By Simone Schleper
Around 1900, an unprecedented panoply of anatomical fold-outs emerged and sold across Europe and North America. Examples ranged from life-size models to supplementary inserts in thick health manuals and booklet-thin charts. As illustrative devises, fold-outs responded to a growing demand for anatomical models and illustrations by a broad authorship and audience. Yet, historiography has neglected this fascinating aspect in the history of anatomy. This entry presents a kaleidoscope of examples of the multifarious genre of anatomical paper fold-outs and their usage, providing new insights into the history of nineteenth-century public anatomy.
Historians of late-nineteenth-century public anatomy have done much valuable work in contextualizing wax models and anatomical illustrations inside larger, complex networks of institutions ranging from wax museums, lectures on comparative anatomy, hygiene and health lectures and anatomical objects at World Exhibitions. As part of a nineteenth-century anatomical culture, the paper fold-out medium, however, has not been granted much historiographical consideration. Doing injustice to the fold-outs’ tangible qualities, the few existing historical accounts have generally reviewed them alongside anatomical graphics and illustrations.
Building on different traditions of models for the purpose of ‘knife-less dissection’, flap anatomies formed part of both public and professional as well as alternative and orthodox practices and networks in medicine and anatomy around 1900. The following presents a number of examples of the multifarious occurrences and functions of anatomical paper fold-outs. Pointing out how these versatile fold-outs served (1) as means of visualization in domestic health manuals and marriage guides, (2) as persuasive tools in alternative medicine and public health lectures, and (3) as teaching aid in the training of nurses, the aim of this blog is to shed new light on the complexity of the media for nineteenth-century anatomical culture. The pervasive and affordable medium of anatomical fold-outs can provide new insights into the breadths of demand and application of models explaining the human physique around 1900.
1. Fold-outs at home
Facilitating domestic treatments
In the late 1880s, anatomical illustrations with movable parts attained unprecedented popularity as illustrative devices in medical manuals for home use. As supplements to medical handbooks in Europe and North America, the fold-outs assisted mothers, wives and others responsible for family health in less accessible or affluent areas. Works like The Cottage Physician provided an instructive manual for situations in which a trained practitioner was absent. Bone breakages and dislocations, sprains and other injuries that might have required bandaging or strapping were all discussed and depicted by The Cottage Physician in great detail. With the help of a fold-out behind the front cover, partners and parents were able to reproduce – on the spot and spot-on – the illustrated treatments.
Illustrating difficult discourses
As illustrative supplements, paper fold-outs also helped to discuss more delicate physiological subjects. In 1878, Hollick’s Origin of Life, a popular treatment of human reproduction represented a new form of marriage guides for English-speaking audiences and it featured a female fold-out. From the 1880s onwards, most works discussing marital life included figures and fold-outs representing a section on the female reproductive organs and their medical names.
While the marriage guides mostly addressed the female party, their winsomeness was certainly not confined to becoming mothers. If one has a look at the pictures below (Fig. 3), one can imagine that even the manuals not specifically focusing on reproduction would have stirred up the curiosity of their female and male readership. Depicting sensitive topics to lesser or greater extents, these manuals therefore often came with a lock or in a wooden locker.
2. Fold-outs as persuasive means
Tactile tools for alternative cures
Perhaps living far from the next doctor’s office, readers of The Cottage Physician and similar medical companions, appreciated practical advice of professional doctors. Yet, fold-outs were not just used to bring mainstream anatomical knowledge to remote homes. Especially less orthodox medical writers recognized and valued the fold-outs’ persuasive powers. The numerously evolving alternative medical schools in Europe and North America substantially differed from regular medical doctors in their empirical epistemology. Homeopaths and healers used fold-outs not merely as means of visualization, but also to stress the experimental roots of their teachings. The fold-outs allowed them to dissociate themselves from the book-trained medicinal teachings, while emphasizing the tangible and comprehensible nature of their alternative cures. Friedrich Eduard Bilz, for example, a natural healer of German origin, explained to his American followers:
it is necessary to place before them [the readers] something useful and sensible rather than such rubbish such as potions, painkillers etc. which are so often nowadays imposed on a credulous public.
