Doctor Tulp, then, was both a pioneer and a leading member of a respectable profession. He had worked to get there. It was as Nicolaes, or Claes, Pieterszoon that he enrolled at Leiden University, the son of a Calvinist linen merchant. He wrote his dissertation on cholera, duly qualified as a doctor of medicine, and returned to his native city of Amsterdam to set up his practice. He was not a specialist in anatomy but a generalist, able to prescribe either medical treatment or surgery for his patients. He adopted the tulip as his emblem, displaying it on his house and coat of arms. The flower, newly arrived from Turkey, would soon become a national mania in the Dutch Republic, sparking the world’s first economic bubble as people bid up the price for the latest exotic bulb. But that was a few years away. The doctor was ahead of the game and, as he prospered, his symbol became his name: Doctor Tulip. By 1628, he had risen to the post of praelector in the surgeons’ guild. He performed his first public anatomy in January 1631. In Rembrandt’s painting, we see him a year later, approaching the age of forty, at the height of his powers, a city alderman, immersed in his second anatomical demonstration.
Tulp’s character is the key to the painting’s broader message. It turns out to be, as we hope from Rembrandt, rather more than another group portrait. Look at the assembled surgeons’ faces, flushed with the January cold and their own importance. Like a cartoon flip book, they move through time from left to right, revealing different stages of expression, from simple perception to intellectual comprehension and finally to something like divine revelation. Tulp himself has the inner light of religious conviction. For, with Rembrandt as his interpreter, Tulp is revealing metaphysical as well as scientific truth. The two men’s choice of the hand as the focus of the anatomy demonstrates their true intent. He can show all his dexterity and skill and invention and sleight – as a surgeon, as a painter, as a light-fingers – and then he dies. Man is both vital and mortal; he creates, but he is God’s creation.
As if the message is not clear enough, the surgeon standing at the back of the group is pointing at the corpse and looking out of the painting directly at us. He is almost accusing.
It is we who should prepare to receive the lesson.
My own first sight of a body under dissection comes as a surprise. It is a woman. Anatomy texts place unfair emphasis on the male body, not only because anatomists and surgeons were men, but also because male cadavers were what tended to issue from the gallows. The emerging medical profession may have struggled with the constant shortage of bodies for study, but fit young men were not underrepresented among them. Illustrated anatomical texts are filled with well-muscled male youth.
I find other surprises too. The woman I am looking at was obviously of a considerable age when she died. Her skin is the colour of putty, like chicken that has been kept in the freezer too long. The greatest shock is that her head has been cut off, and not where you expect, at the neck, but awkwardly through the chin, because the teeth have been taken away with the rest of the head for dental studies, leaving just the lower part of the skull and jawbone.
She is lying in an unzipped white body bag on one of a dozen steel tables in a dissection room at the University of Oxford’s Medical Sciences Teaching Centre. It is a white room, bright with low sunlight that streams in through strip windows and fluorescent lights overhead. Only one thing upsets the air of clinical modernity, and that’s the skeletons dangling from frames placed between the tables. Later, in a book, I see a photograph of a university dissection room in Victorian times, and it has the same array of tables and skeletons. The tables are wooden and the bodies wrapped in cloth bandages, but otherwise the scene is unchanged.
I am here as the guest of the Ruskin School of Drawing and Fine Art, accompanying a class of first-year art students. The Ruskin is the only art school in the country that requires its students to draw from anatomy, something that was once a standard part of any artist’s training. So I find I am standing more in Rembrandt’s shoes than in Doctor Tulp’s.
Drawing teaches proper observation. I, too, will attempt to draw what I see. Our instructor, Sarah Simblet, is an artist and an academic. For her doctoral degree she examined the relation between drawing and dissection, the similarities and differences in action of pen and scalpel. She arrives flushed from bicycling in to town. It is another cold January day and her cheeks are as red as those of Tulp and his surgical companions.
Sarah explains that the bodies we will be drawing have been bequeathed by local people for medical research. (The bodies of members of the medical faculty who become donors are carefully sent elsewhere so that they don’t end up giving former colleagues a nasty surprise.) There is a disadvantage to this. The sex bias of earlier times is eliminated, but the balance is now tipped in favour of the aged bodies of those who have died a natural death. Those who die young usually undergo post-mortem examination, which means that the body afterwards may be no longer ‘viable’.
We pull on white lab coats and latex gloves. Sarah assures us that everything we will see is ‘absolutely inert’ and there is no obligation to handle or touch the anatomies. The students’ anticipation rises. One or two jokily greet each other as ‘doctor’. Somebody wonders aloud whether she was sensible to have eaten lunch.
By way of gentle preparation, Sarah shows us first a box of bones. The students have already acquired the rudiments of human anatomy from studying plastic skeletons, but for most of them this is their first encounter with real body parts. ‘Help yourselves,’ she says, as she picks out her own assortment. She holds up a shoulder blade so thin you can see the light through it, and points out the ridges on the larger bones where the muscles were once attached. I have handled bones before, but still marvel at how light they are.
