20 Jan 2020
This grows out of a talk I first gave at the American Association for the History of Medicine Conference in Columbus in April, 2019. On October 30, I had the opportunity to give an expanded version for the Heberden Society History of Medicine Lecture series at the New York Academy of Medicine. I am immensely grateful to my hosts at both events, as well as to the terrific questions from the audience. What follows is the version of the talk I gave at the NY Academy of Medicine.
I am not a medical historian: I say that at the outset so as to give you all permission to correct anything I get wrong. I am a historian of popular culture, and I focus on comics and popular print culture in particular. I recently curated a show at the Billy Ireland Cartoon Library & Museum at Ohio State called Drawing Blood on the long history of comics and medicine. The show came down last week, but my obsession with the topic has only deepened: in seeking out an early history of cartooning and the comics form, I found medicine, doctors, and illness everywhere along the way. The heart of this story, I discovered fairly quickly, has everything to do with the history of medicine—or, better put, with debates in the public sphere about medical authority and practice—and about issues that lie at the heart of patient-doctor interactions: faith and trust, and the impossible problem of other people’s bodies and especially other people’s pain.
My search for the origins of cartooning has brought me to Bologna in the late Renaissance, and in particular to an art movement within that city that sought to unsettle the classical rules and restraint of Italian Renaissance art. As practiced by the Carracci brothers at the end of the 16th century, caricature—from the Italian word for exaggeration but also connoting an overloading of signification—was meant to free the classically trained painter from the idealized form, to make the human body newly available to scrutiny. Here, for example, are two early examples of caricature by Annibale Carracci from around 1580—a portrait of a tooth-extractor on the left, dressed in a respectable short cape, with his tools in a box beneath his elbow, and, on the right, a beggar peddling a cure for corns (Figs. 1-2). While these two members of the medical practice of the time represent very different positions in Bolognese society, they are both addressed with a similar matter-of-factness, a direct gaze that subjects them neither to ridicule nor to celebration.
While the Carraccis turned to caricature as a tool for observation and for retraining eyes of their students, it would not be long before this new art form began to find a commercial audience, as popular engravings based on this early work began to appear in the marketplace. Inspired by his predecessor, Giuseppe Maria Mitelli, also from Bologna, published in 1660 a collection of engravings of the Arts of the Street which included one of the earliest caricatures editorializing against what will become the increasingly stock figure of cartooning: the quack doctor (Fig. 3).
The caption below the image leave no question as to how we are to interpret the figure:
This man, with biting snakes and vipers
Wishes to become the fecund anatomician.
He is wont to hold up his authentic patents
His privilege to fool the world
The figure of the snake-handler within the walls represents the routine intrusion of country medicine into the urban space during market days. These handlers traditionally claimed immunity to venom through descent from St. Paul and performed handling rituals that served as an attraction to their wares—the promise that this performed immunity to venom could be had by all for a modest price.
Clearly this image offers a critique of folkloric medicine and in favor of a science-based approach to medicine. To be sure, there was what would be a protracted turf battle between the popular practitioners and the trained physicians. The real problem for Mitelli with the snake-handler is epitomized by his ostentatious display of medals and licenses even as he ignores the snake making its way out of the casket by his feet—and into the crowd gathered to watch the performance. The danger presented by the charlatan is that he is unregulated, untrustworthy, bringing danger within the city walls.
In contrast to the itinerant peddler of spurious cures, in a later etching Mitelli offers a different representation of the doctor, in this case the learned physician surrounded by books and other emblems of hard study, including volumes of Galen and Hippocrates (Fig. 5). Unlike the charlatan he does not peddle his wares in the public square, he does not endanger his patrons with dangerous snakes or dubious cures. He is a scholar not a performer. And yet, even as he represents everything the country quack is not, the legend below reminds us of the ultimate futility of the doctor’s wisdom: death will triumph in the end. One of Mitelli’s late caricatures expanded on this theme, focusing the satire on insatiable search on the part of patients for the “surest secret recipe against dying,”—here facetiously giving away the secret of blowing in the death of face, and never stopping—because when you do you will die (Fig. 6).
