THE ART OF JAMA
Journey in Thick Wood: Childhood Henry Norman Bethune Preeti N. Malani, MD, MSJ; Richard L. Prager, MD
I
nfection due to Mycobacterium tuberculosis has been recognized since antiquity. Mycobacterial DNA has been identified in Egyptian mummies dating back to 3000 BCE. Hippocrates described tuberculosis or “phthisis” as a great plague for mankind—and a challenge for physicians. The disease later became epidemic among the urban poor during the 19th century, with industrialization, poverty, overcrowding, and poor nutrition contributing to the sharp rise in cases. Closed windows in cool climates also facilitated person-to-person spread of the bacterium first described by Robert Heinrich Koch in 1882. An estimated 20% of all deaths in Europe were secondary to tuberculosis between the late 1800s and 1930s. Although the incidence of tuberculosis has dropped dramatically, the disease remains a leading cause of infection-related death worldwide, with 1.3 million deaths attributed to tuberculosis in 2012. During the early 20th century, tuberculosis was a common occupational hazard that affected many physicians, including Canadian-educated physician and surgeon Henry Norman Bethune, MD (1890-1939). In September 1926, while a faculty member of the Detroit College of Medicine and Surgery (now Wayne State University School of Medicine), Bethune was diagnosed with pulmonary tuberculosis. Following a brief stay at the Calydor Sanitorium in Gravenhurst, Ontario, Bethune was accepted as a patient at the Adirondack Cottage Sanitarium in Saranac, New York, better
known as the Trudeau Sanitorium. With no known cure at the time, the fresh resin-filled air of the Adirondack Mountains, good nutrition, and rest were considered the best therapy for tuberculosis. In keeping with the lead of German physician Hermann Brehmer, who helped establish one of the first sanatoriums in Silesia, Prussia, extended stays in places like Trudeau and Calydor had become the standard approach to treating tuberculosis throughout North America. In addition to medicine, Bethune held a keen interest in art. His avocational approach to art was heavily influenced by his parents’ strong evangelism. The son of a clergyman, Bethune was well versed in John Bunyan’s The Pilgrim’s Progress and the art associated with it. During Bethune’s clinical training in Europe, his art experience was expanded and reportedly influenced significantly by William Hogarth’s A Rake’s Progress. In subsequent years, Bethune looked to art as a means to express his feelings. While at Trudeau, he drew a series of color sketches as he pondered his own fate. Recognizing that he had what was likely a fatal disease, Bethune wrote, “In a dark moment while taking the early air injections [1927], I drew for the amusement of myself and my cottage mates the allegorical story of my past life and what I thought the future would be.”1 His murals, which he entitled The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes, were drawn on brown laundry wrapping paper using oil pastels or chalk crayons. The continuous colored drawing was 5 feet high and 60 feet long2 (152.4 × 1828.8 cm) and ran around the walls of Lea Cottage, which Bethune shared at various times with fellow patients Dr John Blair Barnwell, Dr Lincoln Fisher, Dr Alfred Blalock, and Nan Li. The drawings were later annotated by Bethune reflecting his earthly evolution and predicted death from tuberculosis. Journey in Thick Wood: Childhood, the sketch highlighted in this theme issue on infectious disease, illustrates a number of childhood diseases. Bethune borrowed from old medieval illuminated manuscripts, artistically portraying each illness as a cruel, terrifying creature. The caption reads: FROM DRAGON DIPTH, SIR SHICK DEFENDS FROM OTHER BEASTS HE CANNOT SAVE THE WOUNDS AND SCARS OF THEIR ATTACK HE’LL CARRY TO HIS GRAVE.
Journey in Thick Wood: Childhood (from The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes) (detail).
1380
The white figure depicts a child being attacked by a giant dragon (“the Dipth”), while a knight (“Sir Shick”) defends the child using a long sword, shaped like a hypodermic needle (representing diphtheria vaccine), to slay the dragon. At the same
JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 05/23/2015
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The Art of JAMA
Henry Norman Behtune (1890-1939), Journey in Thick Wood: Childhood (from The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes). 1927,
Canadian. Oil pastels and chalk crayons on paper. Images courtesy of the Department of Cardiac Surgery, University of Michigan, Ann Arbor.
