Capturing Racial Pathology: American Medical Photography in the Era of Jim Crow

Abstract

This article focuses on the untapped, complicated, fragile, and fluid visual archives of the elite White surgeon Rudolph Matas, a large proportion of which was produced during the late 19th and early 20th century, a time when he was a resident at New Orleans’ Charity Hospital in Louisiana and a professor of general and clinical surgery at Tulane University’s Medical Department. The article’s main aim is to understand the role of visual materials in the production, uses, circulation, and impact of a form of knowledge that Matas termed “racial pathology.” A small but representative sample of visual materials from the Matas collection are placed in context and examined in order to make known this untold chapter from the life story of “one of the great pioneers” in American surgery. The article reveals that many of the photographs were most significant in having been produced and assembled in parallel with the making, publication, dissemination, reception, and use of Matas’ racialized medical research, in particular his influential 1896 pamphlet, The Surgical Peculiarities of the American Negro.

The afflicted woman in Figure 1 was a patient of one Dr J. W. Plunkett in Flora, Mississippi, who forwarded her photograph to Dr Rudolph Matas at Tulane University’s Medical Department in New Orleans, Louisiana, to be displayed as part of the Orleans Parish Medical Association’s routine “exhibition of specimens.”² The woman’s image journeyed far and served many purposes. It was first published in the New Orleans Medical and Surgical Journal’s report on the association’s monthly meeting, held on January 13, 1894, and depicts what the journal described as “a negress having an enormous fibroma growing from the left parotid region.”³ The photo-engraving, in part, exposes a large and misshapen mass, supported by the unnamed woman, while the accompanying caption—“fibroma springing from parotid region”—is typical of a style of pathological medical prose that focused on lesions and their formation (and usually ignored the patient). Disfigured by the massive tumor, and under the stress of posing with it for a photograph, the woman maintains her dignity before the camera.

FIGURE 1—

Unnamed Woman

Note. In keeping with its original presentation in medical journals and various medical settings, this photograph and those that follow have not been censored, but debates about the meanings, ethics, and proper treatment of historical medical photographs are vigorous and ongoing.¹ Image reproduced with thanks to Mary C. Holt at the Rudolph Matas Library of the Health Sciences, Tulane University.

Source. Unknown photographer. “Proceedings of Societies: Exhibition of Specimens,” New Orleans Medical and Surgical Journal XXI, no. 7 (January 1894): 585.

Shortly thereafter, the photograph served as the basis for an artist’s illustration in “The Surgical Peculiarities of the Negro,” Matas’ contribution to the multivolume System of Surgery (1895–1896), edited by surgeon Frederic S. Dennis, an influential textbook in medical education.⁴ The half-tone photograph was reproduced in George Gould and Walter Pyle’s Anomalies and Curiosities of Medicine (1896), an encyclopedic compilation of extraordinary bodies, unusual growths, and uncommon case histories produced ostensibly as a work of medical reference, with a popular edition published in 1900. Much like a circus sideshow, this text was a site of human display that sought to appeal to the morbid curiosity of lay and medical readers.⁵ A copy of the image was also included in an album of medical photographs that belonged to Matas. To date, nothing further is known about the unnamed woman.

Although this is no ordinary portrait, as historians of medicine and photography—including Daniel Fox, Christopher Lawrence, and Larissa Heinrich—have shown, there is nothing uncommon about the burden of sickness it displays. It is a typical pathological photograph of the period and similar to images made, displayed, and circulated across Asia, Europe, and the United States.⁶ In terms of how it was used, it is mostly typical: as a diagnostic description, part of a record of cases and interventions, as a learned observation, a valuable form of professional and social currency, and as a trophy of sorts, with a human being framed as spectacle, intended to be of interest to both medical and popular audiences. Matas collected, displayed, shared, and used such photographic evidence to argue that there was a “ ‘special proclivity’ among the black population toward the development of fibroidal neoplasms” (benign tumors) in various localities of the body, and the visual materials in his archive and publications demonstrate a particular interest in such rare and sizable growths.⁷ The unnamed woman was not merely a proxy for the disease she was directed to display, but also offered powerful visual evidence to support a scientific research project that deepened notions of racial difference.⁸

