by Dr Alan Bates, Honorary Senior Lecturer in Pathology, University College London

When Baron Percy opened the body of Tarrare, he was performing an autopsy, a procedure designed to reveal what the Italian anatomist Giovanni Morgagni had called, some thirty years earlier, ‘the seats and causes of disease.’ The search for post-mortem physical changes that could show what illnesses a patient had suffered during life was to develop into the new science of anatomical pathology, and Morgagni’s phrase was incorporated into the motto of the London College of Pathologists almost two hundred years later. We may take it for granted that a post-mortem examination can discover the cause of death, but in Percy’s time, the idea that the appearance of particular organs and tissues could be used to diagnose disease was novel. There were no professional pathologists to make post-mortem examinations; surgeons had to do it for themselves, and it helped if, like Percy, they were skilled anatomists. The study of disease in terms of the pathology of tissues and organs helped to dispel the time-honoured concept of four bodily humors that got out of balance when a person was ill. From a modern perspective, however, it is far from clear that Tarrare’s depraved appetite was due to disease in a particular organ: an abnormal constitution, or mental illness, have just as well have been responsible, in which case Percy was seeking something that he could never have found.

Many people think that the autopsy was developed by opening up the bodies of the unwilling poor, just as anatomists relied on body-snatchers to supply corpses, and was hampered by opposition from the Catholic Church. In fact, autopsies were fashionable among the well to do, who saw them as intellectually enlightened, and were performed on popes and princes. The unclaimed bodies of patients who died in hospital did provide an important resource for study, and were used without the patient’s or relatives’ consent, but this was relatively uncontroversial. It must be borne in mind that in the eighteenth century there was nothing akin to the modern notion of informed consent in medicine; the question of who owns a body was raised, but the correct legal answer was (and still is) ‘no-one,’ for bodies are not property and cannot be stolen.

The shift in emphasis in late-eighteenth century medicine from the whole body to specific organs and tissues, sometimes studied at microscopic level, was not uniformly welcomed. While there were many enthusiasts for the modern, scientific medicine of the clinic and the laboratory, some patients bemoaned the disappearance of the ‘holistic’ doctor with a kindly bedside manner, who saw them as a whole person and not a collection of cells and tissues. The two approaches are not incompatible, and it can be helpful to consider illness from these different perspectives. Our understanding of Tarrare’s troubles comes partly from Percy’s autopsy findings but also from reconstructions of his life through which we can imagine his experiences as a patient. Suffering, seeking a cure and feeling isolated or even freakish remain part of a patient’s journey despite medicine’s scientific advances.

We are entitled to ask, however, what was wrong with Tarrare from a modern medical point of view, and whether present-day treatments could have helped him. Tarrare had a huge appetite, drank water copiously, and was ‘apathetic.’ His body was reported to have had an unusual odour, especially after eating. Despite his excessive consumption, he never gained weight, and sweated profusely. Did he suffer from a damaged amygdala, part of the brain that controls appetite? Perhaps he had diabetes – a disease unknown at the time – which when untreated can produce all of these symptoms. We cannot know whether Percy, given access to a modern pathology laboratory, could ever have found what he was looking for, or whether Tarrare’s condition was truly something unique to him.

by Professor David M. Turner, Swansea University

The term ‘freak show’ evokes past attitudes to biological diversity very different to our own. The exhibition of human and animal anomalies has become synonymous with exploitation, cruelty and, given the increasing popularity during the eighteenth and nineteenth centuries of shows involving ‘exotic’ non-European human beings, racism. But human exhibition took a variety of forms in the past, and had a variety of motives. Indeed, the modern notion of the ‘freak show’ as a travelling form of entertainment involving several performers working for a manager or showman was an invention of the mid-nineteenth century, thanks to entrepreneurs such as P. T. Barnum in the United States, and Tom Norman in England.

The exhibition of ‘monsters’ and other human and animal curiosities became popular in Europe during the sixteenth and seventeenth centuries. During this period pamphlets detailing ‘monstrous births’ were popular. These phenomena were sometimes interpreted as portents – sending messages of divine displeasure – or as medical curiosities. The development of learned societies such as the Académie des Sciences in Paris and the Royal Society in London from the late seventeenth century fostered growing scientific interest in the wonders of nature and a desire to use them to understand better the natural processes of human development. This learned interest in monstrosity contrasted with popular curiosity in human aberrance, catered for by the display of conjoined twins, people of restricted or exceptional growth, or those born without limbs in fairs and taverns. Human exhibition was not confined to physical ‘deformity’. Popular performers in seventeenth-century England included the ‘posture master’ Joseph Clark – a contortionist – and Nicholas Wood, the ‘great eater of Kent’, who like Tarrare was famed for his remarkable powers of digestion.

