Ferrara V, De Santis S, Silvestri A, Staffoli C.

/Senses Sci 2015; 2 (2):40 -44

doi: 10.14616/sands-2015-2-4044
OPE AC

Art and Medicine: from anatomic studies to Visual Thinking Strategies

Vincenza Ferrara*, Sara De Santis, Claudia Staffoli

DIGILAB, “Sapienza” University of Rome, Italy

*Corresponding author Dr Vincenza Ferrara, DIGILAB, “Sapienza” University of Rome, Via dei Volsci, 122 – 00135
Rome- Italy; e-mail: [email protected]

Article history
Received: June 14, 2015
Accepted: June 23, 2015
Published: June 30, 2015

Abstract
Over the centuries the collaboration between artists and doctors and the relationship between art and medicine disciplines have been
documented. Since the '60s the discipline of medical humanities has been developed in order to enrich the studies in medical sciences
with the humanities. In the belief that medicine is more than just a set of knowledge and technical skills, medical educators have
considered important to include the humanities as art, literature, philosophy, ethics, history, in the curriculum of training a good
doctor. Despite there are examples of previous use of art as part of the curricula of medicine as a tool to develop the cognitive skills of
observation and description, there is a general consensus that the semiotic competence starts from a correct and deep observation,
"clinical eye", using senses to diagnose disease. It can talk about "Visual Thinking Strategy" (VTS) in this context. The VTS provides
a way to enable the observation of the work of art, the process of analysis, comparison and discussion with others that allows the
medical student to acquire a method to be applied also in clinical activity, improving skills in patient examination, by implementing
the problem solving and critical thinking, getting used to teamwork, stimulating empathy toward patient and respect for others
(whether patient or colleague). The observation practice should be key thing for medical training and this theory can be an aid to
improve clinical skills. A trial of VTS for medicine students connected to Semiotic Course in collaboration with the Galleria Borghese
in Rome during last academic year was carried out at The Degree Course in Medicine of the Faculty of Medicine and Psychology of
Sapienza University.

Keywords : Medical humanities, art, Visual Thinking Strategies

Introduction corpse because this practice was prohibited for religious

reasons. They were able to “admire” the representation of
Art understood as 'Tèchne' could be described as the muscles stretching through sculpture, an example is
application of rules set and experiences elaborated by man, Myron's Discobolus.
therefore the knowledge, in order to make objects or to In Medicine field only Herophilus of Chalcedon and
depict images taken from reality or fantasy world. Medical Erasistratus, in the third century B.C. carried out
Science is a discipline defined as Art in so far as it able to dissections of "live" human bodies (1) until 1241 when
apply the knowledge, therefore the Science of the disease Federico II promulgated the edict that authorized and
cure. Over the centuries these disciplines have developed stimulated the use of cadavers by doctors. In 1316
many relationships, in fact, we have document of the Mondino de Liuzzi wrote "Anothomia" founding the first
cooperation between artists and doctors. Let’s think , in School of Human Anatomy in Europe.
Classical Antiquity, when artists could learn anatomical It will have to wait the Renaissance, with the birth of
features only through the observation of athletes in the "modern" medicine, to discover that also the artists
gymnasium. Anatomical features, still unknown to the were able to use the human bodies for their anatomical
doctors, who could not use, for example, the dissection of studies. The first known example was Il Pollaiolo

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 Senses Sci 2015; 2 (2): 40 -44

