Artists portray surgical treatments with different voices and techniques. These images by deceased artists in reverse chronologic order from the present to the past acknowledge their contributions to our understanding of advancements in surgical care. This pictorial history illustrates the influence of culture, knowledge and technology on medical progress.

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NIH Clinical Center (1955)
The surgical repair of intracardiac anomalies require a bloodless and motionless heart. Technical innovations in the 1950’s including hypothermic circulatory arrest, cross-circulation, and extracorporeal circulation with an oxygenator and heat exchanger made this possible. On September 2, 1952 Dr. C. Walton Lillehei (1918-1999) and Dr. F. John Lewis (1916-1993) at the University of Minnesota performed the first successful intracardiac correction of a congenital heart defect using hypothermia. On May 6, 1953 Dr. John Heysham Gibbon (1903-1973) at Jefferson Medical School successfully used extracorporeal circulation with a pump-oxygenator for repair of an atrial septal defect. In 1954 Dr. Lillehei performed a series of pediatric cardiac operations using cross-circulation with the parent as the heart-lung machine. Beginning March 22, 1955 Dr. John W. Kirklin (1917-2004) at the Mayo Clinic used a Gibbon heart-lung machine modified with a vertical screen oxygenator to achieve consistently successful cardiac repairs. Since the 1950’s numerous refinements in perfusion hardware and methods as well as surgical and anesthesia techniques have improved the outcome of the surgical treatment of congenital and acquired heart disease. This 1955 image from the National Library of Medicine photographic archives shows preparation for heart surgery at the NIH Clinical Center. The patient is anesthetized while assistants pack crushed ice around the patient to induce hypothermia.

Frank H. Netter (1906-1991)
Several generations of medical students have studied human anatomy, pathology and pathophysiology from the illustrations of Frank H. Netter. Netter came to medicine after working as a commercial artist. Following medical school he trained as a surgeon and briefly practiced this specialty in Manhattan before committing his professional life to medical illustration.  His full page plates show multiple medical images of photographic accuracy joined together by diagrams and text.  His illustrations tell stories of structure and function in the context of health and disease. His images are appreciated for both their aesthetic qualities and their intellectual content.
 Link to more images by Frank H. Netter, MD

Frida Kahlo (1907-1954)
Mexican painter Frida Kahlo (1907-1954) is an artist whose life and creativity were driven by illness and surgery. The daughter of a photographer and the wife of muralist Diego Rivera, her best known works depict her chronic pain from spina bifida, childhood poliomyelitis, spinal trauma and leg amputation. Confined to bed for long periods of time, Frida gave up her medical studies and began painting from a recumbent position. During 1946-1950 she underwent 8 operations to her spine which she depicts in her dual self-portraits named Tree of Hope, Stay Strong (1946). The right portrait shows a regally seated Frida holding a spine corset. The left portrait shows her lying on a gurney with two large bloody scars on her back. The surreal landscape reveals an earth crumbling at her feet. In July 1954 Frida Kahlo died following pneumonia. The cause of death was recorded as pulmonary embolism.

Surgery through the Ages (1944)
In 1928 the Davis and Geck Company began producing surgical films documenting surgical techniques. The films became known as the Cliné Clinic Films. Davis and Geck also produced a series of dramatic advertisements titled “Sutures in Ancient Surgery,” later published as “Surgery through the Ages” (1944). The series featured prints by photographer Lejaren à Hiller (1880-1969) who staged cinematic photographs with elaborate costumes, dramatic backgrounds and semi-nude young women posing as patients. The series created images of surgeons from ancient Egypt and India, from the Aztecs and from the middle Ages. It included this image described as “XVI century Giovanni Andrea Della Croce performs a successful hysterectomy.” The collection received wide acclaim, including the Edward Bok Award for advertising in 1937.

