Of all of the elements unusual and compelling in a photograph of the South London Hospital for Women and Children (SLHWC), taken around 1934 by Austrian émigré photographer and Comintern agent Edith Tudor-Hart (née Suschitzky, 1908–73), to me the most striking is the simple fact that the photograph exists (Fig. 3.1). Printed for the first time from Tudor-Hart’s secret archive for the recent retrospective exhibition, Edith Tudor-Hart: In the Shadow of Tyranny (Edinburgh, Vienna and Berlin, 2013–14), the image had only previously been an unseen and unused negative. It was one of at least two she made of the phototherapy facilities at the hospital (Fig. 3.2), part of a commission she undertook alongside fellow émigré photographer Grete Stern to illustrate the beneficent work of the institution for a 1935 fund-raising pamphlet. While Figure 3.2 was printed to be reproduced in the pamphlet and put on display at the hospital, Figure 3.1 mysteriously did not make the cut.³

3.1 Edith Tudor-Hart, Ultraviolet Light Treatment, South London Hospital for Women and Children, c. 1934.

Modern silver gelatin print, 30.3 × 30.0 cm. Wolfgang Suschitzky and Scottish National Portrait Gallery, Edinburgh. Presented by Wolfgang Suschitzky, 2004.

3.2 Edith Tudor-Hart, Treatment by Ultraviolet Rays, c. 1934.

In The South London Hospital for Women and Children (Birmingham: Kynoch Press, 1935), p. 16. Wolfgang Suschitzky and the London Metropolitan Archives, London.

Beautiful and eerie, the composition cleverly presents an otherwise resistant subject for the photographer: open arc phototherapy in process. The rich actinic light of a large, suspended carbon arc lamp was employed for general (full body) use on local children. Unlike the Finsen lamp, which focused and channelled the carbon arc’s actinic light through telescopic arms and quartz lenses for a local (lesion-specific) exposure, this carbon arc lamp’s open flame emanated unfiltered in all directions. Figure 3.1 depicts the treatment taking place, as was usual, in a darkened, enclosed interior space, the curtains and door shut and overhead lighting switched off. The children encircled the lamp behind a fixed railing, which marked off the correct distance from the lamp for the exposure, and playfully opened their arms to its actinic light. They did so guided by nurses, as much to entertain them during these exposures – which could last from several minutes up to two hours – as to maximise the surface area of their exposed skin to the lamp. The photograph presents the lamp slightly off-centre in the composition, yet the real focus is the largest of the six children undergoing ultraviolet exposure, whose arms gracefully interlace in the photograph with the shadows of the child opposite him, and whose body takes centre stage. It is important that it does so, because the child acted a shield, or screen, for Tudor-Hart’s camera and its photosensitive film. By positioning herself behind this child, her medium format Rolleiflex camera held at waist height, Tudor-Hart produced a legible negative under exceptionally difficult lighting circumstances.⁴ A few centimetres off and the emanating actinic light of the lamp would have overexposed the film, ‘injuring’ the negative and thus ruining the shot.

Tudor-Hart was a professional photographer known for her technical adroitness, including her ability to control lighting.⁵ But even professionals struggled to take legible photographs of phototherapy in process.⁶ Her photograph is unusual in its handling of the light; while several photographs exist with this composition, where the photographer’s camera was placed behind a patient-‘screen’, rarely are they so well lit – or so expertly printed, I suspect – without succumbing to overexposure or dramatic silhouettes (Figs. 3.3–3.4).⁷ Note, for example, the back of the central child in a photograph reproduced in Victor Dane’s The Sunlight Cure of open arc phototherapy at an unspecified London hospital (Fig. 3.3). Here the back of the child is engulfed in blackness, presenting a striking silhouette, because the only lighting in the room was produced by the arc lamp itself. We find the same in Figure 3.4, of the Institute of Ray Therapy in Camden, but whereas the photographer has managed to use one child’s arm as a shield for the arc lamp on the left, the glaring actinic light of the second arc lamp has evaded its shield and burnt the sensitive film to the point of producing a ‘black sun’.

3.3 ‘Children receiving sunlight treatment in a London hospital.’

In Victor Dane, The Sunlight Cure (London: Athletic Publications, 1929), unpaginated plate. Wellcome Library, London.

3.4 ‘Ray Therapy’ [Institute for Ray Therapy, Camden], undated (c. 1930s).

Hulton Archive, Fox Photos/Getty Images.

By contrast, additional lighting must have been present out of shot in Tudor-Hart’s version (Fig. 3.1), allowing the backs of the children in the foreground to be discernible and thus a more evenly lit overall image, whether by additional lamps or possibly through the use of a flash. However, the primary light enabling the negative to be imprinted in this dark interior – and thus for this photograph to exist at all as a legible print – was, like Figs. 3.3 and 3.4, that of the carbon arc lamp, and only under carefully controlled mediation by the photographer.

In Chapter 2, I opened my discussion with a reproduction of Niels Finsen’s photographed forearm, a photograph that represents the researcher’s sensitive sunburnt skin as a testing ground to visually analyse the effects of actinic light, especially those rays invisible to the human eye: the ultraviolet rays (Fig. 2.1). In that chapter I made it clear that although Finsen’s skin appeared to have acted as a satisfactory register for the solar erythema test – to himself and other practitioners influenced by his work – the photograph (and its reproductions) attempting to represent and disseminate the results failed to convey them legibly. This obscurity of the photograph prompted me to consider the solar erythema itself as an uncooperative, highly transitory, and highly individualised physiological phenomenon that resisted being ‘fixed’ by practitioners in order to enable clear dosage standardisation. I used the specific phrase ‘Finsen’s photographed forearm’ in reference to Figure 2.1 in two distinct but fundamentally interrelated ways: both to mean Finsen’s sunburnt arm and the actual photograph of it. As photosensitive surfaces, both the subject and its material representation act as latent light registers and can be understood literally as ‘photo-graphs’; that is, as ‘written’ or produced by light.⁸

Throughout the present chapter I discuss the frequent analogies made by light therapists between photographs and skin, and perceptions of the resemblances between photography and light therapy as ‘light technologies’: technologies that both depended upon light as a source in order to function. Their similar photochemical operations would make them appear at first to be natural bedfellows. Certainly it seemed this way to practitioners, who looked to photographic processes and larger developments in photochemistry in order to understand how and why light therapy worked on patients. This is evident in the epigraph above, by Drs Eleanor H. Russell and William K. Russell, who made a direct analogy between the actinic light of flash photography and that of phototherapy.

In Section I of this chapter I explore this alliance, but in Section II, I want to tease out the tensions in what came to be an uneasy, incestuous relationship between photography and light therapy, between the visualising and therapeutic powers of light. This was especially the case with phototherapy, a therapy that relied upon artificial light originally intended for electric lighting; in other words, for vision. Tudor-Hart’s negative, newly available as a positive printed for public view, presents light therapy with exceptional delicacy and skill, in which the treatment appears as a highly controlled, well-managed, and technologically progressive practice of bodily exposure to actinic light. The control or management of this powerful actinic light was only further emphasised and validated by the fact that the photograph of the therapeutic process was equally in control of that light. Because of what it is and what it represents, Figure 3.1 offers itself as evidence of both phototherapy and photography skilfully controlling the ‘injurious’ light rays that quickly blinded eyes and burnt skin and film.

But what of the historic photographs that do not wholly contain this blinding, burning therapeutic light, what can they communicate about light therapy? Submerged in archival folders throughout the UK are numerous ‘bad’ photographs of light therapy, injured with photographic accidents known as ‘artefacts’: ‘black suns’, engulfing masses, and legible splays of white light visibly mark numerous overexposed photographs, the results of lens flare and ‘solarisation’. The latter, in which extreme overexposure produces reversals of light and dark in the photograph, is a particularly relevant word here since it was a synonym for light therapy itself. In her 2008 book, The Burning Mirror, Melissa Miles reconceptualises these ‘accidents’ as productive and instructive examples of light’s volatility in the history of photography – of light not as an agent of truth, revelation, and ‘enlightenment’ but as a blinding, excessive, and immaterial force. Throughout this chapter I defer to Miles’s work to understand the complex relationship between actinic light’s therapeutic and visualising powers in the intertwined histories of light therapy, photography, and electric lighting. Like the previous chapters, I continually return to Figure 3.1 as a poignant visual representation and material object driving my argument: that light therapy was encountered and represented photographically as an obscure (literally ‘dark’, unclear, or unknown) practice, in which these light technologies do not so much converge as collide.

