Robert Penn Warren Center for the Humanities-Letters, Spring 2004

I feel particularly honored and lucky to be part of the 2003/2004 Fellows Program on Medicine, Health, and Society (MHS) at the Warren Center. Coming from Michigan, where I teach primarily nineteenth-century American literature and direct the American Studies Program, the weather in Nashville has been delightful, if mild to the point of raising my global warming anxiety quotient a touch. The new friends and colleagues I have made through the Center have confirmed my sense of the vibrant intellectual and academic life going on at Vanderbilt, and the Vaughn Home is such a congenial place to work that I am hardly disturbed by the construction on the Bishop Joseph Johnson Center going on next door. In fact, the construction site—with the drone of its generator, piles of rebar, and roving backhoe—is an apt metaphor for the program, because I am here at a time when MHS is constructing new interdisciplinary relationships throughout the University.

The new MHS Center in the College of Arts and Science and the Emphasis Program requirements for first- and second-year medical students are welcome curricular developments that signal an increased commitment to the exploration of the relations among the humanities, medicine, and society. The diversity of the group of fellows assembled to meet each Wednesday afternoon this fall also reflects the sense of new growth and possibilities. Though we have only been meeting for a short while, we have spent a good deal of time discussing our various projects. One of the great challenges and pleasures of interdisciplinary work is that it forces you to think more profoundly than you ordinarily would about other people’s work, the concepts and theories they use, the books they read, and the specialized vocabularies they employ.

At the Center, each week I have the distinct privilege of sitting down with colleagues with backgrounds in history, ethics, sociology, theology, oncology, and health care systems. Whether discussing Anne Fadiman’s The Spirit Catches You and You Fall Down, a study of a Hmong infant with epilepsy in Merced, California, or essays on the shifting concept of culture over the last thirty years (as we have done this semester), the seminars have been enlivened by this disciplinary mix. An exciting spontaneity also exists in the conversation; people feel free to think out loud, rather than merely recite their scripted thoughts. While specialization brings focus and insight (one hopes) to one’s intellectual pursuits, it inevitably produces blind spots as well. Our discussions have reminded me of the blindness of my own critical habits by exposing concerns I had not entertained or teaching me a great deal about subjects I thought I knew well. To cite just one instance, a reading on metaphoric language and the social construction of scientific knowledge— the ways and extent to which our understanding of nature is mediated by the social and political and expressed metaphorically—prompted one Fellow to remark that much of this debate turned on the philosophical tension between nominalism and idealism. For me, this resonated with the nineteenth-century debates about literary realism (an area in which I specialize), which frequently turned on questions of surface descriptions (nominalist) and deep concepts or essences (idealist), and from which many contemporary debates about the relativity of many truth claims have devolved. A little further along in the conversation, another Fellow attempted to formulate a concern about this kind of social and cultural relativism and disease. To what extent, he wondered, can we have an open-ended concept of disease and not have ideological turmoil? I liked this question because it seemed, in a broader context, to articulate a concern that is implicit in Fadiman’s study and needs to be taken up as a whole. Once we recognize the multiplicity of medical beliefs within and between cultures, how do we live with it, intellectually and ethically?

I also enjoyed a shock of recognition in that I had written a related thought in an essay several years ago in which I spoke of “the powerful tensions between literature and medicine, the play between restricted and open-ended meaning inherent in the predicament of illness and the process of healing.”1 But in our seminar, it seemed to me, the thought was being extended. Once we recognize the open-ended quality of disease concepts, what then? Over the last three decades medical humanists, literary scholars, philosophers, ethicists, physicians, and writers have been describing the connections between medicine and culture for a host of reasons: to promote moral and ethical reasoning, improve communication between doctor and patient, instill a deeper sense of medical history, explore the therapeutic value of storytelling, advance multicultural perspectives, and increase self consciousness on the part of medical practitioners.2 Whether one is interested in promoting any of these ends or merely in chastening an ambient or incipient sense of medical hubris, the need to locate literature in medicine is generally recognized as a corrective to the last century’s overvaluation of medical science and technology. Locating literature in medicine proceeds from the recognition that “every aspect of medicine’s history,” as Charles Rosenberg has observed, “is necessarily ‘social,’ whether acted out in laboratory, library, or at the bedside.”3 If scientific paradigms have sought to render language transparently neutral, and medicine has used the presumed transparency of scientific language to describe diseases and patients, then the cultural study of medicine, doctors, patients, and disease entities—the cultural frame of illness—must become visible once more.4 In this sense, the function of literature, culture, and history in medicine is to restore language to our sight. This, as I say, has been going on for several decades, but once the process of recognition has taken place, what then? Interdisciplinary endeavors like MHS and our seminar are the places through which we can begin to find adequate answers to such questions, and this reflects a crucial development in the paradigm of interdisciplinary medical humanities.

