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Contents

Chapter Authors
Contributors
Research and Review
Foreword
Preface

1 The Practice of Anesthesiology

SECTION
Anesthetic Equipment & Monitors
I

2 The Operating Room Environment

Charles E. Cowles, Jr., MD, MBA, FASA

3 Breathing Systems
4 The Anesthesia Workstation

5 Cardiovascular Monitoring
6 Noncardiovascular Monitoring

SECTION
 II
Clinical Pharmacology

7 Pharmacological Principles
8 Inhalation Anesthetics

9 Intravenous Anesthetics
10 Analgesic Agents
11 Neuromuscular Blocking Agents
12 Cholinesterase Inhibitors & Other Pharmacological Antagonists
to Neuromuscular Blocking Agents

13 Anticholinergic Drugs
14 Adrenergic Agonists & Antagonists

15 Hypotensive Agents
16 Local Anesthetics
17 Adjuncts to Anesthesia

SECTION
Anesthetic Management
III
18 Preoperative Assessment, Premedication, & Perioperative
Documentation

19 Airway Management
20 Cardiovascular Physiology & Anesthesia
21 Anesthesia for Patients with Cardiovascular Disease
22 Anesthesia for Cardiovascular Surgery
23 Respiratory Physiology & Anesthesia
24 Anesthesia for Patients with Respiratory Disease
25 Anesthesia for Thoracic Surgery
26 Neurophysiology & Anesthesia
27 Anesthesia for Neurosurgery
28 Anesthesia for Patients with Neurological & Psychiatric Diseases
29 Anesthesia for Patients with Neuromuscular Disease
30 Kidney Physiology & Anesthesia
31 Anesthesia for Patients with Kidney Disease

32 Anesthesia for Genitourinary Surgery

33 Hepatic Physiology & Anesthesia
Michael Ramsay, MD, FRCA

34 Anesthesia for Patients with Liver Disease

Michael Ramsay, MD, FRCA

35 Anesthesia for Patients with Endocrine Disease

36 Anesthesia for Ophthalmic Surgery
37 Anesthesia for Otolaryngology–Head & Neck Surgery
38 Anesthesia for Orthopedic Surgery
Edward R. Mariano, MD, MAS

39 Anesthesia for Trauma & Emergency Surgery

Brian P. McGlinch, MD

40 Maternal & Fetal Physiology & Anesthesia

Michael A. Frölich, MD, MS

41 Obstetric Anesthesia
Michael A. Frölich, MD, MS

42 Pediatric Anesthesia

43 Geriatric Anesthesia
44 Ambulatory & Non–Operating Room Anesthesia

SECTION
Regional Anesthesia & Pain
 IV Management

45 Spinal, Epidural, & Caudal Blocks

46 Peripheral Nerve Blocks
Sarah J. Madison, MD and Brian M. Ilfeld, MD, MS (Clinical
Investigation)

47 Chronic Pain Management

Bruce M. Vrooman, MD, MS, FIPP and Richard W. Rosenquist, MD

48 Enhanced Recovery Protocols & Optimization of Perioperative

Outcomes
Gabriele Baldini, MD, MSc and Timothy Miller, MB ChB FRCA

SECTION
Perioperative & Critical Care
V Medicine

49 Management of Patients with Fluid & Electrolyte Disturbances

50 Acid–Base Management
51 Fluid Management & Blood Component Therapy
52 Thermoregulation, Hypothermia, & Malignant Hyperthermia
53 Nutrition in Perioperative & Critical Care

54 Anesthetic Complications
55 Cardiopulmonary Resuscitation
N. Martin Giesecke, MD and George W. Williams, MD, FASA, FCCP

56 Postanesthesia Care
57 Common Clinical Concerns in Critical Care Medicine
58 Inhalation Therapy & Mechanical Ventilation in the PACU &
ICU

59 Safety, Quality, & Performance Improvement

Index
Chapter Authors

Gabriele Baldini, MD, MSc

Associate Professor
Medical Director, Montreal General Hospital Preoperative Centre
Department of Anesthesia
McGill University Health Centre
Montreal General Hospital
Montreal, Quebec, Canada

John F. Butterworth IV, MD

Professor and Chairman
Department of Anesthesiology
Virginia Commonwealth University School of Medicine
VCU Health System
Richmond, Virginia

Charles E. Cowles, Jr., MD, MBA, FASA

Associate Professor/Assistant Clinical Director
Department of Anesthesiology and Perioperative Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas

Michael A. Frölich, MD, MS

Professor and Associate Vice Chair for Research
Department of Anesthesiology and Perioperative Medicine
University of Alabama at Birmingham
Birmingham, Alabama

N. Martin Giesecke, M.D.

Professor and Vice Chairman for Administrative Affairs
Department of Anesthesiology
McGovern Medical School
University of Texas Health Science Center at Houston
Houston, Texas

Brian M. Ilfeld, MD, MS (Clinical Investigation)

Professor of Anesthesiology, In Residence
Division of Regional Anesthesia and Pain Medicine
Department of Anesthesiology
University of California at San Diego
San Diego, California

David C. Mackey, MD
Professor
Department of Anesthesiology and Perioperative Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas

Sarah Madison, MD
Assistant Professor
Department of Anesthesiology, Perioperative & Pain Medicine
Stanford University
Stanford, California

Edward R. Mariano, MD, MAS

Professor
Department of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology & Perioperative Care Service
Associate Chief of Staff, Inpatient Surgical Services
Veterans Affairs Palo Alto Health Care System
Palo Alto, California

Brian P. McGlinch, M.D.

