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Klimt, Modernism, and Art’s Relationship with Medicine

The following manuscript was submitted to the April 2017 Arts in Medicine Themed Writing Contest.

In 1894, the State Ministry of Culture, Religion, and Education in Vienna commissioned three paintings for the ceiling of the Great Hall of the University of Vienna to celebrate the institutions accomplishments of Philosophy, Medicine, and Jurisprudence. When the artist who painted these works chose to make a bold stylistic statement, all three were heavily criticized for their eroticism, obscenity, and “ugliness” (Kandel 2012). The creation of these paintings nevertheless marks a critical transition in art history, one which redefined the aesthetic in art and the role of the viewer in its interpretation. Philosophy, Jurisprudence, and Medicine established the Viennese artist Gustav Klimt as a pioneer of the Modernist art movement and became known as some of the earliest examples of Modernist ideologies manifest in art.

Gustav Klimt, Medicine, 1907.

Modernism itself took root in the universities and medical institutions of Europe and came to fruition through the realization of these paintings. The cultural climate of scientific discovery in Vienna at the turn of the century was critical in shaping Gustav Klimt’s ideologies and largely originated in his exposure to the Medical University of Vienna. In response to a criticism that Klimt created “ugly art,” Franz Wickoff of the Vienna School of Art History argued “that the modern period has its own sensibilities and that those who see modern art as ugly cannot face modern truths” (Kandel 2012). In this paper I would like to focus my discussion on uncovering what professor Wickoff meant by the “modern truths,” as revealed through the painting Medicine and how these truths contrasted with the representation of medicine in the art of the past.

Modernism is a school of thought that arose in the mid-19th century as a reaction to the realization that human behavior is inherently emotional and irrational, an idea that stood in direct opposition to the Enlightenment’s belief in the power of human reason over chaos (Foster 2004). Modernism’s ability to realize, and then to uncover, the ubiquitous sexual and aggressive impulses in human kind was inspired by Friedrich Nietzsche, Charles Darwin, Carl von Rokitansky and Sigmund Freud. It substantially influenced art and literature and was brought to the public eye through the works of Gustav Klimt, Oskar Kokoshka, and Egon Schiele (Kandel 2012). Gustav Klimt’s vision was unsettling to its public because he chose to marry traditional painting with Byzantine iconography to promote the controversial image of a powerful (often other-worldly), sexual, and aggressive female (Di Stefano, Klimt et al. 2008). By marrying the changing cultural perspectives of modernity with traditional aesthetics in his work, Gustav Klimt’s paintings became immensely controversial while simultaneously opening the door to his purely Expressionist contemporaries Kokoschka and Schiele (Klimt, Schiele et al. 2005). But in order to understand the many element’s of Gustav Klimt’s Medicine and why they became uncomfortable (“ugly”) for his critics, we must first understand the intellectual environment that led to the development of Modernism. For this, we must look at Vienna in the year 1900, when the exchange of intellectual ideas between doctors, scientists, and thinkers, led to the revolutionary ideas that broke with the Enlightenment and forced the world to turn a critical eye on its own subconscious.

In the year 1900, Vienna possessed a unique position in the world as a cultural and intellectual leader in the fields of philosophy, psychology, medicine and art. An organic flow of ideas existed between the leaders of these seemly separate fields and came to mutually influence the intellectual environment of Vienna. Such interactions began at the college-preparatory level and instilled an early interest in science, humanities, and art among the educated Viennese. The flow of ideas was encouraged and facilitated by the face that Vienna had only one major university, which included the general hospital (Brandstätter 2006). University-educated professors and students would meet and discuss their ideas in select coffee houses, and later, in the fashionable salons held in private homes (Kandel 2012). Arguably the most influential of these was hosted by Berta Zuckerlandl. Berta was herself intellectually diverse and was a writer, and art critic, founder of the Salzburg Music Festival, a student of biology and of Darwinian evolution, and married to the famous anatomist Emil Zuckerlandl. Emil Zuckerlandl was in turn, an associate of Carl von Rokitansky who served four terms as dean of the Vienna School of Medicine who perfected union between the study of medicine and scientific investigation.