I  Material convergences

As Tanya Sheehan demonstrated in Doctored, the close relationship between light therapy and photography began early on in the nineteenth century. She argued they were both perceived as agents of social and physical health, focusing specifically on blue-light therapy and commercial photography studios in mid-nineteenth-century Philadelphia. Sheehan discussed the experiments of General Augustus Pleasonton, who analysed the effects of coloured lights on the growth of grapes and pigs during the 1860s. He reported that blue light, emitted through panes of blue glass, was far more stimulating to vegetative and animal growth than ordinary, clear glass. In his 1872 patent application, Pleasonton claimed similar beneficial, rejuvenating effects for humans using blue glass. According to Sheehan, these claims initiated a blue glass ‘craze’ in Philadelphia in the 1870s and 1880s. She noted that contemporaneous photographers perceived their sky-lit studios as physically and psychologically beneficial spaces for their sitters and workers, and they equally incorporated panes of frosted blue glass for their pleasing light effects on the sitters’ complexions in photographs. Her chapter discussed the fascinating correspondences and ‘material resemblance’ between Pleasonton’s blue-light therapy (what she termed ‘phototherapy’) and studio portrait photography using blue glass, between ‘two technologies of light’.⁹ Indeed, she even argued that beyond mere similarity these two technologies converged, in which this kind of photography ‘emerged as a powerful phototherapy’ in its rehabilitating social powers.¹⁰

Like Sheehan, I view the relationship between photography and phototherapy as more than a ‘material resemblance’ between two light technologies. If, for Sheehan, studio photography using blue light acted as a kind of social ‘phototherapy’, for me phototherapy acted as a kind of excessive, risky form of photography – a blinding, burning practice of ‘light writing’.¹¹ This relationship came to be less one of material resemblance or even material convergence than a material collision. Pleasonton’s blue-light therapy was but one of many, international examples of light therapy correlating to photography’s practices and its technical processes. As a light technology, it was born not simply from older medical practices but out of technologies bound up with vision. For light therapy, and especially phototherapy, to emerge fully in the 1890s, two technologies needed to be embedded within the sciences (broadly here encompassing physics, chemistry, engineering, and medicine), and both of them were fundamentally tied to the visual: photography and electric lighting. Actinic light took centre stage in the intertwined histories of photography, electric lighting, and therapies utilising the wavelengths of the electromagnetic spectrum. As Kelley Wilder made clear,

As I explain in the next chapter, this ‘darkness’ or optical invisibility led to vanguard techniques of representation, particularly montage, to visualise these invisible, therapeutic, and risky rays.

This is not to suggest that photography, as a light technology, did not possess its own tensions and ambiguities as a major form of representation for the sciences. As numerous historians of photography have asserted, through its claims to objectivity as a so-called unmediated and passive mechanical tool, photography gained tremendous authority as a medium for scientific observation, dissemination, and experimentation despite overt awareness of its faults.¹³ The uneven photosensitivity of emulsions to certain light wavelengths over others,¹⁴ and the reliance on ‘doctoring’ or retouching negatives to correct errors are two significant examples.¹⁵ Photography’s limitations as a visualising medium are especially resonant by studying ‘bad’ photographs of light therapy, but they are certainly not exclusive to this medical treatment or to medical photography in general during the nineteenth or early twentieth centuries. As a medical treatment that relied primarily on photography to document and disseminate its efficacy, light therapy was like any other therapy of its day. It was exceptional, however, because actinic light was the source of the cure and the means to its visual representation. In this respect it bears close similarity to X rays, which were used almost immediately upon discovery, in 1895, as both a therapy (radiotherapy) and a diagnostic tool (radiology). The visualising and therapeutic capacities of light collapse onto each other in light therapy literature through the practitioner’s scientific knowledge of light’s generative, transformative role in photography. The more we think about this odd convergence, the stranger it becomes: imagine, by analogy, if the history of hydrotherapy was primarily encountered through archival images made with watercolours. Pushing the analogy further, imagine if hydrotherapists formulated their theories about the therapeutic efficacy of water based on their understanding of watercolour painting, its techniques and material processes.

In this sense, any photograph we find of or about light therapy could be said to present this convergence: it is a visualisation simultaneously of and with actinic rays.¹⁶ But, as is evident by looking carefully at Figure 3.1, the photographer faced significant difficulties when attempting to represent light therapy. That practitioners continued to rely on photography despite these difficulties of representation says as much about photography’s authority as it does about its limitations as a medium. This collision of light technologies occurred at the juncture where the therapeutic utilisation of light exceeded the possibilities of its utilisation to visualise. Put another way, the blinding powers of actinic light were reconfigured and expanded for therapeutic purpose at the expense of photographic representation. When these technologies came together – when photography was called upon in the service of phototherapy – their volatile interaction resulted, more commonly than not, in photographic accidents and representations of technological failure of one or both media: we encounter images in which the delicate photosensitivity of the camera’s film, badly injured, could not legibly represent the lamp’s burning light (photography’s failure), while legible photographic representations exist by means of manipulation and fakery, of patients standing around an unlit lamp (phototherapy’s failure). Even in rare instances of photographic success, like Figure 3.1, our access to the therapeutic process remains obscured. And so we begin, like the occupants in Tudor-Hart’s photograph, in darkness: in the darkroom.

 The dark room

Pleasonton’s blue-light therapy was not, within the history of medicine, defined as ‘phototherapy’ (artificial light therapy) but rather referred to as chromotherapy or colour therapy, and for practitioners Pleasonton was perceived as an early pioneer in the therapeutic benefits of visible, coloured light.¹⁷ As outlined in previous chapters, the historical narrative of phototherapy proper is bound up with Finsen in the 1890s.

Finsen’s experiments with light began during the early 1890s through an observation of its negative influence on variola, also known as smallpox.¹⁸ He discovered that if the patient was placed in a room totally devoid of all but red light within the first stages of smallpox, known as the stage of vesiculation or blistering of the skin, the disease did not develop into the stage of suppuration (in which pus would discharge from the small blisters). By doing so, the patient could heal with little or no scarring. It therefore was not a cure, per se, but a method of managing the illness and minimising risk, including complications and fatalities, at a time when smallpox vaccination was not yet fully widespread throughout Europe. To carry out the treatment he created a room where all the windows were covered with thick, red cloth or a dense red glass, to filter out all but the red rays. He stated in an 1895 article in the BMJ that,

As Finsen made clear, red-light therapy operated according to knowledge gained from photographic practices. The patient’s skin was as photosensitive to actinic light as a photographic plate. His treatment room, consequently, emulated a darkroom. He made sure the conditions were right before allowing his patients to enter by hanging a photographic plate in the centre of the room.²⁰ Any blackening of the emulsion on the plate indicated actinic light was somewhere filtering into the room and therefore it was not safe for patients to enter.²¹ Perhaps unsurprisingly, I have been unable to find photographs of the process. Such conditions purposely excluded the possibility of photographs being taken or subsequently developed, the light enabling photographic impressions a risk to the equally photosensitive skin of his smallpox patients. Instead, Finsen included in that 1895 article only a ‘before’ photograph, of a patient in the stage of vesiculation, and a chart of her temperature fluctuations to mark the progress of the disease. No ‘after’ photograph was provided, only a reassuring text to explain that, following red-light treatment, the patient recovered. This is an overt and early example of light therapy being encountered as an ‘obscure’ practice: it was a short-lived therapy, vaccination rendering it redundant; it was carried out in the dark; and, as a result, no visual representations of it appear to exist.

