What Is Represented “Worthily” in Luke Fildes’ The Doctor?

Audiey C. Kao

doi:10.1001/amajethics.2022.697.

Ethics Close Up

Jul 2022

What Is Represented “Worthily” in Luke Fildes’ The Doctor?

Audiey C. Kao, MD, PhD

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Abstract

One of the most recognized paintings of Western medicine, Luke Fildes’ The Doctor aimed to represent a caring physician in a humble setting during an era when people living with poverty rarely had access to health care and nearly all physicians were White men. The Doctor challenges us to think about what good doctoring is.

One of the most recognized paintings of Western medicine, Luke Fildes’ The Doctor was hailed as an ideal representation of caring when it was first exhibited at the Royal Academy of Art in 1891. Henry Tate wanted an English painting worthy of a new gallery in his name, but he left the subject matter of his commission to Fildes.

As witness to a doctor’s care of his son who died of typhoid fever, Fildes wanted to “put on record the status of the doctor.”¹ Fildes’ surviving son wrote that his father “must have thought a great deal on the subject for…. it was the easiest and quickest painted of his big pictures.”²

Light has long symbolized hope and wisdom and a table lamp provides the primary illumination in this otherwise dimly lit scene. At first glance, the doctor and his young patient seem to be the only figures present.

Nearly centered in the painting, the child lies in a makeshift bed of 2 mismatched chairs. An outstretched left arm hangs over the pillow, signaling a certain precariousness of the moment. The doctor’s presence signals some hope that the child will recover.

Not sitting tiredly despite a night vigil, the doctor is illuminated in a forward-leaning position, chin in his hand. His stare is not a casual gaze, but one that is intensely and diagnostically trained on the child.

A fisherman’s net hardly visible in the rafters represents manual labor, presumably a means by which the father of the child supports his family. This labor is juxtaposed to the doctor’s intellectual and professional work, which apparently supersedes the power of manual labor and that of the child’s parents.

The child’s parents recede into the background, reinforcing their helplessness to affect their child’s fate. A dawn light filtering through the window reveals the father comforting the mother, casting further uncertainty on their child’s immediate future.

Despite the painting’s depiction, a doctor’s presence in a working-class home is more idealized than reality. During the Victorian era, such house calls were generally afforded to those with wealth and power.

Prior paintings of the ill at home also never depicted a medical practitioner with a bottle of medicine, which was previously associated with only familial caregivers.³ The content of this bottle is unknown, but it wasn’t a typhoid vaccine, since none existed until 1896.⁴

On the floor, 2 fragments of paper are probably the filled prescription for the medicine.⁵ The torn and crumpled prescription suggests that the medicine has been dispensed, but its effect remains an open question.

It is notable that the stethoscope, thermometer, and other advances of medical science are nowhere to be seen. Instead, a cup and spoon are the instruments presumably used to deliver medicine to the sick child.⁶Fildes seemed more intent on focusing our attention on the art than the science of medicine.

Despite its idealized representation of doctoring or likely because of it, The Doctor struck a resonant chord with the public and profession alike. An engraved print of the painting sold more than 1 million copies in the United States. "A library of books written in your honour would not do what this picture has done and will do for the medical profession in making the hearts of our fellow men warm to us with confidence and affection," wrote a physician critic in 1892.⁷

Given its popular and professional appeal, The Doctor has been employed over the years to depict the practice of medicine in highly public and sometimes contradictory ways.

Raised by his grandmother, a supporter of the working-class Chartist movement, Fildes established his early reputation as an artistic champion of social realism. His works, including Applicants for Admission to a Casual Ward (1874), captured and drew attention to the harsh lived realities of the poor. Depicting a grim scene of families, homeless and hungry, which most well-off Londoners would have avoided in real life, Applicants attracted gallery patrons so numerous that police and barriers were needed to secure the painting.⁸

Another of Fildes’ popular social realist paintings was The Widower (1875). A father who labors to care for a sick child appears helpless, without either medicine to dispense or a doctor to tend to the child. The rest of his children carry on around him, seemingly oblivious to the gravity of the situation. While Fildes’ works shone a spotlight on the desperate plight of too many in Victorian society, his conscience-raising and critical success did not afford him the material comforts of life. That would soon change.

