While most depictions of legs in our collection show patients to be barefoot, in this photograph a pair of oxfords typical of the 1930s and 1940s are worn. They appear to be heeled and are accessorised with removable frilled flaps – a style that seems oddly impractical and out of place in a hospital.

While family photographs foster recognition of loved ones and prompt the recollection of precious memories, clinical photographs have a fundamentally different objective – namely, to ensure a disinterested experience of disease. By directing a viewer's gaze towards purely clinical ends, "the utility of the images can become more important than the subject" (Berle, 2008). In other words, photographs of this kind objectify the human beings they depict. 

But what happens when patient photographs are no longer needed for the clinical record or used to educate student doctors? When this material loses its clinical value, it appears to gain a new kind of status as historical artefact. This is because images of this kind offer engagements beyond the medical terrain. As a 'slice in time' they provide a window into a place and an experience that we no longer have access to, they offer clues to historical clinical procedures, hospital protocols and equipment, and they indicate the dominance of certain diseases at certain times in history.

Unlike written administrative documents that may provide similar information, clinical photographs also offer hints about patients – who they were, how they were handled, and even (at times) how they may have felt. For Caroline Bressey images like this thus allow histories of otherwise invisible individuals to come to light, for experiences, identities, and lives that would otherwise remain unknown to be spoken (Bressey, 2011). They also allow us to look at patients diagnosed with stigmatising disease like leprosy, syphilis, or (more recently) HIV/Aids not as 'sick' or 'diseased' but as individuals with rich emotional lives.

The photograph of this man was published in a SAMJ article by Prof CFM Saint in 1948. The publication pre-dates concern regarding patient privacy and, because the pathology is present on the man's face, he remains identifiable. The original version of this photograph can be found in our collection at the UCT Pathology Learning Centre.

In an attempt to safeguard a patient’s right to privacy, clinical photographs have historically undergone a degree of censorship to minimize identifiable features whenever possible. The concern lies chiefly in the question of informed consent and the safeguarding of Human Rights (Te Hennepe, 2016), and today the production and publishing of clinical photographs are regulated by various protocols.

Today, without informed consent, a clinical photograph must stay confidential and be treated as an extension of the patient's medical record (Berle, 2008; Koch & Larrabee 2013). Concerns and questions about the nature of an individuals ability to express consent thus remain - particularly with regards to vulnerable research subjects including children and mentally disabled adults (Moumjid & Callu, 2003). But contemporary guidelines were only beginning to be introduced in the 1970s (Te Hennepe, 2016), and many images produced before this time were thus taken and circulated without such consideration. 

The result of uncertainty regarding informed consent has been the use of eye-blocks or other 'masking' techniques in an aim to render patients anonymous. However, while this manner of censorship has been done to protect patients, it has been shown to be largely ineffective at safeguarding identity (Koch & Larrabee, 2013; Lakdawala et al, 2012). However, beyond the failure of this method to prevent recognition, it has unintended detrimental effects.

Too often, the policing of historical photographs is used to keep non-medical viewers away, to protect professional privilege and a self-congratulatory culture of professional discretion in the name of protecting the privacy and modesty of medical “subjects” who are long dead. But who is really being protected? (Sappol, 2017)

Cropping, blacking out, or blurring patient photographs affects both the authenticity of patient photographs (as historical artefacts) and the manner in which patients depicted are perceived by those who look. Anonymising strategies like eye-blocks simultaneously dehumanise those on display and encourage a single way of looking at the patient: as a clinical object rather than as the person. The act of censoring such images heightens this effect: by focusing attention solely towards the signs of disease, patients become little more than medically useful ‘things’. And in doing away with identifying features of the face, those depicted are experienced as ever less human – offering an emotional distance between the medical professionals or laymen (who look) and the patients (who are looked at).

Identifying features make patients recognisable and prevent them from being experienced as mere evidence of pathology to be deciphered or mocked. As seen in the four examples below (all of the same patient featured in the SAMJ article) it is easiest to identify with and feel empathy for the patient in the first, uncensored version.