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Art as an Expression of the Human Condition

2015; Elsevier BV; Volume: 100; Issue: 5 Linguagem: Inglês

10.1016/j.athoracsur.2015.08.061

1552-6259

Richard L. Prager,

Health and Medical Research Impacts

I would like to take us on a journey this morning; before I do so, clearly one does not stand at a podium like this alone, but because of the support, commitment, and efforts of one’s teachers, colleagues, friends, and our families, all of whom help make us who we are. Growing up in a very supportive family in northern New Jersey, and after completion of college and medical school in the northeast, I was trained in general surgery at the University of Michigan and was fortunate to obtain a thoracic surgical residency under Dr Herbert Sloan at the University of Michigan, where I was trained, educated, and mentored by a young Mark Orringer, Douglas Behrendt, who went on to be chair at Iowa, Otto Gago, who eventually recruited me to his superb private practice position in Ann Arbor, and Marvin Kirsh, the consummate educator who had a role in educating four decades of cardiac and thoracic trainees. My first position after residency was at Vanderbilt University under Harvey W. Bender, Jr, MD, a former President of the Southern Thoracic Surgical Association, a mentor, leader, master surgeon, and educator, who by his style and commitment quietly allowed me to clarify and incorporate the goals and standards for my career. John W. Hammon, MD, joined the faculty at Vanderbilt the same time I did, July 1978, and was a colleague there for 5 years; a gifted surgeon and teacher, he has become a lifelong friend, and is a former STSA President. I returned to Ann Arbor in 1983, recruited by Dr Otto Gago, and spent 16 years at St. Joseph Mercy Hospital as a cardiac and thoracic surgeon before being recruited to lead the adult cardiac faculty at the University of Michigan in late 1999. During this time we evolved from a section in the Department of Surgery to our own Department of Cardiac Surgery, and I have had the pleasure to have Michael Deeb, Steven Bolling, Francis Pagani, Himanshu Patel, Jonathan Haft, Matthew Romano, Bo Yang, Donald Likosky, Jenna Hirsch-Romano, Ming Sing Si, Rick Ohye, and Edward L. Bove as friends and colleagues. This unique career moment allows me the opportunity to introduce our family. Laurie and I are most fortunate to have 5 children who are creating their own lives throughout the country. Four of the 5 are here today: Jeremy the oldest and his wife Amanda and their 2 children from Denver, Colorado; Meghan and her 2 children from Chicago; Eliza and her friend Dan Flanagan from St. Louis; and T.J. the youngest, and his wife Boo from Chicago; unfortunately, Mary could not be here today. Again, I would not be standing before you today were it not for the love and support of my wife and best friend, Laurie. Art as a means to express one’s feelings or sense of reality is a consistent theme throughout time. Today’s journey will look at the origins of our specialty of thoracic surgery through the social, cultural, and scientific aspects of tuberculosis and a story told in art by a young thoracic surgeon. First, I feel I must establish my art credentials before this audience. In 1964, as a sophomore at the University of Pennsylvania, I took a one semester art course, “Introduction to Western Art: The Renaissance to the Modern Era,” which set the stage for my expertise. Second, I was educated as a thoracic surgeon by Dr Herbert E. Sloan, whose wife Doris, a Johns Hopkins educated nurse, helped create the docents for the University of Michigan Museum of Art, and there is an endowed lectureship in her name at the Museum of Art. Third, my first date with my lovely wife was at the Art Institute of Chicago. Finally, one of my teachers, Joe D. Morris, a faculty member with Drs Alexander, Haight, and Sloan at the University, was the senior surgeon in the group I joined at St. Joseph Mercy Hospital. He was a surgeon and artist-sculpture. He had a unique set of original negatives, and these are a part of the foundation of this presentation. As Jared Diamond discusses in his Pulitzer Prize-winning book Guns, Germs, and Steel, “major killers of humanity throughout recent history include smallpox, flu, tuberculosis, malaria, plague, and other infectious diseases that evolved from animals” [1Diamond J. Guns, germs and steel: the fates of human societies. W.W. Norton & Co, New York, NY1997: 320Google Scholar]. Tuberculosis, known as the White Plague, has been found in Egyptian mummies dating back to 3,000 b.c.e., and Hippocrates, often considered the father of medicine, and by some, also considered the first “thoracic surgeon” because of his work and approach to treating empyema, used the term “phthisis,” a nearly unpronounceable word, to describe tuberculosis and felt that “consumptives” (people with tuberculosis) begat consumptives [2Firth J. History of tuberculosis. Part 1—phthisis, consumption and the white plague.J Military and Veterans’ Health. 