3 – Model Behaviour

1The anatomical model - a re-creation of normal or pathological anatomy created in various material - is usually regarded as simply a teaching aid for those studying to be physicians, and although the historical discourse surrounding anatomy often testifies to that purpose alone, a diversity in its function emerges if the researcher looks beyond the written text. The artistic choices made by creators of anatomical models reinforce messages about how a society views its own corporality, and by examining the way in which anatomy models are fabricated and decorated, cultural attitudes about the body in a given time period can be analysed and better understood. This study will consider both an eighteenth century and a twentieth century anatomy model, and will show that groups outside the world of medicine were encouraged to view, examine, and interact with anatomical models. In each instance, the visual details of the reproduction provide historical insight into the social and cultural messages their use was intended to reinforce.

2The challenge for the historian then, becomes accessing the historical evidence that is not written down. By taking an approach that includes the methodologies and techniques used by material culture studies, the intricate historical narrative can be more thoroughly interpreted. Material culture methods rely upon material evidence like consumer goods, architecture, clothing, landscape, photography, and museum pieces to inform historical inquiry. As Anne Smart Martin noted, “Material objects matter because they are complex, symbolic bundles of social, cultural and individual meanings fused onto something we can see, touch and own.”1 Each thing forged by humankind is produced for a reason and in each instance, the maker has in his or her mind the reason as to why the item should exist and why it should look the way it does. Jules Prown asserts that by taking a material culture approach, the researcher can exploit the “empathic link” which exists between the material world of the object and the perceiver’s world of existence and experience. In other words, the observer can reflect upon what it would be like to use or interact with the object, and be “transported into the depicted world.”2 This concept of the “empathic link” will be utilised in this investigation of two very different anatomical representations.

3The cultural history of the body and its representations continues to generate a vast number of works, spanning a diverse range of themes from autopsy to art, and from metaphor to the Madonna. Much of the literature on anatomical modeling has been focused on the genealogy, use, and influence of those anatomy models created in wax.3 This is not surprising given that the advent of wax anatomical modeling coincided with, and according to some scholars, reified other sweeping political, philosophical, religious, and social transformations happening in Europe in the eighteenth century.4 One is hard-pressed, however, to find academic investigations devoted to the more recent manufacture and use of anatomy models made from materials other than wax. The aim of this paper is to add further insight to the existing body of literature on wax anatomical models, and to begin to explore the relatively new domain of twentieth century models and their social meanings.

4As is well known, the eighteenth century saw great change in Western and European intellectual thought. A new model of natural knowledge emerged that was based on dualistic, atomistic, and mechanistic assumptions. A rigid distinction between mind and body had been posited by philosophers like René Descartes and John Locke5 in the century before, and their ideas, along with those of many others, were used as the basis for experimental activity over the eighteenth century.6 Experimentation prompted new accounts of vitality and the relationship of body and soul, and discussion flourished within the republic of letters7 in an attempt to re-examine the laws of health and sickness.8

5These new ideas challenged a centuries-old medical canon that had been formulated and practiced according to the texts of the Greek physician Galen. Often referred to as humoral medicine,9 this complex set of beliefs decreed that the body and the cosmic realm were closely connected, and that sickness and ill-health were visible on the exterior of the body.10 Renaissance anatomical studies, however, had begun to reveal that the structures of the body were not exactly as Galen had described, and William Harvey’s discovery of the circulation of the blood in the 1620s further called into question the wisdom of ancient medical belief.11 Harvey’s account of the heart and circulation found favour with Descartes who used it to promote a mechanical philosophy. Descartes regarded medicine as one of the keys to understanding the natural world and often dissected animals, producing several works on what would now be called the life sciences. Overall, the Cartesian view of the body would revolutionize the study of medicine; Descartes regarded the body exactly as he viewed the world as a mechanism and he dismissed the Aristotelian-Galenic idea of the relation of body and cosmos.12 Thus, by the middle of the seventeenth century, traditional medical knowledge was being challenged, and opening up dead bodies or live animals had become one of the places to locate new truths.13 All of this makes clear the important point that what we understand as “science” was not yet a separate discipline with practitioners of its own, nor was it disparate from the study of philosophy. It was practiced within other disciplines under the general term “natural philosophy.”14 As Cunningham and Williams noted, “the whole point of natural philosophy was to look at nature and the world as created by God, and thus as capable of being understood as embodying God’s powers and purposes.”15 To that end, many men, along with some women, began to seek out an understanding of nature through a multitude of means.