The images that I use in this article are from the Matas collection’s complicated, fragile, and fluid visual archives, a significant proportion of which were produced during the late 19th and early 20th century, a time when he was a resident at Charity Hospital and a professor of general and clinical surgery at Tulane. As yet, no scholarly attention has been directed to this body of medical photographs. My article reveals that many of the images were most significant in having been produced and assembled in parallel with the making, publication, dissemination, reception and uses of Matas’ racialized research, a form of medical knowledge that Matas termed “racial pathology.” This is not a specialism for which Matas has been remembered as a “father” or “pioneer” by his biographers and memorialists to date. In fact, this is a key “missing chapter” from his life story. Official and physician-authored biographies have remembered and celebrated Matas for his work “in the development of local, regional and spinal anaesthesia and in the intravenous use of saline solutions and serums for the treatment of shock, haemorrhage, and collapse,” as well as “major contributions in the areas of thoracic, intestinal, and cranial surgery.” He was at the very pinnacle of the professional medical elite, and as the subtitle for Isidore Cohn’s biography of Matas made plain, most mid-20th-century medical professionals saw him as “one of the great pioneer surgeons.”⁹ Yet what these narratives omit, and what medical photographs in his archive reveal, is that the operative procedures for which Matas is best known, such as endoaneurysmorrhaphy (vascular surgery for the treatment of aneurysms), that prompted Sir William Osler to hail him as the “Father of Vascular Surgery” and the “Modern Antyllus,” were developed using Black human subjects at Charity.¹⁰ The main pathology captured and under scrutiny here, then, is that seen in the racial worldview and practices of elite White medical actors, which in Matas’ case crystallized in the making, publication, and dissemination of his influential essay “The Surgical Peculiarities of the Negro” and his pamphlet The Surgical Peculiarities of the American Negro (hereafter abbreviated SPAN).

By introducing and focusing on a small sample of medical photographs from the Matas archive, I aim to inscribe the presence of these vulnerable subjects into the record of a historical moment and experience that is largely dominated by comfortable, paternalistic, White-centric narratives fixated on the medical elite and celebratory visions of medical institutions, to begin to reveal otherwise hidden historical dimensions of the Black American health experience under racial segregation.¹¹ The critical perspective and position of this article is influenced and informed by the work of visual cultures practitioner, scholar, and theorist Ariella Azoulay, and her approach to viewing and working with photographs depicting vulnerable human subjects who have suffered violence or some form of injury. In such cases, Azoulay argues, a viewing and an interpretation that begin to reconstruct the photographic situation, and the circumstances giving rise to suffering and injuries, become a “civic contribution,” or a duty of care toward dispossessed citizens, but decidedly not an act of empathy, guilt, or pity.¹² In the case of the human subjects represented in the Matas visual archive, the civic responsibility and duty of care is clear, because one means by which these most vulnerable of citizens continue to be wronged and dispossessed is through their omission from histories of health and medicine under Jim Crow segregation.¹³

VISUALIZATIONS OF RACIALIZED RESEARCH

There are over 150 medical photographs in the Matas papers at Tulane’s Special Collections.¹⁴ The form of the photographs, as found in the archive, to some extent betrays the original functions of these images as working objects. First, there are many loose photographs, sometimes printed as multiples, which were used to identify the patients and record their diseases or injuries, as part of a larger case file. The Matas collection contains a small number of patient files from Charity, and attached to some of these records are photographs.¹⁵ These images might have functioned as objects of reference for hospital personnel, especially for conditions and illnesses that demanded close observation. If sufficiently “interesting” in pathological or surgical terms, some of these loose copies would have passed between colleagues on the same ward, elsewhere within the hospital, and across the city’s broader biomedical complex and community. The images often circulated more widely, in professional correspondence, to different cities, states, and nations, and in the drafts and proofs that eventually became medical publications. Some images were used in educational displays and professional presentations, at national or international conferences, and also for discussion and display at local, regional, and state society meetings—the very circumstances in which the photograph of the woman with the fibroma surfaced. Other loose images would have been deposited in the files of the pathology department, in the college medical museum, and in the collections of individual physicians like Matas. Furthermore, certain images would have been used in all of these contexts.¹⁶

