PRELUDE.
This first post is about why I am starting a Substack. It may not seem like this post is about why I am starting a Substack. I will get there, I promise. One of my favorite writing techniques is when the author arrives at the point by a series of curves. I hope you enjoy winding through frontage roads in my head with me!
I.
A surgeon stands in a dim operating theater, his shock of white hair aglow with the light cast by the skylight overhead. He holds a scarlet-bloodied scalpel in ungloved hands and a weighty expression on his face. To the right is his patient, or what we can see of them; the twisted flesh held open by medical assistants with clamps. The surgeon: Samuel Gross, Philadelphia's world-famous medical pioneer. The operation: a lithotomy, an extraction of infected femoral bone. The painter: young American anatomy student-turned-artist Thomas Eakins. The year: 1875. The painting: The Gross Clinic, my favorite painting by any artist.
Eakins painted The Gross Clinic to be displayed at the Philadelphia Centennial Exhibition in 1876, but like so many of the most beloved works of art, it was never appreciated in his lifetime. The Centennial Exhibition board refused to display it. The New York Times called its unflinching, austere depiction of medicine, “so dreadful that the public may be well excused if it turn[s] away in horror.” Eakins was reamed for being “unartistic.” He had to sell the work on the cheap, and it was initially consigned to languish in a military hospital. Yet, while it is no doubt brutal, I want you to know why it is now considered one of the best American paintings of all time.
II.
“We have seen something today that will go round the whole world.”
It’s a generic line. It’s neither as bleakly funny as Roald Dahl’s “Ow, f***,” nor as darkly portentous as Oppenheimer’s, “I am become death, the destroyer of worlds.” It’s something you might say when you’re trying to be deep but you have no deep thoughts. But when Jacob Bigelow exclaimed these words on October 16th, 1846, he was right. What he saw that day would go round the whole world. Bigelow was describing the world’s first successful anesthetization using diethyl ether, an easily synthesized chemical that was safe for patients and caused total temporary deadening of consciousness and sensation.
Before general anesthesia, surgery was not the refined, meticulous practice it is today. It was inelegant butchery, causing immeasurable pain and trauma. Patients often resorted to death by suicide rather than the agony of the knife. Doctors would rather have hacked off an infected limb than have subjected a patient to the physical and mental scars of a longer surgery, like, say, a lithotomy.
But ether is a very old chemical. The first reports of its discovery date back to the 1540s. Ether was even a popular drinking intoxicant during periods of alcohol prohibition in Ireland and Scotland in the 1700s. Why did it take doctors so long to figure out its medical applications? The answer lies in the difficulty of dosage.
Sure, a patient could drink ether before surgery and fall unconscious, but that would only last so long. What if they woke up and jeopardized the procedure? That wouldn’t do. You can have them drink more ether, but that runs the risk of stopping their breathing altogether. A patient who doesn’t breathe is a dead patient. How do you control the dosage of an anesthetic agent? By aerosolizing it. That way the patient can breathe it in while they’re unconscious. So, doctors began holding ether-soaked rags over the noses of surgical patients, creating a rudimentary drawover anesthesia system. But that presented another problem. Ether is extremely flammable. By filling a room with its vapor, you’ve essentially built a giant bomb. Explosive mist + open gas lamps (the only source of artificial light available at the time) = kaboom. That brings us to the use of operating theaters with large overhead windows. Skylights provided a way to illuminate the process without open flame while keeping onlookers in darkness to prevent distraction. Ether was a revolution. 30 years after its first successful use, ether was standard in every modern operating room. Suddenly, surgery could be precise and methodical. No longer were surgeons the butchers of the medical field. Now they were artists.
As surgeries ballooned in complexity and length, so did the skill required to perform them. Any old carpenter could amputate. All you needed was a sharp saw, a tourniquet, and some strong assistants to hold the patient down as they writhed. But to remove an appendix without rupturing the bladder? To sew a shoulder tendon back into place without permanently stiffening the joint? To remove a piece of infected femur without destabilizing the bone? That required precision, specialized knowledge. Thus, the birth of the surgeon-teacher.
III.