6By the mid-eighteenth century, natural knowledge was seen as an appropriately genteel pursuit for members of aristocratic society.16 Science gradually became visible and accessible to the broader public with an expanding publications market that included books on popular science; in urban centres there were public lectures and scientific demonstrations, along with the creation of scientific societies.17 Diderot and D’Alembert published their Encyclopédie and Parisians especially indulged themselves in a passion for natural history which included an anatomy craze. Lectures and anatomical demonstrations were held in the drawing rooms of Paris, and aristocratic women went so far as to carry with them dried specimens prepared by famous anatomists.18 The pursuit of both scientific understanding and amusement included visits to newly-opened anatomical collections.

7The vogue for artificial anatomy in Europe was largely due to the prestige conferred upon the Specola Museum, the first great collection of anatomic wax models, which belonged to the Grand Duke of Tuscany, brother of Joseph II of Austria. It was a collection formed by the naturalist Felice Fontana in 1775, with the intent of both augmenting the natural knowledge of anatomy and honouring his sovereign and patron. Fontana’s aim was to establish a collection that would demonstrate all knowledge of the human body in order to teach anatomy without having to directly observe a cadaver19 and without the need of a demonstrator or guide.20 The collection was three-faceted in that each example consisted of a wax model, a tempera drawing, and a written explanation.21

8Guided by Fontana, talented wax modelers worked under anatomists who dissected cadavers obtained from the Santa Maria Nuova hospital and who exposed the part to be modeled. The element was reproduced in clay from which a plaster cast was made. Into this the wax, or rather, a mixture of waxes, resins and dyes, of which the exact composition is unknown, was poured. Finally, the model was assembled and artistic elements refined.22

9The models and figures that make up the Specola collection are numerous and varied. There are the so-called “muscle men” who are full-sized, upright figures with certain organic systems as their focal point; several portray the nervous system, tissue composition, or the organization of muscle masses. Some sculptures depict the various stages of decomposition, while others illustrate views that can otherwise only be achieved with the dissection blade, like a cross-section of an organ or limb. For many observers, the centre-piece of this large assemblage is a full-size female figure known as the Medical Venus (Figure 1).

10The model lies flat on a velvet cushion and under a glass case, both of which are replicas of the Venus’ original accoutrements.23 A breast plate is removable, as are four subsequent layers, to reveal the anatomical structures inside the female body, including a fetus in the uterus (Figure 2). Upon first encountering the wax figure, either in person or in a photograph, witnesses become immediately aware of the painstaking efforts that would be necessary to achieve such an intensely realistic re-creation. The delicate features - hands, feet, and face - and the far-away gaze are unnerving and enticing. When the visual details of the Medical Venus are examined, they render a greater understanding of the messages conveyed to an eighteenth century public.

11While better facilitating the instruction of anatomy was certainly an important goal of the collection, the Specola was also open to all classes of the public from its inception, as long as visitors were clean and presentable.24 This exemplifies nicely the increased consumption of popular science, but fashionable entertainment and mere curiosity are only part of the narrative. The museum was installed in an annex of the royal palace of the Grand Duke Peter-Leopold of Tuscany, very much at his behest.25 Peter-Leopold is considered by many eighteenth century historians to be the quintessential “enlightened” monarch because of his deliberate efforts to implement in Tuscany the new ideas being discussed in Italy, France, England, and the Holy Roman Empire. Although many monarchs across Europe participated and contributed to the intellectual trends of the movement broadly known as the Enlightenment, Peter-Leopold actually changed policies to reflect his enlightened stance - social welfare programs were introduced, ties to the papacy cut, and a constitution calling for elected representation was drawn up.26 The anatomical wax models on public display beside the royal palace were for the Grand Duke another way of promoting the new philosophy, and eradicating superstitious ideas about the connection of body and soul. The artistic choices made by the modeler reflect that goal of educating the observer.

