Nora Jones

The Mütter Museum here in Philadelphia began in 1784 as a medical teaching collection and today retains its 18th century feel as a museum of pathology and anatomy. In wood cabinets with melting glass, wax models, medical instruments, and human specimens lie together on shelves to illustrate the ranges of human pathology. The Mütter collection also includes over 1200 medical photographs, the majority dating to before 1910. In 1989 the Museum presented a special exhibit titled 'photography and medicine', highlighting over 100 images that represent how developments in photography have paralleled, assisted, and illustrated developments in medicine. The message, the meaning, of the photographs for the curators of this exhibit resided in their being objective records of medical science.

Beginning in the late 1980s, another use, another sense of meaning, was being found, or made, in these photographs. Self-described and socially labeled artists, including Joel Peter Witkin and Max Aguilera-Hellweg, began using the medical imagery found at the Mütter and in these medical photographs as themes and content for art projects. One of the consequences of this activity was the Mütter Museum calendar, produced by the Mütter and New York photographers as a fundraiser for the Museum. This calendar coupled intentionally created art photographs with archival images. In the 5 years of its production, the calendar became very popular among many local Philadelphians and even gained a national reputation. The calendar joined the expanding numbers of books and art projects devoted to using the body as an aesthetic object.

Photographs are an elusive phenomenon, an 'attractive nuisance', in the larger study of meaning. The two uses of medical photographs at the Mütter, as medical science and as art, parallel in many ways the two dominant ways to theorize photographs. One way to 'look' at photographs, or to theorize that act of looking, is to see pictorial images as direct imitations of reality, a means of scientific documentation. As such they are considered too weak or too rudimentary to attempt a detailed analysis of their meaning. Alternatively, images are seen to contain more possibilities of signification than it is possible to understand. One school of thought within the anthropology of visual communication approach is that visual and pictorial images should be considered texts that are read by individuals depending on their different and multiple interpretive strategies. As all communication relies on the sign, on the relationship between a token and a referent, the problem with studying photography is that the text in question, the token of photographic images, has most often been assumed to be iconic, a sign based solely on resemblance. A visual semiotic approach provides both theoretical and methodological models to get around this stalemate of the dichotomy of relative simplicity as objective reality, and insurmountable complexity of subjectivity. It is now no longer necessary to argue against the common sense notion that a photograph is simply a view made by one person that is taken up whole by the next viewer. Photographs need to be conceptualized as specific to cultural contexts, by those who have been indoctrinated into particular ways of seeing, and viewing photographs needs to move away from common-sense reductionism to culturally informed processes of interaction. Viewing museum exhibits, like viewing photographs, is increasingly seen as a contextualized communication process, with attention pointed towards the senders, message, and receivers. In the fall of 1997 I curated a small exhibit, 'Medical Photography', to play with this communication process to determine how medical photographs were received in the cultural activity of viewing a museum exhibit in a context where debates over the medically scientific and artistic nature of medical photography were actively being played out. As I mentioned above, the Mütter Museum calendar had become very popular by 1997. According to the director of the College of Physicians, the parent of the Mütter Museum, perhaps too popular. Imagery from the Mütter calendar adorns the tattooed arm of an old city man, web sites, art galleries in New York, and in the form of demonstrations on late night television. The College reacted against these more artistic appropriations of medical imagery, which they felt sensationalized the Museum, by discontinuing the calendar as created by artists and replaced it with a sanitized 'Treasures' calendar, with more straightforward images of what the Museum and College had to offer. Many Mütter fans and the press have reacted strongly and negatively to the actions of the college. Artists have argued for the inherent beauty in the human form and the Mütter continues to attract art students and photographers who use the displays for their projects, while the College remains faithful to its interpretation of medical documentation. The debates have grown to such a proportion that some of the museum staff have made up posters with the heading "We're just a medical museum, goddammit". The situation in 1997 was antagonistic between the board of directors of the College, who were in the process of marketing themselves as a leader in local health care information, and the fans of the Museum who were using medical imagery in alternative, not related to health care or medical information, ways.