Alfred D. Crimi (1900–94)
Alfred D. Crimi immigrated to New York City from Sicily in 1910. He returned to Italy in 1929 to study fresco painting.  When he came back to New York City, he was an accomplished mural painter and was hired by the WPA for the Harlem Hospital project. Crimi was commissioned to paint five fresco panels for the Medical Board Room, but he completed only one. In his preparation for Modern Surgery and Anesthesia (1936), Crimi spent two weeks at Kings County Hospital, where he watched several surgical procedures. This mural accurately describes a patient undergoing lower abdominal surgery surrounded by the anesthetist, the surgeon, the assistants and all the necessary equipment. Harlem Hospital’s historic murals are being restored for later reinstallation in a new patient pavilion in 2009.
 ...more about Alfred D. Crimi

Max Brödel (1870-1941)
Max Brödel was an art student when he emigrated from Leipzig, Germany to the USA in 1894. He established the first "Department of Art as applied to Medicine" at Johns Hopkins School of Medicine in 1911 which by the time of his retirement in 1939 had graduated 160 medical illustrators. At Hopkins he illustrated the works of world-famous surgeons such as Howard A. Kelly, William S. Halsted, and Harvey Cushing. The illustration is from a 1914 Cushing article showing the translabial transsphenoidal approach to the pituitary gland. This and other drawings by Brödel is part of the Brödel Archives at Johns Hopkins University, Baltimore, MD.   
 ...more about Max Brödel

This photograph shows an operating room in the Ancon Hospital, Panama during the failed French attempt to build the Panama Canal (the US took over in 1904). An estimated 22,000 workers died, many from yellow fever and malaria. In 1928 the hospital was renamed Gorgas Hospital to commemorate U.S. Army Colonel William C. Gorgas, MD (1854-1920) who eradicated yellow fever by applying the research of Cuban physician, Juan Carlos Finlay, MD (1833-1915). This posed photograph was taken about 1900 and is from the Battlefield Surgery 101 exhibit of the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C. (NCP 168).  The bearded anesthetist with his drug cart is on the left and the mustached surgeon and surgical assistant are on the right with their instrument cart. A nun is at the patient’s head with a basin. Wash bowls are readied for the surgeon who is dressed in white shirt, bow tie and cummerbund.

Henri Toulouse-Lautrec (1864-1901)
Henri Toulouse-Lautrec was the artistic soul of Montmartre. His paintings and posters of the Belle Époque portray life at the Moulin Rouge, the cabarets and the brothels. He died at the age of 36 due to the complications of alcoholism and syphilis. At age 12 Henri fractured his left femur, and at 14 his right femur. At maturity he was 4 ½ ft tall with a body trunk of normal size but with abnormally short legs. Many believe that Henri suffered from the genetic disorder, pycnodysostosis. Three of his cousins were dwarfs with similar skeletal problems; one spent her entire life in a baby carriage. This disease is characterized by mild dwarfism, underdeveloped facial bones, a receding chin, prominent forehead, incomplete closure of the skull, fragile bones, a parrot-like hooked nose, short digits and dental cavities. Henri suffered from painful fractures of his legs and violent toothaches. His nose grew large and his lips became deformed so that he drooled. Not much is known about this portrait called Dr. Pean Operating (1891). We see prominent and reputed dapper Dr. Jules-Emile Pean with an assistant operating inside a patient’s mouth. The anterior teeth are visible and the nose is covered by gauzes. There is no apparatus of general anesthesia and treatment appears focused on the molars and posterior pharynx. The image is from the Sterling and Francine Clark Art Institute, Museum Collections.

Adalbert Franz Seligmann (1862-1945)
The torch of modern surgery was lit by Christian Albert Theodor Billroth, MD (1829-1894) when he became chief of surgery at Allegemeines Krankenhause in Vienna. Billroth passed his techniques to many including William Stewart Halsted, MD (1852-1922) who in turn trained Harvey Williams Cushing, MD (1869-1939). Billroth reached his surgical fame during a Belle Époque of surgery due in no small part due to the introduction of ether and chloroform general anesthesia in the middle of the 19^th century. The image painted in 1890 by Adalbert Franz Seligmann shows Billroth at the age of 60 demonstrating surgery in a brightly lit  operating theater to an admiring audience. Billroth’s eternal fame did not result from this operation for trigeminal neuralgia but from the complex abdominal surgery on the stomach and small bowel still referred to by his name.
  ...more about Theodor Billroth

