The Spectacle of Surgery

Tucked behind the marble halls of Harvard Medical School academic buildings, stands an austere, Brutalist building-the library. While it may seem obvious Countway Medical Library contains many books and manuscripts from centuries past, what is less obvious is that it is a repository for art as well.  As you enter, the severe and dimly-lit foyer immediately greets you but spotlights and cameras shine on three large paintings set against the concrete. They are arranged counterclockwise from the entrance chronologically, spanning several centuries from the 17th up to the 20th century.  They are each massive, on the same scale of old war paintings  but that is not the common theme uniting these paintings. All the world may not be a stage, but at least these operating rooms are.

While this concept may seem bizarre to the contemporary viewer, there was an era in which surgery was a graphic public affair and that is reflected in paintings we can observe today. While there was still the cast of nurses, technicians and surgeons we know today, operations used to be performed in large halls as both education and entertainment. The patients would be brought in as our  the reluctant and likely unconscious ‘star’. Unlike the onstage divas though, these patients had little if any agency. The patients are brought in for several reasons- to be a learning and experimental experience for the physicians, second as entertainment, and then lastly perhaps for their own well-being. At the turn of the 20th century, those who were admitted to hospitals rarely came out to tell the tale. But while the patients came and went, the artistic renderings of them still remain. The surgical operating hall provided a peculiar challenge for the artist. They had to not only to capture a moment in a dynamic process but also to document important medical breakthroughs clinically and not be weighed down by emotion or sentiment for the patient in what would undoubtedly be a dramatic and gory event.

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The Anatomy Lesson of Dr. Nicolaes Tulp. Rembrandt Hammenszoon van Rijn (1632). Oil on canvas. 

The first painting in our trio is The Anatomy Lesson of Dr. Tulp, a copy of a well-known Rembrandt painting first completed in 1632. While the artist of this particular painting is unknown, it could easily have been one of Rembrandt’s students or his admiring contemporaries. The original painting has been emblazoned in art history textbooks as a paragon of Northern Renaissance. While the copy is executed with slightly less finesse compared to the original, it still retains the most important quality: theatricality. The cadaver (a criminal in life) occupies the center of the painting and is spot lit from overhead, producing extreme shadows in the crevices of his musculature. The eponymous Dr. Tulp stands on the left side of the body, explaining the anatomy to the inquisitive physicians (each of whom would have paid a pretty penny to be included in the commission). The concept of a group medical portrait was hardly new at the time but this was one of the first depictions of such a dynamic engagement with the specimen. The physicians are giving their full attention to this didactic moment as opposed to being depicted as simply a group of surgeons posing with a corpse. As the most iconic depiction of the practice of medicine, it is not at all surprising that it was chosen as the first sight to greet visitors, lending the gravitas of the Old world to the New.

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The First Operation Under Ether. Robert Cutler Hinckley (1893). Oil on canvas. 

Moving further into the foyer, two depictions of Boston medicine flank either side of the Reading Room. Closest to the Anatomy Lesson is a depiction of the First Operation Under Ether. Painted by Robert Cutler Hinckley in 1893, the painting shows a historic operation that took place on October 16, 1846 at Massachusetts General Hospital. The patient sits, a pristine figure in white and beige and clearly the focal point of the entire painting. Dr. John Collins, the surgeon, leans forward, delicately administering the anesthetic to the patient through an incision in his neck while the medical students and other physicians look on. Some are focusing with furrowed brows and others are quizzical. In the background we see yet more spectators shrouded in darkness, anxious to see the results of this groundbreaking new medical technology. The operation was open to the public so in addition to press and the medical community, anyone with voyeuristic tendencies was welcome to attend. The concept of such a public affair is oddly reminiscent of our contemporary reality television shows-if a human life was hanging in the balance. The overtones of the painting are that of scientific inquiry and entertainment. This painting is every bit as dramatic as the last-they are in a literal theatre. While there are so many different narratives to consider in the painting, it serves to first and foremost assert Boston as a hub of biomedical innovation, a title it still wears proudly today.

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The First Successful Kidney Transplant. Joel Babb (1996). Oil on Canvas.

The last painting in the series is The First Successful Kidney Transplant, painted in 1996 by Joel Babb. It depicts the first successful organ transplant ever performed on December 23, 1954, a topic near and dear to my heart as an Immunology student. Plastic surgeon John Murray completed the kidney transfer between twin brothers at Brigham and Women’s hospital after having completed smaller skin grafts during the Second World War. The operating room we see is much closer to what we would expect to see in hospitals today and in general the painting is more photographic than theatrical. The two patients are located in adjoining operating theatres. Like the other paintings, the patients are spotlit for both practical and artistic reasons but in this case, both patients are simultaneously obscured by the team of physicians caring for them. While there is no audience sitting overhead, a team of physicians is waiting outside of the operating room door. But yet again, the painting proclaims the medical prowess of the Boston doctors in performing such an innovative and experimental procedure. The transplant was a historic procedure that fundamentally changed the medical world and yet another addition to Boston’s illustrious legacy.

These three paintings simultaneously capture so much and so little that is the practice of surgery. They span the 17th, 19th and 20th centuries yet only reflect a moment in time of both the dynamic process of the operation and all the preparation leading up to that moment.  Each captures static moments in time when the reality is that surgery is a well-choreographed dance. They tell us much more about the retrospective perception of the event than about the the procedures themselves. Each painting is dignified, restrained and pristine. There is no viscera or blood seen, which speaks to the creative liberties of the artists in omitting grisly details that are fairly central to medicine as a professional discipline.

For the contemporary viewer, it feels slightly voyeuristic to have a view into such procedures and speaks to how much medicine has changed over the years. Many times family members/spouses aren’t even allowed into the operating room, let alone members of the press.  Furthermore, today we have many legal measures in place to protect the anonymity of the patient but here they are laid bare for us to observe. All paintings also show surgery as a incredibly public practice, as a teaching tool but also as entertainment and a source of novelty.

The paintings in Countway very deliberately construct the identity of Harvard’s medical network in particular, as these hospitals represented are members of the Partners Healthcare Alliance and thus affiliated with the medical school. The Anatomy Lesson links the Bostonian practice of medicine to the European one, much like history in general of Boston is intrinsically linked to that of Europe. The latter two paintings document huge breakthroughs in medicine made not only at Boston but at Harvard’s Partner Healthcare affiliates. Combined Celebration of Boston as a medical powerhouse, where we can take up the traditional mantle of one of the oldest apprenticeships from Europe and running with it, creating new innovative therapeutic drugs and procedures. The size and scale of these paintings was previously reserved for depicting battle scenes à la Washington Crossing the Delaware, but undoubtedly used here to impress upon the viewer the true weight of the institution. But perhaps at the same time that they may inspire reverence for the past, they can also comfort us and provide some images of aspiration for the future as well.

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