- Email: [email protected]
The Healing Touch
Media Watch
Exhibition The Healing Touch When Richard Santen, a professor of medicine from Pennsylvania, PA, USA, was invited to speak at an international symposium in Edinburgh, UK, during 1988, he also had the dubious honour of responding on behalf of overseas speakers to a government minister at an official reception in Edinburgh Castle. Santen had done his homework, and pointed out that, until the first US medical school was created in 1780, all physicians in the USA were trained in Scotland, UK. The pioneering role of Scotland in US medicine is alluded to in The Healing Touch—500 years of Scots in Sickness and Health. The exhibition shows the major participation by Scotland in the global evolution of medicine as shown by teaching, training, and the exploits of great Scottish physicians and surgeons. The Healing Touch consists of portraits and models from the national galleries of Scotland and medical collections throughout Europe. Five topics—The Dutch Tradition, Teaching and Training, The Great Doctors, Medicine of the Mind, and Medicine Today are covered. The Dutch Tradition takes visitors back to the 17th century, when Leyden was visited by Scottish academics and students eager to benefit from the University there. The Anatomy Lesson of Professor Frederik Ruysch by Adriaen Backer from 1670 shows seven men, adorned in black robes, stood in a semicircle, guiding the eye down to a pallid cadaver; lymph glands are being teased from the groin of the body. Next to Prof Ruysch is another lesson, Surgical Demonstration by A van der Groes (circa 1700), which depicts students observing the dissection of a cadaver. The macabre detail of a human skin curtain hanging from the ceiling rivals any scene concocted by horror-film directors. Although the historical portraits of The Great Doctors are artistically excellent, the impression is of a gallery of similar po-faced black-suited worthies. Without illustrations of
The Healing Touch Scottish National Portrait Gallery, Scotland, UK; July 9 to Nov 27, 2005 See http://www.national galleries.org
Courtesy of the National Galleries of Scotland, UK
See http://www. scotlandandmedicine.com
Sir Alexander Morison by William Dadd, 1852
646
actual advances, anecdotes become more striking than discovery and artwork. James Young Simpson, Professor of Midwifery and the discoverer of the soporific uses of chloroform, becomes more memorable because the first baby delivered by use of chloroform was named Anaesthesia. Similarly, for the painting of Robert Cleghorn by Sir Henry Raeburn in 1819, an anecdote claims equal attention: Cleghorn was one of the first managers of the Royal Infirmary of Glasgow, and he epitomised the friendly rivalry between Glasgow and Edinburgh by referring to the physicians of Edinburgh as “the wise Men of the East”. The portrait of John Rogerson by Johann Baptist Lampi (1775–1837) reflects the close bond between Scottish doctors and other countries. After qualification in Scotland, Rogerson spent more than 30 years practising in Russia, becoming the personal physician to Catherine the Great. The propensity of Scottish doctors to travel is also highlighted in a preserved watercolour cartoon, The Adventures of Roderick Random (published 1800), which portrays the trials and tribulations of a young Scottish surgeon, having reached a London College board, with an examiner saying “you Scotchmen have overspread us of late as the locusts did in Egypt”. Even in the 19th century, people with mental-health problems were regarded as best managed by confinement rather than treatment, and psychiatry is therefore a fairly new discipline. Medicine of the Mind contrasts William Dadd’s very stylised, but oddly winsome, 1852 work Sir Alexander Morison (showing a portrait of a 19th century psychiatrist painted by one of his patients while in an asylum) with that of Victoria Crowe’s thought-provoking and modern study of the psychiatrist Dr Winifred Rushforth (1982). Several images exude real warmth, including Eve Arnold’s pictures of nurses with elderly patients in Dingleton Hospital, Scotland, published in the UK Sunday Times newspaper in 1967. Medicine Today contains a most haunting piece (arguably the most compelling work in the exhibition) called Three Oncologists by Ken Currie (2002). The work depicts Sir David Lane, Sir Alfred Cuschieri, and Prof Robert Steele from Ninewells Hospital, Dundee, UK. The background is ominous against which the professors glow and blur into swirling mist as if they were spectres. Gowns and gloves are spattered with blood, which matches the redness of the eyes; face masks are lowered, as if at the end of a long operation. The composition is in stark contrast to the classical style of Backer’s work seen on entry to the exhibition. The Healing Touch has something for everyone, whether they be a medical practitioner, art lover, or a visitor seeking some peace and quiet. Nevertheless, doctors in particular will appreciate the insights into the discipline in earlier times. The photographs of medical residents from the late 19th century http://oncology.thelancet.com Vol 6 September 2005
Media Watch
Courtesy of the National Galleries of Scotland, UK
have a real flavour of camaraderie, something which anyone who has endured a job as a junior doctor knows is a necessary survival tool. There are, however, omissions. One could forgive the absence of the bodysnatchers Burke and Hare, but where is Scotland’s favourite oncologist, Sir George Beatson, without whom the Glasgow Institute for Cancer Research and Oncology Centre would be without a name? However, with so much to cover, how could a fairly small exhibition be fully comprehensive? The final comment should be reserved for the series of 12 photographs called Tender by Iain Stewart (2000), which depict general practitioners in their surgery. The text makes observations that can be easily overlooked: “hands feature as a recurring theme” and “they act as a reminder of the bond of trust and faith between doctor and patient, encapsulating the healing touch”.