12The wax figures of the Specola collection are incredibly realistic, with some scholars insisting that they are, in fact, more than simply realistic. Ludmilla Jordanova asserts that “lashes, head and pubic hair were added painstakingly and serve no other function than to make the body as lifelike as possible. They add nothing to the anatomical detail of the model... we have more than realism; a verisimilitude so relentless that it becomes hyperrealism.”27 Remarkable similarities are found between accounts of seeing the wax models of the Specola for the first time, and the reminiscences of physicians today about their initial encounter with a cadaver as a young medical student. Psychiatrist and anthropologist Simon Sinclair notes the “sacredness of the Dissection Room” as reported by medical students upon entering it for the first time. Students are often greatly unnerved, some fainting and some dropping out of med-school entirely after seeing the cadavers. Sinclair relates an introductory address by a medical school professor explaining to new students that the work done in the dissection room is about “doing things that may frighten you so the next time you have to do something frightening, you won’t be frightened.”28 Emotional response and educational objectives are connected to create a physician who can overcome uneasiness and in turn become blasé about the grotesque realities of the human body. Annette Burfoot, a scholar currently studying the wax figures at the Specola, noted that the experience of entering the museum is not to be under-estimated. “Nearly everyone walking into the first room of models recoils at the hyperrealism... a sense of edging towards the abyss and the horrific is heightened as you move into the next room.. ,”29 Again, an emotional response is a desired effect intentionally solicited by the modelers for educational purposes.

13Stark realism is a hallmark of the eighteenth century Specola waxworks, and it is evident that the spectator is meant to have an affective, perhaps even emotional, experience. Some historians struggle with the “dangerous territory” of speculation arguing that just because such objects elicit powerful reactions today, it in no way tells us that they did so in the past.30 I argue that it is very likely that the use of hyper-realism was intended by the modeler to elicit a powerful response, and that speculation and empathic reasoning are valuable tools for the historian. As discussed, material culture analysis allows the researcher to exploit the “empathic link” between the world of the artifact and the world of the observer.

14The string of pearls around the neck of the Medical Venus always draws comment from those to whom I have shown its photograph. It gives pause because, from a twenty-first century perspective, the intersection of art and science is unsettling and unfamiliar (Figure 3). French scholar Michel Lemire goes so far as to say that “these (eighteenth century) models rather evidenced the esthetic contamination of scientific progress, the overtaking of science by art.”31 Lemire’s interpretation has a positivistic bent; as discussed, science was not yet a separate discipline in the eighteenth century, and the exploration of natural philosophy included what today would be considered both artistic and scientific endeavor. The pearls are a fine example of the fusion of art and science in this period, but this detail offers us even more than that.

15The model was constructed so that the pearl necklace hides the crevice created between the body and the removable plate when the model is fully assembled and complete. In fact, the long, flowing locks of hair (that nearly every commentator of the Medical Venus remarks upon) cover the cracks just below the shoulders. Moreover, by examining a variety of sources in which the artifact appears, it is apparent that when the model is photographed today the hair is re-adjusted to mask the lines created by the breast plate when it is in place.32 If the Medical Venus was created primarily for the teaching of anatomy, why all of this seemingly superfluous detail? In a word - perfection.

16Both the model’s creator and twentieth century photographers recognize the utility of the necklace and the hair for masking imperfections. Anatomical artists laboured to construct an example of the faultlessness of the human form. Some scholars attribute this quest for perfection to the rediscovery by Renaissance artists of the ancient canons of classical Greece and the new aesthetic criteria of realism that followed, pointing out the regular dissections by Michelangelo, da Vinci, and Rubens.33 However, attempts by the maker to eliminate flaws on the model stretch beyond trends in art (as influential and sweeping as they might be), and even beyond artistic ego or creative gratification. We must return to the implications of Cartesian dualism.

