Matthew Smith The experimental surgery school
Unit 21 Dr. Shaun Murray, Simon Withers, Yorgos Loizos Greenwich University 2018/19
Introduction
Abstract:
A school for training surgeons that addresses the problem of lost techniques and skill sets. The relationship between surgeons, anatomists and artists will be repaired and reappreciated. The students will explore anatomy by drawing, sculpting, sewing, dissecting and manipulating the human form; forced to showcase the hidden wonders of what sleeps beneath. The students will gain enhanced practical skills and a new creative language to communicate the human anatomy.
Life
The site is situated in St. Brides Ave, a narrow alley running along the perimeter of St. Brides Churchyard. The alley embodies a surgical incision - slicing and opening the skin between the church and adjacent buildings. My architecture reflects this, incorporating elements of ‘anatomical architecture;’ light, precise and organic. What:
Experimental Surgeons School
Who:
Training surgeons
When:
2019
Where:
St. Brides Ave, London
Why:
Surgeons are losing many of the key skills required of their discipline such as manual dexterity and visualisation. Surgeons will be taught as artists. Experimenting with drawing, sculping, sewing and the manipulation of human anatomy in order to bring well-crafted techniques back to the surgeon’s tool kit.
Supporting Quotes
“Artists are crucial to the history of anatomy” Ruth Richardson, Historian and Author “Some of the work they did, we actually can not reproduce with the skills of today” Harold Ellis, Clinical Anatomist, School of Biomedical Sciences, King’s College, London “I have ideas about how everybody should be left beneath their skin” “I want my knots to be beautiful” “You develop a kind of aesthetic” Atul Gawande, Surgeon, Writer, and Public Health Researcher, Professor of Surgery at Harvard Medical School
Supporting Articles
Art
Anatomy
Death
Surgery
Art - Anatomy - 01 Student and Teacher
Drawing from Life at the Royal Academy Thomas Rowlandson (1808) After an RA student had perfected the technique of drawing plaster casts and sculptures, they would be allowed to attend life class, or ‘The School of Living Models.’ At the time this print was made all the students were male, but, in a departure from academic tradition, the models were of both sexes. In order to attend when a female model was sitting, the students had to be over the age of 20 or married.
Boston City Hospital Operating Theatre A H Folsom (c. 1890) The Operating Theatre was born of the anatomical amphitheatres of the Renaissance, where public dissections were held a few times per year to expose the “secrets of Nature revealed by God.” For the price of admission, one could watch as doctors performed an autopsy on the body of a convict. By the early 19th Century it was commonplace for operating theatres to be tiered like an amphitheatre where students and spectators could watch.
The Dissecting Room Thomas Rowlandson (c. 1838) Thomas Rowlandson was himself a student at the Royal Academy of Art where he learnt to draw the human form. Many of his artworks include scientific and medical scenes including this print believed to depict William Hunter leading students in anatomical dissections at his house in Windmill Street.
These three images convey the similarities in the study of the human body from an artist, surgeon and anatomist’s perspective. The educational and artistic merits of first-hand observation of the human form, both living, and deceased are unparalleled.
Art - Anatomy - 02 Anatomical Illustrations
Myologie Complette en Couleur Jacques Gautier D’Agoty (1746) In his, arguably, most famous anatomical illustration, D’Agoty shows a woman turning demurely away from the viewer. Her back open from the neck down, the muscles pulled back like wings to reveal the delicate rise of her spine. Sometimes called the Anatomical Angel, it reveals a vision perhaps more artistic than scientific.
Flayed Man Holding his Own Skin Attributed to Gaspar Becerra (1556) Man Holding His Own Skin Gunther von Hagen’s Body Worlds Exhibition (2002) Here we can plainly see the recreation of Becerra’s original print in the sculpture-like real corpse which has been plasticised and posed for an educational exhibition. Professor von Hagens argues that it will provide unique insights into the human body for a culture deprived of the public spectacle of anatomical theatres. He hopes the display will make us understand our bodies better and to ‘democratise anatomy.’.
