More Medical Contrivances

Ron wrote a medical contrivances post that was published here. In it, he said “A contrivance is an excuse, a way of justifying something that would not normally be acceptable. Pigtails has endeavored to break through this façade and acknowledge that we find images of healthy naked girls (and women) appealing.” Milja Laurila, a Finnish art photographer, has used medical photography as the inspiration for her artistic nude photographs. Laurila wrote, “I look for image material for my works in old books and
archives. During the years, I have seen hundreds and hundreds of medical pictures, mainly from the 1900s. Why do most of them portray young, naked women?” I have not looked at hundreds of books and papers like Laurila has, but I have seen a few dozen. I agree that of those medical photos I have seen, a significant majority are of females. This is especially true of photographs that show the patient with a healthy control subject. An example of such a photo is the following from Dwarfism with Retinal Atrophy and Deafness by E. A. Cockayne, D.M., F.R.C.P. (1935).

E. A. Cockayne – Pearl D with Girl of Same Age (1935)

Was it really necessary to have a normal control posing with the dwarf? We know Pearl’s height because a scale of feet is shown to her right. Shouldn’t a physician know the normal range of height for a girl her age? Is the normal girl on the short end of the normal height distribution, or the tall end?  Perhaps she is somewhere in between; either the mean height, or the median, or the mode. Then again, she may have been chosen not for her height, but simply because she was an attractive girl who volunteered to be photographed. Previously, I had thought that the medical contrivances were contrived by the doctor alone. Now that I have l have seen more of these photos, I believe that both the doctor and the patient or control are responsible for contrivances. Consider the next picture from A Syndrome Resembling Progeria: A Review of Two Cases by Catherine A. Neill, M.D. and Mary M. Dingwall (1949).

Neill and Dingwall – AP and JP Compared with Their Normal Sister (1949)

There were four children in the family at the time the photo was taken; the two brothers with a syndrome resembling progeria were age 15 and 10. They had two siblings who were not afflicted with the syndrome; a brother age 13 and a sister whose age was not given. Although I am not a physician, it seems to me that the most appropriate control for the photo would be the brother of intermediate age.  There is a table in the report that compares the measurements of the two afflicted boys with their normal brother, but not with their sister. Why then did the two female authors (I assume that Catherine and Mary are women) use the sister for the control model in the photo?

My theory is that the authors actually wanted to use the brother as the control model, but he refused to be photographed nude. The sister then volunteered to take his place. This would be consistent with what I remember from my childhood. When I was a child, nudity was one of the strongest taboos. Both boys and girls avoided appearing naked, but I think we did so for different reasons. We boys were taught that our bodies were obscene. We were told we should be ashamed to be naked, and so we were. Girls were taught that they were pretty. They were told if they flaunt their beauty around the wrong kind of boys, they would be in danger. If the wrong kind of boys were not present, they must still avoid being nude because good boys would think the girls were promiscuous, and lose respect for them.

In a situation that is both safe and respectable, such as posing for a medical photo, I believe that boys would still be embarrassed. Girls, on the other hand, may have less qualms about agreeing to pose nude. Could that be the reason that a girl is photographed as the control with the two boys in the photo above, and why females seem to outnumber males in medical photos in general? If this is true, it could explain a strange thing about the following photos from Familial Syndrome Combining Deaf-Mutism, Stippled Epiphyses, Goiter and Abnormally High PBI: Possible Target Organ Refractoriness to Thyroid Hormone by Samuel Refetoff, Loren T. Dewind and Leslie J. Degroot (1966).

Refetoff et al – VG (1966)

Refetoff et al – EG (1966)

Refetoff et al – MG (1966)

In this set of photographs, an 8-year old girl and a 12-year old boy have the syndrome. Their 10-year old sister is the control. Note that the photos of the two girls are clear, but the photos of the boy seem to have the contrast and resolution adjusted to in effect censor his photo. Why did the authors do this?

It may have been because the boy refused to be photographed unless the doctors promised to censor the photos, but the two girls did not request that the photos were censored.   Another possibility is that the doctors may have thought that twelve was too old for an uncensored nude, but it was OK for the girls age eight and ten. This seems less likely because 12-year-olds are not too old for nude photos in other medical works, as shown by the following photos.

The first photograph is of twin 12-year old girls from Grey Turner and the Evolution of Oesophageal Surgery by R. H. Franklin F.R.C.S. (1971). The photo shows the twins cured with only a surgery scar remaining. Did they need to be completely naked to show the scars? The article does not have any photo of the twins before their surgery. The next photo is from The Clinical Study and Treatment of Sick Children by John Thomson (1921). The 12-year old patient is shown before and after treatment. Why is she dressed in the before picture and nude in the after? I can think of no reason why the doctor would want her dressed for the photo taken before treatment. Perhaps the doctor wanted a nude photo, but the girl refused because she was not happy with her appearance. After treatment she lost some weight, became proud of her looks, and volunteered to be nude for the after treatment photo.

R. H. Franklin – Identical Twins Treated for Repair of Hernia (1971)

John Thomson – Juvenile Myxoedema, Before and After Thyroid Treatment, Girl of 12 Years (1921)

Epiphyseal Stapling for Angular Deformity at the Knee by Robert C. Zuege, Thomas G. Kempen, and Walter P. Blount (1979) will be the last paper referenced in this post. Fifty-six patients are covered in this report, of whom 31 are boys and 25 are girls. Only one patient, a girl, was photographed before, during, and after treatment as a child. Another photograph was taken of her at age 20 to show that she was no longer knock-kneed. No photographs of any male patient as a child were included in the report, but one photo of an adult man was included. It is peculiar that the woman was photographed from the waist down and was nude, but the man was photographed only below the hips and wore briefs. There are two possible explanations for this.

  1. Perhaps the doctor told the woman to undress completely, and told the man to leave on his underwear.
  2. Perhaps he just told both to undress so he could photograph their legs. The woman chose to undress completely and the man did not.

I don’t know which is true, but I have the feeling the latter is very likely.

Zuege et al – RE Age Eight Years Five Months (1979)

Zuege et al – RE Three Months After Staples Were Removed (1979)

Zuege et al – RE Age Twenty and Male Patient (1979)