A very real art

The depiction of normal and pathologic anatomy in models is nearly as old as medicine itself. Early examples were created in clay, marble and ivory.1 The art of moulage — the representation of anatomical structures in wax — arose during the Renaissance and was perfected in the 18th century, when it was practised extensively in Germany and Italy. Wax allowed for a versatility and realism unattainable through harder media. The technique was threefold: a clay model was first sculpted and then used to make a plaster cast. Molten wax was then poured into the cast, allowed to set and then removed. Last, fine details and colour were added to achieve a precise and lifelike representation. One of the finest examples of the technique is Clemente Susini's Medical Venus, one of the famous “La Specola” waxes created in the studio of the chemist and physiologist Felice Fontana (1730–1805) in Florence. This exquisitely rendered moulage depicts a supine woman with a removable anterior thoracic and abdominal wall, giving a view of the internal organs (www.specola.unifi.it/cere/wax-collection.htm).

Medical moulage was eclipsed by the use of plastic models in the early 20th century. Plastic allowed for a more durable product to be produced at a lower cost. The newest development is, of course, computer modelling, as in the Visible Human Project (www .nlm.nih.gov/research /visible/visible_human .html).

A brief resurrection of medical moulage occurred, curiously enough, in Ontario during World War II thanks to the efforts of Dr. Edwin Robertson. Educated in his native city of Edinburgh, Scotland, Robertson moved to Canada in 1939 and became chairman of the Department of Obstetrics and Gynecology at Queen's University, Kingston. He had a keen interest in medical education but was frustrated by the scarcity of anatomical specimens. Nor was he the only physician concerned with the lack of teaching material at this time. In 1941, Dr. Robert L. Dickinson, an obstetrician in New York, wrote:

The proportion of female cadavers available for dissection of the reproductive organs runs, I am told, to less than 5 percent of the bodies obtained from the morgue. Moreover, these are chiefly of old women with atrophic tissues.2

In 1940 Robertson had an opportunity to see a moulage collection, mainly of dermatologic conditions, at the Department of Art as Applied to Medicine at Johns Hopkins University. (Founded in 1911, this was the first such department in North America.) When he was unsuccessful in recruiting an artist from Johns Hopkins to create a series of gynecologic moulages for Queen's, he found an able collaborator in Marjorie Winslow, a Kingston artist who had trained in Montreal, England and Rome. This was Winslow's first use of wax as an artistic medium. She recalls: “We went into commission very slowly, learning as we went along piece by piece. Casting in wax was a real adventure.”

The creation of each moulage was quite involved. Winslow began by observing Robertson's patients in the clinic and the operating room. Because Robertson did not permit her to sketch in these settings, she sculpted a preliminary clay model from memory. Robertson approved the models before plasticine casts were made. The wax itself was composed of beeswax, talc and sometimes a little paraffin. Winslow painted the models to mimic skin and blood vessels, using everyday items such as pins, orange peels and rocks to add texture. Another embellishment was the painstaking addition of human hair.3

There are three main groups of moulages in the Robertson collection: obstetric models, gynecologic pathologies and miniature representations of female somatotypes. The extent to which they were used in classroom instruction is not clear; Robertson's lecture notes make no reference to the moulages, although archival photographs indicate that they were displayed in the laboratory where medical students trained. At any rate, by the 1950s instruction in anatomy seems to have been outweighed by a greater emphasis on physiology. The moulages were in storage for about 40 years altogether, and some were destroyed by fire in the 1960s. The remaining pieces were brought to the Museum of Health Care at Kingston, and several were conserved by students in the Master of Art Conservation Program at Queen's.

The moulages are both an educational tool of interest to medical historians and delicate pieces of art. Winslow describes them as “very real art in reproduction of life's drama.” Today's viewer might be reminded of the work of Georgia O'Keefe and Judy Chicago. The collection, which will eventually be displayed at the Museum of Health Care, is unique in Canada and is one of the last groups of medical moulages to be produced in the world.1

Figure. Marjorie Winslow. Normal spontaneous vaginal delivery; baby's head rotated to deliver shoulder, 1940–1946. Wax model, life size. Photo by: Cynthia Copper

Figure. Marjorie Winslow. Normal spontaneous vaginal delivery, 1940–1946. Wax model, life size. Photo by: Cynthia Copper