Of course, the other goal of the Warren Center is to help facilitate the research of its Fellows. The specific project I am working on is entitled “Memento Morbi: Lam Qua’s Paintings, Peter Parker’s Patients.” I have two articles deriving from it that will appear early next year and plans for a book as well. At the core of this project is a remarkable series of at least 114 oil paintings made between 1836 and 1852 in the studio of the highly regarded Cantonese export artist known as Lam Qua. All of these paintings depict Chinese patients of a leading medical missionary Reverend Dr. Peter Parker, an American Presbyterian minister and physician who, in late 1835, opened an Ophthalmic Hospital in Canton (Guangzhou) and soon acquired a reputation as a surgeon of such skill that it quickly became a general hospital in which he treated thousands of cases. Parker used his hospital and the charitable practice of Western surgical techniques as a means to facilitate religious conversion. Arguing that medicine could be the “handmaid of religious truth,” he offered free medical care to bring the Chinese to God and held regular services in the hospital. Among the thousands of patients were a number afflicted with mature tumors (five to thirty-five years old) which Parker had Lam Qua paint. When viewed in the context of Parker's corresponding case notes, Lam Qua’s paintings become even more complex images of cultural confluence and exchange, of East and West, orient and occident, portraiture and clinical documentation, Christian and heathen, rich and poor, revealing the collaboration and contestation of the Chinese and the American at a moment when notions of these terms were in embryonic stages of development.

By combining approaches from art history, cultural studies, and the history of medicine, I have a number of stories to tell. First, there is the cross-cultural relationship between Parker and the Chinese in general and Lam Qua in particular; second, there is the tension between the religious and the medical aspects of Parker’s practice; third, there is Lam Qua’s Anglo-Chinese painting; fourth, there are the individual cases and the task of interpreting the paintings and their historical and cultural significance.

There is also the setting of Canton itself in the 1830s and ’40s, a hotbed of cultural and commercial competition in the period of the Opium Wars. Bounded to the south by the Pearl River and cut off from the general population by the city’s sizable and well-guarded walls, the claustrophobic foreign factory sector of Canton, adjacent to the old walled city was small enough to be measured in footsteps by its pent-up foreign occupants: two hundred seventy paces from one end to the other along the riverfront and a mere fifty from the shore to the shops and factories, or hongs, as they were called. On this strip of land, all of the trade between China and the West was carried out. For the bulk of their acquaintance, both Parker and Lam Qua labored in this factory district. Their workplaces became favored destinations, sites of brisk traffic and frequent visitations. Parker circulated among the Chinese of Canton in the way that Lam Qua circulated among the Westerners. Parker was the first American medical missionary to gain wide cultural acceptance and respect for Western medicine and, to a lesser extent, Western religion in Canton; Lam Qua was the first Chinese portrait painter to be favorably exhibited in the West. The acceleration of trade, trade hostilities, and print media in the 1830s and ’40s allowed for much wider acclaim than was previously possible and consequently both were widely viewed in their day as pioneers who apparently broke through longstanding cultural barriers.

Peter Parker established the Ophthalmic Hospital in the midst of this commercial hive. He believed that the hospital could genuinely facilitate “social and friendly intercourse” between the Chinese and foreigners, diffuse knowledge of Euro-American arts and sciences and, above all, replace “pitiable superstitions” with the gospel truth. As he saw it, the key to reaching the “millions of this partially civilized yet ‘mysterious’ and idolatrous empire” was that his work must be entirely without fee, free from any form of “pecuniary remuneration.” At all times, his motive “must appear to be one of disinterested benevolence.”5 Over the entrance to the hospital a sign was placed that read P’u Ai I Yuan (Hospital of Universal Love). In a city utterly dedicated to getting and spending, gratuitous care raised suspicion among the hong merchants. They assumed that Parker must have some ulterior motive and placed him under surveillance, planting a spy (who worked as a linguist) in the hospital.6 His motive was to gain influence and converts, but there was nothing particularly devious about it. Gratitude for relief from medical complaints would break down the barriers between China and the West. In Parker’s theory, gratitude for bodies cured was a path to the Chinese souls he wished to save.