Assistant Professor
Department of Anesthesiology
University of Minnesota
Minneapolis, Minnesota
Colonel, Medical Corps, United States Army Reserve
Command Surgeon
84th Training Command
Fort Knox, Kentucky

Timothy Miller, MB ChB FRCA

Associate Professor
Chief, Division of General, Vascular and Transplant Anesthesia
Department of Anesthesiology
Duke University School of Medicine
Durham, North Carolina

Michael Ramsay, MD, FRCA

Chairman, Department of Anesthesiology
Baylor University Medical Center
Baylor Scott and White Health Care System
Professor
Texas A&M University Health Care Faculty
Dallas, Texas

Richard W. Rosenquist, MD
Chairman, Department of Pain Management
Cleveland Clinic
Cleveland, Ohio

Bruce M. Vrooman, MD, MS, FIPP

Chief, Section of Pain Medicine
Dartmouth-Hitchcock Medical Center
Associate Professor of Anesthesiology
Geisel School of Medicine at Dartmouth
Lebanon, New Hampshire
John D. Wasnick, MD, MPH
Steven L. Berk Endowed Chair for Excellence in Medicine
Professor and Chair
Department of Anesthesia
Texas Tech University Health Sciences Center
School of Medicine
Lubbock, Texas

George W. Williams, MD, FASA, FCCP

Vice Chair for Critical Care Medicine
Associate Professor of Anesthesiology and Neurosurgery
Program Director, Critical Care Medicine Fellowship
University of Texas Health Science Center at Houston–McGovern Medical
School
Houston, Texas
Contributors

Kallol Chaudhuri, MD, PhD

Professor
Department of Anesthesia
West Virginia University School of Medicine
Morgantown, West Virginia

Swapna Chaudhuri, MD, PhD

Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Lydia Conlay, MD
Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Johannes De Riese, MD
Assistant Professor
Department of Anesthesiology
Texas Tech University Health Sciences Center
Lubbock, Texas

Suzanne N. Northcutt, MD
Associate Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Aschraf N. Farag, MD
Assistant Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Pranav Shah, MD
Assistant Professor
Department of Anesthesiology
VCU School of Medicine
Richmond, Virginia

Robert Johnston, MD
Associate Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Sabry Khalil, MD
Assistant Professor
Department of Anesthesiology
Texas Tech University Health Sciences Center
Lubbock, Texas

Sanford Littwin, MD
Assistant Professor
Department of Anesthesiology
St. Luke’s Roosevelt Hospital Center and Columbia University College of
Physicians and Surgeons
New York, New York

Alina Nicoara, MD
Associate Professor
Department of Anesthesiology
Duke University Medical Center
Durham, North Carolina

Nitin Parikh, MD
Associate Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Cooper W. Phillips, MD
Assistant Professor
Department of Anesthesiology
UT Southwestern Medical Center
Dallas, Texas

Elizabeth R. Rivas, MD
Assistant Professor
Department of Anesthesiology
Texas Tech University Health Sciences Center
Lubbock, Texas

Bettina Schmitz, MD, PhD

Associate Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas

Christiane Vogt-Harenkamp, MD, PhD

Assistant Professor
Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas
Denise J. Wedel, MD
Professor of Anesthesiology
Mayo Clinic
Rochester, Minnesota
Research and Review

Chase Clanton, MD
Formerly Resident, Department of Anesthesiology
Texas Tech University Health Sciences Center
Lubbock, Texas

Aaron Darais, MD
Formerly Resident, Department of Anesthesiology
Texas Tech University Medical Center
Lubbock, Texas

Jacqueline E. Geier, MD
Formerly Resident, Department of Anesthesiology
St. Luke’s Roosevelt Hospital Center
New York, New York

Brian Hirsch, MD
Formerly Resident, Department of Anesthesiology
Texas Tech University Health Sciences Center
Lubbock, Texas

Shane Huffman, MD
Formerly Resident, Department of Anesthesiology
Texas Tech University Medical Center
Lubbock, Texas

Rahul K. Mishra, MD
Formerly Resident, Department of Anesthesiology
Another random document with
no related content on Scribd:
the combination is brought about by images from hither and yon,
that gather and join in the mind. There is some confusion just here
between what is imagination in painting and what is mere
composition, which Mr. Ruskin has tried to clear up by asserting that
the former is intuitive and the latter is labored, that one works by
genius and the other by laws and principles. But the distinction itself
is somewhat labored, and in its practical working it seems to have
small basis in reality. A gathering together of antique pavements,
marble benches stained with iron rust, ideal figures clad in Greek
garments, with various museum bric-a-brac illustrative of Greek life,
such as we see in the pictures of Alma-Tadema, is certainly
composition. It may be good or bad composition, it may be
academic or naturalistic, it may have been put together laboriously,
piece by piece, or flashed together by a momentary lightning of the
mind; but, whatever the method or however brought about, one
thing seems very certain, and that is, the work, in the hands of
Alma-Tadema, contains not one spark of imagination. The same
method of combining in the mind or working on the canvas with
Delacroix or Turner or even J. S. Cotman would have almost
certainly resulted in the imaginative.
 XIII.—VELASQUEZ, Innocent X. Doria Gallery, Rome.