The Vienna School of Medicine served a major cultural role in Vienna role in that it inspired Freud, Arthur Schnitzler, and Klimt, with Berta Zuckerlandl serving a major role in facilitating the exchange of ideas among these pioneers of Modernism and the human subconscious (Schultheiss 2007). In 1844 Carl von Rokitansky became head of the Vienna School of Medicine and worked to place the study of medicine on a firm scientific base. His inspiration in turn came from his to Darwinism and concept of the human being as a product of biology no different from the rest of the animal kingdom. The human body as a product of its evolution, constrained to the rules of scientific reasoning, inspired Rokitansky to abandon culture and tradition as forces influencing the study of medicine (Finkelstein). In his efforts to study disease scientifically, he separated clinical medicine and pathology into different departments and by doing so perfected a distinctly contemporary protocol of diagnosing diseases by correlating them with the underlying gross pathology (Porter 1998). As an early precursor to the idea of “looking beneath the surface,” that would characterize the basis of Modernism, this approach helped to inspire the thinking of intellectuals in wildly different fields.

Before the 18th century, medicine was still largely practiced as prescribed by Hippocrates more than 2000 years ago. Hippocratic medicine was characterized by its emphasis on holism, most notably in the notion that health and disease was due to an imbalance in the four bodily humours. While Hippocrates rejected spirituality in his understanding of disease, the origins of Greek medicine is heavily rooted in religious beliefs. Healing temples dedicated to the god of medicine, Asclepius, were abundant throughout ancient Greece. Ironically, one of these was in the backyard of Hippocrates’ home on the island of Cos (Bynum 2008). In addition, temples devoted to his daughter Hygieia, the merciful goddess of healing dotted the Greek cultural landscape. These temples were run by priests that would receive patients and interpret illness based on dreams that the patients reported to them, much in the same way Freud would do thousands of years later. The patient’s dreams were thought to be affected by holy snakes and the patient would only be cured when the snake sloughed off its skin, and with it, the patient’s affliction. Modern medicine pays tribute to its ancient Greek origins through the universal symbol of Caduceus, the holy snake wrapped around Asclepius’ staff.

In Klimt’s Medicine, Hygieia holds the holy snake of the Caduceus and confronts us with her penetrating stare in the foreground of the painting. Her half-lidded eyes and the bright ornamentation of flowers (representing fertility) make her stunningly sensual. As she confronts us, she turns her back on the wild spiraling mass of human bodies separated from each other only by the clean space representing the river of life. Hygieia’s bright encrusted robes are characteristic of Klimt’s popular “golden period,” inspired by early Byzantine mosaics (O’Connor 2012). By casting Hygieia in gleaming golden iconography, Klimt empowers the Goddess while simultaneous severing her connection with the suffering, naked, humanity behind her. Interestingly her hands and face are the only part of her that seems human, the rest obscured in iconography. The use of hands to communicate a subconscious message, as Hygeia does here of power and sexuality, will later inspire and later become major features of the works of Kokoshka and Schiele, the Modernist contemporaries to Klimt (Di Stefano, Klimt et al. 2008). Hygieia’s hands directly mirror the positions adopted by many of Klimt’s heroines in other paintings. The position implies an inward sexual tension and power. By examining the unnaturally severe angle of her forearms, wrists, and fingers, we can almost the tension in the muscle that holds here here. The same positioning seen in The Kiss and Adele Bloch-Bauer serves to highlight the underlying implied sexuality of the subjects while underscoring an implied aggression (Kokoschka, Schiele et al. 2005). In a truly Modern fashion, Klimt does not overtly portray his Goddess as a sexual creature but relies on subtlety and his viewer’s subconscious imagination to communicate this message. Additionally, Klimt’s use of the snake, Hygeia, and the river of life in Medicine implies not only knowledge of medical history but also serves as a criticism of medicine’s past reliance on cultural folklore. A relationship which Medicine implies was cruelly unconcerned with human suffering.

Hippocratic medicine was transmitted to the West through the writings of Galen (129-200 AD) which continued to be studied through the 18th century. While Galen continued to focus on the idea of humours, he linked his understanding of Hippocratic medicine with a basic theory of physiology. Because his experimentation largely depended on the dissection of pigs and monkeys, these theories of physiology were understandably incorrect. Nevertheless, his theory of circulation would continue to exist until 1628, when William Harvey published his experiment-derived understanding of the system (Porter 1998). Because of the reliance of doctors on these writings, medicine during the period of the middle ages was based on study of the classics, a luxury which very few people had access to. Art from the middle ages to the 18th century showed the physician as a scholarly man, often disconnected from the suffering and care of humanity. As a result, Christianity came to play a much larger role in the collective “health” of humankind at this time (Bordin and Polo D’Ambrosio 2010).