In practice, the hospital gave Parker unprecedented access to the bodies of all ages and classes, male and female, from near and far. Originally, Parker intended to treat primarily eye diseases—blindness (which was reportedly very widespread) and secondarily, the deaf and dumb; one hears the aura of Christ at Bethesda in this decision, to make the blind see, the deaf hear, the mute speak. It was not merely demographic incidence of disease in the Chinese population that was driving his specialization. An early case note from November 1835 reveals Parker ministering to Akeen, a thirty-one year old blind merchant, telling him (through an interpreter) “of the world in which he may see, though never again on earth; that in heaven none are blind, none deaf, none sick.”7 In his first year, he received over 2,100 patients with cataracts and a host of eye complaints, tumors, abscesses, cancer, goiter, bladder stones, scoliosis, hepatitis, pneumonia, impetigo, ulcers, and “opium mania.” Each day, patients would line up by the hundreds where a porter would issue them numbered bamboo tickets and the doctor would see as many as he could. The ferocious demand for his services could scarcely be met and, like a line worker coping with a ruthless speed-up, Parker worked himself into a state of exhaustion. Nor would the gratitude he inspired always come in what he deemed theologically acceptable forms. Patients frequently kowtowed to him and he was at pains to pull his grateful patients from the floor; one patient even requested a painting of Parker to which he might offer daily prayers. But the cases came before him in an endless inundating stream, compelling him to revise his medico-spiritual agenda. The encounters were intense and complex, and it was from the pressure of this onslaught that the collaboration with Lam Qua was born.

The enormity of the tumors and the surgical challenges they presented seemed to warrant illustration. Parker probably planned to donate them to an “Anatomical Museum of the Medical Missionary Society in China,” a group formed in the late 1830s to institutionalize the medical missionary approach exemplified by Parker and his English and American colleagues, but that museum never came about.8 He did, however, deposit a set of portraits at Guy’s Hospital in London, which may have been an expression of the original plan.9 Upon his return to the United States in 1840–41, Parker used the paintings on at least one occasion to illustrate his lectures before medical audiences as a way to advertise his work, raise funds for the hospital, and to recruit young missionary doctors.10

One can perhaps quickly get a sense of these paintings by considering Parker’s display of them during his presentation to the Boston Medical Association in 1841. One of the images he exhibited was of a patient named Lew Akin (Fig. 1). A healthy but rather emaciated twelve-year-old girl, she was accompanied by her parents and
admitted to the hospital in Canton on April 17, 1837. Parker determined to remove the large tumor, which had grown to a size and heft that the girl had to lean forward to keep her balance while walking. He placed her on a “generous diet” to strengthen her for the operation and ten days later removed the tumor in a procedure that lasted two minutes and fourteen seconds. The growth, weighing seven pounds, measured two feet in circumference at its base and “much larger at the middle.” Lew Akin made an excellent recovery, gaining weight and, in a week’s time, walking without pain or injury to the incision.

As extraordinary as this particular tumor was, what interested Parker most about Lew Akin’s case was the patient’s doting father. The father attended the operation, but when he saw the gaping ten-inch incision in his only child’s backside, he was overwhelmed and fled the room in tears. When his daughter cried out at the pain of receiving stitches, he returned to her side only to flee again from the equally harrowing sight of the wound being sewn up. Parker was impressed by the father’s constant vigilance, reporting that he displayed “the strength of natural affections, equalled only by his gratitude for the relief afforded his daughter.” “We cannot suppose the fond parent will remain insensible to the obligations of gratitude when he returns to his home, or fail to speak there of the excluded foreigner who had gratuitously restored his child to the blessings of health. We conceive there cannot be a more direct avenue to influence than will be presented in this department.”