Mitelli’s caricatures established many of the basic elements of early medical cartooning—exposing the quack, but also ridiculing the fantasies of doctors and patients alike who imagine that medicine might provide a cure for death itself.
Mitelli thought about doctors a lot throughout his career, in large measure because the figure of the learned Arab doctor in his city represented a visible and inescapable challenge to the fantasy of a modern Europe born out of the glory that was Rome. The notion of a “Europe” shaped around a vague sense of inheritance from the older model of the Roman Empire was daily called into question by the reality that, throughout the medieval period, in education, math and science, medicine, art and architecture the Muslim world far outstripped the accomplishments of Europe. Recent military victories and the reclaiming of territory—from the Iberian peninsula at the end of the 15th century to eastern Europe at the end of the 17th—began to provide a meaningful territorial buffer between the Christian and Muslim worlds, but the reality was that much of the cultural inheritance of the Roman empire had been cultivated and ultimately restored to Europe by Arab civilization. Nowhere was this more clear than in the area of medicine. While in the 3rd century Galen had been universally acknowledged as the most accomplished medical researcher of the empire, by the 4th century, with Constantine’s conversion Galen, along with many scholars in the Greek tradition, was cast aside. He would be developed in the East, ultimately becoming foundational to Islamic medicine as it takes shape in the 9th and 10th centuries. With the conquest of Constantinople by the Ottoman empire in the 15th century, the last vestiges of the one great Roman empire were now under Arab rule. And it would be through this new Islamic neighbor that Europe would be given an opportunity to catch up on what had been happening in medicine.
Here for example are some images from European manuscripts from the 15th and 14th century testifying to the influence and importance of Islamic medicine:
These moments of acknowledgement were of course quickly followed by acts of erasure, as the central works of medicine were translated from Arabic into Latin. But the figure of learned Muslim and the Arab doctor remained as a reminder of the prominence and dominance of Islamic knowledge in the West, as represented in a Mitelli print from 1699 (Fig. 8). Here Mitelli represents the modern Arab doctor as bleeding and fleecing the poor of his city. Despite the success of European forces in the Battle of Vienna (1683), which Mitelli had enthusiastically celebrated in a series of political cartoons the previous decade and which resulted in the pushing back of the Ottoman empire from eastern Europe, Mitelli here describes not only the ongoing presence of Muslim doctors in Italy but the larger economic importance of the Arab scholar in general.
In fact, that genealogy provides us some insight into the figure of the snake handling quack, as the art of snake handling was first developed in ancient Egypt and was popularized in early medieval Europe by traveling Moroccan merchants and performers. Mitelli would not have known that, of course: for him, this figure represented the ignorance of the populace and the sorry state of Italian medicine in which such people were able to prosper, while the learned Arab represented both a source of grudging admiration and of fierce resentment. A 1700 cartoon by Mitelli celebrating the Treaty of Karlowitz—marking the end of the wars between the Holy League and the Ottoman Empire—allows Mitelli to fantasize that more than simply lands are being handed over (Fig. 9). Here the scene is allegorized with the Sultan as the patient being attended to not by Arab doctors but by the Holy League, while the Grand Vizier leaves the room hopeless for his patient.
Soon a native industry emerged in Britain and elsewhere in Europe, as the new art of caricature spread via the migratory patterns of the Grand Tour. Not surprisingly much of it initially catered to aristocratic craze. While the traditionally trained William Hogarth worked to distance himself from the shoddy caricaturists getting their training from Arthur Pond’s volumes reprinting the greatest hits from Italy, he was without question the most influential and talented of the early 18th century artists to be inspired by caricature and to adopt its principles in his own work. His interest in caricature, however, preceded the publication of Pond’s volume, as did his interest in medicine. In Figure 10, for example, we see his 1726 Cunicularii, or the Wise Men of Godliman in Consultation. Riffing off of the composition of a traditional historical painting, Hogarth recounts the story of Mary Toft. Toft was said to have “delivered” various animal parts and even some whole rabbits under the care of a local surgeon, who then notified several prominent physicians of the rather grotesque miracle. News of the miracle eventually reached Nathaniel St. Andre, a royal surgeon, who signed off on the account of the event. The story became a national sensation and a royal obsession. It was of course also a fraud—Mary and her husband having chosen to insert various animal parts into her womb following a miscarriage.