The knowledge gained from the darkroom, however, did not pass into oblivion. As Edwin Ash wrote in Facts about Artificial Sunlight, in 1925:

Modelling their treatments on photographic practices provided lessons to light therapy practitioners about the physiological action of light as well as its psychological actions. Finsen noted the difficulty of continually excluding the injurious rays to his darkroom, explaining that nurses as much as patients desired to fling open the curtains for their own mental well-being.²³ Further direct references to photographic darkrooms and developing processes relayed the perceived psychological effects of coloured light rays. There are multiple, international references in light-therapy literature to the photographic factory in Lyon of the famous Lumière brothers, who reported that their workers became very agitated, excited, and disruptive after extended periods in darkrooms illuminated by red light. Thomas Nogier, in his 1904 medical dissertation, La Lumière et la vie, described the workers as displaying ‘all the symptoms of an abnormal cerebral excitement: they talked, gesticulated, sung and… manifested in their actions a certain bawdiness that harmed the good [working] order of the factory’.²⁴ Earlier, in 1898, Dr Léon Bouchacourt stated that red lighting was especially excitable to women in this situation, causing ‘incessant disputes’. He explained that it was only by substituting ‘ruby’ red lighting for a ‘cathedral’ green that calm was restored – as if by ‘enchantment’ – to the factory, claiming that one of the Lumière brothers had asserted this to him directly.²⁵ This well-known case was cited for decades by several international light therapists, including British practitioners.²⁶

Finsen also experimented with the biological effects of coloured light on the growth of living things such as tadpoles and insects, and he knew of Pleasonton’s experiments with blue glass (though professed little confidence in Pleasonton’s blue-light therapy).²⁷ When projecting beams onto these creatures he lapsed into the vocabulary of photography, discussing a focused beam of actinic light as a ‘luminous pencil’.²⁸ Returning to Finsen’s photographed forearm (Fig. 2.1), it becomes evident that this experiment, in which he glued various coloured glasses to his arm and then exposed it to actinic light in order to test the glasses’ transmitting properties, was but one of many he conducted in the 1890s with coloured light to understand its physiological effects on the animal world. I am fascinated that physicians looked to practices adopted within photography as models for direct application in light therapy. These darkrooms and photographic factories served unwittingly as testing grounds for phototherapy, on par with laboratories like the MRC’s Hampstead institute, the NIMR (Chapter 2), providing evidence of light’s chemical and physiological effects.

 The chemistry of light

Like other physicians and scientists, Finsen knew that the red light of the spectrum was the weakest in terms of concentrated chemical (actinic) action. Red light is furthest on the spectrum from blue, violet, and ultraviolet light, which are highest in chemical as well as bactericidal action. The naturally bactericidal powers of sunlight had been known since the late 1870s, primarily from the experiments of Arthur Downes and Thomas Blunt in 1877 on the destructive action of actinic light on bacteria.²⁹ However, awareness of its lethal action on bacteria was not the only influence on the earliest experiments with and hypotheses about the ‘injurious’ rays’ therapeutic application. Nor can these origins of light therapy be solely attributed to Finsen. Dr Theobald Palm, a medical missionary trained in Edinburgh and stationed in Japan between 1874 and 1884, cited Downes and Blunt at length in an 1890 article, but he also spoke of photography and developments in photochemistry as explanations to substantiate his belief that rickets could be cured by the systematic use of sunbaths (heliotherapy):

Palm’s direct reference to the ‘chemistry of light’, and particularly its capitalisation, would strongly suggest a citation to the well-known photographer and photochemist Hermann Wilhelm Vogel’s 1875 book, The Chemistry of Light and Photography.³¹ Vogel (1834–89) contributed greatly to developments in photography, researching dye sensitisation that led to new emulsions, inventing instruments such as an improved photometer and spectroscope, and even teaching Alfred Stieglitz in the early 1880s. Vogel’s research on the ‘chemistry of light’ (photochemistry) was directly cited by light therapists well into the twentieth century.³²

The sun’s ability to blacken silver salts was discovered in 1725 by anatomy professor Johann Heinrich Schulze and confirmed in the 1770s by Swedish apothecary Carl Wilhelm Scheele.³³ The experiments by German chemist Johann Wilhelm Ritter clarified that it was the invisible, ultraviolet rays of the spectrum that had the most chemical effect, using paper coated with silver chloride in a dark room, following the earlier research of botanist Jean Senebier in 1782.³⁴ Ritter is credited with discovering ultraviolet rays in 1801, one year after Sir William Herschel discovered the infrared rays. Like Wilhelm Röntgen (X rays) and Henri Becquerel (gamma rays) almost 100 years later, these invisible ultraviolet rays were first detected and discovered by photographic action.³⁵ Photography’s ability to detect invisible phenomena, and specifically wavelengths on the electromagnetic spectrum invisible to the human eye, proved an invaluable resource for scientists. Simultaneously, photography’s ability to visualise and, through photographic reproduction, to disseminate data on that phenomena doubly served the sciences.³⁶ This is exemplified by the contemporaneous growth of spectroscopy as a field.

Spectroscopy emerged, according to Klaus Hentschel, as a visual culture that came to dominate the sciences from the late nineteenth century onwards, in part because of the use of photography to aid it visualising and measuring the electromagnetic spectrum.³⁷ Spectroscopes, alongside various models of photometers (actinometers, actinographs, heliographs, etc.), were equally relied upon by light therapists, who mention it frequently when discussing natural and artificial light intensities.³⁸ Spectrum photographs sprinkle light therapy texts and, as Hentschel and Wilder both noted, highly specialised knowledge was required in order to interpret or ‘read’ them (Fig. 3.5). Like Finsen’s photographed forearm (Fig. 2.1) these photographs were impenetrable to the ordinary viewer. Looking at the images together, they present important similarities. Beyond any visual resemblance of what is pictured as various kinds of vertical bars or lines, we are looking at layers of light registers.³⁹

3.5 ‘Spectrogram showing part of the visible and ultra-violet regions.’

In Eleanor H. Russell and William K. Russell, Ultra-violet Radiation and Actinotherapy (Edinburgh: E. & S. Livingstone, 1925), Figure 4, p. 38. Author’s collection.

 Light registers

When American physicist Henry Augustus Rowland published his impressive spectrum photograph, Photographic Map of the Normal Solar Spectrum, in the late 1880s, he described it as follows: ‘The photograph is the work of the sunlight itself and the user of this map has the solar spectrum itself before him.’⁴⁰ A veritable self-portrait of the sun, the spectrum photograph is a representation of light rays made with light rays, just as Figure 2.1 acts as a light register (photograph) of a light register (sunburnt forearm). In this sense it also presents layers of authorships and subjects: it a photograph of Finsen, by Finsen, but also of, and by, actinic light.

The notion of the sun as the photograph’s rightful author is historically traceable back to the very inception of photography. Corey Keller explained:

Miles added that, ‘As the sun was designated the true author, photography’s prints could be deemed as trustworthy as fingerprints.’⁴² This belief in the photograph as a direct trace or referent of the subject explains its historic (and ongoing) status as a faithful and true document, but this could be said of any photograph. Something different, something more, is happening in the photographs of sunburnt skin scattered throughout light-therapy texts (Figs. 2.1–2.3, 2.13). In their ‘material resemblance’ as photochemically active surfaces, photograph and skin are separate layers of light registers but here collapse onto each other; not simply index and subject, they are conceptually one and the same.

Devices for light registration make obvious this conflation of photograph and skin. Some measuring devices relied upon a comparison between photographic paper and the skin’s erythema production to measure actinic light (see Chapter 2). The Russells explained they used ‘printing-out paper’, which they exposed for different lengths of time to a light source and then compared the various ‘tints’ to measure light intensities.⁴³ The same method is used to produce a photographic test strip in a darkroom when developing a positive from a negative, ensuring the ideal exposure time. As explained in the last chapter, Saidman’s ‘sensitometric test’ was a clockwork mechanism with progressive timed openings, pressed against the patient’s abdomen, which measured how rapidly the skin reacted to actinic light (Figs. 2.12–2.13). In doing so, Saidman used the patient’s skin itself as a photographic test strip in order find the correct ‘dose’ of light for the patient. These gradations of erythematous markings on the flesh were measured and, furthermore, photographed – a register of a register, like Finsen’s photographed forearm.