In one of the earliest artistic portrayals of Hippocrates and Galen the figures of the two scholars are stylistically portrayed as old men with flowing white beards. The prototype for this image is the figure of the prophet, and this association between the scholar and the religious man was commonly understood (Bordin and Polo D’Ambrosio 2010). This fresco is found on the walls of a cathedral tomb, supporting this association. Their conversation, as evidenced by the writing on their books, concerns the origins of the universe. In this way, the artist depicted the Hippocratic saying that “A doctor who is a lover of wisdom is an equal of the Gods” (Emery, Emery et al. 2003). In placing these men in a position of other-worldly wisdom, they are unintentionally also removed from the suffering of humanity. In medieval art, Christian themes came to dominate portrayals of disease and healing. Saints and angels dominated the landscape of medieval medicine and doctors rarely played a role in artistic representation of disease until the 17th century.

Hippocrates and Galen 1231-51, fresco, crypt in the Anagni Cathedral.

In the middle ages, Christianity dominated views people held about death, disease, and social responsibility for the sick. The Seven Works of Charity, cited in the Gospel of Matthew (25:31-46) were considered the origins of a Christian’s charitable acts. Because the bible preached that “what is done to the poor, to pilgrims, and to beggars is done to Christ,” care for the sick and indigent was deemed both a personal and a social responsibility. Poverty at the time was called “morborum genitrix” (mother of maladies), and consequently the Christian need to care for the poor also translated into a responsibility to care for the sick (Bordin and Polo D’Ambrosio 2010). In The Seven Acts of Mercy, Master of Alkmarr locates acts of charity in the everyday lives of urban Europeans (Emery, Emery et al. 2003). In assuming responsibility for the poor, poverty’s connection to disease places power over disease into the hands of ordinary people. Art at this time served a functional role. Because people were largely illiterate, painting served as an effective means of mass “education.” Therefore, Alkmarr’s painting is created with very concrete goals in mind: to teach the masses how they should behave to be good Christians. In a way that allows the viewers of these pieces to identify with the figures in the paintings, he places the action and characters at the center of each work. The people are framed by the familiar walls and silhouettes of their city. The presence of angles (in panels 1 and 4) and saints in these scenes of urban life serve to remind the viewer that he lives in a world where his moral decisions are closely observed.

Master of Alkmaar, The Seven Acts of Mercy, 1504, Amsterdam, Rijksmuseum.

In contrast, Carvaggio’s The Seven Acts of Mercy aims to communicate the same basic ideas as the work of Alkmarr but in a distinctly different Boroque style. In it, Carrvagio used the interplay of light and dark to represent the acts of charity as projected onto mankind through divine light. Alois Riegel, an influential art historian of the twentieth century argued that artists in every age aim to educate their viewer about some new dimension of truth, and that this truth is dependent on the culture of the society to which the artist belongs. In his book “the Group Portraiture of Holland,” Riegel argued that art of the Byzantine, Gothic and Renaissance periods was designed to illicit idealized feelings of piety, faith, pity, pathos, and fear by means of figuratively reproducing the religious hierarchy of the Roman Catholic Church through art (Olin 1992). In Carvaggio’s The Seven Acts of Mercy, three-dimensional space is used to promote the idea of moral hierarchy through the use of composition, space, shadow, and light. As a result, we see the divine figures of the angels overlooking humanity at the top left corner of the painting. Light flows organically from the angels down to the lowest figures of humanity, in this case, the naked beggar in the foreground. The painting is an early precursor to Modernism because in it we can see Carvaggio struggling with his own subconscious guilt. He was notorious in his time for his love of brawling and lethal weapons. When he was commissioned to paint the Seven Acts of Mercy, he was an outlaw seeking refuge in the city of Naples shortly after he killed a man in a casual sword fight. In the painting we see at the foreground a haughty young nobleman holding a shining sword as he stands over a beggar in the street (Warwick and Caravaggio 2006). But the man here has lifted his sword not in anger but in charity: he aims to cut his cloak in half to clothe the naked man. Carvaggio places these two men at the front and center of our attention and the divine light seems to illuminate the back of the homeless man more than that of any other character in the painting. By placing the scene of charity not in a holy land, but in the streets (as Alkmarr did), Carvaggio seems to suggest that charity, and perhaps also retribution, is something that can be achieved through daily acts of charity (Warwick and Caravaggio 2006).