2014; 22: 29-35Google Scholar]. Sir Richard Evans, the Regius Professor of History at Cambridge, describes tuberculosis as the classic disease of the 19th century, secondary to industrialization and urbanization, with the expansion of towns and cities and the use of coal as the source of fuel creating smoke and soot. In the setting of poverty, overcrowding, and poor nutrition, with windows closed, droplets or respiratory transmission of tuberculosis was common. At that time, nearly 20% of all deaths in England were secondary to tuberculosis [3Evans S. The white plague: a social history of tuberculosis. Talk presented as part of the series: the great plagues: epidemics in history from the Middle Ages to the present day. Gresham College, Cambridge University; Nov. 27, 2012; Cambridge, England. Available at http://www.gresham.ac.uk/lectures-and-events/the-white-plague. Accessed November 1, 2014.Google Scholar]. As Thomas Goetz, a science journalist writes in The Remedy, “In 19th century Europe and the United States this [consumption] was the most common of all ways to die. It was a languid, almost casual disease, the first chronic disease . . . as a result few doctors believed that there could be anything contagious about it . . . it was passed along in families with ‘weak constitutions’” [4Goetz T. The remedy: Robert Koch, Arthur Conan Doyle, and the quest to cure tuberculosis.1st ed. Gotham Books, New York, NY2014: xiiiGoogle Scholar]. Noting further that during this time people lived in an era of infectious disease as a constant [5Goetz T. The remedy: Robert Koch, Arthur Conan Doyle, and the quest to cure tuberculosis.1st ed. Gotham Books, New York, NY2014: 89Google Scholar], it is also important to recognize that the prevailing thoughts in the mid-19th century were that of “miasma,” noting that poisonous vapors or environmental vapors caused disease [6Sterner C.S. A brief history of miasmic theory.Bull Hist Med. 1948; 22: 747Google Scholar]. The armamentarium of “modern medicine” was evolving, albeit slowly, from the time Antonie van Leeuwenhoek, a Father of Microscopy, and a cloth merchant in Delft, Holland, created primitive lenses and what is considered one of the first microscopes in 1673 [7DeKruif P. Microbe hunters. Harcourt, Brace and Co, San Diego, CA1926: 1Google Scholar]. After this, Auenbrugger in 1761 described percussion, a technique evolved from tapping the wine barrels in his family’s cellar. Laennec, a French physician, described auscultation with a primitive stethoscope in 1818, and Wilhelm Roentgen in 1885 described the roentgenogram or the first radiographs or chest X-rays, as they are known today. In the serial novel, Nicholas Nickleby, written by Charles Dickens, Smike, one of characters describes tuberculosis:There is a dread disease which so prepares its victims, as it were, for death; which so refines it of its grosser aspect, and throws around familiar looks unearthly indications of the coming change; a dread disease, in which the struggle between soul and body is so gradual, quiet, and solemn, and the result so sure, that day by day, and grain by grain, the mortal part wastes and withers away, so that the spirit grows light and sanguine with its lightening load, and, feeling immortality at hand, deems it but a new term of mortal life; a disease in which death and life are so strangely blended, that death takes the glow and hue of life, and life the gaunt and grisly form of death; a disease which medicine never cured, wealth never warded off, or poverty could boast exemption from; which sometimes moves in giant strides, and sometimes at a tardy sluggish pace, but, slow or quick, is ever sure and certain [8Goetz T. The remedy: Robert Koch, Arthur Conan Doyle, and the quest to cure tuberculosis.1st ed. Gotham Books, New York, NY2014: 91Google Scholar]. The reality of tuberculosis is reflected in another art form, Verdi’s 1853 opera, La Traviata, in which Violetta dies of tuberculosis, recognizing that her hopes for a cure were a wild fantasy. Other luminaries had their lives cut short by tuberculosis, including John Keats, the English romantic