In looking at these photographs of sunburnt skin, we encounter separate layers of light registers or, as Sophia Zweifel discussed in relation to the French psychoanalyst Didier Anzieu’s writings on the ‘skin-ego’, layers of ‘pellicules’. A pellicule is a thin membrane or ‘skin’ enveloping parts of plants and animal organisms, such as the skins of an onion, but it also is used to mean photographic film, onto which the photosensitive emulsion is coated.⁴⁴ Zweifel, analysing the early visual culture of radiology, asserted that the layers of skin displaced by the process of irradiating the body with X rays are reconstituted onto the photographic film of the radiograph itself (Chapter 4). For light therapists, the receptivity of the skin to light and that of photographic media was more than a metaphorical connection; it was literal.⁴⁵

NIMR researchers Albert Eidinow and Sir Leonard Hill had relied upon spectroscopy to measure light intensity and dosages, but they found the process ‘tedious’, preferring to measure intensities and dosages by erythema (sunburn) production.⁴⁶ Underpinning light therapy as a medical treatment was the fundamental notion that the skin is a natural photometer for detecting and measuring actinic light. Eidinow noted the crucial similarities between skin and photographic plates:

But for Eidinow the skin’s erythema production triumphed over both spectroscopic and photographic readings of light – measuring either intensities or varieties of wavelengths emitted from a particular source – because it provided evidence of the light’s physiological (termed ‘biological’) effects.⁴⁸ This was the only reason that measuring light was useful to the physician, in Eidinow’s mind. What good was it, after all, for a physician to measure light if not for therapeutic application? His belief only served to confer more authority and dependence upon the solar erythema as the main light registration ‘system’ for practitioners (Chapter 2). Put simply, the sunburnt skin was the photograph. It superseded photography and rendered photographic registration redundant, at least as a form of measurement. Eidinow, and other British practitioners who guided their practice according to erythema production, clearly still relied upon photography as a form of representation and would push this light technology to its limits in the pursuit of medical progress.

The complicated convergence of aesthetic and therapeutic light occurs in other photographs of light therapy, not only those presenting sunburnt skin. In the 1901 English translation of his book, Phototherapy, Finsen included several plates of his patients and described them as evidence of light therapy’s good effects on patients (see also Fig. 2.4). His many before and after photographs of lupus vulgaris patients may obscure the therapeutic process – it is visually absent, merely implied in the spaces between the two photographs – but once again viewers are presented with images produced of and about actinic light. Like other medical and scientific researchers of his time, Finsen had no issue exploiting the ‘slippery’ nature of photography: he used photography both to explain photochemical processes, for therapeutic application, and to act as a recording device for his results with actinic light.⁴⁹

The same might be said of any of the light-therapy facilities known to have numerous photographers and darkrooms on site, producing photographs and radiographs: the famous Swiss heliotherapist Dr Auguste Rollier’s sanatoria in Leysin; the Royal London Hospital’s Light Department; and the British light therapy sanatorium, the Lord Mayor Treloar Hospital for Crippled Children in Hampshire, where hand-held cameras were apparently in abundance (see Chapter 1 on these institutions).⁵⁰ Treloar’s archives additionally contain several reprints of the same image in various states of light intensities and quality, suggesting the nurses or even the patients practised developing prints in its darkroom using negatives about light therapy.⁵¹ These images depict photography as a representational (aesthetic) tool absorbed into daily practice at the light clinic, for medical purposes and for entertainment.

 Electric light

The Finsen lamp is the most well known of historic examples of phototherapy lamps. As an object it marks light therapy’s inception as a modern and systematised treatment, first utilised to treat skin diseases (Fig. 2.6). But absent within the secondary literature on the therapy’s history, scant as it is, are discussions of the wider context for such an invention. The Finsen light was a modified carbon arc lamp, a form of electric lighting that had been invented at the beginning of the nineteenth century by the British chemist and proto-photographer, Sir Humphry Davy, contemporaneous with his photographic experiments and Ritter’s discovery of ultraviolet light.⁵² By the mid-nineteenth century the carbon arc was used in welding and to light railway stations, public streets, theatres, and even the low-lit interiors of photographic studios. The carbon arc lamp emitted a brilliant white light in an arch formation when an electrical current was passed between its two rods of carbon, which made it ideal for lighting large public spaces or, when focused with a mirror, for spotlights and searchlights (illuminating distances up to six kilometres).⁵³

In his modifications, Finsen’s attached focusing devices, channelling the emitting light of the arc into brass telescopic arms that were fitted with quartz lenses.⁵⁴ In addition to using pyrogallic acid (a staple in photographic darkrooms⁵⁵) alongside light therapy to treat lupus lesions, Finsen experimented with various lenses, coloured glass, and additional filters, as well as coloured stain solutions applied to the lens in order to absorb heat, again reminiscent of photographic practices.⁵⁶ This use of lenses to focus and concentrate sunlight was not without precedent, in optics or medicine. Various references throughout the late eighteenth and the nineteenth centuries exist about physicians who used concentrated sunlight to treat surface lesions.⁵⁷ Finsen was perfectly aware of previous experiments to treat lupus vulgaris by focusing lenses, known as ‘burning glasses’ or ‘burning mirrors’, as well as contemporaneous cases of physicians using incandescent electric and carbon arc lights therapeutically; he cited them directly in his publications. Focusing natural light through lenses and mirrors to produce intense heat had ancient origins in Archimedes, and during Finsen’s time physicians were still attempting to cauterise skin lesions, including tumours, using lenses that concentrated natural and artificial light.⁵⁸ Some even designed their lenses using photography equipment, such as filters.⁵⁹ Original to Finsen was filtering out the heat rays with blue filters and coatings, concentrating the most chemically active visible rays (blue and violet) and, when using quartz lenses, the ultraviolet rays, in order to destroy tubercle bacilli. As noted above, his point of origin lay in photographic experiments common to the developing field of photochemistry.

The Finsen light was known to be extremely costly to buy and to run, and while Finsen may seem to have been the most famous to employ the carbon arc lamp’s output of ultraviolet rays therapeutically – beyond its function to illuminate surroundings – there were other early practitioners who modified his working methods using their own devices. In Britain, Dr J. Alfred Codd, based at the General Hospital at Wolverhampton, explained he had built a home-made ultraviolet lamp to treat a variety of skin conditions, much as physicians would do with X-ray machines.⁶⁰ Another of these physicians was Dr Margaret Cleaves, operating out of New York, who described her method of phototherapy using not only lenses like Finsen but also marine searchlights (Fig. 3.6). In her 1904 book, Light Energy, an early and massive work of over 800 pages, she explained:

3.6 ‘Marine searchlight, with blue glass screen.’

In Margaret A. Cleaves, Light Energy (New York and London: Rebman Company, 1904), Figure 21, opposite p. 478. Wellcome Library, London.

She added that Figure 3.6 showed the lamp with its glass door open, allowing the beneficial ultraviolet rays access to patients’ bodies. When open she used the lamp for large surface exposure, for example on patients with pulmonary tuberculosis, aiming it squarely at their chests.⁶² When closed, she stated, it could be used as a searchlight. Cleaves further modified her lamp, in collaboration with a manufacturer of marine searchlights, with the creation of an iron funnel that localised the rays onto specific skin lesions, just as Finsen had done with telescopic arms. With her device she treated the skin diseases lupus vulgaris and lupus erythematosus, as Finsen was doing in Denmark, and (ironically) carcinomas.

British practitioners also appropriated searchlights early on for therapeutic use, as evidenced by the catalogues of medical instrument-maker Schall (1905, Fig. 3.7).⁶³ These examples of modified carbon arc lamps indicate not only that, in its infancy, phototherapy developed out of great and creative experimentation, but also that it was indebted to knowledge of artificial light’s abilities first and foremost to visualise and only second to heal.

3.7 Carbon arc lamps.

In K. Schall, Electro-medical Instruments and their Management and Illustrated Price List of Electro-Medical Apparatus, May 1905 (London: Bemrose & Sons Ltd, 1905), p. 240. Thackray Medical Museum, Leeds.