An overview of the album sample highlights patterns that provide a measure of the culture, ideas, society, and practices that shaped the images’ production and uses as they circulated between various sites and audiences. The album once contained at least 60 photographs. Fifty images remain, which include men, women, and children of various ages and ethnicities, as well as body parts, body fragments, and specimens. A clear majority of the patients depicted in this subsample are Black and male.¹⁷ This is characteristic of the typical broad patterns in the display and use of human research subjects throughout American medical history.¹⁸ The diseases in this subset of photographs illustrate a range of conditions that—as Jim Crow-era White medical scientists such as Matas and his Tulane colleagues argued—were peculiar to and more prevalent among Black subjects; these included syphilis, tuberculosis, keloids, fibromas, and elephantiasis. Brief handwritten captions provide some means of identifying the diseases depicted in many of the photos, but these are typically terse remarks and provide few (if any) details about the patients beyond age, gender, and hospital ward, with some images destined to remain a mystery (Figure 2).¹⁹

FIGURE 2—

An Unnamed Black Male Patient With What Matas Described in a Handwritten Pencil Note Below as “Cavernous Angioma of the Auricle After Ligation of the External Carotid”

Source. Unknown photographer. Box 43: Matas notebooks, scrapbooks, albums, and prayer books. Rudolph Matas papers, 1829–1960. Louisiana Research Collection, Howard-Tilton Memorial Library; Special Collections, Tulane University.²⁰

Many of the photographs are scenes in which the patient’s fragility and vulnerability overwhelm any intended coding—be it clinical, pathological, or racial—diagnostic function, or formal reading.²¹ A partially naked patient with a chronic case of elephantiasis is among the most troubling of such photographs (Figure 3). Such images are a special category of patient record and raise important questions concerning issues of agency, consent, privacy, and appropriate use and display not only by historians of race, health, and medicine, but also by museum professionals and readers.²²

FIGURE 3—

An Unnamed Black Male Patient With What Matas Described in a Handwritten Pencil Note Below as “Elephantiasis Arabum”

Source. Unknown photographer. Box 43: Matas notebooks, scrapbooks, albums, and prayer books. Rudolph Matas papers, 1829–1960. Louisiana Research Collection, Howard-Tilton Memorial Library; Special Collections, Tulane University.

Only one photo album remains in the Matas archive, but there may have been others—and many more photographs overall—as the collection has migrated, changed shape, and been displaced on several occasions in its institutional history. Changes in personnel, archival practices, and shifts in the sites of the collection have perpetuated the fluid nature of this sometimes incoherent and frustrating body of evidence, a situation further compounded by the multiple crises delivered by Hurricane Katrina in August 2005 and the best efforts of Tulane’s archivists to salvage their collections in the face of disaster.²³

“ONE OF THE GREAT PIONEERS” (OF RACIAL PATHOLOGY)

Rudolph Matas was celebrated and honored by the medical profession in a number of ways, including a sizable portfolio of painted and photographic portraits (Figure A, available as a supplement to the online version of this article at http://www.ajph.org).²⁴ Delivered by an enslaved midwife, Matas (1860–1957) was born on a plantation near Bonnet Carre, St. John the Baptist Parish, Louisiana, to Spanish immigrant parents who worked in pharmacy and medicine.²⁵ He was raised and educated in a culture of racialized medicine characterized by the commonplace American tradition of dissections and experimental surgeries performed on Black subjects.²⁶ This legacy would prove to be influential and instructive for Matas, who went on to build a lucrative career and an international reputation substantially based on clinical observations and surgical encounters with poor Black patients in New Orleans’ Charity Hospital. The production of racialized medical research was shared among Tulane’s medical faculty and evident in numerous journal publications, the university’s curriculum, and teaching resources, including the school’s cadaver supply, the specimens deposited in its medical museums, and medical photographs, such as those in the Matas archive.²⁷

