s essay on beriberi in 1835: drawn by a European army officer, it was produced in Madras (now Chennai) by John Gantz, a watercolorist and engraver.5 One might conclude that the difficulty of making sketches on the spot and, even more, the lack of technical expertise and facilities to reproduce them militated against their more extensive use. And yet, in striking contrast, many of the botanical works of the period, produced by the East India Company’s surgeon-botanists and employing Indian artists, were copiously illustrated, often with large, expensively produced color plates. Botany latched onto, while simultaneously repurposing, an existing Indian practice of DOI: 10.4324/9781003294979-10

158  David Arnold visual representation; medicine could not enlist a comparable, corporeal, tradition. For the accurate identification of plant species and their commercial and medicinal use, botany required a close attention to color, form, and visual detail that medicine seemingly did not; from wealthy patrons and learned societies botanical illustration commanded a level of funding and aesthetic appreciation that the works of medical practitioners lacked.6 This lacuna had its practical drawbacks. Only on their arrival in India might new recruits to the colonial medical service observe the visual signs of India’s contagious diseases and their bodily effects, whether by attending and performing autopsies or through specimens preserved in the pathology collections of medical colleges and hospitals.7 Given the general absence of locally produced visual guides, medical authors used printed text and the power of prose to communicate pathological appearances. Words served as surrogates for images. There was not, for instance, a single visual image in the study of dysentery and hepatitis published in London in 1846 by E. A. Parkes, a former army surgeon whose principal (but not exclusive) “field of observation” had been among European soldiers in India.8 Instead, in his meticulous account of diseased organs and dissected bodies, Parkes used a rich and colorful verbal palette to convey to readers what he alone could see, smell, and touch. Hence, in dysentery, the stools were said to be “slimy,” the surface of the patient’s tongue was “creamy,” and the caecum was covered with a “thick, reddish foetid pus.” On dissection, the colon of one victim was found to be “slate grey” in color; another patient’s had an “almost metallic appearance,” while the surface of a third was “very much thickened, and excessively dense to the feel.”9 In the later stages of dysentery the victim’s stools became “dark coloured and frothy, sometimes yellow, sometimes like bran suspended in a fluid,” “chocolate-coloured, or resembling treacle and water,” or, streaked with blood, the color of “brick dust.”10 Color was a constant register in Parkes’s search for semblances: the spleen of one patient had a “strawberry-jam appearance,” while mixing nitric acid with another patient’s bile produced “a very beautiful pink colour.”11 There was a homely, oddly culinary, quality about Parkes’s analogies, as if he had just stumbled from his Indian dissecting room into an English kitchen. This was contagion visualized through its corporeal effects, but it was also a narrative of racial difference. In the view of Parkes and many of his medical contemporaries, Indian bodies were constitutionally weaker than Europeans’ and showed less resistance to contagion; in their external appearance or the internal state of their viscera they exhibited different or more intense signs of disease. But few visual illustrations were provided in these early texts by which to relate pathogenicity specifically to race.12 In India there existed, however, a very different, non-Western, visualization of disease. This alternative aesthetic arose from the identification of smallpox, cholera, and other prevalent contagions with Hindu disease goddesses. The principal of these, known across northern and eastern India as Shitala, was the deity believed to cause the fever and pustules of eruptive smallpox. But it also lay within her power to moderate or remove the disease if she, in her capricious way, wished to do so or if she were swayed by the offerings, the praise songs, and cooling remedies (such as moistened neem leaves), offered by her mostly female devotees. Shitala was sometimes given visible form: riding on an ass (asses’ milk being one of the “cooling” devices by which the fiery temper of the goddess was assuaged), carrying a broom to sweep away pestilence and a winnowing fan (smallpox pustules having a passing resemblance to household grains), she was represented, in contrast to the disfiguring disease she commanded, as a beautiful young woman, demurely dressed in a scarlet sari (see Figure 7.1).13 Although Shitala was the most widely revered disease deity, other contagions, like cholera (even before the 1830s)

Visualizing Contagion in Colonial India  159

Figure 7.1  Shitala: Kalighat painting, mid- to late nineteenth century. Wikimedia Commons.

160  David Arnold and, in the 1890s, bubonic plague, were also identified with Hindu goddesses and given suitable shrines and propitiation rites. In some of these diseases, too, including cholera and plague, a girl or young woman was revered as a manifestation of the deity, dressed up, decorated, taken in procession, or worshipped by devotees. This folk-based iconography stands apart from both Western medicine in India and the text-based indigenous medical systems—Ayurveda, Unani, and Siddha—widely practiced in India.14 But it was a cultural idiom that exhibited remarkable resilience and versatility. Disease deities and their forms of worship, for instance, became a subject of ethnographic photography in the 1890s and 1900s.15 More recently, disease deities have been one of the ingredients in street art and cartoons during India’s COVID epidemic of 2020–2021, blending with images of a many-armed, virus-beating Mother India.16 It seems important to all societies, at a popular level, to find ways to endow contagion with a visible presence, to capture it in corporeal form and make it into a living entity, one that can then be a focus for collective action and a medium for the expression of personal hopes and anxieties. In this need for visualizing and embodying contagion there lies a degree of congruence or convergence between a Western and an indigenous idiom of disease representation. Among practitioners of Western medicine in nineteenth-century India, the capacity to observe disease and to give it visual representation was at first only partly advanced by the arrival of the microscope. Although these optical instruments had been available in Europe for centuries, they were not much used in India before the 1830s, and then more for recreational purposes than for the investigation of disease. Microscopes served well-to-do Europeans and Indians as a source of amusement, for the fascination of seeing familiar objects magnified or minute creatures brought to life under the lens, as discussed by Ann-Marie Akehurst in Chapter 2. They acquired some use among colonial surgeon-botanists—for example, in examining (and giving graphic representation to) plant structures and reproductive mechanisms.17 But their value to medical science was not immediately obvious to practitioners in India, nor were they seen as adding much to observations made with the naked eye. Parkes, for instance, used a microscope in his 1846 study of dysentery without it contributing significantly to his understanding (or representation) of the disease.18 Nineteenth-century India was wracked by contagions of all kinds—cholera, smallpox, and malaria among them—but most colonial physicians did not turn to microscopes for answers as to how they were caused or transmitted. Instead, they looked to climate, to the monsoon, or to “miasmas,” the supposedly poisonous (but invisible) gasses that emanated from jungles and marshes, or they indicted human behavior, to Indian “manners and customs”—to mass gatherings and Hindu bathing festivals, to crowded slums and insanitary housing, or to what “natives” ate or drank—to explain how and why epidemics occurred. Climate and race, broadly construed, held the key.19 Even when mid-nineteenth-century physicians took to the camera, the subjects of their photography rarely related to disease or furthered the use of that medium as an aid to medical observation and inquiry.20 With respect to microscopy, however, things began to change in the 1850s and 1860s. The clearest demonstration of this was the work of Henry Vandyke Carter (1831–97). Carter was already relatively well known before he began his 30-year career in the Indian Medical Service (IMS): as a medical student in London, he had drawn illustrations for the first edition of Grey’s Anatomy (1858). When he joined Grant Medical College in Bombay (Mumbai) in 1858 as Professor of Anatomy and Physiology, he began teaching microscopy to his Indian students, a subject that had previously been largely neglected

Visualizing Contagion in Colonial India  161 in local medical education. In one of the many research projects he undertook using microscopy, Carter researched a severe fungal infection, which he named mycetoma but was otherwise known as “Madura Foot.” His investigation involved meticulous use of a microscope, employing the highest powers of magnification then available. From his observations Carter produced detailed color drawings of the spores and filaments by which (he argued) the disease spread on and into the human foot. Carter came from a family of seascape artists in Yorkshire, and his keen aesthetic sense and vivid appreciation of color were vital to his anatomical studies, for instance in differentiating between two different varieties of the mycetoma fungus—one “black or dark brown” and the other “more or less pale; pink, brown, or yellowish.”22 Carter’s hand-drawn mycetoma illustrations were reproduced in Britain as 11 lithographed color plates and incorporated alongside his research findings. Carter did not use photography in his work but then no medical photography at the time could possibly have produced, let alone in color, such detailed visual documentation (see Figure 7.2). Paradoxically, though, for such a grossly disfiguring disease, what struck many reviewers of Carter’s Mycetoma was his aesthetic power—the extraordinary beauty of his images.23 Yet this was almost a distraction since his artwork as much as his text failed to convince his many critics that he had conclusively explained the cause of this affliction and the manner of its spread. Kenneth McLeod, editor of the Indian Medical Gazette, observed that the “eleven chromolithographs which illustrate the text form of themselves a most 21

Figure 7.2 H. Vandyke Carter, Sectional Appearances of the Foot in Mycetoma: Black Variety. From H. Vandyke Carter, On Mycetoma, Or the Fungus Disease of India (1874). Wellcome Collection: Royal College of Surgeons. Public Domain Mark.

162  David Arnold valuable contribution to the pathology of this malady.” They reflected “very great credit on Dr. Carter not only as an artist, but as an accurate delineator of the appearances represented by the disease.” But, when it came to the etiology of mycetoma, McLeod believed that Carter was “on the wrong track.”24 It was decades before Carter’s understanding of the disease as a fungal infection was fully vindicated, but it is significant that his work was evaluated at the time as much for its artistry as for its science. Carter applied his microscopical techniques and pictorial skills to other infectious and contagious diseases, notably leprosy, on which he published a major monograph in 1874.25 He broadly endorsed the recent findings of the Norwegian Armauer Hansen that leprosy was caused by a bacillus spread through prolonged human contact. Along with maps and statistics, Carter included 12 color plates, three to illustrate his microscopic investigations and nine showing various stages of the disease and its appearance on different parts of the victim’s body. The images had a clear scientific purpose: to document leprosy visually and make its forms and corporeal progression explicit to the reader. In some respects these precise, clinical delineations of the disease, the concentration on specific sites of infection, and Carter’s artistic mastery of color and form make the images appear relatively anodyne: they suggest little of the widely felt horror of the disease and the intense social stigma that accompanied it (Carter’s textual narrative did much more to demonstrate this). But by showing—in color—the infected parts of bodies the illustrations reinforced a racialized perception of this as an Indian or tropical disease, even though, as Hansen’s research demonstrated, leprosy had a long and still active history in Europe.26 One of Carter’s aims was to show how eruptions of the disease manifested themselves (as he described it) on the dark, “tropical” skins of Indians as compared to the pale skin of the “pure European” of Norway.27 These were not race images in the specific sense that racial profiling and stereotyping was their primary purpose. But race played such a prominent role in the investigation and understanding of disease in nineteenthcentury India that it inevitably informed any visual illustration of it. In considering Carter’s studies of leprosy and other contagions, it is important to recognize the limitations of disease representation in India at the time. From the late 1870s and for each of India’s main epidemic diseases—malaria, cholera, smallpox—the Government of India’s sanitary commissioner produced color maps, charting the yearly progress of these deadly contagions. As well as maps, the annual reports of the sanitary commissioner were packed with detailed statistics: cartography captured the idea of contagion as movement, the ebb and flow of disease advancing and retreating like armies of occupation across an entire subcontinent, just as statistical tables reinforced the prevalent idea that temperature, rainfall, and other environmental factors determined annual or seasonal fluctuations in the disease. As already noted, photography at first played little part in the representation of disease in India. In 1877 two researchers based in Calcutta (Kolkata), T. R. Lewis and D. D. Cunningham, published a report on leprosy which incorporated three monochrome images, derived from photographs, showing different manifestations of the disease; but this pioneering use (for India) of photographs to envisage disease was exceptional.28 Even after the death from leprosy of the Catholic priest Father Damien in Hawaii in 1889 provoked international alarm about the contagiousness of the disease, its visual articulation remained relatively rare.29 When the Indian Leprosy Commission published its report in 1892, it contained seven color maps to illustrate the India-wide distribution of the disease but no photographs or other graphic material.30 Perhaps, to anyone living in, or familiar, with India, no visual prompt was required. From

Visualizing Contagion in Colonial India  163 a state perspective, confinement was the issue, making leprosy less conspicuous to the public, not making it more visible than it already was.31 It was not until the very end of the nineteenth century and the early years of the twentieth, by which time printing and reproductive techniques had greatly improved, that a substantial body of photographic material on leprosy and similarly disfiguring diseases like elephantiasis began to appear in print. Some of these black-and-white images, often to be found in missionary tracts rather than in medical textbooks and monographs, showed philanthropic endeavor and remedial work—the treatment, housing, and education of lepers—but others gave a more alarming and visually explicit account of the disease than had Carter’s hand-drawn illustrations 30 years earlier.32 These unmodified images were intended to shock, to excite compassion, and to elicit charitable support for missionary work. Many of the photographic illustrations printed in Indian medical journals at this time also had a stark and voyeuristic quality. They depicted disease in an extreme and advanced stage or the effects of radical surgery—such as the removal of the large tumors caused by elephantiasis —in the process showing the patient half-naked or with exposed genitalia.33 Nancy Stepan has written forcefully of the repugnance felt by the present-day observer about such “sad and disturbing” photographs of tropical pathology and the racialized and dehumanizing treatment they represented.34 As icons of corporeal otherness, as images of the diseased bodies of alien subjects, photographs of leprosy and elephantiasis in colonial India also fall into this highly objectionable and repellent category. Photographing Plague By the 1890s, India had a flourishing and sophisticated photographic culture. As well as countless amateurs, increasingly armed with handheld cameras, every major city and many a less populous town had its professional photographers; by 1913, there were more than 60 photographic studios in Bombay, Calcutta, and Madras alone.35 Many of these studios offered photographic portraits for their Indian and European clientele; other professional photographers took pictures of prominent buildings and street scenes, or images of India’s representative “types” and “characters” as defined by race, caste, religion, occupation, and gender.36 Officially commissioned photographs showed the opening of public works and the holding state durbars and other ceremonial occasions. While disease as such was largely absent from this broad photographic prospectus, medical colleges and hospital buildings and group photographs of their staff and students were a common trope.37 Into this versatile and lively photographic milieu erupted the bubonic plague epidemic, which began in Bombay in 1896 and harried India for decades thereafter. By the 1920s, as many as 12 million Indians had succumbed to the disease; millions more were affected by the drastic measures the colonial state adopted in attempting to check the spread of the disease, especially during the early years of the epidemic. Although the disease spread into northern, central, and parts of southern India, it was initially concentrated in western India, with the port of Bombay its point of entry (from Hong Kong) and its epicenter, but other cities, like Karachi and Poona (Pune), were also severely affected and served as sites of onward dissemination.38 Contagion fashioned and fueled a new era of Indian photography and for several years—from 1896 into the early 1900s—the camera and the plague maintained a close, reciprocal relationship. In striking contrast to the previous paucity of photographs relating

164  David Arnold

Figure 7.3 Bombay Plague Epidemic, 1896–1897: Interior of a Plague Hospital, attributed to Clifton & Co., Wellcome Collection. Public Domain Mark.

to disease, there now appeared hundreds of plague images, a bulging photographic ­portfolio without precedent in the history of Indian epidemiology (see Figures 7.3–7.6). Why? As already indicated, India by the 1890s had the necessary technical expertise and infrastructure—the cameras, the professional photographers, and the photographic studios. As the 140 or so photographs in an album compiled for Brigadier-General W. F. Gatacre, chair of the 1896–1897 Bombay Plague Committee, demonstrated, the camera could now take to the streets—to record sanitary measures, such as the whitewashing of buildings and the marking or demolition of plague-infested dwellings, as and where they happened.39 Operating in the open air rather than the confines of the studio, the camera could capture scenes of inspection parties and troop patrols at work or of sanitary committees and anti-plague personnel posing for posterity. It could follow the victims of plague into hospitals (as in Figure 7.3) and the segregated into isolation camps, like that at Poona.40 In one of the commoner plague tropes, the camera could pursue the corpses of the dead to cremation grounds and burial sites (Figure 7.4). Here was an unprecedented wealth of material for the enquiring lens, even though, unlike in Carter’s color plates or Parkes’s culinary prose, India’s plague scenes were largely played out in black and white.41 The fact that so much of the activity associated with plague control, as well as the early incidence of the disease itself, happened in the leading cities of western India, especially Bombay and Poona, gave the camera ready access to the contagion, to its social milieu and physical locales. A photography accustomed to depicting street scenes and

Visualizing Contagion in Colonial India  165

Figure 7.4 A Group of Men Lower the Body of a Dead Man on to a Pyre of Logs Prior to a Hindu Cremation Ceremony in Bombay at the Time of Plague, 1896–1897, photographer unknown. Wellcome Collection. Public Domain Mark.

ethnographic “types” had little difficulty in refocusing its lens to capture such a major and highly visible eruption of disease. But this was also photography with a purpose. The camera captured something of the horror of bubonic plague. There had been no cameras to hand in the fourteenth century when plague swept through Europe and caused such devastation. Nor were they witnesses to the plague in London in 1665–1666 or in Marseilles in 1720, or even the scene, captured in oils by Antoine-Jean Gros, when Napoleon visited the pesthouse in Jaffa in 1799. But now, in British India in the 1890s, the camera could produce and transmit to the world images of the sick, the dying, and the dead, of buboes, mass burials, and the half-remembered or reimagined horrors of the Black Death.42 In scenes that anticipated the global depiction of Hindu cremations in India during the second wave of the COVID-19 coronavirus in 2021, the camera could represent for a local, but more especially global, audience the tragedy of mass mortality, the sordid aesthetic of suffering and death. True, sketches were also widely employed in 1890s Bombay, and published in the Western press, showing bodies being carried to cremation grounds or burning corpses, and they possibly did more to capture contagion as movement and anguish than could the images of the still camera; but, even so, in plague, photography found a uniquely compelling subject.43

166  David Arnold

Figure 7.5 Hospital Staff Disinfecting Patients during the Outbreak of Plague in Karachi, 1897, probably by R. Jalbhoy. Wellcome Collection. Public Domain Mark.

Besides, it was someone else’s death that the camera caught. If the Bombay scenes evoked distant echoes of the Black Death and the London plague, they also clearly located that plague in the life and death of empire’s non-white subjects. Very few Europeans in India died of plague or were hospitalized by it (though some certainly did in both Poona and Bombay). Instead, it was Indian bodies on display—men and women corralled into segregation camps, scrubbed with disinfectant, unceremoniously buried or burned (see Figure 7.5). While seldom as lurid as some contemporary images of leprosy and elephantiasis, the plague photographs still made of disease a “native” affliction, one from which civilized, sanitized Europe could both recoil and conveniently distance itself. Photography captured the fear of contagion without the terror of infection. That said, though, Indian professional photographers, such as Karachi’s R. Jalbhoy or Bombay’s Shivshankar Narayan, were among those who took images of the plague, including street scenes and corpses in Hindu cremation grounds. But either they were producing images for official use and a largely Western clientele and so conforming to an imperial aesthetic, or else their images were subtly different, showing a greater respect than their European counterparts for local rituals and mortuary practices and a greater rapport with their Indian subjects.44 The purposefulness behind India’s plague photography also lay in its propaganda effect. Given international alarm that bubonic plague might spread from India to the West and the threat of an embargo on India’s maritime trade, photography gave evidence that

Visualizing Contagion in Colonial India  167 the colonial regime was taking stringent measures to prevent its onward advance and to contain it within India. In an age of widespread sanitary intervention and anti-­contagion campaigns, India’s plague photographs showed the state and municipal authorities in cities like Bombay and Karachi to be actively committed to tackling the disease, and on a scale and with an intensity unmatched in earlier operations against cholera, smallpox, and malaria. The Gatacre album of 1896–1897 can be taken as providing visual testimony to the general’s energetic leadership, the persevering labors of his committee, and, so the viewer is led to believe (misleadingly as it happened), the effective containment of the Bombay plague. This was Gatacre’s personal propaganda portfolio, but it was also evidence of the prompt and resolute remedial action of the regime he served. The importation of a significant number of British doctors and nurses in the late 1890s and early 1900s to help the government tackle the plague epidemic and nurse the sick added to the visual drama and political momentousness of the episode.45 Further, the photograph could act as a reminder that contagion was not an isolated pathogen, something that was visible only under a microscope lens and in the characteristic and by now common circular photographic image derived from it.46 Photography showed plague as a socially situated contagion, located in a place (a filthy street, a crowded bazaar, a squalid slum), and in association with people (invariably Indian) who might harbor or transmit the contagion, and so needed to be hospitalized, segregated, and scrubbed clean (see Figure 7.5). The camera contrasted the dark and disorderly place of contagion with the bright, clean sanitary environment of the hospital and the open and orderly spaciousness of the plague camp (see Figure 7.3); it commemorated and celebrated, in ways that flattered the European rulers and their health administration, the power of modern sanitation and medicine and the heroic role of white doctors and nurses.47 Given that the regime’s initial, highly coercive, anti-plague measures had aroused widespread hostility among Indians of all classes and provoked riots against enforced hospitalization and segregation, the Gatacre album reassuringly showed Indians as members of plague committees or as sanitary workers and medical subordinates. The propaganda effect extended, too, to the numerous photographs that showed injections with the anti-plague prophylactic developed in Bombay by bacteriologist Waldemar Haffkine in 1897. Like the images of plague hospitals, these vaccination photographs almost invariably depicted European doctors and nurses ministering to a needy Indian population (but, exceptionally, for inoculation by what appears to be an Indian physician, see Figure 7.6). This was a racial agenda as well as a sanitary and therapeutic one. The image of the white vaccinator was also one that featured in missionary publications, showing, for the benefit of audiences in Europe and North America, the attentive care of the Christian nurse and physician.48 Once plague had become established across India and the death toll continued to mount, the propaganda value of photography diminished. After the early 1900s fewer images appeared, even though the epidemic only reached its all-India peak in 1907 and was still a leading cause of mortality decades later.49 Plague was not a forgotten disease in India, but it no longer commanded much international attention. It had almost become normalized: there was little that was new or startling for the enquiring lens to record. That said, however, there were ways in which photography and plague remained conjoined. The epidemic, and the early failure to contain it, prompted a radical rethinking of colonial responses to contagious disease and a belated recognition of the urgent need for bacteriological research. Plague was one factor in the proliferation of medical research institutes across India from the late 1890s onward and the creation of a new cadre of

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Figure 7.6 Bombay Plague Epidemic, 1896–1897: Inoculation against Plague, attributed to Cliftion & Co. Wellcome Collection. Public Domain Mark.

medical researchers. One of the functions of photography was to follow this research into the laboratory—to show researchers peering intently into microscopes or to reproduce images of the plague bacillus and other pathogens now rendered visible to medical science and the general public through the combination of microscopy and photography. A new iconography emerged in India as in Europe and North America of the medical investigator, showing a white male seated self-importantly at his desk or busy with his (rarely her) microscope.50 Whatever the ongoing reality of disease in Indian towns and districts, here was a heroic image for the camera to conjure with, a newly dynamic visualization of all that contagion signified. Plague Pedagogy On December 11, 1907, W. Glen Liston of the Indian Medical Service, one of India’s leading bacteriologists and plague researchers, gave a lecture to the Bombay Sanitary Association on “The Cause and Prevention of the Spread of Plague in India.” This was part of a series of illustrated talks Liston (1872–1950) had presented on similar themes— he had spoken, for instance, in November 1904 to the Bombay Natural History Society on “Plague, Rats, and Fleas.”51 In these lectures he sought to make the public aware of the latest research findings on how plague was caused and transmitted especially

Visualizing Contagion in Colonial India  169 in Indian conditions. But his address to the Bombay Sanitary Association had a more ­specific objective. The organization had been founded in January 1904 to o ­ vercome the hostility created by the government’s initial anti-plague measures and by the so-called “Mulkowal disaster” in Punjab in October 1902 when 19 villagers died from tetanus after receiving contaminated anti-plague vaccine. Through lectures, exhibitions, and pamphlets, the association sought to enlist the support of Bombay’s educated and affluent Indian elite for inoculation and other public health measures, in the hope that they in turn would exercise their influence to win over the city’s poorer classes. Bombay’s health officer, Dr. J. A. Turner, was its first honorary secretary and the association enjoyed strong official patronage, including from the provincial governor; local sub-committees, including prominent Indians, visited various wards of the city “with a view to bringing to the notice of the people the value of personal and domestic hygiene.”52 Or, as a speaker at the 1910 annual meeting of the Bombay Sanitary Association succinctly put it, “the people are teachable.”53 It was against this background that in 1908 The Times of India published Liston’s lecture from the previous December.54 Reproducing 25 photographs in its 28 pages (along with a graph showing seasonal fluctuations in the disease and two pages of statistics), Liston’s tract demonstrated the value attached to using a range of visual material to communicate to the public a scientific understanding of contagion, its cause, effect, and, above all, the measures needed for its containment and eradication.55 Here there was no pretension to art, only the utilitarian, pedagogic use of imagery to inform and allay rather than spread fear. Significantly, none of the illustrations in Liston’s tract showed any human victims of plague; but the absence of such corporeal imagery can also be seen as reflecting a significant shift in the perception and representation of contagion, away from exhibiting stricken “native” bodies to dissemination of practical knowledge of disease, the manner of its transmission, and the means of its containment. By 1908 Liston and his associates in the Indian Medical Service were confident in their belief that plague was caused by a specific bacillus and transmitted to humans by rats and their fleas. As Liston remarked, plague was “essentially a rat disease,” so that its transference to humans “might almost be said to be accidental.”56 He accordingly turned first to consider the most common species of “house-frequenting rats” in India: for three of these—the bandicoot, the sewer rat, and the house rat—photographic images were provided, though, being rather poorly reproduced in his text, it would be hard without the accompanying descriptions to tell one species from another.57 Liston then addressed the plague bacillus (the identity of which had been scientifically established by the French bacteriologist Alexandre Yersin in Hong Kong in 1894). “Almost everybody,” he wrote, with an assurance that would have been inconceivable five years earlier, “now knows that the disease is due to the presence of a minute germ or bacillus which is found in the blood of the person or animal suffering from the disease.” Here he reproduced a microscope image, “suitably stained and magnified very greatly,” of a sample of blood from a plagueinfected rat, explaining for the benefit of his audience that the “germs” were the “little dark rods amid the circular red blood cells.”58 There then followed photograph-based sketches of the types of rat flea found in India, especially Pulex cheopis (now Xenopsylla cheopis) the main plague-bearing insect, as magnified microscopically.59 Here, as in the bacillus image, the microscope was the authoritative source of medical information; for Carter, decades earlier, it had provided the basis for his meticulous colored drawings of the mycetoma fungus; now, for Liston, it worked in association with black-and-white photography.

170  David Arnold The remaining images in Liston’s booklet tell a rather different story: not one of the microcosmic aspects of disease—the “germ,” the rat, the fleas—but of the macrocosm, the social and environmental conditions in which plague proliferated in urban India. As scholars have noted, the arrival of germ theory (or theories) and the work of bacteriologists like Liston in establishing the etiology of contagious diseases did not so much supplant as strengthen and reconstruct a preexisting concern for the environment and social milieu in which a disease thrived or through which it might be contained. In other words, Liston highlighted for his audience and readership the idea of contagion as an issue of public health, not just of medical science, and one with which the Indian public should, from its own self-interest, engage. Unlike the early plague images, there were no Europeans visible in Liston’s tract: no white doctors and nurses, no white inoculators or health officers. Instead, there were Indians—Indians who lived in insanitary squalor but also Indians who presided (as in Liston’s final illustration) over, or favorably observed, inoculation against plague. None of the photographs was credited to a particular photographer, but they could as well have been taken by an Indian as by a European and most probably were. Equally, there is no hint in the photographs or in the text that any alternative way of viewing the disease existed, as through the prism of Ayurvedic or Unani medicine, though both were highly active during the plague years. Nor, unsurprisingly, is there any reference in Liston to a plague goddess, despite there being textual and pictorial references to such a deity elsewhere, including at least one photograph, probably by Shivshankar Narayan, showing her worship in Bombay.60 The photographic images that Liston did include, and the narrative accompanying them, instead emphasized a proven connection between plague-carrying rats, fleas, and insanitary living conditions. A section headed “The Structure of Indian Buildings Affords Shelter to Rats” featured interior and exterior photographs of ramshackle Indian dwellings. Other images, including of the ward where Bombay’s plague epidemic began, showed grain shops, with human dwellings above them, as evidence of the inhabitants’, or owners’, indifference to basic sanitation. It was, the text averred, “the habits of the people” that were responsible for “producing and maintaining a close association between rats and men [sic].”61 Another sequence reflected on “Poverty and a Lack of General Order and Tidiness within the Household” as creating conditions conducive to plague. “Look at this picture,” ran the caption to a scene showing a narrow and crowded backstreet, cluttered with people, upturned charpoys, and clothes strung on lines. “Is it wonderful that rats find shelter in such circumstances?” “It is,” Liston concluded, “the presence of Mus rattus, the ‘house’ rat, amid people with habits and customs such as I have illustrated, that accounts for the presence of plague in India.”62 It is only then that Liston turned to remedial measures—the trapping and poisoning of rats, the evacuation of plague suspects and their families to “health camps,” and, above all, anti-plague inoculation. “Fortunately,” Liston observed below the vaccination scene with which his tract (and slideshow) ended, “science has placed in our hands a means by which we may defy the ravages of the disease.”63 I have dwelt on Liston’s plague guide because it was an illustrated talk that was converted into a widely circulated booklet, and so it gives us a double insight into the way in which by the early twentieth century contagion was being visualized and visually communicated. This was done not by displaying the visual horror of diseased bodies or plague-stricken corpses awaiting cremation, but through the use of photographic illustrations—from microscope slides to street scenes, from images of rats to interior views of hovels—to illustrate a scientific idea and a sanitary principle and thereby to mobilize Indian agency and opinion.

Visualizing Contagion in Colonial India  171 A Coda One of the striking features of the coronavirus pandemic of 2020–2021 was the extent of its visualization and the global dissemination of visual images of the contagion. In India, as well as television reports and newspaper articles with photographic illustrations, COVID-related videos circulated widely online and imaginative wall art appeared across the country showing doctors and nurses, the vaccination campaign, and even highly stylized representations of the virus itself. The representation of the virus as a kind of malevolent or cartoonish spikey ball, an imagery for which perhaps only HIV offered even a partial precedent, was a truly global phenomenon. But in India this epidemic artistry—especially the street murals—referenced and revitalized a vernacular visual idiom that went back to earlier representations of Hindu disease goddesses and demons as well as invoking colonial-era images of the plague bacillus as seen through a microscope lens. Perhaps this recent outpouring of iconographic disease images has made it easy for us to assume a kind of linear trajectory by which disease has been made more and more visible over time, as new techniques of medical representation and new public media, like television and videos, have come into being and as science has itself become more visually accomplished. And yet it would be rash to assume that science (and the many visualizing instruments at its command) always progresses, moving on from one representational triumph to another. For epidemic photography and visual media more generally the salutary counterlesson was the “Spanish Flu,” the influenza pandemic of 1918–1919, in which between 12 and 20 million people died in India alone. For the United States, Britain, and even Japan, we have a host of photographic images of crowded hospitals, street scenes with people or police officers and health workers wearing masks, and so on. For India, the country where the human cost was so much the greatest and most catastrophic, where close to half of all the worldwide victims of Spanish Flu perished, we have nothing—no photographs at all, so far as I am aware, not even photographic illustrations in medical journals and textbooks.64 Here was a mass contagion (so unlike the bubonic plague of the 1890s in India with its rich and varied haul of photographic imagery) that seems to have had no visual legacy at all. Notes 1 But see Ilana Löwry, “Making Plagues Visible: Yellow Fever, Hookworm, and Chagas’ Disease, 1900–1950,” in Plagues and Epidemics: Infected Spaces Past and Present, eds. D. Ann Herring and Alan C. Swedlund (Oxford: Berg, 2010), 269–285. 2 A partial exception might be made for ophthalmology where accurate illustrations was ­considered essential: [Anon.], “The Rise and Progress of British Ophthalmology,” MedicoChirurgical Review 21, no. 41 (1858), 98–111; F. H. Brett, A Practical Essay on Some of the Principal Surgical Diseases of India (Calcutta: W. Thacker, 1840). 3 Richard Barnett, The Sick Rose: Disease and the Art of Medical Illustration (London: Thames and Hudson, 2014), 128–143; Tom Koch, Disease Maps: Epidemics on the Ground (Chicago, IL: University of Chicago Press, 2011). 4 James Annesley, Sketches of the Most Prevalent Diseases of India (2nd ed., London: Thomas and George Underwood, 1829); William Twining, Clinical Illustrations of the Most Important Diseases of Bengal (Calcutta: Baptist Mission Press, 1832). 5 John Grant Malcolmson, A Practical Essay on the History and Treatment of Beriberi (Madras: Vepery Mission Press, 1835), 114. 6 See, for example, H. J. Nolte, Indian Botanical Drawings, 1793–1868 (Edinburgh: Royal Botanic Gardens, 1999).