Parker’s Boston audience responded powerfully to his presentation. The association immediately passed a resolution commending the Christian and medical nature of Parker’s efforts. Members of the audience further resolved to bring his efforts to “the attention of men of property,” inviting the wealthy to help finance the permanent establishment of more medical missions, and they formed a committee to facilitate the interest and recruitment of medical men for hospitals in China. This painting and the others that he displayed, however, elicited a different kind of reaction. “They were truly Cyclopean,” a reporter declared. Parker removed a tumor “from the nates of a little girl that would startle the surgeons in this part of the world with all their tact and science.”

The rhetorical impact of Parker’s appeal was conventional, wholly consistent with regular accounts of westerners that were bringing enlightened science and the gospels to the benighted east. But the visual impact of the painting of Lew Akin inspired wonder and curiosity even from an experienced medical audience. “I am indebted to Lam Qua,” Parker explained in his case notes on Lew Akin, “who has taken an admirable likeness of the little girl and a good representation of the tumor.” What Lam Qua captured was not merely the verisimilitude associated with Western portraiture. Rather the curious power of his portraits derives from the way they invite in the viewer a kind of gestalt where the eye and the mind travel between the likeness and the representation, as Parker terms it, the normal and the pathological, the subject and the object.

The contrast between the giant, ball-joint like growth and the petite figure of the Chinese girl seated on a stool looking rather demurely over her right shoulder with an almost questioning look on her face overwhelms the viewer. The pose that Lam Qua has opted for restores to Lew Akin a kind of balance and poise, of which the tumor had deprived her when walking or standing, and the delicate orderliness of the fingers of the right hand at rest force the viewer to confront the explosive morphological tension between the normal and the pathological. While the lecture affirmed the power of western science and the dignity of the missionary enterprise, the painting excited a more subliminal curiosity, “startling” and disturbing the equilibrium of Western “tact and science.”

In another case that Parker likely presented to his audience, that of Woo Kinsheng (Figure 2), the tumor appears as the patient's prop, as a musician might pose with his cello as the eye shuttles between these two ways of seeing. Parker describes Woo Kinsheng as having a ten-year old tumor that had “attained a very great magnitude resembling in figure a tenor viol.” Because the shape and size of Woo Kinshing's tumor resembles a familiar non-pathological object, a “tenor viol” as Parker calls it, Lam Qua's image elicits a further curiosity. In fact, Parker informs us that Woo Kinshing would rest on his growth like a mattress. Referring to the tumor as the patient's “old companion” and calling Woo Kinshing at several points “the old gentleman” (though he was only 49), the indirection or redirection of the pathological gaze toward some other object produces the ludicrous effect, reinforcing the tumor’s status as curiosity. While deformities and pathologies have always made for objects of curiosity, tumors add to this a general absence of function; they seem to serve no purpose but to deform. The effect of these paintings is to force upon the viewer the experience of tumors, in and of themselves, as curiosities. As masses of new tissue growth, independent of surrounding structures having no apparent physiological function but to divert the resources of the body, all tumors call into question the purpose of their existence. But the very massiveness of these tumors, sometimes rivaling the size of their host, makes their apparent purposelessness all the more obvious. They seem to be giant physical manifestations of a kind of extravagance, or excessiveness, a breaking out of boundaries, form and structure. In this context, Parker’s extirpations of them become a restoration of the self from an enormous irrelevancy. If curiosities are curious because, in Barbara M. Benedict’s words, they “have no function but to be looked at,” then Lam Qua’s pictures of giant tumors elicit curiosity in a double sense. They are at once formless and functionless.

The response to these portraits illustrates not merely the collision of sensibilities of Boston and Canton in the 1840s, nor the domination of the western gaze of science, but elements of both. The paintings functioned for Parker as visual testimonials to his medical skill and the nature of the Chinese as he found them. He selected patients to be painted on a principle similar to the one he used to cull the cases worth reporting from the thousands that came through the hospital doors. Some cases were chosen, as he wrote in 1848, “for their interest in a surgical point of view, others illustrating different shades of the character of the Chinese.”11 Like the many scrolls of tribute that grateful Chinese patients would frequently bestow on Parker, the paintings emphasized the enormity of the task he had accomplished.12 The paintings must have served as a form of spiritual compensation for the doctor who took no fees. “God has signally smiled upon efforts to benefit the body,” Parker noted in his journal for March 1843. “…It was from the bended knee in one room that I went to take the knife in another. God heard the petition offered….”13