It is possible that Hogarth’s print sponsored by a group of surgeons in London to produce the print, in order to bring shame to the more elite physicians—and especially to St. Andre—who had fallen quite spectacularly for the hoax. Certainly Hogarth’s later treatment of the licensed physicians would suggest he shared some of the surgeons’ doubts regarding the superior qualifications of physicians. And no pains are spared in the cartoon to make certain that readers will be able to guess at the identities of the physicians involved, as they are labeled and hints are provided below (Figure 11). The scandal of the story of the Rabbit births was indeed a deep shame on the prestige of all involved, and on the profession as a whole, and cartoons like this served to trump that shame as widely as possible. Here we see the physicians examining the patient, with St. Andre himself performing the role of male-midwife, while the other two wisemen stand before the miraculous birth in wonder. Meanwhile John Howard, the male midwife and surgeon who originally delivered the animal parts from Mary Toft, is in the doorway quietly talking with a man who has arrived with more rabbits, rejecting one as “too big” (suggesting that Hogarth, like many others, believed Howard to be in on the fraud—although it is equally plausible he was just really bad at his job).
The cartoon somewhat outrageously indulges in the sacrilege of a nativity scene transposed on top of a story of a grotesque fraud committed on the medical establishment (and by extension on the royal family). With Toth in the role of Mary and the three physicians as the wise men (and rabbits spilling wildly across the floor), the image seeks to expose both the gullibility and empty pomposity of the medical men and, more broadly, the public appetite for medical miracles (like Mitelli’s miraculous secret cure for death). But the physicians are exposed as not only easily gulled but quite vulgar. The title of the print plays on a pun on “coney”—a term for rabbit pelt—and “cunny”—vagina; and lest the reader miss the naught pun, St. Andre’s narration as he performs the role of midwife makes it graphically clear: “It pouts, it swells, it spreads, it comes,” casting Mary’s ecstatic expression in a much different light than the divine allusions to the nativity would suggest [I always have to warn my students that the 18th century was a very raunchy period indeed].
There was something about this story that seemed to call for comics, even if the grammar of what we today would identify as comics did not yet exist in any systemic form. Another graphic recounting of the Toft tale also from 1726 even turns to sequential comics panels, infrequently deployed before the 1840s (see Fig. 12). This print, The Doctors in Labour; of a New Whim Wham from Guildford, combines the pleasures of the traditional topical ballads that circulated through the public markets long before the arrival of caricature, with a visual recounting of the tale—and featuring St. Andre in the role of Merry Andrew, a harlequin historically associated with London’s annual Bartholomew Fair:
The upper tier recounts the tale from Mary’s perspective, offering her tale of the encounter with the rabbit while pregnant and her vision of the miraculous birth. The center of the tale, however, and the visual center of most panels, is St. Andre. The comic breaks takes great pleasure in recounting his scientific process (drawn from his own pamphlet defending his interpretation of the events) and how easily his methods are manipulated by, in the words of the print, an uneducated “Stupid Creature.” Here we see St. Andre examining Mary’s breasts for signs of lactation, “from whence with reason it may be believ’d, / A strange unnatural Fetus is conveiv’d.” Panel after panel describes his “research methods” by which he justified his faith in the impossible claims—he feels her belly, he observes the passage of the animal parts from her uterus, he weighs and compares the parts ‘delivered’ to other animals known to science in order to determine, as in this panel, whether the animal delivered is cat or rabbit, ultimately making the determination in favor of the latter based on the dung removed from the animal—allowing the learned doctor to confidently “swear / tho it has Shit —It never breath’d in air.”