Manuel, a 26-year-old “colored” field worker and Charity Hospital patient, for example, was used as an illustration of the successful surgical procedure for aneurysm developed by Matas (Figure B, available as a supplement to the online version of this article at http://www.ajph.org).²⁸ Matas enjoyed a long tenure as a visiting surgeon to Charity, from 1886 to 1922, and oversaw many hundreds—if not thousands—of “cases” that included those admitted to Ward 2, a segregated clinical space in Charity reserved for Black male patients. This role enabled Matas to hone and display his surgical expertise, and to develop his knowledge of pathology and related technical proficiencies, which included the use of photography and other means of visualization. A significant number of Matas’ reports to the New Orleans Medical and Surgical Journal, for example, featured unusual cases, new approaches, or “pioneer surgeries” undertaken at Charity, and many of these published case histories were illustrated.²⁹ As it had for the teaching of anatomy and surgery in the mid-19th century, Charity provided a vast resource of clinical subjects and bodies for pathological and surgical inquiry, and built additional facilities (a new Dead House, Pathological Laboratory and Museum opened in 1884), hired specialist personnel, and bought new equipment—including photographic tools—to further medical research.³⁰

In 1895 and 1896, Matas published the illustrated System of Surgery essay and a longer unillustrated pamphlet version, SPAN, based on 10 years of clinical practice and surgical interventions at Charity. In the opening section of SPAN, Matas positioned his work in the long tradition of Western scientific studies of racial differences, confirming and reinforcing what were then consensus White perceptions of Black “anatomical peculiarities” and “the lowly status of the negro in human evolution.”³¹ From Charity’s statistical data on the relative mortality of diseases, such as tuberculosis and syphilis, that showed Black patients dying at two and three times the rate of Whites, Matas drew the conclusion that “the colored race is degenerating.”³² These “degenerative tendencies,” he claimed, could be explained by

the influence of unfavorable hygienic surroundings . . . unfavorable social (including moral) environment . . . the causes which lead to a bad heredity, vice, dependency, and degradation . . . acting simultaneously upon an ethnologically inferior and passive race . . . struggling for existence with a superior, aggressive, and dominant population.³³

Molded by the ideological and social context of Jim Crow segregation, Matas’ reading of Black health in New Orleans held no meaningful therapeutic value, blamed the incidence of disease on sufferers, and ignored the key determinants of poverty, inadequate diet, sanitation, education, and substandard housing.³⁴

Although in broad agreement with the fundamental claims and politics of racial scientists and anthropologists, Matas saw “little or no surgical application” that could result from distinctions formulated through various measurements and comparisons of Black and White bodies. The bones of Blacks’ feet might be flatter and longer than those of Whites, and there might be more curve to the tibia, a flatter thorax, and “peculiarities” in the femur, clavicle, and scapula that give “a greater analogy with the simian skeleton than in the white race,” but Matas argued that none of these differences were of “surgical interest.”³⁵ Furthermore, reflecting on a decade of dissection work in the Tulane University anatomical department, “covering the examination of the caecum and appendix of more than three hundred negro cadavers,” Matas stated that he found no evidence “that would give the appendix of the negro an ethnic character.”³⁶

TROUBLING PORTRAITS OF RACIALIZED MEDICAL RESEARCH

Matas’ research on skin and tumor formations in Black patients has mostly been forgotten. These were aspects of surgery that Matas was particularly keen to develop, as he noted in the SPAN, a “curious and interesting field of inquiry . . . still waiting a pioneer explorer.”³⁷ Yet since the earliest encounters with Africans, White Europeans had been fascinated with black skin, which led them to pose questions and to conduct dissections and comparative anatomical investigations, thus producing a continuous global harvest, accumulation, and exchange of specimens (including skulls, bones, and embryos, as well as skins and tumors).³⁸ The various advantages of privileged access to poor Black patients at Charity were hard for Matas to ignore, and his carefully framed notion of a universal surgical body in SPAN was a useful strategy to advance broader personal, professional, and pecuniary interest in the “special anatomy and physiology” of Black skin “and its appendages.” Notwithstanding an array of racial prejudices, which included a long-standing and commonplace White belief that the average Black person displayed a “woful [sic] lack of hygiene,” the sanitary regime of Charity Hospital enabled Matas to declare a special interest in abnormal skin conditions, or “neoplastic formations,” such as keloids, sarcoma, and other malignant growths.³⁹ This research program was bolstered by another persistent and widespread White cultural belief—in a diminished sensibility of the Black human “nervous system to pain and shock.” Matas believed that “this blunt sensibility”—in combination “with a more passive condition of the mind”—made “the negro a most favorable subject for all kinds of surgical treatment with or without preliminary anaesthesia.”⁴⁰ Such a deep-seated White notion was of course profoundly disturbing for Black lives.

