Although it was invented in the 1830s, photography did not find its place in medical illustration until much later. As it happens, the first medical textbook to employ photographic illustration was Henri Dagonet’s Nouveau Traité Elémentaire et Pratique des Maladies Mentales, published in 1876. Dagonet, an eminent but little-remembered figure in nineteenth-century French psychiatry, was a faithful follower of Pinel and Esquirol and the French tradition of meticulous clinical description and classification. Born in 1823, he followed his father into the professions of medicine and psychiatry, obtaining an academic position at Strasbourg in 1853 and publishing the first edition of his textbook in 1862. In 1867 he was awarded the clinical directorship of the new Hospital of St. Anne in Paris, and he remained there until his retirement some 30 years later.

Dagonet was, like many of his contemporaries, a firm believer in physiognomic diagnosis, and it was toward that end that he compiled and published the eight plates of photographs, reproduced in the then-new process of photolithography, that distinguished his 1876 text; one of these is reproduced above. His diagnostic system, relatively divorced from theories of etiology and resting primarily on careful clinical evaluation, was not far in spirit from that of our current DSM nosologists. In each instance, as Dagonet’s colleague Semelaigne said, the resulting system "gave satisfaction to its authors."

Illustrative is the present plate showing five patients with cretinism. All are marked by massive goiters, and all were severely retarded. Dagonet’s lengthy discussion of this disorder demonstrates its prevalence and demonstrates, too, the persistence of etiologic notions concerning bad air, excess humidity, and impure water. Despite his knowledge of the observations of Roulin and Boussingault, which had, as early as 1825 and 1831, demonstrated the prophylactic value of iodized salt, Dagonet continued to reflect the general belief that iodine owed its effect to its ability to purify drinking water. His therapeutic and preventive prescriptions were thus limited to general hygienic measures.

Dr. Esman, 115 East 86th St., New York, NY 10028. Photograph courtesy of Dr. Esman.