(Antonio Benci), whose anatomical drawings are at Louvre medicina abbiano strappato al pennello creatore
(2). In this period the collaboration between doctors and dell’artefice appassionato opere palpitanti di vita, di verità,
artists is very fervent, just refer to the Treaty of Anatomy di sentimento. E poichè il bello è lo splendore del vero, si
wrote by Andrea Vesalio “De humani corporis fabrica libri può dire che anche le più crude verità della patologia
septem” (1543), with its 300 anatomical woodcuts umana rivestite degli splendori dell’arte da una mano
illustrated by the Flemish engraver and painter Jan sapiente di artefice, hanno contribuito alla creazione del
Stephan van Calcar (3). Needless to mention the bello, con opere sublimi di pittura e di scultura" (4).
Leonardo Da Vinci's drawings with his anatomical The artists work makes them excellent observers. They
studies, the descriptions for dissecting cadavers or capture every small detail of the figure's body represented,
Raphael's drawings, and the studies for the composition of also by recording the physical conditions of their models.
the Deposizione Borghese (1507), which documents the This is reason because doctors to describe the disease of
artist's practice and anatomical knowledge. the models in the past paintings such as the diagnosis of
The Art has "borrowed" techniques from the medical scoliosis in the woman behind of the Three Graces (1639)
practice to depict the human figure and it has also by Peter Paul Rubens (5), through careful observation of
documented the medical art as It is highlighted by the details.
numerous paintings illustrating anatomy lectures, as An
anatomy lecture for artists (ca. 1570), Michelangelo
surrounded by other artists showing the Sartorius muscle
of the dead body, by Federico Zuccari or the Anatomical
lecture of Dr. Willem van der Meer (1617) by Michiel
and Pieter van Miereveld or the Anatomy class of Dr.
Nicolaes Tulp (1632) by Rembrandt van Rijn.
In this brief description of the relationship between
artists and doctors it is necessary to cite the anatomical
wax modeling. During the Renaissance takes place the
true rediscovery of the human body; artists and doctors
study the cadavers, encouraged by a strong scientific
interest in anatomy, and it is during this early stage of
research that wax, as material, plays a key role, especially
in the work of the artists. This practice was used in
anatomical research as an expressive and a figurative
vehicle, and there were many artists who used preparatory
small-scale wax models for their artworks. Ludovico Cardi,
called Cigoli used this technique to better represent the
human body and an example is Lo Scorticato (1678). The
flemish Dr. Maiering helped him for the anatomical
investigation.
In the 1700s the anatomical wax modeling was
developed by the collaboration between Gaetano Giulio
Zumbo, a sicilian wax modeler, and the French surgeon This practice has developed a debate on effective of
Guillaume Desnoues. Anatomical artifacts were produced clinic diagnosis of the patients who can no longer be cared
to train the doctors but their extreme realism and the for, and on the 'Iconodiagnostica', practice introduced in
representation of the dramatic death appearance let them Italy by the pathologist, Professor Vittorio Franco, that
to be considered true art works. attracted criticism by some art historian. But one of the
The evidence of diseases in figurative artworks results presented by Franco, and those of a spanish
(painting, sculpture and so on) is another topic that collegue about the Gioconda's case may create curiosity
connect Art and Medical disciplines. Indeed many abound this discipline.
doctors were able through the observation of the Franco, has analyzed about one hundred art works and
representation of the human figure by artists, to trace the He had been able to find that, probably, the Mona Lisa
presence of some diseases that today, fortunately, have had a xanthelasma under his left eye,
been eradicated such as the plague. It Is interesting to Hypercholesterolemia mark, and a Lipoma on hand. The
report what Dr. Giovanni Franceschini wrote in 1906 " Spanish Dr. Francisco Javier Barbado Hernandez studying
anche i lati più tristi e dolorosi della vita umana, così the Mona Lisa of the Prado (1503-1506) by Leonardo's
piena di sofferenze fisiche, siano stati, in quasi tutti i pupils work, found on the hand not a lipoma mark, but
tempi, soggetto di studio da parte di artisti preclari, e sign of a bloodletting. The art historian Carla Gori
come anche le scienze più pietose e ributtanti della comparing evidences by the analysis of Dr. Barbado

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 Ferrara V, De Santis S, Silvestri A, Staffoli C.
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Hernandez and letter by ducal official Giacomo Seregno Housen’s method is connected strictly to Rudolf
dated August 2, 1496 "sappiamo che la primogenita del Arnheim’s research that convincingly explains the
Moro, da mesi sottoposta alle cure dell'archiatra e connection between visual perception and thought.
astrologo Ambrogio da Rosate per una malattia misteriosa, Identify what we see, according to Arnheim, is knowledge
forse da avvelenamento, in quella data rifiutava il salasso", action. When it looks at something, the mechanisms of
has deduced that the Mona Lisa could represent a understanding take place quickly to recognize and grasp
portrait of Bianca Sforza (6). the meaning of what is being put before eyes. Moreover,
Interesting pathognomic signs by artworks it can see in thanks to visual stimulus, thoughts and acts to solve
Galleria Borghese, for example the self-portrait by Gian problems are automatically set (10). So Visual Thinking
Lorenzo Bernini. The doctor of our research team has Strategies teaching can be applied for developing critical
suggested evidence of alopecia areata. thinking (11).
In recent years, Art has a social role in the care centre, The practice of VTS method called students to look
and the Art therapy is used as a support of psychology at and to interpret an art work. A Guide, expert in VTS,
care. brings students in environment characterized by
Art plays an important role in learning, and visual constructive dialogue and encourages them to use the
thinking since Arnheim, is useful tool for improving individual abilities of observation, reflection, and to
knowledge. Debate on the museum roles and relevance of explain and compare their ideas with others.
the art works in contemporary society in education and A key element of VTS teaching is to encourage
training environment is ongoing so it is possible to talk students to present and explain the evidences of details
about Visual Thinking Strategy. The observation practice identified in artwork observed. This cognitive challenge
should be key thing for medical training and this theory encourages students to rely on their skills and knowledge,
can be an aid to improve clinical skills (7). thereby increasing self-confidence to expose their thoughts
and conclusions.
Visual Thinking Strategy (VTS) VTS improves skills that becoming mental processes
repeatable, more or less knowingly, every time that it is
In the mid-70s, in the United States, Abigail Housen, activated learning mechanism. The VTS can be useful in
a cognitive psychologist, daughter of a psychologist and an all education or training subjects and for all students (12).
Art Historian, introduced a study based on the behavior of The studies on the VTS impact argue that in addition to
museum visitors focused on the thoughts that are the growth of aesthetic understanding, is supported the
stimulated by artwork observation. increase of critical thinking skills and creativity that can be
Housen, through an indirect interview, invites the easily transferred to other subject areas. Furthermore the
museum visitors to tell what they see in the artwork and use of visual language highly helps profit and integration
the thoughts that this excite them. The questions are open of disadvantaged students for social, physical or linguistic
and they don't affect the viewer. During this time this issues (13).
survey, called Aesthetic Development Interviews (ADI),
allows Housen to collect a large sample of data and to VTS and medicine
have an idea of people’s thoughts in front of an artwork
(8). Since the '60s Medical Humanities has been developed
The intellect develops thoughts and judgments by to meet need to enrich the studies in medical sciences with
emotions and feelings which lead to subjective the humanities (14). In the belief that medicine is more
interpretation when the viewer is placed in front of art. than just a set of knowledge and technical skills, medical
Housen realized immediately that there is a wide educators have considered important to include the
difference in the analysis ability between an observer humanities as art, literature, philosophy, ethics, history, in
accustomed to look at artwork and another observer that the curriculum of training a good doctor. In recent
is not. The long-lasting relationship with art allows people decades, in medicine field, there were advances in
to develops meaningful changes in thinking. The Art is research related to instrumental and laboratory tests,
able to arouse thought complexity also for viewer less resulting a better efficacy in the diagnosis and treatment.
accustomed to art (9). However, there was an increase in costs for the use of
Results of this study and other researches on this these instruments, often unnecessary, with result to have
theme allow Housen to start to define a teaching strategy congested laboratories and increase false positive results. A
entirely based on the power of visual communication and good Semiotic helps doctors to select few very specific test
to debug the method of the Visual Thinking Strategy, to to accurate diagnosis. So it is necessary to improve this
help concretely students in learning and in getting analysis subject education in medical school. There is a general
skill. agreement that Semiotics starts from a correct and