17The separation of mind and body and the view that all life forms were mechanistic challenged long and closely held beliefs about humanity, and the anatomical exhibitions of Europe helped to facilitate an understanding and acceptance of these new concepts.34 The Specola models forced observers to question their own mortality and corporality. New discoveries were seen to bolster religion, not dispel it, and consumers of popular science who stood in front of the Medical Venus were given the opportunity to realise and internalise the majesty of God’s handiwork. Empiricists and philosophers argued that the supremacy of God was demonstrated in the perfection of the mechanics of the human body. This idea propelled the reception of dualistic reasoning, and by the twentieth century, the separation of mind and body would become an indisputable tenet of modern medicine.

18Scientific medicine came to possess a monopoly over medical knowledge in the twentieth century and the public became distanced from the material of anatomy.35 In every medical interaction there exists a contract - usually verbal, but often unacknowledged altogether - in which the patient assumes of the healer an expert knowledge and anticipates the fulfillment of his or her expectations. Quite simply, as Jacalyn Duffin has stated, doctors can only be doctors when someone else agrees.36 As diagnoses came to rely less on patient report and more on the results of diagnostic technology, the patient was required to contribute less actively to the doctor-patient encounter. Once diagnostic innovations like the stethoscope and the X-ray appeared, doctors had access to what was going on inside the living body, without relying on the subjective report of the patient. Moreover, with technology like X-ray and radiological imaging, doctors began to diagnose in the complete absence of the patient.37 It is essential to remember, however, that both physician and patient would come to rely on pieces of diagnostic equipment for answers to their medical questions. Over time, the doctor-patient relationship became less of a collaborative effort.

19Biomedical discovery also transformed the doctor-patient interaction as the public began to experience successive positive outcomes after specific interactions with scientific medicine. Subsequently, expectations of what medical practitioners could provide in all areas of illness increased substantially. With the major discoveries of anesthesia and antisepsis,38 diseases and ailments that had once been considered fatal could now be painlessly treated and post-surgical infection staved off in many cases. Each individual positive encounter with scientific methods like the use of anesthesia and antisepsis demonstrated to the patient and his or her family the value and promise of scientific medicine. Even if someone had not had a personal experience with the new successes of surgery, reports were available from the highest source; in 1902, King Edward owed his life to the surgical treatment of his appendicitis.39 As a new and positive perception of surgical outcome gradually supplanted the great fear that had once been associated with surgery, patients came to expect a “technical fix” for every ailment. Consequently, by demanding more and more from scientific medical expertise, patients willingly raised the profession to new heights.40 Moreover, the public did not simply acquiesce to a medical monopoly over healthcare, it began to demand one.

20The gradual acceptance of culturally constructed notions of “science” by the public permitted the establishment and recognition of a homogeneous medical profession by the community at large. Growing public trust in an abstract vision of the “Man of Science” helped to raise the physician to a place of reverence and respectability in the community, indeed, onto so high a pedestal, that by the middle of the twentieth century, scientific medicine had a relatively unchallenged dominance over healthcare.41

21By examining a twentieth century anatomical model, the transition of the balance of medical power and subsequent adaptations of the doctor-patient paradigm, can be better understood and analyzed. An anatomical model of a female torso manufactured in the 1930s substantiates these changes. The model is called the 2000 “Durable” Life Size Female Torso and appears in a 1938 mail-order catalogue issued by the Clay-Adams Company with an accompanying price of $180.0042 (Figure 4). The exterior of the model and the removable organs are made of papier-mâché, which have then been hand-painted and heavily lacquered for structural fortification and durability. The torso is relatively solid throughout, perhaps built over a frame, while the removable parts are hollow, light, and would crack if moderate force were applied. An oval-shaped breast plate can be lifted to expose over forty detachable anatomical structures that mount together in a precise and intricate puzzle, with some components fitted with tiny hook and eye fasteners to ensure their placement within the body cavity.43

22The delicate nature of the Clay-Adams model would seem to indicate that it was designed for use by a small number of careful persons, rather than numerous casual users, for example, a new swarm of medical students year after year. This initially was corroborated by the curator who first acquired the model for a now dispersed collection, who indicated to me that it had belonged to a physician and had sat in his office for many years.44 The 1938 Clay-Adams catalogue, however, advertised that “this model is now in use in leading universities, nurses’ training schools, and other institutions teaching anatomy, physiology, hygiene and physical education.”45 But despite the catalogue’s claims of durability, including the promise that the model could be washed with soap and water, the model’s fragility is patent, and doubts about its intended usage linger.