time, the child is being stung by a “T.B. bat.” These figures (red pterodactyls) are noted in several places in this drawing and also in the other scenes of the mural. The color is reminiscent of “red snappers,” a term sometimes used to describe the microscopic appearance of M tuberculosis. “Sir Shick” is a reference to pediatrician Béla Schick, MD, who developed a test to
determine past immunity to diphtheria (the Schick test) and later coordinated a massive vaccination campaign to control the dread and often deadly disease. Bethune wrote, “The third scene is my Childhood. It is depicted as a dangerous journey through a thick wood where lurk various wild animals.” To continue quoting Bethune, “the
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JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
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1381
The Art of JAMA
By December 1927, Bethune’s health had improved and he was ready to leave Trudeau and resume his medical career. His personal struggle with tuberculosis influenced his decision to focus more firmly on the relief of human suffering. In addition to serving his patients, he became an outspoken political activist and an early Communist. Bethune, who had fought in World War I and the Spanish Civil War, later worked as a field surgeon in China. He assisted Mao Tse Tung’s Eighth Route Army and operated on many soldiers with infected wounds. On November 12, 1939, Bethune died of septicemia acquired from a cut he sustained while operating. Forty years following his death, an image of Bethune was featured on the cover of the November 9, 1979, issue of JAMA recognizing the rapprochement between the United States and Mainland China in the 1970s.4 The murals were brought to the University of Michigan by Bethune’s physician and friend at the Trudeau Sanatorium, Dr John Blair Barnwell. Barnwell facilitated the transfer of these murals to the University of Michigan Fluoroscopy Room in approximately 1930 when the Lea Cottage was destroyed, for reasons unknown. The Bethune murals remained there until 1960 when they were returned to Saranac, New York. In the 1970s they were shipped to Fort Bragg in North Carolina for study by the Department of the Army’s experts on China. Although copies exist, the original murals have been unaccounted for and are considered lost at this time. 1. Bethune N. The T.B.’s Progress. The Fluoroscope. August 15, 1932;1(7). Tapestry, 1975, Chinese. 167.6 × 198.1 cm. Woodward Bio-Medical Library, Vancouver, British Columbia, Canada.
2. Judge JK. Henry Norman Bethune, M.D. (1890-1939): The T.B.’s Progress. J Lab Clin Med. 1987;110(1):125-126. 3. Link EP. The T.B.’s Progress: Norman Bethune as Artist. Plattsburgh, NY: Center for Study of Canada, SUNY Plattsburgh; 1991.
Measle is a sort of spotted tiger, the Mump, the Whoop, the Dipth, and the Scarlet are various—wild and weird animals which either lurk behind the trees or fly in the sky, ready to pounce down on the child.”3 Two additional childhood diseases included in the drawing are infantile paralysis (polio) as well as rheumatic fever (detail).
1382
4. Gibson WC. Bethune’s China: forty years on. JAMA. 1979;242(19):2091-2092.
Author Affiliations: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor; Associate Editor, JAMA (Malani); Department of Cardiac Surgery, Frankel Cardiovascular Center; University of Michigan Health System, Ann Arbor (Prager). Corresponding Author: Preeti N. Malani, MD, MSJ ([email protected]).
JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 05/23/2015
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Journey in Thick Wood: Childhood Henry Norman Bethune Preeti N. Malani, MD, MSJ; Richard L. Prager, MD
I
nfection due to Mycobacterium tuberculosis has been recognized since antiquity. Mycobacterial DNA has been identified in Egyptian mummies dating back to 3000 BCE. Hippocrates described tuberculosis or “phthisis” as a great plague for mankind—and a challenge for physicians. The disease later became epidemic among the urban poor during the 19th century, with industrialization, poverty, overcrowding, and poor nutrition contributing to the sharp rise in cases. Closed windows in cool climates also facilitated person-to-person spread of the bacterium first described by Robert Heinrich Koch in 1882. An estimated 20% of all deaths in Europe were secondary to tuberculosis between the late 1800s and 1930s. Although the incidence of tuberculosis has dropped dramatically, the disease remains a leading cause of infection-related death worldwide, with 1.3 million deaths attributed to tuberculosis in 2012. During the early 20th century, tuberculosis was a common occupational hazard that affected many physicians, including Canadian-educated physician and surgeon Henry Norman Bethune, MD (1890-1939). In September 1926, while a faculty member of the Detroit College of Medicine and Surgery (now Wayne State University School of Medicine), Bethune was diagnosed with pulmonary tuberculosis. Following a brief stay at the Calydor Sanitorium in Gravenhurst, Ontario, Bethune was accepted as a patient at the Adirondack Cottage Sanitarium in Saranac, New York, better
known as the Trudeau Sanitorium. With no known cure at the time, the fresh resin-filled air of the Adirondack Mountains, good nutrition, and rest were considered the best therapy for tuberculosis. In keeping with the lead of German physician Hermann Brehmer, who helped establish one of the first sanatoriums in Silesia, Prussia, extended stays in places like Trudeau and Calydor had become the standard approach to treating tuberculosis throughout North America. In addition to medicine, Bethune held a keen interest in art. His avocational approach to art was heavily influenced by his parents’ strong evangelism. The son of a clergyman, Bethune was well versed in John Bunyan’s The Pilgrim’s Progress and the art associated with it. During Bethune’s clinical training in Europe, his art experience was expanded and reportedly influenced significantly by William Hogarth’s A Rake’s Progress. In subsequent years, Bethune looked to art as a means to express his feelings. While at Trudeau, he drew a series of color sketches as he pondered his own fate. Recognizing that he had what was likely a fatal disease, Bethune wrote, “In a dark moment while taking the early air injections [1927], I drew for the amusement of myself and my cottage mates the allegorical story of my past life and what I thought the future would be.”1 His murals, which he entitled The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes, were drawn on brown laundry wrapping paper using oil pastels or chalk crayons. The continuous colored drawing was 5 feet high and 60 feet long2 (152.4 × 1828.8 cm) and ran around the walls of Lea Cottage, which Bethune shared at various times with fellow patients Dr John Blair Barnwell, Dr Lincoln Fisher, Dr Alfred Blalock, and Nan Li. The drawings were later annotated by Bethune reflecting his earthly evolution and predicted death from tuberculosis. Journey in Thick Wood: Childhood, the sketch highlighted in this theme issue on infectious disease, illustrates a number of childhood diseases. Bethune borrowed from old medieval illuminated manuscripts, artistically portraying each illness as a cruel, terrifying creature. The caption reads: FROM DRAGON DIPTH, SIR SHICK DEFENDS FROM OTHER BEASTS HE CANNOT SAVE THE WOUNDS AND SCARS OF THEIR ATTACK HE’LL CARRY TO HIS GRAVE.