The artist and surgeon were often one. The surgeon would have to become an artist to record and study the anatomy of the human body. An artist needs deep knowledge of the human anatomy in order to understand how the body moved and hung. These boundaries became blurred and many surgeons would give a unique perspective on the strange, showing off their talents and expertise, curating the body for an audience to observe and become familiar.
Art - Anatomy - 03 Anatomical Illustrations
The Incredulity of Saint Thomas (1601–1602) Caravaggio The painting depicts Jesus carefully guiding Saint Thomas hand to explore the incision left by the roman spear. St Thomas is wide eyed as he curiously inserts his finger into the wound. He needed to see it and touch it for him self to believe it. Jesus had in fact crossed the boundary from life to death and then back to life again.
The Anatomy Lesson of Dr. Deijman (1656) Rembrandt van Rijn Here Rembrandt is show the undertaking of a brain dissection on a cadaver. The surgeons assistant is holding the top of the cadavers skull as if it was a bowl. The view of the painting makes the viewer feel they as partaking the dissection. Looking up the table to the cadavers face. Rembrandt also painted another dissection ‘The Anatomy Lesson of Dr. Nicolaes Tulp’ (1632).
Study of Skeletons (Left) Studies of the Shoulder and Neck (Right) Leonardo DaVinci (c. 1509 – 1510) This sheet displays the full range of Leonardo’s illustrative techniques, showing the structure of the muscles of the shoulder. Pectoralis major is divided into parts to represent the lines of force along which it acts. This method reaches its logical conclusion in the drawing at top right, which is an example of Leonardo’s ‘thread model’. This technique - invented by Leonardo - reduced the muscles to single cords along their central lines of force, such that the spatial structure of an entire system can be perceived at once.
These three images convey the similarities in the study of the human body from an artist, surgeon and anatomist’s perspective. The educational and artistic merits of first-hand observation of the human form, both living, and deceased are unparalleled.
Art - Anatomy - 04 The Surgeon and The Artist
Dissection of theTrunk of the Body John Bell (1794)
Dissection of the Mucles of the Back John Bell (1794)
Second Dissection of the Belly John Bell (1794)
John Bell was a practising surgeon and anatomist who, due to his unconservative demeanour, attracted large audiences whenever he would lecture. Bell, following the interests of his mother, was also a talented artist, and was one of the few medical men to illustrate his own work. Bell believed in the exploration of the human anatomy through artistic studies.
Art - Anatomy - 05 D’Agoty - A Pioneer in Colour Illustrations 1:1 sections
Two Dissected Men, One Seated, the Other Standing Behind, with a Seperate Section of Viscera (Left) A Standing Man, Posterior View, with Separate Sections of the Brain (Right) Jacques Gautier D’Agoty (1764-1765) These are 2 panels from a set of 12. D’Agoty worked in association with anatomists such as Pierre Tarin and Joseph-Guichard Duverney, he published some of the first colour prints of anatomical subjects. The dissections shown here were performed by Tarin, who commisioned D’Agoty to create the series of 12 pieces to be published in an Anatomical Encyclopaedia.
Art - Anatomy - 06 Memento Mori: Remember That You Will Die
Aerial Cutaway View of the Bank of England from the South-East Joseph Gandy (1830) Better known as the Bank of England in Ruins, this painting was created as a homage to Gandy’s long-time friend and colleague, Sir John Soane. Gandy celebrates Soane’s genius and achievement as impressive and iconic as that of the great ruins of Ancient Rome or Pompeii. Soane exhibited this water colour at the Royal Academy of Art to illustrate the results of his near forty-five years of labour on the Bank of England, of which Soane was the architect. Alongside the painting was a quotation describing the work as a ‘meat pie with the crust removed.’
Wax Vanitas, Europe (1701-1800) This Vanitas seeks to remind the viewer not only of the certainty of death, but also that of the uselessness of vanity. The decaying flesh and insects that feast on it is in stark contrast to the other side of the model which does the face during life. There is a quote from the book of Ecclesiastes etched on the front which reads “vanity of vanities, all is vanity.”