While practicality was a much-touted feature of alternative cures, these manuals often comprised no less than several hundred pages. Here, hands-on paper models thus presented tactile tools for non-orthodox practitioners to convince their readership of both the empirical foundation and the applicability of their cures.
Affordable models for public health lectures
Fold-outs as means of anatomical demonstration were not confined to domestic settings. While few sources provide direct insights into the purpose and use of life-size anatomical fold-outs, several well-preserved exemplars suggests that they belonged to a larger genre of anatomical models for public health demonstrations. A life-size fold-out, held by the Wellcome Library and displaying the anatomy of a young woman (Fig.4), is for example equipped with little hooks and eyes that indicate its original position as having hung from the wall.
Late-nineteenth-century public health and hygiene lectures, luring with presentations of the human physique, drew vast crowds. In 1886, for example, The British Medical Journal reported of public hygiene lectures with audiences of seven to eight hundred people, in particular praising the graphic demonstrations. However, such large-scale clarifying visuals were not always easy to obtain. While existing wax models reproduced anatomical details very accurately, for example, they were extremely costly and the wax was too fragile to be handled frequently. Already in the 1830s the French doctor Louis Auzoux (1797-1880) therefore exhibiteda new educational 129-piece anatomical papier-mâché model in London (Figure 5). Papier-mâché was sturdy enough for constant usage at less than a tenth of the price of similar wax models. Still, importing French papier-mâché models, with a price of $250, was still not always an option. A paper Life-Size Anatomical Model of the Human Body, as for example sold by Philip & Son, ranged from £3.3s and thus offered health lecturers an affordable alternative.
Paper anatomies might have furthermore accompanied the moral lessons in the lectures of contemporary health populists. The American life-size fold-out White’s Physiological Manikin, for example, portraits the negative effects that toxics or tightlacing can have on the body (Fig. 6).
3. Knife-less dissection for new (female) medical professions
In the early nineteenth century, paper fold-outs had also been used for scholarly lectures. The academic Alexander Ramsay (1754-1824), for example, had made use of paper flap-models for his anatomy lectures. Similarly, fold-out dissection had a tradition of teaching professional audiences in mid-nineteenth-century obstetric teachings. However, when practicing on human cadavers became the standard in the latter half of the century, the use of models by the established medical profession declined.
Yet, with dissection remaining a privilege of (always male) university students, flap-anatomies increasingly found application in the training of professionals who were denied access to the anatomical theater. Especially for the training of the emerging (female) professions of nurses and midwives, anatomical models were used to remedy the perceived lack of practical experience. A look at contemporary professional medical journals reveals that female professionals employed smaller fold-outs for individual hands-on study. In 1904, for example, the British Journal of Nursing (1904) promoted Philips’ Anatomical Model of the Human Body (Female) (sized about 50 x 20 cm) as
admirably adapted to serve a useful purpose […, to] lessen the difficulty of nurses [who have] little opportunity of learning anatomy in the thorough manner upon which so much stress is laid in the case of students of medicine, namely by the study of the dead subject.
Another anatomical model by Owen Lankester (1859 – 1933), was perceived by the British Medical Journal as “most valuable” for “training schools [for] pupil midwives.”
The functions of fold-outs in 19th century anatomical culture
The usage of nineteenth-century anatomical fold-outs was multifarious and hard to classify. Amongst their users were establishing professions like nursing or midwifery, excluded from human dissections. Public lecturers, for whom dissection was out of question, used them as cheap alternatives to wax or papier-mâché. In domestic settings, fold-outs supported practical treatments for diverse sicknesses and confidential instructions for intimate matters. Fold-outs were not used simply to diffuse knowledge from top to bottom. Advocates of less established medical conventions drew on fold-outs to enhance the tangibility and with it the acceptance of their cures.