23This created a quandary for me the historian: the catalogue advertises the figure for use in educational settings, yet its fragility seems to belie that kind of usage. Something is possible (indeed probable) however, when I consider usage and consumption behaviours: the potential for cultural bias. Material culture methodology requires that careful attention be paid to the researcher’s preconceptions about a given artifact. My own lifelong knowledge of, and interaction with, durable plastic objects like Fisher Price toys and Tupperware may facilitate a predisposition to regarding papier-mâché, by comparison, as exceptionally delicate. Before the early twentieth century, the other materials used in the manufacture of anatomy figures had been primarily ivory and wax. Ivory, of course, was expensive and heavy, and did not allow for much detail. Wax models were delicate and onerous, and had to be kept below a certain temperature so they would not melt. Thus, it is entirely possible that the heavily lacquered papier-mâché model was more resilient and better suited to casual, regular handling than models previously available, and was welcomed as a new alternative for the fabrication of anatomical teaching aids for use in institutions. Nevertheless, we know that this particular artifact was a fixture in a physician’s office who had a general medical practice.

24The 1930s Clay-Adams model belonged to a Dr. Yankoff, who practiced in the Leaside area of Toronto, Ontario. Other sources of information about his practice have not been found, and so we must rely on the artifact to generate both questions and answers. Medical training in the first decades of the twentieth century included plenty of time dissecting cadavers and memorizing the patterns of both healthy and diseased tissue as they appear under a microscope. During the hospital internship and residency, new doctors would witness and interact with the human body in almost every imaginable way. From delivering babies to assisting autopsies, from attending emergency room tragedies to performing hundreds of manual internal examinations, medical doctors had an extensive and tactile knowledge of the body and its components.46 Indeed, many returned home from a tour of duty in the Medical Corps having witnessed the utter devastation that could be inflicted upon the human body. In sum, the doctor’s experience with the biological reality of the body was comprehensive, even if more extreme instances of anatomical contact became less frequent once one was established in general office practice. With this kind of experience behind him, why did Dr. Yankoff have need of an anatomy model that was so unrealistic?

25The Clay-Adams model is viewed like an impressionistic painting; from a distance, its organs and tissue look fairly realistic and well-formed, but studied up close, they are barely identifiable. Both the interior removable elements and the exterior skin and tissue of the model are painted by hand. Various techniques re used to achieve the look of a particular organ. Scenic painters and interior decorators call these techniques “treatments” and regularly use them to create a three-dimensional look on a flat surface. For instance, a technique where different colours of thin, wet paint are applied to the object, allowed to mix erratically and then blotted with a rag are used on the lungs to create a mottled, marbled effect. Spackling, or freckling, is used on the spleen to create a textured, porous look.47 In fact, some structures are painted simply to imply their biological reality, and seem quite decorative; the component representing the interior of the breast looks more like the decoration embroidered on the hem of a traditional folk costume than fatty, mammary tissue (Figure 5).

26Thus, unlike the Medical Venus, the Clay-Adams figure does not provoke an extreme reaction from viewers, but it does arouse curiosity and interest. As I was examining the Clay-Adams model at the Science and Technology Museum in Ottawa, and placing her forty some odd parts around her on the table, a member of the maintenance staff took an interest in what it was I was researching and approached me. I asked her what she would think if she saw this in her doctor’s office, and she exclaimed, “I would think she just had an operation! She’s all chopped up!” The woman pointed to the model’s missing arm and laughed. Interaction with the twentieth century papier-mâché model is fairly straightforward and even blasé. But recall the hyper-realism of the eighteenth century wax figures and the kind of affective, intense experience they can elicit in spectators. Now imagine the Clay-Adams figure just as realistically formed and confronting the patient in Dr. Yankoff’s office - skinned, amputated, and eviscerated. An uneasy, terrified patient is not what the doctor ordered! Once again, the visual design of the object reveals the intentions of the maker and the kind of reaction expected from users.

