The Doctor | |
---|---|
![]() | |
Artist | Luke Fildes |
Year | 1891 |
Medium | Oil on canvas |
Dimensions | 166 cm× 242 cm(65 in× 95 in) |
Location | Tate Gallery, London |
The Doctor is an 1891 painting by Luke Fildes that depicts a Victorian doctor observing the critical stage in a child's illness while the parents gaze on helplessly from the periphery. It has been used to portray the values of the ideal physician and the inadequacies of the medical profession. Different theories exist as to the painting's origin but it is most likely based upon Fildes' own experience of the death of his son. Critics have noted that Fildes omitted common medical equipment of his era in order to focus on the relationship between physician and patient.
The painting was commissioned by Henry Tate in 1890 as a work of "social realism" on a topic of Fildes' choosing to be displayed in the National Gallery of British Art, now known as the Tate Gallery London. [1] Fildes was paid £3,000 for the work, a sum he felt was too small for such a painting and less than he expected for painting portraits. [2] Two Victorian doctors, Dr Thomas Buzzard (neurologist) and Dr Gustavus Murray (obstetrician), have been particularly associated with the painting, as has the genre of the period in which it was painted. [3] Fildes had the particular desire "to put on record the status of the doctor in our time". [1]
Different theories exist as to the origins of the painting. [4]
The most important personal influence was probably the death of Fildes' first child, his one-year-old son, Philip, from typhoid fever on Christmas morning, 1877. [5] Fildes' biographer has described how the boy's death compelled Fildes to paint a picture revolving around the compassionate Dr Murray visiting his dying child. The story was confirmed later by Fildes' second son, who described this as Fildes' "quickest painted of his 'big' pictures". [6]
Documentation of Fildes' work with the homeless reveals that a child was once brought into the studio by a labourer, a scenario which prompted the painting The Widower (1876). This painting included many features later seen in The Doctor. [1]
Fildes most likely modelled the characters in the painting on his own family and himself. Observing photographs of himself, Fildes guided his models, who were frequently his friends. His daughter was likely the prototype of the sick child, and a professional model was used for the mother. [8] The child's resting hand and extended arm may have been drawn from Fildes' older son. Despite reports that doctors visited Fildes in the hope of being used as models, the final painting of the doctor resembles Fildes himself. [6]
Paying tribute to his family origins in the fishing industry, Fildes adds a fishing net hanging from the ceiling. His father was a mariner and shipping agent. [9]
The cottage setting has led some to believe that the painting was ordered by Queen Victoria to honour her own physician, Sir James Clark. This alternative account also originates in the story about her physician being sent to Balmoral to care for the sick child of a servant. [4] [10] This account, however, is simply groundless because not a single contemporary reviewer mentioned this episode when the picture was first exhibited in 1891 at the Royal Academy in London and Fildes himself made no mention of Queen Victoria in his several interviews concerning the painting. [11]
18th and 19th century concerns by society of the rise of scientific medicine also could have possibly influenced the format of the painting. [4]
The painting was first exhibited in 1891. [4] Prior to completion, a number of sketches were made which are preserved at the Tate Gallery and depict various alternative compositions such as the doctor being on the right side of the canvas, the child seated rather than lying down, and different facial expressions for the doctor. [12] Fildes built a model cottage to copy after visiting numerous cottages in north-east Scotland, ensuring that the picture included authentic detail of roof rafters, tablecloth, lampshade, and lighting. [10] Particular attention was paid to ensuring the room had a poor, Victorian, multi-purpose appearance. [9]
The focus of the picture is the worried but sympathetic physician and the sick child, with everything else in the shadows. The child had experienced a 'crisis', the critical stage of a potentially life-threatening illness. [4] The 'dawn' light through the window, represents recovery and hope as the child survived the night. [12]
The concentrated focus of the doctor on the child shows the patient as a person and individual and the doctor as a compassionate carer with empathy for the patient's suffering. [5] [13] In 2002, Douglas wrote in the British Medical Journal , "So his manner is all, and Fildes captures it forever: the furrowed brow; the hand propping the firm bearded chin; the calm, concerned authority". [4]
The parents are insignificant, helpless, and not central to the picture. A father gives support to his wife by extending his arm and resting his hand on her shoulder. She appears to be crying and possibly praying. [5] He, however, is also helpless and peers on at the doctor and child. [4]
The artificial light from the lamp on the table and the natural rising sunlight beginning to shine through the single window suggest that the doctor has been in attendance all night. [6] A distressed, poor, and modest family is depicted by one small carpet and the washing suspended in a small room. [6] Two mismatched chairs, pressed together, construct a makeshift bed in the labourer's cottage. [4] A couple of scrunched up papers lie on the floor, "most probably a filled prescription" which has been frustratingly discarded. [9] An easily missed medicine bottle is placed in the shadow of the lamp and in close proximity to the doctor and his control, not the parents'. [9]
Fildes stated that his choice of subject was "to put on record the status of the doctor in our own time", [4] but his depiction of 19th-century healthcare is not entirely accurate. There is no stethoscope, microscope, sphygmomanometer, or thermometer in the picture, well-known instruments of physicians in the late 19th century which saved time. [4] It may be that these instruments were omitted in order to show the doctors' "professional and personal commitment". [6] Fildes does include a pestle and mortar, and a cup and a spoon, equipment used before the scientific era of medicine. [4]