Their diverse occurrences and functions are what makes anatomical fold-outs fascinating and relevant objects of investigation in the research on late-nineteenth-century anatomical culture. Especially the fold-outs’ function as educational material offers opportunities to better understand and compare the role of anatomical knowledge in the self-conception of different social and professional groups. Thus, studying these delicate but unimposing paper models may provide further insights into the connecting links of the complex public anatomy networks around 1900.
Simone Schleper is a PhD candidate at the History Department of Maastricht University. Part of a research team on the history of experts in nature conservation, Simone examines the strategies of ecologists in international environmental projects between 1960 and 1980. Prior to her return to Maastricht, where she also obtained her BA, she completed her MPhil at the Department of History and Philosophy of Science, University of Cambridge.
Fig. 1: The Cottage Physician (1887). Retrieved from http://thumbs1.ebaystatic.com/d/l225/m/mR9cE9FmyqSb0_U2-IhVWkg.jpg, on 15 December 2013.
Fig. 2: Origin of Life (1878). Retrieved from http://2.bp.blogspot.com/-NSf4hjUTk-c/Tc45OC1nASI/AAAAAAABa1I/40OaDNZvGbg/s1600/Frederick%2BHollick%25252C%2BThe%2Borigin%2Bof%2Blife%2Band%2Bprocess%2Bof%2Breproduction..%252528inside%2Bof%2Bpregnant%2Bwoman%252529%25252C%2Bc1902.jpg), on 15 December 2013.
Fig 3: Witkowski, G.J. A movable atlas showing the progress of gestation. (Paris: H. Lauwereyns, 1878-1888).
Fig. 4: Pilz Anatomical Manikin (?) (ca. 1900). Retrieved from http://collectmedicalantiques.com/sites/default/files/imagecache/thumb/gallery-images/2010/25/apilzanatomicmanikin.1285387946.jpg, on 15 December 2013.
Fig 5: Auzoux’s papier-mâché model (ca. 1930). Retrieved from http://www.hps.cam.ac.uk/whipple/explore/images/models/5893_large.jpg, on 4 January 2014.
Fig. 6: White’s Physiological Manikin (ca. 1900). Retrieved from http://4.bp.blogspot.com/-lPgC20xth7M/UZ-_IP6BEkI/AAAAAAAAFYw/AZehR5AF9yw/s1600/oservatory_4.jpg, on 4 January 2013.
American Thermo-Ware Company. ca. 1900. Pilz Anatomical Manikin: American Thermo-Ware Company.
Al-Gailani, Salim. 2009. “Magic, science and masculinity: marketing toy chemistry sets.” Studies In History and Philosophy of Science Part A no. 40 (4):372-381.
Bates, Alan W. 2008. “” Indecent and demoralising representations”: Public Anatomy Museums in mid-Victorian England.” Medical history no. 52 (1):1-22.
Bilz, Friedrich Eduard. 1898. The New Natural Method of Healing: A Golden Guide to Health, Strength and Old Age: F.E. Bilz.
Buklijas, Tatjana. 2010. “Public anatomies in fin-de-siècle Vienna.” Medicine Studies no. 2 (1):71-92.
Carlino, Andrea. 1999. “Paper bodies: a catalogue of anatomical fugitive sheets 1538-1687.” Medical History. Supplement (19):1.
de Chadarevian, S., and N. Hopwood. 2004. Models: The Third Dimension of Science: Stanford University Press.
Faukner, T., and J.H. Carmichael. 1897. The Cottage physician: for individual and family use. Prevention, symptoms and treatment. Best known methods in all diseases, accidents and emergencies of the home: King-Richardson Pub. Co.
Furneaux, W. S., ed. ca. 1900. Philips’ Model of the Human Body (Female). London: George Philip & Son.
Furneaux, W.S. 1898. Philips’ Life-Size Anatomical Model of the Human Body. With Explanatory Handbook by W.S. Furneaux: London.
Klaver, E. 2009. The Body in Medical Culture: SUNY Press.
Kruschkowitz, Christina. 2011. Know Yourself. Reading University.