172  David Arnold 7 Allan Webb, Pathologia Indica, Or the Anatomy of Indian Diseases (2nd ed., Calcutta: Thacker, 1848), ii, xii–xiii. 8 E. A. Parkes, Remarks on the Dysentery and Hepatitis of India (London: Longman, Brown, Green, and Longmans, 1846), x. 9 Ibid., 11, 19, 34. This reliance on words to convey visual impressions is also evident in George Ballingall, Practical Observations on Fever, Dysentery, and Liver Complaints, as They Occur amongst the European Troops in India (2nd ed., Edinburgh: Adam Black, 1823). 10 Parkes, Remarks, 51. 11 Ibid., 61, 97. 12 For Parkes’s observations on race, see Suman Seth, “Race, Specificity, and Statistics in Victorian Medicine,” Journal of Victorian Culture, https://doi.org/10.1093/jvcult/vcac015 13 Ralph W. Nicholas, “The Goddess Sitala and Epidemic Smallpox in Bengal,” Journal of Asian Studies 41, no. 1 (1981): 21–44; David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press, 1993), Chapter 3. 14 The literature on these medical traditions and their modern transformation is extensive: for two outstanding examples, see Kavita Sivaramakrishnan, Old Portions, New Bottles: Recasting Indigenous Medicine in Colonial Punjab, 1850–1945 (New Delhi: Orient Longman, 2006); Guy N. A. Attewell, Refiguring Unani Tibb: Plural Healing in Colonial India (Hyderabad: Orient Longman, 2007). 15 Photographs of processions in honor of smallpox and cholera deities, dating from c. 1890– 1900, can be found at Getty Images no. 120213523 and Wellcome Collection image no. 578479i. 16 Ravinder Kaur and Sumathi Ramaswamy, “The Goddess and the Virus,” in The Pandemic: Perspectives on Asia, ed. Vinayak Chaturvedi (Ann Arbor, MI: Association for Asian Studies, 2020), 75–94; Nandini C. Sen, “Corona Mata and the Pandemic Goddesses,” The Wire, September 25, 2020, https://thewire.in/culture/corona-mata-and-the-pandemic-goddesses 17 As in the case of William Griffith (1810–45): see his Icones Plantarum Asiaticarum (Calcutta: Bishop’s Press, 1847). 18 Parkes, Remarks, 49. Likewise, see Allan Webb, Elephantiasis Orientalis, and Specially Elephantiasis Genitalis, in Bengal (Calcutta: Bengal Military Orphan Press, 1855). 19 Arnold, Colonizing, Chapter 4; Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India, 1600–1850 (New Delhi: Oxford University Press, 1999). 20 On doctors as early photographers, see John Falconer, India: Pioneering Photographers, 1850– 1900 (London: British Library, 2001), 10–11; Ray McKenzie, “‘The Laboratory of Mankind’: John McCosh and the Beginnings of Photography in British India,” History of Photography 11, no. 2 (1987): 109–118. 21 Ruth Richardson, Mr. Gray’s Anatomy: Bodies, Books, Fortune, Fame (Oxford: Oxford University Press, 2008); Annual Report of the Grant Medical College, Bombay, 1859–60 (Bombay: Education Society’s Press, 1860), 7, 9. 22 H. Vandyke Carter, On Mycetoma, Or the Fungus Disease of India (London: J. and A. Churchill, 1874), 1. 23 This tension between the beauty of color and form, as revealed by the microscope, and the grossness of human disease informed other aspects of Carter’s work, notably H. Vandyke Carter, The Microscopic Structure and Mode of Formation of Urinary Calculi (London: J. and A. Churchill, 1873). 24 Kenneth McLeod, “The Etiology of Madura Foot,” Indian Medical Gazette 10, no. 2 (1875): 44–46. 25 H. Vandyke Carter, On Leprosy and Elephantiasis (London: Eyre and Spottiswoode, 1874). 26 H. Vandyke Carter, Report on the Prevalence and Characteristics of Leprosy in the Bombay Presidency, India (Bombay: Education Society’s Press, 1872). For some of Carter’s images see https://kingscollections.org/exhibitions/specialcollections/great-leveller/leprosy/ henry-vandyke-carter 27 Carter, Leprosy, 6. 28 T. R. Lewis and D. D. Cunningham, Leprosy in India: A Report (Calcutta: Superintendent of Government Printing, 1877).

Visualizing Contagion in Colonial India  173 29 For international alarm over leprosy, see Rod Edmond, Leprosy and Empire: A Medical and Cultural History (Cambridge: Cambridge University Press, 2006). 30 Report of the Leprosy Commission in India, 1890–91 (Calcutta: Superintendent of Government Printing, India, 1892). 31 Jane Buckingham, Leprosy in Colonial South India: Medicine and Confinement (Basingstoke: Palgrave Macmillan, 2002). 32 For instance, John Jackson, Lepers: Thirty-One Years’ Work among Them: Being the History of the Mission to Lepers in India and the East, 1874–1905 (London: Marshall Brothers, 1906). 33 See R. D. Murray, “Elephantiasis of the Scrotum and Penis,” Indian Medical Gazette 37, no. 12 (1902), 457–459, illustrations facing 459. On the second of these, the author adds: “The engraving is from a bad photograph, hence the blurred appearance, but it well illustrates the formidable nature of the disease.” 34 Nancy Stepan, Picturing Tropical Nature (London: Reaktion Books, 2001), Chapter 5. 35 The Asylum Press Almanack and Directory of Madras and Southern India, 1913 (Madras: Lawrence Asylum Press, 1913), 1287–1288, 1311, 1337–1338. 36 On the last of these, see John Falconer, “Ethnographical Photography in India, 1850–1900,” Photographic Collector 5, no. 1 (1984): 16–46. 37 Examples from Bombay’s Grant Medical College in the 1900s can be found in the photograph album presented to H. P. Dimmock, IMS, photo collection 311/2, British Library, London. 38 Myron Echenberg, Plague Ports: The Global Urban Impact of Bubonic Plague, 1894–1901 (New York: New York University Press, 2007), Chapter 2. 39 Several versions of the Gatacre album exist, including at the British Library and Wellcome Library in London. For its contents, see Shivani Sud, “Water, Air, Light: The Materialities of Plague Photography in Colonial Bombay, 1896–97,” Getty Research Journal 12 (2020): 219–230. 40 For images of the Poona Plague Hospital and camp in 1897–98, see the photograph album of J. L. T. Jones, IMS, photo collection 578/4, British Library. 41 A series of watercolors attributed to Ernest Schwarz-Lenoir were painted in Bombay, showing anti-plague operations, especially rat-catching: Wellcome Collection, images nos. 566936i, 566938i, 566955i. 42 Some of the most brutal images of plague victims, alive or dead, appear in the album “Poona Plague Pictures, 1897–98,” compiled by C. H. B. Wylie, IMS, and held at the Getty Research Institute, Los Angeles: http://hdl.handle.net/10020/cifa96r95 43 David Arnold, “Picturing Plague: Photography, Pestilence and Cremation in Late Nineteenthand Twentieth Century India,” in Plague Image and Imagination from Medieval to Modern Times, ed. Christos Lynteris (Basingstoke: Palgrave Macmillan, 2021), 111–139. 44 Ibid., 128–132. 45 As in the case of a woman doctor, Marion Hunter, and the several white nurses shown at work at the Poona Plague Hospital in the Jones and Wylie photo albums previously cited. For Hunter’s views and experiences, see K. Marion Hunter, “Fighting the Bubonic Plague in India,” The Nineteenth Century 43, no. 256 (1898): 1008–1016. 46 For examples of photographic imagery of the plague bacillus derived from microscope slides, see William Ernest Jennings, A Manual of Plague (London: Rebman, 1903), plates 6–9. The slow acceptance of germ theory and the continuing attachment to environmental explanations in India can be seen from Nancy P. Sutphen, “Not What but Where: Bubonic Plague and the Reception of Germ Theories in Hong Kong and Calcutta, 1894–97,” Journal of the History of Medicine and Allied Sciences 52, no. 1 (1997): 81–113. 47 Abhijit Sarkar, “Reflexive Gaze and Constructed Meanings: Photographs of Plague Hospitals in Colonial Bombay,” in Lynteris, Plague Image, 141–190. The sanitized, orderly view of the plague hospital and camp is particularly evident from the photographs and accompanying ­captions in the Wylie album cited above. 48 Notably, R. W. Hornabrook, Report on the Dharwar Plague Hospital, August 28th–December 18th, 1898 (Dharwar: Dharwar Plague Hospital, 1899). 49 Arnold, Colonizing, 201. 50 One of the photographs in the Jones album, 578/4 (21), shows Marion Hunter at the Poona Plague Hospital seated alongside two male colleagues with microscopes on the table in front of them.

174  David Arnold 1 W. G. Liston, “Plague, Rats, and Fleas,” Indian Medical Gazette 40, no. 2 (1905), 43–49. 5 52 Times of India, January 28, 1905, 7. 53 John Muir Mackenzie, Times of India, February 2, 1910, 10. 54 A third edition of this work, from the Bombay Government Central Press, appeared as late as 1925. 55 Many of the same images were published in J. A. Turner, Report on History of Plague in Bombay, from 1896 to 1907 (Bombay: Times Press, 1907). 56 W. Glen Liston, The Cause and Prevention of the Spread of Plague in India (Bombay: Times Press, 1908), 1. 57 Ibid., 3–4. 58 Ibid., 17. 59 Ibid, 19–20. 60 Published in The Graphic (London), September 1897; see Arnold, “Picturing Plague,” 128–129. 61 Liston, Cause, 11. 62 Ibid., 12–13, 17. 63 Ibid., 33. 64 For this lacuna, see David Arnold, “Death and the Modern Empire: The 1918–19 Influenza Epidemic in India,” Transactions of the Royal Historical Society 29 (2019): 181–200.

8 Capturing the Invisible Enemy Photographs of the 1918 Influenza Epidemic Louisa Iarocci

The 1918 influenza epidemic has been called the first “mass-mediated” pandemic in ­history – arriving at the end of World War I and at the beginning of the modern era of journalism.1 Photography played a critical role in recording and shaping the story of this global crisis –widely disseminated for the first time due to the increased circulation of newspapers and magazines in the first decades of the twentieth century.2 In this chapter, I examine the imaging of the influenza epidemic in the newspaper photographs in relation to contemporary developments in mass communication and public health in the United States. The pandemic arrived at a critical moment in the rise of photojournalism and the advancement of medical knowledge about the cause and transmission of infectious diseases. News coverage played a key role in disseminating official information that shaped public behavior and perceptions of the health crisis in the popular imagination. Like the war imagery with which it competed, still photography served as both instrument and propaganda for civic agencies and medical authorities battling the disease. At the same time, these widely seen images made visible the otherwise invisible dimensions of the pandemic, revealing the scope and character of its physical and psycho-geographies in the mind of the public. The 1918 influenza pandemic is considered to be one of the deadliest infectious disease outbreaks in recorded history, estimated to have killed between 50 and 100 million people globally.3 This highly virulent, deadly strain of the seasonal flu was distinguished by its speed of transmission and high mortality rate – but knowledge of its origins and pathology remains incomplete even to the present day.4 The misnomer of “Spanish flu” has been attributed to the many early cases in Spain that were freely reported by the press there unlike the censored publications of the United States and other European countries involved in World War I.5 Contemporary scholars in medicine, sociology, and science have argued that the extent of the health crisis was intentionally downplayed in newspaper coverage of the flu in the United States.6 The Sedition Act of 1918 made it a federal crime to say anything perceived by the government as harming the country or the war effort – ostensibly in the aim of maintaining public morale. It has been frequently suggested that even as cases spiked in the fall of 1918, the popular press glossed over the harsh statistics and even purposely spread misinformation. Certainly, the timing of this second deadly wave of the flu in the closing months of World War I meant that it often took second place to news from the front. But business historian Tom Dicke has argued that “as a whole, flu coverage was extensive enough and accurate enough to make it unlikely that there were many attempts to suppress or shape reporting.”7 Rather, he suggests that those not yet experiencing the health crisis underestimated the deadliness of the Spanish flu due to “cognitive inertia” that blinded people to changed realities, causing DOI: 10.4324/9781003294979-11

176  Louisa Iarocci them to see the once harmless “flu as the nuisance it had always been rather than the killer it had become.”8 Similarly uncertain and in flux is the role that the medium of photography played in the news coverage of this newly deadly disease. Illustrating newspaper reports with images had become a reality for daily papers in the last decades of the nineteenth century, thanks to a series of technical innovations in taking and reproducing photos. David D. Perimutter observes that even with key developments like the shift from handmade woodcut engravings to photomechanical half-tone reproductions, the news industry was slow to incorporate photographs into the printed page.9 He notes that the rise of photojournalism (versus “visual journalism”) was influenced by commercial as well as technical innovations – including the rising status of professional photographers and increasing numbers of amateurs. Perimutter points out the role of the photo agency as a repository for freelancers not “only helped the world’s dallies gain access to pictures outside of their hometowns, [but also] popularized pictures of national and international news.” Agencies like Underwood and Underwood (1901) and International News Photos (1909) established standards for types of news photographs and also for the quality and style of the “proper press photograph.”10 Photography’s emerging status as a reputable medium of visual communication11 was fueled by the public appetite for more realistic illustrations, giving the crowded news market a means to compete for readership.12 Estelle Jussim has argued that the combination of images and words endowed photojournalism with the authority of “visual fact” at the turn of the century – regarded as irrefutable evidence of an event or situation – even when often really “propaganda and/or pure sensationalism.”13 The coverage of the influenza pandemic in newspapers, the main form of mass media at the time, was thus taking place at a particularly formative time in the development of the photographic image as a legitimate means in its own right to tell a story.14 Geography of a Disease The history of the “Spanish” flu is bound up in the myths and realities of its origin story as it transmuted from a familiar seasonal affliction to a deadly disease.15 The trajectory of the flu was tracked in news media as it spread worldwide in multiple waves between 1918 and 1920. Dating back to January of 1918, sporadic reports can be found in American newspapers regarding the emergence of a highly contagious and potentially deadly variant of the influenza virus.16 Known by various names, from the more familiar “grip” or “la grippe” to the foreign Spanish “flu” or influenza, mentions of the disease can be found in scattered references, often linked to reports about the war. American newspapers typically traced the flu outbreak to the camps and trenches of the war in Western Europe, where it was then said to have been transmitted across the Atlantic through the movement of soldiers, prisoners, and personnel.17 It was not until the spring of 1918 that the first known cases were reported in the United States – initially reported to have only infected military personnel confined to bases and installations.18 The second more deadly wave arrived at the end of September – evident in a major shift in the frequency and depth of news coverage of the flu’s progress in the United States.19 As the first cases were identified in civilians in east coast cities, civic authorities initially tended to downplay their significance, in some cases waiting several weeks to implement interventions.20 But by early October, when the high morbidity rates were undeniable, Tom Dicke notes that “over the space of roughly a week, the magnitude of the crisis became generally visible and cities scrambled to prepare.”21

Capturing the Invisible Enemy  177 Epidemic Psychology The influenza pandemic was a crisis in public health that was a bio-medical reality in its essential nature but also produced a unique set of human responses that, according to sociologist Philip Strong, “constitute pandemics in themselves.” He argues that this epidemic psychology is a distinctive kind of collective social psychology that emerges as a response to the threat the disease posed to everyday assumptions and also the epidemic nature of psychology itself.22 These reactions become “rooted in fundamental properties of language and human interaction [becoming] a permanent part of the human condition.”23 In her study of the coverage of the 1918 flu in Spain, Samantha N. Edwards uses Strong’s framework to analyze newspaper reports through a set of “media themes of contagion” that reveal how the “public engages information on health and safety.”24 Through the work of editors and reporters, she argues that pandemics can be understood as “processes, not things” that unfold within an “ecological and social context” and impact human order not only in terms of economics and welfare but also in a deep “psycho-social way.” The fluid relationship between “public perceptions of contagion and the social activities” that took place is expressed in the three categories of epidemic psychology: epidemics of explanation or instruction, epidemics of action, and epidemics of fear. What follows here is an effort to use these themes of contagion as a means to understand the representation of the 1918 pandemic in image as well as text. What does the news photograph reveal about the cultural perception of disease in the early twentieth century? For most of the public, urban newspapers were the primary mode of communication – but the photograph itself was a new means of documenting the unfolding events, writing a history of disease and story of contagion that persist to the present day.25 Epidemics of Explanation The first type of psycho-social response to pandemics that seems most immediately ­evident in early news coverage in US urban newspapers is the “epidemic of explanation or instruction.” Philip Strong observes that when an unknown disease first appears, human responses are often characterized by a “volatile intellectual state” as people are uncertain how to handle it. Appearing in the first week of intense reporting on the pandemic, the full page spread in the Richmond Times-Dispatch on October 6, 1918 provides an example of efforts by newspapers to serve as an extension of civic and public health authorities by providing critical information to the public (Figure 8.1). The lengthy article authored by Dr. Gordon Henry Hirshberg, AM, MD, presents a detailed overview of the history of “the first really serious epidemic of the world war,” tracing its historical trajectory across the globe and ultimately into the body of the potential patient.26 The reader is provided with detailed scientific information about the transmission and symptoms of the disease, along with advice to individuals for protecting themselves.27 The accompanying illustrations employ an array of media to supplement the text beginning with a military tactical map showing the path of the contagion said to have been carried by military personnel and German U-boats from the trenches of Europe to the east coast of the United States. Adjacent is a photograph of a soldier in a profile view modeling the mask – “that can entirely [do] away with Danger of communicating the infection,” reinforcing its link with military bodies. The flanking profile view of a woman’s head provides an anatomical section that goes beyond surface reality to illustrate the nasal passages noted to be the “Seat of Infection.” The use of the collaged photograph as a scientific image reinforces

178  Louisa Iarocci

Figure 8.1 “Medical Science’s Newest Discoveries about the ‘Spanish Influenza’,” Richmond Times – Dispatch, October 6, 1918, 2.

the general tone intended to educate but at the same time reassure the reader. The author claims that “modern medical science [has] devised infallible means of coping” with the current epidemic…[unlike] “past pestilences that followed Wars,” like “The Plague” depicted by British artist, John Collier below (1902). In this news story the photographic medium is employed in a variety of ways from the documentary, as a piece of scientific evidence in unraveling a medical puzzle, to the sensational, as a means to reproduce the dramatized depiction of a disease as a mysterious scourge of the past. For newspapers in competition for readership in competitive urban markets, pictures incorporated into text could provide a critical edge in gaining mass appeal.28 The early imaging of the pandemic in newspapers shows the collective effort of mass press to help familiarize the public with the disease as a biological and scientific event that had a history that everyone needed to understand. In her study of reporting in Spain, Samantha Edwards observes that newspapers covering the flu in 1918 were obsessed with the geography of influenza - that is, tracing the physical origins and path of transmission of the unknown invader. In the early stages when the public was determining whether to accept the danger of the new threat or dismiss it as trivial, Edwards observed that newspapers sought to “[arm] readers with important information that enabled them to protect themselves” and “to reassure them with a sense of agency in an otherwise chaotic situation.”29 Early reports on the pandemic tread a fine line during this period of new uncertainty – oscillating between hyping the risk and allaying anxiety. Mainstream news

Capturing the Invisible Enemy  179 media certainly sought to impress upon the public the severity of the outbreak of this transformed pathogen – and the potential danger it posed to everyone. The press adopted a rhetoric about the pathology of the disease that “engaged its audience at a personal and public level30 [by employing] both active and passive attempts at persuasion.”31 While mistaken in their reporting that the influenza was bacterial, and not viral in origin, news reports were generally more accurate in stressing the highly contagious nature of the disease. Newspapers played a critical role in identifying “aerosolization” and the handling of contaminated objects as prevailing theories of transmission in a manner that could be easily understood by the public:32 The disease is spread by droplet infection that is, by little drops swarming with germs scattered by infected persons who sneeze, spit and cough in public places. One sneeze in a streetcar may infect a whole city.33 Samantha Edwards observes that newspaper readers in 1918 were provided with a “tool kit” for self-diagnosis. Preventive measures familiar today appeared repeatedly in newspapers with an emphasis on personal hygiene and social restraint, including washing hands frequently, keeping the mouth and nose clean, and avoiding crowds. In addition to avoiding public gatherings and staying home if sick, people were advised to cover their coughs and sneezes, avoid sharing personal items, and refrain from spitting in public places. Crowding and unsanitary behaviors on public transportation like street cars and elevators were considered to be particularly suspect. Many cities issued orders to disinfect city vehicles daily and keep streetcar windows open a certain distance in order to assure proper ventilation. In Philadelphia, for example, street cars displayed placards with the ominous warning that “Spit Spreads Death.” In August of 1918 the Sun in New York advised its readers to refrain from kissing “except through a handkerchief.”34 By early October the Richmond-Times Dispatch reported kissing should absolutely be stopped “except in cases where it is absolutely indispensable to happiness.”35 In this uncertain time where a full knowledge of the epidemic was lacking, the press was the central, if often capricious, engine of information – on the one hand raising alarm, and then on the other, as Edwards notes, “arming [the public] with important information about the virus while also reassuring them with a sense of agency in an otherwise chaotic situation.”36 The role of photography in this public information campaign was especially critical in making visible social behaviors like mask wearing. The wearing of surgical masks, made of layers of gauze and produced and distributed by Red Cross volunteers, was initially recommended for health personnel, then for public workers, and eventually, in many cities, for all citizens in public places as the pandemic progressed.37 In San Francisco, for example, all the major newspapers collaborated on one day in late October to devote a full page to an appeal to the public for the wearing of masks, declaring they “were 99 per cent proof” protection against infection and death.38 Throughout the country local public officials, medical and military personnel, and city workers appeared in the pages of newspapers, modeling patriotic behavior by sporting their “gas masks.”39 Those in uniform on the frontline of battling the pandemic were particularly popular subjects, including the police, streetcar conductors, and sanitation workers.40 But most prevalent were medical workers, particularly female ones like the nurses, volunteers, and ambulance drivers who stepped up to fill the serious shortage of medical staff caused by the war.41 The photo, “Not a Turkish Harem, but Red Cross Workshop Unit Making ‘Flu Masks,’ ”

180  Louisa Iarocci

Figure 8.2 “Not a Turkish Harem, but Red Cross Workshop Unit Making Flu Masks,” Omaha Daily Bee, October 6, 1918, 20.

that appeared in the Omaha Daily Bee on October 6, 1918 was one of many stories featuring the work of masked women in action (Figure 8.2). Authors Jessica Brabble, Ariel Ludwig, and E. Thomas Ewing observe that while the “image of the masked nurse became part of the daily experience” in 1918, masked women in general were often rendered as “exotic sexual objects [obscuring] their work, both volunteer and paid.”42 In this way an effort is made to allay the seriousness of threat that has resulted in the masked faces and actions of the Red Cross workers by the effort to transform them into an “alluring, costumed other.” The story, “Influenza Masks Play Big Role in Curbing Epidemic,” in the San Francisco Chronicle on October 30, 1918 (Figure 8.3) featured scenes from a local children’s hospital where the youngest flu victims were being transported to make space for adult patients. The on-the-ground report of the city-wide effort to care for the most vulnerable sufferers strives for a heartwarming, positive tone and, at the same time, restates the warning to readers to wear masks or risk death. The photographs carefully woven into the columns of text capture the “pale, wan young sufferers” being cared for by “brawny sailors” and the brave women of the Red Cross and other civilian female volunteers contributing to this humanitarian effort. The photographs help to reinforce the mass appeal of the reporting – the sentimental scene is intended to please and placate readers – in contrast to an adjacent report on the misallocation of pandemic funds by the mayor’s office. Specific mention is made in the text that many of these “dark babies and fair babies”

Capturing the Invisible Enemy  181

Figure 8.3 “Influenza Masks Play Big Part in Curbing Epidemic,” San Francisco Chronicle, October 30, 1918, 11.

had been made orphans by the pandemic: notably a child of color that “didn’t know its name… whose mother could not be found.” The intent is to both evoke sympathy in the viewer for the plight of these motherless children and at the same time implicate people of color as victims, and by implication vectors, of the disease.43 This flu orphan is tellingly not depicted in the series of photographs, which instead include a range of the most photogenic, healthy, and white vulnerable victims to evoke sympathy in the reader. Epidemics of Action The influenza epidemic arrived at a moment in the twentieth century when scientific knowledge of infectious disease was in its formative stages. Symptoms were sudden and mimicked those of the flu, with high temperature, body aches, sore throat, and cough. New diagnostic techniques like monitoring body temperature and analyzing blood were being employed in the field while scientists worked in the lab, having already solidified germ theory of disease and made advances in understanding the immune system.44 The epidemiological origins of this novel strain of a virus, against which no one had immunity, had yet to be discovered. But the disease was correctly understood to be transmitted from person to person through airborne respiratory secretions. Most scientists today agree that much of the official advice to curb infection was accurate.45 Public health officials in newly created positions gained increased authority as advisors to civic officials

182  Louisa Iarocci who sought to present their orders as grounded on solid scientific evidence. Often quoted in newspaper reports, city doctors became local celebrities, dispensing advice on topics that ranged from medical advice to personal behaviors. These local authorities across the United States resorted to a wide variety of nonpharmaceutical administrative interventions at the city scale in order to control the physical movement and social behavior of people and germs. The earliest measures consisted mainly of cancellations of all public gatherings, restrictions on sizes of crowds, and closures or limited hours of public buildings, including theaters, churches, schools, dance halls, and saloons. Other frequently employed social distancing measures included restricted or staggered hours in stores selling essential goods that remained open, rules forbidding crowding on transit systems, and the introduction of isolation rules for sick persons.46 These wide-ranging drastic actions to lessen the possibility of disease transmission through contact had a major and highly visible impact on daily life in the city, driving home the seriousness of the advance of the disease. Variety Magazine, covering the impact on the theater industry, declared that the city had “gone dark” as urban residents barricaded themselves from the insidious and invisible enemy.47 Starting in early October in 1918, newspapers all over the country published directives from the US Government Public Health Service in addition to serving as the mouthpiece of local authorities. Led by the coordinated efforts of civic leaders and health officials, the “health of the city” became a frequent topic of concern in the urban newspapers. Numerous reports detailed how, on the advice of health officials, civic governments stepped up their cleaning regime, removing trash and even regularly washing paved streets and flushing gutters.48 Official recommendations issued in pamphlets, displayed as placards in public places, and reprinted in newspapers impressed on the public that it was “the patriotic duty for every American citizen to assist in preserving the health of himself and his fellow citizens.”49 Jennifer Carrie Hass notes how the rhetoric in newspaper reports, using the military language of war, “further demonstrates the implied relationship between fighting the influenza ‘war’ and the ‘Great War’ abroad.”50 Stories detailed campaigns to tackle the visible dirt and waste in the streets and the invisible germs in the air by fumigating streetcars and other public places51 (Figure 8.4). The action on the ground included infantries of uniformed street sweepers fanning out into the city and the police maintaining order by enforcing masking policies.52 Some newspapers reported that paved streets would be regularly washed, gutters flushed, and even “sprinkled with antiseptic.” The removal and isolation of sick bodies as well, as seen above, was also a concern. Scenes mimicking military parades featured the work of ambulance brigades like the Red Cross Motor Corps which transported flu victims to hospital and chauffeured nurses between quarantined houses. To assist treating patients at home, quickly established “motor corps” of volunteers drove doctors and nurses to the homes of flu sufferers. Often staffed by women, these volunteer teams with little or no medical training are posed in ready formation alongside their fleet of vehicles – even if their stretchers are empty. Newspapers featured crowd-pleasing “battle stories” about the heroism of local volunteers and other essential workers who were aiding the effort to combat disease and the war.53 This kind of on-the-ground action reporting of the city in action is represented in feature stories in which photographs emerge to stand on their own as reportage.54 Regular features like “Camera News” which depicted the day’s events in photographs accompanied only by captions are seen in a series of full-page features in Evening Public Ledger in the first week of October.55 In most of this short-lived run, the top band of scenes

Capturing the Invisible Enemy  183

Figure 8.4 “Philadelphia Winning the Fight against Influenza,” Evening Public Ledger (Philadelphia, PA), October 9, 1918, np.