Mark Miller, Lynn Greig, *Bill Miller [email protected]
Three Oncologists by Ken Currie, oil on canvas (2002)
Books Hepatocellular cancer Although this book has a “bias toward” the “experience of one centre” (University of Pittsburgh, PA, USA), clinically useful information abounds. Hepatocellular carcinoma: Diagnosis and Treatment has 14 chapters ordered logically from epidemiology to treatment, including a synthesis of information on practical guidelines. The book is strong in its coverage of epidemiology, molecular mechanisms, histopathology, clinical features, and role of radiology in diagnosis and treatment. The chapter on epidemiology is comprehensive, and although it reads like a listing of studies, it provides a fine starting point. Chapters on molecular biology and histopathology fill in the pathophysiological backdrop for the clinician: they are well written, and have depth and breadth that even an academic who specialises in hepatocellular carcinoma (HCC) will appreciate. Radiographic features in the diagnosis of HCC by CT and MRI are nicely summarised in a table. In addition, radiographic features of the frequently overlooked fibrolamellar type of HCC are covered. However, chapters on interventional radiology and radiation are the best of the bunch, perhaps reflecting the editor’s area of expertise. The discussions of local ablative therapies and transarterial chemoembolisation are pleasing in practical detail such as length of hospital stay, use of sedation and anaesthesia, and risks and benefits. Any clinician who refers patients for these procedures, but who may never actually see one done, should read these sections. Too many times, patients are left in that information vacuum between referring clinic and busy radiology suite, where the intervenhttp://oncology.thelancet.com Vol 6 September 2005
tionalist might have little time to converse with the patient. The chapter on radiotherapy is current, well written, and uses past hepatotoxicity problems with whole-liver radiation as a way into discussing more promising clinical trials that use new technology (eg, three-dimensional conformal radiotherapy and microsphere brachytherapy). However, a substantial part of the chapter on liver transplantation is oddly outdated. The Model for End Stage Liver Disease (MELD) is not mentioned at all, even though it has been the basis for the US prioritisation system for transplant candidates, including those with early HCC, since February, 2002. Although MELD is mentioned elsewhere in the book, it should be central to the transplant chapter, because the model substantially improved intention-to-treat outcomes by giving patients with HCC higher priority for receiving a graft. Furthermore, the important topic of screening for HCC is addressed in two unrelated chapters (serum markers and imaging studies), and lacks depth; one cohesive section or whole chapter would have been better. This book provides a good, but incomplete, overview for the clinical oncologist. For the most part, single-centre bias was not a problem. The reader must be forewarned that certain tests and methods used at the University of Pittsburgh are not widely used. I recommend this book to the clinician interested in HCC, with the caveat that other reading will be necessary.