The modifications by manufacturers and physicians also evince how a light technology intended for use in large, public spaces or at long-range distances was transformed into a new, far more intimate, interior use while still retaining its original function. After all, carbon arc lamps continued to be used for public lighting, theatre lighting, and as searchlight devices into the twentieth century.⁶⁴ Even as late as 1923 the Royal Northern Hospital in London reported using discarded carbon arc railway lamps to treat lupus vulgaris patients.⁶⁵ Incandescent lighting, made accessible through Thomas Edison’s carbon filament light bulb, was also exploited, but for its heat, since it emitted little in the way of actinic light. ‘Light cabinets’ multiplied and extended the use of the ordinary light bulb by irradiating patients, especially arthritics in need of the analgesic properties of heat, in enclosed boxes of incandescent light. Much later, in 1931, Dr William Beaumont described a modified stage light, also an incandescent filament lamp, that was used for colour therapy (chromotherapy). It had specially designed filters to obtain specific coloured rays for local application.⁶⁶ Intriguingly, manufacturers of photographic equipment, such as the Amalgamated Photographic Manufacturers Ltd, also simultaneously produced light-therapy lamps (see Chapter 1).⁶⁷ Returning to the United States, the physicist Matthew Luckiesh considered the visualising and therapeutic powers of light to remain intertwined in light technologies’ developments. As director of the Light Research Laboratory at General Electric, a company initially started by Thomas Edison, Luckiesh continued to experiment with light for health and for vision.⁶⁸

Both electric lighting and photography operated as visualising media: to see, to picture, to capture, and to know. Aiding and enabling the development of light therapy, these visualising media were appropriated by physicians and researchers to exploit light’s therapeutic potential. So far I have focused on the convergence of light’s visualising and therapeutic powers in light therapy’s early development, describing its archival images as light registers. I have also described photographs of light therapy as multi-layered ‘self-portraits’ of actinic light, especially Finsen’s photographed forearm (Fig. 2.1). But what happened when this self-portraiture went wrong, when the ‘luminous pencils’ of light obscured rather than illuminated light therapy? I made it clear in Chapter 2 that Figure 2.1 is, by its fuzzy, illegible outlines and poor ‘fixing’, a ‘bad’ photograph, one that, despite its best intentions, communicates solar erythema as an equally illegible phenomenon. I now want to explore these ‘bad’ representations, in which the photograph-as-light register was pushed to its representational limits, rendering light therapy a blinding, obscure practice. Not simply converging, photography, electric lighting, and light therapy materially collide in these ‘bad’ representations, producing photographic ‘accidents’ and ‘injuries’.

II  Material collision

Let us return to Tudor-Hart’s photograph of the phototherapy room at the SLHWC (1934, Fig. 3.1). That it failed to make the cut in the photographic selection for the pamphlet only piques my interest in it all the more. Like Finsen’s fuzzy, lost photographed forearm, we could consider Tudor-Hart’s photograph a ‘failure’ (despite its high quality) in that it is seemingly tangential or incidental to the larger context of light therapy in Britain: the work of an émigré photographer that was never shown at the time.⁶⁹ But Tudor-Hart’s practice and this photograph in particular sit at the nexus of a discourse on the visualising and therapeutic powers of light during the early twentieth century. Metaphors of light and darkness prevail in discussions of her work. Her radical political beliefs in Communism, supported by the Popular Front in Britain, fuelled her interest in bringing to light the ‘shadow’ of social injustice, especially through her documentary photographs of dark slums and abject poverty in both Austria and England.⁷⁰ Lobby groups such as the Sunlight League adopted wholeheartedly this rhetoric of bringing light into the slums to eradicate the ‘diseases of darkness’, as social campaigner Dr Caleb Saleeby so poetically called them.⁷¹ Tudor-Hart’s training as a Montessori teacher in the 1920s, through to her photographs of children for the British Medical Association and ministries of information, health, and education in the 1950s, show a life-long devotion to child health, welfare, and ‘enlightened’ education.⁷² As such, her commission at the SLHWC exemplifies Tudor-Hart’s photographic oeuvre, despite receiving merely passing mention in her biographical literature (Figs. 3.1–3.2).⁷³

Located in Clapham Common and founded in 1912, by the time of the booklet’s publication in 1935 the SLHWC boasted it had become ‘the largest general hospital in the country officered by women for women and children’.⁷⁴ The expensively produced booklet was intended to help raise £45,000 funds for a considerable extension, including a second level for a ‘light and airy’ children’s ward as well as two maternity wards, and this cost did not include new equipment.⁷⁵ Triumphing modern technology, the booklet stated:

It had a special radium clinic here too, to treat women with breast cancer, for which it also desperately needed funding. The hospital’s aims must have resonated with Tudor-Hart, for in addition to serving middle-class women it noted working-class women were in ‘appreciable proportion’ and many came from the slums.⁷⁷ It also spoke forcefully of the need to provide training and support to facilitate more women practising medicine. The many other photographs by Tudor-Hart and Stern throughout the pamphlet represent these female staff members interacting with patients in consulting rooms and hospital wards, examining radiographs, and working in the pathology laboratory. Figures 3.1 and 3.2, as photographs depicting child patients undergoing phototherapy, must therefore be contextualised within the pamphlet’s larger purpose: they, like the other photographs, represent the hospital above all as beneficent and as modern – through its forward-thinking beliefs about women as well as its technologically sophisticated equipment.

Significantly, these are not the only photographs Tudor-Hart produced about bodily exposure to therapeutic light: she took photographs of sunbathers at Vienna’s bathing area, the Lobau, in the early 1930s and of sunbathing children for the journal, Sun Bathing Review, dating from 1935 to the late 1940s (see Chapter 5). Tudor-Hart and her photographs are therefore not incidental but vital to understanding light therapy’s history as an ‘obscure’ practice. Quite aside from the fact that we know her name and can attribute specific photographs of light therapy to her (a rarity in itself), Tudor-Hart is a case study cloaked in layers of invisibility: she produced photographs of heliotherapy and phototherapy that did not in fact circulate within the standard light-therapy literature but rather in an exceptional promotional pamphlet or in non-medical journals; her presence is erased in the production of her photographs by virtue of her position behind the lens;⁷⁸ and while taking on various commissions during the 1930s and 1940s in Britain, including photographing children being exposed to therapeutic light, she acted as a Comintern spy. Her clandestine contribution to light therapy’s development exemplifies the ongoing dead ends researchers must face if they are to engage with a thorough examination of its history, and in Chapter 6 I discuss the myriad numbers of light therapy’s ‘invisible’ women, including nurses, patients, patrons, and artists. Discussions of success and failure, light and dark, clarity and obscurity, visibility and invisibility, and ‘good’ and ‘bad’ photography thus are prompted by Tudor-Hart’s photographs of bodily exposure to light.

 Accidents and artefacts

In their books, Wolfgang Schivelbusch, Chris Otter, and Graeme Gooday have explained that arc lighting was the first form of artificial lighting that produced too much light for vision, making it practical for use only in large spaces like railway stations, streets, and factories, places Schivelbusch states had an ‘insatiable appetite for light’.⁷⁹ Its blinding powers meant it needed to be installed high above crowds when used for public lighting, to the point that it not only illuminated streets but entire towns by ‘tower lighting’.⁸⁰ This penetrating, all-encompassing light proved too harsh and too expensive for ongoing practical use, eventually replaced by Edison’s electric incandescent light bulb. Producing dazzling light so alike sunlight, with such intensity that it could not be looked at directly, arc lighting was not, according to Schivelbusch and Gooday, used in the home.⁸¹

The history of light therapy, of course, indicates that this was not entirely the case. Small, portable carbon arc lamps were produced well into the 1950s for prophylactic tanning within the privacy of one’s home. More interestingly, during the 1920s when small arc lamps began to be marketed for home use they necessarily had to be plugged into the home’s primary electrical outlet (Fig. 3.8). As is clear from Figure 3.8, this was the central light source in the main living room. Electricity in the British home was not the norm until well into the 1930s, and for those who could afford it the outlets installed were few and far between (see Chapter 4). To operate this Ajax arc lamp, users had to replace the ‘normal’ incandescent light source with this blinding, therapeutic light. Unless they took the cure outdoors in natural daylight, they found themselves, once again, within the obscurity of the darkroom. Light therapy, and in particular phototherapy, transformed the visualising powers of carbon arc lighting and exploited its abilities to dazzle and blind, bringing its excessive actinic light (as a veritable mini sun) into the interior and close to patients, instead of illuminating surroundings above them.⁸² This blindness or obscurity was a condition of its therapeutic use and made photographic representation difficult, if not impossible.