Finally, “The Doctors here and Midwives all consult / If ‘tis a foetus Rabbit or adult / When up the learned Merry Andrew Starts / This Animal (quoth he) in all its parts / Does with a Natural Rabbit well agree / And therefore it must Preternatural be” (Fig. 13). Where Hogarth’s account delighted in ridiculing all involved, this one is focused primarily on ridiculing St. Andre—less on critiquing the man as a bad doctor, as on the ways in which his confidence in observation and scientific reasoning is so easily perverted to justify the most preposterous (and unscientific) of conclusions. While we know nothing of the artist behind this work, it is safe to assume that the Court itself was also being attacked by proxy by attacking a physician very much in favor with the King (and indeed that favor would be withdrawn permanently following the rabbit scandal), but the real assault of the cartoon seems to be on what passes for scientific discourse among the medical profession— where empirical study is so easily diverted into the search after wonders, profits, and sensation. By dressing the royal surgeon up as Merry Andrew, a regular at the city fair, the artist suggests that the differences that doctors would insist on between their licensed practice and those of the itinerant quacks who perform in the marketplace are not so very different at all.
Pond’s album of Italian caricatures was published in middle of the following decade, and the impact on 18th century British popular art was immediate. Hogarth’s most famous medical caricature demonstrates this influence keenly (Fig. 14). Combining his own experience in engraving British heraldry with the newfound pleasures of caricature portraiture, Hogarth’s Company of Undertakers offers a group portrait of many notable medical practitioners of 1730s London, placing at their top three so-called quacks, at the center of which stands Sally Mapp, a well-known bonesetter, with Joshua Ward, a seller of dubious patent medicines on her left, and on her right John Taylor, a trained doctor who turned his back on his professional colleagues for the itinerant life of a peddling mountebank. By placing these figures in the privileged position at the top of the grouping, and identifying them in the caption below as the DOCTORS and the twelve below as the QUACKS, Hogarth deliberately inverts the hierarchies of the profession, refusing the distinctions the Royal College of Physicians had spent the previous two centuries attempting to enforce.
Beneath our elevated quacks gather the dozen licensed physicians, each bedecked with their traditional wigs and holding their canes, whose handles—stuffed with camphor or mint to ward off the stench of the ill—they ostentatiously sniff. At their center we have one physician dipping his finger into the urine flask, engaged in the already dubious practice of uroscopy—while his colleagues on the lowest rung of the group portrait look on with interest as to what shall be deduced from his sampling.
Where in Cunicularii a decade earlier, Hogarth had relished in reworking the elements of a traditional religious painting for this most un-divine of births, focusing on the figures and their compositional relation to each other and the humble “manger” in which they had gathered, in Company of Undertakers, Hogarth zooms in tight for a most unflattering closeup, allowing us to see them not as they wish to be seen but as they truly are. We don’t know the identities of most of the 12 physicians, although all are believed to be based on doctors practicing in the city at the time. But one of them is known to be John Bamber, and conveniently we have a portrait of him as he wished to be remembered (Figure 15). Hogarth himself had knowledge of Bamber, as he had recently become a member of the Board of Governors at St. Bartholomew’s, a position extended to him in gratitude for the artist’s gift of elaborate murals in the hospital— the same hospital from which Dr. Bamber had resigned in a huff when the Board refused to employ his son-in-law shortly before Hogarth’s arrival. One can imagine that Hogarth, now an insider to hospital business and seeing the men behind the wigs and canes, likely had similar stories about each of those gathered in this scene.
Despite his elevating the unlicensed itinerants above the physicians for this print, Hogarth had no fondness for the predatory practices and dangers posed by quacks, as we see in other works. Borrowing from the fascination with public quacks from Italian and North European caricature, these figures became recurring objects of satire in England in the 18th century. One popular subject was the infamous Dr. Richard Rock. Rock had arrived in London from his native Germany and set up shop in the square in Covent Gardens, where he hawked his wares, especially his patented “ANTIVENEREAL ELECTUARY” branded “RESTORATIVE VIPER DROPS”—a callback, now without the snake, to his 17th-century predecessors in the marketplace of public performative medicine (Fig. 16). This 1740 print captures Rock at work, selling his Viper Drops and performing his own erudition by holding up a book, even as a monkey at his feet performs the same routine, exposing it all as nothing but performance. Above him a highwire act and behind him a harlequin—another Merry Andrew—perform to draw in the crowd, but their performance also doubles as a cautionary reminder, for those paying attention (which apparently includes no one in this crowd), of the dangers Rock’s remedies themselves pose: the highwire performer totters perilously above him, while the harlequin creeps up behind, blackjack in hand, a reminder of the highway robbery being so openly committed in the public square.