poet, who interestingly trained at Guy’s Hospital to be a physician; Frederic Chopin, the Polish composer and pianist; Stephen Crane, the American author of the Red Badge of Courage; Anton Chekhov, the Russian physician, playwright, and short story writer; and Christy Mattewson, a New York Giants famed baseball pitcher, and an inaugural member of the Baseball Hall of Fame. Working as scientists in this reality were Louis Pasteur, a French chemist who helped clarify the “germ theory,” and Heinrich Robert Koch, who isolated mycobacterium as the causative agent of tuberculosis in 1882 and 2 years later wrote “Postulates for Disease.” This era also produced an approach to treating tuberculosis even before recognition of the germ theory and the bacterial isolation, and years before the roentgenogram. Hermann Brehmer, a University of Berlin physician who was diagnosed with tuberculosis, opened a hospital in Görbersdorf, Silesia, Prussia, in 1854 and championed good nutrition, fresh air, and the “rest cure” for sufferers of tuberculosis. Following this approach, Edward Livingston Trudeau, a Columbia College of Physicians and Surgeons graduate, was diagnosed with tuberculosis 2 years after his medical school graduation and moved to the Adirondack mountains in the late 1800s to establish his practice. In 1915 he established the Adirondack Cottage Sanatorium, which became known as the Trudeau Sanatorium at Saranac Lake, New York. Garry Trudeau, a famed cartoonist and writer, is the great-grandson of Edward Livingston Trudeau. With these understandings of the origins of tuberculosis and its unrelenting features and mortality, as depicted as medicine evolved, a University of Toronto-educated physician, Norman Bethune, leads us into further understandings of “the human condition.” Born in Gravenhurst, Ontario, on March 4, 1890, and educated at the University of Toronto as a classmate of Banting, the discoverer of insulin, Norman Bethune took leave from his studies to join the Canadian Army Field Ambulance Group in World War I and was wounded at Ypres, France. He returned to complete his studies at the University of Toronto in 1916. He had an avocational interest in art and was influenced by his parents’ fundamental evangelism throughout his youth. After graduation he spent nearly 5 years in England and was a “House Surgeon” at the Hospital for Sick Children, Great Ormond Street, and in 1922, passed his examinations and became a Fellow of the Royal College of Surgeons of Edinburgh. During his time in England and on the continent, he continued his interest in art, and it was said he was influenced by the English painter and satirist William Hogarth and his “sequential art” [9Stewart R. Stewart S. Phoenix: the life of Norman Bethune. McGill—Queens University Press, Montreal, QC2011: 56Google Scholar] as well as by Giotto. Returning to North America, he opened a practice in Detroit with an appointment at the Detroit College of Medicine and Surgery in 1924, the eventual Wayne State University College of Medicine. Practicing with an interest and focus on thoracic diseases for nearly 2 years, he was diagnosed by Dr J. Burns Amberson, Jr, with tuberculosis and initially admitted to Calydor Sanatorium in Canada in the fall of 1926, awaiting an opening at the Trudeau Sanatorium where he was admitted in mid-December 1926. At the Trudeau Sanatorium he was eventually placed in the Lea Cottage with cottage mates Lincoln Fisher, Alfred Blalock, Nan Lee, and apparently for a period of time, John Barnwell. Following the approach of Dr Hermann Brehmer, the Trudeau Sanatorium with the resin-filled air of the Adirondacks offered fresh air, good nutrition, and rest. Recognizing this was a period of alcohol prohibition in the United States, apparently everything was not serious at the Trudeau Sanatorium, with several speakeasies present in Saranac as well as the opportunity for bootlegged whiskey from Canada not far away. The Lea Cottage, as well as staff at the Trudeau Sanatorium, created festive parties at various times [9Stewart R. Stewart S. Phoenix: the life of Norman Bethune. McGill—Queens University Press, Montreal, QC2011: 56Google Scholar]. As the germ theory evolved and further understandings of tuberculosis created opportunity for consideration of operative approaches, Carlo Forlanini, a Milanese physician with an interest in respiratory disease working at Ospedale Maggiore, created a pneumothorax apparatus to induce a pneumothorax and allow a healing process of the “rested lung” [10Alexander J. The collapse therapy of pulmonary tuberculosis.1st ed. Charles R. Thomas, Springfield, IL1937: 225Google Scholar]. This concept, perhaps originally suggested by James Carson of Liverpool, England, in the early 1820s [11Keers R.Y. Two forgotten pioneers. James Carson and George Bodington.Thorax. 