One thing was certain: Mason’s Wall of the Unknown Dead allowed medical photography at Bellevue to survive. In the coming decades, Mason photographed thousands of medical procedures and diseased patients at the hospital with the enthusiastic backing of the staff. A good example was the blood transfusion—a novel procedure in this era, and a dangerous one given the ignorance of different blood types. A number of Bellevue physicians had done these transfusions in the past, believing it made more sense to add blood to a distressed patient than to withdraw it. As a young army doctor, William Hammond had transfused several cholera victims with bull’s blood, all of whom died (whether from cholera, or the transfusion, or both, is unknown). And Austin Flint, Jr., had revived a “moribund patient” with seven ounces of her husband’s blood while working at a hospital in New Orleans, only to see the woman die the next day.
In 1876, Mason took the first photograph of a blood transfusion. The procedure was real, but the scene had been carefully staged. The setting is immaculate. The donor—who was carefully weighed before and after the event to determine the amount of blood taken—appears calm and healthy, while the frail recipient is receiving oxygen through the nose. Between them is a physician controlling the proper blood flow and direction. Unlike previous paintings of transfusions, nobody is unconscious or about to faint, and there are no red drippings splattered about. Everything is in perfect order.
More than likely, this photograph was intended as a promotional device. Austin Flint had recently lectured on the benefits of blood transfusion to his peers at the New York Academy of Medicine. And there was good money to be made, as Oscar Mason soon discovered, by publishing these photos in popular medical textbooks.
Mason’s earliest collaboration was with Bellevue’s Lewis A. Sayre, one of the founders of orthopedic surgery. In preparing his 1877 monograph, Spinal Disease and Spinal Curvature, Sayre employed Mason to dramatically demonstrate the treatment of skeletal deformities through photography. The result was stunning; Mason’s twenty-one albumen prints completely overshadowed Sayre’s meticulous text. And it wasn’t hard to see why. The before-and-after images of a half-naked female patient with Pott’s disease, and a photo of her on her tiptoes in Sayre’s “tripod suspension derrick” with the fully clothed Sayre standing inches away, offered a whiff of eroticism deeply at odds with Victorian norms. Had this not been a “medical procedure,” it might have been banned.
Other photographs showed the woman immobilized in a snug plaster of Paris cast, known as the “Sayre’s jacket.” How well these devices worked was a matter of debate, though they’d be used well into the twentieth century. At the very least, the enormous success of Spinal Disease and Spinal Curvature spurred the development of new methods for the treatment of scoliosis through bracing and body casting. And, as Sayre himself noted, the tripod suspension derrick had a side benefit as well: the patient grew a bit taller from the constant stretching.
Mason’s most haunting photographs appeared in George Henry Fox’s Photographic Illustrations of Skin Diseases, published in 1881. Almost completely forgotten today, they sparked outrage at the time for supposedly crossing the line between medical instruction and voyeuristic pandering, especially those with female subjects. The 1870s and 1880s were the height of the controversial but enormously popular “side shows” in America. Hucksters like P. T. Barnum attracted huge throngs by booking fire-eaters, sword swallowers, and “freaks” with assorted medical abnormalities, some bogus, others disturbingly real. There were the “Wild Men of Borneo” (actually two mentally disabled dwarfs from Ohio), “Jo-Jo the Dog-Faced Boy” (suffering from hypertrichosis, a profusion of body hair), “General Tom Thumb” (the world’s smallest human), eight-foot giants, bearded ladies, Siamese twins, and people with humongous body tumors attached to their back, face, and scrotum. To some critics, Photographic Illustrations of Skin Diseases resembled a Barnum freak show masquerading as a medical text.