Carvaggio, The Seven Acts of Mercy, 1606-7, Naples, Pio Monte della Misericordia.

In Miracle of Saint Patrick, we see Tiepolo utilizing similar themes of hierarchy to communicate his message to the viewer. However, unlike in the previous painting, here the artists attests that the performance of “miracles” is a blessing only possessed by the very few. The Saint clearly stands out from the desperate ordinary people at his feet. His divinity is not only represented in the contrast between his white robes and the dark clothing of the men and women around him, but also in his physical elevation in space. The viewer, however, is placed on the same level as mankind around him. The role of the beholder in these Renaissance paintings is thus intended to be one of the pious, respectful observer (Olin 1992). In this way were are not meant to be inspired into action, as Carvaggio’s painting would have us do, but rather inspired into respectful worship. We are encouraged to acknowledge that divine miracles are out of the hands of humanity, as is disease, sickness, and healing.

Giambattista Tiepolo, Miracle of Saint Patrick, ca. 1740, Padua, Museo Civico.

In looking at the painting Medicine, we see that Gustav Klimt has broken with the traditions of early painting in numerous ways. By placing the divine goddess of healing at the level of the observer, he has placed us into intimate contact with her. She stares directly at us from the painting, challenging us to accept our own power over the humanity that she has neglected. In addition, by casting her down to our level, Klimt challenges us to question the value of mythological powers of healing. Medicine contrasts with Carvaggio’s painting additionally in that the space in the painting has been flattened from three to two dimensions. In the vertical column of bodies, one cannot distinguish between one body and the next. Interestingly death is central, and therefore integral to this column of bodies. The empty space on the left side of the mass, representing the river of life, is bridged by two solitary limbs: that of a man and woman (Klimt, Schiele et al. 2005). Even as we see death in the masses of flowing bodies behind Hygieia, life and fertility is represented by this bridge. Upon closer observation, we start to realize that even the figure of death is covered by tiny symbols of fertility. Many argue that these are images of early embryos, symbols which Klimt used extensively though much of his work. He was able to observe these cellular forms through his extensive interaction with Vienna School of Medicine, most notably Emil Zuckerlandl (Kandel 2012).

The vertical mass of suffering human bodies in Klimt’s painting mimics the artistic representation of disease and suffering that was utilized in medieval art. Many of these paintings dealt with the terrifying experiences people faced during the plague of Europe. Between 1347 and 1350, the plague caused the deaths of approximately forty-three million people, broke down communities and families, and restructured the moral foundations of the Middle Ages (Porter 1998). By necessity, its rapid spread from person to person helped to facilitate the formation of an early form of public health. While physicians maintained that plague was caused by airborne “miasmas,” illustrations as early as 1349 depict ordinary people burning the clothing and possessions of the dead, for fear of “contagion”(Bynum and Porter 1987). Paintings from this time also depict the widely held belief that the plague was a curse sent to humanity from heaven as punishment for sinful behavior. Desperation, and the realization that neither doctors nor religious leaders (mortality rate among the clergy was reported around 90%) were immune to the plague, led the prevalent theme of death’s domination over life in many renaissance paintings.

One of the most famous of these, The Doctor (of a series known as The Dense Macabre), depicts a skeletal corpse challenging a doctor (Philadelphia Museum of Art. and Karp 1985). In this image, the skeleton hands the doctor a flask of urine from a sick elderly man, and in so doing figuratively challenges him to take the patient away from death’s possession. This print is significant not only in that it captures the sense of desperation and powerlessness that was felt during plague times, but that it directly pokes fun at the powerlessness of doctors, the “pisse prophets” of the middle ages. In a similar way, Hygieia in Klimt’s Medicine confronts the viewer, the future doctors of the hall of the University of Vienna. By challenging the viewer with death and humanity to her back, she metaphorically asks if we truly believe medicine can change the natural order of human life.

Hans Holbein the Younger, The Doctor, detail of the Danse Macabre, 1538, woodcut.