184  Louisa Iarocci continues to focus on the dominating subject of the war, while depictions of the local battle against disease appeared in the lower register. On October 9 the story entitled “Philadelphia Winning the Fight against Influenza” was composed of four overlapping images with captions (Figure 8.4). The largest photograph on the upper left shows a uniformed transit worker “disinfecting P.R.T. Trolleys at the end of each trip.” This concern with disease transmission on modes of conveyance from street cars to elevators is also further evident in the oval inset to the right in which Doctor H. E. Bricker demonstrates how to use an unknown “influenza safeguard” on the nose of an unlucky transit worker. The lower right vignette shows Ms. Margaret Lincoln of the Emergency Aid Shop, unmasked to reveal her attractive visage, displaying an influenza mask being sold for ten cents. Lastly, the street view in the lower right corner of a horse and carriage driving over a pile of waste is captioned as a “Belated Attack on Accumulated Highway filth.” The combination of subjects mirrors the array of war subjects above that range from a distant view of a fallen city to an on-the-ground view of an official military visit to the front to a close-up of a deadly looking German rifleman.56 But in contrast to those more stilted and posed compositions, the portrayal of the “battle” against disease at home conveys the sense of an active campaign in the streets of the American city. These essential workers are all engaged in a distinctive intervention against the enemy, caught in the heat of a battle on the verge of being won.57 Epidemics of Fear World War I has been described as the first extensively photographed war – despite the limitations of technology and politics that continued to largely produce static and sanitized scenes. Bernd Hüppauf has observed that the public imagery of modern warfare “remained separate from—and with few notable exceptions—alien to…the abstract and mediated reality of modern warfare.”58 The imaging of the pandemic seems similarly to have produced rare instances of photographs of “real war,” as in devasted landscapes and dead and mutilated bodies – unless its battlefields are understood to be the streets and interiors of the contagious city. The prolonged battle against the disease was one conducted in the public and private spaces of the city – through restrictive measures like bans on public gatherings and home quarantine. But despite these efforts, the need to treat the severely ill quickly taxed existing medical facilities and staff that were already suffering severe shortages during the war. Local governments across the United States built massive open-air field hospitals and “tent camps” and converted existing public buildings like city halls, churches, schools, and gymnasiums into emergency “flu hospitals.”59 In their continuing mission to present positive news about the state of the pandemic, newspapers devoted extensive coverage to the contribution these facilities were making to the war on the disease. The Worchester Telegram, for example, reported in early October that the repurposing of a dance hall into the New Emergency Hospital in the Greendale Fair Grounds involved a complete interior renovation, including building partitions and building systems.60 In the accompanying images all the involved parties are depicted and identified by name from the city superintendent to the local patrolmen, doctors, and nursing staff. The comfortable and hygienic character of these physical “modern” facilities and the high standards of care were often stressed in newspaper coverage of these makeshift facilities.61 But typically details about the patients are scarce, their bodies barely visible or completely absent in textual and visual descriptions. Rather

Capturing the Invisible Enemy  185 it is the legions of medical staff that are more often posed in a regimented formation, occasionally set in a field of empty cots in these domestic “field hospitals.”62 But despite the usually positive rhetoric surrounding the flu hospital as evidence of winning the campaign in the war on influenza, the rising tide of fear and despair can be read between the lines and in the illustrations of news reports. The official campaign to move the sick into these isolation buildings usually focused on those who could not afford a private physician or a private hospital stay and could not be confined to their own homes. In some cities, like Seattle, a specially appointed influenza squad used police officers to drive physicians to house calls, in many cases forcibly escorting the sick to local facilities. Many newspapers published daily lists of fatalities due to the flu that included the place of the victim’s demise. The frequent appearance of flu hospitals suggests that these temporary facilities had in many cases become the place where the destitute sick would go to die.63 The foreign-born and poor were frequently characterized as the victims and carriers of the disease, especially those who lived in overcrowded “living conditions” like lodging and tenement houses and refuge establishments. In late October the New York American reported that a group of 23 men who were taken off a ship from China and placed in one ward of the temporary hospital at the Municipal Lodging House were likely to all die.64 The news that two patients, delirious with fever, had “escaped” from the Old Court House Hospital in Seattle reinforced the impression that the facility was less an institution of healing and more a place of incarceration for flu sufferers with no other options.65 But newspapers often refrained from directly blaming poor and working-class people who rode public transit because in many cases these were the workers driving wartime production – and even likely battling the health crisis – in the streets and hospitals.66 Reporting on the plight of the poor, who are largely absent from newspaper coverage and photographs, tends to foreground the beneficent work of charities providing aid. The front page of the Oakland Tribune on October 14, 1918, for example, was dominated by stories about the influenza, featuring the newly created flu hospital in the former Oakland Municipal Auditorium. The main article, that details the well-oiled organization of the facility as a civic and business institution, includes praise for officials from the city, county, the Red Cross, and the Chamber of Commerce. But the tone of the article quickly shifts to a more frantic one with the news that the arrival of over 100 patients for the originally 70 bed facility has led to an “urgent call to the public for beds, bedding, and cooked food,” in addition to volunteer workers to answer telephones and dispatch ambulances. Under the heading “ ‘Give Us Beds, Bedding,’ Is the Plea of Flu Hospital” (Figure 8.5) is a rare view of the interior of a hospital ward showing female patients in beds receiving treatment from the hospital director, Dr. S. H. Buteau, and an unnamed nurse.67 The viewer is placed very close to the action, in direct visual contact with the masked medical staff and almost at the level of the patients. The spare surroundings focuses attention on the draped recumbent forms of the sick who are tightly spaced together. In the photo, the masked nurse appears to be taking the pulse of a female patient while the masked doctor administers to another. With no effective drugs or vaccines, treatment was largely therapeutic, aiming to reduce symptoms like fever rather than treat the underlying cause of disease.68 While numerous newspapers reported cases were going down, they also continued to publish long lists of victims who had succumbed to the disease, identified by name and address. The somber mood conveyed by the photograph reflects the reality that a diagnosis of the flu was regarded as a sentence of death.

186  Louisa Iarocci

Figure 8.5 “‘Give Us Beds, Bedding’ Is the Plea of Flu Hospital,” Oakland Tribune, October 14, 1918, 7.

Such austere portrayals of flu sufferers continued to be rare even in newspapers as the pandemic worsened in late October. But the epidemic of fear, as described by Phillip Strong, can nevertheless be traced in public responses to the health crisis in newspapers that “amplified and legitimized public worries about contracting the dread disease.”69 Janice Hume argues that people quickly transitioned from general concern, often due to a lack of knowledge of the “mysterious malady,” to full blown collective anxiety beyond the disease itself – fears about crowds and immigrants “who might bring this disease from afar.”70 The Oakland Tribune front page included an anecdotal story related by a newspaper staff member who took a call about a group of inflicted patients confined to a “Chinese boarding house.”71 They were said to have “become panic-stricken when their nurse fainted from overwork – requiring the intervention of Chinese leaders to quiet the fear-stricken ‘celestials.’ ” The use of this ethnic slur for Chinese people makes clear the dominant racist prejudices against immigrants and laborers and the anxiety surrounding the dispensing of charity to those in need. In some cases, it was reported that cities did fund flu hospitals, even promising free care to those who could not pay along with sick care for their families. But across the country, African Americans were denied admission to hospitals or relegated to segregated wards in undesirable locations.72 Segregated hospitals in some cases staffed and run by African Americans were insufficient to meet demand and lacked financial support. As victims of the epidemic, people of color were further discriminated against – awaiting burial by “colored undertakers.”73 On October

Capturing the Invisible Enemy  187 18 the Baltimore Sun reported that 175 bodies of African American soldiers who had died of influenza awaited burial at the Westport Cemetery because “men to dig the graves could not be found at any price.”74 While conditions at white cemeteries were also noted to be “unsatisfactory,” the horrific scene of the “rapidly accumulating bodies… lying on a ‘long trench’ above the ground in some cases for weeks was noted to be one of much concern to the health department and certain to evoke distress in the reader.” However, if influenza sufferers were rarely seen in the pages of newspapers, the faces of the actual victims of the disease were almost completely absent. As the death count rose, headlines tended to focus on the active response running in parallel with war news – with reports of the epidemic causalities confined to later pages. Many papers at least for a period of time included daily lists with the names of the dead identified by name, age, and address, or sometimes place of death. Some reports can be found about the overcrowding at cemeteries and lack of undertakers as seen above and the severe shortage of coffins. A full-page photospread from an unidentified Philadelphia newspaper presents a highly unusual set of images entitled “Preparing to Bury City’s Influenza Victims” (Figure 8.6). The upper image is captioned as the “digging of a trench grave in the Municipal Cemetery in Philadelphia for the temporary burial of influenza victims.”75 The deep perspectival view captures the long rows of deep trenches, conveying the scale and magnitude of the grim task. The mass graves are still empty except for the army of workers, some absorbed in their task while others stand, gazing at the viewer. The image of these open graves on the local front stands in contrast to war images of distant fallen, offering a stark portrayal of the human toll of the epidemic. Below left, a darkened interior depicts the embalming of victims at the city morgue, with the staff posing next to the exposed male bodies laid out on the ground awaiting their turn on the table. The image on the right is identified as “row upon row of unburied dead,” the human forms now dissolved into an anonymous pile of drapery that harshly conveys “the terrible stress of existing conditions.” As the microscope was helping to capture microorganisms in the lab in order to better understand and prevent the disease, the camera was being utilized to document the impact of the virus in the streets of the city and in the psyche of newspaper readers. The influenza epidemic arrived at a critical moment in the advance of medical knowledge and the rise of photojournalism. Stories in newspapers often aimed to reinforce the official messaging of local authorities. Photographic images supplemented efforts to shape the behavior and environment of the public by serving as a scientific exhibit in explanations of current knowledge about the pathology and geography of the disease – from its global scope to the internal psyche. At the same time, these “factual” illustrations could offer concrete methods of instruction to support social distancing, sanitation, and hygiene, including mask wearing. Capitalizing on its rising status as a mass medium in documenting World War I, the still photograph in newspapers captured an epidemic of action – both actual and proposed – in the encounters with its origins in distant places and local battles with contagion in city streets. While documenting the physical encounters between public officials, frontline workers, and flu sufferers, these images also begin to reveal the psycho-emotional impact of the disease, especially on marginalized members of society. Illustrating news stories with photographs fed the public need for objective evidence of an unknown and threatening enemy, while stoking their desire for sentimental and sensational stories. Images could both allay and inflame anxieties about the invisible health threat and about the poor and indigent on whom it was subtly blamed. The epidemic of disease that unfairly attacked the bodies of this vulnerable group was accompanied by another epidemic of social

188  Louisa Iarocci

Figure 8.6 “Preparing to Bury City’s influenza Victims,” Unidentified Philadelphia newspaper, circa 1918, np.

Capturing the Invisible Enemy  189 psychology. The biological and social were interconnected, “feeding off on another but at the same time distinct.”76 In their shots of empty hospital floors and trash-strewn streets, photojournalists played a major role in supporting the challenge local newspaper dailies faced in balancing their task of communicating risk to the public and reassuring them in order to sell newspapers. At the same time the photographs reveal public anxieties in the “ghastly masked” faces of essential workers and everyday citizens documenting and sensationalizing the emotional toil of the disease. In the battle to battle this invisible enemy of contagion and fear, the spaces and bodies of citizens and outsiders were the ultimate battleground. Notes 1 Nancy Tomes, “ ‘Destroyer and Teacher’: Managing the Masses during the 1918–1919 Influenza Pandemic,” Public Health Reports 125, no. 3 (2010): 4. See also Joshua S. Loomis, Epidemics: the Impact of Germs and their Power over Humanity (Santa Barbara, CA and Denver, CO: Praeger, 2018) and Nancy Bristow, American Pandemic: Lost Worlds of the 1918 Influenza Epidemic (Oxford and New York, NY: Oxford University Press, 2012). 2 Julian Navarro, “Influenza in 1918: An Epidemic in Images,” Public Health Reports 125, no. 3, (2010). 3 The actual count is uncertain due to misdiagnosis and incomplete records. See Peter Spreeuwenberg, Madelon Kroneman and John Paget, “Reassessing the Global Mortality Burden of the 1918 Influenza Pandemic,” American Journal of Epidemiology 187, no. 12 (December 2018): 2561–2567, https://doi.org/10.1093/aje/kwy191. 4 David M. Morens and Anthony S. Fauci, “The 1918 Influenza Pandemic: Insights for the 21st Century,” The Journal of Infectious Diseases 195, no. 7 (April 2007): 1018–1028. 5 Sandra Opdycke, The Flu Epidemic of 1918: America’s Experience in the Global Health Crisis (New York, NY and London: Routledge, 2015), 5–6. 6 See Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918, 2nd edition, (Cambridge and New York, NY: Cambridge University Press, 2003), 48–49. John M. Barry, The Great Influenza: the Epic Story of the Deadliest Plague in History (New York, NY: Penguin Books, 2004), 218–219 and 333–338. 7 Tom Dicke, “Waiting for Flu: Cognitive Inertia and the Spanish Influenza Pandemic of 1918,” Journal of the History of Medicine and Allied Sciences 70, no. 2 (April 2015): 195–217. 8 Dicke, “Waiting,” 196–197. 9 Halftone is a photomechanical process in which a photograph is converted into dots of varying sizes or densities through a glass screen, allowing it to be printed in black and white in newspapers, with the illusion of different tones of gray. See David D. Perimutter, “Photojournalism (Still News Photography),” in Encyclopedia of International Media and Communications, ed. Donald H. Johnston (Santa Barbara, CA: Praeger, Inc., 2003), 471. 10 See Michael Carlebach, The Origins of Photojournalism in the United States (Washington, DC: Smithsonian Institution Press, 1992). 11 Hilary Roberts, “Photography,” in International Encyclopedia of the First World War, eds. Ute Daniel, Peter Gatrell, Oliver Janz, Heather Hones, Jennifer Keene, Alan Kramer, and Bill Nasson (Berlin: Freie Universität Berlin, 2014). 12 Loop Langton, Photojournalism and Today’s News: Creating Visual Reality (Chichester, West Sussex: Wiley-Blackwell, 2008), 16–17. 13 Estelle Jussim, “The Tyranny of the Pictorial: American Photojournalism from 1880 to 1920,” in Eyes of Time: Photojournalism in America, ed. M. Fulton (New York, NY: Little, Brown and Company, 1989), 38. 14 “The Camera as a Deadly Weapon,” The Indianapolis Star, March 31, 1918, 52. 15 Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch, “Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” PNAS 104, no. 18 (May 1, 2007), https://www.pnas.org/doi/10.1073/pnas.0610941104. 16 Dicke, “Waiting for Flu,” 198.

190  Louisa Iarocci 17 A leading theory today is that the illness actually broke out among soldiers in the United States, who when dispatched to serve in World War I, spread it to Europe. The number of US troop deaths due to influenza and pneumonia has been said to have been roughly comparable to the casualties caused by battle. Sarah Boslaugh, “Influenza,” Encyclopedia of Epidemiology (Thousand Oaks, CA: Sage Publications, Inc., 2012). 18 According to the CDC, cases of the flu are first detected in March of 1918 in soldiers at Camp Funston in Kansas. On April 5, 1918, the Weekly Public Health Report reported 18 severe cases and three deaths in Haskell, Kansas. “1918 Pandemic Influenza Historic Timeline,” Centers for Disease Control and Prevention, accessed May 1, 2020, https://www.cdc.gov/flu/ pandemic-resources/1918-commemoration/pandemic-timeline-1918.htm. 19 Military installations are again identified as the first sites of outbreak of the second wave of the disease – in particular Camp Devens, an Army training camp just outside Boston and a naval facility in Boston. CDC, “1918 Pandemic.” 20 Hatchett et al., “Public Health Interventions.” 21 Dicke, “Waiting for Flu,” 198. 22 Philip Strong, “Epidemic Psychology: A Model,” Sociology of Health & Illness 12, no. 3, (September 1990): 249–255. https://doi.org/10.1111/1467-9566.ep11347150. 23 Strong, 249. 24 Samantha N. Edwards, “Understanding the Present thru the Past: A Comparison of Spanish News Coverage of the 1918 Flu and the COVID-19 Pandemics,” Journalism & Mass Communication Quarterly 99, no. 1 (2022): 12–15. 25 James T. Patterson, “How Do We Write the History of Disease,” Health and History 1, no. 1 (1998): 7–15. 26 Gordon Henry Hirschberg, “Medical Science’s Newest Discoveries about the Spanish Influenza,” Richmond Times-Dispatch, October 6, 1918, 2. The article also appeared in the South-Bend News-Times (Indiana) on October 6, 1918, 14 and the Washington Times, October 6, 1918, 22. 27 “In order to guard against infection it is necessary to keep the mouth and nose clean and healthy by means of some mild antiseptic and to treat all colds promptly.” Hirschberg, “Medical Science,” 2. 28 Langton, Photojournalism, 16–17. 29 Edwards, “Understanding the Present,” 21. 30 Ibid. 31 J. A. Kuypers, “Framing Analysis from a Rhetorical Perspective,” in Doing News Framing Analysis: Empirical and theoretical perspectives, eds. J. A. Kuypers and P. D’Angelo (New York, NY: Routledge, 2009), 289. 32 Other reports stated that the virus did not “travel in the air” but rather was spread by physical contact. “Killing the Flu,” Reading Times, December 31, 1918, 4. 33 Hirschberg, “Newest Discoveries,” 2. 34 “If You Must Kiss, Kiss via Kerchief, is Warning,” The Sun, August 17, 1918. https://www.snopes.com/fact-check/handkerchiefs-kissing-covid/. 35 Hirschberg, “Newest Discoveries,” 2. 36 Edwards, “Understanding the Present”, 21. 37 Nancy Rockafellar, “ ‘In Gauze We Trust’: Public Health and Spanish Influenza on the Home Front, Seattle, 1918–1919,” Pacific Northwest Quarterly 77, no. 3 (July 1986): 104–105. 38 People who would not wear a mask were called “dangerous slackers,” referring to those who did help the war effort. “Wearing Masks Recommended by Board of Health,” The Morning Union (Grass Valley, California), October 23, 1918, 5. 39 A photo story published in the Chicago Tribune featured a Street Sweeper, County Hospital Nurse and Interns all wearing “gas” masks, again linking the fight with the flu with World War I. “Gas Masks in Chicago,” The Chicago Daily Tribune, October 2, 1918, 1. 40 See, for example, “Epidemic Mask,” showing a Red Cross nurse wearing a mask, which appeared in the New Britain Herald, CT, October 10, 1918, 4. 41 Bristow, American Pandemic, 131–135. 42 Jessica Brabble, Ariel Ludwig and E. Thomas Ewing, “  ‘All the World’s a Harem’: Perceptions of Masked Women During the 1918–1919 Flu Pandemic,” nursingclio.org

Capturing the Invisible Enemy  191 (September 8, 2020), https://nursingclio.org/2020/09/08/all-the-worlds-a-harem-perceptionsof-masked-women-during-the-1918-1919-flu-pandemic/. 43 Other stories featured children impacted by the epidemic, especially the “grip orphans” who had lost their parents to the disease. “Fund to Aid ‘Flu’ Orphans is Sought,” The Washington Times, October 22, 1918, 2. 44 Molly Billings, “The Medical and Scientific Conceptions of Influenza,” The Influenza Pandemic of 1918 (June 1997, modified RDS February 2005), https://virus.stanford.edu/uda/fluscimed. html. 45 Miles Ott, Shell F. Shaw, Richard N. Danila, and Ruth Lynfield, “Lessons Learned from the 1918– 1919 Influenza Pandemic in Minneapolis and St. Paul,” Public Health Reports 122, no. 6 (November–December 2007): 803–810. 46 Medical studies have determined that death rates were approximately 50% lower in those cities that enforced these public health measures earlier. Hatchett et al., “Public Health Interventions.” 47 “Epidemic shows no signs of immediate abatement,” Variety, October 11, 1918, 1. 48 “ ‘Clean-Up Week’ To Be Strongly Pushed,” Dallas Morning News, October 13, 1918, 2. 49 “Gov. Stephens Calls on All People to Wear Gauze Masks,” San Francisco Chronicle, October 23, 1918, np. 50 Jennifer Carrie Hass, “Press Coverage of Three Epidemic Diseases,” MA Thesis (University of Minnesota, 2004), 95. 51 “ ‘Clean-Up Week’ to Be Strongly Pushed,” Dallas Morning News, October 13, 1918, 2. 52 “Sprinkle Streets with Antiseptic,” The Buffalo Commercial, December 26, 1918, 9. 53 “Call on Women of Waukegan with Cars to Step Up,” Waukegan News-Sun, October 9, 1918, 8. 54 Langton, Photojournalism, 16–17. 55 Between October 4 and October 11 a series of these full page photo sections in the Evening Ledger in Philadelphia included images related to the pandemic before returning to covering war reporting from the front and less serious local events. 56 Commercial photographers were banned from the war zone by all Allied armies. Frank J. Wetta, “Photography and the American Military,” in A Companion to American Military History, ed. R. Eberwein (New York, NY: John Wiley and Sons Inc., 2009), 819. 57 Susan Sontag, Regarding the Pain of Others (New York, NY: Farrar, Straus and Giroux, 2003), 20–21. 58 Bernd Hüppauf, “Modernism and the Photographic Representation of War and Destruction,” in Fields of Vision: Essays in Film Studies, Visual Anthropology, and Photography (Berkeley: University of California Press, 1995): 99–101. 59 Thomas Dicke points out that consolidating the sick also allowed more efficient use of medical personnel. Dicke, “Waiting for Flu,” 203. 60 “New Hospital for Influenza is Ready at Fair Grounds,” Worchester Telegram, October 5, 1918, np. 61 See also “Fighting the Influenza,” The Mellette County Pioneer, October 4, 1918, 3, and “State Health Authorities Visit Eight Tent Hospitals used in War on Grippe,” The Boston Globe, October 16, 1918, 9. 62 Nurses, in particular, were especially in need for “keeping patients clean, fed, hydrated and comfortable.” Dicke, “Waiting for Flu,” 203. 63 “Close Hospital in Court House,” Seattle Post-Intelligencer, November 21, 1918, 18. 64 An appeal for “delicacies and broths” for 22 “Chinese” and equal number of poor children was made in the New York Herald. “Drop of 745 in New Grip Cases in N.Y.,” New York Herald, October 14, 1918, 12. The Dallas Evening Journal reported that the miserable living ­conditions and lack of equipment were leading to extreme cases among people from Mexico. “Poor Suffering From Influenza; Charities Helping,” Dallas Evening Journal, October 23, 1918, 6. 65 “Epidemic Losing Hold on Seattle,” Seattle Daily Times, October 23, 1918, 9. 66 Seattle Health commissioner Dr. J. S. McBride even directly accused those who “lived in congested rooming houses and hotels” of driving up infection rates by waiting too long to admit themselves for treatment. “Influenza Mask Order Extended,” Seattle Daily Times, October 26, 1918, 12.

192  Louisa Iarocci 7 “ ‘Give us beds, bedding’ is the Plea of Flu Hospital,” Oakland Tribune, October 14, 1918, 7. 6 68 How to Nurse “Flu Victims,” Chicago Sunday Tribune, October 20, 1918, 1. 69 Janice Hume, “The ‘Forgotten’ 1918 Influenza Epidemic and Press Portrayal of Public Anxiety,” Journalism and Mass Communication Quarterly 77, no. 4 (December 1, 2000): 899, 909. 70 Hume, “The ‘Forgotten,’ ” 909–910. 71 “Give us beds,” Oakland Tribune, 7. 72 Vanessa Northington Gamble, “  ‘There Wasn’t a Lot of Comforts in Those Days’: African Americans, Public Health, and the 1918 Influenza Epidemic,” Public Health 125, no. 3 (2010): 114–122. 73 “Early Closing kept the crowds off the streets,” The Miami Herald, October 22, 1918, 1. 74 “Soldiers to Bury Them,” The Baltimore Sun, October 26, 1918, 14. 75 “Preparing to Bury City’s influenza Victims,” Unidentified Philadelphia newspaper, circa 1918, Undated Clipping from Scrapbook, August 1918–March 1919 (Historical Medical Library of the College of Physicians of Philadelphia). 76 Strong, “Epidemic Psychology,” 251.

9 Contaminating the “End of AIDS” in Contemporary British AIDS Media Chase Ledin

Introduction In this chapter, I explore the relationship between contagious bodies visualised in film, television, and contemporary British AIDS media. Medical historian Allan Brandt argued that the histories of HIV/AIDS reflect “deep cultural fears about disease and sexuality [from] the early twentieth century,” including concerns about “hygiene, contamination, and contagion” that draw from a “pervasive fear of the urban masses, the growth of the cities, and the changing nature of familial relationships.”1 Earlier epidemics, including cholera and tuberculosis, framed contagious bodies as a problem of working-class relations. To that end, the problem of “social contagion” was intimately bound up in the politics of personal habits, social relationships, and lifestyle choices.2 Similar concerns emerged in response to HIV/AIDS in the 1980s and 1990s: an epidemic that was first documented amongst gay and bisexual men, a decidedly marginalised community marked by their active sexual lives outside the family home. In responding to the emerging crisis, gay and bisexual men were uniformly cast as “natural” sources of contamination, and thus their bodies were further transformed through metaphors of hygiene and contagion.3 For social critics like American senator Jesse Helms and the British Reverend Robert Simpson, HIV/AIDS was “ ‘proof’ of a certain moral order.”4 HIV/AIDS was the natural consequence of engaging in homosexuality. These conservatives argued that a return to the moral majority could be found through family values and disassociation from sexual promiscuity.5 This response, which comprised the longer social hygienist anxieties about cross-class contamination (an anxiety drawn from nineteenth- and twentieth-century eugenics projects6), situated homosexuality as “social waste” and reframed disease transmission in the media as a problem easily solved by abstinence, focusing on the family and pathologising individual behaviours.7 As sociologist Cindy Patton notes, this moralist thinking threaded early public health and governmental responses to AIDS crisis.8 Much contemporary work has criticised and reframed these responses, especially to focus on stigma and homophobia. In that sense, responses to HIV/AIDS since the 1990s have sought to unpin gay male sexuality and disease, thereby troubling the idea that gay and bisexual men occupy inherently infectious lifestyles.9 However, as I will show, even whilst more progressive perspectives about disease and homosexuality have changed contemporary discourses about HIV/AIDS, ideas about contagion and moral disorder continue to predominate representations of life with HIV/AIDS in Britain today. I suggest that this is especially true of AIDS media that tries to inform contemporary lifestyle choices to bring about an “end of AIDS.”10 DOI: 10.4324/9781003294979-12

194  Chase Ledin In what follows, I examine contemporary AIDS media that represents gay and ­ isexual men negotiating HIV transmission in both historical and near-present scenarios. b Specifically, I analyse how the web series The Grass Is Always Grindr (Luke Davies, 2018–2019) and the television show It’s a Sin (Russell T. Davies, 2021) represent contagious bodies to narrate AIDS crisis and articulate ideas about how to end new HIV transmissions. The narrative and visual choices within these media, I suggest, revitalise AIDS crisis for contemporary viewers and thus invoke crisis to create a sense of urgency amongst gay and bisexual communities who have new tools to end HIV transmissions. I situate these images within the context of the national and global public health movement to “end AIDS,” which centralises new and effective treatments for HIV infection to idealise a “society without AIDS” by 2030.11 In doing so, I demonstrate how both The Grass and It’s a Sin represent contagious bodies on screen. I argue that these representations limit the frame of AIDS pasts, presents, and futures “after AIDS,” but also provide new ways of interpreting those histories and temporalities. A History of Hygienist Imagery and Contemporary AIDS Media In June 1981, the US Centers for Disease Control and Prevention (CDC) reported a significant increase in pneumocystis pneumonia-related deaths amongst gay men (a fungal infection of the lungs, commonly called PCP). The term “gay-related immune deficiency” (GRID), which circulated in late 1981 and early 1982, was used to describe a series of opportunistic infections amongst gay men.12 In September 1982, the CDC refined this definition and re-classified GRID as an “acquired immune deficiency syndrome” (AIDS)  – an ostensibly “neutral” and scientific categorisation of infection that was spreading ­outside gay male communities.13 The human immune deficiency virus (HIV) was formally documented in 1983, thereafter leading to a host of controversies about who facilitated its onward transmission and how to stop it. Though the HIV/AIDS pandemic is a global phenomenon – which Jih-Feh Cheng, Alexandra Juhasz, and Nishant Shahani have characterised as a scattered “distribution of crises” with localised and historically specific factors that contribute to the sustained transmission of HIV across national and international contexts14 – gay and bisexual male histories have predominated stories about HIV/AIDS. This is because whilst HIV/AIDS does not only affect gay and bisexual men, HIV/AIDS has inordinately impacted this community in the West. Since the 1980s, gay and bisexual men have used art and visual media to respond to HIV/AIDS crisis.15 Much of the art and visual media archive, then, reflects the “problem of AIDS” through the subjective accounts of gay and bisexual men. In the mid-to-late 1980s, AIDS media used visual tropes to standardise narratives about overcoming homophobia and contagious bodies, to provide resources for communities struggling to access information and stories about HIV/AIDS. Films like John Erman’s An Early Frost (1985) and Gregg Araki’s The Living End (1992) focused on visualising the violence of AIDS deaths to advocate for the severity of the AIDS crisis and the increasing need to intervene. AIDS cinematic histories also ruminated on kinship and community ties, such as Arthur J. Bressan Jr’s Buddies (1985) and Norman René’s Longtime Companion (1989). This early AIDS media also illuminated queer community struggle to employ scientific knowledge and to agitate for social change, as in Gregg Bordowitz’s Fast Trip, Long Drop (1993). Many of these visual media took aim at governmental messages about social contagion and contamination.16 Alternative media strategies, including home videos and testimonials, documentaries of activist

Contaminating “End of AIDS” in Contemporary British AIDS Media  195 interventions, and art film parodying governmental neglect, were used to generate action and ­information for those individuals who could not access early (toxic) treatments for HIV infection like AZT.17 In 1996, following the emergence of effective HIV treatments, the landscape of AIDS media transformed to accommodate experiences of living “healthy” lives with HIV infection. This narrative shift, which Gary Dowsett describes as a “post-AIDS” framing of gay and bisexual men negotiating safer sex with treatable HIV infection, entangled representations of AIDS deaths with images of chronic illness.18 Media studies scholar Dion Kagan describes this “post-crisis” imagery, emerging from the late 1990s into the early 2010s, as largely representing white gay men who religiously took their antiretrovirals and avoided risky sex.19 For Christopher Castiglia and Christopher Reed, this narrative shift validated “forgetting the trauma of AIDS,”20 thereby cleaning up gay male imagery to focus on “squeaky clean, asexual or monogamous, life- and love-affirming” gay members of society.21 In the American context, John Schlesinger’s film The Next Best Thing (2000), for instance, represented a gay man struggling to situate his sexual desires alongside raising a child with his female best friend. As Kagan attests, little reference to the ongoing struggles of HIV transmission exists within the “post-AIDS” narrative frame. In the British context, Russell T. Davies’s television series Queer as Folk (1999–2000) followed the out-and-proud lifestyle of a Manchester-based friend group working towards “healthy” sexual and romantic relationships. Here, too, little recognition was given to the ongoing problem of HIV/AIDS on screen.22 This narrative cleansing of HIV/AIDS was confronted by a resurgence of interest in AIDS activist video projects in the early 2010s. Ted Kerr (2017) coined this new AIDS media landscape as the “AIDS crisis revisitation” movement, which was: different than the work that had been happening since the start of the AIDS crisis, in that looking back, it was understood to be something new. On screens, walls and in discourse, mass death and community responses are remembered through culled and curated video and film footage, photos, and ephemera from personal collections as well as individual and institutional archives. Footage of pre/re-gentrified urban centers populated primarily by passionate, white 20-somethings fighting for their lives, conjures memories and trauma for many who were there, as well as a possible displaced nostalgia for those who were not, and a desire for many to be able to return to such an engaged moment, yet without the loss.23 For Kerr, crisis-revisitation imagery reflected on AIDS activist archives, such as How to Survive a Plague (2011) and United in Anger (2012), but also risked further cleansing those narratives by articulating AIDS history as demonstrably middle class, white, cisgender, and male – as in Dallas Buyers Club (2013) and Holding the Man (2015).24 To that end, more recent examples of contemporary AIDS media, like Ryan Murphy’s television series Pose (2018–2021) and Russell T. Davies’ television series It’s a Sin (2021), have sought to counter what Sarah Schulman has called the “gentrification” of AIDS media and history.25 In the British context, few AIDS films and television series were produced during the early “post-crisis” moment (1996–2010) and the crisis-revisitation movement (2010–present).26 However, as in the North American context, the mid-to-late 2010s saw renewed interest in stories about HIV/AIDS across British film, television, theatre, and art. For example, the VICE documentary Chemsex (2015) told the story of “sexualised drug