It is a fond fancy of Mr. Ruskin, and also of ourselves, that genius

despises laborious composition and does things with a sudden burst
of inspiration. We think, because the completed work looks easy or
reads easy, that it must have been done easily. But the geniuses of
the world have all put upon record their conviction that there is more
virtue in perspiration than in inspiration. The great poets, whether in
print or in paint, have spent their weeks and months—yes, years—
composing, adjusting, putting in, and taking out. They have known
what it was to “lick things into shape,” to labor and be baffled, to
despair and to hope anew. Goethe may have conceived “Faust”
intuitively, but it took him something like fifty years to record his
intuitions. He composed laboriously, and yet was no less a man of
superlative imagination. Listen a moment to his Prologue to “Faust”:
Raphael.
“The sun-orb sings in emulation
Mid brother-spheres his ancient round:
His path predestined through creation
He ends with step of thunder-sound.
The angels from his visage splendid
Draw power, whose measure none can say;
The lofty works, uncomprehended,
Are bright as on the earliest day.

Gabriel.
“And swift, and swift beyond conceiving,
The splendor of the world goes round,
Day’s Eden-brightness still relieving
The awful Night’s intense profound:
The ocean-tides in foam are breaking,
Against the rocks deep bases hurled,
And both, the spheric race partaking,
Eternal, swift, are onward whirled!

Michael.
 “And rival storms abroad are surging
From sea to land, from land to sea,
A chain of deepest action forging
Round all, in wrathful energy.
There flames a desolation, blazing
Before the Thunder’s crashing way;
Yet, Lord, thy messengers are praising
The gentle movement of thy Day.”[5]

5. The original German lies open before me, but I prefer to give the quotation
in a language which will not fail to be understood by all American readers. It
is Bayard Taylor’s translation, and so far as the imaginative conception is
concerned it reproduces the original fairly well.

Here is the imagination presenting us with a great cosmic picture

that in sublimity I venture to think has no superior in either poetry or
painting; yet it cannot be doubted that it was built up thought by
thought, line upon line; torn down perhaps a dozen times to be
modelled anew with something added or omitted. In other words it
has been composed, not flashed together by intuition.
The combining imagination in painting does not work differently
from this. The picture is built up; and memories often play a
prominent part in the process. One may mingle lines from Greece
with colors from Japan and an atmosphere from Holland if he will.
The result might be something heterogeneous and incongruous, but
it would nevertheless be a true enough display of the imagination.
But such a gathering from hither and yon, such a mingling of many
foreign elements, would not be necessary or essential or even usual
in art. Pictures are made in simpler ways. Here, for example, is a
sea-piece from the “Ancient Mariner,” imagined and composed again,
but brought together as a homogeneous whole.
“The western wave was all aflame,
The day was well-nigh done,
Almost upon the western wave
Rested the broad bright sun.”
 There the marine would seem to be quite complete, but Coleridge
has yet to heighten the effect of the sunset by introducing a memory
of an impression received perhaps in boyhood. His imagination,
having conjured up the image of the phantom ship, combines it with
the burning sunset:
“When that strange shape drove suddenly
Betwixt us and the sun.”

“And straight the sun was flecked with bars

(Heaven’s Mother send us grace!)
As if through a dungeon grate he peered
With broad and burning face.”