In The Doctor woodcut, Hans Holbein puts death and the living into close proximity while figuratively allowing them to challenge and oppose one another. In Klimt’s work, the skeletal form of death becomes a central figure in the vertical column of humanity. We can almost imagine that his removal from the composition would lead to the collapse of the fragile human forms around him. In renaissance art, the presence of death in paintings became almost ubiquitous during the height of the plague years. Pieter Bruegel the Elder’s haunting landscapes created a morbid anxious tension through the use of meticulous detail and flattened space. In his 1562 painting The Triumph of Death humanity is dwarfed and distant. Tortured, dying human bodies take on the same dimension as the skeletal corpses that drag them away. The loss of the comforting hierarchical structure that we observed in religiously themed paintings of the time serves to alienate the terrified viewer. This loss of order and hierarchy hints to a figurative loss of divine protection(Olin 1992). In the bottom right corner of the painting, we see a group of young lovers, and card players, a clear indication by the painter that this devastation on humanity is a form of divine punishment for immoral behavior. In Verona Suppliant at the Feet of the Trinity, a painting created almost a century later and after the worst of the plague years had ended, we see the hierarchy of divine power return in the composition to punish humanity below. Here, the personified city of Verona kneels above the dead bodies of her citizens and begs for forgiveness from the unsympathetic forms of the Trinity above. In this composition, the hierarchy of the angry Gods dwarf the defenseless mankind below. In both paintings we see how the painters have isolated and alienated mankind. Our participation in these compositions and the observer is meant to illicit fear, obedience, and piety. Klimt’s Medicine in contrast, becomes a true work of Modernism in that its interaction with the viewer is intended to promote a much more introspective discussion. In the piece, Hygieia challenges us to look within ourselves and decided whether we alone are except to the column of bodies behind her. We are not simply looking at her, she is also confronting us with her gaze.

Pieter Bruegel the Elder, the Triumph of Death, 1562-63, Madrid, Museo del Prado.

Antonio Giarola, Verona Suppliant at the Feet of the Trinity, 1630, Verona San Fermo Maggiore, Chapel of the Conception.

Art of the time of the 17th century remained critical of the accomplishments of physicians, even as the movement of Enlightenment took hold of Europe and brought with it the promise of global scientific accomplishments. Holland in the 16th and 17th centuries was a democratic society that was tied together by a cultural understanding of civic responsibility. This political environment, attests Riegl, promoted painting focused on everyday life and allowed artists to place their viewers on the same physical level as the subjects of the paintings (Olin 1992). Similarly, the aesthetic tradition of portraying figures in a hierarchy of moral order were not typical of Dutch painting. As a result, “genre” painting was among the first to focus on scenes of everyday life where observers were metaphorically placed on a similar plain as the subjects in the work. Among themes that were popular were those portraying the doctor at work (Emery, Emery et al. 2003). As such, Dutch painting of the 16th and 17th centuries portrays the changing attitudes of society towards medicine. The Quack Doctor by Gerrit Dou, illustrates the common perception of the doctor as a medical swindler. Here we see a man comically and extravagantly dressed, who attempts to peddle “potions” under a silk chinese umbrella (Emery, Emery et al. 2003; Bordin and Polo D’Ambrosio 2010). The bustle of life around him is either only passively amused or ignores him all-together. Through the use of a woman changing her babies diaper beneath his stand, the artist seems to make a subtle statement about the legitimacy of his claims. According to a critique by Alan and Marcia Emery “the little boy trying to catch a bird [seems to] imply the elusiveness of trying to find an effective cure” (Emery, Emery et al. 2003). Likewise, Gerrit Dou created the Physician in 1653, a painting which shows a finely dressed young man examining the urine of an anxious patient behind him. Again, the doctor is portrayed in lavish robes and surrounded by textiles and finery, all pointing at his pretentiousness and privileged position in life. In the corner, a copy of Veslius’ De Human Corporis Fabric looms in a manner to suggest the physicians credibility. Important here is the contrast between this lavish young man and the sick person behind him. While the doctor is fulling devoted to the flask of urine, his anxious patient is practically hidden in gloomy shadow. The extreme difference between wealth, social standing, and education between the two men is made abundantly clear. Perhaps Dou is saying that the physician’s dedication to books and “pisse” overwhelms his ability to relate to the patient who he is supposedly serving. Like Hans Holbein’s Dense Macabre, we are also left wondering what benefits uroscopy could really bestow on its patients.

Gerrit Dou, The Quack Doctor, 1652, Museum Boijmans Van Beuningen, Rotterdam.

Gerrit Dou, The Physician, 1653 Christchurch Gallery.