Study of the processes that underpinned development of diseases such as fibroma, elephantiasis, and keloid were, Matas argued, “a most fruitful” and legitimate line of inquiry for the “racial pathologist.” In a medical context, this research confirmed for Matas his “pathological axiom that fibroid processes are relatively more frequent in the dark races; so much more so, in fact, as to constitute a racial peculiarity.”⁴¹ Matas’ investment in racial differences, however, also had clear ideological dimensions, as his semantic neologism and scientific specialism were formulated at a historical moment when negative stereotyping and surveillance of Black bodies greatly intensified, because of real and perceived threats and challenges to White hegemony. Supported by medical and sociological data, the era’s “negro problem” construct sought to weaponize notions of Black inferiority and deviance.⁴² In New Orleans, for example, diseases such as syphilis, leprosy, and tuberculosis were racialized and blamed on the degraded morality of Black citizens.⁴³ In this context, Matas’ statistically and visually informed research on “racial pathology” only deepened and extended such damning portraits of Black health.

Presenting the comparative statistics of diseases such as elephantiasis, fibroma, and keloid, Matas acknowledged the limitations of his evidence. The overall number of cases was low, and in some categories of tumor—such as osteoma, enchondroma, and myxoma—there was insufficient incidence to “draw useful comparisons.”⁴⁴ Statistics resonated well with educated medical elites, but in the late 19th century physicians like Matas recognized and embraced the potential of photography to evidence and reinforce arguments, reach new audiences, and develop reputations. The large number of growths and tumors captured in Matas’ visual archive highlights the value of medical photographs in the confirmation, elaboration, presentation, and circulation of his argument about Black racial distinctiveness. Photographs seemed to provide objective diagnostic evidence of clinically identified racial pathologies, with otherwise mutable appearances of various conditions and diseases fixed in a medium that readily facilitated close observational analysis, categorization, comparison, and exchange.⁴⁵

On the reverse of Figure 4, one of four separate three-quarter-body profile photographic views of the same late-middle-aged Black patient, Matas wrote the words, “Beautiful case of keloids”—one of several pathological skin conditions, including elephantiasis, tuberculosis, and syphilis, that Matas argued were either distinctive among Black people or to which they were particularly susceptible.⁴⁶ The photo ensemble bears close resemblance to police photography, with the characteristic flattened front-and-side profile poses of the “mug-shot.”⁴⁷ It also bears the institutional stamp of its production in other ways, seen in the Pathology Department code inscribed on the photo’s surface and across the patient’s torso. Not just an identifying mark, but also a claim of ownership, an intellectual patent number. The photograph circulated in correspondence with Matas’ professional colleagues and is included in his album.⁴⁸ In all likelihood, the image was used by Matas in various pedagogical contexts, and perhaps formed part of a sequence of slides in one of his favored lantern-slide clinical recitations, and part of the evidence base in development and promotion of his SPAN pamphlet and the “Surgical Peculiarities of the Negro” essay for the Dennis textbook. The look and posture in this photograph are suggestive of a man resigned to compulsory visibility, tolerance of intrusive examinations, and endurance of painful interventions.

FIGURE 4—

An Unnamed Male

Note. In a note below the image, Matas wrote: “Double keloids involving lobules of ears (non-cicatricial) illustrating the characteristic tendency in the negro-race to connective tissue hypertrophies.”

Source. Unknown photographer. Box 43: Matas notebooks, scrapbooks, albums, and prayer books. Rudolph Matas papers, 1829–1960. Louisiana Research Collection, Howard-Tilton Memorial Library; Special Collections, Tulane University.