The introduction of the “dungeon grate” still further increases the

effect. We now have the flaming sky, the sea, and the skeleton ship
through which the sun mockingly peers, as through dungeon bars,
at the dying crew. The effect is weird, uncanny, unearthly, just what
Coleridge intended it should be. This, I should say, was the
imagination adding and combining. And so far as I can see it is also
the intelligent mind composing.
It would be difficult to find a parallel in painting to this picture
from the “Ancient Mariner.” One thinks at once of Turner’s “Ulysses
and Polyphemus” as resembling the Coleridge conception, because
of the sea and the sun; but the likeness is superficial. In the Turner
the spread of the sea, the golden waves in the foreground, the
heave of the mountains out of the water, the spectral figure on the
mountain top, the far distance of the ocean with the sun on the
uttermost verge, are all highly imaginative; but the real glory of the
picture is its decorative splendor rather than its expressive meaning.
The “Fighting Téméraire,” as we have already noted, is imaginative
in the magnitude of the bulk and there is something of the Coleridge
effect in the glare of the red setting sun that peers through clouds,
taking its farewell look at the old war-ship being towed to its last
berth; but the imagination is not so clear-cut here as with Coleridge
(Plate 11).
In some of Turner’s “Approaches to Venice” there is perhaps a
better example of the combining imagination, for Turner never
hesitated about “composing”—putting things into the picture that
were not there in reality; and in the Venetian pictures he sometimes
did this with startling results. I have in mind one of these pictures,
where Venice is seen a mile or more away; but the domes of the
Salute and the tops of the campaniles have been so shifted about to
suit Turner’s views of composition that I have never been able to
determine whether the city is seen from the east or the west. And
apparently Turner did not care anything about geography or
topography. His imagination brought up out of the blue-green sea a
city of palaces, builded of marble and hued like mother-of-pearl, with
distant towers shining in the sun—a fairy city floating upon the sea,
opalescent as a mirage, dream-like as an Eastern story, a glamour of
mingled color and light beneath a vast-reaching sky glowing with the
splendor of sun-shot clouds. It is most beautifully unreal, and yet by
dint of its great imagination and suggestion it is more Venetian than
Venice itself. It is that kind of distortion by the imagination which
sacrifices the form to gain the spirit of things.
Here at Venice one can see the work of the combining imagination
very well in some of the old Venetian pictures. Paolo Veronese, for
instance, has upon the ceiling of one of the rooms in the Ducal
Palace, a towering majestic figure, clad in silks and ermines,
crowned with pearls and sceptred with power, seated under a
gorgeous canopy in a chair of state, and representing the glory of
Venice. She is a magnificent type of womanhood, splendid enough in
herself to symbolize the splendor of Venice, but Paolo’s imagination
adds to her importance still further by placing her upon a portion of
a great globe representing the world, while below at her feet are
two superb figures representing Justice and Peace, offering the
tributes of the sword and the olive branch (Plate 14).
XIV.—PAOLO VERONESE, Venice Enthroned. Doge’s Palace, Venice.
 Another Venetian, Tintoretto, had possibly more imagination than
any other of his school—yes, any other Italian in art-history; and yet
it is not always possible to say just how his ideas originally took
form. No doubt he labored and composed and tried effects by
putting things in and taking them out. No doubt the “Ariadne and
Bacchus,” or the “Miracle of the Slave” (Plate 15) as we see it to-day,
was the third or fourth thought instead of the first; but there is no
questioning the exaltation of the final result. The subject of the
Resurrection in his day had become a tradition in painting, and was
usually shown as a square tomb of marble with a man rising from it
between two angels. This stereotyped tradition had been handed
down for centuries; but how greatly Tintoretto changed it and
improved it in his picture in the Scuola San Rocco! He imagined the
side of a mountain, a rock-cut tomb with angels pulling away the
great door, and as it slowly opens the blinding light within the tomb
bursts forth, and the figure of Christ rises swiftly, supported by the
throbbing wings of angels.
However this last-named picture was produced, by combination or
association, at least it is purely pictorial—that is, it deals with forms,
lights, and colors, things that can be seen. I hardly know what to
make of Mr. Ruskin’s remarks upon some of the other pictures by
Tintoretto, in the Scuola San Rocco. He seeks to exemplify the
painter’s ever-fertile imagination by pointing out, in the
“Annunciation,” that the corner-stone of the building is meant by
Tintoretto to be that of the old Hebrew Dispensation, which has
been retained by the builders as the corner-stone of the new
Christian Dispensation; and that, in the “Crucifixion,” the donkey at
the back eating the palm-branches recently thrown down before
Christ upon his entry into Jerusalem is a great piece of imaginative
sarcasm. I confess my inability to follow Mr. Ruskin just here, and I
cannot believe that Tintoretto meant anything of the sort about
either the corner-stone or the palm-branches. If he did, it was
perhaps a mistake. The motives would be more literary than
pictorial. I think it all exemplifies Mr. Ruskin’s imagination rather than
Tintoretto’s, and in either case it has little to do with imagination in
painting as generally understood among painters. Painting and the
pictorial conception, it must be repeated, have to do with forms and
colors seen by the eye or in the mind’s eye; they have very little to
do with a sarcasm or a Hebraic mystery.
There is still another phase of imagination which figures in
metaphysical text-books under the name of fancy. It is sometimes
called the passive imagination, apparently for no reason other than
distinction’s sake. It is supposed to be temporary and accidental in
its association of ideas and images, to be light, airy, capricious,
perhaps indefinite; whereas, imagination is said to be more sober,
serious, single in purpose, seeking unity of effect. The illustrations
usually cited are taken from Shakespeare. The “Midsummer Night’s
Dream” is said to be a product of fancy, while “Lear” or “Hamlet” is a
work of the imagination. But again I must confess my inability to
comprehend the distinction. The thought in the one case busies itself
with a light or gay theme, and in the other with a sober or tragic
theme; but the mental process would seem to be the same in either
case. The mind may grow happy over a birth or grieve over a death,
but one mind and one imagination would seem flexible enough to
comprehend them both. There is a difference in art between what is
called the serious and what is called the clever; but the imagination
has nothing to do with it. A figure of a soubrette dashed off in a
Parisian studio, and sent in a hurry to a Salon or Academy exhibition
as a “stunning thing,” may be clever. Mr. La Farge has defined such
cleverness as “intelligence working for the moment without a
background of previous thought or strong sentiment.” And this
definition suggests that the serious in art is just the opposite of the
clever. A figure by Millet, such as that of “The Sower,” is serious just
because the intelligence has been working upon it for many months.
But, in spite of calling a Jacquet soubrette fanciful and a Millet sower
imaginative, there would seem to be no difference in the mental
processes. The difference is one of subject, time, men, original
endowment; not a difference in the kind of thought.
The fantastic is also a product of the imagination, but it is a
lighter, more volatile and irresponsible expression than fancy. It is
the imagination just escaping from control, dominated by caprice
and leaning toward the bizarre. The griffins and the spouting
dragons along the gutters of the Gothic churches, and the boar-
headed, bird-footed devils of early art are perhaps fair illustrations of
it. In modern painting Blake and Monticelli came perilously near the
fantastic in some of their creations. Turner in his last years quite lost
himself in fantasy, and a number of the painters in France and
England might be named as illustrating the tendency to the bizarre.
When the bizarre is finally reached we may still recognize it as the
working imagination, but uncontrolled by reason. Our dreams which
often strike us as so absurd are good instances of the play of the
imagination unfettered by reason; and if our dream-land conceptions
could be reduced to art we would undoubtedly have what we have
called the bizarre. Caricature and the grotesque are different again.
They are conscious distortions, designed exaggerations of certain
features for effect. They are not ruled so much by either fancy or
caprice as by a sensible view of the extravagant.
 XV.—TINTORETTO, Miracle of Slave. Academy, Venice.