The representation of medicine in art underwent a dramatic transformation during the age of enlightenment. During this period, scientific progress allowed for physicians to understand pathophysiology in ways they could never have been for. By opening their minds to the possibility of scientific accomplishment, physicians began to possess greater power over the course of disease, and therefor over the well-being of their patients (Bynum 2008). The Enlightenment, or Age of Reason, which dominated thinking in the 18th century was born as a reaction to the scientific revolution of the 16th and 17th centuries. The revolution is arguably the product of three triumphant discoveries in astronomy: Johannes Kepler’s description of the movement of the planets, Galileo Galilei’s placement of the sun at the center of the Universe, and Isaac Newton’s discovery of gravity, calculus, and description of the laws of motion (Porter 1998). In a period of intense scientific inquiry, these three landmark thinkers illustrated that even profound questions of the natural universe could be described through science. Success in the realm of science did not stop with physics and astronomy but allowed thinkers to assume that other aspects of human action, and human biology, could be improved through human reason. Thus the Enlightenment was, above all else, a celebration of the power of human reason over the chaos of the natural Universe. It is telling that this ideology, one that also assumes that people have a natural right in the “pursuit of happiness” contributed to the Jeffersonian Democracy in the United States (Kandel 2012).

In France, Enlightenment ideologies led to the reformation of social and political culture via the French Revolution, which lasted from 1789 to 1799. According to the historian Francois Aulard, the Revolution was characterized by a “suppression of the feudal system … emancipation of the individual … abolition of the privileges of noble birth, the establishment of equality, the simplification of life” (Aulard and Miall 1910). The guillotine, which in modern times has become synonymous with the revolution, was ironically the invention of a French physician who testified to its humanity (Porter 1998). This tool is a prime illustration of the combination of “idealism and inhumanity” that came to characterize the French Revolution. In its aftermath, hospitals were for the first time removed from the hands of the Church and placed into the hands of the nation. In addition, restrictions on the ability of doctors and students to conduct autopsies were lifted. The combination of the increased importance of secular medical care, the Enlightenment’s insistence on the power of science, and the huge numbers of patients available to French physicians ultimately led to what is now considered the “medical revolution” of the 18th century. Doctors in the aftermath of the French Revolution were among the first to stress the importance of physical examine over the study of ancient texts. As a result, doctors came to realize that their patients were killed by underlying “lesions,” which in turn were born of their diseases (Grell and Cunningham 2007). In this way, diseases came to be understood in much the same way that the physicists of the Enlightenment understood the universe — as being determined by key scientific laws. Doctors like Thomas Sydenham and Morgani in the 1760’s made morbid anatomy the clue to disease in the living (Bynum, Lock et al. 1992). Medicine in Paris became dubbed anatomico-pathological, in a way that distinguished it from the humoral-holistic medicine of Galen. In this way, the French Revolution freed medicine from the restrictions of its traditional past.

In line with the developments of medicine in France, we see a greater appreciation of the physician begin to emerge in art. In particular, we can contrast the two critical paintings of Gerrit Dou in the 17th century with the portrayal of Laennec in the early 19th by Theobald Chartran. In 1816 Laennec invented the stethoscope, an invention which was able to solidify the link between physical exam and the findings at autopsy that was the standard of medical practice in post-Revolution France. In addition, the stethoscope was unique in that it facilitated direct physical contact between the doctor and the patient, thereby encouraging an intimacy that was hitherto unseen (Porter 1998). In Dou’s depiction of the Physician the young man is in every way removed from the anxious patient behind him, both by virtue of his social stature (revealed by his elegant clothing) and education (the thick volume at his side). In contrast Laennec is in intimate contact with his ailing patient. With his ear pressed to the patient’s chest, and a stethoscope in one had, he exudes concentration and concern. The artist attempts to portray the doctor’s dedication to the sick patient in the silvery cold tones spilling from the wintery landscape outside and the hastily deposited pile of Laennec’s coat and hat in the chair, implying that he had just run into the room from the outside cold. The humanistic view of the physician by the community, and the community by the physician is perhaps also exemplified in Philippe Pinel’s treatment of the mentally insane. Under influence of the human-centered teachings of the Enlightenment, Pinel rejected the traditional methods of bleeding, purging, blistering, and shackling the psychiatrically ill and opted for a human patient-centered approach in treatment (Porter 1998; Grell and Cunningham 2007; Bordin and Polo D’Ambrosio 2010). A 1876 painting by Tony Robert-Fleury depicts Pinel’s act of mercy in a work titled Pinel Frees the Insane from their Chains.