There is an urn in a cemetery in the woods of Pennsylvania with an inscription that reads of Samuel Gross, “he recast surgery as it is taught in North America.” This is the grave of the real-life man depicted in Eakins’ painting. Born at the right time and in the right place for a medically inclined boy, Dr. Gross quickly adopted the new medical technologies available to him to supercharge medical progress. He was the first to teach systematic pathological anatomy in the United States and is widely credited for bringing American trauma surgery into the modern (for his time) era. He was known to teach with “wit and anecdote,” according to his students. The one area in which he lacked was his total disbelief in the effectiveness of antiseptics.
This brings us full circle back to the painting. Observe the ether rag over the hole at the center of the painting where the patient’s face would be. This demonstration, this procedure, this painting, would not have been possible without the technology on display. But now that anesthesia was here, it was here to stay. And the pace of progress increased.
Oh, and a final detail, my favorite one: on the far right side of the painting, so obscured by shadow that you might have to turn up the brightness on your device to see him, there is a man, madly scribbling in a tiny sketchbook. His eyes are affixed to Gross’s scalpel, his pencil a blur. He almost seems to set his writing instrument as equal to the doctor’s surgical instrument. That man is Thomas Eakins.
What Eakins is trying to tell us, and what the board of the Philadelphia Centennial Exhibition failed to realize, is that art and medicine have the same aim: to illuminate the world in greater, sharper detail. Art and science aren’t at odds. They’re just two different lightbulbs that cast the world in two different shades of truth. Blood might be spilled either way, but the truth of medicine doesn’t bear hiding, even in art. After all, the occasion in The Gross Clinic is a happy one. The patient gets to leave the surgery, heal, and resume their life with full access to all their limbs. Eakins gets to leave with the seeds of his magnum opus in his sketchbook. Gross gets to leave having given more to the human project than he had the day before. And every member of the audience gets to leave knowing a little more than they did coming in. That’s progress.
Today, The Gross Clinic is displayed prominently in the main gallery of the Philadelphia Museum of Art as a reminder that science and art are two sides of the same coin. To be an artist is to be a scientist; it is to observe the world, hypothesize about how it works, and then test your theory. They’re not opposite genres. They’re mediums. Each conducts truth and each has things to say to us and about us. The pencil, the scalpel, the pen, the sword: each cuts across the edge of progress, each is necessary to make our headway into the future.
IV.
Now we are here, at the point where I make the point. I’ve often described myself as a bag of contradictions. Besides the fact that everyone is a bag of contradictions, I feel it’s especially true of myself. I love art and music and poetry and theater, and I’m obsessed with empirical evidence and science and hard facts. I feel the most at peace in the wide outdoors of Utah, and I just barely moved to the concrete jungle of New York City, which no sane person would describe as “wide open.” I am pragmatic about what needs to be done in a crisis, and yet I am pursuing dreams that are, frankly, ludicrous. Sometimes I feel that the matter and antimatter of which I am composed must someday stop circling each other. When that happens, the opposing parts of me will slam together and I will be annihilated in the process.
When I look at The Gross Clinic, I don’t feel that tension within myself. I feel how harmonious the different parts of me are, how they can all play in concert. I see how art and science dance like quantumly entangled particles. I feel like a symphony. That’s why I’m starting a Substack. I’m starting it so I can have an excuse to share the things that stitch me together, what I’m thinking about, what I’m doing, and how it’s going. I think it’s necessary to feed all the parts of yourself. If Thomas Eakins hadn’t learned anatomy as well as art, we never would have gotten the view into the operating room that we did from his painting. The world is built when people cross aisles, mix disciplines, and climb useless walls. Things get better when we aren’t afraid to enter worlds we know nothing about. Maybe the next theory of relativity will come from a poet. Maybe the next Citizen Kane will be written by a finance bro. It won’t be, if we decide that to be human is to focus on one thing only. Maybe if I write bridges between things, I can inspire one of you.
-JT
Learn more: the history of ether, an exploration of The Gross Clinic, the era before general anesthesia, and a biography of Samuel Gross.
Enjoyed reading this aloud to Kele through the beautiful Driftless region. He wants to know if the “sword” refers to war or revolution. Or something else entirely?
So thoughtfully written! I admire how much you strive to be aware of and embrace the dissonance within yourself. Crossing the aisle socially, politically and spiritually is so urgently needed! I wish more people would pause and consider the intersectionality of their surroundings and choose to be compassionately empowered! Hooray for you!