There is no metaphysical or æsthetic term to designate an

absence of the imagination, but possibly the words “baroque” or
“bombastic” will suggest the results in art. And there is no lack of
material to illustrate it. Unfortunately the master minds in both
poetry and painting have been few and far between. The names and
works that have come down to us from the past are the survivals
from many siftings; and the few geniuses of the present are perhaps
still obscured by the bombastic performances of smaller men. The
Robert Montgomerys and the Martin Farquhar Tuppers somehow
contrive to make a stir and delude the public into considering them
as great originals. They have not imagination of their own, so they
imitate the imaginative utterances and styles of others. Not one but
many styles of many men are thus brought together in a
conglomeration that may deceive the groundlings into thinking it
genuine poetry; but the judicious soon find out its true character. Of
course, all imitators try to imitate the inimitable individualities. The
Montgomerys and the Tuppers aspire to no less than Shakespeare
and Milton. Just so in pictorial art. Vasari, Guido, the Caracci reached
out for the imaginations of Michael Angelo, Raphael, and Correggio.
The result was the contorted bombastic art of the Decadence than
which nothing could be less imaginative and more monstrous. The
mind of a Michael Angelo of necessity distorted the image in the first
place and then a Salviati came along to distort the distortion! The
figure of a Madonna, for instance, is elongated by Correggio for
grace, and Parmigianino following after elongated the elongation!
This is what I have called the bombastic. It is indicative of a lack of
imagination. Modern painting is full of it. The attempts at the heroic
that overstep the sublime and fall into the ridiculous, the rant and
high-sounding utterances of the brush, the inflated figures of
allegory and the vacuous types of symbolism, are all illustrative of it.
But the bombastic and its companion evils in art need no further
consideration at this time. It is not my aim to illustrate the
deficiencies of painting, but to point out its higher beauties, and if
the reverse of the shield is occasionally shown it is but to illustrate
and emphasize the brighter side. Perhaps one may be pardoned for
thinking that sometimes the analysis of error is a potent factor in the
establishment of truth.
 CHAPTER IV

PICTORIAL POETRY

Time was, and not very long ago at that, when an argument for
poetic thought in art would have been considered superfluous.
Everyone was agreed that the higher aim of language was to convey
an idea, a feeling, or an emotion. That the language should be
beautiful in itself was an advantage, but there was never any doubt
that the thought expressed was greater than the manner of its
expression. To-day it would seem that we have changed all that. The
moderns are insisting that language is language for its own sake,
and art is art for art’s sake. They are, to a certain extent, right in
their contention; for there is great beauty in methods, materials and
the general decorative appearance.[6] But perhaps they insist too
much. We are not yet prepared to admit that because Tennyson’s
poetry sounds well, his thoughts have no value; nor, for all
Tintoretto’s fine form and color, can we believe his poetic
imagination a wholly unnecessary factor in his art.
6. I have stated the case for the decorative side and for the technical beauties
of painting in Art for Art’s Sake, New York, 1902.

The technical and the decorative beauties of painting, however

important they may be, are not necessarily the final aim of the
picture. In the hands of all the great painters of the world they have
been only a means to an end. The Michael Angelos, the Rembrandts,
the Raphaels, and the Titians have generally had an ulterior meaning
in their work. And by “meaning” I do not mean anything very
abstruse or metaphysical, nor am I thinking of anything ethical,
allegorical, or anecdotal. The idea which a picture may contain is not
necessarily one that points a moral, nor need it have anything to do
with heroic action or romantic sentiment or fictional occurrence.
There are many ideas, noble in themselves, that find expression in
literature better than in painting, and it is a sound rule in all the arts
that a conception which can be well told in one art has no excuse for
being badly told in another art. The materials and their application to
the best advantage are always to be regarded. Why waste effort in
cutting glass when you can blow it? Why chisel curtains in marble
when you can weave them in cloth? Why tell sequential stories,
moral, narrative, or historical, in paint when it can be done more
easily in writing? And why describe landscapes in writing when you
can do it so much better in painting? It is mere consumption of
energy and distortion of materials to write down the colors of the
sunset or to paint the history of Greece or Rome.

XVI.—DAUBIGNY, Spring. Louvre, Paris.

 It is well for us then at the start that we have no
misunderstanding about the relationship between literature and art.
That they are related in measure may be said with equal truth of
preaching and science, of poetry and politics, of music and history.
Science has been preached and politics have been poetized, and
history has been shrieked in a high treble at the opera. Just so art
has illustrated literature and literature art; but it can hardly be
contended that any one of them has been put to its proper purpose.
The main affair of literature is to illustrate literature, and the
business of art is primarily to produce art. They are independent
pursuits and there is no need of confounding their aims or being
confused by their apparent resemblances.
Therefore, in using the phrase pictorial poetry I would be
understood as meaning pictorial poetry and not literary poetry. They
are two quite different things by virtue of their means of expression.
The idea in art, whether poetic or otherwise, has its material
limitations, which we must not fail to take into account. The first
limitation is the major one and it demands that painting deal with
things seen. We have referred to this in speaking of Tintoretto’s
“Annunciation,” but it is worth while to take it up again and more
definitely.
The couplet,
“The mind that broods o’er guilty woes
Is like the scorpion girt by fire,”

