NRPLUS MEMBER ARTICLE D epicting 40,000 years of medicine in a little over 240 pages, internist and historian Philip Mackowiak offers an accessible and comprehensive survey of life, death, and doctoring in Patients as Art. Rather than presenting a weighty chronology of medicine marching indiscriminately over millennia, Mackowiak focuses on sources of illness to introduce readers comprehensively to practical, cultural, and historical elements of the medical world. Foundational topics in medicine are introduced, ranging from nutrition to genetics; medical activities such as diagnostics and therapeutics are covered; and still larger topics in medicine, such as military surgery and public health, are touched on. Over 160 reproductions of paintings, sculptures, and drawings illuminate these subjects with fresh insight, offering the non-clinical eye a sense of the doctor’s clinical gaze, limned by the artist’s perspective.
Whether introducing the 30,000-year-old carved Venus of Willendorf to illustrate obesity and perceptions of body image or using watercolors of faceless South African townships to consider the social determinants of health, Patients as Art is remarkably inclusive, reaching well beyond the war-horses of the Western canon. With a nuanced sensitivity, Mackowiak unpacks pictorial representations freighted with ambiguity and does not shy away from grappling with shifting tastes and morals in the visual and medical arts. Taking note of a solitary tear crossing the cheek of an obese child in Juan Carreño de Miranda’s La Monstrua (the monster), Mackowiak reflects upon how “the artist saw fit to violate the angelic confidence of a small child without refuge . . . by portraying her more as an object of derision.” He uses a hand-colored X-ray combining diagnostic technologies and artistic techniques to explore radiography’s power to disclose secrets.
For those approaching the visual arts with a medical background, there are occasional elements of armchair diagnosis that will delight, such as a 16th-century Toltec terra-cotta figurine bearing the characteristic facial features of Down syndrome. In another instance of medical hindsight, Mackowiak observes that in Georges Chicotot’s painting of his first attempt at X-ray therapy, neither patient nor physician shields himself from exposure to the deadly radiation. In other cases, however, the images are nothing more than sign posts that serve as passing mentions of a disease. Andy Warhol’s painting of Michael Jackson is used in reference to body dysmorphia, but there is no explication of the Warhol itself, or of the increased prevalence of body dysmorphia among those in the public eye. A picture may be worth a thousand words, but a few could be spared to elaborate for a general audience.
Some works of art have become canonical both in art and in medicine. Many of these are included in the book and are neatly contextualized, such as The First Operation under Ether, by Robert Cutler Hinckley, which depicts the ushering in of anesthesia, or The Gross Clinic, by Thomas Eakins, who, Mackowiak tells us, “wiped his blade on his boot before operating, so great was his disdain for Lister’s doctrine of antisepsis.” These works introduce figures legendary in the medical world but largely unknown to the public and puts their accomplishments and personalities into perspective.
A separate section of the book, more like a coda, focuses entirely on artists and their own diseases, such as the clubbed fingers and distended veins in Dick Ket’s self-portrait suggesting heart disease, or Toulouse-Lautrec’s physical deformities in a self-caricature indicating a possible diagnosis of pycnodysostosis. However, there is no transition from the subject of patients as art to artists as patients, making the work feel like two smaller books sutured together.
Additionally, the paperback edition does not do justice to the art represented; a larger page and higher-resolution image would. And a natural extension of the author’s theme of patients as art would have been the role that medicine and medical professionals depicted in art play in social controversies, but this is largely ignored. One could consider the aesthetic and gender norms enmeshed in Johns Hopkins Hospital’s evolving relationship with Jamie Wyeth’s portrait of Helen Taussig, an aging female cardiologist who made her name in a man’s world. The raw, unvarnished portrait for many years was regarded as a shocking embarrassment, and was kept hidden in the belly of Johns Hopkins’s archives; now it is proudly displayed at the hospital. Unfortunately, the role clinicians and patients as art play in today’s cultural conflicts is a canvas left blank by Mackowiak.
Throughout the book, art is used as an intellectual tool to, in the author’s words, “fill in the gaps . . . [and] provide glimpses below the surface of patients’ physical ills into the psychology [and] sociology . . . of the human condition.” In painting a picture of dynamic shifts in the history of medicine, Patients as Art portrays how painters and physicians not only inspect patients, but see them for who they are.