196  Chase Ledin use”27 amongst gay and bisexual men, specifically depicting scenes of forced drug use and intentional HIV transmission.28 Then, a series of London-based stage plays emerged to address the complexities of HIV transmission in chemsex cultures, including Peter Darney’s 5 Guys Chillin’ (2016), Patrick Cash’s The Chemsex Monologues (2016) and The HIV Monologues (2016), and Alexis Gregory’s Riot Act (2018). These plays set out to tackle the problem of HIV within modern London sexual cultures – specifically to tackle problematic chemsex use, or the practice of using crystal methamphetamine, mephedrone, and GHB/GBL during sex.29 In doing so, these plays extolled the virtue of “healthy” relationships through regular testing, treatment, and therapy, and indirectly positioned conservative notions of familial and romantic relationships and a general sexnegative response to ending new HIV transmissions. In the following sections, I examine two key examples of contemporary AIDS visual media that follow from this media culture, specifically focusing on how they represent contagious bodies. First, I explore how Luke Davies’s web series The Grass Is Always Grindr (2018–2019) narrates the AIDS crisis in the contemporary context of chemsex cultures, analysing how its representation of contagious bodies narrowly defines HIV prevention strategies and creates a moralistic narrative about gay male relationships. I then bring The Grass into conversation with Russell T. Davies’s BBC television show It’s a Sin (2021), which I argue represents contagious bodies to motivate viewers to learn more about the AIDS crisis and to acquire tools to prevent HIV in the present. In a later section, I then explore how and why these themes contribute to the national and international public health projects to “end AIDS.” I situate both media texts as key cultural products that ruminate on a societal fear of endless HIV transmission. I suggest that these media exemplify the anxiety that surrounds the perceived contamination of “ending AIDS” public health programming and argue that such positioning limits our understanding of the pasts, presents, and futures of HIV/AIDS. The Grass Is Always Grindr Written by playwright Patrick Cash, directed by Luke Davies, and commissioned by the London-based sexual health clinic 56 Dean Street, The Grass Is Always Grindr (2018– 2019) is a seven-episode web series that dramatises sex and drugs, open relationships, and social media use amongst gay and bisexual men in London. The series follows protagonist Joe (Denholm Spurr) and his open relationship with Adam (Taofique Folarin). The narrative centres on the potential for love and secure attachments and foregrounds the serious threat of HIV transmission within and across formal and casual relationships. From the opening scene, where Joe appears isolated in his room reflecting on the death of his best friend, to the final scene, where Joe is ostracised and denied a budding long-term relationship, The Grass represents the possibilities and follies of casual sex. As such, it takes a morally conservative approach: exposing Joe as reckless and in need of redemption whilst figuring Adam as the morally just and stable character. In this way, the series centralises contagious bodies. Hence, my analysis attends to how and why these contagious bodies are represented and how they interact on screen. I begin with protagonist Joe. In the opening shots of Episode 1, Joe lays on his bed, scrolling through social media. He occasionally looks to a photo of his recently deceased best friend. The camera lingers for a long time on this scene, establishing the sombre mood. Joe then decides to have Adam over for a hook-up. Over the course of several minutes, there is elaborate sexual build-up, and the sex hinted at off screen after failed

Contaminating “End of AIDS” in Contemporary British AIDS Media  197 seduction. Afterwards, they talk about Joe’s love life. Adam asks what Joe wants. Joe waffles – with clear pining for his lost friend, whose photograph occasionally comes into view. Here, Joe’s emotions wash over the sexual encounter. He’s sad so he invites Adam to keep him company – even if, as his demure attitude suggests, he only really wants to be cuddled. The series begins with this muted, but no doubt melodramatic, representation of sexual and emotional desires to establish a sad and sobering narrative about the troubles of substance use and the consequence(s) of failed romantic attachments. Here also, the series represents Joe as a contagious body who overflows with emotions – and later, micro-organisms, conflicting intentions, and personality flaws – which threaten to infect other people in his life. Joe is constructed by the writer as a contagious subject to be pitied and who requires rehabilitation. Joe’s sexual encounter with Adam leads to a trip to the clinic, where Joe is treated for an STI which he gives to Adam. Having never been tested for HIV or STIs, Adam also discovers he is HIV positive. Already in Episode 2, the theme and problem of contagious bodies is highlighted as a key function of The Grass’s narrative arc. Both Joe and Adam are infectious – with varying degrees of treatment and recovery. Their redemption is tied to the purification of their own bodies as well as their dedication to making their relationship work. Here both the function of biomedical treatment and the perceived stability of a monogamous relationship serve as routes for rehabilitating both contagious bodies. Dion Kagan has previously described this historical narrative construct as “sero-melodrama.”30 In the remainder of the series, the narrative follows this sero-melodrama: visualising the possibilities – and failures – of adhering to biomedical treatments, emotional growth, and romantic attachments. The series’ contagious bodies, then, are represented using the tools of melodrama: narrating the problem of sustained AIDS crisis through individual flaws and lifestyle practices, which are seen as contaminating the desire and ability to end new HIV infections. The sexual health nurse Ryan (Matthew Hodson) also exemplifies sero-melodramatic narrative. From Episode 2 onwards, his character frames the potential resolution to AIDS crisis and the perception that strategies to intervene in HIV transmission are contaminated by ongoing sexual practices. For instance, in Episode 7, Ryan delivers a monologue about his experience of the early AIDS crisis. Having seen many of his friends and lovers die during the early AIDS crisis, Ryan brings this experience to bear on his tireless work as a sexual health nurse for 56 Dean Street. He administers tests and safer sex advice – including information about HIV-PrEP and HIV treatment – for both Joe and Adam. Based on his interactions with these characters, he laments the younger generation’s dispirited participation in ending HIV transmissions. Whilst watching the London Gay Men’s chorus in a local church – a scene that is not without irony, given organised religion’s historical homophobia and neglect during the early AIDS crisis – Ryan asks his boyfriend: Do you ever get angry? I was so young when I started on the AIDS ward. They’d all tease me and say: Ryan, do you ever eat fellatio? A bit later, I’d wrap their bodies in biohazard tape in the morgue. So now, these young guys come in and say: “I was on a chems bender all weekend, and I forgot to take my meds.” I just think: take the fucking drugs. My friends died for [this] so that you could live. Ryan laments his inability to properly serve people precisely because they refuse to simply “take the fucking drugs.” In this way, Ryan acknowledges contagious bodies

198  Chase Ledin as a key site of intervention. He highlights the erratic and highly individualised choices that emerge from sex, substance use, and daily life. Yet Ryan also exposes himself as a contagious body. He is an emotional and political force that, on the one hand, demands a narrow understanding of how to live a healthy life and, on the other hand, begs to be seen and admired as a legitimate subject within London’s sexual cultures. Ryan orates the need for stable relationships and through these relationships idealises a world without AIDS. To that end, his contagious body infects other characters with a historically moralistic approach to HIV prevention: that is, the idea of reducing partners and entering monogamous relationships to prevent HIV. A key receiving character of this moralistic approach is Adam. In a clinical interaction with Ryan in Episode 3, Adam says: “I won’t miss a dose, I promise.” But Adam’s statement is a key character flaw from which The Grass produces a powerful moral message. Indeed, before his boxing match in Episode 5, Adam throws away his antiretroviral treatments. This gesture – Adam throwing the medicine into the bin – extends Ryan’s frustration, but it also catalyses the series’ main redemption narrative. In Episode 7, Adam eventually returns to taking his medication, and, in the final scenes, is given the power to say no to Joe, who refuses to adhere to HIV prevention strategies and belies the safety and security of the monogamous relationship. The unwillingness to adhere to HIV treatments is a transgression of a desired future “after AIDS.” Contagious bodies foreground this broken promise, and critically attesting to their erratic and unusual interactions allows the viewer and analyst to understand both the writer’s appeal to a future with less HIV and more secure romantic attachments. But also, analysing contagious bodies illuminates the potential limitations of a strict, public health message about ending new HIV transmissions. Contagious bodies are not confined to the narrow conventions of sero-melodrama or, indeed, to the public health idealisation of a world with less or no HIV transmission. Indeed, it is worth attesting to ways in which contagious bodies in The Grass complicate the notion(s) of a world with less HIV transmission, upending the historical notion that HIV treatment is the predominant frame through which to articulate the AIDS crisis and the sexual cultures impacted by sustained HIV transmission. In Episode 6, Joe agrees to meet a Spanish man for a hook-up. Upon meeting, Joe decides he is not interested in sex. Instead, he wants to cuddle. The man resists the romantic gesture and tells Joe he’s going to a sex party instead. Out of pity, Joe agrees to write on the man’s back: “If passed out please don’t bareback” (Figure 9.1). Here, the viewer sees a dichotomy of contagious bodies: a man who plans to pass out during chemsex juxtaposed with Joe who wishes to disrupt and tame his contagious capacity. The Spanish man figures a contagious body willing and open to the contagion of chemsex – the written warning signifies intentionality even when cognition fails. Using art historian João Florêncio’s theory of porous masculinities, this opening and closing of contagious bodies might best be described as apertures of “porosity.” For Florêncio, bodies have the capacity to give and receive fluids, emotions, and affects, with varying degrees of pleasure and harm. Bodily porosity allows both seminal and affective materials to move across boundaries and borders without necessary pre-emption, providing a sort of freedom from the anxious state of being (whether in modern society or individual insecurity).31 In this scene, Joe’s pitying response signifies the series’ dominant message – i.e. encourage individuals to become aware of their unhealthy behaviours. Yet interpreting bodily porosity in this scene might enable the viewer to see beyond the series’ narrative preoccupation with “unhealthy” behaviours. Instead, understanding this contagious body as

Contaminating “End of AIDS” in Contemporary British AIDS Media  199

Figure 9.1 Joe writes a warning on a man’s back. Scene from Luke Davies, The Grass Is Grindr (2018–2019). Image permission via Luke Davies and Patrick Cash.

constituting a new form of inter-personal practice of sexual ethics and care might open the scope of understanding contagious bodies as multiplicitous and ethically complex.32 Where Joe’s and Adam’s bodies are seen as conventional contagious bodies, whose melodrama heightens the fear of HIV transmission which, in the series’ main narrative, can only be rehabilitated by biomedicine and psychotherapy, the Spanish man’s contagious body upends the easy structuring of a black-and-white narrative about contagion and disease transmission. Thus, a porous, contagious body changes the narrative such that what it means to “end HIV” in the series might not simply mean adhering to biomedicines or building stable relationships (a point to which I will return below). The porous body complicates the assertion that managed bodies can be sources of overcoming AIDS crisis. As the series’ antagonist Jean-Paul (Alexis Gregory) reveals, contagious bodies have agency. To that end, they can be willing and forceful, changing the terms of HIV infection and its relationship to sexual pleasure and intimacy. In Jean-Paul’s case, porosity is used to produce self-pleasure and cause harm to those on the receiving end (since, as an HIV-positive man, he only selectively takes his treatments). Yet as Florêncio articulates, this simulated harm on screen – heightened by the sero-melodramatic ­narrative – is nullified by the presence of other porous bodies. That is, in Episodes 2 and 3, Joe begins to take daily pre-exposure prophylaxis, and in doing so, pre-empts the potential harm caused by Jean-Paul’s failure to take his medication. Of course, this porosity does not save secondary character Leo, whose wilful ignorance about HIV treatment and prevention – and his neglectful encounters with Jean-Paul, in which he allows Jean-Paul to use his body however he wants – leads to a positive diagnosis. On the one hand, it is easy to read The Grass as a moralistic account that draws from historical perceptions of contamination and infection – drawing not simply from the context of 1980s AIDS crisis but also from the longer histories of pandemics and disease in society. On the other hand, my analysis also suggests that to truly understand the problem of AIDS within contemporary British media, it is necessary to examine and critique the representation and interaction of contagious bodies. Doing so allows the media analyst to describe traditional perceptions of healthy and unhealthy behaviours, as constructed within professional HIV health promotion. It also allows us to unpick the

200  Chase Ledin messy, social nuances of sexual life in the contemporary moment: and to allow subjective and conflicting notions of sex and contagion to flow through contagious bodies without insisting on the simplicity of a single way of living with and through HIV/AIDS crisis. Put simply, The Grass tells us more through its dubious sexual politics – that is, what it perceives as unhealthy – than through its simplistic moralistic narrative. In the next section, I consider how contagious bodies are represented in Russell T. Davies’s television show It’s a Sin. In It’s a Sin, I suggest that contagious bodies operate across temporal planes and offer viewers an anxious positionality from which to acquire the agency to learn about the pasts and presents of HIV/AIDS crisis. It’s a Sin Russell T. Davies’ BBC television series It’s a Sin (2021) portrays a group of queer friends living in 1980s London as the onrush of the AIDS pandemic overcomes scenes of euphoric disco and sexual liberation during the 1970s. The five episodes move from 1981, in which the virus is emergent but unnamed, to 1991, when deaths from AIDS reach dramatic heights. Through this temporal movement, It’s a Sin thematises the mounting devastation of familial neglect, homophobia, and lack of governmental intervention. The gay men depicted are both defiant and passive, taking on tropes from earlier representations of AIDS crisis, including the role of the activist, the patient, and the repenting son.33 As film studies scholar Monica Pearl suggests, these characters embody historical anxiety about social contagion and a return to the family as retribution for their homosexual practices.34 Framed as such, It’s a Sin might be thought of as a conservative history of HIV/ AIDS. Whilst I agree with this argument, I pursue a somewhat different claim herein. I attend to the representation of contagious bodies to articulate how these bodies interact and to question what their porosity (as in The Grass) offers our understanding of the pasts, presents, and futures of HIV/AIDS. Specifically, I examine how contagious bodies underpin the anxiety and promise of living with the traumas of AIDS crisis, to provide viewers with a new way of thinking about AIDS crisis. All the protagonists in It’s a Sin might be characterised as contagious bodies. I focus on the characters Henry (Neil Patrick-Harries) and Colin (Callum Scott Howells), who are both tragic subjects who acquire HIV and die from AIDS. In Episode 1, which is set in 1981, Colin befriends Henry at his day job as a tailor-in-training. Henry introduces Colin to his long-term partner, and over several scenes, the viewer sees Colin growing closer to Henry. At the same time, the characters learn about a mysterious illness amongst gay men in New York. One day, when Henry stops attending work, Colin goes to his flat to see him. No one answers the door. Colin later learns from the neighbour that Henry has been admitted to the local hospital. Colin finds Henry in the contagion ward, where Henry – with visible Kaposi’s sarcoma lesions – wastes away in bed. When Colin learns that Henry’s lover has gone home to Portugal (cared for by a possessive mother), Colin seeks to comfort him. But Henry pays him no mind. Henry speculates where he acquired the illness, likening his symptoms to a spot of mould that returns between the kitchen tiles. “Was it the mould or the chest?” he wonders, paralleling his experience with his fierce (and ultimately unsuccessful battle) with the mould. The fungus returns, despite Henry using a variety of solvents and cleaners. For Henry, this adequately describes the encroaching illness that pervades his own body and his frustration with his inability to eradicate the problem. This simple metaphor attests to the anxiety of contagious spread, which is not only a fungal infection within his body, but

Contaminating “End of AIDS” in Contemporary British AIDS Media  201 also a transitory phenomenon in the environment. It is an act of prophylactic cleansing, which, in the history of hygiene and contamination, derives from the emergence of germ theory and the cleansing of nineteenth-century hospital wards.35 This metaphor can be read literally – as Susan Sontag described, the war metaphor employed to “defeat” disease through persistent battle36 – but if we attend it as a transitory, multi-body problem, it might also be seen as a form of porosity. Henry’s body is simultaneously contagious through his physical embodiment and the fungus he interacts with (and fails to extract) in/from his kitchen. It thus literalises the disease in his environment, and it also provokes the viewer to consider the expansiveness of HIV/AIDS beyond the body – that is, as more than a situated problem that can be reduced to the homosexual body. Viewed in this way, Henry’s body also becomes the spreading mould, generating contagion and infection – but as a natural process in the environment. This softening of the war metaphor – a romanticisation of the fight against AIDS – might be seen to naturalise the idea of living with HIV/AIDS (even whilst Henry dies in the process). This contagion passes indirectly through Colin, whose own HIV infection and AIDSrelated death mediate his character arc. Early in Episode 1, Colin is dubbed as the “virgin” who has few sexual experiences and refuses to disclose his sexual partners. In Episode 3, the viewer learns that Colin has been having sex in secret with his housemate, who as a closeted gay man has unknowingly passed on HIV to Colin. In a dramatic flashback sequence, the viewer learns that this secret tryst – romanticised through small gestures and knowing glances within the shared house and then a prominent scene in which the flatmate roughly fucks Colin without a condom – causes Colin’s rapid decline and death. Here, contagion follows many paths. Colin’s interaction with the closeted gay man, and his own conservativeness through his unwillingness to talk about his sex life, ruptures this idealised notion of the “virgin.” It contaminates the romanticised idea of a budding sexual relationship through discrete partners, thereby exposing what Florêncio described as the porous interflow of fluids, bodies, and affects. Contagion also extends through and into the family household, thereby transforming the domestic space into both a morally ambiguous household and a space that is necessarily informed by homosexual desire. The presence of the closeted gay son and the secret affair exposes the absurdity of the neat familial unit. The parents remain oblivious to the inner workings of homosexuality, yet the viewer has a privileged view into the visual gestures and glances that make homosexuality normalised in this space. The meaning of Colin’s and the housemate’s contagious bodies, then, is more than simply the moral decline of the family. It is also the normalisation of homosexuality using a backwards-looking narrative. There are two other representations of contagious bodies I wish to explore in It’s a Sin. More than simply the dual threat of homosexuality and disease, contagion is also portrayed as a social problem in It’s a Sin. Notably, both protagonists Jill (Lydia Baxter) and Ritchie (Olly Alexander) embody this contagion. In Episode 2, Jill helps to keep secret their friend’s HIV diagnosis. But when it is soon apparent that Gloria (David Carlyle) is too sick to hide his illness – despite showing up to the friend group’s shared flat, the Pink Palace, pretending to be healthy – Jill takes precautionary measures. Upon leaving the flat, Jill furiously scrubs Gloria’s used cup (Figure 9.2). In the middle of the night, Jill decides to smash the mug and discard it in the bin so the cup will not contaminate others. Shortly following, in a dramatic scene where his parents burn his belongings, the viewer learns that Gloria has died. Here, Jill undertakes a ritual cleansing of the house. Like Henry’s attack on the mould, Jill’s scrubbing has a double meaning: purging the domestic space of potential infection (real or imagined) and removing physical traces

Figure 9.2 Jill scrubs contaminated dishware. Scene from Russell T. Davies, It’s a Sin (2021). Still © Red Production Company & All3Media International.

202  Chase Ledin

Contaminating “End of AIDS” in Contemporary British AIDS Media  203 through symbolic and literal destruction of the used item. Where cleaning the surface doesn’t extract the problem, breaking the mug into pieces and throwing it into the bin – for Jill – has the effect of eliminating the contagion. If we attend to Gloria’s body, which is an extension for social hygiene, we immediately see the conservative impulse to clean up the situation. Here and throughout the series, Jill is an ally who is grounded in the instinct of cleanliness. Her body is never ruptured, despite her close contact, and thus her own form of contagion – that moral purification – comes to stand-in for her friends who are furiously scrubbed away and then removed from history altogether. Throughout the series, Ritchie is an obvious contagious body, given his own HIV diagnosis and eventual death. But I want to focus here on the symbolic contagion his actions and representation mediate. In Episode 2, Ritchie accosts an AIDS activist who attempts to leave flyers about HIV/AIDS on the bar. Roscoe pushes the man away, likening him to his father who proselytises about the end of times. The camera focuses on Ritchie who, amidst a change in up-beat music and staged pink lighting, rolls off a series of conspiracy theories about HIV transmission. Ritchie begins by suggesting AIDS is “a money-making scheme” by drug companies, humorously questioning the claim that HIV infects only gay men (“what about bisexuals? Do they only get sick every other day?”). In one of the only scenes where a character breaks the fourth wall, Ritchie speaks directly to the viewer, stating as facts myths that arose during the early AIDS crisis. But more than this, Ritchie addresses the viewer and steps away momentarily from the main narrative. He thus places the viewer in a critical perspective where AIDS crisis is both historically defined and brought into relief. That is, Ritchie’s contagious body bleeds across the edges of the frame, into the viewer’s home, thereby rupturing the assertion that what is being televised is simply an imaged historical past. Indeed, the rupture pulls the series into the present, making it (symbolically) so that the series is not itself history (though artist Brian Mullin has characterised It’s a Sin as revisionist history) and instead as a form of living contagion that intimately links with the contemporary viewer’s knowing eyes. This movement signifies not only a tainted past but also an impacted present and future. My point here is that these contagious bodies in their multiple manifestations embody a difficult history of HIV/AIDS, which is not solely defined by traditional narratives about family, relationships, or sex, but also about ways of seeing those relationships from the present. That is, contemporary AIDS media draws on a significant history of contagion, contamination, and social hygiene to realistically engage lived histories, but it also implants perspectives that did not exist in the past – vantage points that can only be seen from the present and which point to a particular present and future of HIV/AIDS within media. I explore this re-positioning of presents and futures in the next section, but here, it is important to recognise that It’s a Sin employs both the past and the present to engage the viewer in memory practices: specifically, in the action of reflecting on and reproducing AIDS crisis in new ways. Like The Grass, It’s a Sin represents contagious bodies to produce anxieties of AIDS crisis – especially the threat of unmitigated disease transmission – and thus presents a historically conservative narrative that links up with concerns about morality and social hygiene. Yet, as I have argued, both of these media texts portray porous bodies that, when read as open to exchanges of fluids, affects, and objects, change our understanding of both the media text itself and the histories it attempts to tell. In other words, reading for porous bodies foregrounds predominant narratives about healthy behaviours, drawing from the larger HIV prevention paradigm. But these bodies present challenges to that paradigm, too, which unsettle a clear notion of what HIV/AIDS crisis is and has been

204  Chase Ledin across history. In the next section, I bring this reading of The Grass and It’s a Sin into conversation with the contemporary context of HIV health promotion to understand the implications of reading porous bodies within a national and global movement to “end AIDS.” Contaminating the End of AIDS The media texts I explored above represent individuals engaging in sex and substance use and their narratives are conservative in nature. Cast in the language of moral conservatism and contamination, both The Grass and It’s a Sin gesture towards a particular view of HIV/AIDS history and are thus also complicit in its making. This is not to say that either of these texts is necessarily moralistic in its approach – though I suggest that The Grass has a particularly negative view of substance use. To clarify and deepen my ­assertions, thinking critically about the porosity of contagious bodies and their meaning for contemporary viewers, I want to bring them into context with ongoing ­public health ­perspectives that employ HIV/AIDS histories to talk about ending new HIV transmissions. This is not to say that all contemporary British AIDS media is created by health promoters or with professional health messages necessarily in mind. What I mean, as I suggested earlier, is that many of these media texts have been informed by professionals and activists working in and around HIV prevention in gay communities. To that end, all these media texts exist within a media culture that is intimately informed by new thinking about ending HIV – especially thinking that points towards a future point without HIV/ AIDS. In this section, I bring my analysis of The Grass and It’s a Sin into conversation with the ongoing context of “ending AIDS” public health promotion strategies. I thus seek to articulate how contagious bodies and their visualisation on screen serve for the institutional framing of ending new HIV transmissions in Britain by 2030. Contagious bodies within contemporary British AIDS media depend not only on ­historical fears of unmitigated disease transmission, both in general populations and specifically within gay and bisexual communities. They are also informed by a temporal politics that looks both backwards and forwards, a sort of “retrovision,” to use Kagan’s specific term,37 to engage a contemporary viewer in the practice and politics of remembering HIV/AIDS crisis today. This narrative practice – which playfully reconstructs ­historical facts, timelines, characters, and themes to present a new way of viewing AIDS crisis – aligns with the aspirational discourses of “ending AIDS” health campaigns in the UK and Europe. As sociologist Tony Sandset suggests, end-of-AIDS health campaigns are embedded in a firm belief in biomedical and technological interventions, such as increased HIV testing rates, the scale-up and rollout of antiretroviral treatment (ARV) drugs for people living with HIV (PLHIV), increased reliance on pre-exposure prophylaxis (PrEP) for people who are at high risk of contracting HIV, as well as enhanced HIV surveillance methods, such as viral load maps and HIV transmission mapping through so-called “phylogenetic testing”. On top of this, mathematical modeling of transmission rates, treatment coverage and testing uptakes have come to occupy increasingly central positions within epidemiological modeling, alleging to show the way toward the end of AIDS.38

Contaminating “End of AIDS” in Contemporary British AIDS Media  205 Focused on biomedical intervention and disease modelling, these campaigns devise ­ essages about ending HIV through the dissemination of medicines and treatment and m use motivational language to encourage national governments to take on the challenge and invest in new healthcare infrastructure. If this is the primary message of HIV prevention today, then all messages and images that concern HIV/AIDS presently relate to this (even if that relationship goes unstated). To exist in this moment, where HIV is both treatable and preventable, means also that how we view and interpret narratives about HIV/AIDS from both historical and contemporary perspectives is intimately informed by this drive to “end AIDS.” What I am suggesting here is that both The Grass and It’s a Sin emerged within this cultural context and that their internal messages and images are shaped by this context. To critically analyse the fictional history in It’s a Sin, then, is not to take as truth the television’s central narrative but rather to recognise its ability to transport the viewer for the purpose of learning about AIDS crisis to respond in the present. Indeed, because the television series is characterising the HIV/AIDS past as highly emotive, the viewer begins to see the viewing practices of the present. I suggest that this historical dramatisation with its entanglement of porous bodies allows not for histories to be truthfully told and followed on screen. Instead, it provides Russell T. Davies, Luke Davies, and their respective viewers to articulate key ideas within those histories – but also to recognise ways in which they might enter those histories by looking backwards. As I mentioned above, when Ritchie directly addresses the camera in It’s a Sin, the narrative world is ruptured and opened for the viewer to laugh at and contest the absurdity of the myths – taking the position of an informed viewer who knows that such myths are impossible. So too in The Grass, the familiar faces of notable HIV activists taking on the role of characters – including Jonathan Blake and Matthew Hodson – transforms The Grass into something more than just a harrowing narrative about the problems of gay men taking drugs during sex. These porous bodies, which contaminate both the narrative worlds and the viewers themselves, enable the shifting of histories and temporalities. Contagion, and the bodies it flows through and occupies, might be understood as something more dynamic than a moralistic narrative about healthy and unhealthy behaviours in need of rehabilitation. Contagion, then, concerns the shifting of historical and temporal boundaries, through dedication to understanding the past to make informed viewers in the present and to encourage practices and perspectives for different kinds of living in the future. Though no direct link can be made between The Grass, It’s a Sin, and the “end of AIDS” messages in public health promotion (though I have probed this idea elsewhere39), the context provides a useful positioning for art historians and media scholars. The media analyst concerned with health and medicine, and specifically an analyst of narratives about gay and bisexual men, must attend to the ways in which contagious bodies remain porous – and thus produce multiple meanings beyond moralistic or conservative notions of healthy behaviours. In place of focusing solely on the biomedical perspective of HIV/ AIDS histories, thus reinforcing a deterministic and static history, the media ­analyst should attest to interflows of fluids, affects, and meanings that cross bodies, spaces, and species. Leaving contemporary British AIDS media unproblematised means accepting the narrowing of AIDS pasts, presents, and futures to align with public health agendas that serve only a small part of the larger population at high risk of transmitting HIV. To that end, the media analyst should actively locate and interpret conflicting ideas about

206  Chase Ledin what pasts, presents, and futures of HIV/AIDS live in contagious bodies, and what those ­interpretations might provide for potential presents and futures “after AIDS.” Conclusion Contemporary British AIDS media draws on a significant history of contagion, contamination, and social isolation. These media often represent contagious bodies to inform viewers of the consequences of unmitigated HIV infection. Visualising contagious bodies has the added effect of encouraging viewers to learn more about preventing HIV transmission, thus linking them with contemporary messages about “ending AIDS” as a national and international public health programme. I suggest that whilst this linkage usefully provides material effects in the global effort to halt the HIV/AIDS pandemic, it also narrows our understanding of the histories, presents, and futures of HIV/AIDS crisis. That is, the predominating narrative about AIDS crisis, that AIDS crisis is unending without streamlined biomedical intervention – which both The Grass and It’s a Sin represent and explore – neglects the ways in which contagious bodies (and the act of interpretation) inform new ways of living healthy with HIV/AIDS in the present and future. More attention needs to be paid to how ideas about contagion, contamination, and hygiene are changed within and through the interflow of porous bodies – and if/how we might be able to create greater nuance within the messages that currently construct the “end of AIDS” as a narrow present and future. Acknowledgment This research was funded in whole, or in part, by the Wellcome Trust [Grant number 209519/Z/17/Z]. Notes 1 Allan Brandt, “AIDS in Historical Perspective,” American Journal of Public Health 78, no. 4 (1988): 367. 2 Charles Rosenberg, “What Is an Epidemic? AIDS in Historical Perspective,” Daedalus 118, no. 2 (1989): 6. 3 Simon Watney, Policing Desire: Pornography, AIDS and the Media (London: Methuen, 1987), 8. 4 Brandt, 368. 5 Dion Kagan, Positive Images: Gay Men and HIV/AIDS in the Culture of “Post-Crisis” (London: I.B. Tauris, 2018), 57. 6 Anne Hanley, “Histories of ‘a loathsome disease’: Sexual Health in Modern Britain,” History Compass 10, no. 3 (2022): 4–5. 7 See visual and textual examples in Tessa Boffin and Sunil Gupta, Ecstatic Bodies: Resisting the AIDS Mythology (London: Rivers Oram Press, 1990). 8 Cindy Patton, Inventing AIDS (New York, NY: Routledge, 1990). 9 Asha Persson, “Non/infectious Corporealities: Tensions in the Biomedical Era of ‘HIV Normalisation’,” Sociology of Health and Illness 35, no. 7 (2013): 1067. 10 This chapter was written amidst the rise of Monkeypox transmissions in the UK, especially amongst gay and bisexual men, and occurring through sexual and intimate contact. This context is outside the scope of the current study. However, ideas of contagion and moral disorder predominate within Monkeypox discourses. Public health discourses have drawn upon historical HIV/AIDS crisis narratives to articulate intervention strategies and to envision a synchronous “end” to new HIV and monkeypox transmissions.

