‘The Sick Rose: Or; Disease and the Art of Medical Illustration’ by Richard Barnett (Thames & Hudson, 2014).
Following our initial call for a clinical and artist’s review of ‘The Sick Rose,’ Dr Alice McLachlan offers her perspective as a Foundation (Year 1) doctor.
The Sick Rose: Disease and the art of Medical Illustration is, as Richard Barnett describes so perfectly in the book’s synopsis, a ‘beautifully gruesome and strangely fascinating visual tour through disease’. Barnett uses a series of illustrations from the late 18th to early 20th century to narrate the course of medicine, with written descriptions of how understandings of the human body have changed over time. The book is a work of art in itself; it is set out in chapters focusing on specific diseases with the illustrations taking centre stage so that each page can be turned slowly and savoured. That is, as long as you enjoy ogling pictures of pendulated tumours and leprosy-ravaged limbs.
The preliminary chapters set the stage for the rest of the book, summarising the changing face of medicine and surgery from the 13th century (when medical practice was principally guided by ‘the four humours’) to the 18th century push towards pathology and finding a more specific focus for disease. In the 19th century, the rise of ‘Paris medicine’ heralded a greater anatomical understanding, focusing on dissection of the dead body. This is all quite interesting from a historical point of view, but I found the writing to be quite dense and much of these early chapters went straight over my head; perhaps because I do not have much experience with historical literature. It was not until the chapters focusing on individual diseases that I really began to sink my teeth into this book. I had not known, for instance, that Jon Snow’s fantastic epidemiological work on the spread of cholera had been largely ignored; or that variolation against smallpox had been commonly practiced long before the practice of vaccination had been introduced by Edward Jenner at the start of the 19th century. To be diagnosed with painful, unsightly gout was almost considered a status symbol, and in the 19th century there was no death more glamorous than being slowly consumed by tuberculosis. In fact, women would powder their faces and squeeze into tiny corsets to get that ‘emaciated look’.
As a recently fresh out of medical school junior doctor, the historical and social context of disease is typically overlooked as we desperately try to memorise an enormous curriculum. The textbooks that form the backbone of our education are based on the most up-to-date guidelines of the diseases we will most commonly encounter. After all, this is what we really ‘need to know’. A book that focuses purely on medicine from a historical perspective rather than a scientific one goes against the grain, and The Sick Rose certainly wouldn’t make it onto any medical student’s essential reading list. This is fair enough, as it most certainly is non-essential, and does not pretend otherwise. There are no sneaky footnotes telling us ‘FYI – this is how you would manage gonorrhoea today’. Instead, it allows us to simply take a step back in history, and relish in the morbid fascination that surrounds illness and the unsightly effects it can have on the human body.
This is nothing specific to our time; human beings have had a strange fascination with disease, disfigurement and deformity for centuries. ‘Freak shows,’ which began to emerge as a form of entertainment in the 1600s, were popular for over 200 years before attitudes began to change – and now resurge. Today, there are endless medical documentaries (such as the popular ‘Embarrassing Bodies’) which allow people to gleefully gawk and gape at unsightly conditions in the comfort of their own home. As a junior doctor, I freely admit that I love these kind of programmes, and a morbid interest in the human body (i.e. getting to see ‘cool gross stuff’) likely influenced my entire career choice.
But as clinicians today, can we learn anything from The Sick Rose and its historical narrative? I believe that it has a lot to offer. Firstly, it serves as a reminder that medicine is constantly evolving. It’s easy for us now to look back and scorn at the idea of treating syphilis with mercury (now known to itself be a to xic agent); yet in a hundred, fifty, even twenty years time, the next generation of doctors may have the same attitude to chemotherapy, and wonder what on earth we were thinking. We must not become complacent with the treatments we currently have; instead, we should continue to challenge and push boundaries, just like our predecessors did.
It is also a reminder that whilst a science, there is a certain art to the practice of medicine. The human body is intricate and overwhelmingly complicated. When all the parts work perfectly in harmony, it is a beautiful well-oiled machine. As doctors, it is our job to keep that machine functioning as smoothly as possible. We might need to tinker with bits and pieces along the way, add a little more oil, replace old cogs that can’t be fixed, but we must not lose sight of the bigger picture. Negotiating this delicate balance between harm and benefit is the art of practicing medicine.
Finally, as a practicing clinician, it is easy to get sucked into the role of the ‘doctor’ with its challenging work-life balance, and forget why many of us chose this career in the first place. This book helps to restore a sense of excitement in the human body, how far we have come and what the face of disease would look like if we were no longer around. This is not a book to be read and absorbed in one go (in fact, I believe it is a little heavy going for that). It is one to keep on your coffee table, to flick through at leisure. It is also a book that visitors will be morbidly enticed to, and will almost certainly not be able to resist picking up and flicking through whilst feeling overwhelmingly grateful that we live in the fortunate age of vaccination, antibiotics and anaesthesia (rather than tuberculosis-inspired corsets).
Reviewed by Dr Alice McLachlan, a Foundation Year 1 doctor currently working in West Middlesex University Hospital, London. She graduated from the University of Dundee in July 2015, and has a BMSc in International Health with a dissertation exploring the ethical implications of research in developing countries. She has a keen interest in global and public health, and the increasingly complicated world of medical ethics. As well as aspiring to a career in palliative care, public health or general practice (she remains a little undecided), she secretly hopes to become a published author herself one day.
Correspondence to Dr Alice McLachlan.