Partridge, A.R. 2005. Public Health for the People: The Use of Exhibition and Performance to Stage the “sanitary Idea” in Victorian Britain: Northwestern University.
Roberts, K.B., and J.D.W. Tomlinson. 1992. The fabric of the body: European traditions of anatomical illustrations: Clarendon Press.
Rosenberg, C.E., Library Company of Philadelphia, W.H. Helfand, and J.N. Green. 1998. Every Man His Own Doctor: Popular Medicine in Early America : an Exhibition Drawn from the Collections of: Library Company of Philadelphia.
Sappol, M., L. Lindgren, A. Svenson, and National Library of Medicine. 2012. Hidden Treasure: The National Library of Medicine: Blast Books.
Sappol, Michael. 2006. Dream anatomy: Government Printing Office.
Spratt, G. 1850. Obstetric Tables: Comprising Graphic Illustrations with Descriptions and Practical Remarks; Exhibiting on Dissected Plates Many Important Subjects in Midwifery: J.A. Bill.
Taylor, Katie. 2009. “Mogg’s celestial sphere (1813): The construction of polite astronomy.” Studies in History and Philosophy of Science Part A no. 40 (4):360-371.
Van De Walle, Etienne, and Virginie De Luca. 2006. “Birth Prevention in the American and French Fertility Transitions: Contrasts in Knowledge and Practice.” Population and Development Review no. 32 (3):529-556. doi: 10.1111/j.1728-4457.2006.00136.x.
Whorton, James C. 2002. Nature Cures : The History of Alternative Medicine in America: The History of Alternative Medicine in America: Oxford University Press, USA.
Wilson, A. 1910. Physiology, a Popular Account of the Functions of the Human Body. New York: Frederick A. Stokes Co.
(de Chadarevian and Hopwood 2004, Carlino 1999, Sappol 2006, Buklijas 2010).
 (Roberts and Tomlinson 1992, Sappol 2006, Kruschkowitz 2011)
 (allowing for anatomical insights without the cutting-up of dead bodies)
 (Faukner and Carmichael 1897).
 (Van De Walle and De Luca 2006, 533).
 One of the authors, Thomas Faulkner, was the president of the Royal Medical Council in London.
 Especially in North America the boundaries between lay and professional medical knowledge remained indistinct (Rosenberg et al. 1998, 4).
 (Whorton 2002, 75)
 (Bilz 1898)
 See e.g. Wilson (1910).
 Possibly Pilz Anatomical Manikin (ca. 1900). For a comparison see: http://collectmedicalantiques.com/gallery/anatomic-models.
 (BMJ 1886, Feb 20), also see Bates (2008, 10); see Partridge (2005, 14) on the popularity of physiological diagrams.
 The Athenaeum (1849) 358.
 For Auzoux’s models see: http://www.hps.cam.ac.uk/whipple/explore/models/drauzouxsmodels/.
 (Furneaux 1898). For more on the anatomical fold-outs by Philip & Son see here.
 Three pounds and six shillings, as advertised in Philip’s Model of the Human Body (Female) (Furneaux ca. 1900).
 (Sappol et al. 2012)
 See George Spratt’s Obstetric Tables (1850).
In Britain, for example, as of 1875 the General Medical Council required all students of medicine to undertake human dissections. (Bates 2008, 2, Klaver 2009).
(Sappol et al. 2012).
 “Every hospital matron who holds classes for probationers […] to impart the elements of anatomy has felt the difficulty of doing so with any degree of accuracy.” BJN (1904, Jan 30) 97.
 BJN (1904, Jan 30) 97.
 Younger brother of the biologist E. Ray Lankester. He served as the consolatory physician to the London Nursing Association (BMJ, 1934, Jan 6, 43)
 BJN (1913, Jan 18).
 How educational tools can provide relevant insights into shifting roles of science in education and the self-understanding of societal segments has been shown by an number of excellent studies on nineteenth and early twentieth-century domestic, pedagogic materials (e.g. Al-Gailani 2009, Taylor 2009).