27The medical sphere of the twentieth century emerged from its nineteenth century professionalization process as separate and insulated, its knowledge and expertise completely detached from the public realm. Many historians of medical professionalization have laid the responsibility for this marked separation squarely at the feet of the medical elite, claiming physicians agitated for a monopoly over medical knowledge merely to enhance their income and prestige.48 This narrow view of the monopolization of medicine is misguided, and other scholars have explored the broader social and cultural attitudes that attest to the willingness of the laity to have scientific medicine control and facilitate the delivery of its healthcare.49 Rapid urbanization during the Victorian era focused public attention on new social issues like crime, prostitution, mental hygiene, and public sanitation. A faith in scientific management and professional expertise saturated politics, criminal justice, and extended to medicine and public health as well.50 Victorian middle-class concerns about public health51 provided an intellectual environment in which science held the answers for grave social problems. Whether for pleasure, prevention or reform, scientistic thought permeated the public sphere, and by the turn of the twentieth century, a new trust in scientific medicine became almost absolute.

28In the post-war medical paradigm, it is the responsibility of the medical professional to shoulder the reality of the biological body and mediate the complexities and sometimes the horrors of medical knowledge into more acceptable and less threatening terms for the patient. The physician comes to understand his or her role in this relationship during medical school - recall the professor who told his students that dissection would help them not to be “frightened” when next confronted with “frightening” things. This division of the medical world and the “normal” world is reified by another item that appears in the Clay-Adams catalogue. A steel display cabinet was available for order which would accommodate not only small anatomical preparations on two shelves, but also the 2000 “Durable” Life Size Female Torso52 (Figure 6). Let us return to the scene in Dr. Yankoff’s office. The doctor wishes to convey some medical information to the patient. He walks to the cabinet containing the anatomy model, perhaps unlocking it, and he removes the needed organ or points out the region in question. The cabinet becomes a metaphor for the new doctor-patient relationship. Dr. Yankoff possesses medical knowledge which is inaccessible to the patient. Both are aware that this is part of their unspoken doctor-patient contract and his monopoly over this knowledge meets the expectations of the patient. He then uses the model as a vehicle for mediating and expressing medical knowledge in a language the patient is comfortable with.

29But if the public not only accepts but demands that medical knowledge remains marshaled by the medical sphere alone, why does the patient need to receive any medical knowledge whatsoever? Why not simply follow the doctor’s orders and graciously accept his or her authority? Stated in a different way, if the diagnosis is cancer of the liver, why does the patient need to see a representation of a liver and understand the pathological changes happening to it? These are complicated questions about a complex relationship between society and medical culture. Thomas Kuhn, of course, began to explore the artificial nature of a scientistic society,53 and other historians continue to examine the impact of scientific thought on our social interactions and conventions,54 but more research must be done in investigating how the emerging culture of science changed the doctor-patient relationship.

30The steady amassing of medical triumphs in the early twentieth century caused patient expectations of what medicine could and should provide to soar, and as Roy Porter notes, “as those expectations become unlimited, they are unfulfillable.”55 What must still be explored by historians of medicine then, are the details surrounding why, in the era after World War II, it came to be a fundamental desire of patients to understand in scientific terms the biological happenings inside their bodies, while at the same time, continue to seek protection from the grotesque and frightening aspects of anatomical reality.

31When the Clay-Adams model and the Medical Venus are examined side by side, the observer is struck by the virtually identical features of the internal anatomical structures - the relative consistency of human anatomy over time if you will. The years that separate their manufacture are not immediately apparent when examining the viscera alone. When the eye travels to the exterior representations, however, all similarities are forgotten - one is an object and the other a person; one sparks curiosity and invites interaction, the other creates unease and cautious observation. It is evident that the artistic qualities of anatomical models help to convey not only information about human anatomy but also that of abstract social meaning. As seen in the eighteenth century design of anatomy models, hyper-realism was employed to provoke an affective experience in observers and to encourage a particular philosophy or reform. As medical knowledge came increasingly under the guardianship of scientific medicine, the anatomy model became impressionistic, a tool used to gently convey medical ideas while continuing to shield the patient from the more grotesque nature of the human body. When material culture methodologies are used to analyse the artistic elements of these artifacts, there is seen deliberation and intention beyond, and in addition to, the primary aim of teaching anatomy.