1980; 35: 483-489Crossref PubMed Scopus (8) Google Scholar] became a “ray of sunshine” as a treatment of tuberculosis and evolved as a part of the Trudeau Sanatorium armamentarium to treat tuberculosis. Entering this picture is a young thoracic surgeon with training at the University of Pennsylvania, and a new position to lead thoracic surgery at the University of Michigan, who had studied under Leon Berard at the Université de Lyon after World War I. A young John Alexander contracted tuberculosis and was a patient at the Trudeau Sanatorium from 1924 to 1926 just before Dr Norman Bethune was admitted to Trudeau. While being treated at Trudeau and on a Bradford frame for his spinal tuberculosis, Alexander authored the first English text on the operative treatment of tuberculosis titled, “Surgery of Pulmonary Tuberculosis,” published in 1924 by Lea and Febiger, and was awarded the 1925 Philadelphia Academy of Surgery, Samuel D. Gross Prize. In Dr Alexander’s preface he notes, “Few physicians and surgeons are yet aware that surgery is now curing or improving approximately two-thirds of those selected cases of far advanced pulmonary tuberculosis that other methods of treatment have failed to benefit” [12Alexander J. The surgery of pulmonary tuberculosis.1st ed. Lea and Febiger, Philadelphia, PA1925Google Scholar]. In the early 1930s, the City of Chicago Municipal Tuberculosis Sanitarium Bulletins devoted two additions to collapse therapy, noting that collapse measures created conversion of positive tuberculosis sputum to negative sputum by the proper timing and selection of collapse therapy with pneumothorax alone, creating a 38.9% conversion of positive to negative sputum [13Collapse therapy II. City of Chicago Municipal Tuberculosis Sanatorium Bulletin 1933–1934;13–14:54.Google Scholar]. With this as the backdrop for Norman Bethune’s early weeks at the Lea Cottage at the Trudeau Sanatorium, Dr Bethune later related, “in a dark moment in 1927, in Trudeau Sanatorium, Saranac Lake, I dramatized, in a series of allegorical drawings, the story of my life” [14The Fluoroscope. Published monthly by the patients of Maybury Sanatorium, Northville.Michigan. Aug 15, 1932; 1: 2Google Scholar]. The continuous colored drawings, 5 feet high and 60 feet long, ran around the wall [15Link E.P. The T.B.’s progress. Norman Bethune as artist. Villanti & Sons Printers, Milton, VT1991: 7Google Scholar]. These oil pastel or chalk crayon paintings on laundry wrapping paper provide insights into one man’s views of his life with his background, his goals, and the reality of having a probable fatal disease, tuberculosis. These paper murals will help all of us understand “Art As an Expression of the Human Condition.” To further set the stage about these unique murals, Alfred Blalock, in a 1963 letter to Dr John Barnwell, who helped care for Dr Bethune and became a lifelong confidant of his, comments about Dr Bethune and the Lea Cottage murals. As Dr Blalock himself noted in 1963, his memory of the events at Trudeau was rather vague. Hospitalized himself as a patient there in March 1927, he was transferred to the Lea Cottage after approximately 10 months. Noting that he was living there when Bethune began work on his murals and when Bethune had his initial pneumothorax treatment, he described the unique story of Dr Bethune the evening after a treatment. Specifically, when Bethune returned to the cottage after a pneumothorax treatment, he resumed work on the murals and slept on the porch of the cottage together with Dr Blalock. Dr Blalock notes that he was awakened in the middle of the night by a severe coughing spell and was concerned that Bethune was actually going to “pass out” [16Blalock A. Letter from Alfred Blalock, M.D. to John B. Barnwell, M.D. June 17, 1963.Google Scholar]. Bethune survived and continued to create his murals, and Dr Blalock eventually was discharged and received pneumothorax treatment as well at the Trudeau Sanatorium and later at Vanderbilt Hospital in Nashville, Tennessee, all before to his move to Baltimore and the Johns Hopkins Medical School and hospital. Bethune titled his murals the “T.B.’s Progress, a Drama in One Act and Nine Painful Scenes,” as Eugene Link points out in his 1991 monograph, written after Link’s discovery of old glass slides of these murals in a box in the library at Saranac Lake