ORIGINAL ARTICLES From the Southern Association for Vascular Surgery Presidential address: Art and commitment S. Timothy String, MD, Mobile, Ala. "...Any man's death diminishes me because I am involved in Mankind; and therefore never send to know for whom the bell tolls; it tollsfor thee." ---John Donne (1572-1631) While strolling along the streets of Paris, a promi- masterpieces that relate to American medical history nent philosopher and his companion encountered a (the Thomas Eakins paintings The Gross Clinic and magnifio:nt Gothic cathedral with an awe-inspiring The Agnew Clinic and Benjamin West's Christ Heal- forum. Upon surveying the prolific architectural ing the Sick) exemplify commitment. edifice, the companion questioned why these monu- The crucial task of the artist who would portray mental structures were no longer constructed and the people of any period in history is labored. The why they appeared out of vogue. "Commitment" was English poet and author Thomas Carlyle (1795- the succinct reply from the philosopher--"commit- 1881) put it best: the artist "...could not sing the ment." heroic warrior, unless he himselfwere at least a heroic Commitment through college, medical school, warrior too. ''1 Eakins was a heroic warrior. internship, residency, and vascular fellowship is a Thomas Eakins's life and work ( 1844-1916) have compelling force that affords us the privilege to held my interest since my early experience at the practice ou r specialty of vascular surgery. What com- College of the University of Pennsylvania. His por- mitment are we wilhng to forge in order to secure an traits and their subjects' personal contributions to enduring specialty that will flourish with the genera- Philadelphia society encompassed the fiber of life in tion to follow? Much is expected of those to whom the late nineteenth century United States. much is given. A core curriculum of the classical past and the Commitment is encountered in all walks of life. scientific present based on self-discipline was to gov- Tomes have been penned regarding commitment in ern Eakins' future, as was the egalitarian philosophy of individual lives. Art as a manifestation of commitment the Philadelphia Central High School. Upon passing has always held a particular fascination for me with its the rigorous entrance examination that was required historical perspective, immense related talent, and for this institution, Eakins' formal education com- resultant: sensual pleasure. The commitment of the menced at 13 years of age. This public school was one artist and his subjects will be my focus in this address. of a select few in the United States that had no class The painting artist requires talent, well-honed skills, distinction for admission. Its graduates were held in and freedom of expression in order to reveal a visual high esteem, which provided an entree into the canvas of enduring quality. Two American artists, intellectual, scientific, and public life of Philadelphia.1 Thomas Eakins and Benjamin West, and three of their Eakins maintained a deep interest in anatomy and physiology, which is reflected in his original research From the Mobile InfirmaryMedical Center and Department of presented before the Philadelphia Academy of Sci- Surgery, University of South Alabama School of Medicine, Mobile. ences entitled, "On the Differential Action of Certain Presented at the Twentieth Annual Meeting of The Southern Muscles Passing More than One Joint." These scien- Associationfor VascularSurgery, Naples, Fla., Jan. 24-27, 1996. tific endeavors led to a series of 1884 experiments Reprint requests: S. Timothy String, MD, 171 Louiselle St., Mobile, AL 36607. photographing moving animals and athletes that J Vasc Surg 1996;24:319-27. became an important contribution to the develop- Copyright © 1996 by The Society for Vascular Surgery and ment of the motion picture camera. InternationalSociety for CardiovascularSurgery, North Ameri- can Chapter. Eakins believed the human figure to be the most 0741-521.4/96/$5.00 + 0 24/6/72868 important element in painting. The depth of his 319 JOURNAL OF VASCULAR SURGERY 320 String September 1996 character portraits, the rigid adherence to the truth, blood), where physical substance is portrayed in every and the energy with which he endowed his painting figure and object. The depth and power of the reflects this belief. His masterpieces have caused many lighting of Dr. Gross' prominent figure can only best critics to regard him "as perhaps the strongest painter be appreciated in the third dimension. in America." The choice of subject material is The profundity of Samuel Gross' (1805-1884) summed up by the artist himself, "If America is to portrait depicted a man of considerable attainment of produce greater painters and if young art students surgical sldll, outstanding clinical acumen, knowl- wish to assume a place in the history of the art of their edge, and eloquence of teaching. Not only did Gross country, their first choice should be to peer deeper found, edit, and