3.8 ‘Ajax “Sunlight” portable apparatus in use.’

In ‘Sunlight’ Treatment: A Concise Guide for the Use of Ultra-violet Irradiation in Actino-therapy, undated (late 1920s), p. 47. Thackray Medical Museum, Leeds.

In Tudor-Hart’s photograph (Fig. 3.1), the powerful open flame of the carbon arc lamp was the primary light that simultaneously allowed the patients to heal and to be recorded onto the camera’s photosensitive negative. In other, similar photographs of London clinics it was the only light source. No additional lights and no flash were used in Figures 3.3 and 3.4, and thus the legible prints were produced by the same and sole light that simultaneously treated the photographs’ subjects. In this way we might consider that the camera was as much a participant – even a patient – in this light seance as the subjects.⁸³ Skin, eye, and film are photosensitive surfaces that were activated, transformed, and imprinted by the lamp’s actinic light.

They were also easily burnt and injured by it. As I pointed out in the opening of the chapter, it was only by effectively using the child patient as a shield or ‘screen’ in Figures 3.1 and 3.3 that these photographs remain legible instead of overexposed. Overexposed photographs, sometimes subtle (as in the case of an overexposed white hat in Fig. 3.9), sometimes not so subtle (Fig. 3.10), are common representations of heliotherapy and phototherapy in process.⁸⁴ Both Figures 3.9 and 3.10 depict Treloar Hospital, an institution run by Sir Henry Gauvain employing both heliotherapy and phototherapy to treat tuberculous children (see Chapter 1).

3.9 ‘Lord Mayor Treloar Cripples’ Hospital and College: solarium at Alton’, undated postcard.

Author’s collection.

3.10 A child patient receiving phototherapy by a tungsten arc lamp at Treloar Hospital, undated photograph.

Science Museum/Science & Society Picture Library, London.

Overexposure, visualised by means of sunburn, blistered skin, or a so-called ‘unsuccessful’ or ‘bad’ photograph, attests to the light’s volatility in therapeutic and photographic processes.⁸⁵ Figure 3.10 is a strange depiction of phototherapy, both in the context of what is happening in the image as well as its aesthetic representation. The camera was aimed parallel to the open flame of a tungsten arc lamp. From the photograph it was likely a ‘Premier’ tungsten arc lamp, aimed directly at the neck of a child patient.⁸⁶ Yet, unusually, the arc was unshielded, and, worryingly, the patient wore no goggles and was not attended by a nurse. A skilled operator was particularly needed for this type of lamp, which required almost constant manual adjustments to the tungsten electrodes.⁸⁷ That person perhaps was the photographer; the Treloar archives contain several photographs made by the nursing staff.⁸⁸ Other comparable photographs were, more logically, taken from behind the lamp’s reflector (Fig. 3.11). In Figure 3.11, a child patient suffering from rickets was made to stand for the camera while receiving general treatment with the lamp, supported by an attendant nurse. Both clearly wore the requisite goggles to protect their eyes from the light, and the photographer took the image diagonal to and behind the lamp to avoid overexposure. By contrast, in aiming the camera at the lamp without any protection or ‘screens’, the photographer of Figure 3.10 produced an injured negative of enveloping black orbs where the actinic light burnt the film, printed as encompassing white globes in the positive. The print is a dramatic example of a photographic ‘accident’ known as lens flare, in which stray intense light bounces and refracts within the camera, leaving white sprays and streaks, starbursts, rings, circles, or an overall haze across the image. Aside from the striking orbs, streaks are visible in the top right-hand corner of the photograph, and a haze is detectable in the lower right-hand corner. These are known as ‘artefacts’, and, as Wilder pointed out, they can serve as useful pieces of information depending upon who looks at them.⁸⁹

3.11 ‘A tungsten arc [lamp] at work at the Hull Corporation Clinic.’

In Katherine Gamgee, The Artificial Light Treatment of Children in Rickets, Anaemia and Malnutrition (London: H. K. Lewis and Co., 1927), Figure 20, p. 66. Wellcome Library, London.

Unintended artefacts are particularly common in photographs of phototherapy (Figs. 3.12–3.13). Figure 3.12 captured the phototherapy room at Guy’s Hospital, where multiple suspended open arc lamps were used on masked and goggled children and, in the background, adults. Intense starbursts of actinic light emit from the carbon arcs and radiate translucent orbs, which overlap across the right side of photograph and lead the viewer’s eye to the visible spray of light streaking towards its lower corner. Actinic light similarly consumes a mysterious photograph of phototherapy treatment from the Daily Herald archives (Fig. 3.13). Goggled unclothed child patients and a nurse, positioned at the outer edge of a dosage circle (see Chapter 2), faced a camera that shared the full blast of open arc treatment. A giant white orb radiates in the photograph like the sun itself, while the lower right-hand corner is damaged by the ghostly splaying lines characteristic of lens flare.

3.12 [Underwood Commercial Studios Ltd], Light Department, Guy’s Hospital, undated photograph.

London Metropolitan Archives, London and courtesy of Guy’s and St Thomas’ Charity.

3.13 ‘Ultra violet (sun lamp) therapy’, undated.

Silver gelatin contact print from a glass plate negative. Daily Herald Archive/NMEM/Science & Society Picture Library, London.

Miles perceived damaged prints like these as theoretically productive, revealing light’s excesses and photography’s dependence upon a mastery over light to function – an issue of control that light therapy also struggled to master (Chapter 2). As marks of excessive or disruptive light visibly present on the photograph, they betray the materiality of the photograph as an object. No longer the transparent stand-in for the thing it represents, the ‘injured’ photograph announces itself as a material sign, disrupting photography’s status as an index of the ‘real’.⁹⁰ Indeed, the artefacts in Figure 3.10 present significant similarities with Roland Barthes’s concept of the punctum, which he described as a shocking, piercing wound or mark:

We might add that it is also a burn, an injury to the negative: note the small black circles in the centre of the white orbs in Figures 3.4 and 3.10, ‘black suns’ burnt by the light’s greatest intensity that ‘punctuates’ like the dot of an exclamation mark. Citing Ansel Adam’s The Black Sun, Tungsten Hills, Owens Valley, California (1939), Miles explained that black suns, like lens flare, are traditionally considered to be photographic ‘accidents’ or ‘injuries’ to the negative due to overexposure.⁹² These ‘suns’ are artefacts made by intense, excessive light, which is so powerful that it reverses negative and positive on the film. As an historic symbol of melancholy and madness, ‘the black sun … does not mark so much an absence of the light of reason and vitality, but a soul-destroying blindness to a light which is expected to nurture, enrich and offer hope’.⁹³ The black sun photograph was but one example in Miles’s arsenal to deconstruct or ‘exceed the limits’ of ‘reductive photographic dualisms’, the most potent of course being that of light versus dark.

 Solarisation

When it comes to analysing photographs of light therapy, the word ‘solarisation’ is particularly apt. First reported by British photographer William Jackson in 1857, solarisation (sometimes called the Sabatier effect) is described as an accidental reversal of dark and light, of negative and positive.⁹⁴ Through overexposure the film loses its photosensitivity, setting into effect the reverse process. It can occur at the point of photographing, as in the case of Figure 3.10, or during the development process, if an extra flash of light is introduced into the darkroom. During the early twentieth century Surrealist artists such as Man Ray and Maurice Tabard adopted solarisation as a vanguard technique in photography, calling attention to the photographic surface as an experimental ground (Chapter 4).⁹⁵ Like Nicolai Howalt’s photography (Chapter 6), chance and happenstance were welcomed with open arms, the results of these photographic exposures unknown until the finished print was revealed and thus deliberate attempts to make productive accidents.

