Medicine and Art have a common goal: to complete what nature cannot bring to a finish, to reach the ideal, to heal creation. This is done by paying attention. The physician attends to the patient; the artist attends nature. If we are attentive in looking, in listening and in waiting, then sooner or later something in the depths of ourselves will respond. Art, like medicine, is not an arrival; it’s a search. This is why, perhaps, we call medicine itself an art.”
These are the words of Marie Therese Southgate, a physician and former Deputy Editor of the Journal of the American Medical Association. This was an enlightened journal in many ways, not least of all because, amongst the clinical and scientific reports it published, it placed fine art high enough to have reproduced images of paintings and sculpture on its covers for almost 50 years.
M. Therese Southgate, MD, Physician-Editor (1928-2013)
This essay is designed to explore this quotation – the common ground between art and medicine. In particular, I want to explore the role of fine art in medical education, and I want to show through a series of examples how works of art can be used to effect and enrich a formalised and all too often conservative medical curriculum.
My credentials for this task are admittedly poor. I am not an Art Historian, nor an expert in any of the humanities. But I am a doctor, a teacher, a writer and perhaps above all I am a lover of art. What I have to say about Medicine and Art will not be profound – it will be personal, as is my choice of the paintings I want to show you.
To assist us in this discussion I have chosen to divide the paintings we shall look at into several rather arbitrary categories. The first of these is Medical History.
The Anatomy Lesson of Dr Nicolaes Tulp, Rembrandt van Rijn (1632)
I have chosen to begin with this painting because it was the only one ever to feature in my own medical education, and I have never forgotten it. Almost 40 years ago, one of my lecturers at the University of Glasgow went off-piste one afternoon and surprised us by starting his lecture on orthopaedics with a slide of a painting, a great painting. He talked us through it and drew us in, and of course that was his plan.
The painting in question hangs today in the Mauritshuis Museum in The Hague, and in 1633 it was Rembrandt’s first important commission for a group portrait. On the canvas, he portrays the eminent anatomist Dr Nicolaes Tulp demonstrating the dissection of the muscles of the forearm. Propped up at the foot of the dissection table, perhaps to show his credentials, he has the famous anatomy textbook by Vesalius. Huddled around the cadaver, there are a group of rather ageing medical students ….or were they. Despite the familiar group demeanour – the over-eager ones at the front, the one trying to crib from his notes, and the one staring off into space at the back – despite all this, these seven were in fact not medical students, but Masters of the Surgeons Guild of Amsterdam – indeed the top Dutch surgeons of the day.
The dissection itself is also not all that it seems. Before the practice of preservation of cadavers – those organs that would deteriorate first, had to be dissected first, viz. the contents of the abdomen and the head. A dissection would never begin with the muscles of the forearm, and as such this scene is staged and unrealistic.
If, then, we are viewing this painting as an historical document it falls short on several counts, but it is an excellent backdrop on which to hang a discussion of the pros and cons of small group teaching in medicine, and that’s certainly how I still use it in my own workshops.
The Anatomy Lesson of Dr Deijman, Rembrandt van Rijn (1656)
A more historically accurate portrayal of the 17th century dissection room is seen in the only surviving fragment of Rembrandt’s other great medical work. This is “The Anatomy Lesson of Dr Deijman” from 1656, now hanging in the Amsterdam Museum in the Netherlands. Here, the abdominal cavity lies empty and the dissection of the brain is underway.
Both these paintings have obvious appeal to the pre-clinical anatomist, but they also raise more important issues on the use of fine art as a documentation of historical fact. In many instances, what is portrayed is what it appears. But not always. We often, wrongly, ascribe an almost photographic quality to fine art representations of people, events and places connected with medicine. We should leave these two examples on a note of caution, but remembering that even a misrepresented image may be of educational use.
Visiting the Sick, Master of Alkmaar (1504)
Another image of medical history is provided by one of the Master of Alkmaar’s Seven Works of Charity: “Visiting the Sick”, which hangs today in the Rijksmuseum in Amsterdam. Here we are afforded a glimpse into an early 16th century hospital. Has so much changed?
This painting documents a number of key similarities between the hospital ward of today and that of more than 500 years ago. Patients are in beds; patients are being washed; and patients are being comforted and spoken to. In short, patients are being cared for – but even then the administrators are at the very door of the ward with outstretched hands.
The depiction of patients in this painting leads us to our second category that of Images of Illness.
Images of Illness
The Sick Child, Gabriël Metsu (c1660)
You don’t have to be a physician to know that this child is ill – you only need to have eyes. While there is nothing to direct the diagnostician to any specific disease, this child is unmistakably sick. Painted in around 1660 by the Dutch master Gabriël Metsu, this painting also hangs in the Rijksmuseum in Amsterdam, and it is an image with immediate educational appeal. When we teach our students clinical medicine we hope, that even if they do not retain all that they learn they will acquire the basic clinical skill of recognising and separating the sick from the well. I vividly remember one senior Paediatrician taking us, his group of awkward 5th year medical students, on a ward round at the Children’s Hospital. He said that we could talk all day long about the details of the diseases and their treatments, but that first and foremost he wanted us to leave his tutelage with one skill, that of being able to tell if a child is sick or well. Everything else can follow from that, but if we could not distinguish, we would be very poor clinicians.
I believe a discussion of this painting could find a useful place at the start of any course in paediatrics or clinical examination.
Monna Vanna, Dante Gabriel Rossetti (1866)
While Metsu clearly intended to represent illness, the same cannot be said for Dante Gabriel Rossetti. This sumptuous portrait of his model, Alexa Wilding was painted in 1866, and Rossetti himself thought it one of his best. It now hangs in the Tate Britain in London.
Alexa was a dazzling redhead, who like some of his other models was found by Rossetti on the streets of London. She figures in several of Rossetti’s major works and her features and colouring have become almost synonymous with the Pre-Raphaelite ideal of beauty. Beautiful though she was, she also had thyroid disease as evidenced from the swelling of the thyroid gland, or goitre, in her neck.
There are countless instances throughout the galleries of the world of clinical signs inadvertently captured by the artist, and it makes an amusing game finding them.
Elderly Woman, Frans Hals (1633)
Returning to Holland again….some 350 years ago the artistic skill of Frans Hals inadvertently captures in oils another interesting clinical sign with his “Portrait of an Elderly Lady” which hangs in the National Gallery of Art in Washington, DC. This lady has tendon xanthomata or fatty lumps in the tendons on the back of of her hands as a result of a genetic disorder of her cholesterol metabolism. If you look at a close up of her left hand, you can see without too much trouble the abnormality in question.
It would probably be true to say that whatever clinical sign you choose, there will be a painting of it somewhere in the world.
The Sick Lady, Jan Steen (c1663-66)
While depiction of clinical signs may be common in Art, so are examples of clinical techniques. This mid 17th century painting by Jan Steen entitled, “The Sick Lady” can be found in the Rijksmuseum in Amsterdam, and it shows us that palpation of the pulse is hardly a recent part of clinical examination.
The presence of the doctor and his prominent portrayal in this painting leads us to our third category – that of images of the physician and we will look at these as well as images of the Artist as Patient in the next part of this series.
© Allan Gaw 2020
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