We move on to the anatomies. The row of tables nearest the window have whole bodies on them in various stages of dissection, prepared by the surgical students of the medical school who work on them progressively over the course of the academic year. The remaining tables support an assortment of torsos and limbs with the skin and layers of subcutaneous tissue cut away in places. These are so-called prosections, dissections of key features of the human anatomy that have been expertly prepared for the instruction of general medical students, who will not perform their own dissections.
We gather round the first table, the one with the old woman on it. Her skin has been cut in such a way that it can be pulled away from the chest to reveal a thin layer of yellow surface fat. We see the muscles connecting the breasts to the ribs. The muscles taper away and become tendons. The tendons, Sarah points out, have ‘this rather beautiful silver quality’. The ribs and breast bone have been neatly sawn free from the rest of the skeleton. With a teacher’s enthusiasm, Sarah brushes away her long blonde hair from her face, aware perhaps that she should perhaps have tied it back, and peers in to the chest cavity. ‘Oh, you’re in luck this year,’ she says. ‘It’s beautifully done.’ She lifts out the woman’s lungs, the right lung with three lobes, the left with two. The spongy tissue has a bluish colour. It suggests that she lived in the country. (City lungs are black, as I find on a later visit to the museum of a London teaching hospital.) Holding them in her hands, Sarah shows how the two lungs come together like the parts of a cast, leaving a void shaped for the heart. Next, she pulls back the pericardium, the cup-shaped membrane that holds the heart in position. We see the heart itself.
The second body is also a woman’s, stouter than the first. A thin, rancid odour produced by the creeping oxidation of her body fat pierces the fumes of the fluids used to preserve the anatomies. (Very fat people tend not to be selected for dissection because the fat is simply waste in anatomical terms, and it makes unnecessary work to clear it away.) Her lungs are pushed up high into her chest, perhaps indicative of some medical condition, such as an enlarged liver, or maybe just a normal variation.
The third body is a man’s. A tattoo is discernible on his right arm, a motif combining a heart and a sword. He retains his chest hair. This evidence of pe
rsonal identity makes it harder to see him as just a cadaver. His flesh appears darker than the women’s because the blood did not drain easily from his body. He has a large frame, and we observe that his heart has become enlarged so that it could continue to push blood around his clogged arteries.
Seeing these bodies, I am struck by the way the major organs take shape so as to nest tidily alongside one another. This very neatness seems to imply design, and was seen by early anatomists, certainly including Doctor Tulp, as evidence of God’s creation. One of my initial naive questions – do organs exist, or are they cultural inventions? – seems to be answered. The organs appear quite distinct from each other and from other tissue. They have their own colours, textures and densities. I can lift them out and pop them back in sequence just as in one of those medical students’ plastic models. Sliding a liver in under the diaphragm or tucking one of the lungs round the back of the heart has a pleasing action about it, as the organ and the cavity from which it came feel their way wetly towards one another, slipping easily back into their arrangement in life. After seeing several more bodies, it is clear that people vary on the inside at least as much as they do outwardly. We are not all the same beneath the skin. I see great variations in internal morphology that, seen on the surface, would undoubtedly be cause for comment, disapproval, revulsion and discrimination. Inside the body, they pass unnoticed even by their possessor. What, I wonder, does this tell us about our humanity?
The prosections are a miscellany: a couple of hearts, a ribcage neatly opened up like sideboard doors, a green-tinged gall bladder, kidneys with their ureters linking them to the bladder, a uterus with its ovaries and Fallopian tubes. The intestine is not like the string of sausages shown in cartoons, but is fed by an intricate web of blood vessels along its length. One heart has a plastic tube in it, a relic of historical surgery. One skull has been forced apart along the suture lines where the cranial bones first fuse in infancy. This is done by filling the skull with dried peas and then soaking them so that they absorb water and then gently expand to ease the pieces apart. Some of the prosections have been here for many years. They are preserved in a cocktail of alcohol, formaldehyde and water that pervades the atmosphere with a tangy odour and which still clings to me and my clothes hours after the class has finished. The muscle tissue is more wrinkled than on the dissection bodies. The flesh, I am alarmed to find myself noting, is undeniably the colour of slow-cooked meat. One prepared spinal cord is 150 years old, dissected to a standard that nobody can equal today.
Sarah’s course comprises eight classes that take the body piece by piece: shoulder and arm, forearm and hand, torso and so on. I return the second week, which is devoted to the head and neck. From a tank containing a dozen or more, we each choose a head to draw. One old man has a pointed chin with fine white stubble and a Roman nose bent over to one side. His tongue sticks out slightly. He seems full of character, like a gargoyle. The brain has been removed from another head, leaving one eyeball tethered in space, the flesh around the eye socket dissected away. Another man’s head has been sectioned vertically, slicing in half even his ginger moustache. He seems quite recognizable from just half of his face, leading me to ponder the importance of symmetry in the human face and form.
The head is a great subject for drawing. There is the formal difficulty of its shapes. There is the hint of identity in the face, or what is left of it. There is the challenge of recovering a sense of life in this now dead flesh. Perhaps it’s more than a challenge. Perhaps it is the artist’s duty to bring his subject back from the dead in some way. There is too much detail to draw it all. A big part of the artist’s job is to edit. What to show? What to leave out? It raises the question of motive. Is the artist depicting an inanimate curiosity, or presenting an allegory of human vanity, or aiming for a scientifically accurate illustration?