Contaminating “End of AIDS” in Contemporary British AIDS Media  207 11 See Chase Ledin and Benjamin Weil, “ ‘Test Now, Stop HIV’: COVID-19 Pandemic and the ‘End of HIV’,” Culture, Health and Sexuality 23, no. 11 (2021): 1470–1484; and Chase Ledin and Benjamin Weil, “ ‘Healthy Publics’ and the Pedagogy of It’s a Sin,” European Journal of Cultural Studies (2022). https://doi.org/10.1177/13675494221097136. 12 Paul Flowers, “Gay Men and HIV/AIDS Risk Management,” Health 5, no. 1 (2001): 53. See also Chapter 1 in Steven Epstein, Impure Science: AIDS, Activism, and the Politics of Knowledge (Berkeley: University of California Press, 1996): 45–78. 13 Epstein, Impure Science, 45–55. 14 Jih-Feh Cheng, Alexandra Juhasz, and Nishant Shahani, AIDS and the Distribution of Crises (Durham, NC: Duke University Press, 2020). 15 See Douglas Crimp, Melancholia and Moralism: Essays on AIDS and Queer Politics (Cambridge: The MIT Press, 2002). 16 The classic example of HIV-related social contagion being Senator Jesse Helms’ assertions in the late 1980s that homosexual men should be branded if they received an HIV diagnosis (Schulman, 2021). Similarly, as Richard McKay (2017) demonstrates, the AIDS “Patient Zero” scapegoat – Canadian flight-attendant Gaëtan Dugas – exemplifies unfounded theories of the origin of HIV transmission in the United States, threaded through a homosexual social contagion narrative. 17 See Alexandra Juhasz, AIDS TV: Identity, Community, and Alternative Video (Durham, NC: Duke University Press, 1995), and Virginia Berridge, “The Early Years of AIDS in the United Kingdom 1981–86: Historical Perspectives,” in Epidemics and Ideas, eds. Terence Ranger and Paul Slack (Cambridge: Cambridge University Press, 1992), 303–328. 18 Gary Dowsett and David McInnes, “Gay Community, AIDS Agencies, and the HIV Epidemic in Adelaide: Theorising ‘Post AIDS’,” Social Alternatives 15, no. 4 (1996): 29–32. 19 Dion Kagan, Positive Images: Gay Men and HIV/AIDS in the Culture of ‘Post-Crisis’ (London: I.B. Tauris, 2018). 20 Christopher Castiglia and Christopher Reed, If Memory Serves: Gay Men, AIDS, and the Promise of the Queer Past (Minneapolis: University of Minnesota Press, 2011). 21 Kagan, Positive Images, 10. 22 Reflecting on Queer as Folk after the release of It’s a Sin, Russell T. Davies described this absence as intentional. He wanted to avoid entrenching the trauma of AIDS crisis at a moment, remarking that it was too soon for him – and for others – who were deeply impacted by AIDSrelated losses in British gay communities. 23 Kerr, Theodore. AIDS 1969: HIV, History, and Race. Drain Magazine. Accessed 19 March 2023. Available from: http://drainmag.com/aids-1969-hiv-history-and-race/, 2017. 24 The “white washing” of the AIDS archive has emerged as a dominant concern in American HIV/AIDS cultural studies. See for instance recent work by Jih-Fei Cheng, Nishant Shahani, and Sarah Schulman. 25 Sarah Schulman, Let the Record Show: A Political History of ACT UP New York, 1987–1993 (New York, NY: Farrar, Straus and Giroux, 2021). 26 Evidenced by the dearth of media scholarship about HIV/AIDS in British cinema and television in the 2000s. 27 David Stuart and Leigh Chislett, “The Dean Street Wellbeing Programme: Culturally Tailored Community Engagement Programmes to Combat a Challenging Epidemic,” HIV Nursing 16 (2016): 7–10. 28 See Chapter 3 in Kagan’s Positive Images (2018) for an analysis of the Chemsex documentary. 29 Kristian Møller and Jamie Hakim, “Critical Chemsex Studies: Interrogating Cultures of Sexualised Drug Use Beyond the Risk Paradigm,” Sexualities (2021): 1. 30 See Chapter 2 in Kagan, Positive Images, 89–124. 31 See João Florêncio, Bareback Porn, Porous Masculinities, Queer Futures: The Ethics of Becoming-Pig (London: Routledge, 2020): 169–170. 32 This politics of care is foregrounded in Jaime Hakim’s work on gay men and chemsex cultures. See Jaime Hakim, “The Rise of Chemsex: Queering Collective Intimacy in Neoliberal London,” Cultural Studies 33, no. 2 (2018): 249–275. 33 See David Halperin, What Do Gay Men Want? An Essay on Sex, Risk, and Subjectivity (Ann Arbor: University of Michigan, 2009).

208  Chase Ledin 34 Monica Pearl, “Tell the Story of a Virus,” European Journal of Cultural Studies (2022). https:// doi.org/10.1177/13675494221106497. 35 Charles Rosenberg, “Florence Nightingale on Contagion: The Hospital as Moral Universe,” in Explaining Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge University Press, 1992), 90–108. 36 Susan Sontag, AIDS and Its Metaphors (London: Penguin, 1989). 37 Kagan, Positive Images, 167. 38 Tony Sandset, ‘Ending AIDS’ in the Age of Biopharmaceuticals: The Individual, the State, and the Politics of Prevention (London: Routledge, 2020), 5–6. 39 See Ledin and Weil, “Healthy Publics” (2022).

Part III

Public Health The Politics of Body and State

10 Plague, Trade, and Governance in Eighteenth-Century Tunisia Edna Bonhomme

Introduction On a warm day in April 1199 AH/1784 CE, a ship carrying 150 Muslims from Alexandria, Egypt, arrived at La Goulette. Most passengers were returning from their pilgrimage to the holy city of Mecca, al-hajj.1 At the time, Ottoman officials in Tunis practiced different procedures for managing pilgrimages and commercial travel, making a distinction between “secular” and religious activities.2 While the concept of secular did not exist then, as we understand it today, social relationships and governance were evolving to meet the demands of travelers of all backgrounds. Although those undergoing religious pilgrimage to Mecca could be subject to quarantine in the Ottoman Empire, unlike some commercial ships that arrived at La Goulette, this one was not detained at the port as per the quarantine procedures. The word quarantine emerged from Italian and has a strong connection to the plague. Carlo Cipolla (1973) remarks that the quarantine was first enforced in 1377 to assure that no latent cases were on board. Interwoven in this quarantine narrative is the debate about the theoretical understandings of infection. The term infection predates the nineteenth century and comes from the Latin word infectio: “staining, dyeing, and polluting.” In contrast, the Arabic etymologies for quarantine and ­infection have a distinct conception. In the Arabic language, the term quarantine ‫ كرنتي‬is imported from Italian. However, the root for the word “infection and contagion” ‫ َع ْد َوى‬comes from ‫عدو‬, which means “enemy.”3 The passengers quickly disembarked, crossing the shallow lagoon that separated the port from the city proper, carrying their goods and stories of their holy journey. Unknown to the Tunisian authorities, one of these travelers arrived at La Goulette infected with the bubonic plague (otherwise known as Yersenia pestis or ṭāʿūn).4 Soon, much of the city was infected in a devastating outbreak that killed up to one-third of Tunis’s inhabitants out of a population of 100,000. While this was not the first time the bubonic plague had arrived on Tunisian shores, what made this outbreak different was its protracted length and impact, which led Tunisian officials to describe it as al-wabaʾ al-Kabīr (the great epidemic).5 Like other cities in the region, Tunis had been affected by diseases, including bubonic plague, on many previous occasions. Epidemics such as the outbreak of 1784 were especially consequential; epidemics expose both unity and division in a society, laying bare the social and political risks of contaminated goods or infected people.6 The enormous loss of life spurred political action by local leaders, including quarantines and other public health measures.7 Plague dominated the popular imagination, and global public health responses often invoke images of the European episode of the Black Death in the fourteenth century. DOI: 10.4324/9781003294979-14

212  Edna Bonhomme This chapter interrogates techniques of health regulation employed in response to plague outbreaks in Ottoman Tunisia at the end of the eighteenth century and the beginning of the nineteenth century. The text reveals how burgeoning biomedical strategies by local Tunisian elites laid the groundwork for health systems that operated independently of the Ottoman center. The early modern period in Tunisia is marked by a litany of traditional healers, foreign merchants, and semi-autonomous rulers who produced multiple modalities of disease management. As I show in this chapter, these formed a new constellation of mercantile capitalism that could reify the Tunisian province’s semi-autonomous status. For Tunisian elites, public health practices, particularly quarantine, were a technique for managing mercantilism and asserting their power over foreign merchants in the context of nascent Tunisian state formation. The port of La Goulette in Tunis was the primary site where these practices were developed (Figure 10.1). This nineteenthcentury French lithograph foregrounds its forbidding fortifications at the point where the headland between the Mediterranean Gulf of Tunis and Lake Tünis is bisected by a canal overlooked by bartizan turrets atop monumental stone walls. This fortified landscape announces a culture of surveillance and control. Most of the European literature on epidemics before the nineteenth century focuses on the Black Death in the medieval period and the plague outbreaks in fifteenth- and

Figure 10.1 Jules Marie Vincent De Sinety and Bayot (lithographer), Entrée de S. A. Royale dans le port de la Goulette (Tunis) (Entry of the S.A. Royale into the Port of La Goulette), lithograph, Collection de Vinck. Un siècle d’histoire de France par l’estampe, 1770–1870.  Vol. 103 (pièces 13029–13102), Monarchie de Juillet (July Monarchy). Source: gallica.bnf.fr / Bibliothèque nationale de France.

Plague, Trade, and Governance in Eighteenth-Century Tunisia  213 sixteenth-century Italy, imperialism’s role in spreading epidemics, the celebration of the professionalization of physicians, and path-breaking public health interventions. Whereas previous research provides ample evidence that enriches our understanding of the social impact of plague’s reach, more work can be done on how the early modern experience of epidemics also induced rulers to experiment with health policies that dictated the counters of life and death—an example of what Michel Foucault terms biopower.8 Foucault used the term to describe how governments or administrations order life; I use the term in a similar manner within the context of North Africa. As historians such as Richard Evans have demonstrated with reference to cholera in the nineteenth century, epidemics could function as a powerful incentive for political change.9 The development of health policies in Tunisia did not follow a single coherent path. Rather, it emerged as a consequence of a set of negotiations by local elites responding to emergent mercantilism. Disease management as a modern phenomenon was rooted in the assertion of social control, which operated with the concurrent and constitutive uses of biopower and biopolitics.10 Techniques of subjugating bodies and controlling their movement are not entirely new and are indispensable to merchant capitalism. Public health emerged concurrently with techniques of social control such as the prison which are the object of Foucault’s work and should be similarly understood as an instrumentalization of biopower for the purposes of social and political control. The management of disease outbreaks was the primary goal of public health policies. This chapter addresses the following questions: what happens during an outbreak when there are competing notions of the origins of a disease and how it is spread? How do international communities that converge in one space negotiate disease management? To what extent do semi-autonomous leaders seek to exercise their power or legitimacy by exercising their statecraft in their responses to the disease? This chapter intervenes in the historiography by illustrating how medical and health reforms occurred before the French colonization of Tunisia in 1881 and exploring the role that the management of the port of La Goulette had in determining which goods or people had access to the port and the city beyond. It is particularly important to understand the management of disease concerning the port because it demonstrates how ­biopower is enacted in and across space. Although the port is distinct from typical sites of scholarship on biopower, such as the asylum or the prison, it functions in a similar way as a hyper-regulated space in which different forms of discipline and power are operative. It is important to articulate the ways that Tunisians managed disease because it shows how elites on the Ottoman periphery could produce their own subjectivity independent of the center. This was mostly possible through the interactions of people and goods constitutive of emergent capitalism in what Mary Louise Pratt terms, and Valeska Huber refers to, as “contact zones”: “social spaces where cultures meet, clash, and grapple with each other, often in contexts of highly asymmetrical relations of power.”11 During the eighteenth century, officials of the Husaynid dynasty (1705–1957 CE) were increasingly able to assert and cement their political autonomy from the Ottoman center. This was achieved mainly through their control over taxation. While the nature and extent of Ottoman Tunisia’s autonomy has been debated in the historiography, what is important to note is the extent to which the Husaynid rulers were able to produce and reproduce their power, which was a continuation of political alliances from the Muradite dynasty (1613–1705 CE). There are two schools of the “autonomy” thesis in eighteenth-century Ottoman Tunisian history. Mohamad-Hédi Chérif (1986) argues that eighteenth-century leaders were proto-nationalist officials operating independent of the

214  Edna Bonhomme Ottoman center, whereas Asma Moalla (2004) asserts that there were greater political and ­administrative links between Tunis and Istanbul. Moalla uses Ottoman sources to show the extent to which these political links were forged between Istanbul and Tunis.12 The social and political configurations in Ottoman Tunisia were shaped by the ruling elite in Bardo who subsequently played a role in disease management during the various plague epidemics of the eighteenth century. In addition to assisting commerce, local endowments, taxes, and policies strengthened the military at the beginning of the century.13 Plague outbreaks at the port of La Goulette seemed to connect commerce with disease, while early modern trade in European port cities provided the blueprint for the liberalization of trade.14 As such, tax policy had implications for the regime’s response to the bubonic plague. Linda Darling maintains that Ottoman officials used the taxation system to finance the empire’s infrastructure for the central government and the provinces.15 This chapter shows how the bubonic plague shifted the port of Tunis, perceptions about contagion, and Tunisian-led biopower, which, I argue, offers insight into international relations, commercial governance, and provincial governance. The Political and Economic Rhythms of Eighteenth-Century Tunisia Plague outbreaks during the late eighteenth century paved the way for nineteenth-century public health reforms, which were enacted as part of a wider process of state formation. Nineteenth-century Tunisian scholar Aḥmad ibn Abī Dīyāf (1217 AH  /1802–74 CE) remarked that Tunisia’s Beys (rulers) were permitted freedom of action, in accordance with the maslaha (public interest), to impose regulations sanctioned by Islamic law.16 By the end of the seventeenth century, because of a series of political defeats in the Ottoman center, the administration in Istanbul had become more decentralized and thus delegated provincial administration to local elites and Mamlūk rulers. These powers included improving medical and public health infrastructure,17 recognizing hospitals as an essential feature of state-building. Jean-André Peyssonnel was a doctor from Marseilles who witnessed the 1720 plague in Marseilles and wanted to understand how people in Tunis handled the disease. According to Peyssonnel,18 Husayn ibn ʿAlī I (r. 1705–35 CE) renovated the medina’s hospital in the 1720s and expanded its services to poor people.19 Like other Ottoman medical practitioners, Tunisian physicians were trained in a classical master-apprentice relationship, whereby they received practical experience in a hospital either in Kairouan (Tunisia) or in Süleymaniye Tıp Medresesi (Istanbul). The Ottoman center functioned as a medical school. It was established in 1551 to educate physicians who worked in the military and court system.20 The Tunisian projects during the 1770s and 1780s were primarily funded through awqaf (religious endowments). Taxes tended to be collected by the mahalla (tax-collecting group) for services such as hospitals, religious buildings, and more.21 This matters insofar as religious endowments and taxes more broadly were essential to maintaining public infrastructure, a program which could be pursued independent of the Ottoman center. Building and expanding infrastructure, including health facilities, represented a way for Tunisian officials to instrumentalize their power, as did the development of new administrative policies and practices. Taxation provided the productive capacity to fuel this power, while infrastructure was a crucial tool in enacting activities and spaces at the port. Within the broader political context, developments between Istanbul and Tunis were often similar and sometimes connected. However, the broad trend across the century was

Plague, Trade, and Governance in Eighteenth-Century Tunisia  215 for Tunisian local administrators to strengthen their rule over the province and tighten state religious ties through taxation and infrastructure. To carry out these projects, the state collected taxes from its Muslim and non-Muslim subjects—the zakat and the jizya, respectively.22 A portion of these taxes were redirected to Istanbul, but most were controlled and spent locally. Taxes went to state infrastructure, which included repairing major buildings, constructing fountains, and supporting the military. The process of state-building meant that Ottoman Tunisia and other provinces in North Africa were constantly adapting, and Tunisia’s relationship to Istanbul was dependent on a set of local rulers and households.23 Yet, these policies were further tested during the bubonic outbreaks in the eighteenth century. Eighteenth-century public health measures in Tunis took on a variety of forms, all part of a broader attempt at state intervention in public health.24 Painful Death by Plague The bubonic plague recurred in Ottoman Tunisia in discernible cycles during the eighteenth century, mostly in 1701, 1725, 1740, 1756, and 1784 CE.25 However, outbreaks were more diffuse in the early part of the century and occurred in more peripheral cities, with lower casualty numbers. In 1701, three ships with a thousand soldiers from Murād Bey in Istanbul arrived at Port Farina carrying the plague. It spread to other Tunisian cities, including Djerba, Sfax, and Bizerte.26 In a letter dated 4 April 1725, an official from Versailles wrote: The traders are upset since their packages are not being received, which is likely infected with the plague. Potential sources include hairs of animal, flock, muslin, cloths, etc. … There must be revocation for the Consuls and recall in France for the merchants.27 Significantly, he insists that goods—especially textiles—were perceived to be plague vectors, a view shared by both French travelers and Tunisian leaders. French merchants often coordinated with local consuls to respond to outbreaks. Husayn ibn ʿAlī I imposed a strict quarantine on ships and merchandise coming from Aix-en-Provence, France, as well as from Jerusalem or Mecca, during this period. In the 1730s and 1740s, there were plague epidemics in neighboring North African cities, including Algiers and Tripoli, and Europeans often surmised that passengers who were carriers traveling between the various Mediterranean ports transferred the plague, although it appears that the early outbreaks in Tunisia came from a number of sources, including the hinterland.28 State-sponsored ʿulamāʾ (scholars), hired to preserve the political history of the state, witnessed the outbreaks and documented the fatalities. Their Arabic-language chronologies offer insight about the plague outbreaks and political responses and were integral to preserving the political and social history of the region.29 These works predominantly focused on urban areas, especially coastal cities, with occasional reference to the Algerian border. The eighteenth- and nineteenth-century historian Muḥammad al-Ṣaghīr ibn Yūsuf (d. 1820) discussed the impact of plague outbreaks in the late 1750s: The Bey of Tunis wanting to submit to Western principles for adopting to a full quarantine system antagonized the Bey of Istanbul. We began to make life difficult for traders who came from the West; they are accused of bringing the plague, and under this pretext, we applied quarantine laws what Christians call forty, that is to say that every newcomer was obliged to go to a distant place where he was to remain for forty days.30

216  Edna Bonhomme This assertion that Tunisian Beys implemented quarantine—especially as modeled by Christians (Europeans)—suggests that Tunisians employed a multitude of medical and public health practices specifically around moving the cemetery outside of the medina (old city) and establishing more sanitary cisterns for cleaner water. Indeed, the Bey of Tunisia implemented a quarantine system similar to—but developed independently of— that which was adopted in Istanbul.31 While ibn Yūsuf was correct in asserting that this system existed, it did not apply to all ships or land-based caravans arriving from other parts of the African continent. The consensus was that plague could not be eliminated, but that it could be dealt with in ways that would serve the interest of mercantile capital. At the heart of the attempt to control circulating goods and people was the quarantine system at the port of La Goulette. Quarantine measures at La Goulette were generated by both Tunisian officials and French travelers, which meant incoming ships were beholden to their owners’ cultural understandings of the plague and to local policies toward the disease. Due to its impact on economic and political life, the bubonic plague was particularly detrimental in port cities because circuits of exchange contributed to plague outbreaks. French travelers and Tunisian elites had similar perspectives about how to manage disease. Both were concerned by the possibility that commerce would suffer, which generated compatible perspectives about how local authorities should respond to the plague. In some cases, the quarantine policy served Tunisian interests by protecting the populace; in other cases, it undermined the financial welfare of the government by lowering tax revenue. It also prevented goods from entering the Tunisian market quickly. Public health policies could promote or diminish trade, and this structured the shipment of goods in the Mediterranean Sea more broadly. Quarantine was intimately connected with trade and more broadly associated with economic development and imperial expansion. In Tunisia, then, enforcement of quarantine measures was erratic and did not have a clear regulatory pattern. The application of the quarantine system was coordinated by the ruling family in the Bardo Palace. Plague had a life of its own, and its trajectory within the Mediterranean Sea was constantly confronted in the early modern period.32 The bubonic plague followed coastal routes in the Mediterranean. In the early 1780s it moved mostly from Alexandria toward coastal cities such as Tripoli, Tunis, and Algiers. In a moment when disease etiology was poorly understood, the directionality of its transmission was attributed by local Tunisians and foreign merchants alike to travelers and commerce along the Mediterranean Sea. Some went as far as to claim that the bubonic plague emerged from “the East”—either Alexandria or Bilad al-Sham (Greater Syria). At the same time, Tunisian officials ameliorated its effects somewhat by providing medical care to plague victims and moving the cemetery outside the city walls. The bubonic plague outbreak of 1784 diminished the local administration’s capacity to provide its political subjects with adequate medical resources, pointing to the vulnerability of the state.33 As many as 90 people died per day in Tunis during peak plague season; in some cases, reported deaths were as high as 300 per day. Cities and coastal populations were primarily impacted. By July 1784, the death tolls decreased to under 15 per day and at the end of October, the outbreak had killed a reported 18,000 people in Tunis.34 Ḥammūda Bey imposed hygienic policies to manage the plague epidemic. He ordered that the clothing and remains of the dead be burned and that tombstones be cleaned.35 In response, a Tunisian mufti (Muslim legal expert), alluding to Sunni tradition that

Plague, Trade, and Governance in Eighteenth-Century Tunisia  217 promoted deference to God, argued that these actions did not correspond with Islamic law: Man should submit to God’s will. In any case if it were deemed medically advisable the heirs who were deprived [including widows and orphans] were entitled to compensation.36 As a legal professional jurist, the mufti expounded Islamic law and was held in high esteem. His opposition to the Bey’s practice was part of an established intellectual and religious network that was built on a corpus of Islamic interpretation. His expertise gestured to ninth-century Sunni jurist Muḥammad al-Bukhārī (d. 854 CE) who stated, It was a scourge sent by God unto whom He willed. Now it has been made a blessing for the Muslims. A person who stays in the affected town, shows patience, and believes that nothing will befall him except what God has ordained, will receive the same reward as a martyr.37 Medieval Arab and Islamic medical theories shaped how local figures responded to the plague, with some scholars arguing that one should not flee if an outbreak occurred.38 The disagreement between Ḥammūda Bey and the mufti affirms the tensions between political rulers and religious figures’ responses to the plague, with ʿulamāʾ siding with religious doctrine and political officials moving away from piety. The Port of La Goulette The Ottoman Regency of Tunis had an internal market economy that worked in concert with Ottoman and European trade, and its quarantine system reflected that. One important contemporary source from the Mediterranean contact zone appears in the work of traveler-reformer John Howard who argued for the establishment of an English lazaretto.39 Howard’s 1780s An Account of the Principal Lazarettos in Europe: With Various Papers Relative to the Plague combines his personal first-hand accounts with correspondence and questionnaires from international merchants and physicians from ports across the sea, France to Turkey, and addresses the etiology, transmission, and treatment of plague as far afield as Moscow and Egypt. Howard’s plans of Mediterranean lazaretto architecture reveal common features: isolated coastal locations, and the fusion of elements of martial security—such as defensible monumental cyclopean walls—with the mercantile pragmatism of waterside access and ample protected space for disembarked merchandise. Though not discussed, La Goulette also appears to fit into this template. The location and layout of the port on a narrow spit of land, separated from the city by a shallow lagoon, meant that the space could be easily controlled and made open in some contexts and closed in others (Figure 10.2). It was exposed to the Mediterranean Sea, but because of its size and position, the placement of docks and ships was restricted. Moreover, the lagoon meant that the port could not be expanded into the city proper. As a consequence, the port was a manageable space for the enforcement of quarantine measures, and its semi-enclosed status also created a site for the imposition of discipline. The eruption and spread of infectious diseases could be easily tracked in this insular yet connected space, and thus it is a fruitful location for understanding epidemics in the early modern context.

218  Edna Bonhomme

Figure 10.2 Jacques-Nicolas Bellin and Jean-Baptiste Croisey, Plan des forts et canal de La Goulette. (Map of the forts and canal of La Goulette) Dépôt des cartes et plans de la marine. 1740–1749. Source: gallica.bnf.fr/Bibliothèque nationale de France.

Plague, Trade, and Governance in Eighteenth-Century Tunisia  219 La Goulette was central for European mercantile interests as well as Tunisian ­military control. Its importance to political rulers and the commercial elite made it a vital stronghold of Ottoman Tunisia. Most Tunisians lived within the confines of city walls or in the rural interior, which meant that the Tunisians at La Goulette were part of p ­ eripatetic communities that engaged in religious pilgrimage or trade. Some were multilingual ­ bureaucrats or Ottoman soldiers; others were part of a burgeoning indigenous elite. Ottoman Tunisia’s ports can be understood within the context of their cities, which had fortresses to protect them as well as ports that looked outward and were open for trade. Ports were one site where merchants and capital came together, yet their convergence extended far beyond the goods traded or the ships in which they moved, reflecting the expansion of capitalism itself in the context of the decentralization of the Ottoman Empire.40 The changing priorities induced by merchant capitalism encouraged merchants to maximize profits, while states worked increasingly to facilitate them in this goal.41 Tunisia’s increased production of export commodities and direct commercial ties with European states contributed to its increased economic independence from the Ottoman center and its increased interdependence with Europeans.42 However, the effects of expanding trade were not solely geopolitical, but were tied to sanitation measures enforced by Tunisian officials as they extended their powers, including their biopower. The plague was most notably connected to the mercantile system, which was deeply entrenched in political initiatives to further cohere and expand nation-states; the imposition of quarantine and sanitation, through practices that shifted ­according to the local context, was part and parcel of regulating disease.43 Mercantilism, the guiding philosophy of early modern absolute monarchies, elaborated a rationale: since power was the first aim of the state and a large healthy population was a vital component of power, the state could promote the health of its people from the cradle to the grave.44 Health policies such as the quarantine system were political insofar as they could be used to alter commerce. Birsen Bulmus has argued that quarantine was used to undermine “free trade” while promoting domestic commerce.45 Commodities emerging from the Ottoman Empire were often perceived by foreigners to be vectors of disease: for instance, Europeans would assume that cotton and wool arriving from the Eastern Mediterranean Sea or Egypt were potentially infectious. Perceptions about the plague impacted revenues in that Ottoman Tunisian officials enacted reforms to minimize its spread. Following from that, regulating the spread of disease through trade meant that ports were zones where disease could be managed. Ports were also at the center of debates about claims that bodies and goods were vectors for the plague. Tunisia was a small domain in the Ottoman Empire, with a population of one million in the late eighteenth century. The Regency of Tunis was a coastal region with mountains stretching along its porous borders, while its gulfs provided space for ships to conceal themselves from the open sea. However, European merchants were often prevented from traveling to the Tunisian interior; doing so required the approval of local officials. As an accessible, non-mountainous route to trade, the port became important for thinking about new modes of regulating public space. Tunis and Sfax were the two most active merchant cities in the province.46 Tunis in particular was critical as a crossroads for trade and cultural exchange. It also provided travelers with an opportunity to comment on the conditions and dimensions of these spaces through travelogues. Military garrisons, located at the port of La Goulette, were one arm of the Tunisian technology of power. The secure, militarized nature of La Goulette meant that it was

220  Edna Bonhomme used as a holding site for prisoners. The prison was highly regulated, and prisoners were ­registered by the port commander. Foreign prisoners were usually held temporarily before deportation. If an assailant was sentenced to capital punishment, they might be hanged in the prison, as was the case with a number of prisoners held under the mid-century military official Younés. But the prison regime was also used for disease control, in that execution was also a permissible remedy against prisoners who were suspected of being infected. At the height of the conflict with Algeria in 1752, two prisoners were subjected to death for this reason.47 This incident demonstrates the broad reach of state power into the management of the sick and even the right to impose state-sanctioned death. Thus, in addition to civil and military crimes, the prison at La Goulette was a space in which diseased bodies could be managed. The tension between Arab/Islamic perspectives with epistemologies and techniques of disease management and the power dynamics of politics was constantly at play, making Tunisian ports contested locations of biopower. The plague prompted debates among indigenous and foreign groups about disease etiology; the port served as a liminal zone where contagion and sanitation were contingent and, authorities hoped, potentially manageable. Given its deleterious impact on urban spaces, the plague invites historians to think more critically about the role of disease in relation to trade, state formation, and state power over death. Mercantilism and healthcare were intertwined and were part of state and diplomatic initiatives. However, it was under the conditions of trade that quarantine or quasi-­quarantine could be enforced. The French commercial company in Tunisia and the Royal African Company worked alongside the French consul in Tunis to address French ­ financial and diplomatic concerns in the province.48 Commercial relations between Tunisian m ­ erchants and Europeans were only sometimes pleasant, but there were systematic efforts to track the goods being exchanged. Certificates for port entry were distributed by the Tunisian state since ships entering the port had to be administered by state health officials. Tunisian commercial and mercantile data are fragmentary, but European sources provide additional information on goods and health regulations during the period. Ottoman cities depended on each other for agricultural goods, and the French were keen on documenting the nuances of the origins of agricultural goods. This was particularly helpful in pointing to the origins of allegedly contaminated goods. If a shipment of cotton, for example, was thought to be the origin of a plague outbreak, it could be traced to a specific city of origin. By the end of the eighteenth century, North African port cities such as Tunis, Alexandria, and Tripoli were beginning to transform into cosmopolitan spaces where elites and commoners converged: “both consequence and cause of macro-level phenomena—global capitalism, imperialisms, communications revolutions and so on.”49 Port cities were perceived in terms of notions of freedom, given their ability to be zones of circulation and licentious liaisons. Yet the response to the plague outbreak in Tunisia demonstrates how the regulation of peoples and goods does quite the opposite: the financial conditions to enter this space (through taxation) and medical scrutiny (through quarantine) produced a dynamic that put travelers under the microscope of the state and emergent capitalist forces. As the Tunisian state became more centralized, such regulation made the port a location where political rulers and merchants promoted their interests as well as public health measures.