and most likely a title influenced by Dr Bethune’s early exposure to The Pilgrim’s Progress by John Bunyan. The negatives of the murals from Dr Morris from the University of Michigan Fluoroscopic Room in the tuberculosis unit included all of these scenes, except Scene I the “Womb and Foetus,” which is copied from the Link monograph. Clearly, although the title may not have been counted and is not shown here, as Professor Link noted, there were actually 11 continuous colored drawings encircling the room, and all but one were in Dr Morris’ negatives. The damage and perhaps even areas that were written over may have been done so by Bethune or by a cottage mate at some time after Bethune was discharged [17Link E.P. The T.B.’s progress. Norman Bethune as artist. Villanti & Sons Printers, Milton, VT1991: 8Google Scholar]. As the title notes, “A Drama in One Act and Nine Painful Scenes” the first scene “Womb and Foetus” includes Bethune’s poetic commentary (Fig 1):Look, O Stranger, at the dangerTo our hero, embryonic.T.B. bats, so red, ferocious,In the breast of our precociousLaddie, do him just like his daddy;His dark cave no barrier knows,Against this worst of mankind’s foes. As Link explains, this was actually found at the National Film Board of Canada in a black and white incomplete set from presumed photographs of these murals [18Link E.P. The T.B.’s progress. Norman Bethune as artist. Villanti & Sons Printers, Milton, VT1991: 9Google Scholar]. Here Bethune’s description notes the Mycobacterium tuberculosis as a red pterodactyl and consistently shows the red pterodactyl throughout his murals. In the second scene and all remaining ones from the Morris negatives “Entrance into World, Carried on Arms of Beautiful Angel of Life,” we see Bethune as a newborn carried by a beautiful angel with the legend (Fig 2):The angels at his birth,Foreseeing all his years,Restrain not, nor should we,The tribute of their tears. As noted by Link and others, this painting appears to have an Egyptian motif and perhaps may reference the biblical story of Moses being found in the bullrushes, as well as a reference to a male angel or angel of fate reading from a scroll with the initials at the bottom R.I.P. or rest-in-peace. Bethune’s Scene III “Journey in Thick Wood: Childhood” may well, as Link notes, reference Tennyson’s King Arthur, with Sir Shick in a knight’s armor dramatically defending Bethune’s childhood journey through the thick wood from multiple and various childhood diseases. This dramatic depiction reveals measles, mumps, whooping cough, diphtheria, scarlet fever, rheumatic fever, infantile paralysis, scarlatina, as well as the persistent bat of tuberculosis. The legend is (Fig 3):From Dragon Dipth, Sir Shick defends, From other foes he cannot save. The wounds and scars of their attacks, He’ll carry to his grave. In Scene IV, the next scene, titled “Early Manhood,” this actually may be a reference to a temptation of Ulysses and the classical allusion to Homer, as Link also believes. Here, perhaps halfway across the seas, as with Homer’s Ulysses is a reference to the mythical sirens. Bethune is veered off course by these enchantresses of the sea: Art, Fame, Love, and Wealth noted in the legend (Fig 4):On Adolescence’s troubled seas,The sails of argosy are set,Alas, he hears the Sirens’ song,His course is changed, his bark a wreck. Noting Scene V: “Abyss of Despair,” Bethune is attacked by the ever-present tubercular bats as he is about to enter the castle of Heart’s Desire, while the castle is actually a sham, as the legend notes (Fig 5):Down, down he falls from that high mount,Success so near at hand,His foes triumphant see him reelDown to that bloody strand. In the next painting, which Bethune titled “The Trudeau Sanctuary,” he is looking up and depicts in this very detailed painting a castle tower with an American Respiratory Association seal (these were created in the early 1900s to solicit funding for tuberculosis sanatoria). Trudeau is depicted as sitting outside the sanatorium, the Lea Shack, as it is called, is in the center with an allusion to the pneumothorax treatments on the right, a station for “free gas,” and finally, John Barnwell’s cottage with the apparent words of a common tune that Dr Barnwell and friends would sing coming from the cottage. The legend or poetry includes (Fig 6):On Pisgah’s Peak stands Trudeau strong,Bright sanctuary high,Where Heise, Brown and AmbersonHis enemies defy. The next scene is a rainbow, which perhaps was a connection between various scenes, and there is no legend to this (Fig 7). In Scene VIII Bethune