From chapel to table, from prayer to cutting, the doctor moved, and he saw surgical outcomes (at least the positive ones) in providential terms. Many of the paintings were, indirectly, the mementos of answered prayers, visual analogues for his entire missionary enterprise. Grotesque fusing of diseased bodies and the strivings of a missionary doctor’s soul, Lam Qua’s paintings become, as my title is intended to suggest, Memento Morbi, tokens of disease and cure. The paintings are genuinely interdisciplinary artifacts that cut across the borders of medicine and culture, at once open-ended and restricted in their meanings. In looking to the past that these paintings summon up in all its strangeness and wonder, I hope through this project to begin to imagine and construct anew the relationships among medicine, health and society.

1. Stephen Rachman, “Literature in Medicine” in Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, eds. Trisha Greenhalgh and Brian Hurwitz (London: BMJ Books, 1998): 126.

2. M. Faith McLellan and Anne Hudson Jones, “Why Literature and Medicine?” Lancet 348 (1996): 109-11. Kathryn Montgomery Hunter, “Toward the Cultural Interpretation of Medicine,” Literature and Medicine 10 (1991): 1-17.

3. Charles E. Rosenberg, “Introduction: Framing Disease: Illness, Society, and History” in Rosenberg and Janet Golden, eds., Framing Disease: Studies in Cultural History (New Brunswick: Rutgers Univ. Press, 1992): xiv.

4. Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, trans. A.M. Sheriden Smith (New York: Vintage Books, 1975), most forcefully articulated the emergence of the transparent medical gaze in the 18th-century French clinic, and the point has been reiterated in a variety of contexts by students of literature and medicine. See, for example, Rita Charon, “To Build a Case: Medical Histories as Traditions in Conflict,” Literature and Medicine 11 (1992): 118-25, and Arnold Weinstein, “The Unruly Text and the Rule of Literature,” Literature and Medicine 16 (1997): 2-3.

5. Thomas Colledge, Peter Parker, and E.C. Bridgman, “Suggestions for the Formation of a Medical Missionary Society Offered to the Consideration of all Christian Nations, More Especially to the Kindred Nations of England and the United States of America”: 3-5.

6. Edward Gulick, Peter Parker and the Opening of China (Cambridge: Harvard University Press, 1973), 55-8.

7. Christian Review (CR) February 1836: 466.

8. Article six of the regulations indicates that the “museum of natural and morbid anatomy” would include “paintings of extraordinary diseases, &c.” (CR “Medical Missionary Society: Regulations and Resolutions” May 1838: 34).

9. William Lockhart, The Medical Missionary in China: A Narrative of Twenty Year’s Experience (London: Hurst and Blackett, 1861), 171.

10. Peter Josyph, From Yale to Canton: The Transcultural Challenge of Lam Qua and Peter Parker [Exhibition catalogue] (Smithtown, NY: Smithtown Township Arts Council, 1992), 5, claims that Parker displayed these paintings widely during his travels in 1840-1, but I have found less evidence of this. For one account of Parker exhibiting the paintings, see Boston Medical and Surgical Journal April 21, 1841: 177.

11. CR March 1848: 133.

12. Parker’s hospital reports are dotted with these testimonials. For example, here is Parker’s translation of a scroll: “Sie Kienhang of the Province of Kwangsi, presents his respects the very benevolent Dr. Parker and moved by polite attention, addresses to him the following sentiments: ‘One book of healing wisdom he to regions far imparts, And thousand verdant orange trees by the fountain’s side he plants.’” Parker, Report of the Ophthalmic Hospital at Canton for the years 1850 and 1851 (Canton, 1852): 26-27.

13. George B. Stevens, The Life, Letters, and Journals of the Rev. and Hon. Peter Parker, M.D., Missionary, Physician, Diplomatist, The Father of Medical Missions and Founder of the Ophthalmic Hospital in Canton (Boston and Chicago: Congregational Sunday-School and Publishing Society, 1896): 236-7.

Stephen Rachman, 2003/2004 William S. Vaughn Visiting Fellow at the Warren Center, is an associate professor of English and Director of the American Studies program at Michigan State University.

For more information, contact the Center's executive director, Mona C. Frederick.

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