Depicting in great detail fiery rashes, scabs resembling igneous rocks, and inflamed skin patterns spread out like archipelagos, the pages of dermatological texts may make your skin crawl. Still, these aptly named skin atlases were in high demand when they first emerged in Europe in the early 19th century, collected by members of the middle and upper classes as fascinating additions to their libraries. Richly illustrated with cases of lupus, syphilis, eczema, and other skin diseases, these dermatological books deviated from previous, older medical publications, which were filled with textual descriptions of cases.
“They really set a new pattern for a medical text,” Professor Jonathan Reinarz, director of the History of Medicine Unit at the University of Birmingham, told Hyperallergic. “Medical practitioners decided to make the most of this visual manifestation on the skin and publish these images, with which they could very easily show a typical case of congenital syphilis or say, this is what a two-month-old looks like with lesions.”
A number of pages from these historic texts, archived at Cadbury Research Library, are now on view in Skin Atlases, an exhibition at the University of Birmingham. Curated by Reinarz, it showcases dozens of colored drawings of skin ailments intended primarily for physicians to study and improve upon their diagnostic skills. Especially after the French Revolution, many practitioners found it difficult to return to their original jobs and had to find a focus to make a living; dermatology was simply part of a wave of specialization in the 19th century that included a rise in orthopedics and optometry, Reinarz explained.
But while the medical texts we see today contain clinical illustrations that focus only on the scientific, these early skin atlases were faithful portraits of real patients — or, at times, hybrids of individuals — filled with expression rendered with artistic flourish. This was long before patient confidentiality as we know it was an established right, and you probably could have recognized someone if you were walking down the streets of their small hometown, Reinarz said.
Credit was rarely given to these illustrators, but in most cases, the artists were likely the doctors themselves, who would have received plenty of practice sketching figures during university lectures or dissections. (In contrast, the seminal Gray’s Anatomy, originally published in 1858, gave attribution to its illustrator directly below Henry Gray’s name.) These portrait sessions would have occurred in the massive skin-specialist hospitals emerging in Europe at the time that mostly served lower-class individuals, and one drawing would likely require multiple sittings.
The level of detail in the resulting pictures, some of them spanning as large as one meter, is what makes these so particularly striking as they are quite beautiful despite the subject matter. Artists spent as much time drawing clothing — capturing the lace of bonnets or the creases of shirts — facial expressions, and slivers of surroundings as much as they did the actual diseases. In an illustration of psoriasis gyrata from Thomas Bateman’s 1828 book Delineations of Cutaneous Diseases, a woman turns away to reveal a back filled with tentacle-shaped sores; depicted in a relaxed pose with sheets gathering around her waist, she still resembles an elegant odalisque figure. Another page shows the profile of a woman with ichthyosis faciei, her hair in a braided bun so she looks like a Greco-Roman beauty. In Jean-Louis Alibert’s Nosologie Naturelle, a young boy perches on a bed with a cherubic smile despite the severe discoloration of his limbs due to internal bleeding. Artists even drew inspiration from representations of flora and fauna in natural history books, adapting the style of those field drawings for these new depictions: fungus that appears on skin, in some instances, resembles lichen; scaly psoriasis is sometimes softly colored, crawling on skin like plant tendrils.
According to Reinarz, an artist may have asked a patient to wear a particular outfit for the sole purpose of the portrait. Sometimes the request was intended to emphasize a person’s occupation or class to associate a specific disease with a certain background: if you’re a prostitute, you’re more prone to gonorrhea, a picture may suggest. Other creative choices were much more empathetic, suggesting closer relationships that developed between patients and practitioners.
“It’s interesting that in some cases [artists] put a sympathetic expression on a patient,” as Reinarz said. “It challenges some of the notions that people were not sympathizing with patients. It struck us at times that some of these patients had more agency.
“They were allowing these images to say quite a lot,” he continued. “I think some of these details that don’t seem necessarily related, people actually thought about very carefully about.”
Today, dermatological texts are still among the most highly illustrated of medical books, although long gone are such artistic flourishes. Hand-drawn portraits of the sick had largely disappeared by the 1920s and ’30s, replaced, of course, by photographs. These skin atlases, however, held significance beyond the field of medicine. As Reinarz described, physicians were among the first to call for better regulations of working conditions, recognizing that certain afflictions were the direct results of spending hours in hazardous environments. Much more than simply presenting someone’s physical state and occupation, these pages relay the real, day-to-day threats to personal health that 19th-century working class Europeans faced.
Skin Atlases continues at the University of Birmingham’s Muirhead Tower Atrium (University of Birmingham, Edgbaston, Birmingham, UK) through April 18.