The anatomy lesson of Dr. Nicolaes Tulp painted by Rembrandt in 1632.

From the beginning of the 16th century onwards, public anatomy demonstrations developed and spread acrossEurope. In 1555,King Philip II granted the AmsterdamGuild of Surgeons the privilege to dissect bodies of executed criminals to teach anatomy. Dissections were held once a year in the winter season as the corpses could be preserved at low temperatures. An anatomical theatre of the 17th century was usually designed to accommodate 200 to 300 persons. Physicians, surgeons, magistrates and other distinguished citizens were invited and paid admission to join the event. Rembrandt’s painting ‘The Anatomy Lesson of Dr. Nicolaes Tulp’ (1632) is considered a masterpiece and represents a group portrait of the Amsterdam Guild of Surgeons in the setting of an anatomy lesson (Fig. 1). Dr Nicolaes Tulp, physician and lecturer in anatomy (Praelector Anatomiae) in Amsterdam, demonstrated an anatomic dissection of a forearm using the corpse of an executed criminal. It was the body of Adriaen Adriaensz, also known as Aris Kindt, a man with a long criminal record. He was hanged for stealing a cape and using violence against his victim in January 1632. The anatomical accuracy, painting technique and interpretation of the painting have recently been discussed in this journal by Professor Mellick.1 He states that the exchange of the lateral and medial epicondyle of the left humerus in the painting should be considered an anatomical ‘error’. However, we do not agree with this conclusion on the basis of our own observations. We recently assessed the accuracy of the painting by comparing the depicted forearm with the dissected left forearm of a cadaver.2,3 Our comments provide a concise overview of the anatomical accuracy of the dissected arm in Rembrandt’s painting. Professor Mellick discusses the adjustments that have been made to the painting during the painting process. He refers to Schupbach’s analysis published in 1982.4 However, the restoration of the painting from 1996 to 1998 offered a unique opportunity to analyse the painting methods used and provided important new insights into Rembrandt’s painting technique.5 The second part of our comments deals with these new insights. Finally, Professor Mellick raises the question that the painting truly is a lesson in functional anatomy. In the third part of our comments, we discuss some additional information about the symbolic interpretation of the painting, which should help to answer this question. The presumed errors in the anatomy of the dissected forearm in Rembrandt’s painting have been extensively discussed in medical and art history literature for decades.2,3 Professor Mellick stated that ‘the origin of the forearm flexor group of muscles appears to be in the region of the lateral epicondyle of the humerus and this ‘‘mistake’’ has often been remarked upon.1 The muscle held up in the forceps is the flexor digitorum sublimis with the flexor digitorum profundus beneath, and the proximal direction of the two muscles points directly to the revealed lateral epicondyle’.1 Hence, Rembrandt’s famous painting contains a well-known anatomic error in that the flexor muscles in Dr Tulp’s forceps seem to originate from the lateral instead of the medial epicondyle of the humerus.2,3 We recently investigated the accuracy of the anatomy depicted in the painting by comparing the forearm in the painting with the dissected left forearm of a male cadaver.2,3 The left forearm in Rembrandt’s painting is extended and supinated, with the wrist placed in the groin. The medial epicondyle of the humerus points towards the body. The lateral epicondyle of the humerus appears to be turned away from the body and is therefore not visible in the painting. Dr Tulp clearly shows the flexor muscles of the forearm that correctly originate from the medial epicondyle of the humerus, with its tendons coursing distally to the intersection of superficial and deep flexor tendons on the digits. The assumed anatomic error concerning the exchange of the lateral and medial epicondyle of the humerus should therefore be abandoned.2,3 Furthermore, dissection of the forearm of the cadaver revealed four anatomic differences compared with the anatomical structures in Rembrandt’s painting (Fig. 2): (i) the sloping muscle that is prominently shown on the ulnar side of the proximal aspect of the forearm in the painting was not found at dissection; (ii) the flexor digitorum superficialis muscle lifted in Dr Tulp’s forceps has a larger amount of muscle tissue; (iii) the muscle bellies of the flexor digitorum superficialis muscle in the forceps, giving rise to the tendons of the index/small fingers and the middle/ring fingers, have reversed positions in the painting compared with the anatomical dissection; and (iv) the longitudinal, cord-like white structure situated on the ulnar part of the small finger in the painting was not verified at dissection. Several anatomic variations and muscle transpositions have been proposed in the published reports to explain the discrepancies of the painting with the dissection.2,3,6 The painting was restored from 1996 to 1998, offering a unique opportunity to analyse Rembrandt’s painting technique.5 Professor Mellick stated that ‘Thus, the 1632 painting itself was achieved by adding the seated surgeon to the left, removing the hat of the Fig. 1. ‘The Anatomy Lesson of Dr. Nicolaes Tulp’ painted by Rembrandt in 1632 (canvas 169.5 · 216.5 cm), exhibited in the Royal Picture Gallery Mauritshuis in The Hague, The Netherlands. (Reproduced with permission from the Royal Picture Gallery Mauritshuis in The Hague, The Netherlands.) ANZ J. Surg. 2008; 78: 1059–1061 doi: 10.1111/j.1445-2197.2008.04750.x