Medicine and the humanities--doctors as artists.

While only some can claim to be physician/artists, like neurosurgeon Roger Melvill whose paintings featured frequently on the covers of CME, we can surely all claim to be physician/connoisseurs of the arts. This piece is sparked by the art of Dorothy Kay, an acclaimed portrait painter, whose paintings of surgeons and anaesthetists at work in Port Elizabeth in the late 1930s we feature in this edition. There is a growing trend towards integrating the arts into medical education with the aim of promoting creative and scholarly work at the intersections between the arts, humanities and medicine. There exist journals of the creative arts such as The International Journal of the Creative Arts in Interdisciplinary Practice whose mission is to publish research and articles featuring the arts and medicine. Against this background and the establishment of formal programmes that seek to integrate the arts and humanities in medical education, especially in the US, Canada and the UK, the University of Cape Town recently launched a ‘Medicine and the Arts’ masters-level course in the medical humanities. Doctors are also painters, authors, poets and musicians. According to Martha Fleming, ‘Artists and doctors share highly developed observational skills and a fundamental love for humankind’. Luke the Greek physician, patron saint of artists, physicians, students and surgeons (and, interestingly, also of butchers), was an early physician/painter and the first painter of icons (including those of the Virgin Mary and child and Saints Peter and Paul). In the first century AD, Luke wrote the Gospel of St Luke and the Book of the Acts of the Apostles, which has been followed by a long list of physicians writing creatively outside their field of medicine. There were several whose novels I enjoyed while contemplating medical school. Frank G Slaughter was an American novelist and surgeon, whose novels sold millions of copies. Slaughter ignored the advice to ‘stick to operating’ from his Pulitzer Prize winning patient and published his first novel, That None Should Die, in 1941. He went on to write a further 55 novels, his last being Transplant in 1987. That None Should Die dealt with socialised medicine and The Road to Bithynia (1951) captured the medical training that Luke would have undergone in Jesus’ time. Scottish novelist AJ Cronin’s The Citadel may have influenced the creators of the UK’s National Health Service. Richard Gordon’s hilarious Doctor in the House novels spawned movies and TV series and featured that most pompous of surgeons, Sir Lancelot Spratt, and his retinue of sycophantic junior staff, nurses and students. Arthur Conan Doyle began writing as a student at Edinburgh University. He specialised as an ophthalmologist, but began to develop the exploits of the legendary sleuth Sherlock Holmes when his practice proved slow. Doyle had Holmes employ the scientific thinking in the course of reasoning out a diagnosis used by Joseph Bell, his former teacher and chief, to solve crimes ... ‘It is most certainly to you that I owe Sherlock Holmes ... around the deduction and inference and observation which I have heard you inculcate’. Interestingly, there is an South African-Doyle connection – Doyle served during the second Boer war. Arriving in Cape Town in March 1900, he was assigned to the Langman Enteric Hospital in Bloemfontein. He wrote of the experience, ‘the general condition of the town was very bad. Coffins were out of the question, and the men were lowered in their brown blankets into shallow graves at the average rate of sixty a day. A sickening smell came from the stricken town. Once when I had ridden out to get an hour or two of change, and the wind changed ... You could smell Bloemfontein long before you could see it. Even now if I felt that lowly death smell compounded of disease and disinfectants my heart would sink within me.’ Britain’s conduct in the war – her scorched earth policy and establishment of concentration camps – was widely criticised. In a mitigating response, Doyle wrote ‘The War in South Africa: Its Cause and Conduct’ to emphasise that 14 000 British soldiers died of disease during the conflict, in addition to 8 000 killed in combat. Like Doyle, Kopano Matlwa, a contemporary South African doctor/ novelist, began writing as a medical student. She won the European Union Literary Award and the Wole Soyinka Prize for African Literature in 2010 for her debut novel Coconut that dealt with young blacks negotiating life in the ‘new’ South Africa and was listed for the 2011 Sunday Times Fiction Prize for her subsequent novel, Spilt Milk. Doctors’ success as writers is a reflection of their dealing with patients’ narratives, repeating these in the course of case presentations and documenting consultations, histories and physical examinations, to which all apply analysis and interpretation. According to McLellen, it is ‘through their privileged and intimate contact with those moments of greatest human drama (birth, illness, injury, suffering, disease, death) that physicians are in a unique position to observe, record and create the stories that make us human’. The connection between medicine and poetry was honoured by the ancient Greeks under the dominion of Apollo and there are many well-known modern doctor/poets – John Keats comes to mind. In 2011, the School of Medicine at Yale University and the Medical School at the University College London jointly sponsored a students’ poetry contest that attracted more than 160 entries. The winning poems are worth reading. Many physicians are musicians: the world’s great cities sport symphony and chamber orchestras comprising members of the profession, which are also worth a listen.