One of the photographs showed the hundreds of skin grafts applied to the bare chest of a thirty-seven-year-old woman badly burned by a kerosene lamp. She would die a few months later, the cause listed as “acute pleurisy,” but more likely the result of blood poisoning. Mason’s penultimate photo was of a nineteen-year-old woman with elephantiasis, taken against a stark white background. A black cape shields her face. Her fully naked body is normally proportioned from the waist up; her legs, ankles, and feet show the full force of her disease. She appears to be silently praying, her clasped hands pointing skyward. The text reads: “There are one or two patches of superficial ulceration, oozing a large quantity of…fluid. Since this oozing the legs have diminished in circumference. The general health is failing.” An admirer of Mason’s, perceiving a subtle blend of innocence and dignity in the photograph, dubbed it Bellevue Venus, and the name stuck. What happened to the patient is a mystery.
Before long, Mason had become a self-described expert on the female form. He spent his spare time as the photographer for “a very private and select coterie” of New York physicians known as the “Artistic Medical Club,” whose main object, it appeared, was to find the “perfectly proportioned woman.” A diligent search ensued, with various subjects interviewed and photographed, before one of the club members struck gold. “He is [her] family physician,” it was reported, “and as such had exceptional privileges accorded him. He made certain measurements, comprising the young woman’s height, size of waist, etc., and found them all to approach remarkably close to the ideal standard of correctness—the greatest deviation [being] the sixteenth part of an inch.”
Photographing her, however, took “several months of negotiation.” Mason had to promise to protect the woman’s anonymity. She would pose “in various positions, her face alone concealed by a heavy veil of drapery”—much like Bellevue Venus. And the photographs had to remain within the Artistic Medical Club, a bargain apparently kept. There appears to be no record of anybody else even knowing about them (and they may have been destroyed). Mason’s work, in this instance, was meant for fellow medical voyeurs, not for the larger profession.
At Bellevue, meanwhile, his reputation soared. His photographs had become indispensable in bringing medical procedures and oddities to an increasingly curious public. “When some eight years ago [our] department was first fully organized, through the efforts of a few of the more active and progressive members of the medical profession, some of their brethren seemed to look upon it with little favor,” Mason admitted. But times had changed. Thanks to photography one could chart an operation from start to finish, or follow the different stages of disease—all done quickly, cheaply, precisely. No longer did doctors have to rely on the inexact renderings of portrait artists or the “often imperfect methods of written description.” At Bellevue, even the most hardened skeptics of photography had become believers, Mason boasted, removing “any doubt as to [our department’s] great importance.”
Mason took so many photos in these years that Bellevue soon became the largest such repository in the world. He was particularly drawn to unique surgical procedures—the odder the better. And no part of the hospital seemed quite as fertile as the recently opened Department of Dermatology, one of the nation’s first, where novel experiments in facial reconstruction were already taking place—a logical step given the needs of badly disfigured Civil War veterans and the sharp rise in violent crime and street accidents in rapidly urbanizing New York. Bellevue’s leading surgeon, Frank Hamilton, had already performed twenty rhinoplasties when, in 1879, his protégé Thomas Sabine attempted a radical variation in which the patient’s middle finger would be refitted as his nose. Mason eagerly photographed it all.
The twenty-two-year-old male patient had come to Bellevue suffering from a massive nasal infection, which, according to his doctors, “was finally cured, leaving him without a nose and with deformity about the eyes.” After consulting with Hamilton and Lewis Sayre, Sabine began the multistage procedure by removing the nail from the patient’s left middle finger and placing
his left arm in a sling with the finger pressed into the exposed nasal cavity. Waiting several weeks for the surrounding tissue to bind, Sabine then amputated the finger and connected it permanently to the face with a series of silver wires. The procedure was not without complications. “Patient suffers pain from the constrained position [of the immobilized arm], relieved by hypodermics of morphine,” read an early notation. “The end of the middle finger has slipped from the pocket to which it has been attached,” said another. At one point, the patient required artificial respiration after the wound turned blue from oxygen loss.
