Thursday, April 09, 2015

In the clinic --- a reprise (September 2013)


The American artist Thomas Eakins (1844-1916) is perhaps best known for his paintings of rowers on Philadelphia's rivers, but two of his major works are interesting documents in the history of scientific medicine.

The Gross Clinic (1875) is a huge painting, 96 by 78 inches, and took a year to execute (click to enlarge). It shows Dr. Samuel Gross and his surgical team removing infected bone from the thigh of an adolescent boy (or possibly girl) before an audience of students in the amphitheater of the Jefferson Medical College in Philadelphia. We see little of the patient but the exposed thigh and buttocks. The patient's mother (presumably) cringes nearby. A clerk make notes of the proceedings.

Ether and chloroform had been in use for surgery since the middle of the 19th century, and Dr. Gross's patient is presumably feeling no pain. Surely, few discoveries have more radically transformed medicine than the use of effective anesthetics. By 1875, Joseph Lister in England had pioneered the idea of sterile surgery, including the sterilization of surgical instruments with carbolic acid, greatly reducing deaths by post-operative infections. Gross was defiantly behind the curve in this regard, in spite of his lofty reputation.

A second painting on the same theme, The Agnew Clinic, followed in 1889, depicting Dr. David Hayes Agnew and assistants performing a partial mastectomy at the University of Pennsylvania medical school. Everyday frock coats have been replaced with clean, white over-garments, hands are washed, instruments are sterilized, and a nurse (a woman!) is in attendance. As in the earlier painting, the artist has placed himself in the audience; that's him at furthest right. The other spectators are doctors associated with the school, individually recognizable.

In my opinion, The Gross Clinic is far superior as a work of art. The composition forcefully draws the viewer into the scene. The lighting focuses our attention on the brow of the surgeon and the patient's incision. The audience is in semi-darkness. Blood is in evidence, especially on the scalpel in the surgeon's hand. Everything is contrived for dramatic effect. The viewer might as well be there leaning over the patient with instrument in hand, or shrinking like the woman from participation. It is impossible to be emotionally uninvolved.

The Agnew Clinic, on the other hand, is not only biologically sterile; it is emotionally aseptic too, as represented by the apparently bored attitudes of the audience. Only Dr. Agnew's open right hand suggests a hint of passion. This, of course, is what we have come to expect of scientific medicine: cool dispassion and sterile scrubs.