Hepatocellular Cancer: Diagnosis and Treatment Brian I Carr (Ed) Humana Press, 2005 US$135·00 (£74·64, €109·18), pp 298 ISBN 1 58 8291251
Paul Hayashi [email protected]
647
Exhibition The Healing Touch When Richard Santen, a professor of medicine from Pennsylvania, PA, USA, was invited to speak at an international symposium in Edinburgh, UK, during 1988, he also had the dubious honour of responding on behalf of overseas speakers to a government minister at an official reception in Edinburgh Castle. Santen had done his homework, and pointed out that, until the first US medical school was created in 1780, all physicians in the USA were trained in Scotland, UK. The pioneering role of Scotland in US medicine is alluded to in The Healing Touch—500 years of Scots in Sickness and Health. The exhibition shows the major participation by Scotland in the global evolution of medicine as shown by teaching, training, and the exploits of great Scottish physicians and surgeons. The Healing Touch consists of portraits and models from the national galleries of Scotland and medical collections throughout Europe. Five topics—The Dutch Tradition, Teaching and Training, The Great Doctors, Medicine of the Mind, and Medicine Today are covered. The Dutch Tradition takes visitors back to the 17th century, when Leyden was visited by Scottish academics and students eager to benefit from the University there. The Anatomy Lesson of Professor Frederik Ruysch by Adriaen Backer from 1670 shows seven men, adorned in black robes, stood in a semicircle, guiding the eye down to a pallid cadaver; lymph glands are being teased from the groin of the body. Next to Prof Ruysch is another lesson, Surgical Demonstration by A van der Groes (circa 1700), which depicts students observing the dissection of a cadaver. The macabre detail of a human skin curtain hanging from the ceiling rivals any scene concocted by horror-film directors. Although the historical portraits of The Great Doctors are artistically excellent, the impression is of a gallery of similar po-faced black-suited worthies. Without illustrations of
The Healing Touch Scottish National Portrait Gallery, Scotland, UK; July 9 to Nov 27, 2005 See http://www.national galleries.org
Courtesy of the National Galleries of Scotland, UK
See http://www. scotlandandmedicine.com
Sir Alexander Morison by William Dadd, 1852
646
actual advances, anecdotes become more striking than discovery and artwork. James Young Simpson, Professor of Midwifery and the discoverer of the soporific uses of chloroform, becomes more memorable because the first baby delivered by use of chloroform was named Anaesthesia. Similarly, for the painting of Robert Cleghorn by Sir Henry Raeburn in 1819, an anecdote claims equal attention: Cleghorn was one of the first managers of the Royal Infirmary of Glasgow, and he epitomised the friendly rivalry between Glasgow and Edinburgh by referring to the physicians of Edinburgh as “the wise Men of the East”. The portrait of John Rogerson by Johann Baptist Lampi (1775–1837) reflects the close bond between Scottish doctors and other countries. After qualification in Scotland, Rogerson spent more than 30 years practising in Russia, becoming the personal physician to Catherine the Great. The propensity of Scottish doctors to travel is also highlighted in a preserved watercolour cartoon, The Adventures of Roderick Random (published 1800), which portrays the trials and tribulations of a young Scottish surgeon, having reached a London College board, with an examiner saying “you Scotchmen have overspread us of late as the locusts did in Egypt”. Even in the 19th century, people with mental-health problems were regarded as best managed by confinement rather than treatment, and psychiatry is therefore a fairly new discipline. Medicine of the Mind contrasts William Dadd’s very stylised, but oddly winsome, 1852 work Sir Alexander Morison (showing a portrait of a 19th century psychiatrist painted by one of his patients while in an asylum) with that of Victoria Crowe’s thought-provoking and modern study of the psychiatrist Dr Winifred Rushforth (1982). Several images exude real warmth, including Eve Arnold’s pictures of nurses with elderly patients in Dingleton Hospital, Scotland, published in the UK Sunday Times newspaper in 1967. Medicine Today contains a most haunting piece (arguably the most compelling work in the exhibition) called Three Oncologists by Ken Currie (2002). The work depicts Sir David Lane, Sir Alfred Cuschieri, and Prof Robert Steele from Ninewells Hospital, Dundee, UK. The background is ominous against which the professors glow and blur into swirling mist as if they were spectres. Gowns and gloves are spattered with blood, which matches the redness of the eyes; face masks are lowered, as if at the end of a long operation. The composition is in stark contrast to the classical style of Backer’s work seen on entry to the exhibition. The Healing Touch has something for everyone, whether they be a medical practitioner, art lover, or a visitor seeking some peace and quiet. Nevertheless, doctors in particular will appreciate the insights into the discipline in earlier times. The photographs of medical residents from the late 19th century http://oncology.thelancet.com Vol 6 September 2005
Media Watch
Courtesy of the National Galleries of Scotland, UK
have a real flavour of camaraderie, something which anyone who has endured a job as a junior doctor knows is a necessary survival tool. There are, however, omissions. One could forgive the absence of the bodysnatchers Burke and Hare, but where is Scotland’s favourite oncologist, Sir George Beatson, without whom the Glasgow Institute for Cancer Research and Oncology Centre would be without a name? However, with so much to cover, how could a fairly small exhibition be fully comprehensive? The final comment should be reserved for the series of 12 photographs called Tender by Iain Stewart (2000), which depict general practitioners in their surgery. The text makes observations that can be easily overlooked: “hands feature as a recurring theme” and “they act as a reminder of the bond of trust and faith between doctor and patient, encapsulating the healing touch”.