Other caricaturists captured Rock at work as well (Fig. 17). Here is a 1743 caricature of the man at work in Kennington common, while John and Charles Wesley preach behind him in what was their chief stomping ground at the time—drawing as many as 30,000 at a time. Without knowing the artist it is hard to be certain as to the bite of the satire, bringing the leading figures of the Methodist movement together with one of London’s most notorious medical charlatans. But the image does not deploy caricature in the representation of the Wesleys—reserving it instead for those who Rock’s lay sermon is drawing away. Rock holds a bowl of Hygieia in one hand—the old handler’s snake now safely frozen in the form of a handle—while in the other he holds a vial of his viper drops. Whatever claims he is making on its behalf draws wonder from at least one of his onlookers, although the one nearest him is clearly more interested in getting closer to the contents of his pockets.
Much of the fascination with medicine and doctors—both legitimate and self-proclaimed—draws on the issue of performance—and faith. Here is someone in whom you must put unreasonable faith when you are most vulnerable and terrified. Before modern medicine, it was common knowledge that even the most talented physician had little to offer—bleeding, emetics, amputations—the vast majority of treatments involved the removing something from the body, liquid or solid (or both). Thus, the draw of the quack in the market square: the promise of something miraculous, modern, in a pill, tincture, or salve.
It was by no means simply the uneducated who put their faith in these treatments, after all. Joshua Ward, who stands to Mapp’s left in Company of Undertakers, waited on the King himself, and Sally Mapp consulted with the Queen. One of the most successful of all eighteenth-century patent medicines was Dr. James Fever powder—a great favorite among many of the most brilliant literary wits of the age, including Samuel Johnson, Oliver Goldsmith, and Horace Walpole. The latter declared it “always shall be” his “panacea” and that he had such “such faith in these powders, that I believe I should take it if the house were on fire.” Not long after, these same powders—whose primary active ingredient was antimony—contributed to the death of Goldsmith. When the educated physicians had little to offer that wasn’t available to patients in the age of Galen, and when they poked and prodded you with their ubiquitous canes and addressed you with those same canes pressed haughtily to their nose to ward of your stench, there was much appeal in the practitioner who stood among the throng, who proffered miracles, no matter how unlikely, and who set your bones with a combination of brute strength and intimate skill. In whom should one put one’s faith—the man devoted to a learning that had changed little in centuries, or the miraculous pill that promised at least something new? In which performance should we trust: the cane, wig, and library, or the tightrope walker or snakes in the public square?
For the first cartoonists, medicine was a fascination in itself—as Hogarth’s connections to St. Bartholomew’s suggests—but it was also a window into what would become their true subjects: the disparity between surface performance and innate character; and a rigorous secular exploration as to the meaning of faith in modern times.
Medicine at the dawn of cartooning epitomized modernity: it was speculation and its attendant concerns of faith and futurity. It was branding, salesmanship, and performance. It was the radical collision between dreams of tomorrow and the crippling pains of today. It was the beginning of a new priestcraft, one that would promise us a different kind of eternity.
Hogarth—no friend of the disreputable—placed Sally Mapp at the top of his company of undertakers and gave her the title the physicians would have denied her not out of respect, but because he believed her talents and knowledge were not in the end any less effective (even if they were vastly different) from those of her learned brethren. At least she was willing to get her hands dirty. And at least she openly acknowledged who and what she was. He had a grudging respect for the quack in this regard. But he did not trust them.
Our Dr. Rock makes an indirect appearance in Morning from Hogarth’s Four Times of Day series in 1738, in a billboard being carried by a young man employed to advertise his wares in Covent Garden before Rock’s arrival and the start of the day’s performance (Figure 19). He appears more directly in Hogarth’s series The Harlot’s Progress, where in this later entry in the narrative we find our protagonist, recently released from Brideswell prison, now dying from syphilis She is wrapped tightly as part of a sweating treatment presumably prescribed by a previous physician, while Dr. Rock and a rival, the French doctor John Misaubin, argue over the appropriate treatment at this late stage in the disease, each angrily insisting on their preferred treatment. While doctors differ, the patient expires. For me the achievement of this print is that one experiences it as unfolding in time such that Moll, the “harlot” of the story, is dying when we start reading all of its details, and has died by the time we have finished.