In 1997 when I created this exhibit, I knew that medical photography was polysemic, but wanted to know more about how and why different messages were created. To approach such an understanding, I followed Constance Perin's 'Museums as Communicative Circle' model to allow for the connection of exhibition makers and viewers, through exhibitions which are seen to be sites of open messages, enabling communication to work as a dialogue both ways between exhibitions and viewer.

In the remainder of this paper I will detail the exhibition maker, the exhibition, and the receivers as experienced in a reception study to attempt to understand how and what meanings are made when looking at, creating a dialogue with, medical photographs. I need to reinforce that the reception study from which the following observations emerged was never intended to be an exhaustive study. In the course of 1 month I received 45 survey responses and conducted 10 interviews. The responses I received represent relatively well the variety of visitors to the museum. Visitors are in general educated or in educational situations, coming as part of school groups - high school and community college biology, English, and art classes, and pre-med or pre-allied health. Many come because they have heard that the Museum is 'freaky', 'cool', an alternative place. The other end of the visitor spectrum are professionals in the field of medicine, who generally come for medical history, or artists who come to use and view the body as subject. The value of this study rests in placing medical photographs soundly in an ethnographic design as a research tool to explore not only how certain people created messages from medical photographs, but to explore the possibilities for reception studies in the context of larger anthropological questions. The design of the exhibit centered around three themes in the development of medical photography with text panels discussing how developments in photographic technology influenced how medical subjects were depicted pictorially. In smaller text panels surrounding the images I placed quotes that deliberately brought attention to the possibilities of alternative views of photographs. Some of the quotes were by artists that mentioned the formal qualities of the human body, others were more general to the medium of photography as an art form. My intention was to have the linguistic messages in the exhibit be purposefully ambiguous. I wanted to keep my influence on the viewer minimal in relation to the question of objective meaning, or perceived objective medical history, and artistic meaning, more obviously connotative messages, in the realm of verbal language. The medium of photography particularly masks the fact that in images both denotation and connotation are cultural. Medical photography especially is a medium conceived of as purely descriptive and denotative. So then, the question becomes: what are the signs in medical photographs. Following Roland Barthes, the non-coded iconic messages (those that rely solely on perception and recognition that the object represented is 'something') include, but are not exhaustive to, the following signs: bodies, context within the image, medical pathologies, doctors and patients, medical instruments and treatment modalities. The coded iconic messages (those images or clusters of images that require a more culturally informed knowledge to infer meaning) could include class markers within the image and doctor-patient relationships, or recognition of certain formal elements that resemble other photographic or artistic works. Theoretically I could continue hypothesizing connotative iconic messages for the remainder of my time here. To understand the connotative messages of a photographic discourse requires reception analysis. The questions in my surveys and interviews were designed to be open-ended enough to determine without too much prodding the cultural understandings viewers brought to the act of viewing. The first two questions asked the viewer to identify which image was most and least interesting and to explain, if possible, why. I asked for 'interesting' to see if the viewer would self-select aesthetics, medical interest, or other reasons. In response to these questions there was a range of opinions, but overwhelmingly people chose this image of a pre and post operation for a bony tumor of the jaw. Respondents ranged from a puzzle-writer, medical students, practicing physicians, social worker, to musician; all who chose this image commented on its content as a record, wondering how he lived, what an unusual thing it was to see, how unbelievable it was, and/or why treatment was so delayed.

The other images that had a consensus of responses as most interesting are these silver-prints with post-processing airbrushing of paralytic deformities. All who chose this image had an art-oriented career or were studying art, and listed the visual aesthetic qualities as their reason for finding it most interesting. One said that although she wasn't sure this was intentional, the airbrushing bridged the gap between documentation and art. Another cited the uniqueness of the color in the photograph, and the third wrote that the airbrushing gave the photograph a painterly quality.

While there was some form of unanimity in regards to the choices of most interesting, the least interesting photographs of the people in these two groups were not unified. Most of the artists', those who noted most interesting due to visual aesthetics, chose as least interesting the artificial limb and the photographs of feet. The rationale for these choices was based on the observation that these photographs did not present any additional information. Similarly, a majority of those that chose the bony tumor as their most interesting image on the basis of curiosity and wonder, chose the paralytic deformity of the feet as the least interesting photograph. One respondent said that the color airbrushing took away from the photograph. All of the others noted the lack of interest in the content: there didn't appear to be anything wrong with the feet, people are not just parts, least visual aberration, or that they didn't understand it.

