War Horse, Whistlejacket, and an anatomist.

Abstract

During my stay in London, I had a chance to enjoy the National Theater production of “War Horse,” played at the New London Theatre located in the West End. [Correction added on 29 August 2020, after initial online publication. Information about the National Theatre production was added.] This famous play is the story of a young boy and his beloved horse, which has been requisitioned by the army to fight in World War I. The life-sized puppet was manipulated by three puppeteers—the head, the heart, and the hind—who worked together to make the character of the horse come alive on stage. The puppet was made by the Handspring Puppet Company in Cape Town, South Africa, of cane, leather, and synthetic fiber, and an aluminum-reinforced spine. [Correction added on 29 August 2020, after initial online publication. The puppet manufacturer was added.] With life-like accuracy, the puppeteer operators articulated the limbs of the horse and communicated its emotions (Figure 1). I was so impressed, because the skeleton and joints of the limbs as well as the spine were anatomically very similar to a real horse. In order to achieve this life-like effect, the skilled craftsmen who constructed this incredible puppet had anatomical knowledge of horses. For detailing equine anatomy, Ruini's Anatomia del Cavallo was a first, foundational text (Ruini, 1618), followed by Snape's The Anatomy of an Horse (Snape, 1683), and Stubbs' illustrated book The Anatomy of the Horse (Stubb, 1766), which is still in print today (Figure 2). Stubbs dissected horses to learn about their anatomy for his illustrations and paintings. He rented a farmhouse for study and dissection. The horses were sacrificed by cutting the jugular vein, and the blood vessels were injected with tallow. The carcass was lifted with a tackle of hooks and bars attached to the ceiling; the horse's feet were arranged on a wooden plank beneath. He removed the skin, prepared the muscles layer by layer toward the skeleton, and sketched them (Fountain, 1968; Vincent-Kemp, 1985). In the National Gallery, I saw a very famous oil painting entitled “Whistlejacket” (1762) by Stubbs. The scale and pose was typical of an equestrian portrait, although without the rider. This horse has a dynamic personality and glowing vitality (Figure 3). It is obvious that Stubbs could paint horses in realistic detail because he had great knowledge of their anatomy. He could see the muscles, bones, and joints under the skin and their actions from the sketches he made during dissections. As a plastic surgeon and a teacher in resident training program, I considered the role of anatomy for surgeons and surgical trainees. On reading the top-cited paper in the first 25 years' history of Clinical Anatomy, I realized the importance of anatomical dissection cannot be overemphasized in medical education. In that paper, 57% of the residency program directors responded that residents need a refresher in gross anatomy upon arrival, 29% thought that they were adequately prepared, whereas 14% felt they were seriously lacking. The residency programs indicated that residents need to arrive more proficient in clinical applications, general knowledge, and cross-sectional applications (Cottam, 1999). I was worried that about half of the anatomy departments are not consisted of training teachers of anatomy (gross anatomy, histology, embryology, and neuroanatomy) (Albertine, 2012). The gross anatomy is no longer a free-standing course representing anatomy-for-anatomy's-sake, but rather is now strongly clinically oriented in many schools (Carmichael, 2012). Artists need knowledge of anatomy for painting animals or human beings in realistic detail, and surgeons need precise understanding of anatomical details for successful operations. Stubbs could see the horse muscles and their actions during his dissections, and so too can surgeons recognize the critical structures such as vessels or nerves through anatomical knowledge obtained from surgery or dissection. Though there are many texts and atlases showing surgical and radiological anatomies for students and trainees, I do believe nothing can replace the anatomical dissection. We thank the Handspring Puppet Company (London) for giving permission to reproduce the artwork War Horse and 3 puppeteers, which this company created. The puppeteers in the photograph (2013) of Joey, taken in the Victoria and Albert Museum's John Madejski Garden (London), are Nicholas Hart (head), Stuart Angell (heart), and Thomas Goodridge (hind). We also say thank you for permissions from the National Theater of London and the Victoria and Albert Museum of London to reproduce the same artwork. Likewise, we thank The British Museum of London for permission to reproduce the artwork The Anatomy of the Horse (1766) and the National Gallery of London for permission to reproduce the artwork “Whistlejacket.” [Correction added after initial online publication. The Acknowledgments section was added.]