Fildes’ works drew fashionable attention from those who desired to be lavishly showcased in self-portraits. He became one of the highest-paid portraitists in England and reached the heights of social and political circles, counting among his portrait subjects members of the British monarchy, including King George V. He was knighted by King Edward VII in 1906.⁹

Being paid handsomely to immortalize the powerful rich seems far from what a young Fildes could imagine, let alone accept, as an artist of the voiceless poor. So when Tate offered him The Doctor commission, Fildes jumped at the chance at some redemption by creating “something that would worthily represent me….. It is some time now since I painted an English subject of importance—a long time since the Casual Ward, The Widower and The Return of the Penitent series.”¹⁰

While the principal model was clean shaven, the painted doctor bore a striking resemblance to Fildes. Potentially casting himself as the dedicated professional tending to a sick child, Fildes captured the essence of a caring doctor that many patients apparently sought. “Many are the letter I have received asking for the name of ‘the doctor,’” said Fildes in 1893, “whilst one came from somebody who was ill, assuring me that she would be very thankful to have his address, for if she only had a doctor like him to attend her she felt sure she should soon get better!”¹¹

The fanfare generated by The Doctor prompted many to leverage its visual potency to promote policies and market products. The painting was inspiration for a cartoon satirically critical of the National Insurance Act of 1911.¹² Given that this act eventually set the groundwork for a social welfare system in Great Britain, this cartoon would probably not have sat well with Fildes—or at least with his younger self.

At the 1933 Chicago World’s Fair, Petrolagar Laboratories, makers of an emulsion to treat constipation, created a life-size, “sculpticolor” diorama of the scene depicted in The Doctor, celebrating the “human touch” and the “ideal relationship between physician and patient.”

Joseph Tomanek was also commissioned to create a brighter reproduction of The Doctor for the Petrolager exhibit. Lest brightness be idealized, the faceless mother is now depicted in a pink garment, seeming to emphasize her emotional frailty in the face of her child’s illness, while the men in the room remain calm and collected.

In 1947, The Doctor was reproduced on a US postage stamp to celebrate the centennial of the American Medical Association (AMA).¹³

“Healthy citizens constitute our greatest natural resource, and prudence as well as justice demands that we husband that resource.… [A]s a nation we should not reserve good health and long productive life for the well-to-do, only, but should strive to make good health equally available to all citizens.”¹⁴ Thus wrote President Harry S. Truman in a draft message to Congress in 1947, proposing a national health insurance plan.

In response to Truman’s plan, which would have created a system similar to the United Kingdom’s National Health Service (NHS), the AMA evoked the imagery of the dedicated and indefatigable doctor as the centerpiece of its campaign to defeat what it called “socialized medicine,” whereby time spent with patients and medical decisions would be dictated by politicians and bureaucrats.¹⁵The Doctor was seen by millions on countless billboards, posters, and brochures with the slogan, "Keep Politics Out of This Picture."

The AMA’s campaign to defeat “socialized” medicine tapped into deep-seated reservations about government intrusion into what many considered to be personal affairs and matters of individual choice. Such vested concerns about the supposed ills of universal health coverage were even expressed by some of President Truman’s friends, and universal coverage remains an elusive goal in the United States.

Replace “compulsory health insurance” with “mandatory masking and vaccinations,” and this brochure produced more than 70 years ago can eerily speak to the views of millions of Americans today. But as the COVID-19 pandemic has shown, individual well-being is inextricably tied to the collective welfare. Even the most libertarian conception of freedom must recognize that no person is an island.

Luke Fildes’ The Doctor aimed to represent a caring physician at a time when only the rich had access to such care. Despite anachronistic uses to market health-related products, celebrate milestones in medicine, and advocate for and against universal health insurance, The Doctor challenges us to think about what good doctoring is. As humanity confronts a myriad of natural and man-made threats to its health and well-being, how physicians act individually and as a profession in combatting these threats will determine whether they are worthy of the public’s trust.¹⁶

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Citation

AMA J Ethics. 2022;24(7):E697-713.

DOI

10.1001/amajethics.2022.697.

Acknowledgements

I want to thank Kelsey Walsh for her valuable research assistance.

Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.