Theobald Chartran, Rene-Theophile Hyacinthe Laennec Visits a Patient, early 19th century, University Paris-Sorbonne.

At a time in art when individual physicians began to gain celebrity status and were celebrated in paintings depicting academic medicine, it is perhaps significant that Klimt specifically omits the presence of doctor in his Medicine. It seems that Klimt would have considered this possibility in his depiction of the theme, given that he was commission to create his painting for the Medical School of Vienna. In omitting the role of the doctor, it may be that Hygieia is specifically challenging us to tackle the column of human life behind her. Perhaps in envisioning this painting in the great hall of the University, Klimt had pictured her challenging, and in so doing inspiring, the future physicians that walked through that hall. As the French style of diagnosis based on objective signs, physical exam, and autopsy continued, modern medicine seemed to move further from the intimacy indicated in Chartran’s painting. Ultimately, medicine changed under the French style in a way that was best summarized by the German physician Robert Volz when he said “the sick person has become a thing” (Kandel 2012). In attempting to reconnect physical diagnosis, pathology, and patient care, we are brought finally back to Germany and Vienna in the 19th century and the the social and cultural climate that would shape the ideas of Modernism.

While the Enlightenment was inspired by astronomy, physics, and mathematics, Modernism was principally inspired by biology. In 1859, Charles Darwin published his book The Origin of Species. In so doing, he brought to surface the radical idea that human-kind was not uniquely designed by an all-knowing God, but that it is subject to the same principles of survival as the rest of the animal kingdom (Emery 1968; Vall and Zwijnenberg 2009). As a result, it became clear that sex must be central to human behavior, just as it is with other animals. The Modernist ideology came into being as a result of the realization of the brutality of human existence, an idea which came into being as a reflection on the experiences of modern life in the Industrial Revolution. The effect of the Industrial Revolution revealed that human life and behavior was not always mathematical and logical, as the Enlightenment had taught. The effect on art was that artists began to reevaluate the value and the implications of traditional themes in painting. In his Dejeuner sur l’Herbe of 1863, Edouar Manet tests the ideas of human sexuality by juxtaposing fantasy and reality (Klimt, Schiele et al. 2005). His work was shocking and provocative to its Parisian viewers because the female nude broke with traditional aesthetics and representation. The woman’s body rather than standing in as a fantastic symbol, is shown instead as a regular naked woman in the context of normal life. Thus, she becomes at once real and an illusion. The disregard of the men in the scene tests the viewer’s psychological expectations of men and women. This painting has maintained its controversial place in history and stands as an important example of perhaps the first true work of Modernity (Foster and Foster 2011). Its definition as such comes not simply from the fact that Manet has disregarded tradition, but because his work elicits a subconscious reaction in his viewing public.

Edouard Manet, Dejeuner sur l’Herbe.

In Vienna, early inspiration for Modernism came from the Vienna School of Medicine, with Carl von Rokitansky playing a crucial role in its emergence. Carl von Rokitansky was the dean of the School of Medicine and was a pioneer in promoting thinking that inspired the ideologies of Modernism as they would be seen in Klimt’s paintings and in those of his contemporaries Kokoschka and Schiele (Kokoschka, Schiele et al. 2005; Kandel 2012). The strength of his influence came partially from the waning of France’s influence in the medical field and the emergence of German-speaking institutions as centers of international fame. This transition become evident in thee huge shift of foreign medical students from France to the German-speaking institutes in mid-19th century. During his time as head of the Vienna School of Medicine, Rokitansky split pathology and clinical medicine into two distinct practices and served as the head pathologist for over 30 years. His principle idea concerning medicine was that in order to approach treatment of a disease, the physician must first be able to diagnose, and therefore define the nature of the pathology of the disease itself. This ideology was manifest in his three-volume Manual of Pathologic Anatomy (Kandel 2012). This outlook, coupled with his rigorous study of pathology, helped him to promote medicine as a truly scientific discipline built upon the Darwinian notion that mankind is governed by the same biological processes as all other animals. Rokitanksy was also revolutionary in his decision to translate and teach medical works in his native German, therefore opening the study of medicine to the public as well as to the artists and thinkers of Vienna. Important in his renown was his camaraderie with the physician Joseph Skoda. Skoda was a clinical physician who adopted Rokitansky’s principles of methodological examination to his interaction with his living patients. Through this, he was able to perfect auscultation and percussion, earning him international fame as the founder of modern physical diagnosis. Overall, Rokitansky’s ideas were not unique from that of his French predecessors, but his emphasis on pathology as the root of medicine helped to place the field on footing more scientific than its French past had done. Likewise, Rokitansky’s principle of understanding “what lies beneath,” came to shape Freud’s theories of the subconscious as well as the Expressionist artist’s aim to portray the psyche, over the aesthetic, in their work. His concept of uncovering what dwells beneath the surface helped to shape and inspire the Modernism that would inspire Freud and through him, Klimt, Kokoschka and Schiele.