Robert C. Hinckley (1853-1941)
The controversy over the invention of general anesthesia and the first public demonstration of diethyl ether at the Massachusetts General Hospital on October 16, 1846 is matched by the uncertain origin of this recreation of the event by Robert Cutler Hinckley completed in Paris in 1892.  A photographer (daguerreotypist), Josiah Hawes, is said to have been so frightened that he was unable to record this momentous event. "The First Operation with Ether" is painted after the style of Thomas Eakins (1844-1916). The participants have been identified as: Gilbert Abbott, the patient; John Collins Warren, MD, the surgeon; William T. G. Morton, the anesthetist; and Henry J. Bigelow, MD, the junior surgeon.  Each one knew that he was a participant in medical history. The inscription on Morton's graveside monument pays tribute to him as the "Inventor and Revealer of Anesthetic Inhalation. BEFORE WHOM In all time Surgery was Agony. BY WHOM Pain in Surgery was averted and annulled. SINCE WHOM Science has control of pain." The painting hangs in the Boston Medical Library.

Battlefield Surgery (1861-1865)
The introductions of general anesthesia and photography occurred within a few years of each other. The camera recorded the new reality of the operating theatre which for the first time included an anesthetist who shared the photographic stage with the surgeon. Open drop chloroform and ether anesthesia (and a mixture of the two) were used during the Civil War (1861-1865). Chloroform was nonflammable and produced anesthesia faster but was associated with a greater incidence of cardiac arrest. This surgical scene shows an army medical wagon with a man supine on a wooden table. The military surgeon appears ready to perform a below the knee amputation of the right leg while the anesthetist (with a hat) applies an anesthetic sponge to the face. The photograph is from the Battlefield Surgery 101 exhibit of the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C. (NCP 1563)
  ...more about medicine and surgery during the Civil War

Ether Anesthesia (1846)
The middle of the 19^th century witnessed the beginning of photojournalism.  Robert Fenton (1819-1869) photographed the Crimean War (1853-1856). Mathew Brady (1823-1896) and his staff photographed the American Civil War (1861-1865). Yet the contemporary standard for recording historical events remained paintings, sketches, engravings and lithographs. William Morton demonstrated ether anesthesia at the Massachusetts General Hospital on October 16, 1846. Approximately six months later a re-enactment of the event was recorded in a daguerreotype, “Early Operation Using Ether for Anesthesia" (1847) by Albert Sands Southworth and Josiah Johnson Hawes. The photo shows the original participants, William Morton and John Warren. The commemorative painting, “First Operation Under Ether” by William Hinckley (1853-1941), was begun 35 years later in 1882 and completed in 1893. This painting and not the earlier photograph, is thought to characterize this event for eternity. Even though the daguerreotype records a re-enactment of surgery, it may qualify as the first photographic image of surgery.

David Teniers the Younger (1610-1690)
David Teniers the Younger, the Flemish painter and engraver, was a distinguished member of a family of painters. He studied with his father, David Teniers the Elder (1582-1649), and married the granddaughter of Pieter Bruegel the Elder (1525-1569). Teniers is known for the depiction of everyday rural events blended with religious and mythological themes. At 41, Teniers moved to Brussels, where he served as court painter, tapestry designer and curator of paintings. His multiple careers brought him wealth and nobility. The colored etching shows a troubling theme of the times, the surgical extraction of stones of madness. Teniers portrays the surgeon as a grotesque single-toothed charlatan and the grimacing patient as a frightened recipient of the therapy. The prominent black hat has unknown significance.

Rembrandt van Rijn (1606-1669)
Surgery and biblical folklore come together in this 1636 allegory, Tobias Returns Sight to His Father (Staatsgalerie, Stuttgart, Germany). by Rembrandt van Rijn. This theme which appears in several of Rembrandt's etchings, sketches and paintings is from the Book of Tobit (the Apocrypha) and recounts the story of righteous Tobit who becomes blind when bird droppings fall in his eyes. His son, Tobias, aided by the Archangel Raphael, returns from a journey of discovery and restores the sight of his blind father by smearing fish gall on his father's eyes. If we put textual accuracy aside (Tobit’s blindness was not caused by cataracts and the restoration of his sight was not by surgery), we remain grateful to Rembrandt for dramatically documenting the technique of cataract surgery called couching, used during Rembrandt's time in 17^th century Holland.

