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Anatomy lessons, autopsies, and surgery: they’re different

Posted: 15 Apr 2018 04:30 AM PDT

Accustomed as we are to viewing bloody casualty simulations and surgical procedures on TV, Rembrandt’s Anatomy Lesson of Dr. Nicolaes Tulp still strikes many modern viewers as a strange painting. In what at first appears to be another of his wonderful group portraits, said Dr Tulp is in the midst of dissecting a human forearm, still attached to its former user.

Another gruesome work, Enrique Simonet’s The Autopsy made that artist’s reputation at the Salon in 1895, and Thomas Eakins’ painting of surgery in The Agnew Clinic (1889) is recognised as one of his major works, although at the time controversial for its depiction of a nude woman.

There may seem little difference between depictions of anatomising, autopsies, and surgery, and reading around there appears to be a great deal of confusion between them, even among those who painted them. This article looks at some important works in this strange sub-genre, and how they might be read.

Anatomising

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Rembrandt Harmenszoon van Rijn (1606–1669), The Anatomy Lesson of Dr. Nicolaes Tulp (1632), oil on canvas, 169.5 x 216.5 cm, Koninklijk Kabinet van Schilderijen Mauritshuis, The Hague, The Netherlands. Wikimedia Commons.

Rembrandt painted his Anatomy Lesson of Dr. Nicolaes Tulp in 1632, a decade before his Night Watch. An early commission soon after his arrival in Amsterdam, it is unmistakeably a group portrait of distinguished members of the Surgeons’ Guild in their working environment. Most remarkable is the fact that its principal, Dr Tulp, and most of his colleagues are not looking at the dissected forearm.

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Michiel van Mierevelt (1566–1641) and Pieter van Mierevelt (1596–1623), The Anatomy Lesson of Dr. Willem van der Meer (1617), oil on canvas, 146.5 x 202 cm, Museum Prinsenhof Delft, Delft, The Netherlands. Wikimedia Commons.

Rembrandt was by no means the first Dutch artist to paint such a group portrait. Back in 1617, Michiel van Mierevelt and his son Pieter, specialists in portraiture, had painted The Anatomy Lesson of Dr. Willem van der Meer. Here the company is larger, and all ignoring the cadaver in front of them, preferring to look at the painter.

At that time, surgery was quite separate from medicine, and more of a craft. In the absence of any form of anaesthesia, surgical procedures were almost invariably as brief as possible, and usually (mercifully for the patient) far too swift for an artist to paint them. Besides, the dangers of haemorrhage and infection were so great that surgery was generally dreaded as a likely precursor to death.

Surgeons are, of course, highly reliant on their anatomical knowledge, something learned and reinforced repeatedly by the dissection of cadavers. Although those bodies were sometimes obtained through a trade based on grave-robbing, the most reliable supply came from the execution of criminals – the source of the unfortunate Aris Kindt whose body fills the middle of the Rembrandt.

Dissection, often in public, was part of the punishment of those who were executed for crimes. They may have been dead for a few hours by then, but no effort would be spared to deprive them of the last dignity. This is shown very clearly in William Hogarth’s fourth and final stage of cruelty, from 1751.

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William Hogarth (1697–1764), The Fourth Stage of Cruelty: The Reward of Cruelty (1751), line engraving on thick, white, smooth wove paper, 38.7 x 32.4 cm, Yale Center for British Art, New Haven, CT (Gift of Patricia Cornwell). Courtesy of Yale Center for British Art.

By The Reward of Cruelty, the protagonist of the series has been tried, convicted, and hanged, and his body handed over for dissection. This was not yet routine, but the following year the Murder Act made it standard that the bodies of murderers would be handed over for dissection, and would not be buried, as a further penalty for the crime.

The noose remains around his neck, and the mutilation which his body is subjected to reflects the cruelties previously inflicted on animals: his eye is removed, his intestines coiled out into a pail, a dog is about to make off with his heart (shown in popular not anatomical form), and incisions are being made in the chest and left foot. In the left foreground, previous skulls and bones are being boiled to prepare them for anatomical specimens.

The room is the round anatomical demonstration theatre of the Surgeon’s Hall. Presiding over the scene is John Freke, then President of the Royal College of Surgeons of England, who had been an admirer of Hogarth’s work until the pair quarrelled over Handel’s music.

The skeleton on the left is that of James Field, a boxer who was hanged just before the first prints of this series were issued. That on the right is of Macleane, a notorious highwayman who had been hanged the previous year.

Human dissections for anatomy teaching continue, although during the twentieth century they came to rely on those who generously ‘gave their body to science’, and growing respect was paid to the deceased. Their depiction in visual art has all but ceased, which may seem the more puzzling as many painters who underwent formal training studied anatomy, often with the aid of dissections.

Autopsies

By the nineteenth century, advances in medicine and surgery had reached the point where the subjects were transitioning from superstition to science. Disciplines such as pathology were established, and doctors became deeply interested in causes of death – particularly as they could help the quest to prolong healthy life. One of the advances in pathology was the autopsy, in which a small number of doctors (often only one) would dissect the cadaver and perform gross examinations – not elaborate anatomical displays – to try to determine the cause and mechanism of death.