notes that he is starting off to the southwest in pursuit of his own health and happiness, again denoted as siren type figures. Bethune with a sputum cup on his side is emaciated and passing through the desert with multiple carcasses present. The legend includes (Fig 8):Once more laid flat upon his back,Our victim pulls a boner;Instead of back to SaranacHe’s off to Arizona.And so the plains got his remainsFor his disease deceased him;He coughed and spat, lost all his fat,Kind death at last released him. In Scene IX we have a modernist impression of a city, which although sketched before Margaret Bourke-White’s photographs of the Chrysler building, certainly makes one think of those later photographs [19Bourke-White M. Chrysler building tower–gelatin silver print. 1930. Collection of the SACK Photographic Trust.Google Scholar]. Again, the pterodactyl tuberculosis bat lurks over the city, with its high skyscrapers, people, and cars as diminutive figures or figurines at the bottom of the picture. His comments of this Scene IX: “The City” (Fig 9):Lured by that Siren, Spurious FameWho had no heart nor pity,Our hero strives to win a name,In the canyons of the City.Temptations flourish thickly there,But T.B. bats are thicker,They swarm about the fetid air,While he grew sick, and sicker. This certainly appears to be a reference to his moving to Detroit to create a career as a thoracic surgeon where he hoped success and reward would be imminent. In his last scene, the angel of death is holding Bethune in his arms, and it is noteworthy there are 7 tombstones present of various Trudeau residents and friends. Bethune predicted his own demise in 1932 and predicted Dr Alfred Blalock would die in 1929. Apparently, it is noted by Dr Bethune that two of the predictions did come true. His poetry includes (Fig 10):Sweet Death, thou kindest angel of them all,In thy soft arms, at last, O let me fall;Bright stars are out, long gone the burning sunMy little act is over, and the tiresome play is done. It is noteworthy that Bethune’s comments about his own murals, noting that the murals may have been altered by cottage mates after his discharge, were created by Bethune for the August 15, 1932, edition of the Fluoroscope, which was a monthly publication of Mayberry Sanatorium in Northville, Michigan, and was several years after his discharge from the Trudeau Sanatorium. In this review or recollection without the murals present, he provided commentary, which is actually part of these descriptions [20The Fluoroscope. Aug 15 1932;1:2.Google Scholar]. In 1931 the Lea cottage was demolished, and Dr John Blair Barnwell, who had moved to the University of Michigan to become an Associate Professor of Internal Medicine with an interest in tuberculosis, arranged to have the murals placed in the Fluoroscopy Room of the Tuberculosis Unit at the University of Michigan Hospital. Bethune, after his release from the Trudeau Sanatorium returned to Detroit briefly and moved on to Montreal and McGill Medical School, aspiring to the career of a dedicated thoracic surgeon. Working with Dr Archibald, a Trudeau tuberculosis survivor as well, Bethune’s focus on world affairs and the oppressed became a dominating feature of his life, and he moved to Spain as part of the anti-Franco forces and helped organize the Spanish transfusion unit into a unified blood transfusion service. He returned to Canada briefly and, maintaining his interest in world affairs and the underserved, and the care of all, it is said he joined an illegal organization, the Communist Party, and was quoted in the newspaper The Commercial Appear, Memphis, Tennessee, as saying “There is little hope for a real improvement of the health of the people until the practice of medicine is liberated from its debasing aspects of private profit and taken as an elementary obligation of the state” [21Stewart R. Stewart S. Phoenix: the life of Norman Bethune. McGill–Queens University Press, Montreal, QC2011: 151Google Scholar]. With this as a fundamental platform for Dr Bethune and perhaps a redefining of success and happiness in his own mind, he helped organized a Canadian medical unit and travelled to northwest China to help the Eighth Route Army led by Mao Zedong in the war against the Japanese. His military surgical role was one of constant battlefield wound care for both the Chinese as well as injured Japanese soldiers who were brought to his mobile hospital. He continued his work in northwest China with Mao’s army, but died tragically on November 13, 1939, 2 days after cutting his hand on a portion of bone from an