But solarisation has other meanings. As a verb, to ‘solarise’ is to affect, modify or, in the specific case of photography, to injure by the influence of the sun’s rays. One can solarise vegetation and soil, inhibiting photosynthesis, or solarise glass, altering its transmission of light wavelengths, through prolonged exposure to intense light. With respect to the latter a peculiar irony occurred with the manufacture of glass that permitted ultraviolet rays, such as ‘Vita’ glass, which was widely installed throughout Britain during the late 1920s and 1930s in hospitals, factories, and schools to allow the buildings’ occupants greater access to sunlight. The rays ‘Vita’ glass permitted quickly altered its properties, through the unavoidable process of solarisation, and eventually made it block their passage, effectively becoming ordinary glass.⁹⁶

Significantly, American physicians referred to solarisation to mean light therapy itself, whether heliotherapy or phototherapy, and sociologist Simon Carter used it to describe light therapy in Britain.⁹⁷ R. A. Houstoun, a specialist in optics at the University of Glasgow, intriguingly included a section on solarisation in photography within a chapter on phototherapy, in his 1923 populist book, Light and Colour.⁹⁸ Photographs like Figures 3.4 and 3.10 are marked by small, distinct instances of solarisation as ‘black suns’, but glimpses of these strange reversals can be found that altered the entire photographic surface (Fig. 3.14): in this photograph of Rollier’s child patients taking a fortifying walk in the Leysin countryside, the beginnings of solarisation take place to the patients’ bodies and contours. The fine line between light therapy’s success and failure, between desirable sunburns and dangerous injuries, is usefully captured in the word ‘solarisation’. At once positive and negative, desired and feared, the solarised photograph does more than metaphorically refer to the accidents of overexposure on the patient’s sensitive flesh and eyes. For practitioners, the connection between photosensitive film and body was literal. In the words of Daniel Freund, ‘the benefits from therapy reversed with overexposure: bodies became more susceptible to disease and less able to heal themselves’.⁹⁹ Figures 3.10 and 3.12–3.14 are therefore poignant examples in which light therapy’s tensions – as beneficial or dangerous – are materially (physically) and conceptually embedded.

3.14 ‘Little convalescents in battle dress. Walk amongst the flowers (Rollier).’

In Alexandre Aimes, La Pratique de l’héliothérapie (Paris: A. Maloine, 1914), Figure 4, unpaginated plate, opposite p. 104. Martine Gagnebin and author’s collection.

 Blinding light

Like red-light therapy, the conditions for open carbon arc treatment necessitated emulating the photographic darkroom, but this time a fully functioning one where photochemical development took place. Some practitioners considered visible light – the red to violet rays, detectable by the human retina but which in excess produced glare or dazzlement – a nuisance that interfered with ultraviolet light’s therapeutic action, and consequently they shut out daylight by closing doors and curtains, as is evident in Tudor-Hart’s photograph (Fig. 3.1), or by practising phototherapy in windowless rooms (Fig. 3.11).¹⁰⁰

Awareness of ultraviolet light’s explosive photochemical action and its blinding effects, analogous to a camera flash, did not deter the Russells from their enthusiasm for light therapy, as is apparent from this chapter’s first epigraph. In their section on ultraviolet light’s chemical properties, the Russells offered the following quote from the Bible: ‘Truly the Light is sweet, and a pleasant thing it is for the eyes to behold the sun.’¹⁰¹ Sidestepping metaphor here, in practice, the therapeutic use of actinic light necessitated never beholding the light of the sun or lamp, at least not directly. Mediated by the strategic use of screens – the judicious use of goggles or facemasks for both patient and operator – light therapy was encountered as an obscure visual practice, one literally performed ‘blind’. In the phototherapy room interior, contrasts of light and dark were at their most extreme, the goggled patient and operator encountering the blinding light of the lamp, or total darkness: not only because the lamp often acted as the sole artificial illuminant in a windowless room but furthermore because the tinted goggles darkened one’s visual field (or, if masked, partially or wholly restricted it). An article of 1925 in the Yorkshire Post, explaining the treatment, advised the public that, ‘So fierce is the glare … that very dark glasses must be worn, and, for greater protection, the eyes themselves should be closed when facing the light.’¹⁰² This blindness or obscurity is thus the result both of darkness and excessive light.¹⁰³ As Michel Foucault put it, ‘Dazzlement is night in broad daylight, the darkness that rules at the very heart of what is excessive in light’s radiance. Dazzled reason opens its eyes upon the sun, and sees nothing, that is, it does not see.’¹⁰⁴

In the production of Figure 3.1, Tudor-Hart was doubly photographing ‘blind’. In the first instance, one could argue that any photograph is the product of a moment of blindness; a photographer cannot know in advance if a shot will be successful until the negative is removed, developed, and subsequently printed into a positive. Geoffrey Batchen, referencing Jacques Derrida, elucidated: ‘The photographer points his camera at a scene and removes the lens cap for a certain duration; only later, after development, will he see exactly what the camera has seen. Thus … during the extended moment of photographing he does not see it. He photographs blind, from memory.’¹⁰⁵ Beyond this, however, in these particular circumstances at the SLHWC Tudor-Hart, holding her camera at waist height (instead of in front of her eyes, as a kind of filter), needed to be wearing goggles just like every other person in that room. Looking through the camera’s viewfinder with tinted goggles in such extreme contrasts of light and dark, little would have been discernible. Had she refused to wear them, her vision would have been sorely affected nonetheless, suffering from acute conjunctivitis (inflammation of the conjunctiva) from the ultraviolet light soon afterwards. In her 1928 manual, the nurse Myrtle Vaughan-Cowell warned,

Photographs do exist that show children unmasked and ungoggled in front of these open arc lamps (e.g., Fig. 3.10), contrasted by reports in local newspapers of practitioners blinded by ultraviolet lamps.¹⁰⁷ Conjunctivitis due to ultraviolet light was also known as snow blindness, the bane of Arctic and Alpine explorers, and some described it as the optical equivalent of sunburnt skin.¹⁰⁸ It was particularly problematic for actors and directors when creating early films, since arc lights were commonly used for studio lighting.¹⁰⁹

At its most extreme, phototherapy as a blinding or obscure practice even extended into the treatment of eye diseases, the localising extensions and applicators of mercury vapour lamps aimed directly at the eye.¹¹⁰ In such instances, blindness could be both produced and rectified, the stimulating flash of actinic light emitted from these lamps a particularly risky tool that, if overdosed, could ironically cause permanent blindness in an effort to restore unimpaired and healthy vision.¹¹¹

While the mechanical functions of a camera and a phototherapy lamp might seem at first to work in oppositional ways – one absorbing actinic light, the other producing it – they both operate by harnessing and manipulating light through focusing devices, and this is because they share similar apparel inside them: lenses and reflectors (mirrors, chrome surfaces, etc.), as mentioned in Section I.¹¹² But in the 1930s flash photography did produce its own light source, and, as the Russells pointed out, its actinic output closely resembled that of a mercury vapour lamp. Miles provided ample evidence throughout photography’s history about the dangers of using flash powder, an explosive concoction of chemicals (especially magnesium) ignited to produce a dazzling white light. Invented in the 1860s and in use until the 1930s, flash powder provided temporary artificial illumination for interior or night-time photography. Highly volatile, it could cause physical harm to sitters and photographer, cause fires, and produce shocked and blinded faces under harsh lighting in resultant photographs.¹¹³

The notion of the flash’s actinic light as a weapon finds important parallels with practitioners’ belief in the perceived beneficial ‘light shock’ of therapeutic exposures. The phrase was used by Gauvain (Treloar Hospital), who stated in 1927 that, ‘It has long been recognized that morning light is most therapeutically valuable. This, in my opinion, is not due solely or even chiefly to the nature of the light but because the light shock evokes a greater response as immediately following the darkness necessarily antecedent.’¹¹⁴ While not yet at its highest intensity, the dawning sun was effective for patients in Gauvain’s mind precisely because it acted like a stimulating flash emerging out of the darkness. As I explain in Chapter 4, Gauvain’s notion of the ‘light shock’ was metaphorical and unintentionally literal: electric shocks, severe burns, and even death occurred during treatments, risks that came to be part and parcel of therapies using the invisible ultraviolet, X, and gamma rays during the early twentieth century. Gauvain proudly reproduced photographs in his publications about Treloar’s revamped Light Department, newly equipped with the latest phototherapy lamps in 1924 (Fig. 3.15). In this postcard, the multiple, suspended open arc lamps emitted so much visible and ultraviolet light that they appear to consume patients. Because of their even higher output of ultraviolet radiation, mercury vapour lamps were also photographically represented as irradiating patients to the point of eradication (Fig. 3.16).¹¹⁵ Figure 3.16 is a photograph of St Thomas’s electro-therapy department, where light therapy was used in conjunction with X-ray therapy and diagnostic imaging, shown on the left-hand side of the photograph.