Memento Mori - Latin translation: ‘Remember you will die’ Art has always expressed close links to death and the human anatomy. Architects rarely consider or design the death of their building. Gandy’s ‘Bnk of England in Ruins’ is the best architectural example of a Memento Mori or Vanitas; visualising the death and decay of architecture. This is something the architecture for my Surgeon’s School will embrace and harness.
Art - Anatomy - 07 Fritz Kahn, Exploring anatomy at an architectural scale
Travel experiences of a wandering cell; in the dust storm of the windpipe Fritz Kahn (1924)
Fairy-tale journey along the bloodstream – entering a glandular cavity with an idealised cell-scape Fritz Kahn (1924)
Entering a gland cave Fritz Kahn (1924)
German Polymath Fritz Kahn devised an innovative visual design language for understanding science as the human body. A scientist by trade and artist by inclination, Kahn used an artistic medium to convey scientific information about the human body, Kahn was able to strip the scientific ideas of their complexity and engage a wider audience. These series of drawings explore the human anatomy at an architectural scale. The users have been scaled down and the body scaled up. This allows Kahn to show off the complexity and intricacy of the human anatomy. My architecture aims to embrace this, with each space designed at a high level of detail and complexity, and fusing multiple scales.
Apparatus - 01 Artist - Surgons
The Taxonomy of the Artist’s tools Artists use a range of tools to create their work, they are considered to be an extension of the artists body, wielding them as one. The relationship and interaction with these tools is highly personal, requiring dexterity and time to master.
The Taxonomy of Surgical instruments Due to the fast paced advancements of surgical procedures throughout history, surgeons would take it upon themselves to invent, or commission their own tools. Many of the surgical instruments which are used today were created by the innovative minds of the surgical pioneers of the past. Surgeons, like artists, use a range of tools to dissect, push, pull, examine and stitch the body. Like the artist these tools are an extension of the surgeon’s arm and often hand chosen depending on their preferences. Each tool would be specialised for a series of actions making up a procedure. They are precise and brutal, delicate and heavy; there is a tool for each task.
Surgical Techniques Much like with personalised surgical instruments, it is often noticed that surgeons and anatomists have their own techniques and styles when performing a procedure. There are guidelines and strict stipulations in the operating theatre or dissection room, but much like an artist, we can observe the differing marks that are made by the surgeon or anatomist on the human body.
Apparatus - 02 Retractors
The oncology Thompson retractor system Modified Makuuchi Incision for Foregut Procedures. B Chang, Sharon & Palavecino, Martin & Wray, Curtis & Kishi, Yoji & Pisters, Peter & Vauthey, Jean-Nicolas. (2010).
left: Thompson, GYN Oncology System
right: Thompson, Body contouring system
Retractors are used in surgery pull back and hold unwanted tissue away from the insertion to allow the surgeon space to work. The retractor being used depends on the part of anatomy being dissected. Each system is made up of a taxonomy of parts, each one being interchangeable in order for the surgeon to adapt it as they see fit. To explore incisions in architecture I will need to make and adapt my own architectural retractors.
Site location Large Extent
London boroughs
This map shows the span of the River Fleet from its’ birth in Hampstead Heath down to its’ death at Blackfriars. Key historical points and observations have been highlighted. Each location being pinned by a ‘what3word’ tag. The Fleet has a talent for attracting death and decay.
Site location Definded
Google Maps
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River Thames St. Paul’s Cathedral Blackfriars Station
.com/maps/@51.5127393,-0.1052424,1203m/data=!3m1!1e3
City Thameslink Station Ludgate Circus 100 Stm Brides Church
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Fleet Street Ludgate Circus
St Bride’s Avenue
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Site Plan 1:500
Site Outline
The site is located in the churchyard of St Brides Church situated just off Fleet Street in the city of London. The churchyard sits north of the main church and is surrounded by buildings on each side. To the west and north it is broken up by st brides ave a narrow footpath and to the east, a one-way street. This site was chosen due to the burial ground underneath which the project aims to excavate and build a new necropolis, where the cadavers will be laid to rest.