Plague, Trade, and Governance in Eighteenth-Century Tunisia  221 La Goulette was a zone where trade was pursued and power was displayed, a ­ icrocosm of Tunisia and a gateway to understanding other forms of social control. m The trade and public health-related polices enacted by the Tunisian Bey were integral to exercising power, subjection, and knowledge. Moreover, policies were inconsistently enforced at the beginning of the eighteenth century but became more consistent by the beginning of the nineteenth century, allowing Tunisian authorities to enforce quarantine policy more readily. This was especially the case with reference to the bubonic plague. The port and its quarantine system served as a biopolitical technology of governance insofar as officials regulated who could enter and leave. For French and Tunisian officials alike, confining disease through the quarantine system at La Goulette was a way to manage bodies and spaces specifically for either making a profit or limiting migration to the Tunisian hinterland. Conclusion In the 1790s, the plague continued to spread through coastal cities in North Africa: Tripoli (1797), Tunis (1794), Algiers (1793), and Tangier (1800).50 By the end of the eighteenth century, Algiers—not Alexandria—was perceived as the source of the plague in Tunisia. It also moved westward to Morocco and eastward to Tripoli (Libya). Ottoman Tunisian figures responded by taking direct action to deal with it at a mass scale, which included keeping records of mortality, regulating burial spaces, and cleansing cities of perceived filth.51 In Europe, as has been studied at length with reference to cholera, commissions were set up to regulate commerce and disease.52 By the nineteenth century, plague was less important as a disease; cholera started to have a more detrimental impact as early as 1827. What made the 1784 plague in Tunis different from the previous epidemics in Ottoman Tunisia is that both domestic and foreign authorities responded by regulating goods and people perceived as diseased.53 Trade was central to understanding how disease traveled and how it was interpreted by local and foreign authorities alike. In turn, disease management and other public health policies were incentivized by the need to facilitate the smooth trade flow and protect merchants’ profits. Understanding the development of mercantile capitalism in Tunisia requires that historians grapple with the state’s role, including how it developed its biopower. This chapter explored Tunisian governance and European anxieties about the disease and the interaction between local and foreign actors: how disease and the ideologies associated with it shaped trade, and ports functioned as a site for biopower. Quarantine measures in Tunisia were part and parcel of an emergent biopolitical and public health order linked to foreign capital and increased local rule. Europeans and Tunisians saw a deep relationship between trade and plague; their policies were driven by material, political, and religious motivations. More importantly, the Tunisian port of La Goulette went from being militarized in the eighteenth century to cosmopolitan in the nineteenth century. La Goulette was a locus where military leaders, commercial elites, and officials gathered to regulate the bodies and goods that could enter Tunisia. It thus symbolized an entry point for contagion, but mostly served as a site where policy and trade could be repackaged. State formation, the development of nascent capitalism, and new concepts of public health were all facilitated by and took their shape in the shadow of a new constellation of biopower. A new regime of politics, and a new system of political economy,

222  Edna Bonhomme required a new ideology of power. Plague epidemics represented the crisis moment in which this ideology began to be worked out. Notes 1 Michael Christopher Low, “Empire and the Hajj: Pilgrims, Plagues, and Pan-Islam under British Surveillance, 1865–1908,” International Journal of Middle East Studies 40 (2), 2008: 269–290. 2 Talal Asad, Formations of the Secular: Christianity, Islam, Modernity (Stanford, CA: Stanford University Press, 2003), 2: “The distinctive feature of ‘secularism’ is that it presupposes new concepts of ‘religion,’ ‘ethics,’ and ‘politics,’ and new imperatives associated with them.” 3 Cipolla Carlo, Cristofano and the Plague: A Study in the History of Public Health in the Age of Galileo (London: Collins, 1973). 4 For more information on the history of plague in the Middle East refer to Lawrence I. Conrad, “  ‘Tāʿūn and Wabāʾ’: Conceptions of Plague and Pestilence in Early Islam,” Journal of Economic and Social History of the Orient 25 (3), 1982: 268–307. 5 “Every plague is an epidemic but not every epidemic is a plague,” from Al-Suyūṭī, Jalāl al-Dīn Abū al-Faḍl ʿAbd al-Raḥmān ibn Abī Bakr, “Ṭibb Al-Nabawī or Medicine of the Prophet.” Osiris 14, 1962: 33–192. 6 For an exploration of the relationship between science, social life, and facts, refer to Bruno Latour and Steve Woolgar, Laboratory Life: The Construction of Scientific Facts (Princeton, NJ: Princeton University Press, 1986). 7 Eugène Plantet, Correspondance des deys d’Alger avec la cour de France, 1579–1833 (Paris: F. Alcan, 1889) 298, 432, 436, 447. 8 Michel Foucault, The History of Sexuality, Volume 1, translated by R. Hurley (London: Penguin Books, 1998), 138. 9 Richard Evans, Death in Hamburg: Society and Politics in the Cholera Years, 1830–1910 (Oxford: Clarendon Press, 1987). 10 Foucault, Sexuality, 1998. 11 Mary Louise Pratt, “Arts of the Contact Zone,” Profession, 1991: 33–40, 34. 12 Asma Moalla, The Regency of Tunis and the Ottoman Porte, 1777–1814: Army and Government of a North African Ottoman Beyalet at the End of the Eighteenth Century (Abingdon: Routledge, 2004). For more on the Muradite dynasty, see M’Hamed Oualdi, Esclaves et maîtres: Les mamelouks des beys de Tunis du XVIIe siècle aux années 1880. Bibliothèque Historique des Pays d’Islam (Paris: Publications de la Sorbonne, 2011). 13 Ahmed Abdesselem, Les historiens Tunisiens des XVIIe, XVIIIe et XIXe siècle: Essai d’histoire culturelle (Paris: Librairie C. Klincksieck, 1973). 14 In particular, Amsterdam introduced the “free port” system to minimize taxation on imported goods, so as to encourage imported goods into Holland. See Thomas Leng, “Commercial Conflict and Regulation in the Discourse of Trade in Seventeenth-Century England,” Historical Journal 48 (4), 2005: 933–954. 15 Linda Darling, Revenue-Raising and Legitimacy: Tax Collection and Finance Administration in the Ottoman Empire, 1560–1660 (Leiden: Brill, 1996). 16 Ahmad Ibn Abī al-Diyaf , Ithaf Ahl Al-Zaman Bi-Akhbar Muluk Tunis Wa- ʾAhd Al-Aman (Tunis: Institut de Recherche sur le Maghreb Contemporain, 1994). 17 For example, the Treaty of Karlowitz, signed in January 1699, marked the end of the Ottoman Empire’s expansion into the Austro-Hungarian Habsburg territory. Within the Ottoman center, a few families and the hereditary monarchy dominated local rule. In Istanbul, Sultan Ahmed III (r. 1703–30) ushered in a reign that inherited the military defeats from the seventeenth century. See Jane Hathaway and Karl K. Barbir, The Arab Lands under Ottoman Rule, 1516–1800 (Harlow, UK: Pearson Longman, 2008). 18 See letter of 25 June 1724 in Eugène Plantet, Correspondance des beys de Tunis et des consuls de France avec la cour, 1577–1830, vol. I (Paris: F. Alcan., 1893), 137–138. 19 For more see Jean Andre Peyssonnel, Voyage Dans La Régence De Tunis, 1724 (Tunis: Centre de Publication Universitaire, 1004), 52. Plantet, Correspondance des deys d’Alger avec la cour de France, 1579–1833, 1889, 135, 137–138.

Plague, Trade, and Governance in Eighteenth-Century Tunisia  223 20 For a thorough history of hospitals in the Ottoman period, refer to Miri Shefer-Mossensohn, Ottoman Medicine: Healing and Medical Institutions, 1500–1700 (Albany: State University of New York Press, 2009). For a medical treatise guide in these sources, see Peter E. Pormann and Emilie Savage-Smith, Medieval Islamic Medicine (Washington, DC: Georgetown University Press, 2007); Peter E. Pormann, Islamic Medical and Scientific Tradition: Critical Concepts in Islamic Studies, vol. 2 (London: Routledge, 2011), 1598–1599. For more on hospitals in the Middle East, see Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion, and Charity (Cambridge: Cambridge University Press, 2015). 21 The revenues came from shops, some personal homes, and inns. 22 Taoufik Bachrouch provides extensive detail about the monetary system and the difficulties that arose from it with respect to salaries and distribution. There is also information about how the Beys distributed public finances. Taofik Bachrouch, Le saint et le prince en Tunisie (Tunis: Publications de l’Université de Tunis, 1989), 1. 23 M’hamed Oualdi. Esclaves et maîtres, 2011 24 Daniel Panzac, La Peste Dans L’empire Ottoman: 1700–1850 (Leuven, Belgium: Peeters, 1985). 25 See Plantet, Correspondance des deys d’Alger avec la cour de France, 1579–1833, (1889), 7. 26 Édouard Bloch, “La peste en Tunisie,” MD diss., Faculté de Médecine de Paris (1929), 6–7. 27 Bloch, 6–7. 28 Saint-Gervais, Mémoires historiques qui concernent le gouvernement de l’ancien et du nouveau Royaume de Tunis (Paris: Ganeau, 1736); see also Adrien Berbrugger, Mèmoires sur la peste en Algérie depuis 1552 Jusq’un 1819 [1847)] (Paris: Imprimerie Royale, 1969), 1540–1561. 29 Authors tended to be secretaries in the beylical chanceries of their time and, as such, the ­chronologies focused on local politics, political succession, and death. Some of the key scholars of the period include: Muhammad ibn Abi Dinar (d. 1698–99), Muḥammad al-Wazīr al-Sarrāj al-Andalūsī (d. 1736 CE), and Ḥammūda ibn ʿAbd al- ʾAziz (d. 1775). These three figures provided context for how Tunisian society transformed politically in the seventeenth and eighteenth centuries. 30 Muhammad Al-Ṣaghīr ibn Yūsuf, Muḥammad, Tārīkh Al-Mashraʿ Al-Milkī Fī Salṭanat Awlād ʿalī Turkī] = Mechra El Melki = Chronique tunisienne (1705–1771): Pour servir à l’histoire des quatre premiers beys de la famille husseïnite, translated by Victor Serres and Mohammed Lasram (Tunis: Éditions Bouslama, 1978), 347. 31 Birsen Bulmus, Plagues, Quarantines, and Geopolitics in the Ottoman Empire (Edinburgh: Edinburgh University Press, 2012); Varlik, 2015. 32 Daniel Panzac, La Peste Dans L’empire Ottoman: 1700–1850, 1985. 33 Valensi’s manuscript outlines the ways that the epidemic caused a mortuary crisis in Tunis. Lucette Valensi, “Calamités démographiques en Tunisie et en Méditerranée orientale aux XVIIIe et XIXe siècle,” Annales. Économies, Sociétés, Civilisations 24 (6), 1969: 1540–1561. 34 Archives de la Chambre de Commerce de Marseilles (ACCM). 1784. 1331, doc. 23 June. 35 Aḥmad Ibn Abī al-Ḍiyāf, Ithaf Ahl Al-Zaman Bi-Akhbar Muluk Tunis Wa-ʾAhd Al-Aman (Tunis: Institut de Recherche sur le Maghreb Contemporain, 1994). 36 Ibn Abi al-Diyaf, 14–15. 37 Muḥammad al-Bukhārī, Sahih al-Bukhārī (Cairo: Dar al-Hadith, 2004). 38 Mohammad Melhaoui, Peste, Contagion et Martyre: Histoire du Fléau en Occident Musulman Medieval (Paris: Publisud Editions, 2005). 39 John Howard, An Account of the Principal Lazarettos in Europe; With Various Papers Relative to the Plague… (London: J. Johnson, C. Dilly, and T. Cadell, 1791). 40 Rosa Luxemburg, The Accumulation of Capital [1913] (London: Routledge, 2003). 41 Manuel Herrero Sánchez and Klemens Kaps, Merchants and Trade Networks in the Atlantic and the Mediterranean, 1550–1800: Connectors of Commercial Maritime Systems (Abingdon: Routledge, 2–17; Joel Mokyr, The Enlightened Economy (New Haven, CT: Yale University Press, 2010). 42 Peter Gran, “Medial Pluralism in Arab and Egyptian History: An Overview of Class Structures and Philosophies of the Main Phases,” Social Science and Medicine, 138, 1979: 339–348, 340. 43 The eighteenth-century merchant trade was undergoing a range of transformations and being theorized by economists, including the French physiocrat Marquis de Mirabeau (1715–89) and the Scottish philosopher Adam Smith (1723–90). See also Philip J. Stern and Carl Wennerlind.

224  Edna Bonhomme Mercantilism Reimagined: Political Economy in Early Modern Britain and Its Empire (Oxford: Oxford University Press, 2014). 44 Kuhnke, LaVerne, Lives at Risk: Public Health in Nineteenth-Century Egypt (Berkeley: University of California Press, 1990), 9. 45 Bulmus, Plagues, Quarantines, and Geopolitics in the Ottoman Empire, 2012, 109. 46 Julia A. Clancy-Smith, Mediterranean: North Africa and Europe in an Age of Migration, c. 1800–1900 (Berkeley: University of California Press, 2010). 47 Al-Ṣaghīr, 1978, 316. 48 For a thorough account of the relationship between French commerce and North Africa, refer to Paul R. Masson, Histoire des Établissements et du Commerce Français dans l’arique Barbaresque, 1560–1793 (Paris: Hachette, 1903). 49 Julia A. Clancy-Smith, “Making a Living in Pre-Colonial Tunisia: The Sea, Contraband and Other Illicit Activities, C. 1830–81,” European Review of History 19 (1), 2012: 94. 50 Panzac, La Peste Dans L’empire Ottoman: 1700–1850, 1985. 51 This was not unique to the Ottoman Empire. Ruth Rogaski’s Hygienic Modernity highlights the discourses on health and hygiene in the era of germs, bacteriology, and the increasing attention to vectors, whereby microbes were made into visible small entities harboring disease, and the ideologies associated with them. Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2004). 52 Pierre de Ségur-Dupeyron, Mission en Orient (Paris: Impr. Royale, 1846). 53 Valensi, “Calamités démographiques en Tunisie et en Méditerranée orientale aux XVIIIe et XIXe siècle,” 1969.

11 Deconstructing the Story of a Contagion Tuberculosis and Its Representations in Early Republican Turkey Alev Berberoğlu and Cansu Değirmencioğlu Introduction From Robert Koch’s discovery of the tubercle bacillus in 1882 until the revolutionary invention of Streptomycin in 1944, tuberculosis (TB) was among the most fatal contagious diseases that provoked public anxiety—“germ panic”—in many parts of the world.1 In the absence of an effective drug therapy, public health authorities had no alternative but to resort to preventive measures, primarily early diagnosis methods and education of the masses, in order to slow down the transmission of TB. As in the analysis of Michel Foucault, with the transformations in medical practices starting in the late eighteenth century and the scientifically accepted distinctions between the healthy and unhealthy, definitions of sickness have been closely related to the governmental supervision of and intervention in the bodies of individuals in modernizing societies.2 TB, an epidemic with destructive effects on the productive capacities of nations, enabled mechanisms of social control through public health policies. The task of not only curing the disease but also protecting the bodies from sickness became a practice of power operated through ­medical knowledge, especially in the cases of diseases that became social burdens such as TB. In addition to its medical meanings, as Katherine Ott identified in 1996, TB had overarching cultural implications in relation to “the social, political, and economic experiences of those dealing with the illness in their particular time and place.”3 In the interwar period, healthy bodies and sturdy young generations held significance in nation-building societies, such as Turkey, both for increasing the military power and workforce and for fashioning a self-image of national strength. With the popularization of the germ theory of disease, Turkish public health experts focused on preventing the contagion in antituberculosis education. This information was communicated not only through texts but also through images that were clear and legible for everyone. The nation-building process of Turkey started in 1923 with the formation of the Republic and was marked with the Kemalist (Mustafa Kemal Atatürk) regime’s progress reforms to distance itself from the Ottoman past, remove the traces of “the sick man of Europe,” and emerge as a robust society. Epidemics were undoubtedly detrimental to the ideals of the regime. Significantly, the period from 1925 to 1937, when Refik Saydam was the Minister of Health and Social Welfare, was also the time in which the public health policies and practices were shaped and organized on a national scale in fighting communicable diseases, which distinguished the early Republican period (1923–1938)4 from the interrupted modernization strategies of the previous periods.5 Although the struggle with TB had started earlier in the Ottoman period,6 during the founding years of war-stricken Turkey the disease turned into a much larger social DOI: 10.4324/9781003294979-15

226  Alev Berberoğlu and Cansu Değirmencioğlu problem, and thus became the focus of an organized effort to contain its spread.7 Due to the insufficient capacity of healthcare services resulting from the political and economic conflicts of World War I and the Turkish War of Independence (1919–1923), as well as geographical and material issues, approaches in preventive medicine were transformed into civic duties.8 As Ceren Gülser İlikan Rasimoğlu has observed, in publications on communicable diseases, including TB, protecting the health of citizens was primarily defined as a matter of national public health, whereas the government was considered to have a subsidiary role with the municipalities and voluntary associations functionating as reinforcements.9 As a national issue, TB was associated with ignorance, backwardness, and socially irresponsible behavior. According to the official discourse promoted by Sıhhat ve İçtimaî Muavenet Vekâleti [the Ministry of Health and Social Assistance], those who loved their country were regarded as responsible for protecting both themselves and their children from TB.10 Hence, not following medical advice when ill would imply a lack of patriotism, which was likely to result in social stigmatization and isolation.11 The child was regarded as the public subject of a national cause, and the person who was primarily responsible for the well-being of the child was identified as the mother. Accordingly, various methods of nationwide sanitation campaigns, such as publications by medical professionals, and health advice content circulated in popular culture that targeted women or mothers specifically, promoted the methods of scientific childrearing and preventive approaches of medicine. These methods incorporated visual and textual narratives to make visible the invisible pathogens, materialize the disease, and create public consciousness and a sense of hygienic modernity. Through educating people in epidemiology and the germ theory of disease, the shared goal of the government, intelligentsia, and public health reformers was to establish a culture of preventive medicine. As Ebru Boyar argues, they needed mechanisms “to persuade the populace to buy into the new concepts of public health, to adopt them and to become willing propagators of such policies to the wider community” to succeed in this manner.12 In accordance with the common and dual use of the term “propaganda” by the regime, referring to the means of public education by the Kemalist reforms and the publicity of its modernizing achievements, this organized effort was officially named “sıhhî propaganda”13 [sanitation propaganda].14 The campaigns were carried out through various informative tools, including books and journal articles published by medical doctors, posters, booklets, brochures distributed by the Ministry of Health and Social Assistance, films, radio programs, museums, and exhibitions. All advised individuals to protect themselves, but especially children, from contagion. In the visual culture of TB in the early Republican period, microbes, modes of transmission, prevention recommendations, diagnostic technologies, and sanatorium photographs became very common. During the administrative period of Health Minister Refik Saydam, the visualization of TB messages continued in line with the general importance given to visualization by the regime in the education of the public. However, from the 1920s into the 1930s, more diagrammatic narratives came to the fore which began to focus more on germs and their transmission between the respiratory systems of people.15 It is within reason to suggest that in early Republican Turkey, the language employed in the public health propaganda publications about TB was markedly more visual in nature compared to the other contagious diseases and, moreover, it was heavily imbued with military overtones.16 For instance, the tubercular microbes were described as if they were enemies and they were continuously personified: “The favorite place of the tubercular microbe is the ‘Lungs.’ They reside there and from time to time they search for weak

Deconstructing the Story of a Contagion  227 spots, they hit them like the treacherous enemy.”17 Thus, viewed from a geographical lens, the human body was likened to the homeland, recently emancipated from foreign occupation, and the microbes were described as if they were the invaders of a certain place called “the Lungs.” As historians Evered and Evered argue, “Positioning graphic narratives alongside nationalist rhetoric, the Turkish state portrayed diseases as ‘enemies’ menacing the nation, just as it depicted particular ailments attacking the health and productivity of individual citizen.”18 Therefore, the early Republican health authorities were working both in textual ways by evoking a visual narration method and in pictorial strategies to give visibility, physicality, and substance to the invisible TB. This chapter examines the role of visual media in educating the public about TB during the transition period from the Ottoman Empire to the Turkish Republic. It aims to analyze the socio-cultural meanings of the issues that occur within medical history by concentrating on two case studies. The first discusses the TB pictures published in Sıhhi Müze Atlası (1926), created by Dr. Hikmet Hamdi, the founding director of the Istanbul Health Museum, and the second examines the diagrams about contagious diseases displayed in the 1935 Ankara Hygiene Exhibition organized by Dr. Wilhelm Wadler. As platforms of “mutual exchange between the scientific and public domains,”19 both cases contained advice about the contagion of TB and presented visual narratives and basic texts about the stages before and after the emergence of the disease, aiming to educate the public by means of simplified medical knowledge. At the same time, they reflect the shifting political dynamics of the period, developments in health, and changing aesthetic preferences from the 1920s to the 1930s. The Foundation of the Istanbul Health Museum Rising concerns due to the spread of contagious diseases in the Ottoman lands in the 1910s led to discussions of establishing a museum that would serve to educate the public in matters of health. Such a museum was first established in the late Ottoman capital of Istanbul in 1918.20 İstanbul Hıfzıssıhha Müzesi [the Istanbul Health Museum] witnessed a tumultuous time, when the Ottoman Empire was crumbling away, and the Republic of Turkey was emerging with plans to revitalize and fortify the nation and ensure that the new generations would be healthy and strong. Thus, throughout this major transitional period from the post-World War I occupation of Ottoman Istanbul (1918–1923) and the Turkish War of Independence (1919–1923) to the foundation of the Republic of Turkey in 1923, the museum’s crucial role fitted well with the extensive public health program of the new Republic’s political agenda. As a consequence of the growing political ties between the Ottoman Empire and Germany, which eventually led to their alliance as the Central Powers in World War I,21 the Ottoman medical authorities, too, turned their gaze toward German health museums before creating their own. In fact, the idea of a German model for Istanbul originated primarily in the observations of two medical doctors: Dr. Tevfik Rüştü Aras (1883–1972) and Dr. Adnan Adıvar (1882–1955). In 1914, the former explained his views in an article regarding the need to establish a health museum like the one in Germany. According to Aras, people tend to easily forget the information they encounter in conferences, newspapers, and books about health; however, only if there were a health museum would this problem be resolved.22 Having visited the Permanent Exhibition for Workers’ Welfare in Berlin,23 he underlined the necessity to build a similar museum in the Ottoman Empire to raise awareness about contagious diseases. Furthermore, he placed an emphasis on

228  Alev Berberoğlu and Cansu Değirmencioğlu the TB section in the museum and the tools, pictures, models, graphics, and information boards that would be easy to understand.24 Another step in medical museology, which brought the Ottomans and the Germans closer, was taken by Adıvar, who was the head of Sıhhiye Müdüriyet-i Umumiyesi [the General Directorate of Health] from 1917 to 1919 and the leading figure in the realization of the Istanbul Health Museum. Owing to his educational background in Germany,25 Adıvar was inclined to follow German health museums as a model for the one he was planning in Istanbul.26 For this purpose, Adıvar employed Dr. Hikmet Hamdi—who had an exceptional skill set as a medical doctor and a painter—to create the first health museum of the country. Hikmet Hamdi (1872–1931) was arguably the most suitable and qualified person for the task, since Adıvar was convinced that “the person who would be the founder of the museum should be both a painter and a medical doctor.”27 After graduating from the School of Military Medicine in 1897, Hikmet Hamdi worked in municipalities and in the Hygiene Department of the Directorate of Public Health; he later became the founding director of the Istanbul Health Museum in 1917.28 Adıvar sent him to Germany to examine the health museums in Berlin, Frankfurt, and Dresden for four months.29 He returned to Istanbul having prepared illustrated panels about contagious diseases, which he exhibited in Hilâl-i Ahmer [The Red Crescent] exhibition in 1917, where he represented the General Directorate of Health.30 On July 23, 1918 the Istanbul Health Museum was inaugurated in the building of the Society for National Defense in Divanyolu, Sultanahmet.31 The museum also included a painting studio and a moulage studio; for the latter the technician Halit Hakkı Bey was appointed.32 Analyzing Dr. Hikmet Hamdi’s role as the director, curator, and painter in the preparation of the museum requires an examination of his artistic background and formation. Interested in the visual arts since his childhood, he had the opportunity to hone his painterly skills with Hoca Ali Rıza (1858–1930), a very prominent Turkish artist who specialized in landscapes and was an influential painting teacher at the time. He also served as the president of the Ottoman Society of Painters.33 Ali Rıza’s paintings are “characterized by close observation of nature, study of atmospheric effects, and skilled use of light and shade and color tones,” and these characteristics can also be observed in Hamdi’s paintings.34 Therefore, the pictures prepared primarily for the Istanbul Health Museum and, later on, for other health museums in Turkey cannot be described merely as medical illustrations. Owing to the fact that Hikmet Hamdi was invested in the subtleties of pictorial representation, his aim was to capture the attention of the museum visitors by drawing them into the narratives of health by constructing familiar scenes and settings with many descriptive details in his pictures. For this reason, his approach aligns with the Horatian principle to both “instruct and delight.”35 In other words, aesthetically pleasant landscapes of Hoca Ali Rıza are transformed by Dr. Hikmet Hamdi into imagery with a pedagogical purpose aimed at public health. The Health Museum Atlas and Pictures of Tuberculosis In close collaboration with Hikmet Hamdi and the health museums in Turkey, Sıhhî Müze Atlası [the Health Museum Atlas] (henceforth abbreviated as the Atlas) was published in 1926 by the Ministry of Health and Social Assistance with the intention of instructing the public with striking pictures and concise texts. As indicated in the preface by Dr. Refik Saydam, the first health minister of the Republic, the aim of the health museums was to inform the public of the destruction caused by contagious diseases, to teach

Deconstructing the Story of a Contagion  229 them about preventive measures, and to protect their health and well-being.36 Saydam added that since it was not possible to open a health museum in every city, he found it useful to publish an album by bringing together the paintings and other materials exhibited in the health museums of Turkey and printing them in color.37 In other words, the Atlas could be considered as a portable museum, or a traveling exhibition of health in the practical format of a book, which had the potential to create a more intimate dialogue with its reader. Moreover, the pictures illustrating the Atlas, as well as the walls of the health museums, received wide exposure throughout Turkey, since 5,000 copies of the book were published in 1926.38 Vergili points out that copies of the Atlas were distributed in schools even in the most distant parts of Turkey.39 The images in the Atlas were designed to leave a strong long-lasting impression on the viewers, which would then induce them to be watchful about the lurking dangers to their health. To achieve this, different strategies were employed by Hikmet Hamdi. Sometimes the aim is apparently to shock and horrify, such as in the representations of patients suffering from syphilis,40 so that the public would understand the seriousness of the disease and protect themselves accordingly. In other cases, for example in the representation of smallpox, sick women’s bodies are undressed, almost eroticized, to evoke fear and despair in seeing a youthful female body, “whose beauty is irrevocably ruined,” with the signs of disease.41 In the case of TB, the visual strategy which Hikmet Hamdi employed is significantly different from other contagious diseases in that he chose to create a picture story to communicate how easily TB could spread and destroy children’s health.42 Thus, his visual narrative follows closely the nineteenth-century literary descriptions of TB, aptly defined by Susan Sontag as “the romantic disease which cuts off a young life.”43 In the same vein, tragedy is employed as a narrative and visual strategy to convey the transmission of TB. Similar to a short film, the story of a contagion case of TB unrolls in front of the reader’s eyes, where the sequence of the images follows the direction of Ottoman Turkish writing, from right to left. The first picture (Figure 11.2) provides the setting, reminiscent of Hoca Ali Rıza’s paintings of the historical districts of Istanbul. The eyes of the reader are guided to the street sweepers in the center by means of the caption, and the image underlines the invisible danger of TB microbes in the dust spread around due to the sweeping. The next page has two pictures that show a man sick with TB spitting on the street44 and another man stepping on the sputum (Figure 11.1). The images on the following pages demonstrate how the second man unwittingly carries the germs into his home on his dirty shoes (Figure 11.3). Afterward, the reader enters the living room of an affluent Ottoman household that closely follows the Western trends in home decor, clothing, and lifestyle (see Figure 11.4). The reason behind choosing a well-to-do family could be for demonstrating to the readers that neither the poor nor the rich could escape from TB. While the mother plays the piano, an emblem of Western culture, the child plays on the floor amidst the germs. What could be interpreted as sheer negligence on the part of the mother—if the public health publications that overemphasized the mother’s responsibility in protecting her children’s health are considered—is moderately overturned in Hikmet Hamdi’s narrative. Instead of putting the entire blame on the mother, who continues to enjoy her music instead of paying attention to domestic hygiene and opening the windows for fresh air or following the medical authorities’ advice against letting children play on the floor, Hikmet Hamdi targets the father as the guilty one who carelessly brought the germs home. In this way, Hamdi balances parental responsibility in terms of gender responsibility. The next picture (Figure 11.5) depicts a scene several years later when the

Figure 11.1 Dr. Hikmet Hamdi, Illustration, The Atlas, 1926, 37.  Caption reads: “A tubercular man spits on the street. Someone else unwittingly steps on the sputum.”

230  Alev Berberoğlu and Cansu Değirmencioğlu

Deconstructing the Story of a Contagion  231

Figure 11.2 Dr. Hikmet Hamdi, illustration. The Atlas, 36.  Caption reads: “Dried tuberculosis sputum is scattered with dust and lands on fruits and other food, and those who eat them unwashed are infected with the germs.”

child begins to show tubercular symptoms and undergoes physical examination, which underlines the importance of visiting a medical doctor for an accurate diagnosis. In the final picture (Figure 11.6), the boy comes down with TB. The mother cares for him in the sick bed, while the father weeps in desperation. The caption reiterates the irresponsibility of the father who caused the infection of his child. This visual story of TB adhered to the nationwide health campaign to teach the public about the dangers of contagious diseases. One of the most crucial points was to materialize the germ and render it in a way that was comprehensible to a diverse audience with varying degrees of literacy. For instance, dry sweeping was repeatedly criticized, and the resulting dust was held responsible for spreading germs (see Figure 11.2). Moreover, the ignorance of parents was considered lethal for their children since they did not know how to protect their health. Furthermore, the importance of prevention methods was highlighted, and it was deemed a personal responsibility to protect the health of oneself and, implicitly, the nation, and keep both domestic and public spaces clean. As Evered and Evered point out, “In the morality tale trope of public health curriculum, the atlas conveys the constant imperative to self-regulate, self-police, and self-govern the behavior and the health of oneself and one’s family.”45 Finally, in case of any symptoms, the sick person was strongly encouraged to see a medical doctor for an accurate diagnosis, as in Dr. Hikmet Hamdi’s tubercular story.

232  Alev Berberoğlu and Cansu Değirmencioğlu

Figure 11.3 Dr. Hikmet Hamdi, illustration. The Atlas, 38.  Caption reads: “He dirties his home because he enters the room with dirty shoes.”

Figure 11.4 Dr. Hikmet Hamdi, illustration. The Atlas, 39.  Caption reads: “His child swallows the germs while playing in the dirty room.”

Deconstructing the Story of a Contagion  233

Figure 11.5 Dr. Hikmet Hamdi, illustration. The Atlas, 40.  Caption reads: “As the child grows up the signs of tuberculosis begin to appear.”

Figure 11.6 Dr. Hikmet Hamdi, illustration. The Atlas, 41.  Caption reads: “The child falls ill due to his father’s carelessness.”

234  Alev Berberoğlu and Cansu Değirmencioğlu Hikmet Hamdi’s last major contribution to the field of public health could be c­ onsidered to be his participation in the Second International Hygiene Exhibition held in Dresden from May to October 1930, where he represented the Turkish Republic.46 According to the exhibition guidebook, the inventory of the Turkish Pavilion included the visual story of TB from the Atlas.47 The 1935 Hygiene Exhibition in Ankara The sixth bi-annual National Medical Congress opened on October 7, 1935 with the speeches of Prime Minister İsmet İnönü and then Minister of Health Dr. Saydam at the People’s House in Ankara, the new Republican capital.48 In his speech, Saydam asserted that in addition to providing grounds for scientific exchange, these congresses were sources of national joy, attesting to success in matters of national health.49 After the opening, the Congress recessed for the inauguration of the Hygiene Exhibition,50 a complementary event to the Congress but also open to the public.51 A large group, including İnönü, visited the exhibit assembled in the Ankara Exhibition Hall,52 and in the following days, this exhibition was praised in daily newspapers and medical journals: In the modern and bright halls of the Exhibition House, this modern, high-tech, clean and tidy exhibition that we contemplated as a mature and advanced example of Turkish science, Turkish intelligence and Turkish methodical work, made us proud by being a testament to the visible rise of our culture day by day.53 National exhibitions became spatial embodiments of Turkish modernization during the 1930s and, as Bozdoğan stated, “became showcases for modern architecture and republican public space,”54 as well as “effective instruments of ideological propaganda.”55 The most iconic exhibitions of this period included Istanbul Domestic Products exhibitions, the Izmir International Fair, and various shows that were held at the Sergi Evi [Exhibition House] in Ankara, built in 1934. According to Bozdoğan, not only the exhibitions but also the design of the building by Şevki Balmumcu (1905–1982) symbolized the regime’s progressive agenda.56 With its dominant horizontality, rounded ends, band windows, and asymmetrically located clock tower, the architecture of this concrete building resonated with the modernist aesthetic adopted by the regime from the late 1920s.57 Hence, it had wide coverage in La Turquie Kemaliste, the official multilingual journal to promote the new Republic to foreign audiences.58 Hygiene exhibitions were pivotal events which guided people “towards a ‘sensible’ lifestyle”59 and epitomized the contemporary discourses on healthy bodies and a hygienic world view in the context of industrialized modernity. Moreover, as Brecht and Nikolow argue, they “represented the official gaze upon the propagation of diseases.”60 In parallel with the popularization of the holistic approaches in preventive medicine, such exhibitions aimed to educate the masses about the medical aspects of diseases and their social context. For instance, one of the most iconic hygiene exhibitions, the Second International Hygiene Exhibition held in 1930 in Dresden, was designed to display progress in health practice “not only in Germany but throughout the world.”61 Five years later, the very same Dr. Wilhelm Wadler, who had worked on the preparation of the TB section of the Dresden Exhibition in 1930, was also in charge of the Turkish Hygiene Exhibition organized by the Ministry of Health and Social Assistance. Born in Vienna, he studied medicine in Munich and received art training in Munich,

Deconstructing the Story of a Contagion  235 Berlin, and Paris. Wadler had practiced as a medical doctor but also contributed in many art exhibitions as a painter.62 In the 1930 Dresden Hygiene Exhibition, the section on TB contained “models and pictures which graphically demonstrate the avenues of transmission, the methods of prevention and treatment, and prevalence charts for Germany.”63 During a time when the discussions on eugenics and racial hygiene were intensifying, Wadler pointed out in a panel the scientific fact that TB was “not transmitted by heredity but by contagion.” He drew further attention to the socioeconomic outcomes of TB contagion in the text that he penned for the exhibition guide in 1930: Although the number of tuberculosis deaths has decreased in recent years, the risk of infection has not decreased. The main thing that emerges from the statistical surveys is that tuberculosis kills people at their best working age, so not only individuals and families have an interest in combating this disease, but also the general public.64 In 1934, Wadler, who was a Jewish man, a socialist, and an avant-garde artist, emigrated to Turkey like many other Jewish scientists who fled from the political pressure of the National Socialist movement.65 During his stay he worked in the Institute of Pathology at Istanbul University,66 took part in the assembling of the instructive museum in the Higher Institute of Agriculture in Ankara,67 and, finally, worked for the preparation of the Hygiene Exhibition. In 1936, an article written in German by Dr. Wadler about the Hygiene Exhibition was published in La Turquie Kemaliste accompanied by several photographs (see Figure 11.7).68 The Hygiene Exhibition in Ankara was not only a pedagogical and recreational event; it was also a display of modernity for the lay public and an informative platform showcasing the public health infrastructure that was being established by the government. Accordingly, a large and colorful “map of health” greeted the visitors at the entrance, marking with light bulbs the locations of hospitals, dispensaries for malaria, syphilis, and TB, trachoma hospitals and dispensaries, nursing homes for infants, and border and coastal sanitary organizations.69 One of the foremost attractions of the exhibition was the expansive architectural model of a “Healthy Village.”70 The theme of the Hygiene Exhibition was infectious diseases. The main content consisted of many diagrams which depicted the human body in “a simplicity that even the most uninformed people could easily understand,” and separate parts were devoted to the most common diseases and the most “dangerous epidemics in the country,”71 including trachoma, malaria, syphilis, and TB.72 Such diagrams comprised semi-abstracted illustrations of human bodies and graphic representations of enlarged isolated microbes for each disease, accompanied by photographs of health institutions, easily readable texts in large Latin scripts in modern sans serif fonts,73 and statistical data which symbolized “the administrative gaze upon the population.”74 Each section devoted to a disease contained information about the means of contagion, the affected parts of the body, signs of disease, and information on diagnosis and treatment. The focus was on the modes of contagion and prevention. Wadler highlighted the fact that infectious diseases were not simply individual cases that affected individual families, but that they occurred in high numbers, affecting everyone.75 The contagion potential of a single case had the risk to impact the entire society. Thus, education of laypeople and the masses were closely connected with disease prevention.76 The number of visitors reached nearly 120,000 and Wadler was impressed that the exhibition attracted various types of people, especially the general public, who returned

236  Alev Berberoğlu and Cansu Değirmencioğlu

Figure 11.7 Photographs from the Hygiene Exhibition (1935) in Ankara that illustrate Dr. Wilhelm Wadler’s essay. La Turquie Kâmaliste 11 (February 1936): 6.

