The Art of Hand Surgery

Abstract

Anatomic dissection is an essential component of a surgeon’s education. This is especially so for hand surgeons concerned with the intricate features of the upper extremity. With the acceptance of human cadaveric dissection by religious and civil authorities in the 14th century, human anatomy emerged as a recognized scientific discipline in the Western world. This spawned the publication of anatomy textbooks, the most famous being Vesalius’ De Humani Corporis Fabrica in 1543, as well as the construction of anatomic theaters, the first permanent one of which was built in 1594. These theaters gained popularity, not only to educate medical students and surgeons, but also to entertain the curious public at large. Several renaissance artists chose this dissection scene as the subject for their paintings. For the most part, the dissected body was not the primary focus of the artists’ works; rather, the intent of the painting was to portray a group of prominent observers, often times eminent surgeons. Generally speaking, the artistic composition was always the same. A pale, lifeless body, usually an adult male one, lay exposed on a table in the center of the painting, surrounded by several well dressed gentlemen. The corpse’s abdomen or lower limb was flayed open, revealing the underlying structures. The dissection itself was somewhat simplistic, undetailed, and often viewed from too great a distance to adequately present specific morphologic features; rather it served as an incidental prop on which to focus the attention of the portrayed individuals. The most notable exception to this artistic genre is Rembrandt’s 1632 painting (Anatomy Lesson of Dr. Nicolaes Tulp) of seven Dutch surgeons viewing the body and dissected left forearm of a recently executed criminal. The intricate anatomic details of Rembrandt’s rendering are remarkable, at times garnering more attention and interest than the portrayed group of prominent individuals. The dissection is so detailed that the anatomic accuracy of the dissected structures has become a subject of debate among medical and art historians. In 1982, the editor of this journal challenged readers to identify the anatomic error in the painting,1Light T.R. Hands on stamps.J Hand Surg. 1982; 7: 20PubMed Scopus (5) Google Scholar which was presumably an inappropriate origin of the flexor muscles from the lateral epicondyle.2Cremone Jr, J.C. Letter to the editor, The Anatomy Lesson of Dr. Nicolaas Tulp.J Hand Surg. 1982; 7: 530PubMed Scopus (5) Google Scholar, 3Meals R.A. Letter to the editor, The Anatomy Lesson of Dr. Nicolaas Tulp.J Hand Surg. 1982; 7: 530PubMed Google Scholar In the current issue of the Journal, IJpma et al4IJpma F.F.A. van de Graaf R.C. Nicolai J.-P.A. Meek M.F. The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt (1632) a comparison of the painting with a dissected left forearm of a Dutch male cadaver.J Hand Surg. 2006; 31A: 882-891Google Scholar address this challenge along with other anatomic controversies, as they present a comprehensive analysis of this celebrated upper extremity dissection. Dr. IJpma and his colleagues compare Rembrandt’s dissected forearm to the features of a fresh cadaveric forearm dissection, rather than to drawings from anatomic atlases, as has been done by previous critics. Their observations suggest that Rembrandt’s knowledge of forearm and hand anatomy is surprisingly accurate and comports with that of modern-day hand surgeons. Although the findings of their study will not likely impact the reader’s surgical approach to the upper extremity or alter physiologic concepts of hand function, nevertheless this presentation should enrich and broaden our appreciation of the timelessness of human anatomy and remind us of the fascinating interplay between hand surgery and other professional disciplines. It is only fitting that a critique of this renowned work of hand surgery art be presented in Journal of Hand Surgery in the 400th year of Rembrandt’s birth. The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt (1632): A Comparison of the Painting With a Dissected Left Forearm of a Dutch Male CadaverJournal of Hand SurgeryVol. 31Issue 6PreviewRembrandt’s The Anatomy Lesson of Dr. Nicolaes Tulp (1632) is considered a masterpiece and is a group portrait of the Amsterdam Guild of Surgeons in the form of an anatomy lesson. Dr. Nicolaes Tulp, Doctor of Medicine and Praelector Anatomiae to the Amsterdam Guild of Surgeons, showed an anatomic dissection of a forearm on the corpse of an executed criminal. The anatomic accuracy in Rembrandt’s famous painting has been discussed in the literature for decades without any general consensus. In 2006, on the 400th anniversary of Rembrandt’s birth, a forearm dissection of a cadaver and a comparison with the anatomy in the painting are presented to analyze the anatomic accuracy of Rembrandt’s famous painting. Full-Text PDF