Site location Scaning the Site
Aerial from the South East
Plan
Aerial looking West
The site has been recorded using a laser scanning, taking 17 scans and stitching them together to accurately reconstruct the site. The scans not only provided accurate surveying information but polarize it with a new lenses to reveal and highlight parts of the site that were not available.
Site location Retracting the urban flesh
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Diagramatical Site Plan
3D Scans of the site reveal the immediate context of the site. Retracing back its surrounding, allowing the architect to design as a surgeon, pulling away flesh of the urban environment to a focused area.
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Site Investigation Dissection
Left - Right Passageways in the RA school where the student medal-winners board hangs. Both Soane and Gandys names are engaved into it. Photos at each end of St. Brides Passage, reminisent of a surgeons incision.
Site layering revealed by dissection with anatomical cutlery, slicing through the sites’ epidermis layers.
Each layer being dissected and retracted by modified tools. Revealing the hidden layers and relationships.
Proposal Overview
Programme Taxonamy Dissection room - one of the focal points of the architecture. The room will be one of the largest spaces in the school, flooded in natural light. Bodies will be brought up from the morgue for students and teachers to dissect. Morgue - the cadavers will be stored and embalmed in this space before dissection. Living circulation - the connective areas between the spaces inhabited by the living. Dead circulation - the connective areas for the transference of cadavers around the building. Living entrance - a main entrance into the building for staff, students and visitors. Dead entrance - the cadavers will have a separate entrance to the building and be taken directly to the morgue. There will be road access for delivery and transportation of bodies. Studio - another key space in the building. The students will inhabit this space when they are learning several artistic techniques. Workshop - this space will allow students access to tools and machinery to further expand their craft, make larger sculptures and design and manufacture their tools. the students will craft the coffins for the dissection cadavers which will be laid to rest in the necropolis. Operating theatre - one of the key larger spaces in the building which will be used equally for teaching on the anatomy in terms of dissection and art. Classroom - this space will be a traditional classroom space used for lectures of a more conventional sense. Consulting room and office - this room will allow future cadavers to come in, ask questions about the process their body will go through on donation. Changing room - acting as a threshold between the living and the dead, students, teachers and technicians will use this space to prepare for work either with a cadaver or with a canvas. Necropolis - the cadavers will eventually be laid to rest in a large underground necropolis in the existing graveyard of St. Bride’s Church. This space is in tribute to Gandy’s last project to exhibit at the RA before his passing; an underground necropolis consisting of metal coffins below London. An annual funeral will be held at the necropolis in honour of those who donated their bodies to art and science. The tutors, students and families will all be invited to attend.
Apparatus - Site Dissection
Level 05
Artist Studios Living circulation
Space Hierarchy and Conections
Building Level 04
Dead circulation Living circulation Dissection Studios
Dead Entrance
Living Entrance
Dead Circulation
Living Circulation
Necropolis Level 03
Studio
Changing rooms Living circulation
Coffin Workshop
Morgue
Changing Room
Consulting Rooms
Tool Workshop
Dissection Room
Classroom
Theatre
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Dead circulation Theatre Theatre Lobby + Bar WC’s Living circulation
Level 01
Workshop Classroom Staff Office WC’s Living circulation
Death
Life
Apparatus - Site Dissection
Level 00
Living circulation Living entrance
Space Hierarchy and Conections
Building Level B1
Dead entrance + waste store Morgue Graves Necropolis Graves Living circulation Reception room
Dead Entrance
Living Entrance
Dead Circulation
Living Circulation
Necropolis Level B2
Studio
Plant + BoH Graves Necropolis Graves Living circulation
Coffin Workshop
Morgue
Changing Room
Consulting Rooms
Tool Workshop
Dissection Room
Classroom
Theatre
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Dead circulation Graves Necropolis Graves Living circulation
Level B7
Dead circulation Graves Necropolis Graves Living circulation
Death
Life
Programming - 03 Level - 02
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Activities - People Activities - Space Tools - People Tools - Activities Space - People Space - Tools
Key of Links Activities - People Activities - Space Tools - People Tools - Activities Space - People
Users
Space - Tools
Spaces
Entrance
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Classroom
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Changing Room
Changing Room
Changing Room
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Student
Necropolis
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Cadavers
Theatre
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Dissection Room
Dissection Room
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Living Circulation
Living Circulation
Living Circulation
Living Circulation
Living Circulation
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Living Circulation
Dead Circulation
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Dead Entrance
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Staff
The graphics depict and communicate the journeys set users embark on and the spaces each user comes into contact with before reaching their final destination. Exploring the relationship and interactions between users, spaces, tools, and activities. One can understand the overlaps and needs of each space and where best to programme it.