Deconstructing the Story of a Contagion  237 home with “the ingrained concepts of cleanliness and the need for medical support in the country,” while many, including doctors, and students, took notes. “Men, women and children, mothers with their babies in their arms” attended. Wadler observed a “naive curiosity” as the mothers lifted their children up to show them the anatomical models. He noticed that the repetition of the simplified representations made orientation and understanding of the disease groups considerably easier for non-professionals to comprehend.77 As a final note, Wadler praised Saydam for his intelligence and efforts to carry out hygiene education for the whole country despite the relatively limited sources.78 The Hygiene Exhibition transformed the visual arts into pedagogic tools for public instruction. In fulfilling the educational aims of the ministry, the methods of representation were as crucial as the content, as stressed by Wadler: A word should also be said about the design, about the ‘how’ of the exhibition. No matter how well concentrated and polished the ‘what’ is, the content remains ­ineffective if it is not given the appropriate, well-formed expression in the ‘how.’79 Accordingly, among his main principles were “accuracy, clarity, simplicity, m ­ emorability and what is called artistic effect,” and the exhibited content had to be “scientifically correct, very straightforward, absolutely understandable.”80 Wadler typified and clarified the repetitive basic concepts, symptoms, and measures, and constructed them as “hieroglyphs” which “even the ordinary visitor hammers into his head.”81 However, this “ordinary visitor” was assumed to know how to read and at least be familiar with microscopic images. Although printed in large fonts, there were numerous texts that required literacy to comprehend the content.82 In this regard, the stylistic character of this exhibition reflected the positivist and secularist discourses of the Republic, as well as the contemporary transformations of popular culture which increasingly introduced scientific knowledge into the everyday lives of the people in Turkey. Throughout the exhibition the human bodies were imaged as minimalistic and uniform. “The base of the human form, the body, was executed in a generous, correct, but semi-abstract drawing in unrealistic colors,”83 explained Wadler. The figures were intentionally anonymous, devoid of distinctive features, and did not even have faces. Any indicators about class and personal identifiers were excluded. It was almost a modernist reinterpretation of the human body: standardized mechanisms with unadorned, pale, streamlined, and smooth surfaces. Only, when necessary, the internal organs were depicted in a pared-down but rather more realistic style. This was a result of what Wadler called the “artistic effect,” since to him art meant “the transformation of the everyday into the timeless, and the timelessness of symptoms or complications seemed to demand an unrealistic capture of plasticity and movement.”84 It was the diseased organs or systems that mainly differentiated and categorized the bodies. This implied that all human bodies were equal until they were infected by a disease. Germs and diseases were universal, and anybody could be a potential host when the conducive circumstances occurred. Dr. Wadler, commenting on this uniformity of the bodies, noted that illnesses “don’t stick to people’s conception of borders, race or class, they spare neither the thinker nor the strong manual worker.”85 As a medical doctor, Wadler perceived and represented the human body as pathologic systems, organisms that were only identified by their interaction with the bacterial world, and as an artist he had those bodies abstracted and isolated separately in the form of collages. Thus, the human bodies became like bacteria: identical organisms varied only by biological processes. Such

238  Alev Berberoğlu and Cansu Değirmencioğlu

Figure 11.8 Photograph of the panel explaining tuberculosis in the Izmir Fair (1937). Ahmet Piriştina City Archive and Museum (APIKAM)/İBB İzfaş Endowment Fund.

standardized and unified representations of bodies and germs evoked a sense of ­assurance and reliability for medical practice, as they suggested that all bodies would respond in the same way to treatments.86 However, at the same time, this stylistic abstraction of Modernism and reductionist approach of modern medicine can be seen as a reproduction of biopolitical viewpoints which excluded any cultural or social context in which the disease operates. The Tuberculosis Section in the Hygiene Exhibition The TB panel in the Hygiene Exhibition (Figure 11.8) was a collage that contained textual and visual information about contagion, microbes, how to avoid infection, the process and symptoms of the disease, types of TB infection, diagnostic methods, and treatments.87 Although it displayed a totally different artistic style from Hikmet Hamdi’s pictures, it was similar to his linear narrative in being divided into chronological sections depicting the before, during, and after phases of the contagion, but from left to right. The panel opens with a written statement: “Tuberculosis is not hereditary. It mostly occurs in childhood through transmission,” a message like the one Wadler had formulated in Dresden. Comparable with Hikmet Hamdi’s narrative, the main subjects of TB infection here are healthy parents and their children. Although less dramatic, in these diagrams the worst social outcome of TB is identified as the infection of children, referring to the demographic problems of the nation. Visualizing microbes, i.e., the “invisible enemy,” became increasingly common in the 1930s popular culture. Hence, the TB

Deconstructing the Story of a Contagion  239 bacillus was illustrated on a large scale on the panel, made visible to the naked eye. This type of representation of the germs also had an implication that by isolating and ­making visible, the disease-causing germs were being taken under control, disciplined, and ­dominated by the tools of modern medicine.88 The many diagrams about various diseases in the exhibition depicted the ways in which “the penetration of the smallest, only microscopically perceptible pathogens into the human body” caused infectious diseases and how these microbes could enter the body through different ways such as touch, injury, bites and stings from animals, respiratory tract, food, and sexual intercourse.89 Accordingly the incidence of contagion was one of the main points of the TB panel. In line with the first message—that TB spreads through contact—the moment of contagion was depicted as an adult man either coughing or sneezing without covering his mouth while he was sitting among other adults and children playing on the ground. The infectious sputum was sprayed through the ­subjects, potentially causing them to catch the disease. In this period, the anti-TB education had shifted its focus from secondary factors to airborne contagion resulting from direct ­contact with the sick or their sputum. Therefore, the instructive health propaganda highlighted the dangers of kissing children and not covering one’s mouth while sneezing or coughing. TB patients were advised to always carry a spittoon.90 Moreover, a principle of social distancing was especially advised to people with TB, or to the ones who lived with them. Likewise, the second text on the TB panel advised the visitors to avoid contracting the bacillus and noted that those who lived together with tubercular people and in unsanitary crowded places, meaning especially the poor, were more likely to catch this disease. Next, the focus shifted to describing the effects of TB on the lungs. Briefly, different types of infection were summarized via texts, and visualized in drawings and threedimensional models of lungs. This was followed by the signs of TB, methods of diagnosis, and treatment. Early diagnosis and control became one of the most important stages of the struggle against the disease. It was almost a national responsibility for a person with TB symptoms, such as fever, weakness, cough, and sensitivity to cold, to go to authorities. And it was possible to prevent infection and “save a life doomed to death” with timely intervention.91 In these visuals, except for the moment of contagion, an individual infected with TB was not fully illustrated. Instead, it was a pair of lungs which was ill, not a person dramatically suffering from TB. In short, there were no depictions of diseased individuals. Christoph Gradmann remarks that diseases came to be portrayed as “a duel between doctors and microbes” after Koch’s research conducted on isolated bacteria instead of humans, which led to the disappearance of the diseased individual in popular images.92 Similarly, Wadler’s design identifies contagion as a pathological process between microbes and lungs. Contemporary methods for TB diagnosis were presented next, accompanied by the message that “the doctor makes the final diagnosis with X-rays and bacteriology examinations.” There were photographs of medical experts working with microscopes and taking X-rays. Such images were also existent in the popular visual culture of the time. While these medical imaging technologies enabled experts to have control over nature, the microcosm, and bodies, they also accelerated the transition of medical knowledge to daily life due to their objectivity and reproducibility. They delivered the ability to see the “invisible enemies” and to trace the visible damage they had done inside of the body.93 The microscope, according to Boris Jardine, was “one of the truly emblematic tools of science,” and “a sign of diligence, of control over nature, and access to hidden worlds.”94

240  Alev Berberoğlu and Cansu Değirmencioğlu Furthermore, as Bruno Latour asserts, the laboratory itself was a powerful symbol since it was where phenomena, i.e., the germs and diseases, finally became smaller under the supervision of a group of people who could then dominate and discipline them.95 X-ray technology, as Lisa Cartwright stresses, was also emblematic for having “revealed more about the modern body than any other imaging modality,”96 and was acknowledged as the most valuable assistant in the diagnosis of TB.97 The bacteriologist and radiologist had a similar role with a public health exhibition: they translated the medical knowledge from laboratories to laypeople. In a way, images of microscopes and X-rays on the panel carried the message that nothing could be hidden from the medical gaze and that every individual was responsible for their own health, hence for the continuity of the nation. Finally, the photographs on the right side of the panel featured the landscape views and the long balconies where TB patients received sunlight therapy and benefited from fresh air at Istanbul’s Heybeliada Sanatorium, established by the ministry in 1924. The sanatorium images were positioned under the bacteriology and radiology photographs since admittance as a patient in the sanatorium required bacteriological and radiographic evidence of TB. Because it was still the pre-antibiotic era, sanatorium treatment was the best option for a TB sufferer and offered not a drug-based treatment but instead hygiene, rest, fresh air, and a rich diet which also targeted the social grounds of TB such as overwork and malnutrition resulting from the low-income level of the patients admitted in public sanatoria. Another significant function of sanatoria was isolating the infected from society and teaching them how to live with this disease without spreading the contagion. Sanatoria aimed to create germ-proof spaces where contagion was almost impossible to occur: high-tech, anti-dust, well-ventilated, concrete, and white. At the time of the exhibition, there were only few sanatorium establishments in Istanbul.98 These photographs can also be considered as a response to the complaints about the lack of TB hospitals circulating in the press. In summary, the central point that Wadler and the ministry emphasized in these diagrams on TB was that the disease was transmitted by air rather than genetics, and that attention to this fact was crucial for protection and prevention. The diagrams offered simplified narratives of scientific content about infections, germs and organs, symptoms of TB, and the effect of early detection and the medical imaging tools that made it possible. Finally, the display highlighted the existence of modern facilities functioning in service to the public. Two years later, the inventory of the exhibition was eventually transferred to the permanent health pavilion set up inside the Izmir Fair.99 It was again Refik Saydam, in his last year as the health minister, who arranged the construction of this pavilion. The exhibition was first opened as part of the seventh Izmir Fair of 1937.100 Conclusion Despite their visually different artistic styles and graphic techniques, the presentations of Dr. Hikmet Hamdi and Dr. Wilhelm Wadler share a common pedagogy: to inform the public in an easy-to-understand manner that the best method of prevention is avoiding contagion. As the products of the anti-TB movements from the pre-antibiotic era, these two distinctive attempts to visualize contagion gained publicity due to the efforts under the direction of the same Minister of Health. Although Hikmet Hamdi and Wadler were both artists and medical doctors, they had quite different cultural backgrounds. As an Ottoman-Turkish intellectual, the first was able to engage with cultural references

Deconstructing the Story of a Contagion  241 adapting skillfully the informative panels and pictures about contagious diseases from the hygiene museums in Germany to the local context for the Turkish audiences, whereas the latter, a German émigré, introduced the latest European trends in visual representations of interwar notions related to public health. Moreover, Hikmet Hamdi aimed to educate a wider audience, including illiterate citizens, while Wadler’s design was more understandable for literate people who were also familiar with microscopic images. They had a common ground in their social objectives, though: depicting children as the main victims and parents as the primary responsible persons for their protection. Also, compared to the pessimistic undertone in Hikmet Hamdi’s visual story, Wadler’s images were more optimistic in forecasting recovery from the disease because the public health infrastructure was more developed in the 1930s. In contrast to the emotionally charged content of the Atlas, the panel from the Hygiene Exhibition, with its undramatic tone, focuses on scientific facts, rationality, and appeals to the mind of the viewer; knowledge about the disease is essential. In other words, Wadler’s diagrams resonate with the rationalist mindset that came to the fore simultaneously with cultural modernization, and they universalize the process of falling sick through the anonymity of the bodies, while Hikmet Hamdi’s pictures evoke romanticized literary descriptions of TB.101 Hamdi elevates the pathos element of the domestic tragedy by nourishing his visual narrative with dramatically changing emotions, as well as attaching familial values to the process of falling sick of a personalized individual. Whereas Hamdi’s narrative incorporates content from both the before and after periods of the modernization of healthcare practices, Wadler’s work is a total product of the bacteriological era of medicine. These two methods display differences which document the changes in medical approaches and preventive measures over time. For instance, they depict different transmissions of contagion via indirect or direct contact. A comparison between the two reflect further developments in medicine, such as changing methods of diagnosis and treatment, and increased systematic attention on the surveillance and isolation of the sick. Another indication of the changes in health infrastructure is the disappearance of the sick room in Wadler’s panel. With the modernization and institutionalization of medicine, the ideal care of the sick relocated from home to hospital. In this narrative, the sickbed of a tubercular person in the domestic space is transformed into a recliner on the balconies of the sanatorium. One final difference is the absence of the diseased individual in Wadler’s graphics. This can be regarded as an indicator of the increased emphasis on bacteriology, with a focus on germs as the cause, rather than the sick person as carrier, of the disease. For the modernization project that shaped the socio-cultural policies of the early Republican period in Turkey, nation-building also meant citizen-building. This meant robust bodies, healthy minds, modern spaces, a rational lifestyle organized according to scientific norms, and various media of cultural production to make these changes visible. In this period, the Ministry of Health and Social Assistance made systematic efforts to build public health infrastructure and put extensive emphasis on mass health education with an increase in the 1930s. These became literally visible in the propaganda works. While health instructions were increasingly loaded with ideological content to highlight the role of state authorities in the well-being of the citizens and social implications to identify disease prevention as a matter of civic duty, health exhibitions and museums reified the national discourses on public health and the anti-TB struggle. The contemporary communication media adopted by the ministry, such as instructive leaflets, posters, books, educative movies, radio lectures, and exhibitions, documented how public

242  Alev Berberoğlu and Cansu Değirmencioğlu health propaganda and discourses became increasingly integrated into the nation-building ­project. Indeed, regardless of their time, place, or creators, the final products born out of the dialogues between visual arts and medicine shed light on cultural histories in a unique way. Notes 1 Tomes describes the period between 1900 and 1940 as the time of “the First Germ Panic” which resulted from the popularization and the scientific acceptance of the germ theory of disease. See Nancy Tomes, “The Making of a Germ Panic, Then and Now,” American Journal of Public Health 90, no. 2 (2000): 191–198. 2 See Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (London: Routledge, 2003). 3 Katherine Ott, Fevered Lives: Tuberculosis in American Culture since 1870 (Cambridge, MA: Harvard University Press, 1996), 4. 4 This time frame differs in early Republican Turkish historiography. While historians take the beginning of the early Republican period as the formation of the Republic (1923), the end date varies between 1938 and 1950, according to the context. In our case, we are adopting 1938, which was when the founder of the Republic, Mustafa Kemal Atatürk, died but also when Dr. Refik Saydam’s duty as the minister of health ended. 5 Fatih Artvinli, “Salgınların tarihi: Toplumsal ve siyasal açıdan kısa bir bakış,” TTB Covid-19 Pandemisi 6. Ay Değerlendirme Raporu, 55, accessed June 7, 2021, https://www.ttb.org.tr/ yayin_goster.php?Guid=42ee49a2-fb2d-11ea-abf2-539a0e741e38. 6 For some illustrated publications on TB from the Late Ottoman period, see Abdullah Cevdet, Vereme karşı müdafaa (Istanbul: Sıhhiye Müdüriyeti-i Umûmiyesi, 1913–1914); Mehmed Şevki, Vereme Karşı Terbiye ve Tedrisat (Istanbul: Şirket-i Mürettibiye Matbaası, 1916); Besim Ömer, Verem Tehlikesi – Veremle Mücadele (Istanbul: Matbaa-i Ahmed Ve Şürekâsı, 1919). 7 See Nuran Yıldırım and Mahmut Gürgan, Türk Göğüs Hastalıkları Tarihi, ed. Muzaffer Metintaş (Istanbul: Türk Toraks Derneği, Aves Yayıncılık, 2012). 8 Kyle Thomas Evered and Emine Önhan Evered, “An Atlas of Maladies, Microbes, and Morals: Tropes of Scientism in Early Turkey’s Public Health Education,” Historical Geography, no. 44 (December 29, 2016): 105–106. 9 Ceren Gülser İlikan Rasimoğlu, “ ‘Verem iyi olur bir hastalıktır’: Cumhuriyetin ilk yıllarında verem mücadelesi ve siyaset,” Toplumsal Tarih, no. 296 (2018): 54; Ceren Gülser İlikan Rasimoğlu, “Erken Cumhuriyet Döneminde Sağlıklı Bireyin İnşası: Pronatalist Politikalar, Çocuk Sağlığı ve Verem,” İstanbul Üniversitesi Sosyoloji Dergisi 39, no. 2 (2019): 337. 10 T. C. Sıhhat ve İçtimaî Muavenet Vekâleti, Verem (Tüberküloz) (Ankara: Ankara Cezaevi Matbaası, 1938), 11. 11 A short story from the 1930s describes how a tubercular person was shunned by people on the ferry once he began to cough and spit incessantly. The story implies that someone with TB risks becoming a social outcast isolated from his community – an unpleasant condition from which he is liberated only when he has undergone the proper medical treatment. Muvaffak İhsan, “Sanatorium,” Yaşamak Yolu, March–April 1932, 28–30. 12 Ebru Boyar, “Taking Health to the Village: Early Turkish Republican Health Propaganda in the Countryside,” in Middle Eastern and North African Societies in the Interwar Period, eds. Ebru Boyar and Kate Fleet (Leiden: Brill, 2018). 13 It is important to note that the negative connotations which the word “propaganda” has in English are not necessarily applicable to the usage of the same word in Turkish. In the latter case, the word’s meaning centers on the act of disseminating and promoting ideas or doctrines verbally and textually. 14 In fact, a dedicated department was formed in 1936, named “Sağlık Propagandası ve Tıbbi İstatistik Umum Müdürlüğü” [General Directorate of Health Propaganda and Medical Statistics]. See Feyza Kurnaz Şahin, “Propaganda ve Sağlık: Cumhuriyet Döneminde Sıhhî Propaganda Faaliyetleri ve Halk Sağlığına Etkileri (1923–1945),” in Türkiye Cumhuriyeti’nin Ekonomik ve Sosyal Tarihi Uluslararası Sempozyumu (26–28 Kasım 2015 İzmir), vol. 1 (Ankara: Atatürk Araştırma Merkezi Yayınları, 2017), 549–589.

Deconstructing the Story of a Contagion  243 15 See, for instance, Verem (Tüberküloz), Sıhhat ve İçtimaî Muavenet Vekâleti Neşriyatından No. 60 (Ankara: Cezaevi Matbaası, 1938), 5. 16 For an insightful analysis of the military rhetoric in medicine, see Susan Sontag, Illness as Metaphor (New York, NY: Farrar, Straus and Giroux, 1978), 64–66. 17 İsmail Hakkı Kutkam, Köylülere Öğütlerim: Verem (Istanbul: Halk Basımevi, 1937), 10–11. 18 Evered and Evered, “An Atlas of Maladies,” 103. 19 Christoph Gradmann, “Invisible Enemies: Bacteriology and the Language of Politics in Imperial Germany,” Science in Context 13, no. 1 (2000): 12. 20 Soon other health museums opened in Ankara, Bursa, Çorum, Erzurum, Giresun, Izmir, Kars, Konya, and Ordu. Propaganda ve Yayın İşlerine Ait Çalışmalar 1923–1954 (Sıhhat ve İ.M. Vekâleti Basımevi, 1955), 14. 21 For a discussion of their growing relations from the nineteenth century onward, see Ulrich Trumpener, “Germany and the End of the Ottoman Empire,” in The Great Powers and the End of the Ottoman Empire, ed. Marian Kent (London: Frank Cass, 2005), 107–135. 22 Yusuf Ziya Aktaş, “Sıhhi Müze Hakkında,” Uluslararası Müze Eğitimi Dergisi 2, no. 1 (November 30, 2020): 18. 23 In fact, rather than a museum, it was a permanent exhibition. 24 Aktaş, “Sıhhi Müze Hakkında,” 17–19. 25 In the 1910s, he went to study in Germany on different occasions, first at the Charité Hospital in Berlin, then at Rixdorf (Neukölln) Hospital in Berlin. Nuran Yıldırım, “Hekim Kimliği ile Abdülhak Adnan Adıvar ve Tıp Tarihi ve Deontoloji Müderrisliği,” Osmanlı Bilimi Araştırmaları 7, no. 2 (2006): 57–58. 26 Yıldırım, “Hekim Kimliği ile Abdülhak Adnan Adıvar,” 68. 27 Ayten Altıntaş, “Sağlık Müzesinin Yağlı Boya Tabloları,” Tombak, no. 18 (1998): 37. 28 For a detailed biography of Hikmet Hamdi, see Naciye Turgut Cebeci, “Üsküdarlı Sanatkar Hekim Hikmet Hamdi Bey,” in Uluslararası Üsküdar Sempozyumu X, ed. Coşkun Yılmaz (Istanbul: Üsküdar Belediyesi, 2019), 3: 129–153. 29 Yıldırım, A History of Healthcare, 39. 30 Ibid. 31 Ibid. 32 Cebeci, “Üsküdarlı Sanatkar Hekim,” 135. 33 Süheyl Ünver, “Ressam Doktor Hikmet Hamdi 1872–1931,” Poliklinik 2, no. 8–20 appendix (February 1935): 240–241. For further information on Hoca Ali Rıza, see Naciye Turgut Cebeci, Ressam Hoca Ali Rıza 1858-1930 (Istanbul: YKY 2013), and Ömer Faruk Şerifoğlu, ed., Hoca Ali Rıza: İstanbul’un Ressamı: Ev ve Şehir, 2 vols. (Istanbul: TOKİ, 2018). 34 Serpil Bağcı, et al., Ottoman Painting, ed. Serpil Bağcı, trans. Ellen Yazar, 2nd ed. (Istanbul: Ministry of Culture and Tourism, The Bank Association of Turkey, 2010), 307. 35 R. V. Johnson, Aestheticism (Oxon and New York, NY: Routledge, 2018), 13. 36 Preface of Sıhhî Müze Atlası, 1926, Refik Saydam. 37 Ibid. 38 Propaganda ve Yayın İşlerine Ait Çalışmalar 1923–1954, 1. 39 Ayhan Vergili, “Cumhuriyet’in İlk Yıllarında Halk Sağlığı Propagandası Amacıyla Yayımlanan Bir Kitap: Sıhhi Müze Atlası,” in Tıp ve Kültür Tarihi Araştırmaları, eds. Aykut Kazancıgil and Hüsrev Hatemi, 18 (Istanbul: Derin Tarih, 2015), 79. 40 Sıhhî Müze Atlası (T.C. Sıhhiye ve Muavenet-i İçtimaîye Vekaleti, 1926), 20–21. 41 Sıhhî Müze Atlası, 44. 42 Sıhhî Müze Atlası, 36–41. 43 Sontag, Illness as Metaphor, 18. For a detailed discussion of TB as a romanticized disease see also Sontag, 26–31, and Frank M. Snowden, Epidemics and Society: From the Black Death to the Present (New Haven, CT and London: Yale University Press, 2019), 269–291. 44 The dangers of spitting in the streets are reiterated in public health publications that focus on tuberculosis. See for example: Kutkam, Köylülere Öğütlerim: Verem, 6, and Hikmet Hamdi, Sıhhî Müze Rehberi (Ankara: Sıhhat ve İçtimaî Muavenet Vekâleti, 1931), 14. 45 Evered and Evered, “An Atlas of Maladies,” 116. 46 “Dresden’de Bizim de İştirak Ettiğimiz Hıfzıssıhha Sergisi Açıldı,” Cumhuriyet, May 27, 1930. 47 Internationale Hygiene Ausstellung Dresden 1930, Amtlicher Führer (Dresden: Verlag der Internationalen Hygiene-Ausstellung, 1930), 173.

244  Alev Berberoğlu and Cansu Değirmencioğlu 8 “Altıncı Tıp Kurultayı Açıldı,” Ulus, October 8, 1935. 4 49 Altıncı Ulusal Türk Tıp Kurultayı, 7-9 Birinci Teşrin 1935 Ankara (Istanbul: Kader Matbaası, 1936), 31. 50 The exhibition was mentioned with different titles in the Turkish press, such as “Health,” “Public Health,” “Hygiene,” or “Medical Exhibition.” 51 “Altıncı Ulusal Türk Tıp Kurultayı,” 35. 52 “Altıncı Tıp Kurultayı Açıldı.” 53 “Görülecek Bir Eser: Sağlık Sergisi” Ulus, October 13, 1935. 54 Sibel Bozdoğan, Modernism and Nation Building: Turkish Architectural Culture in the Early Republic (Seattle: University of Washington Press, 2001), 137. 55 Sibel Bozdoğan, “Introduction: Modernization, National Identity, and Visual Culture in Turkey,” The Journal of Decorative and Propaganda Arts, no. 28, Turkey Theme Issue (2016): 15. 56 Bozdoğan, “Modernism and Nation Building,” 138 and 140. Also, see Şevki Balmum, “Sergi Evi – Ankara,” Arkitekt, no. 52 (1935): 97–107. 57 Bozdoğan, 138. 58 La Turquie Kemaliste/Kâmaliste (Kemalist Turkey) was an official propaganda journal ­published and distributed internationally by the Turkish Republic Press General Directorate between 1934 and 1949 in order to announce the reforms in Turkey to the rest of the world, especially to Western audiences. The magazine, prepared mainly in French and containing a few articles in German and English, featured many photographs of Turkey taken by its Austrian staff photographer Othmar Pferschy. 59 Klaus Vogel, “The Transparent Man – Some Comments on the History of a Symbol,” in Manifesting Machine: Bodies and Machines, eds. R. Bud, B. Finn, and H. Trischler (Amsterdam: Harwood Academic Publishers, 1999), 35. 60 Christine Brecht and Sybilla Nikolow, “Displaying the Invisible: Volkskrankheiten on Exhibition in Imperial Germany,” Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 31, no. 4 (2000): 521. 61 George C. Dunham, “The International Hygiene Exhibition,” American Journal of Public Health and the Nation’s Health 21, no. 1 (January 1931): 2. 62 See Franz Peschke, “Arnold Wadlers Bruder, Der Arzt Und Künstler Wilhelm Wadler,” in Gebrochene Leben – Die Wadlers (Bochum/Freiburg: Projekt Verlag, 2021), 23–56. 63 Dunham, “The International Hygiene Exhibition,” 7. 64 Internationale Hygiene Ausstellung, 187. 65 It is difficult to track Wadler both in the records of German political archives, as he was “­stateless,” and in the Turkish national archives. Perhaps this is because he changed jobs in a brief time frame. All these different assignments indicate that the authorities had difficulty positioning Wadler within the state personnel. However, many scientists stayed longer and contributed extensively to the university reform, some of them founding and serving as the chairs of departments, such as doctors and social scientists. The architects were especially effective in building the new modern government buildings in Ankara. 66 Corry Guttstadt, Turkey, the Jews, and the Holocaust (Cambridge: Cambridge University Press, 2013), 93. 67 “Yüksek Ziraat Enstitüsü müze işlerinde 4 ay çalıştırılacak olan Alman Wadler’le sözleşme yapılması” BCA [Turkish Republican Archive] 30-18-1-2/48-65-15/ 28.07.1934. 68 Dr. Wadler, “Hygiene Ausstellung in Ankara,” La Turquie Kâmaliste, no. 11 (February 1936): 6–9. 69 Süreyya Kadri Gür, “Altıncı Ulusal Türk Tıb Kurultayında Gördüklerimiz,” Poliklinik 3, no. 4–28 (October 1935): 125. 70 “Görülecek Bir Eser.” 71 Ibid. 72 Gür, “Altıncı Ulusal Türk Tıb Kurultayında Gördüklerimiz,” 125. 73 These texts were translated into Turkish by the members of the commission. Dr. Wadler, “Hygiene Ausstellung in Ankara,” 9. 74 Brecht and Nikolow, “Displaying the Invisible,” 522. 75 Dr. Wadler, “Hygiene Ausstellung in Ankara,” 6. 76 Dr. Wadler, 7–8.