is certainly a poetic image; but fancy, if you can, how a painter

would paint that brooding mind. He could not do it. Why? Because it
is not tangible, it cannot be seen, it has no form or color. It is an
abstract idea to be comprehended by the mind through sound, and
belongs to literature. Perhaps you think the painter might have
rendered it by showing a sad face and a wrinkled brow, but how
would you know whether the wrinkles came from mental or from
physical pain? And what can he say to you about “guilty woes” with
a paint brush? The writer can tell you about the inside and the
outside of the head, but the painter is limited to the outside.
The inability of painting to deal with sound—a something without
tangible form—may be further illustrated by Millet’s celebrated
picture of the “Angelus.” It has already served me for illustration, but
I shall not at this time go out of my way for a newer example. The
expressed thought of the picture, the whole story, hinges on the
sound of a church-bell—the Angelus bell of sunset. How does Millet
attempt to picture this sound? Why, by painting far back in the
distance a church-spire seen against a sunset sky, and in the
foreground two peasants with bowed heads. But the effort at sound
is inadequate. The peal of the bell is beyond the reach of paints and
brushes. The most brilliant colors make no sound. It is not to be
wondered at, therefore, that there have been half a dozen different
readings of the picture’s meaning. The idea of the Angelus is in the
picture only because it has been read into it by the title of the work.
That is a leaning upon literature which is unnecessary in art. The
painting should require no explanation by language.
It need not be denied that the Angelus story is poetic; but it is
perfectly just and proper to contend that by its dependence upon
sound it is better fitted for literature than for art. A Tennyson could
have made a poem about it wherein the sound of the bells would
have been in the cadences of the language—in the very syllables
breaking upon the ear. We all remember his flying notes from the
horns of Elfland in “The Princess.”
“Oh hark, oh hear! how thin and clear
And thinner, clearer, further going.
Ah! sweet and far, from cliff and scar,
The horns of Elfland faintly blowing.”

In those lines we have the idea of sound conveyed to us most

forcibly. The flow of the words describes exactly (and they even
imitate) the long travel of the bugle notes, far across the lake, up
the vales, and finally dying away into the remotest distance. Surely
the thought of that passage is best told in language. What could
pigments do with it? What could a fine technician like Bargue or a
poet in paint like Delacroix make of that mellow music? They might
picture someone with a horn to his lips and a mountain lake in the
background; but the fetching part of those Elfland horns is not their
look, but their sound. What could the painters do with the sound?
Why nothing except to let it alone. A flat canvas will not discourse
music like the board of a piano. Forms and colors may talk very
eloquently to the eye, but they say nothing to the ear. The old
division of the arts made over a century ago by Lessing is still
acceptable to-day. The fine arts of architecture, sculpture, and
painting address the sense of sight; the fine arts of music and
literature address the sense of hearing. Therefore, let us assume
that such thoughts, ideas, or emotions, poetic or otherwise, as a
painter may wish to express in painting should be primarily pictorial
by addressing the sense of sight.
XVII.—BENOZZO GOZZOLI, Adoration of Kings (detail). Riccardi Palace, Florence.

There is another, a minor limitation put upon painting which in its

way is quite as binding as the major one. This is the time limit. A
painting is not a shifting panorama like a drama. It cannot picture
(though it may hint at) the past or the future; it can deal adequately
only with the present. You may turn the leaves of a book and pass
from Greek days to the present time as you read; but you cannot do
that with a picture. It does not turn or shift or show any more than
the one face. Therefore the idea in art, generally speaking, should
not concern itself with time, or be dependent upon shiftings of
scene, or deal with anything that has gone before or is to come
after. A picture of Charlotte Corday on the way to the guillotine
indicates a present happening, and, so far as it offers something
complete in itself, it is pictorial enough; but the picture fails to tell us
that some days before she assassinated Marat, and that some
minutes later she herself will be done away with by the executioner’s
knife. The title of the picture may tell us her story, but then that is
leaning upon literature again. A painting of “Alexander Entering
Babylon” by Lebrun may show us marching troops, elephants,
chariots, and Alexander himself surrounded by his generals. It is a
present scene; but how shall the picture tell you who Alexander was,
what battles he fought, what ending he came to? It may suggest the
past and the future by the present condition, but the suggestion is
often too vague for human comprehension. Time-movement,
sequential events are really beyond the reach of pigments.
It is much easier deciding what painting can picture than what it
cannot. We have only to ask ourselves if the subject is one that may
be comprehended by the unaided eye, and if it is a theme completed
in present time. Painting moves freely only within these boundaries,
whereas literature moves within and without them as it pleases, and
with measurable success even in pictorial themes. Here is a word-
landscape by Scott that illustrates my meaning:
“Sweet Teviot, on thy silver tide
The glaring bale-fires blaze no more,
No longer steel-clad warriors ride
Along thy wild and willowed shore.”

There we have a picture painted in words. Scott has gone poaching

into the domain of pictorial art, and with astonishing results. It is a
picture. Literature is certainly capable of dealing with forms and
colors as with abstractions of the mind, but it cannot handle them so
well, perhaps, as painting. We have here not abstractions, but
entities of form and color. There is something for the painter to
grasp with pencil and brush. Perhaps he can paint the “silver tide”
and the “willowed shore” more effectively than Scott can describe
them; and if he should paint them with that feeling which would give
us the wildness of the shore, the weirdness of the bale-fires, the
crush and rush of steel-clad warriors along the banks, paralleling the
push-forward of the stream itself, we should have what I am
disposed to call pictorial poetry.
But, if you please, it is not to be inferred that this pictorial poetry
is to be gotten out of literary poetry only. Painting is no mere servant
of literature, whose duty it is to illustrate rather than create. There is
no reason why the painter, looking at the river Teviot, should not see
poetry in it as well as the writer. Delacroix not only could but did see
it. Turner saw the same kind of romantic sentiment as Scott in all the
rivers he ever pictured. Daubigny saw it less romantically, but with
more of the real charm of nature, along the banks of the Marne; and
Claude Monet has certainly shown us many times the poetry of light,
color, and rushing, dancing water on the Seine. Monet is just as
susceptible to poetic impressions as Leconte de Lisle, only his poetry
comes to him in forms and colors rather than in the measured
cadences of language. It is painter’s poetry, not writer’s poetry.
It is true enough that painting has often taken its themes from the
play, the novel, and the poem, and not without success. All the older
painters of England spent their time illustrating Shakespeare and
Milton. But it was not at all necessary, nor did it result in the best
kind of art. And as for literature taking its theme from painting, one
can pick illustrations of it in quantity from any anthology. For
instance, what is more probable than that Scott was looking at a
painting when writing this:
“No earthly flame blazed e’er so bright
It shone like heaven’s own blessed light,
And, issuing from the tomb,
Showed the monk’s cowl and visage pale,
Danced on the dark-browed warrior’s mail,
And kissed his waving plume.”