Rembrandt van Rijn (1606-1669)
Rembrandt van Rijn was 26 years old when he was commissioned to paint The Anatomy Lesson of Dr. Nicolaes Tuip (1632). Dr. Tulp, a surgeon and anatomist, is performing a public demonstration of the dissection of the forearm of a recently executed criminal. The source of light comes from above and behind the viewer, boldly contrasting a serious Dr. Tulp and the wonder and astonishment of the onlookers.
 Link to Mauitshuis National Gallery in The Hague

Caspar Stromayr (c.1530-1580)
Little is known about Caspar Stromayr who was a famous cutter of hernias and a coucher of cataracts. He wrote Practica Copiosa in 1559, a copy of which was discovered in the city library of Lindau (Bavaria) in 1909. Primarily dealing with the surgical repair of hernias and hydroceles, the manuscript includes 186 full page water-color drawings. Stromayr is credited with establishing two principles for repair of inguinal hernias: reinforce the anterior wall of the inguinal canal and tighten the external inguinal ring. This drawing shows a man restrained to an inclined board undergoing a left inguinal herniorrhaphy. Practica Copiosa has an appendix which describes the anatomy, pathology and treatment of cataracts.

Pieter the Elder Bruegel (1525-1569)
Pieter Bruegel the Elder, a Dutch painter and printmaker, was known for his landscapes and peasant scenes. Some call him “Peasant Bruegel” to distinguish him from other members of the Brueghel dynasty of painters. Within his landscapes Bruegel recounted folk stories, combining several elements of a story within a single painting. Many paintings have a cartoon character which may have concealed complex levels of aphorisms, satire and social commentary. His painting, Cutting Out the Stone of Madness or an Operation on the Head (1568), shows a chaotic and comic asylum where patients are undergoing trepanning procedures to relieve madness.

Andeas Vesalius (1514-1564)
Upon entering the operating room both the patient and the surgeon lose their visual identities. The patient becomes an amalgam of bones, fat, blood and muscles. The surgeon becomes a composite of mask, cap, gloves and gown. Both patient and surgeon dwell in their altered identities until leaving the operating room. Within this visual space, even minor visual cues become important. The posture of the body, the juxtaposition of any real or imaginary objects assist our interpretation. Images which are frightening become humorous. Images which are pedantic become profound. Andeas Vesalius, a Flemish physician and anatomist living in Padua, struggled against popular prejudice to make dissection a recognized part of medical education. He created the De Humani Corporis Fabrica with the assistance of students of Titian from nearby Venice. These woodcut engravings of anatomical dissections joined with panoramas of the Italian countryside have inspired generations of medical illustrators and physicians.
 ...more about Vesalius

Ambroise Paré (1509–1590)
Ambroise Paré may be thought of as the father of modern prosthetics. A French military surgeon, Paré developed treatments of wounds and amputations which greatly reduced the death rate on the battlefield. He abandoned the use of cauterization and reintroduced ligatures to tie off blood vessels. Paré advocated natures healing power and the inscription, "Je le pansay, Dieu le quarit" (I dressed him; God healed him) appears on his grave. Paré treated many amputees during his career and is credited with the first medical description in 1551 of the phantom limb syndrome. The illustration of a mechanical hand appears in his 1564 book, Instrumenta chyrurgiae et icones anathomicae. Paré had no way of understanding the advancements in materials, surgery and antibiotics needed to make the prosthetic hand a reality.

Giovanni Andrea Della Croce (1509-1575)
Little is known about Giovanni Andrea Della Croce (1509-1575) who published a textbook on surgery, Cirugia Universale e Perfect  in 1573. The woodcut depicts a domestic setting including a child, dog and cat with the patient strapped prone on a table as the surgeon appears to drill a hole in the skull.