This was all part of the rise of objectivity in science during the middle of the nineteenth century, and led to microscopic examination of samples of various organs, and developing understanding of disease processes – a prerequisite for the development of effective treatment.

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Henri Gervex (1852–1929), Study for Autopsy at the Hôtel-Dieu (1876), oil on canvas, 53.3 x 43.2 cm, The National Gallery of Art, Washington, DC. Wikimedia Commons.

In 1876, Henri Gervex painted an Autopsy at the Hôtel-Dieu. Although that exhibited work is currently inaccessible, above is a study which he made for it earlier that year. This was the main Paris morgue of the day, and the corpse being examined is so thin as to have died as a result of starvation – in Paris, in 1876.

This scene contrasts with earlier anatomy demonstrations. Autopsies have often taken place in the basements of hospitals, in dark and dingy surroundings. Gervex appears to have been one of the first artists to have used an autopsy for a stark social message, one which was common among Naturalists.

simonetautopsy
Enrique Simonet Lombardo (1866–1927), The Autopsy (Anatomy of the Heart; She had a Heart!) (1890), oil on canvas, 176.5 x 292 cm, Museo de Málaga, Málaga, Spain. Wikimedia Commons.

Almost twenty years later, in the Salon of 1895, Enrique Simonet Lombardo enjoyed great success with another painting of a similar theme: The Autopsy also known as Anatomy of the Heart; She had a Heart! (1890), in which the victim is a young woman who has drowned herself. Here is another social message: was she an Ophelia, or one of the many ‘fallen women’ who decided to end her life with one final fall?

Surgery

For surgeons, one of the watersheds was the discovery of general anaesthesia during the 1840s. Prior to that, all they could attempt were brief life-saving procedures; with general anaesthetics all those centuries of studying anatomy suddenly enabled surgeons to perform lengthy procedures with patients who were relaxed and unconscious. I have looked more generally at paintings of hospital medicine and surgery here.

eakinsagnewclinic
Thomas Eakins (1844–1916), The Agnew Clinic (1889), oil on canvas, 214.2 x 300.1 cm, Philadelphia Museum of Art, Philadelphia, PA. Wikimedia Commons.

Surgery was transformed from rushed mutilations to theatrical performance. Its empires grew, and their leaders wanted their portraits painted. In The Agnew Clinic (1889), Thomas Eakins shows a retiring professor of surgery, Dr. David Hayes Agnew, at work in the University of Pennsylvania School of Medicine. His patient is a woman, who is partially naked (to the consternation of many who saw this), and unconscious thanks to a volatile liquid general anaesthetic administered via a mask.

Bright surgical lighting puts six figures literally in the limelight: Agnew, holding a scalpel at the left but appearing detached from the operation; three assistants who are attending to the patient and her surgery, and the only woman present (other than the patient), nurse Mary Clymer, who is dressed not for the operating theatre but for ward work. These lead figures are paying attention to the patient rather than their teacher; although the teaching is professorial and theatrical, its goal is here the cure of the patient.

Puzzles

In the anatomy class, we have group portraits of successful surgeons in their workplace. In the autopsy, we have a hidden corner of the hospital, where the tragedy of death is used to comment about contemporary society. In the operating theatre, we finally have advancing medical science being applied to change people’s lives. But there are still a couple of paintings which don’t fit those moulds.

vonmaxderanatom
Gabriel von Max (1840–1915), Der Anatom (The Anatomist) (1869), oil on canvas, 136.5 × 189.5 cm, Neue Pinakothek, Munich, Germany. Wikimedia Commons.

Gabriel von Max’s Der Anatom, which can surely only be translated as The Anatomist, of 1869 doesn’t appear to be anatomising to me. A young woman – every bit as beautiful as Simonet’s drowning victim – lies naked under a diaphanous sheet. Peeling back that sheet is a significantly older well-dressed man, his eyes downcast, and his chin resting on his left hand.

The cavader rests on a mortuary slab in a darkened office, with a couple of human skulls and piles of papers on the desk in the background. There are no signs of dissection instruments or the trappings of a hospital mortuary, nor had any internal examination of the body commenced.

My impression is that this depicts the moments before the start of an autopsy, in which the pathologist is contemplating the tragic premature death of the woman. Anything else would only become deeply sinister.

cezanneautopsy
Paul Cézanne (1839–1906), Preparation for the Funeral (Autopsy) (1869), oil on canvas, 49 × 80 cm, Private collection. Wikimedia Commons.

Early in his career, during his ‘dark period’ in 1869, Paul Cézanne painted Preparation for the Funeral or Autopsy (1869), possibly intended for the hospital in his home town of Aix. This seems to have been the culmination in a sequence of works including The Rape and The Murder.

A corpse is propped up in a semi-recumbent position, its arms by its sides. A man, dressed as a workman rather than a doctor, is working with both hands obscured at the far side of the cadaver, to the outside of its thigh. Standing to the right, with her back towards the viewer, is a woman wearing a bright red blouse.