infected wound and becoming septic. His image has endured since the Journal of the American Medical Association publication on November 9, 1979, commemorating the 40th anniversary of his death depicting Bethune caring for a wounded soldier. With tuberculosis still a major disease, the physician’s armamentarium expanded with the discovery of streptomycin in 1944, para-amino salicylic acid in 1946, and isoniazid in 1952, and with these drugs, the tuberculosis sanatoria gradually closed, with the rare patient requiring operative therapy. At the same time, our specialty of thoracic surgery continued to evolve after World War II, with expanded treatments of pulmonary and esophageal carcinoma and the evolution of open cardiac surgery in the 1950s. Unfortunately, with the challenge of immunosuppressive diseases and immunosuppressive drugs, tuberculosis remains a major world medical issue as drug resistance continued to expand and the death rate from tuberculosis exceeded 1.4 million in 2011 [22Zumla A. Raviglione M. Hafner R. et al.Tuberculosis.N Engl J Med. 2013; 368: 745-755Crossref PubMed Scopus (614) Google Scholar]. What of the murals that were at the University of Michigan until 1960? They were returned to Saranac Lake to the Free Library in February 1960, noting that the Trudeau Sanatorium had closed in December 1954, where they remained until 1967 when they were “loaned” to the John F. Kennedy Center for Special Warfare at Fort Bragg, North Carolina [23Stephenson L.W. The Blalock—Bethune connection.Surgery. 2001; 130: 882Abstract Full Text Full Text PDF PubMed Google Scholar]. The Department of the Army wrote to Dr William Steenken on June 29, 1967, at the Trudeau Foundation for Medical Research at Saranac Lake, noting that, “This work could be most beneficial to our China area specialists, as well as appropriate in our museum” [24Stephenson L.W. The Blalock—Bethune connection.Surgery. 2001; 130: 886Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. It is here that there is an opportunity for the divergence of fact and myth, because it is at this point, as it is said in the Museum Newsletter of July 1976, that the “trail disappears,” and no one has been able to locate the murals since that time [25Proceedings of the Museum Conference. Army Museum Newsletter, July 1976:13.Google Scholar]. While speculation abounds, including that the murals became a gift from the United States or from the United States and Canada to Mao’s government, noting that Canada initiated diplomatic relations with Communist China in 1972 and that the United States began a rapprochement in 1972 and formalized diplomatic relations later in the decade. There are other theories that they remain lost, and finally, because they were on brown wrapping paper that they have essentially disintegrated. Richard Meade, a thoracic surgeon–historian, wrote in his 1961 History of Thoracic Surgery:it has seemed worthwhile, to present briefly the story of the growth of knowledge of the disease itself. Not only is the gradual uncovering of the form of this tremendously intricate process a fascinating story, but, illustrating as it does the advancement of all learning and of all civilization, a knowledge of it seems a fitting and even necessary part of the background of all physicians, and particular of all those who in their work deal with any manner with tuberculosis [26Meade R.H. A history of thoracic surgery. Charles C. Thomas, Springfield, IL1961: 98Google Scholar]. Although it remains unlikely the brown paper murals will ever be found, the opportunity to present this unique story surrounding them supports Richard Meade's thoughtful comments. The story incorporates an understanding of a disease process that formed much of the foundation of our specialty and of the evolution of scientific investigation itself. Clearly the fascinating story of a Canadian thoracic surgeon, Norman Bethune, who was deeply influenced by his illness and portrayed his feelings in art, and the social and cultural history of the time, affords all of us an opportunity to recognize, as others have noted, “Art Makes You Smart” [27Kisida B. Greene J. Bowen D. Art makes you smart.New York Times. November 24, 2013; : SR12Google Scholar]. I wish to thank all of you for the wonderful opportunity to be President of the Southern Thoracic Surgical Association this year and for the occasion to present this to all of you today. The author wishes to thank Ms Sandy Marshall, Administrative Assistant, for her technical and computer skills, and Larry W. Stephenson, MD, for generous sharing of historical references.