Walther Hermann Ryff (c.1505-1548)
Walther Hermann Ryff's Grosse Chirurgie: Traumatologie und Feldchirurgie published in 1545 is largely descriptive rather than analytical and summarizes sixteenth-century surgical instruments, drugs, injuries and treatments. Ryff trained as an apothecary before becoming a municipal physician and surgeon in Strasbourg (Alsace). The print shows a left below the knee amputation and is an example of the colored woodcuts Ryff used for his textbooks on a variety of subjects including botany, distilling, nutrition, mathematics, anatomy, engineering and surgery.

Vidus Vidius (c.1500-1569)
Treatments for joint dislocations and simple bone fractures by traction and compression were known in ancient times. In the 10^th century a Byzantine physician, Niketas (also spelled Nicetos), transcribed ancient surgical manuscripts which included the commentary by Galen (129 -200) on the treatment of dislocations by Hippocrates (460 BCE -380 BCE). The texts and illustrations were brought to Crete in 1495 and were used by Guido Guidi, known by his Latin name Vidus Vidius, in his book about surgical treatments. Guidi supported the principles established by Hippocrates and Galen and gained fame as a teacher of Vesalius (1514-1564). Chirugia of Vidus Vidius (1544) shows simple and complex methods of reducing fractures and dislocations, including the famous Scamnum traction table attributed to Hippocrates.

Leonardo da Vinci (1452-1519)
The life and work of Leonardo da Vinci parallel the emergence of European culture from the Dark Ages during the Italian Renaissance. His drawings mark the rebirth of art, science and philosophy.  Using pen, chalk and brush, he created scientific illustrations which offered visual answers to mysteries which had confounded scholars for centuries. Leonardo began his anatomical studies of human muscles and bones around 1490. Later he concentrated his energies on embryology and cardiology. This image circa 1505 of a Fetus in utero is astonishing in its detail though limited in understanding of function. Later anatomists and physiologists would correct the science in preparation for modern obstetric surgery on the womb. This image is one of 200 anatomic drawings which appear in the Royal Collection, U.K.

Hieronymus Bosch (1450-1516)
Little is known about the meaning of the painting, The Extraction of the Stone of Madness, The Cure of Folly (1475-1480). This image is frequently included in anthologies of medical images even though its inclusion may depend on speculation about the intentions of the enigmatic Bosch. Was Bosch depicting psychosurgery or was he painting an allegory, social criticism or satire? During medieval times, people speculated that stones of madness existed inside the skulls of the mentally ill. The painting shows the extraction of a "keye" (a stone or bulb) from a man's skull by a trephining operation known in Bosch's time. Bosch exchanged the “keye” for the bulb of a flower and placed a second flower on the table. The inscription reads, "Meester snyt die Keye ras - myne name is lubbert das" (Master, cut away the stone – my name is Lubbert Das). Lubbert Das was a comical character in Dutch literature and the flower may be a pun on "tulip head" - meaning mad. The funnel hat and the flower are humorous and hint that the doctor is a charlatan. The woman balancing a book on her head may represent additional folly or melancholia.

The Miracle of Cosmas & Damian (15th c.)
Just as man’s dream to build a machine to fly like a bird predates the first airplane by hundreds of years, man’s dream to transplant limbs and organs predates by centuries the modern technology of organ transplantation. The legend of the “Miracle of the Black Leg” describes two surgeon brothers, Sts Cosmas and Damian, who lived during the 3rd century in Asia Minor. The legend relates their miraculous removal of the diseased leg of a Caucasian Roman named Justinian and its replacement with the leg of a recently deceased black African (Moor). Because of this miracle, Sts Cosmas and Damian became the patron saints of medicine. The wood panel is a 15th Century Gothic Swabian paintings depicting this miracle. The painting is self-explanatory and shows Sts Cosmas and Damian at Justinian’s side. In the foreground are his black right leg and his white left leg. The amputated leg lies on the floor.
 ...more about Sts Cosmas & Damian

The Circumcision of Christ (1440-1450)
From time to time new arguments are offered for the therapeutic benefits of male circumcision, but at its core, circumcision is ritual surgery performed to satisfy religious beliefs. The painting by the Master of the Tucher Altar (Nuremberg) shows this ritual circumcision of infant Christ with three men dressed in robes adorned with Hebrew letters. In contrast to other paintings of the time which show empathy and compassion, this image evokes abhorrence. Long before this painting, Baptism was deemed a replacement for circumcision. Should Baptism include full or partial immersion? Should Baptism, like Jewish circumcision, occur on the infant’s eighth day? Did a religious person who was baptized in infancy require a second Baptism (Anabaptism) as an adult? These differing opinions were formalized by Hussites, Lutherans and Protestants but labeled as heresies by the Catholic Church. Mary and Joseph look on with their faces partially hidden. The Chair of Elijah frames the circumcision nearing completion. Surgery, ritual and superstition meet as an evil eye watches from behind the bespectacled reader.

