T.B. Harlem

The Journal of the American Medical Association (aka JAMA), is quite distinctive amongst prestigious scientific journals in featuring a piece of art on the cover of each issue. These usually have some medical significance and there is a commentary about the art inside the issue.

This painting, T.B. Harlem by Alice Neel, was featured on the cover of a 2005 issue but was painted in 1940, before the advent of effective drugs for tuberculosis. According to the commentary more hospital beds were devoted to the care of patients with tuberculosis than to those afflicted with any other disease.

From the commentary:

T.B. Harlem shows a man who has undergone a thoracoplasty, the most radical form of collapse treatment. This was usually done in three separate procedures through a long curving incision parallel to the border of the scapula to expose the chest wall. Ribs 1 through 7, 8, or 9 were freed from their peristeal sheaths and excised, allowing the soft tissues of the chest wall to fall inward on the lung. The procedures were frequently done with the patient under local anesthetic and each return to the operating room was a terrifying prospect for the patient.

The deformity produced by a thoracoplasty is vividly shown in Neel’s painting. The dressing and tape from a white cross on the dying patient, but are hardly a blessing for they probably cover a fistula into the pleural space or cavity in the lung. The patient’s expression is one of calm resignation, his thoughts far away from his present predicament. His body forms a graceful sigmoid curve, for a thoracoplasty always resulted in a thoracic scoliosis from the pull of the muscles on the side not operated on, with a compensatory cervical scoliosis in the opposite direction. Even though the patient’s skin is dark, the artist has skillfully shown the pallor so characteristic of tuberculosis with highlights on the brow, cheeks, and shoulders. Disease and disuse have atrophied the muscles of the arms and hands. The protruding abdomen that occurs with severe malnutrition accentuates the appearance of wasting in the rest of the body and reminds us that this disease was often called “consumption.” 

As in so many of her portraits, Neel has omitted all background detail. We are compelled to fix our whole attention on the face and mutilated figure, finally bringing our gaze to the hand that points to the dressing and surgical scar as if he is indicating, “See what has been done to me.”