It has also been pointed out that it was unlikely that a Victorian physician would make an overnight home visit to a poor family, such services being available only to the middle class and the wealthy. [4]
The painting caught the public's attention and toured Britain. Received with a striking admiration, there is one report of an observer who, overwhelmed at the painting, died on the spot. [9] The work is considered one of the most famous depictions of the practice of medicine and has been described as "iconic". [6] It epitomises an idyllic kind of medicine [1] and has often been used to illustrate the virtues of a good doctor and the inadequacies of the medical profession. [4]
Subsequently, the painting received comments including this by surgeon W. Mitchell Banks: "What do we not owe to Mr. Fildes for showing to the world the typical doctor as we would all like him to be shown – an honest man and a gentle man, doing his best to relieve suffering?" He continued: "A library of books written in your honour would not do what this picture has done and will do for the medical profession in making the hearts of our fellow men warm to us with confidence and affection". [9]
Seen today as "Victorian spin" by some, in its time the depiction of the doctor as a hero serving the poor raised the status of the medical profession during a period when public opinion was critical of the increasingly impersonal nature of medicine. [4]
The painting has inspired poetry and film. [4] In 1911 it featured in a Punch cartoon commenting satirically on the effect of the National Insurance Act 1911 on doctors. [14] In 1933, the American artist Joseph Tomanek painted a version of the painting making small changes to the composition. [16] In 1947 it was reproduced on a United States postage stamp for the centenary of the American Medical Association, [9] which in 1949 used it in their campaign against nationalised medical care as proposed by President Harry S. Truman. The image was printed on 65,000 posters and brochures with the slogan, "Keep Politics Out of this Picture". This has been described as contributing to public distrust of nationalised medical care in the United States. [17] By contrast, in Britain it was used as the emblem for a celebration of Britain's National Health Service. [9]
In 1933, a sculpture of the scene in the painting was made using the "life-size, life-like, new art form" of sculpticolor and displayed at the Petrolagar laxative exhibit in the Hall of Science at the Chicago Century of Progress exhibition. It was cast from a model made by the sculptor John Paulding and then painted by Rudolph F. Ingerle, the entire work measuring 15 feet (4.6 m) in length, 11 feet (3.4 m) in height, and 9 feet (2.7 m) in depth. Publicity stated that "The Doctor impressively emphasizes the ideal relationship between physician and patient - 'The Human Touch'". [18] [19]
As late as 1951, the painting was used in advertising for Wyeth pharmaceuticals, which repeated the story that Queen Victoria commissioned it, adding: "the pictured child recovered despite the inadequacies of her humble home–a tribute to her doctor's genius and to the progress of medical science". [20]
Since the mid-1990s, the medical humanities journals The Lancet and the British Medical Journal have revived interest in the painting, stimulating discussion about the role of the doctor. [9] Debate on the role and status of doctors has led to the inclusion of medical humanities in medical schools, where this painting has been used as a teaching aid for medical students. [5]
The reason for the painting's popularity has been much debated. The universal sentiment associated with a doctor tending to a sick child appears simple. Ultimately, it is likely that The Doctor was hailed as iconic due to the wish to be cared for with single-minded attentiveness. [9]
Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths or homeopathic physicians, believe that a substance that causes symptoms of a disease in healthy people can cure similar symptoms in sick people; this doctrine is called similia similibus curentur, or "like cures like". Homeopathic preparations are termed remedies and are made using homeopathic dilution. In this process, the selected substance is repeatedly diluted until the final product is chemically indistinguishable from the diluent. Often not even a single molecule of the original substance can be expected to remain in the product. Between each dilution homeopaths may hit and/or shake the product, claiming this makes the diluent "remember" the original substance after its removal. Practitioners claim that such preparations, upon oral intake, can treat or cure disease.
A physician, medical practitioner, medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.
Christian Friedrich Samuel Hahnemann was a German physician, best known for creating the pseudoscientific system of alternative medicine called homeopathy.
Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns", a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.
Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman". The term quack is a clipped form of the archaic term quacksalver, derived from Dutch: kwakzalver a "hawker of salve" or rather somebody who boasted about their ‘salves’, more commonly known as ointments. In the Middle Ages the term quack meant "shouting". The quacksalvers sold their wares at markets by shouting to gain attention.
A medical license is an occupational license that permits a person to legally practice medicine. In most countries, a person must have a medical license bestowed either by a specified government-approved professional association or a government agency before they can practice medicine. Licenses are not granted automatically to all people with medical degrees. A medical school graduate must receive a license to practice medicine to legally be called a physician. The process typically requires testing by a medical board. The medical license is the documentation of authority to practice medicine within a certain locality. An active license is also required to practice medicine as an assistant physician, a physician assistant or a clinical officer in jurisdictions with authorizing legislation.