Keloids were a particular source of fascination for Matas. Although Black patients rarely sought treatment of this condition at Charity, nor elsewhere in the New Orleans biomedical complex, Matas claimed that there was an “extraordinary preponderance of this condition in the colored race.” Although he noted that just 10 cases of patients with this condition were recorded at Charity between 1884 and 1893—eight Blacks and two Whites—Matas concluded that “keloid is about nine times more frequent in the negro than in the white.” Yet in the hospital context, Matas observed, it was the case that “only exaggerated and extreme cases” of “traumatic origin” presented. Rarity and peculiarity presented an irresistible challenge to a surgeon who had “tried on various occasions to remove keloids by total extirpation,” but “totally failed” to prevent the reappearance of the condition. Indeed, Matas’ account of experimental interventions indicated that surgical interference was harmful and caused keloidal tumors to spread:

In one case I decided to excise a small keloid and to cover the raw surface with Thiersch grafts; in another I removed two square inches of keloidal scar and substituted in its stead an exact equivalent of entirely healthy skin (Wolfe graft). No sutures were used; exact approximation was maintained. In both cases the grafts were taken from the patients themselves. In both the immediate results were perfectly satisfactory, but in both the keloid recurred not only in situ, but in the distant surfaces from which the grafts had been taken.⁴⁹

The unnamed man in Figure 4 was used to develop, evidence, and disseminate Matas’ racial scientific theories, but he may also be the subject who experienced this failed surgical experiment at Charity.

IMAGES OF SUFFERING: PURPOSE AND PRESENCE

What has been ignored in official biographies of Matas are his contributions to racial science, most specifically the field that he termed “racial pathology,” recognition of the role played by Black patients upon whom he “pioneered” his surgeries, and his use of photography as a method of defining, displaying, and circulating notions of alleged racial diseases and degeneration. The world into which Matas was born, educated, and practiced was deeply racist, and he took full advantage of a professional culture and society based on racist ideology and sustained by often violent racial practices. These salient facts were not included in the celebratory accounts of his life and career.⁵⁰

In four of the photographic examples included in this article, the close framing of a pathological condition visible through and beneath the skin—the ultimate marker for racial scientists and “everyday racists” alike—reinforced the notion of diseased Black subjects as profoundly “other” and “degenerate,” and drew attention to the value of these cases as medical research opportunities, curiosities readily transformed into legitimate objects of scientific observation, rumination, and experimentation. I not only argue that medical photography functioned as a powerful race-making tool in the era of Jim Crow, but I demonstrate that such images also captured, legitimated, and enabled an ideologically driven and experimental racialized medical research agenda. As other visual documents in Matas’ archive reveal, many of the test subjects for Matas’ key surgical breakthroughs and notions of “racial pathology” discussed in SPAN were developed using the patients he encountered at Charity, especially the Black men housed on the hospital’s racially segregated Ward 2.

Matas’ writings, visualizations, and surgical interventions at Charity and Tulane fit into a long tradition of racialized clinical research and human experimentation in New Orleans—activities that were always routine and widespread in American medical institutions, such as city hospitals—and which saw a decided upsurge well before the Tuskegee Syphilis Study was initiated.⁵¹ Furthermore, in one of the few fragments of scholarly commentary on Matas’ SPAN, medical historian David McBride drew attention to uses and effects of this pamphlet, which he described as a standard reference “for medical and sociological research through World War I postulating race distinctions as the basis for the black–white health discrepancy,” and it remained influential in medical research down to the 1930s and beyond.⁵²

Medical photographs such as those included in this article played a key role in deepening racial stereotypes and circulated warped notions about Black bodies and Black health. Today, these images and Matas’ SPAN serve as stark reminders of discredited notions of racial difference and racialized diseases that were once commonplace in medical science and clinical practice. Read in context and against the grain of their intended purpose, these sources can be used as a form of social healing, to help reconstruct a fuller and more sensitive portrait of Black health and the Black patient experience in the era of Jim Crow, and restore the presence and the personhood of these human subjects to the historical record.