Changing Room Necropolis
Dissection Room Studio
Dead Entrance
Life and Death Axis Existing and future condi-tions
Existing life and death axis
proposed life and death axis
The building reflects the existing life, death dived across the coronal plane of the site. The dead and the living will only ever cross paths in designated mixed areas. which sit on the coronal plane acting as buffers.
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Film - 01 Frames
The source of the river in beautiful Hampstead, autumn leaves and branches begin to fall.
Battle Bridge, an ancient river crossing in now Kings Cross. A major battle in AD 60 between the Romans and the Iceni, the first blood is spilt into the river.
We enter the City of London, the river becomes a means to transport detritus out of the city, including human and animal waste and the unpalatable spoils from Smithfield’s Market.
Eventually the river is irreparable, and the city begins to bury the filthy, disease ridden water.
The fleet is buried and Laid to rest, or so they thought.
Stills from a short film depicting the slow death of London’s lost river Fleet. Over time the river was neglected and polluted. From the fallen leaves and branches at its source to the staining of blood from Battle Bridge. Slowly becoming a cesspit of an open sewer. Desperately trying to negotiate not just the human waste of Londoner’s, but the waste and innards of livestock from Smithfield’s. Pronounced dead, The Fleet was buried and laid to rest… only for its grave bell to chime..
Film - 02 Layering of the Frames
A series of frames dissected from the body of the film. Ordered in reference to its’ time stamp, each frame has been examined, removing and highlighting the contours of colour shades, layered back onto eachother to form a palimpsest of the Fleet.
Film - 03 Frames into 3d Forms
Movie extract driving floor typology via grasshopper
studio floor build up
The palimpsest of the Fleet has been explored in 3D form. These calcifications of the film act as an undulating surface to be used in the architecture of the building. They reference the build-up of paint and materials on the floor of artist studios, growing over time and becoming a unique answer to the interaction with its’ environment.
Epidermis Modelling Exploring skin layering
Frame variations showing a single, double and triple skin using the same latex build-up
single frame variations showing a 5, 10 and 15 layer build -up of latex
Singel layer opacity test
Double layer opacity test
User defined layer opacity test
The artist will paint the walls of their studios using latex, building up layers over time in particular areas. This allows the students to adapt their environment blocking excessive light or sight lines of overlooking neighbours. The skin can be cut and sewed up practising different types of sutures. Latex will then be painted on over the top of the suture, thus creating a scar. The studio will grow with the user reflecting their journey over the course of time.
Triple layer opacity test
Epidermis Modelling Incisions and apertures into the architecture epidermis
Anatomical faรงade model 1:50 The model anatomises the architecture. The faรงade is represented in a skin-line material; soft, opaque and impressionable. Surgical incisions are made into the skin and retracted to widen the opening. These incisions represent the architectural orifices, allowing the passing of vectors in and out of the building. In the bottom image I am exploring the scale of the facade by moving the light source around the model manipulating the scale of projected shadow onto the wall behind.
Approaching St Brides Ave - Night
Experiences whilst journeying down St Brides Ave
Living entering dissection studio
Dead entering dissection studio
Living and dead united in dissection studio
Artist and Surgeons united in art studio
Dissection and life drawing merge in the anatomical theatre
St Brides Churchyard