I don’t believe for a moment that this was intended to represent faithfully a scene at an autopsy. Its most obvious reading is that the man is an undertaker who is preparing the corpse for a funeral. That is an unusual event to depict in art, and very different from the autopsies above.

Having had the privilege in the past of dissecting a cadaver to learn anatomy, of attending many autopsies, and of performing surgery, rest assured that their sigificance and reading is profoundly different, even though, to the unaided eye, they might appear superficially quite similar. Saying that a painting like Rembrandt’s Anatomy Lesson of Dr. Nicolaes Tulp is similar or related to a Naturalist painting of surgery is like saying a landscape with grazing horses is similar to a cavalry charge.

Last Week on My Mac: Apple’s calendar

Posted: 15 Apr 2018 12:00 AM PDT

For such a huge organisation spread across the globe, Apple maintains a remarkably consistent and cohesive image, and singular corporate direction. It’s relatively unusual to find major disparities in different parts of its organisation, but last week emphasised one which is causing many Mac users problems: the continuing incompleteness of High Sierra.

It’s now over six months since Apple released High Sierra 10.13, and time for Apple’s apps to make the most out of its new features and technologies. So it shouldn’t have been a surprise that last week’s round of software updates, including iMovie, Final Cut Pro, Motion, and Compressor, applied only to High Sierra.

There was an ulterior motive driven by another calendar too. Ten months ago, at WWDC 2017, Apple announced that apps needed to be 64-bit by the release of macOS 10.14. Amazingly, until this update Apple’s Compressor 4.4 was still a 32-bit app. As High Sierra was to start naming and shaming those apps which were still 32-bit on 12 April, Apple had to update Compressor in time to meet its own deadline.

At this stage in the previous cycles of El Capitan (and earlier) and Sierra, there was no problem with Apple dropping app updates for the previous release of macOS/OS X. Those versions of macOS were feature-complete and reasonably stable after six months, although some specific models still suffered frequent kernel panics and other issues.

High Sierra is different. Not only was it the most rushed and immature major release of macOS for many years (some would say ever), but its major new feature, APFS, is still far from complete, and a long way from being fully supported by macOS itself.

For the last five years, Apple has been unique among major computer manufacturers in promoting its combined hard drive and SSD combinations – Fusion Drives – to those purchasing two of its most popular ranges, the iMac and Mac mini. Apple engineered a whole new layer in its storage software, CoreStorage, to enable users to enjoy much of the speed of SSDs at a cost little greater than that of a plain hard drive.

Had Apple only offered the traditional choice between hard drives and SSDs, few of those who have bought Macs with Fusion Drives could possibly have afforded the high cost of SSDs. Apple has thus gained significant commercial benefit from its Fusion Drives.

When High Sierra was detailed for the first time at WWDC in June 2017, it was announced as supporting SSDs, Fusion Drives, and rotating hard drives. When it shipped three months later, it initially only supported SSDs, but Craig Federighi stated in an email to a concerned user that Apple planned to add support for Fusion Drives “in a future update”.

Since then, High Sierra’s APFS has come to support hard drives, but the millions of users who have invested in iMacs and Mac minis with Fusion Drives have been left stranded. Apple has not, as far as I can tell, even mentioned whether or when APFS will eventually support their Fusion Drives.

Yet Apple continues to sell several models for which a Fusion Drive is a standard configuration, and more in which it is an option. All three of the current iMac 27-inch models come as standard with Fusion Drives, for example, and ship with High Sierra installed without its major new feature.

While Apple is keen to reassure prospective purchasers that the fan assembly of their new iMac is made with 26% bio-based plastic and that its display glass is arsenic-free, nowhere in its promotional pages about macOS High Sierra does it mention, even in the fine print of a footnote, that Fusion Drives currently do not use its new file system.

If that was not sufficiently disjoint, Apple’s built-in backup system in High Sierra cannot back up to an APFS volume. So even if you have spent all that cash on an iMac Pro with an internal 4 TB SSD and an external SSD RAID array, you’ll be stuck backing it up to your array using 20-year-old HFS+, which Apple admits was never designed for use on SSDs.

As I have pointed out before, the stumbling block to Time Machine is lack of support in APFS for directory hard links, which appears to have been a design decision probably made more than two years ago. Over that long period, Apple has failed to respond to its own decision and devote the resources needed for Time Machine 2. Presumably we will have to wait for macOS 10.14 this autumn for Apple to see its way to that solution.

If you have an iMac or Mac mini with a Fusion Drive, or want to be able to back up to an APFS volume, High Sierra 10.13.4 does not deliver the goods, nearly seven months after its release. If you are looking to purchase a new Mac with a Fusion Drive, you should first ask Apple whether that Fusion Drive will ever be able to use APFS, and if so, when.

It’s all very well Apple keeping to its calendar for dropping support for Sierra in updates to its software. But it also needs to keep to its calendar for delivering the features of High Sierra which it promised us almost a year ago.

Or is Apple deeming many of its current products obsolete before they have even been sold?