Mark Miller, Lynn Greig, *Bill Miller [email protected]
Three Oncologists by Ken Currie, oil on canvas (2002)
Books Hepatocellular cancer Although this book has a “bias toward” the “experience of one centre” (University of Pittsburgh, PA, USA), clinically useful information abounds. Hepatocellular carcinoma: Diagnosis and Treatment has 14 chapters ordered logically from epidemiology to treatment, including a synthesis of information on practical guidelines. The book is strong in its coverage of epidemiology, molecular mechanisms, histopathology, clinical features, and role of radiology in diagnosis and treatment. The chapter on epidemiology is comprehensive, and although it reads like a listing of studies, it provides a fine starting point. Chapters on molecular biology and histopathology fill in the pathophysiological backdrop for the clinician: they are well written, and have depth and breadth that even an academic who specialises in hepatocellular carcinoma (HCC) will appreciate. Radiographic features in the diagnosis of HCC by CT and MRI are nicely summarised in a table. In addition, radiographic features of the frequently overlooked fibrolamellar type of HCC are covered. However, chapters on interventional radiology and radiation are the best of the bunch, perhaps reflecting the editor’s area of expertise. The discussions of local ablative therapies and transarterial chemoembolisation are pleasing in practical detail such as length of hospital stay, use of sedation and anaesthesia, and risks and benefits. Any clinician who refers patients for these procedures, but who may never actually see one done, should read these sections. Too many times, patients are left in that information vacuum between referring clinic and busy radiology suite, where the intervenhttp://oncology.thelancet.com Vol 6 September 2005
tionalist might have little time to converse with the patient. The chapter on radiotherapy is current, well written, and uses past hepatotoxicity problems with whole-liver radiation as a way into discussing more promising clinical trials that use new technology (eg, three-dimensional conformal radiotherapy and microsphere brachytherapy). However, a substantial part of the chapter on liver transplantation is oddly outdated. The Model for End Stage Liver Disease (MELD) is not mentioned at all, even though it has been the basis for the US prioritisation system for transplant candidates, including those with early HCC, since February, 2002. Although MELD is mentioned elsewhere in the book, it should be central to the transplant chapter, because the model substantially improved intention-to-treat outcomes by giving patients with HCC higher priority for receiving a graft. Furthermore, the important topic of screening for HCC is addressed in two unrelated chapters (serum markers and imaging studies), and lacks depth; one cohesive section or whole chapter would have been better. This book provides a good, but incomplete, overview for the clinical oncologist. For the most part, single-centre bias was not a problem. The reader must be forewarned that certain tests and methods used at the University of Pittsburgh are not widely used. I recommend this book to the clinician interested in HCC, with the caveat that other reading will be necessary.
Hepatocellular Cancer: Diagnosis and Treatment Brian I Carr (Ed) Humana Press, 2005 US$135·00 (£74·64, €109·18), pp 298 ISBN 1 58 8291251
Paul Hayashi [email protected]
647