Rokitansky’s influence spread to the artists of Vienna through his connections with Berta and Emil Zuckerlandl. As mentioned previously, Berta was a well known and connected socialite in the art world while her husband Emil was head of anatomy at the Medical School of Vienna at the same time that Rokitansky was head of institution. Emil is well known to have invited Klimt to his dissections and it is through Emil that Klimt was able to attend lectures on cell biology and human development. Throughout much of Klimt’s work, including Medicine, he plays with images of fertility as visualized literally though a microscope. Thus, transposed on the image of the skeleton in Medicine, are small oval and circular shapes which represent early embryos. In many of his other paintings, Klimt aims to represent fertility, masculinity, and femininity through the use of small geometrical shapes representing sperm, eggs, and embryos. His profound understanding of the human body, as seen in many of his paintings is also credited in part to the anatomical dissections he was able to participate in with Emil Zuckerlandl. Importantly, through his connection with Rokitansky, Zuckerlandl was also to introduce Klimt to Darwinian evolution and to the idea that the human body held the answers to clinical questions, often just below the surface of the skin. Through his connection with the medical school, Klimt was also undoubtedly introduced to Freudian ideas of the human subconscious (Brandstätter 2006).

Through a Freudian lens we can understand the sexually provocative, aggressive Goddess of Medicine. We see her at once as divine and as profoundly human. Klimt’s choice to flatten the three-dimensional space of his image embodies the image of dreams as disconnected images bound together through space. By creating a work of seemingly discordant images, Klimt’s Medicine becomes dream-like in the Freudian sense. In his “On Dreams,” Freud states:

“The dream thoughts which we first come across as we proceed with our analysis often strike us by the unusual form in which they are expressed; they are not clothed in the prosaic language usually employed by our thoughts, but are on the contrary represented symbolically by means of similes and metaphors, in images resembling those of poetic speech… The manifest content of dreams consists for the most part in pictorial situations; and the dream thoughts must accordingly be submitted in the first place to a treatment which will make them suitable for a representation of this kind.” (Freud 1952; Freud, Strachey et al. 1953)

Thus, just like dreams, paintings and poems allow themselves ready access to the viewer’s subconscious. By creating this mass of images and symbols, Klimt does not communicate his meaning, but rather, relies on the interpretation of his viewer to fill in the gaps. Klimt’s evocation of the Freudian subconscious in his painting communicates an understanding of female sexuality that perhaps surpasses that of Freud (Kandel 2012). This painting is known to have been created years before Freud began to ponder the horrors of the castrating female and the popularized notion of the “penis envy.” In fact, Freud’s views of female sexuality were Yet in Medicine, Hygieia’s sexuality becomes oppressive and challenging because of its aggressiveness, because of its threat. Thus, this painting, intended to be displayed to a Hall of future male doctors, is also meant to evoke their deepest sexual insecurities. Gustav Klimt’s painting was a testament to his criticism and also deep respect for the field of Medicine. More importantly, the style of this painting and its two counterparts helped to establish Klimt as a pioneer of Modernism. As we have seen, Medicine was a dramatic break from the traditions of artistic representation of medicine, death, and suffering in art of the past. In a way that allowed him to break free from three dimensional space, hierarchical order, and aesthetic realism, Medicine allowed Klimt a degree of artistic freedom that was a valuable precursor to the Expressionists Kokoschka and Schiele.


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Polina Advolodkina, MD Polina Advolodkina, MD (1 Posts)

Resident Physician Contributing Writer

Emory University School of Medicine

Polina is an obstetrics and gynecology resident at Emory University School of Medicine. She received her undergraduate degree at the University of Maryland in College Park. Before medical school, she worked as a medical assistant in a busy primary care clinic outside of Washington D.C. She then attained her medical degree from the State University of New York at Downstate Medical College in Brooklyn, New York. During medical school, she studied healthcare abroad by traveling to Peru and India. Her career interests are in maternal chronic disease and infertility.