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 Senses Sci 2015; 2 (2): 40 -44

thorough observation, in fact it talks about "clinical eye" Conclusion and perspective
to indicate semiotic competence related to use of senses to
diagnose disease (15). The relationships between art and medicine, as we
Despite there are examples of previous use of art as have seen before, are many. The relationships between art
part of medicine curricula and as a tool to develop the and medicine, as we have seen before, are many. A
cognitive skills of observation and description (16), detailed observation of the context, the narrative and
"Visual Thinking Strategy" by Housen was applied for the emotional dimension of person are key roles in both
first time in a degree course in medicine and surgery at the disciplines. Art, through the activities of observation,
Harvard University in the academic year 2003-2004 for analysis, comparison and discussion given from the VTS
the students of the 3rd year, with a 9-week elective course tools, allows the medical students to gain a method that
entitled Training the eye (17). The course was held at the can be applied in clinical practice. They can improve the
Museum of Fine Arts in Boston and at University with skills related to physical examination of patient, problem
clinical lectures, both in the classroom and in the aisle, solving and critical thinking, getting them used to
where teachers bring medical attention to the visual teamwork, cultivate empathy toward patient and respect
diagnosis for connecting between the physical examination for others (whether patient or colleague) (21).
and artistic concepts. The VTS is applied both in school and in academic
At the museum the students perform observation, environment, also in the care field in USA. In Europe and
description, and creative collaboration of the meaning especially in Italy, there aren't still such experiences,
working in pairs, directly with original artwork. In the although in medicine degree are becoming more frequent
final session, medical director of the course interview and the elective activities related to art, literature, music and so
examine a patient with a complex disease with the active on. In academic year 2014-2015 at the Medicine Degree
involvement of students (18). Course of the Faculty of Medicine and Psychology at “La
Afterwards, this strategy has been adopted by other US Sapienza” University, application of Visual Thinking
universities as Ohio in collaboration with the Art Museum Strategy has been experimenting in an integrated course in
of Colombo, in Art of Analysis elective course , involving scientific-methodology and human sciences. "Art of
students of the 5th year of medicine starting from the observation: from artwork to diagnosis" course has been
academic year 2010-2011.Starting from Housen VTS, it held as VTS application for medicine students of the 3th
was designed a critical thinking form to guide the analysis year in collaboration with the “Galleria Borghese” in
of the works, called ODIP, an acronym of “ to Observe, Rome. The VTS is a useful tool for the development of
to Describe, to Interpret, to Prove” (19). critical thinking, suitable to stimulate the sensitivity to art
In academic year 2014-2015 also the Dallas and to improve awareness of the cultural heritage. In order
department of dermatology and the Art museum of the to strengthen evidences on VTS impact on semeiotics
city have held course "Art of observation" applied VTS. learning, participants to the course will be tested at the
The students, divided into small discussion groups, are end of this experiment. If results will be promising VTS
placed in front of artworks and Tutor as facilitator guides will be proposed in different learning environments and as
them to bring their attention on observation and supplement in museum educational activities.
description and discuss together (20).

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