Deconstructing the Story of a Contagion  245 7 Dr. Wadler, 9. 7 78 Ibid. 79 Ibid. 80 Dr. Wadler, 8. 81 Dr. Wadler, 9. 82 This is understandable, since many of the visitors were those living in Ankara where the bureaucratic Republican elite resided. 83 Dr. Wadler, 9. 84 Although we do not know whether Wadler painted the images himself or not, his statements in the article reveal that he took an active role as a decision maker/curator in the artistic production of the exhibition. Moreover, some of Wadler’s previously signed paintings have a similar style of shading to the ones in the exhibition. See Wadler, 23, 37. Peschke, “Arnold Wadlers Bruder, Der Arzt Und Künstler Wilhelm Wadler,” 23, 27. 85 Dr. Wadler, 6–7. 86 For a detailed discussion about the socio-cultural evolution of public health imagery in the twentieth century, see Roger Cooter and Claudia Stein, “Visual Imagery and Epidemics in the Twentieth Century,” in Imagining Illness: Public Health and Visual Culture, ed. David Serlin (Minneapolis and London: University of Minnesota Press, 2010), 169–192. 87 As there are not any images available showing the Ankara Exhibition’s TB diagrams, we base our visual analysis on a photograph from the Izmir Fair, where the exhibits in Ankara were permanently transferred in 1937. 88 For a similar approach, see Brecht and Nikolow, “Displaying the Invisible.” 89 Dr. Wadler, 8. 90 For an example, see “Veremden Korunma Çareleri,” Yaşamak Yolu, no. 7 (July 1929): 4–7. 91 Fazıl Şerefeddin, “Veremin ilk tezahürleri,” in Sıhhat Almanakı, ed. Mazhar Osman (Istanbul: Kader Matbaası, 1933), 365. 92 Gradmann, “Invisible Enemies,” 16. 93 For a discussion on the role of microscopic images and X-rays in transforming the medical knowledge into the domains of popular culture, see Cansu Değirmencioğlu and Nurçin İleri, “Doğanın Gözlerden Sakladığı Gizemlerin Keşfi: Mikroskop ve Röntgenin Erken Cumhuriyet Türkiyesi’nde Kültürel Temsilleri,” Journal of Turkish Studies (Türklük Bilgisi Araştırmaları), Edebiyattan Tıp Tarihine Uzun İnce Bir Yol: Festschrift in Honor of Nuran Yıldırım 1, no. 55 (December 2021): 117–152. 94 Boris Jardine, “Microscopes,” in A Companion to the History of Science, ed. Bernard ­Lightman (Wiley Blackwell, 2016), 515. 95 Bruno Latour, The Pasteurization of France, trans. Alan Sheridan and John Law (Cambridge: Harvard University Press, 1993), 74. 96 Lisa Cartwright, Screening the Body: Tracing Medicine’s Visual Culture (Minneapolis and London: University of Minnesota, 1995), 107. 97 B. Muhterem, “Verem başlangıcının teşhisinde Röntgen’in ehemmiyeti,” in Sıhhat Almanakı, 650–651. 98 In 1935, besides Heybeliada, there were two private institutions on Büyükada and Burgazada established in the 1920s. As Heybeliada was the only free-of-charge institution of this period, another option was Erenköy Sanatorium, operated by the Istanbul Society for the Struggle against Tuberculosis in Istanbul which required a more affordable fee compared to the private sanatoria. These were followed by new establishments in Istanbul in the late 1930s; only in the 1940s were sanatoria opened in other parts of Turkey. See Yıldırım and Gürgan, Türk Göğüs Hastalıkları Tarihi. 99 La santé publique et l’assistance sociale en Turquie (Ankara: Direction Generale de la Presse, 1941), 99. 100 For an architectural evaluation of Izmir Fair’s Health Pavilion, see Ebru Yılmaz, “Modernite, Hijyen ve Bedenin Teşhiri,” Megaron 11, no. 4 (2016): 502–514. 101 Sontag, 26–31.

Index

Note: Italic page numbers refer to figures and page numbers followed by “n” denote endnotes. Abī Dīyāf, Aḥmad ibn 214 An Account of the Principal Lazarettos in Europe: With Various Papers Relative to the Plague (Howard) 217 Ackermann, R.: The Microcosm of London 52 Adıvar, A. 227–228 aerosolization 179 AIDS crisis revisitation movement 195 AIDS media: gentrification 195; The Grass Is Always Grindr 196–200, 199; history of 194–196; It’s a Sin 200–201, 202, 203–204 Akehurst, A.-M. 4–5, 7, 12, 77, 87n1, 160 Aldersley-Williams, H. 54 ʿAlī I, Husayn ibn 214 Ali Rıza, H. 228 Allen, L. W. 80, 85 Alpers, S.: The Art of Describing: Dutch Art in the Seventeenth Century 54 And in His Eyes I Saw Death (Nielsen) 116, 117, 122, 124–125, 127, 130 Ankara Hygiene Exhibition 3, 7–9, 227, 234– 235, 236, 237–240 Annesley, J. 137 The Appearance after Death of a Victim to the Indian Cholera, Who Died at Sunderland 3, 43, 62, 141, 141 Araki, G.: The Living End 194 Aras, T. R. 227 architectural programs 32–33 Arne, T. 50 Arnold, D. 2–3, 5, 8, 10 The Art of Describing: Dutch Art in the Seventeenth Century (Alpers) 54 Asiatic/Indian cholera 10, 41, 44, 59, 73, 137– 139, 141–142, 154n2, 157 the Atlas see Health Museum Atlas (the Atlas) Austen, J. 43; Persuasion 63

Bachelard, G. 13, 116, 118, 122, 127 Bachrouch, T. 223n22 Bahr, H. 13 Bakhtin, M. 11 Baltimore Sun 187 Barnett, R. 42 Bassano, J.: Saints Sebastian and Roch 26 Baudelaire, Charles 120; Les Fleurs du Mal 124 Bellin, J. N. 218 Berberoğlu, A. 3, 7–8 Berkowitz, S. 2, 5, 11 Berman, P. G. 133n62 Bertillon, J. 98–99, 113n32 Besnard, A. 104 Bey, H. 216–217, 228 Bhabha, H. 77 Black Death see bubonic plague (Yestinia pestis) Blake, J. 205 Blane, G. 56, 70n73 Bleakley, A. 13 blended modernity 41 “Blue Stage of the Spasmodic Cholera” 44–45, 45 Boeckl, C. M. 142 Böhme, G. 123–124 Bombay plague 163–170, 164, 168 Bombay Sanitary Association 8, 168–169 Bonaparte Visiting the Plague Victims of Jaffa (Gros) 146 Bonhomme, E. 5, 10 Bonnat, L. 94 Bordowitz, G.: Fast Trip, Long Drop 194 Boschini, M. 33, 34 Bournand, F. 95 Boyar, E. 226 Bozdoğan, S. 234 Brabble, J. 180

248 Index Brandt, A. 193 breastfeeding 99–100, 102 Brecht, C. 234 Bretonneau, P.-F. 105 brevet de capacité (official credential) 102 Bricker, H. E. 184 British India 44, 157, 165 Brouardel, P. 96 bubonic plague (Yestinia pestis) 5, 44, 65, 77– 78, 93, 142, 144, 160, 163, 165–166, 171, 211–212, 214–216, 221 Budin, P. 99 Buisson, F.: Nouveau dictionnaire de pedagogie et d’instruction primaire 97–98 al-Bukhārī, M. 217 Bull, J. 10–11, 152 Bulmus, B. 219 Burke, W. 61, 133n60 Burns, S. 89n26 Buteau, S. H. 185

Claretié, L.: L’Université moderne 97 cognitive inertia 175 Colley, L. 64 Collier, J. 178 Colombe, J. 144 contagion 8, 10–11, 118, 139, 157, 162–164, 169, 239; defined 12; and poor people 27–28; social 193–194, 200–201, 203, 205, 207n16; visual documentation 74 Cooper, E. 149 Cooter, R. 7 Coronavirus Crisis 151–152 Cosso, D. 30 COVID-19 (SARS-CoV-2) 1–2, 4–5, 10, 14, 74, 87, 137, 149–154, 160, 165, 171 Croisey, J.-B. 218 Cruickshank, G. 42, 52, 57–58, 57, 66; Salus Populi Supreme Lex Esto 58 Csergo, J. 98 Cunningham, D. D. 162

Canaletto, A. 25 Capodiva, G. 31 Carlevarijs, L. 34–35 Carter, H. V. 160–164, 161, 169; Mycetoma 161 Cartwright, L. 240 Cash, P.: The Chemsex Monologues 196; The HIV Monologues 196 Cassatt, M. 98 Castiglia, C. 195 cellular microbiology 12 Centers for Disease Control and Prevention (CDC) 88n7, 90n52, 194 Chadwick, E. 139; Report on the Sanitary Condition of the Labouring Population of Great Britain 65 Chamber of Commerce 185 charity 28, 30, 99, 186 Chatterjee, S. 2, 15n7 Chemsex (2015) 195–196 The Chemsex Monologues (Cash) 196 Cheng, J.-F. 194 Chérif, M.-H. 213–214 cholera: blue 10, 62–65; contracting 77–79; epidemic 41, 43–44, 52, 56–58, 99, 138–139, 146, 149, 152; in Japan 79– 83; as plague 142–149; in Sunderland 139; symptoms 56; See also Asiatic/ Indian cholera The Cholera Morbis 51, 51 Cholera Tramples the Victor & the Vanquished Both (Seymour) 50, 142, 143 Christianity 6, 32, 41, 43, 62, 66, 121, 167, 215–216 Cipolla, C. 211 circumfusa 123

Danse Macabre (Dance of Death) 144 Darling, L. 214 Darney, P.: 5 Guys Chillin’ 196 Davenport, R. J. 57 Davies, L. 196, 205; The Grass Is Always Grindr 194, 196–200, 199, 203–206 Davies, R. T. 195–196, 200, 202, 205, 207n22; It’s a Sin 195–196, 200–201, 202, 203–204; Queer as Folk 195, 207n22 Death and the Cripple (Nielsen) 116, 125, 127, 129 Death in the Sickroom (Munch) 128, 130 Death’s Dispensary. Open to the Poor, Gratis, by Permission of the Parish 146–147, 148 Death Struggle (Munch) 116, 118, 119, 126–128 Debat-Ponsan, E. 102 Decadence 131n18 Default Mode Network (DMN) 122 Defeating Cholera (Kimura Takejiro) 5, 11, 74, 75, 76–77, 82–87, 90n50 Defeating Smallpox (Shungyō) 80, 80 defenceless sex 63 Degeneration (Nordau) 120 Değirmencioğlu, C. 3, 7–8 De humani corporis fabrica (Vesalisus) 59–61 The Dernier Resort (Seymour) 144, 145 Dicke, T. 175–176 Dinet-Lecomte, M.-C. 115n72 diphtheria 97, 105, 107 the diseased body 163, 170, 220 disease etiology 8, 10, 216, 220 Doherty, M. C. 54 Doppelganger 127–128 Dowsett, G. 195

Index  249 Dresden Hygiene Exhibition 234–235 Dufour, L. 99 Dunstall, J. 145 Dutch Republic 47–48 An Early Frost (Erman) 194 East India Company 157 Eberth, K. 96 Echenberg, M. 6 Eckert, A. 88n7 ecstasies of things (Böhme) 124 Edo period 78 Edwards, S. N. 177, 179 Edwards Vaughan, J. 57 elephantiasis 163, 166 Elias, N. 11 Elizabeth I, Queen 64 El Rafaie, E. 13, 18n59 emotions 12, 63, 97, 116, 121, 124, 129, 197–198, 241 end of AIDS 193, 204–206 England 43–44, 48, 142, 150 English cholera/cholera nostra 137, 139 Epidemic Commission 119 epidemic of explanation 177–181 epidemic psychology 177 epidemics of action 181–182, 184 epidemics of fear 184–189 Erenköy Sanatorium 245n98 Erman, J.: An Early Frost 194 Evans, R. 3, 213 Evered, E. O. 227, 231 Evered, K. T. 227, 231 Ewing, E. T. 180 Fair, I. 238 Farr, W. 63, 66, 142, 147–148, 154n8; Plagues of London 147; Report on the Mortality of Cholera in England 63 Fast Trip, Long Drop (Bordowitz) 194 fear and denial 30–31 fin-de-siècle 94, 118, 120 5 Guys Chillin’ (Darney) 196 Fleming, A. 12 Florêncio, J. 198, 201 folklore & traditional narratives 74, 76, 82– 83, 85, 203 Foucault, M. 3, 7, 11, 110, 213, 225 Fracastoro, G. 5, 27–28 Franco-Prussian War 7, 93, 95 Freud, S. 133n58; The Uncanny 128 Gantz, J. 157 Garrick, D.: Harlequin’s Invasion 50 Gatacre, W. F. 164, 167, 173n39 The Gate of Calais or O, the Roast Beef of Old England (Hogarth) 62

gay-related immune deficiency (GRID) 194 Gear, J. W. 141 General Directorate of Health 228 Geoffroy, H. J. J. 5, 7, 93–100, 110–111n1; Bureau des Nourrices 100–101, 110; Christmas Tree at the Goutte de Lait 108; depopulation and disease in infants 98–102; The Great Hall of the Poor 105, 106, 107, 109; Hôpital des Enfants-Assistés 98–99; At the Hospital of Notre-Dame du Perpetuel Bon Secours 102, 103, 104; hygiene in the classroom 95–98; La Crèche 99–100, 101; Mothers’ Diploma of Special Merit 99, 100; nursing 102, 103, 104– 105, 106, 107–110, 109; Obligatory Education 96–97; Palm Sunday (Les Rameaux) 94–95, 104; Return to Life 109, 109; soeurs hospitalières 107–108; Triptyque de la Goutte de Lait de Belleville 99; Visit to the Hospital 105; The Washbasin at the ecole maternelle 96, 96–98; Young Girls in Procession at the Feast of Corpus Christi at the Hospices de Beaune 108 germ theory 12–13, 41, 66, 77, 93, 120, 123, 170, 181, 201, 225–226, 242n1 Gibson, R. 94 Gilbert, P. K. 141 Gillray, J. 42, 52 Gilman, Sander L. 1–3 Goeneutte, N. 98 Gradmann, C. 239 Grainger, R. D. 142, 149 Grancher, J.-J. 114n54 graphic medicine narratives 2, 13 graphic satire 2, 41–43, 52, 55 The Grass Is Always Grindr (Davies) 194, 196–200, 199, 203–206 Great Plague of 1665 43–44, 55, 142, 144– 145, 153; See also bubonic plague (Yestinia pestis) Gregory, A.: Riot Act 196 Gregory, Pope 142, 144 Grigsby, D. G. 146 Gros, A.-J. 165; Bonaparte Visiting the Plague Victims of Jaffa 146 Habermas, J. 7, 43–44, 47, 63 Haffkine, W. 8, 167 Hales, S. 67n25 Halftone 189n9 Hallett, M. 42–43, 61 Hals, F. 47, 59 Hamdi, H. 6–8, 227–229, 230–233, 231, 234, 240–241 Hancock, M. 150–151

250 Index Hansen, A. 162 Hansson, O. 124 Harlequin’s Invasion (Garrick) 50 Harrison, J. 50 Harvey, K. 11, 139 Hass, J. C. 182 Hatty, J. 6 Hatty, S. 6 Havard, H. 110–111n1 Hays, J. N. 3 Health Museum Atlas (the Atlas) 7–8, 228– 229, 230–233, 231, 234, 241 “The Health of the People Is the Supreme Law” 56–58 Health of Towns Association 65 Heath, W. 12, 52–53, 53, 55–56, 59, 60, 63; Microcosm: Monster Soup 52, 53, 55, 56, 59, 63; Sketch from the Central Board of Health 59, 60, 62 Heine, H. 13 Heintz, G. 32, 35 Heller, R. 124 Helms, J. 193, 207n16 Herold Hospital 98 Herring, D. A. 9 Heybeliada Sanatorium 240, 245n98 Higgins, D. 88n7 Hirshberg, G. H. 177 HIV-AIDS (human immunodeficiency virus infection/acquired immunodeficiency syndrome) 193–196, 200–201, 203–206 The HIV Monologues (Cash) 196 Hoca Ali Rıza 229 Hodson, M. 205 Hoffman, E. T. A.: The Sandman 128 Hogarth, W. 7, 42, 52, 61–62; The Gate of Calais or O, the Roast Beef of Old England 62 Holbein, H. 60–61 homeless 122 homosexuality 193, 201 Hooke, R. 48, 53–55, 69n61 Hopkins, A. 5, 41, 44, 65 Howard, J. 46; An Account of the Principal Lazarettos in Europe: With Various Papers Relative to the Plague 217 Huber, V. 213 Hume, J. 186 Hüppauf, B. 184 Husaynid dynasty 213 Huygens, C. 48, 54, 69n55 Hygiene Exhibition see Ankara Hygiene Exhibition Hygienic Modernity (Rogaski) 224n51 Iarocci, L. 2–3, 8–9 İlikan Rasimoğlu, C. G. 226

Illustrated London News (Miller) 142, 146, 147 Illustrated Narrative on Preventing Cholera (Tsukioka Yoshitoshi) 82, 83 Il Redentore 21, 31–32 Indian cholera see Asiatic/Indian cholera Indian Medical Gazette (McLeod) 161–162 1918 influenza (H1N1 Influenza A virus) 175 Influenza Masks Play Big Role in Curbing Epidemic 180–181, 181 influenza pandemic 171, 175–177 İnönü, İ. 234 International News Photos 176 the invisible enemy 182, 189, 238–239 isolation & quarantine 5, 9–11, 21, 23–24, 28, 31, 44, 54, 65, 71n99, 78–79, 107, 114n54, 116, 122, 124, 126, 143–144, 164, 182, 184, 206, 211–212, 215– 217, 219–221, 241 Istanbul Health Museum 227–228 It’s a Sin (Davies) 195–196, 200–201, 202, 203–204 Izmir Fair 238, 240 Jackson, M. 41 Jacob, M. 47–48 Jalbhoy, R. 166 Jameson, J. 137 Jardine, B. 239 Jensen, M. B. 121 Jessore 137–138 John Bull Catching the Cholera 10–11, 48, 49, 50–51, 139, 140, 150, 152 Johnson, B. 151–152, 154 Johnston, W. 77 Jones, J. 61 Juhasz, A. 194 Jussim, E. 176 Kagan, D. 195, 197 Karachi plague 166, 166–167 Kemp, M. 64 Kennedy, J. 10 Kent, N. 130 Kerr, T. 195 Kimura Takejiro 5, 83; Defeating Cholera 5, 11, 74, 75, 76–77, 82–87, 90n50 Kjærsgaard, E. 116, 124–126 Koch, R. 16n37, 77, 118, 120, 225, 239 Kolb, R. 4, 10, 16n18 korori 79, 91n65 Krohg, C. 121 kwakzalver 58 Laënnec, R. 120 La Goulette port 5, 211–214, 216–217, 219–221 The Lancet 4, 10, 44, 56, 62, 138–139, 142, 155n17

Index  251 Langlois, C. 114n45 La Puériculture pratique (Variot) 99 Larson, B. 5 Latour, B. 240 Law of Associations 114n44 Lawson, I. 54 Lazarus 28 Lazzaretti and public health 23–25 Lazzaretto Nuovo 21, 24 League against Infant Mortality 99 Lebensreform movement 121 Ledin, C. 4, 12 Leeuwenhoek, A. 56 legislative act 97, 99 Leo XIII 104–105 leprosy 162–163, 166 Les Fleurs du Mal (Baudelaire) 124 Levasseur, E. 94 Lewis, T. R. 162 Lieferinxe, J. 142 Lisieux, T. d. 104, 114n51 Liston, W. G. 8, 168–170 lithography 45 The Living End (Araki) 194 Llewellyn, N. 65 A London Board of Health Hunting after cases like cholera 46–47, 47 London plague 166 Longhena, B. 21, 32–33, 35 Louise Cattel: Wet Nurse (Roll) 101 Ludwig, A. 180 L’Université moderne (Claretié) 97 Madura Foot 161 maisons maternelles 99 Malcolmson, J. G. 157 Mann, T. 21, 23, 30 Marková, I. 44, 53, 56 mass-mediated pandemic 175 McBride, J. S. 191n66 McKay, R. 207n16 McLeod, K.: Indian Medical Gazette 161–162 Mecca 211, 215 the medical gaze 157–158, 160–163 Meiji Restoration 11, 78 memento mori 62 mercantilism 10, 212–213, 219–220 Mercuriale, G. 31 metaphors of disease: anthropomorphic 118, 127; military 13, 46, 82, 84–85, 87, 176–177, 179, 182, 184; skeletal 62, 141, 144, 146, 152 Metro 137, 150, 150–153, 151 miasmata 45 miasma theory 21, 23, 45–46, 77, 101, 139 Microcosm, A Grand Display of the Wonders of Nature 52–53

Microcosm: Monster Soup (Heath) 52, 53, 55, 56, 59, 63 The Microcosm of London (Ackermann) 52 Micrographia 54–56, 55 Milan 25 Miller, T. 142; Illustrated London News 142, 146, 147 Milton, J. 56 Ministry of Health and Social Assistance 226, 228, 234, 241 Ministry of the Interior 97, 101, 111n7 Moalla, A. 214 Monkeypox 206n10 Montoy, A. 107 moral contagion 17n51 Morisot, B. 101; The Wet Nurse Angele Feeding Julie Manet 101–102 Mortensen, K. 13 Morton, M. 87n1 mufti 216–217 Mulkowal disaster 169 Munch, E. 6, 13, 116, 118, 119, 120, 122– 124, 125, 126–130, 127, 133n56; Death in the Sickroom 128, 130; Death Struggle 116, 118, 119, 126–128; The Origins of the Frieze of Life 128–129; Self Portrait with the Spanish Flu 122; The Sick Child 116, 127, 127–129, 133n56; Spring 124, 125, 128–130 Municipal Corporations Act (1835) 65 Murger, H. 102 Murphy, R.: Pose 195 Mycetoma (Carter) 161 Napoleon Bonaparte 146, 151, 165 Narayan, S. 166 Nationalokonomisk Tidsskrift 118 Naturalism 93, 110, 120 natural philosophy 41 New Emergency Hospital 184 The Next Best Thing (Schlesinger) 195 Nielsen, E. 3, 6, 13; And in His Eyes I Saw Death 116, 117, 120–127, 121, 129– 130; Death and the Cripple 116, 125, 127, 129; The Sick Girl 121, 121 Nightingale, F. 64; Notes on Nursing 66 Nikolow, S. 234 Nordau, M. 120, 131n14; Degeneration 120; Volkerdammerung 120 The Northern Looking Glass 55 Notes on Nursing (Nightingale) 66 Noulens, J. 97 Nouveau dictionnaire de pedagogie et d’instruction primaire (Buisson) 97–98 Oakland Tribune 185–186, 186 objective inquiry 62

252 Index Old Court House Hospital 185 Omaha Daily Bee 180, 180 On the Mode of Communication of Cholera (Snow) 66 The Origins of the Frieze of Life (Munch) 128–129 Orton, R. 137 Ott, K. 225 Ouradou, M. 107 Owen, S. 151 Palladio, A. 21, 31, 35 Pallasmaa, J. 123, 133n69 pandemic disease: and children 6–7, 93–110, 111n10, 114n54, 226, 229, 237–239, 241; colonialism & trade 50, 65, 73, 78–79, 214–221; and gender 6, 43, 63, 84–85, 90n50, 229; and race 9–11, 158, 160, 162–163; and religion 44, 94–95, 104, 108, 110; and social class/poverty 27–28, 30, 65, 95, 108, 117, 170 Parkes, E. A. 158, 160 Pasteur, L. 5, 13, 93, 95–96, 105, 107, 111n2, 111n7 Patton, C. 193 Pearl, M. 200 Perimutter, D. D. 176 Persuasion (Austen) 63 Pest House 71n99 Peyssonnel, J.-A. 214 Philadelphia 179, 183, 184, 187, 188 Philadelphia Winning the Fight against Influenza 182, 183, 184 photojournalism & clinical photography 45, 157, 160–169, 171, 175–176, 179, 187 phylogenetic testing 204 plague 34–35; Bombay 163–170, 164, 168; cholera as 142–149; iconography 143– 144; Karachi 166, 166–167; London 166; painful death by 215–217; pedagogy 168–170; photographing 163–168, 164–166, 168; see also bubonic plague (Yestinia pestis) Plagues of London (Farr) 147 Porter, R. 1, 3, 41–42 Pose (Murphy) 195 Pratt, M. L. 73–74, 86, 213 Preparing to Bury City’s Influenza Victims 187, 188 Preto, P. 39n52 Provveditori alla Sanità 24, 31 Prudenti, B. 32, 33 public health 7, 211–216, 220–221, 225–229, 231, 234–235, 240–241; and disease management 41, 212–214, 220–221; of England 41, 151; in France 95; movement 95, 194

Pugin, A. C. 52 Pulex cheopis (Xenopsylla cheopis) 169 Pullan, B. 28 quarantine see isolation & quarantine Queer as Folk (Davies) 195, 207n22 Rainy Day Tanuki (Tsukioka Yoshitoshi) 84, 84 Ranger, T. 3 rationalist mindset 9, 241 Raza Kolb, A. F. 4, 10, 16n18 The Red Crescent 228 Red Cross 179–180, 180, 182, 185 Reed, C. 195 Reform Bill 10, 50, 56, 59, 64, 139, 144–145 Rembrandt 47, 59–61 Report on the Mortality of Cholera in England (Farr) 63 Report on the Sanitary Condition of the Labouring Population of Great Britain (Chadwick) 65 Richmond Times-Dispatch 177 Riding, C. 61 Riot Act (Gregory) 196 Robinson, M. 63 Rogaski, R.: Hygienic Modernity 224n51 Rolin, N. 105, 107 Roll, A.: Louise Cattel: Wet Nurse 101 romantic personality 120 Rosenberg, C. 3, 6 Roussel Law of 1874 100 Roussel, T. 99 Rowlandson, T. 42, 52 Royal College of Physicians 46, 58, 61 Royal Naval Hospital Stonehouse 46 The Royal Society of London 48, 52–55, 64–65 Saint Mark Enthroned 22, 23 Saint Roch 23, 25–27, 26 Saint Roch and the Story of his Life 26 Saints Sebastian and Roch (Bassano) 26 Sale of Spirits Act 1751 7 Salus Populi Supreme Lex Esto (Cruickshank) 58 The Sandman (Hoffman) 128 San Francisco 7, 179–180 Santa Maria della Salute 21–22, 26, 32, 35 Santa Victoria 64 Satchell, M. 57 Saydam, R. 225–226, 228–229, 234, 237, 240 Schedel, H. 144 Schlesinger, J.: The Next Best Thing 195 Schulman, S. 195 Sciampacone, A. 3–4, 10–11, 48, 77 science and supplication 31–32

Index  253 scientific vulgarization 94 Scuola Grande di S. Rocco 25–26, 31–32, 35, 39n59 Sedition Act of 1918 175 Self Portrait with the Spanish Flu (Munch) 122 Senate decree 23–24, 32 Serenissima 21, 23, 35 Serlin, D. 4, 7 sero-melodrama 197–199 Seymour, R. 13, 50, 142–145, 143, 145, 152; Cholera Tramples the Victor & the Vanquished Both 50, 142, 143; The Dernier Resort 144, 145 S. Giorgio Maggiore 35 Shadwell, T. 52 Shahani, N. 194 Shakespeare, W. 48, 56 Shapiro, A.-L. 112n17 Shaw-Taylor, L. 57 Shipping Measles Away (Utagawa Yoshifuji) 80–81, 81 Shitala 158, 159, 160 Shūtendōji 80–81, 90n50 The Sick Child (Munch) 116, 127, 127–129, 133n56 The Sick Girl (Nielsen) 121, 121 The Sick Goose and the Council of Health (Aesop) 58 sickroom 116; air of 128–129; art, degeneration, and illness 118–121; atmosphere of 122–124; corners of space 125–126; shadow of the self 126–128; as space 117–118; window 129–130 Siebold, P. F. B. von 90n51 Simmel, G. 123 Simmons, D. B. 82 Simpson, R. 193 Sirot, O. 107 Sjåstad, O. 131n15 Sketch from the Central Board of Health (Heath) 59, 60, 62 Slack, P. 3 Slott-Møller, H. 122 smallpox 77, 80–82, 90n51, 95, 97, 107, 158, 160, 162, 167, 229 S. Marco 27, 31–33 Smith, T. S. 108, 139, 143 Smits, G. 87n3 Snow, J. 65–66, 141; On the Mode of Communication of Cholera 66 social history of medicine 3–11, 41 social hygiene 203 social waste 193 Sontag, S. 13, 201, 229 Sorensen, R. 133n55 Spanish flu 122, 171, 175–176

spes phthisica 117 S. Pietro di Castello 32 Spirito Santo 23 Spring (Munch) 124, 125, 128–130 Stein, C. 7 Steinlen, T. 94 Stepan, N. 163 Stop COVID-19 Hanging Around 152, 153 Strong, P. 177, 186 Strozzi, B. 30 St. Sebastian 4, 6, 23, 26, 144 St. Thomas’s Hospital 152 Stubbs, G. 71n96 Swedlund, A. C. 9 Swift, J. 52 tanuki scrotum 74, 76, 79, 82–85, 87, 88n13, 91n61, 91n65 taxation 213–215, 220, 222n14 Third Republic (France) 5–6, 93, 97, 99, 102, 104, 107–108, 110 Thomson, J. 50 Thomson, R. 113n33 Tiepolo, G. 32 Tintoretto, D. 29, 30, 35 Titian 22, 23, 26, 30, 39n52 Tokugawa Shogunate 78 Tomes, N. 242n1 transi 65 Treaty of Karlowitz 222n17 Trolleys, P. R. T. 184 Tsukioka Yoshitoshi 82, 83, 84, 84, 91n63; Illustrated Narrative on Preventing Cholera 82, 83; Rainy Day Tanuki 84, 84 Tuan, Y.-F. 128 tubercle bacillus (Mycobacterium tuberculosis) 117–118, 123, 225 tuberculosis (TB) 94, 96, 102, 104, 107, 112n12, 116–121, 123–130, 146, 225–227, 235; in Hygiene Exhibition 238–240; in Istanbul 214–216, 222n17, 227–229, 240, 245n98 Tuberculosis Laws 119–120 Tunis 211–212, 214–217, 219–221 Tunisia 10–11, 211–221 Turner, J. A. 169 The Uncanny (Freud) 128 Underwood and Underwood 176 vaccination 4–5, 90n51, 118, 123, 167, 170–171 Vaillant, E. 96 Variety Magazine 182 Variot, G. 93, 98–99, 101, 105, 108, 110; La Puériculture pratique 99

254 Index Ventura, G. 110 Vesal (Vesalisus), A.: De humani corporis fabrica 59–61 Vesoux, A. 107 Vibrio cholerae 77; see also cholera The Virgin Appearing to Plague Victims during the Plague of 1630 (Zanchi) 27, 35 Visconti, L. 23 visual culture 1–2, 7, 43, 53, 55, 65–66, 73– 74, 76, 79–83, 85–86, 94, 101, 123, 149, 157, 226, 239 Volk, A. 84 Volkerdammerung (Nordau) 120 votive processions 21, 23, 31–33 Waddington, K. 2–5, 7, 16n26, 41 Wadler, W. 227, 234–235, 236, 237–238, 240, 244n65, 245n84 Wald, P. 9 Wallis, M. 64

The Wet Nurse Angele Feeding Julie Manet (Morisot) 101–102 Weyden, R. van der 93, 105, 107 Wollstonecraft, M. 63 Worchester Telegram 184 World Health Organization (WHO) 149–150, 152 World War I 7, 175, 184, 187, 190n17, 226–227 Wright, J. 53 X-ray technology 240 York Country Hospital 56–57, 71n96 Yūsuf, Muḥammad al-Ṣaghīr ibn 215–216 Yvon, A. 94 Zanchi, A. 25; The Virgin Appearing to Plague Victims during the Plague of 1630 27, 35 Zola, E. 99