The light-and-shade of the scene seems to bring to mind some lost

Correggio. And how like Giorgione is the “flame” dancing on the
warrior’s mail, and “kissing his waving plume!” (Plate 24.) In reading
the “Faery Queene” one finds a whole gallery of pictures painted
with words. Spenser would have made a painter, for he had the
pictorial mind. Milton is not unlike him; and Shakespeare goes hither
and yon over all fields and through all departments. Here, for
example, is his genre picture of the hounds of Theseus:
“My hounds are bred out of the Spartan kind,
So flewed, so sanded: and their heads are hung
With ears that sweep away the morning dew;
Crook-kneed and dew-lapp’d like Thessalian bulls.”
XVIII.—VAN DYCK, Jean Grusset Richardot. Louvre, Paris.
Surely a very striking picture, but after all you cannot see
Shakespeare’s hounds so completely and perfectly as those of
Velasquez or Snyders or Troyon.
Sculpture, too, may furnish material for good poetry, as witness
this description of the marble figures upon the tomb in the Church of
Brou.
“So rest, forever rest, O princely Pair!
In your high church ‘mid the still mountain air,
Where horn and hound and vassals never come.
Only the blessed saints are smiling dumb
From the rich painted windows of the nave
On aisle and transept and your marble grave;

· · · ·

So sleep, forever sleep, O marble Pair!

Or if ye wake, let it be then, when fair
On the carved western front a flood of light
Streams from the setting sun, and colors bright
Prophets, transfigured Saints and Martyrs brave,
In the vast western window of the nave;
And on the pavement round the tomb there glints
A chequer-work of glowing sapphire tints
And amethyst and ruby....”