The nervous joking stops and the students fall silent as they begin to draw. I have chosen a head and shoulders that lie flat on the table. The face is intact but turned slightly away from me. The skin, fat and some of the muscle of the cheek have been removed, and the neck has been prepared in such a way as to reveal a mass of blood vessels and tendons. I try drawing what I think I see, giving the head an outline and then edging in major features such as the dramatic line where the skin has been abruptly cut away. Aiming for accurate representation, I expect the parts to clarify themselves as I go along, but it doesn’t happen. This head, with its tangle of sinews, muscles and tubes, seems hopelessly disordered. I find my freehand pencil strokes can follow the organic curves easily enough. The telephone-shaped opening of a nostril comes out well. But the complex ebb and flow of surfaces and the change of textures between skin and flesh and bone defeat me.
The students draw better, but above all more quickly, than I do. I try to work faster, more spontaneously. I try softer pencils. My efforts disappoint me, as I knew they would. I look at the students’ work. A few are plainly not interested, whether in drawing as a medium, or in human anatomy as a subject, but most have responded bravely. I am impressed by their battery of techniques and choice of difficult or apparently unpromising subjects. One, drawing the interior of a skull, cross-hatches dramatically to emphasize the changing fall of light across its concavities. Another seems to find all the loops and whorls in a prosection that includes the aorta, lines I’d never think to follow, and keeps them going to build up an almost abstract composition.
Body parts are complex throughout. They may vary in relative flatness or smoothness, but they don’t really have easy bits and difficult bits. In my case, it’s all difficult. There is no helpful contrast between organic form and regular geometry as there is in a still life of a bowl of fruit or a pipe on a table.
‘Well, I recognize her,’ Sarah says diplomatically of my effort when I have given up. She has drawn these same heads herself as well as overseeing her students, and knows them like old friends. In her own work, Sarah has moved on from anatomy to botanical subjects. Her pen-and-ink drawings of trees seem to accentuate their bony aspect, with branches trailing out into sinister fingery twigs and knuckly boles for trunks. She has found the change of subject matter instructive. ‘I’m often astonished at the number of errors there are in drawings of bodies in quite well-known texts,’ she says. ‘You don’t get those errors in drawings of plants. With plants there isn’t that presumption that we know what this is.’
But the body is us, and we think we know it better than we do. Even Vesalius famously got certain anatomical details wrong, and there is controversy too over whether Rembrandt’s dissected hand of the criminal ’t Kint is an accurate representation. Leonardo da Vinci, Sarah tells me, drew the valves of the heart correctly in a way that would not be repeated until the twentieth century, but even he couldn’t resist putting a hole through the pericardium in order to allow for the passage of spirit, the fluid life force then thought to run through the body.
I am aware as I write about these classes that they may sound more alarming than I found them at the time. It is perhaps shocking to read about wheeled plastic bins labelled so casually with, for example, ‘Hands and arms’, and to find that they do indeed contain hands and arms, each dissected so as to demonstrate particular points of anatomy, but all then thrown in apparently at random so that they appear to writhe around one another, with a few reaching out of the water in which they are preserved. It could be a gruesome sight. But the context is important – not just the bright light, the clinical surfaces and the antiseptic smell, but also the quiet mood that automatically descends on our group in the presence of the bodies.
I find myself wondering about these people. If they gave their bodies ‘to science’, were they aware that they might also become artistic subjects? Would they have minded? The Ruskin artists are learning about human anatomy in their chosen way. They are not medical students, but then the body should not be the domain of medicine alone. The way they ultimately employ their knowledge may be different, and less directly applied for human benefi
t, but they are continuing a noble tradition of forcing the rest of us to see what the human body is like.
If we think of an autopsy, our mind immediately leaps to scenes from television crime thrillers. Here is the detective desperate to get the killer – haggard, blustering, under pressure. And here is the pathologist probing the dead body that will reveal the vital clue – methodical, unflappable, quietly humorous. It’s always the pathologist who has the critical distance necessary to solve the case. But it is only latterly that autopsy has come to apply to the inspection of a dead body specifically and almost exclusively for the purposes of discovering the cause of death or disease. The word literally means ‘to see with your own eyes’. Its connection with the opened body arises from the first tentative Western investigations of human anatomy in Ancient Greece and the novelty of seeing and knowing the organs and parts for the first time.
Seeing with our own eyes necessarily applies to the body of another. ‘NOSCE TE IPSUM’ reads the pious placard in the anatomy theatre – ‘know thyself’. But we cannot know our own self in this way because we cannot see our own interior exposed. This impossibility allows us to believe in our own immortality. We cannot see ourselves as we are, either inside (because we must be dead first) or out (because we cannot step outside our body to look). So the best we can do is to look at other bodies on the assumption that they are like our own. It’s a major step to do this. It requires us not only to accept our own mortality, but also to acknowledge the unity of humankind.
Anatomies: A Cultural History of the Human Body Page 3