3.15 ‘Lord Mayor Treloar Cripples’ Hospital and College: the Light Department at Alton’, undated (mid-1920s) postcard.

Author’s collection.

3.16 ‘Electro-therapy: X-ray treatment rooms – mercury lamp on right’, St Thomas’ Hospital, undated photograph.

London Metropolitan Archives, London and courtesy of Guy’s and St Thomas’ Charity.

In such difficult circumstances of photographing while the therapy was in process, some resorted to alternative photographic tactics to reproduce ‘reality’. A simple solution was to photograph the open-flamed carbon arc lamp, surrounded by patients but not actually on. In Figure 3.17, a 1930 photograph of the ‘Sun Ray Room’ at White Oak School Hospital in Swanley (Kent), nurses and patients were fully goggled, masked and in the correct position to receive the actinic rays, but the light source enabling this photograph to exist was the bright sunlight flooding into the room from the large open windows. The arc lamps were conspicuously unlit, no doubt because of difficulties presented to the photographer.¹¹⁶ Such artifice went without comment in the literature. The primary focus of Chapter 4, these limitations of photographic processes – due to the blinding powers of actinic light – enabled other vanguard representations based on photographic techniques, that of heavy retouching and montage. It brings me to my final point: what exactly are we ‘seeing’ in these photographs, and what remains obscured? In Figure 3.17, the viewer is presented with what is intended as documentary ‘evidence’ of light therapy in practice, a so-called objective visual record about how the cure was carried out. It was meant to function, in other words, as a visualisation of phototherapeutic technology in operation. Yet it did not and cannot: upon closer inspection it presents a falsified version of phototherapy in order to exist as a legible photographic representation. The one light technology only truly functioned at the expense of the other. One had to remain, to some extent, inoperative and impotent, lest photographic accidents result.

3.17 ‘Sun Ray room’, White Oak (Swanley), June 1930.

London Metropolitan Archives, London.

In their complicated, incestuous relationship, photography acted as both a parent to light therapy, guiding and nurturing its development (Section I), and its difficult lover, materially converging and clashing with it (Section II). In those rare instances in which we find ‘successful’ photographic representations of phototherapy in action, like Tudor-Hart’s exceptional image (Fig. 3.1), we must understand that this fruitful resolution was only enabled through the careful mediation of an exceptionally skilled photographer. The light, used both aesthetically and therapeutically, was heavily controlled and so were the patients, offering their bodies as screens to enable legibility.

Conclusion

When it comes to ‘seeing’ ultraviolet light, we are always in the dark. ‘The two ends of the spectrum gradually fade away into darkness’, stated Shelford Bidwell in his popular book Curiosities of Light and Sight (1899), and ‘we cannot see them; they fall upon our eyes without exciting the faintest sensation of light’.¹¹⁷ Yet he persisted in making analogous the physiological action of the human eye and the camera, a long-held connection in photography’s history.¹¹⁸ Photography offered to enlighten the eye to these invisible rays, detecting and visualising that which it cannot naturally see, just as telescopes, camera obscuras, magic lanterns, and microscopes provided an ‘extra-ocular way of observing the world’.¹¹⁹

Again we must ask ourselves, what are we ‘seeing’ in these photographs of light therapy? What were viewers at the time? Since photographic film registers wavelengths differently to the human eye (including the invisible ultraviolet rays), how can these photographs function as purely ‘documentary’? How could viewers recognise the visible wavelengths from the invisible ultraviolet ones in these photographs simply by looking at them?¹²⁰ The remarkable beams of light and alternating shadows projecting within Tudor-Hart’s photograph contain a combination of visible and ultraviolet light, producing a dramatic and eerie image (Fig. 3.1). But what did the patients, nurses, and photographer actually ‘see’ during the experience of light therapy in process? On the one hand, we will never be privy to the ‘real’ experiences optically witnessed by the patients, nurses, and photographers present at the moment of photographing light therapy. What they saw can never be seen by us through the photograph as a mediating object; that will always be obscure to us. Yet on the other hand, we will always be privy to seeing light obscure to the subjects. The photograph registered not only ultraviolet wavelengths but also the excesses of visible and invisible light that blinded subjects, whether by glare, dazzlement, or acute conjunctivitis. These are marked on the photosensitive surface as the ‘accidents’ or artefacts of lens flare and solarisation (Figs. 3.10, 3.12–3.16).

In attempting to understand light therapy’s processes and methods through archival photographs as ‘documents’ or as evidence, this conundrum may lead one to wonder why I should invest in these objects at all as points of access to the past. Like Miles, I believe that it is precisely these photographic ‘accidents’ that present the opportunity to critically engage with light therapy’s history in a new way. Indeed, that they are problematic documents makes them productive to my analysis. Submerged and hidden in numerous archival boxes, the handful of photographs I discuss in this chapter, exemplified by the photography of Tudor-Hart (Figs. 3.1–3.2), remain obscured from view. Rarely are they looked at in the first place, and as damaged prints they are just the sort of documents others historians interested in light therapy or particular institutions like Treloar’s have passed over without comment.¹²¹ But photography’s historic role in the development and dissemination of light therapy provides significant insights about how we access and understand medical history.

In many cases, employing black-and-white photography to visualise the effects of light therapy seems to have been extraordinarily difficult or ineffective, as I discussed at length both here and in Chapter 2 in relation to Finsen’s photographed forearm (Fig. 2.1). These difficulties of representation communicate much about light therapy’s own tensions as a nascent series of treatments struggling to gain legitimacy. In light treatments such as red-light therapy, photography proved impossible as a means of representation. Yet, even in this instance, in photography’s absence, we learn how practitioners conceptualised the dangers and advantages of particular wavelengths of light by emulating photographic practices. Lastly, through ‘bad’ photographs we become aware of photography’s limits of representation and how these limitations revolved around picturing the excessive actinic light considered so therapeutically valuable. They also act as notable contrasts to the photographs which succeed where they apparently ‘fail’: Figures 3.1–3.3 depict excessive, therapeutic light in control, produced by cameras shielded from the open arc lamp by patients, and we come to appreciate the high level of skill, strategies of composition, and sheer determination of certain photographers to produce legible negatives in such blinding circumstances.

Physicians found evidence for the efficacy of the actinic rays, whether natural or artificially produced, in photography itself as a light-sensitive medium. This was asserted over and over again by British physicians interested in light’s therapeutic potential.¹²² The logic went that if these rays acted on photographic surfaces, they must act in a like manner on the patient’s skin; that is, photochemically. Batchen described photosynthesis as a form of photography, writing, ‘there has never not been a photography. What is photosynthesis, after all, but an organic world of light writing?’¹²³ We might well ask, in a similar vein, what is light therapy but a deliberate invention and intervention with skin as an excessive, therapeutic form of ‘light writing’? The skin was so effective acting as a photograph (photogram) that for practitioners like Eidinow it superseded photographic devices for measuring light intensities, such as photometers and spectroscopes. Developing from, merging with, and eventually superseding photography, light therapy was a stimulating and excessive form of photography itself.

As a ‘light shock’ for the patient, bodily exposure to actinic light was a therapeutic practice that exploited the excessive light of electric arc lighting and exceeded the limits of photography as visualising media. Yet, as we have seen, this did not signal the end of their interaction, however volatile. Photography remained in the service of phototherapy, despite commonly producing illegible representations (‘accidents’). That practitioners continued to rely on photography in spite of these difficulties says as much about photography’s authority as a medium of representation as it does about light therapy’s unstable reputation. As with the case of ‘fixing’ sunburn, much was at stake in producing visible results that could effectively legitimise light therapy during its nascent development. Legible representations, fit for dissemination, were only enabled by a high degree of control and mediation: unusual skill, fakery, and manipulation such as heavy retouching or montage – the subject of my next chapter. But legible or illegible, these representations unsettle precisely because they communicate light therapy’s obscurity, as revealing manifestations of its light that, ultimately, leave us in the dark.