Matthew Arnold has certainly made a striking picture in words out of

the tomb and its figures, but again the poetry is plastic—that is,
fitted for sculpture or painting.
So it is—to repeat and summarize—that the writer with his words
shows things picturesque and sculpturesque—inadequately perhaps
as compared with the plastic mediums, but nevertheless effectively;
but not so the painter with his colors. The brush will not reveal and
can scarcely do more than hint at things without form. It is perhaps
possible for painting to be as clear-cut and as definite in its ideas as
literature, but, as a matter of fact, it seldom is so. More often there
is suggestion than realization, and the poetry comes to us in an
almost indescribable feeling or sentiment of the painter. Indeed, the
greater part of what we have called “pictorial poetry” lies in a
glimmering consciousness of beauty, an impression that charms, a
feeling that sways, rather than in any exact statement.
Now that word “feeling” is not a cant expression of dilettanteism.
It has a distinct meaning in all the arts. In the presence of beauty
the artist “feels” that beauty and is emotionally moved by it as you
or I might be moved by an heroic action, a splendid sunset, or a fine
burst of orchestral music. He responds to the charm and yet is not
able to express his whole feeling, not even in words, much less in
forms and colors. With all the resources of language and with all his
skill in expression Tennyson is not cunning enough to tell the whole
passionate tale of Arthur and Launcelot and Guinevere—the three
who lived and loved and died so many years ago and now lie “low in
the dust of half-forgotten kings.” All the heroism, the nobility, the
splendid pathos of those lives, could not be put into words.
Tennyson could only summon up a sentiment about them, and
deeply imbued with that sentiment, he left a tinge of unutterable
sadness in the poem which you and I feel and love, and yet can but
poorly describe. We do not know it like a mathematical problem; we
feel it.
And consider that old man forsaken of his children—Lear. His
complaints and tempers seem almost childish at times; and yet
through that play, more than through any other written expression
of human woe, runs the feeling and the passion of a great heart
breaking through ingratitude. Again think of that last act in “The
Cenci,” with Beatrice cursed by fate, stained with crime, and finally
brought face to face with trial and death. Have you ever read or
known of such another whirlwind of wildness and calmness, of
weakness and fortitude, of courage and fear! And the ghastly,
creeping horror of it all! Can you not feel it? Neither Shakespeare
nor Shelley can chart and scale upon a board the passion he would
show us. It could not be pinned down or summed up scientifically. It
can, in fact, be brought home to us only by that great under-current
running through all notable art—feeling.
 Consider once again Wagner’s “Götterdämmerung!” How would it
be possible to tell with musical notes all the tragic power that lies in
that opera? Wagner himself was not able to do it. What he did was
to summon up a romantic mood of mind by contemplating the
theme in his imagination and then, to suggest by a choice of motives
and orchestration, the immense passion of the story. By following
the orchestration rather than the individual singers you can feel in
the different motifs the poetry of that heroic age—the glorious
achievements, the sad passing, the mournful sunset, the fading into
oblivion of those who ruled the beautiful world. If you cannot feel
the mystery, the sadness, the splendor of it all, I am afraid it argues
some want of music and romance in your soul rather than a want of
poetry in the opera. The feeling is there; it is the last thing perhaps
to be recognized by the student of music, and yet it is the one thing
above all others that has made Wagner a great poet. He could
suggest more than he could describe, and because he suggests and
does not describe is one reason why he is, at first, so difficult to
understand.
XIX.—GAINSBOROUGH, Mrs. Siddons. National Gallery, London.
 The picture in this respect, is not different from music or literary
poetry. Poetic feeling in painting may be and has been shown in
many subjects and in many ways. If we go back to the Gothic period
in Italy, when the painters were just emerging from mediævalism,
we shall find a profound feeling for religion. It shows in Giotto and
the Florentines, in Duccio and the Sienese. They do not know how to
draw, color, or light a picture correctly; they are just learning to
paint, and like children they feel infinitely more than they can
express. And they do not try to express any precise or detailed
account of Christianity. They could not if they would. That which is
called “religious feeling” in the altar-pieces of the Gothic period and
the early Renaissance is really a mental and emotional attitude of
the painter—a fine sentiment, an exquisite tenderness in the
presentation of biblical themes and characters. It is no matter
whether the sentiment is really religious or merely human; it is in
either case poetic. And it is no matter whether the painter’s devotion
and earnestness were misplaced or not; at least they were sincere.
There never was a time in the history of painting when the body of
artists believed more thoroughly in their theme, their work, and
themselves than during that early Italian time.
You can see this well exemplified in Orcagna—in his “Last
Judgment” in Santa Maria Novella. The Madonna looking up at her
Son is an embodiment of all the pietistic sentiment of the time. The
figure is ill-drawn, stiff, archaic-looking; but in the white-cowled face
what purity, what serenity, what pathos! The clasped hands seem
moved in prayer; the upturned eyes look unutterable adoration.
Orcagna is bent upon telling the faith of the Madonna in her Son,
but he can only do so by telling the faith that is within his own soul.
His revelation is a self-revelation, but it is not the less a religious
feeling and a poetic feeling. Is this not equally true of that pious
monk of San Marco, Fra Angelico? Can there be any doubt about his
life-long sympathy with religion and the religious theme in art? It
was his sympathy that begat his painting. That sweet, fair face full
of divine tenderness, which we have so often seen in the copies of
his trumpet-blowing angels, is it not the earthly embodiment of a
divine spirit?
Fra Angelico was the last of the great religionists in art, and before
his death the sentiment of religion began to wane in the works of his
contemporaries. They were straying from the religious to the
naturalistic subject, but wherever their sympathy extended their
feeling showed. When Masaccio, Benozzo, Botticelli, and Leonardo
began to study the outer world with what earnestness and love they
pictured the humanity, the trees, the grasses, the flowers, the long,
flowing hill-lines, and the wide, expanding Italian sky. Botticelli’s
“Allegory of Spring” (Plate 29) or Benozzo’s “Adoration of the Magi”
in the Riccardi palace (Plates 2 and 17) or Leonardo’s face of “Mona
Lisa” must have been seen sympathetically and thought over
passionately, else we never should have felt their beauty. Benozzo,
inheriting his religious point of view from Fra Angelico, blends his
love of man, animals, and landscape with his belief that they are all
made for righteousness; Botticelli is so intense that he is half-morbid
in his sensitiveness; and Leonardo, with that charm of mood and
sweetness of disposition in the “Mona Lisa,” is really transcendental.
It is all fine, pictorial poetry, howbeit more in the suggestion than in
the absolute realization.
This quality of poetry shown so largely in what I have called
“feeling” is apparent in all great art, regardless of nationality or
subject. The Venetians, for example, had none of the intense piety
of the Umbrians, but they had perhaps just as much poetry. Even
the early Venetians, like Carpaccio and Bellini, were more material
than Fra Angelico and Filippino. They painted the Madonna with all
seriousness and sincerity, with belief in the truth of their theme, but
with a human side, as noble in its way as the spiritual, and just as
truly marked by poetic feeling (Plate 7). After them came another
painter, of greater skill and power. He was not so boyish in his
enthusiasm as Carpaccio, but Theocritus in love with pastoral nature
never had so much feeling for the pure joy of living as Giorgione. His
shepherds seated on a hill-side playing and singing, in a fine
landscape and under a blue sky, make up a picture far removed in
spirit from theology, philosophy, science, war, or commerce. The
world of action is forgotten and in its place there is Arcadia with
sunlight and flowers, with beautiful women and strong men. But is it
not nobly poetic? When Giorgione painted the Castelfranco Madonna
(Plate 24) he did not change his spirit to suit the subject. The picture
has written upon the face of the Madonna as upon the face of the
landscape: “I believe in the beauty and glory of the world.” You may
call this a pagan belief if you choose, but it is with Giorgione a
sincere and a poetic belief.
Correggio at Parma was not materially different from Giorgione as
regards the spirit of his art. His religious characters were only so in
name. He never had the slightest sympathy with the melodramatic
side of the Christian faith and could not depict the tragic without
becoming repulsive; but he saw the beauty of women and children
in landscape and he felt the splendor of sunlight and shadow and
color (Plate 8). There is no mystery or austerity or solemnity or
intellectuality about his characters. They are not burdened with the
cares of the world; but how serenely and superbly they move and
have their being! What grace of action! What poetry of motion!
What loveliness of color! Shall you say that there is no poetry in that
which appeals directly to the senses, that which belongs only to the
earth? As well contend that there is no beauty in the blue sky, no
loveliness in flowers, no grace in the wave that curves and falls on
the beach.