Aside: Hogarth’s Harlot’s Progress is indebted to a remarkable print by Mitelli from forty years earlier, which told the same story—a young woman led astray into a life of debauchery before ultimately dying of syphilis—in twelve panels, one for each month, an important early example of sequential comics in the 17th century where comics historians generally don’t go looking.
Rock and Misaubin in Harlot’s Progress serves as the launch of what would become one of the most commonly utilized tropes in early cartooning: “doctors differ.” Below are a few examples inspired by the punchline. As we travel from Hogarth to the early years of the 19th, we see the evolution of cartooning style—a loosening of the line, a sense of spontaneity and movement that earlier etching techniques could not reproduce. But the basic grammar is indebted to Hogarth, and still earlier to the Italian caricaturists with which we began. And of course the obsession with medicine remains not only intact, but intensified. “Doctors differ” became shorthand for the futility of human knowledge, the limits of enlightenment, and the impossible choices that patients were asked to make with uncertain outcomes and no roadmap to guide them. And indeed the choices of patients in the world of pre-modern medicine easily served as a metaphor for the plight of all in the new age of modern capitalism. The image of doctors beating each other up, tearing off the wigs and diplomas that served as their veneer to the world, was a reminder of how profoundly ignorant and vulnerable we all remained at our entrance to the modern era. On the eve of modern medicine and modern comics, these early cartoonists skewered the medicine of their time, but in doing so, they were skewering the human condition itself—and of course simultaneously celebrating it in all its chutzpah, hustle and showmanship.
Thus medicine was more than simply a topic among others for caricaturists—a fact that continues to be the case through the 19th and into the 20th centuries, as Bert will explain next. Caricature emerged out of the desire to get beneath the polished exterior of the idealized renaissance body into the true character hidden. It was, in a sense, its own kind of medicine—and, to be fair, its own kind of quackery. It is at its essence an art that seeks to anatomize that which would otherwise remain inaccessible behind the veneer of exteriors —through, paradoxically, the practice of exaggerating external features—the funhouse mirror-as-x-ray, if this audience can forgive my very anachronistic figure. Like the physician, the caricaturist seeks to diagnose that which the façade of the flesh would conceal: an inner truth. And like the doctor, the caricaturist gets at this interiority through violence against the body itself. For the physician, this violence might take the form of phlebotomies or emetics; for the caricaturist, the violence involved the exaggeration of a loaded feature, an attribute whose distortion exposed a truth otherwise invisible, leaving it open for reform, or amputation. As one British commentator in the 18th century complained, the caricaturist seeks “to magnify and hold to shame/ Each little blemish of our frame.”
While caricature was developed as a method for rethinking classical renaissance strictures, it left the high art world relatively quickly and entered into popular culture. Painters and critics generally disdained the form for its exaggeration and emphasis on particulars over universals—on the blemish, the disease, over the idealized form and the capital T Truth to which capital A art was committed. As the gatekeepers of academic painting set about defining their own principles and rigors in the 18th century, caricature provided a convenient negative example— the singular, particular, and ugly as opposed to the restraint, polish, and beauty of the Academicians. The caricaturist thus found himself structurally positioned with the quacksalvers, medicasters, empirics, and mountebanks their work so often satirized. The irony, one can be certain, was not lost on these pioneering cartoonists, whose spiritual descendants would go on to forge an entirely new art form known far beyond the reaches of the Academy—one known, beginning in the 1840s, as cartooning.
PS: As you can tell, I’ve been pretty obsessed with Mitelli of late. A talk I have in Leipzig about comics and games also features Mitelli in a prominent role. A video of the talk is online at https://www.youtube.com/watch?v=IfdATibqei0
Some provisional thoughts about Mitelli and “comics” can be found at a Extra Inks: http://extra-inks.comicssociety.org/2019/08/03/what-if-comics-began-in-the-16th-century/
Jared Gardner is a professor and patient at the Ohio State University.