contribute to numerous medical into the heart of American life .... ,,2 Eakins fulfilled journals, but he produced several texts that were this in his life. classics of the time. A prolific writer with a prodigious While professor of anatomy at the Pennsylvania literary output too exhausting to review, Gross was Academy of Fine Arts, Eakins returned to Jefferson dubbed the "Dean of American Surgeons. ''4 Medical College to further his knowledge of anatomy. His prodigiousness makes his rise to being the Continued learning was characteristic of Eakins most influential surgeon in the United States and throughout his life, always striving to improve his Europe understandable. Many honors were bestowed knowledge and techniques, never closing his mind. on Gross, who became the twentieth President of the Ealdns had abandoned the idea of securing a patron or American Medical Association (1868) and was the acquiescing to those with societal status to fund his founding President of the American Surgical Associa- professional career as a portraitist. These two com- tion (1880). I believe, however, that his greatest mon manners of obtaining financial security were ongoing contribution to surgery was to be The Gross used by prominent contemporaries such as John Clinic. Singer Sargent and earlier artists such as Gilbert Stuart The painting depicts an era of surgery (1875) and Benjamin West. Contrarily, Ealdns would seek before the acceptance of the Listerian principles of out his subjects because of their contributions and antisepsis. Dr. Gross and his colleagues are attired in achievements. Only a quarter of his portraits were drab frock business coats, with their bare hands commissioned. The professor of surgery at Jefferson wielding the scalpel, holding the retractor, passing the Medical College was Samuel Gross, who was one of instruments (which were kept in a carrying case), and the most respected surgeons of the era and a mag- closing the wound. Even the patient retains street netic, impressive teacher of strong character whose clothes and continues to wear socks. Joseph Lister's lectures Eakins attended 2 days a week. Dr. Gross was newly conceived theory of antisepsis ( 1865 ) was yet to the perfect subject "hero" to entice to sit for what be accepted by the surgical profession. Lister was a would become Ealdns' masterpiece for future genera- featured speaker in Philadelphia at the International tions, entitled The Gross Clinic. Medical Congress in 1876 and delivered a 3-hour Eakins' feelings about The Gross Clinic were ex- address on the subject~--Dr. Gross was nowhere to be pressed in a letter to his friend, Earl Shinn: "...far found. Indeed, at the first official meeting of the better than anything I have ever done." In contrast, American Surgical Association, where Dr. Gross was Dr. Gross's comment after numerous sittings was, most influential, more speakers opposed Listerian "Eakins, I wish you were dead. ''3 practices than supported them. s The Gross Clinic (Fig. 1) is a large (8 ft × 6.5 ft) and The Philadelphia Centennial Exposition 1875) ambitious painting of a subject rarely attempted in the with its jured art pavilion was the impetus for the modern art of the day and never before executed in production of The Gross Clinic. The spectacular, the United States. The realism of Dr. Gross removing vibrant visual affect and physical substance of this a sequestrum from the thigh in the surgical amphi- portraiture of a modern surgical hero was lost on the theater while lecturing to his students is total, with no selection committee. Five of Eakins' portraits were detail spared. Seven elements are unified in a pyrami- accepted, but The Gross Clinic was rejected due to dal geometry: Dr. Gross, the patient, assistants, the the blood mad the depiction of an actual operation, patient's mother, clerk, students (20 figures), and the even though the painting's technical merits and two people in the amphitheater entrance (Gross' son psychologic power were acknowledged. The work and Eakins). All charity cases required a family mem- was relegated to the U.S. Hospital Building and ber in attendance, the mother in this instance, but Army Surgeon General's office, where various medi- wives were discouraged. Dr. Gross resides at the apex cal artifacts were displayed in a mock hospital ward of this monochromatic painting (except for the and visitors could have their minor injuries and JOURNAL OF VASCULAR SURGERY Volume 24, Number 3 Stfing 321 Fig. 1. The Gross Clinic by Thomas Ealdns, 1875. Courtesy of the Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pa. complaints attended. This was the fate of the greatest pay if they were excluded from the painting. As the American painting at the Exposition--condemned painting progressed, it was observed that these im- because of the realistic, grisly details of a hero in his patient fellows would no sooner climb the three surgical surroundings and because of "poor taste" flights to Eakins' studio than they would be eager with choice of subject matter.