Journey in Thick Wood: Childhood (from The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes) (detail).
1380
The white figure depicts a child being attacked by a giant dragon (“the Dipth”), while a knight (“Sir Shick”) defends the child using a long sword, shaped like a hypodermic needle (representing diphtheria vaccine), to slay the dragon. At the same
JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 05/23/2015
jama.com
The Art of JAMA
Henry Norman Behtune (1890-1939), Journey in Thick Wood: Childhood (from The T.B.’s Progress, a Drama in One Act and Nine Peaceful Scenes). 1927,
Canadian. Oil pastels and chalk crayons on paper. Images courtesy of the Department of Cardiac Surgery, University of Michigan, Ann Arbor.
time, the child is being stung by a “T.B. bat.” These figures (red pterodactyls) are noted in several places in this drawing and also in the other scenes of the mural. The color is reminiscent of “red snappers,” a term sometimes used to describe the microscopic appearance of M tuberculosis. “Sir Shick” is a reference to pediatrician Béla Schick, MD, who developed a test to
determine past immunity to diphtheria (the Schick test) and later coordinated a massive vaccination campaign to control the dread and often deadly disease. Bethune wrote, “The third scene is my Childhood. It is depicted as a dangerous journey through a thick wood where lurk various wild animals.” To continue quoting Bethune, “the
jama.com
JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 05/23/2015
1381
The Art of JAMA
By December 1927, Bethune’s health had improved and he was ready to leave Trudeau and resume his medical career. His personal struggle with tuberculosis influenced his decision to focus more firmly on the relief of human suffering. In addition to serving his patients, he became an outspoken political activist and an early Communist. Bethune, who had fought in World War I and the Spanish Civil War, later worked as a field surgeon in China. He assisted Mao Tse Tung’s Eighth Route Army and operated on many soldiers with infected wounds. On November 12, 1939, Bethune died of septicemia acquired from a cut he sustained while operating. Forty years following his death, an image of Bethune was featured on the cover of the November 9, 1979, issue of JAMA recognizing the rapprochement between the United States and Mainland China in the 1970s.4 The murals were brought to the University of Michigan by Bethune’s physician and friend at the Trudeau Sanatorium, Dr John Blair Barnwell. Barnwell facilitated the transfer of these murals to the University of Michigan Fluoroscopy Room in approximately 1930 when the Lea Cottage was destroyed, for reasons unknown. The Bethune murals remained there until 1960 when they were returned to Saranac, New York. In the 1970s they were shipped to Fort Bragg in North Carolina for study by the Department of the Army’s experts on China. Although copies exist, the original murals have been unaccounted for and are considered lost at this time. 1. Bethune N. The T.B.’s Progress. The Fluoroscope. August 15, 1932;1(7). Tapestry, 1975, Chinese. 167.6 × 198.1 cm. Woodward Bio-Medical Library, Vancouver, British Columbia, Canada.
2. Judge JK. Henry Norman Bethune, M.D. (1890-1939): The T.B.’s Progress. J Lab Clin Med. 1987;110(1):125-126. 3. Link EP. The T.B.’s Progress: Norman Bethune as Artist. Plattsburgh, NY: Center for Study of Canada, SUNY Plattsburgh; 1991.
Measle is a sort of spotted tiger, the Mump, the Whoop, the Dipth, and the Scarlet are various—wild and weird animals which either lurk behind the trees or fly in the sky, ready to pounce down on the child.”3 Two additional childhood diseases included in the drawing are infantile paralysis (polio) as well as rheumatic fever (detail).
1382
4. Gibson WC. Bethune’s China: forty years on. JAMA. 1979;242(19):2091-2092.
Author Affiliations: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor; Associate Editor, JAMA (Malani); Department of Cardiac Surgery, Frankel Cardiovascular Center; University of Michigan Health System, Ann Arbor (Prager). Corresponding Author: Preeti N. Malani, MD, MSJ ([email protected]).
JAMA October 8, 2014 Volume 312, Number 14
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 05/23/2015
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