Serafeddin Sabuncuoglu (1385-1468)
Serafeddin Sabuncuoglu lived in central Anatolia and authored in Turkish one of the earliest surgical textbooks, Cerrahiyetul-Haniyye, in 1465. Three original handwritten copies of this book are in existence. Sabuncuoglu, an artist and calligrapher, included color illustrations of his surgical techniques. He is often referred to as the father of pediatric surgery because of his original contributions to the surgical treatments for hydrocephalus, webbed fingers, inguinal hernias, and erroneous circumcisions. His description of the surgical treatment for imperforate anus includes this miniature drawing.
  ...more about Sabuncuoglu

Guido da Vigevano (c.1280-1349)
Guido of Vigevano was an Italian anatomist, physician and engineer. He was the court physician of the French king, Philip VI, and is given credit for designing a windmill powered wagon (never built). In this illustration the artist combines an idealized impression of the ancient technique of trephination with a surprisingly modern rendering of the human bodies. This illustration is from Guido's 1345 manuscript on human anatomy.

Roger Frugard of Salerno (c.1140-1195)
Prior to the discovery of general anesthesia, the surgeon was restricted to using his scalpel on the surface of the body and its superficial cavities. A successful surgical procedure had several attributes. The acute pain of the surgery needed to be commensurate with the chronic pain of the disease and the procedure needed to be brief. It was likely that the surgeon required advance payment for the procedure. This late twelfth century Anglo-Norman illuminated manuscript from the British Library is attributed to Practica Chirurgiae by Roger Frugard of Salerno. He illustrates three surgical procedures: surgery for hemorrhoids, nasal polyps and corneal opacity. The surgeons appear in short-robes and the Latin text describes the procedures.
   ...more about Roger of Salerno

Al-Beruni (973-1051)
This image may be the first illustration of a caesarean section. Called “The Birth of Caesar”, it appears in "Al-Asrar-al-Baqiyah-an-al-Qurun-al-Khaliydh" or the Chronological of Ancient Nations (Edinburgh University Library) which was written by the famous Muslim chronicler, Al Beruni, (973-1051). Al-Beruni traveled extensively throughout the Islamic world and India and is famous for reporting that the earth may rotate around the sun. However, scholars point out that this illustration is not evidence that Caesarean sections, post-mortem or live, were performed by medieval physicians.

This image of uncertain origin (in a style similar to Sabuncuoglu) shows an Arabic attired bearded man operating on a woman's eye performing the ancient cataract operation called couching. Using this technique, a sharp instrument punctures the sclera and displaces the opaque lens from the line of vision into the vitreous humor. The famous Indian surgeon, Sushruta (also spelled Susruta and Sushrutha), referred to as the father of modern surgery, described this and other surgical techniques in his works known as “Sushruta Samhita” which were translated into Arabic by the 8^th century CE. The uncertain dates of the life of Sushruta place him sometime between 800 and 500 BCE.
 ...more about Sushruta

Many of the earliest recorded surgical procedures would be categorized as urologic. Perhaps the most ancient is the ritual circumcision of the penis. Among Jews this was mandated on the eighth day of life as physical evidence of the covenant with God. Moslems perform the ritual circumcision between the age 5 and 15. The Egyptian practice of circumcision of priests and nobility may predate the Jewish ritual which, according to the Torah, dates back to Abraham. This relief of the 6th Egyptian Dynasty, in the Saqqara Necropolis outside of Cairo, is from the Tomb of Ankhmahor (2345 BCE), referred to as the “Tomb of the Physician.” The mural shows the two young men, one with arms restrained, undergoing circumcision.