Sabine and his colleagues deemed the operation a triumph. “The nose has become firmly united,” a Bellevue surgeon assured the medical community. “It is about normal color. Its sensibility is quite acute….The parts are looking very well indeed.” This appeared to be a minority opinion, however. Years later, a former intern gave the assessment of those at Bellevue who weren’t directly involved in the case. “The nose was not a great success as an ornamental feature,” he recalled, “and I doubt it was very useful from a utilitarian standpoint; but, at any rate, he had a nose.”
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For all its richness and diversity, Mason’s surviving portfolio is but a sliver of what occurred in the clinics and operating theaters of post–Civil War Bellevue. No photograph could possibly illuminate the diagnostic genius of an Austin Flint, who used the newly discovered binaural (two-eared) stethoscope to describe the first heart murmur and listen for the symptomatic wheezes and crackles of lung disease. And no photograph could illustrate Flint’s remarkably prescient instincts in recommending moderate exercise for cardiac patients—“indolence” led to “degeneration” of the heart muscle, he warned—and urging them to substitute fruits and vegetables for “fatty substances,” especially meat.
The same went for Bellevue’s Job Smith and Abraham Jacobi, the acknowledged “Fathers of American Pediatrics,” whose insights were better suited to the printed word than to the telling photograph. Or Francis Delafield, whose stunning experiments in microscopy were performed at his workbench, invisible to the naked eye. Or William Hammond, whose ingenious lectures on the importance of drugs and electrotherapy in treating disorders like insomnia, vertigo, and paralysis were heard and read by thousands of medical students and physicians. Even Lewis Sayre, one of Mason’s favorites, discouraged photographs of himself performing his most controversial procedure—circumcision—though he did allow occasional “before” and “after” shots of the children who had undergone it.
Sayre’s interest in circumcision had come about quite accidentally. In the early 1870s, a colleague had asked him to examine a five-year-old boy “unable to walk without assistance or stand erect,” whose knees were bent at a 45-degree angle to his trunk. “This little fellow,” the colleague wrote him, “has a pair of legs that you would walk miles to see.”
Sayre was intrigued. Already a leader in orthopedics, he was among a handful of surgeons to perform a gruesome operation called a tenotomy, in which the hamstring tendons are severed to expand movement in the legs. Sayre had no idea what had caused the problem until the boy’s nurse warned him: “Oh, doctor, be very careful—don’t touch his pee-pee—it’s very sore.” What Sayre discovered was a penis so tightly wound in its foreskin as to literally cripple the child. A few days later, in the surgical amphitheater at Bellevue, Sayre first tried a scissors and “the thumbs and finger nails of each hand” to perform an emergency circumcision. Within weeks, the lad was walking “with his limbs quite straight.”
It was, Sayre recalled, a eureka moment. If circumcision worked so well in this case, what else might it do? Sayre would spend much of his professional life seeking the answer. His experiments on Bellevue children and others regarding the dangers of the “constricted penis” led him to boast, often ludicrously, of having cured patients with club foot, epilepsy, bladder disease, extreme sexual urges, and serious mental conditions. Lecturing to a group of doctors in 1876, Sayre spoke of turning two wild boys—one “an idiot,” the other a “vicious lunatic”—into veritable angels through the simple act of circumcision. “This is almost a miracle,” he said. “It is beyond the power of man to comprehend it unless you see these cases from the start.” But further trials upon children at the local asylum proved disappointing. While Sayre claimed some “improvement” in his subjects, none was deemed well enough to be discharged.
Sayre would never quite find the “magic bullet” he so relentlessly pursued. What he did do, however, was to almost single-handedly bring circumcision into public view. “When a man of Sayre’s experience, reputation, and professional standing insisted that [serious conditions] could be cured by a comparatively simple operation on the foreskin,” an observer noted, “the medical world was prepared to take him seriously.” In the coming years, more and more doctors would come to view circumcision as essential to the nation’s public health. Using the 1880 U.S. Census, for example, John Shaw Billings, a founder of the Johns Hopkins Medical School, singled out immigrant Jews for their greater longevity, smaller number of “defective classes” (idiots and epileptics), and lower rates of cancer, syphilis, and other diseases—most of which he simplistically attributed to circumcision. (Several studies of that era suggested that Jews were better off because circumcised people masturbated less frequently.) Thanks largely to Sayre’s persistence, an obscure religious ritual became, by 1900, a routine medical procedure for millions of American boys.
