The diagnosis of art: Dr Péan's operation

Abstract

We mostly associate Henri de Toulouse-Lautrec with paintings of the demi-monde of Paris night-life.1 However, his oeuvre stretches much further than that. Figure 1 shows one of his paintings of the famous Paris surgeon, Dr Jules-Emile Pean (1830–98). The patient has his mouth wide open and his nose is covered with a pad, presumably soaked in ether or chloroform. An assistant stands on the other side (we see his left shoulder, his head, and his right hand), restraining the patient and holding a scalpel in readiness. And at the centre of focus we see the surgeon probing the patient's mouth with an instrument–perhaps the haemostatic compression forceps that Pean controversially claimed to have invented in 1868.2,3,4 Figure 1 Dr Pean Operating, 1891–1892. Oil on cardboard, 74 × 50 cm. Sterling and Francis Clark Art Institute, Williamstown, Massachusetts, USA. In colour online In The Story of San Michele (1929), a book that is perhaps best described as fictionalized memoirs, the Swedish physician Axel Munthe5 described Pean: “I tremble at the thought of what would have happened to me had I fallen into the hands of one of the other leading surgeons in Paris in those days. … The famous Professor Pean, the terrible butcher of Hopital St. Louis, would have chopped off both my legs on the spot and thrown them on the top of some stumps of arms and legs, half-a-dozen ovaries and uteruses and various tumours, all in a heap on the floor of his amphitheatre besmeared with blood like a slaughter-house. Then, his enormous hands still red with my blood, he would have plunged his knife with the dexterity of a conjurer into his next victim, half conscious under insufficient anaesthesia, while half-a-dozen others, screaming with terror on their brancards, were awaiting their turn of torture. The massacre en masse at an end, Pean would wipe the sweat from his forehead, rub a few spots of blood and pus from his white waistcoat and dresscoat–he always operated in evening dress–and with a: ‘Voila pour aujourd'hui, Messieurs!’ he would rush out of the amphitheatre to his pompous landau and drive full speed to his private clinic in Rue de la Sante to cut open the abdomens of half-a-dozen women driven there by a gigantic reclame like helpless sheep to the slaughterhouse of La Villette.” It should be added, however, that Munthe's descriptions are not to be relied upon.6 Gabriel Tapie de Celeyran, Toulouse-Lautrec's cousin, who studied under Pean, introduced the painter to the surgeon. After studying him at work for several days, Lautrec made preliminary drawings and then painted him a few times. In the painting shown here we see an item that Munthe did not mention–over his dress coat the surgeon wears a white bib, probably to protect himself from the blood and pus that Munthe described rather than to protect the patient from infection. We do not know the identity of Pean's assistant in the painting. Could it have been Tapie de Celeyran? One of Lautrec's friends, Paul Leclerq, wrote that he had “black hair, gleaming with pomade”, but Leclerq also says that the hair was “parted down the back and carefully brushed upwards at each side”. Furthermore, Lautrec painted his cousin in 1894 and showed him with steeply sloping shoulders, in contrast to the assistant. And the diagnosis? As so often, only wild speculation is possible. The painting has been called “Une Operation de Tracheotomie”, although that is not what it looks like at first glance, for Pean's forceps are in the patient's mouth. But perhaps the patient's swollen neck is the bull neck of diphtheria and Pean is inspecting the pharynx before performing a tracheotomy, which Pierre Bretonneau introduced in 1825 for diphtheria, the name of which he also coined.7 Then again, in addition to the swollen neck the lips are prominent; perhaps the patient has laryngeal obstruction due to angio-oedema, which Quincke had described in 1882.8 Tracheotomy was also a common treatment for tuberculosis and cancer of the larynx in the late nineteenth century.9 Or perhaps the surgeon is about to incise an abscess or to excise a tumour or ulcerated tonsils. The nub of flesh just under the teeth could be the tongue displaced to the right; in which case, perhaps he is removing a salivary calculus. Whatever the reason for the operation, with a few expert strokes, some shading, and apart from black and white using little more colour than that of the cardboard for contrast, Toulouse-Lautrec has given us a vivid picture of a late nineteenth century surgeon at work.