The second set of questions asked what the viewer would think if these photographs were displayed at the Philadelphia Museum of Art or at the Franklin Institute, a museum displaying scientific developments; I hoped that the viewer would think about and articulate their opinion on context. These questions also yielded a wide range of responses, equally positive and negative. Four of the respondents answered in the manner I had most anticipated, noting that context was important in determining the message of photographs: that they would be great at the PMA in the context of art and function, and great at the Franklin in the context of science, and that as these photographs belong not only to the realm of science, therefore at each institution they would need to be properly contextualized. The majority of responses, however, dismissed the possibility of displaying medical photographs at the PMA (although the PMA has over the past 15 years held special exhibits on the art of medicine). Some wrote that medical photography doesn't belong at the PMA because photographs are not art. One, a practicing physician, is representative of what I see as the colleges rationale for prohibiting the calendar production by artists: as these images were taken for science, not art, exhibiting them outside of the context of the Mütter Museum could be dangerous in that it may reinvent the freak show.

This brings me to the final issue of interest here in creating a dialogue with medical photography, whether or not the images have artistic qualities. In the final question, I told the viewer directly that I thought these images had artistic qualities and asked if they saw any and if so, could they give examples. This question brought the most emphatic, if least explained answers. Almost a third simply wrote 'No', some in all capitals multiple times. One said that the human condition was too sad in the photograph to be artistic. Similarly, one respondent wrote that art is an expression of emotion and thought, not deformities and unnatural unfortunates. Another answer conjures up the crowded vision of all the words that have been written on this medium, that these photographs are 'documentation, not art'.

In terms of those who did see artistic qualities, reasons for this opinion fall into two camps. There are those who see artistic merit in the human condition represented in the photographs, and others who commented on the formal qualities of lighting and composition. In terms of formal qualities, examples listed include: the composition, quality of print, background chosen, fine range of tones, unique perspective, quality of image, lighting, subject placement, framing, allusion to something else, the wrist drop looks like a swan, and qualities of shadow, space, perspective, and depth.

There is a strong similarity of answers on the artistic quality of the human condition. Some commented on the story behind the photographs, others philosophically wrote about the beauty of nature, science, and the beauty and dignity of the human condition.

What I have excerpted here from this reception study is not meant to be used to definitively answer how photographic messages are read as either records of reality or as endless strings of subjective, aesthetic signifieds. The central question this reception study attempted to prod viewers to address was how messages and meaning were created from photographs, to possibly see what dialogues are being created, what cultural interpretive backgrounds are being used to recreate messages. A semiotics of medical photography involves forcing attention to all of the messages, the rhetoric of the image. The responses to the questions posed in relation to a small exhibit on medical photography shows that images are polysemic, with some correlation of personal background and interest. It also implies that the boundaries limited by the categories medical science and art are used, either as viable distinctions or as false boundary.

So medical science and art are still useful categories - not for understanding the nature of photographic meaning, but as conceptual social categories that are differentially drawn upon when looking at photographs. It is this which allows reception of medical photography to be placed within a larger anthropological study of the Mütter; how visiting the Mütter is a locus for other activities that fit with peoples lifestyles, and also how changes and varieties, as seen in the calendar debates, of social attitudes towards the body in medicine and art are being created. Visual anthropologists must be wary, however, of looking for groups of people and their codes of interpretation. Distinction needs to be made between ideal and empirical spectators, and empirical spectators cannot be seen as microcosms of an ideal. The best question, then, for visual semiotics to ask is 'from where, from what position, is the reconstruction of meaning being made?, in all of the circles of communication, the exhibition makers, the site of the exhibition, and the viewers, forming a larger communicative circle enmeshed in socio-cultural context.

Bibliography

Barthes, Roland
1977 Rhetoric of the Image, in Image, Music, Text. Farrar, Straus, and Giroux.

Perin, Constance
1992 The Communicative Circle: Museums as Communities. In Karp, Ivan, Christine Kreamer, and Steven Lavine, eds. Museums and Communities: The Politics of Public Culture. Washington DC: Smithsonian Institution Press.