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O. G. Mason amassed a remarkable résumé in his lifetime. The list includes one of the first lunar photographs, the first image of a lightning flash in a thunderstorm, and the first known photo album “for the safe storage and sharing of portraits.” When Bellevue purchased one of the first X-ray machines in 1896, Mason naturally became the house radiographer. (He retired in ill health in 1909, blaming the X-rays.) But Mason’s greatest service was his public depiction of Bellevue as a place of clinical riches and original research—a place where bold, creative, if sometimes bizarre and Frankenstein-like, experimentation prevailed. Hospitals earn their stripes, the illustrious Dr. Oliver Wendell Holmes had told the graduates of Bellevue Medical College in 1872, when “men of well-sifted reputations” arrive to turn them into “true centers of medical education.” Bellevue had approached that status, he declared, by attracting extraordinary talent and then disseminating the work.
Thanks, in some measure, to the vision of O. G. Mason and the medical photography he so deftly pioneered.
9
NIGHTINGALES
Medical progress comes in many forms. Sometimes a shift in public perception can be as valuable as a lifesaving scientific advance. During the Civil War, Americans were forced by circumstance to reassess one of the most reviled symbols of antebellum medical care. As the casualties mounted with each new military campaign, tens of thousands of soldiers found themselves in a place they’d never been before—a hospital. A farmer from Iowa now shared a ward with a shopkeeper from New York; a blacksmith from Ohio recuperated next to a carpenter from Maine. For sick and wounded veterans, the commonly held perception of the hospital as a dumping ground for the poor no longer matched their personal experiences. Many claimed to have been well treated, and what they remembered most fondly, according to their diaries and letters home, was yet another practical innovation of the war: the female nursing care made possible, in part, by the good works of Florence Nightingale in a faraway conflict a decade before.
In English history, notes the website of the British National Archives, the Crimean War of the 1850s “is principally remembered for three reasons: the charge of the Light Brigade, maladministration of the British army, and Florence Nightingale.” In almost all wars in that era, more soldiers had died from sickness than from enemy fire. But the British experience in Crimea had been alarmingly one-sided: 4,774 men lost to battlefield wounds, 16,323 to illness and disease. The public took notice—and the government almost fell—as newspaper correspondents in the field, using the ne
wly discovered telegraph, relayed their gruesome stories in current time. The London Times, in particular, exposed the frightful state of the transports that ferried the wounded across the Black Sea to military hospitals in Turkey, where conditions were even worse. “Cause of death” in these places read like a medical encyclopedia: cholera, dysentery, gangrene, malaria, scurvy, typhus—even frostbite. When a witness at the main hospital asked an orderly why a wounded soldier lay unattended, his uncovered wounds crawling with lice, the orderly replied: “It’s not worthwhile to clean him: he’s not long for this world.”
Under enormous pressure, England’s war minister, Sidney Herbert, authorized Nightingale to lead a team of female nurses to Crimea. “Her interventions, considered at the time to be revolutionary, seem in hindsight to be acts of common sense,” an admirer noted. Nursing had long been scorned because the job attracted women Nightingale herself described as “too old, too weak, too drunken, too dirty, too stupid, or too bad to do anything else.” Those who accompanied her to Crimea, by contrast, were well-trained devotees (including fifteen Catholic nuns) with a fetish for cleanliness and order. Once there, they scrubbed down the wards, emptied the waste buckets, bathed the patients, cleared their bodies of lice, laundered the bedding, and threw open the windows for fresh air. Nightingale never saw much good in bleeding or purging a wounded man, or in providing opiates to dull his pain. What she did see was a “clear relationship between the diseases killing [her] patients and the filth in which they lay….”
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