During the eighteenth century some performers gained considerable fame, helped by the growth of the newspapers and the use of advertising for performances. Although the social elite increasingly distanced themselves from tavern and fairground entertainments, some performers aimed their shows at more genteel audiences. Matthew Buchinger (1674-1739), the ‘little man of Nuremburg’, born without arms or legs, exhibited himself before royalty and aristocracy across Europe before coming to England in 1716. He deliberately courted an elite audience, promising private performances in the homes of ‘ladies and gentlemen’ and seeking their patronage for artistic work such as drawing coats of arms and family trees. Russian emperor Peter the Great collected examples of human diversity and exhibited them at his court. Many performers advertised their exceptional skills and refined manners. The appeal of human exhibition as an entertainment often depended on the contrast between the performer’s ‘normal’ attributes (such as their good manners or settled domestic life) and their remarkable appearance or talents. Some entertainers such as Buchinger made a good living from displaying themselves and human exhibition may have been a preferred choice of making a living for some people with disabilities for whom other options may have been limited. However, their success depended on their novelty, which meant that they often had to travel and seek out new audiences and patrons.

Matthias Buchinger, a phocomelic. Engraving after a self portrait. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org

When concerns were raised about human exhibition in the eighteenth century, they primarily focussed on the potential for disorder associated with large plebeian gatherings at fairs or taverns rather than the exploitation of performers. However, in 1810 the case of Sartjie Baartman, the so-called ‘Hottentot Venus’, became a legal cause célèbre in London when a lawsuit was brought against her ‘keepers’ for exhibiting her without her consent. Baartman was born to a Khoisan family in the East Cape of South Africa in 1789 and had been persuaded to travel to Britain to exhibit herself to audiences fascinated by her distinctive anatomical features (particularly her large buttocks). However, following Britain’s ending of the slave trade in 1807 the abolitionist group, the Africa Society, brought a case challenging her exhibition. In her own evidence, Baartman claimed that she exhibited herself freely and claimed the right to earn a living this way. However, her case revealed the vague terms on which human exhibits were employed by their promoters. She moved to Paris in 1814 where she became the subject of interest of doctors and naturalists, while continuing to exhibit herself to popular audiences. After her death in 1815 she was dissected.

Small poster advertising the exhibition of the Hottentot Venus Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org

Sartjie Baartman moved between the popular world of entertainment and learned medical interest – just as Tarrare did. Interest in the ‘freak’ was never simply a matter of raucous entertainment or cruel exploitation of the ‘unfortunate’ (although may be part of the story). The taste for ‘freaks’ in the eighteenth and early nineteenth centuries was part of a broader interest in the limits of the human, in classifying and explaining the variety of nature. The world of the ‘freak’ crossed boundaries between science and showmanship, between autonomy and exploitation and between the elite and the popular. ‘Freaks’ were exhibited for their difference, but taught people about what it meant to be human.

The University of Bristol’s one-year intercalated BA in Medical Humanities (iBAMH) is the only degree of its kind in the UK. It gives around a dozen students from Medicine (and sometimes from Dentistry and Veterinary Sciences) the opportunity to study literature and philosophy, and to look at medical practice from the perspective of those disciplines.

The end results of the course are various, as the students talk of them. Some talk of having gained a better cultural understanding of medicine, of its history and institutions; some of having changed how they think about what constitutes medical evidence; and some of having found some new tools with which to understand and interact with their patients, and with their own responses to their patients and their patients’ sufferings.

Most of the students time is spent, as might be expected, studying academic classes. But alongside these is the Oakhill programme. This part of the course is more free-wheeling; for a programme director, it has the great advantage of having a structure flexible enough to take advantage of opportunities as they come along.

One such opportunity arrived in 2013, when Wattle and Daub got in touch with us, wondering whether we might be able to work together. It sounded a great opportunity for the students, and a schedule of meetings was devised whereby the students would help with medical aspects of the development of the opera.

Tarraré’s case history is fascinating, but the real interest of the meetings lay in the way in which ‘other’ Tarrarés quickly emerged as the case history was juxtaposed with dramatic staging which was in turn influenced by the musical and vocal scores. The different ‘treatments’, in other words, produced different subjects, all of whom are versions of the historical person. Which might be most helpful to Tarraré? Which to us? And what if that ‘us’ is an audience of patients? or doctors? For the iBAMH, seeing the opera take shape was to gain a richer sense of the possibilities of dialogue between medicine and the arts.