Allopathic medicine, or allopathy, is an archaic and derogatory label originally used by 19th-century homeopaths to describe heroic medicine, the precursor of modern evidence-based medicine. There are regional variations in usage of the term. In the United States, the term is sometimes used to contrast with osteopathic medicine, especially in the field of medical education. In India, the term is used to distinguish conventional modern medicine from Siddha medicine, Ayurveda, homeopathy, Unani and other alternative and traditional medicine traditions, especially when comparing treatments and drugs.
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was 'general practitioner' in the US; however in the United Kingdom and other countries the term general practitioner is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote primary care providers.
Sir Samuel Luke Fildes was a British painter and illustrator born in Liverpool and trained at the South Kensington and Royal Academy Schools. He was the grandson of the political activist Mary Fildes.
Drexel University College of Medicine is the medical school of Drexel University, a private research university in Philadelphia, Pennsylvania. The medical school represents the consolidation of two medical schools: Hahnemann Medical College, originally founded as the nation's first college of homeopathy, and the Woman's Medical College of Pennsylvania, the first U.S. medical school for women, which became the Medical College of Pennsylvania when it admitted men in 1970; these institutions merged in 1993, became affiliated with Drexel University College of Medicine in 1998, and were fully absorbed into the university in 2002. With one of the nation's largest enrollments for a private medical school, Drexel University College of Medicine is the second most applied-to medical school in the United States. It is ranked no. 83 in research by U.S. News & World Report.
The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. The trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties.
The Agnew Clinic is an 1889 oil painting by American artist Thomas Eakins. It was commissioned to honor anatomist and surgeon David Hayes Agnew, on his retirement from teaching at the University of Pennsylvania.
Bullying in the medical profession is common, particularly of student or trainee physicians. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession which may result in a bullying cycle.
A Clinical Lesson at the Salpêtrière is an 1887 group tableau portrait painted by the history and genre artist André Brouillet (1857–1914). The painting, one of the best-known in the history of medicine, shows the neurologist Jean-Martin Charcot giving a clinical demonstration with patient Marie Wittman to a group of postgraduate students. Many of his students are identifiable; one is Georges Gilles de la Tourette, the physician who described Tourette syndrome.
Science and Charity is an oil on canvas painting by Pablo Picasso, which he painted in Barcelona in 1897. It is an example of one of Picasso's earliest works, as he painted it when he was only 15 years old. The painting depicts a formal composition of a sick patient in bed, attended by a doctor and a nun holding a child. It was the culmination of Picasso's academic training and displays his talent as an artist before he moved away from this style to pursue his own artistic career. The painting is housed in the collection of the Museu Picasso, Barcelona.
Homeopathy Looks at the Horrors of Allopathy is an allegorical painting by Russian artist Alexander Beideman, painted in 1857. It is owned by the Tretyakov Gallery in Moscow, Russia. The picture measures 65.5 × 77.3 cm. and has the accession number 1795. In the 19th century, the painting was also known as Triumph of Homeopathy.
Thomas Lovell Buzzard MD FRCP was a Victorian English doctor who worked at the National Hospital, Queen Square. He was a pioneering neurologist who founded an epilepsy society and wrote also on Parkinson's disease. One of the last doctors to be trained through the apprenticeship route, Buzzard witnessed the Crimean War and later was a role model for the famous painting The Doctor.
Gustavus Charles Philip Murray was a British obstetrician who may have been the inspiration for Luke Fildes' 1891 painting The Doctor. His work in the examination of pregnant women was recognised by Adolphe Pinard in 1889 but ignored in England. He was popular with his patients and had a thriving practice with many professional appointments but as a result wrote little. He died at the age of 56 years from heart failure.
Applicants for Admission to a Casual Ward is an 1874 oil painting by British painter Luke Fildes, a key work in nineteenth-century British social realism. The painting shows a street scene of impoverished and weary men, women and children waiting by the side of the road outside a police station, huddled against the cold evening, waiting to be given a ticket for temporary admission to a workhouse for the night. Many resisted taking up permanent residence at the workhouse, where men and women would be separated, and would be required to work to pay for their board and lodging; once they entered, many only left when they died. Instead, from 1864, if the police in London certified that a person was genuinely in need, they could stay for one night on a "casual" basis, and leave the next morning, but they would have to queue up again for temporary admission the next evening. Poverty and vagrancy were pressing issues in Victorian London, and the issuance of "casual" tickets doubled from around 200,000 in 1864 to over 400,000 in 1869.
Charles Stone Bryan is an American retired infectious disease physician, researcher, author and Heyward Gibbes distinguished professor emeritus of internal medicine at the University of South Carolina School of Medicine (UofSC). His contributions to medicine have included working on a formula for administering the maximum possible dose of penicillin to people with kidney failure which would treat the infection and avoid penicillin toxicity, and treating and writing on HIV/AIDS. He is also a noted medical historian and an authority on the life of William Osler.
Media related to The Doctor at Wikimedia Commons