 And last up, we've got Dr. Strav Faguntas. She's going to talk or actually just show us pictures. So whenever we're talking. Thanks, Rhys. OK, so I'm going to switch gears completely and dive into the medical humanities. My topic is about art and medical history, specifically during the mid-19th century. So sometimes when I look at a work of art, I wonder sometimes how did this artist really see the world, not just figuratively, politically, or socially, but also physically, what was he or she able to see? And it's a difficult question to answer, especially when we're looking at 19th century artists. But there are a lot of articles and books published, both in the medical literature and art history, that dive into the medical records of these artists and speculate sometimes on what these artists could have had. So I'll talk about three famous impressionists and how their art may have been affected by their eye diseases. And I'll also talk about the state of ophthalmology care at that time. The mid-19th century was specifically an important time in the evolution of ophthalmology because in 1851, Hermann von Helmholtz invented the direct ophthalmoscope. And this opened up a whole new world for ophthalmologists. And early users of this ophthalmoscope had to use a candlelight as the light source. And over the course of a decade, they were able to use gas lamps and oil lamps as well. During the course of Dr. Helmholtz's life, there were over 50 types of direct ophthalmoscopes that were invented by various ophthalmologists who were prominent during that time, including his own student, Richard Liebreich, who was also a famous ophthalmologist in Germany and throughout Europe. He was also a physiologist, a painter, and a sculptor himself. And he was also interested in this question of, how did an artist's vision affect their art and their style choices? Liebreich was known for many different things. He was a student of also Dr. von Greife, but he specifically helped describe a method to develop fundus photography. He also published the first paper in the field of ophthalmic genetics on consanguity and retinitis pigmentosa as well. But probably his most important contribution to ophthalmology was his atlas of ophthalmoscope. So he published this in 1863. This was 12 years after the invention of the direct ophthalmoscope. And it was a wonderful compilation and world acclaimed for its systematic drawings and paintings of the fundus. He had 57 color paintings, and he also included very accurate diagnostic descriptions of what he saw. It's pretty remarkable. In Berman's article, he published some black and white photos of his fundus paintings. And this is a corridor hemorrhage that he drew. On the next slide, I have retinitis albuminurica, retinitis pigmentosa. And he had very detailed descriptions of these diseases and what he saw as well. And this atlas was so important because it really summarized over the course of those 12 years after the invention of ophthalmoscope, how much ophthalmology and understanding of eye diseases had progressed. He has a very interesting career overall, which we don't have a lot of time to go into. But towards the end of his career, he did retire and just become a painter and a sculptor and really dived into that. He also still continued to study how vision affect artists. And he said, fascinated in art by that which approaches the border of disease and even goes beyond it. So I'll talk about our three Impressionist snacks, but what is Impressionism? So Impressionism is a very important movement of art that started in France in the 1860s. And it was a direct rebellion against the Paris Salon at that time. It had very rigid rules on how art should be made. The topics were mostly just historical or mythological figures. But Impressionism was a rebellion against that. And specifically, it's a visual impression of a moment. It's more about a feeling that the artwork is trying to capture rather than a realistic representation of a scene. So the movement itself was named after Claude Monet's painting here, Impression Sunrise, where he painted the port in Lavra, which is his hometown. And some people ask, is Impressionism just a result of poor refractive error? Because the pictures tend to look a little bit blurry. But honestly, it isn't. Because a lot of these Impressionists, they actually had very good vision. They didn't have refractive errors. And even if they had an issue with that, there were glasses available at that time for them to use. So you can also see as proof here in his early career, Claude Monet painted this painting that's very realistic, both at near and far. So I'll talk about the three different Impressionists who had interesting eye diseases. Well, Monet's cataracts, dichrocystitis, and retinopathy. So cataracts are very common, but the way that they affected Monet's paintings is actually really interesting. So he was diagnosed with cataracts at the age of 71. It's mostly in his right eye is more significant than his left eye, but he continued to paint with his left eye and tried to avoid surgery as long as possible. So as his vision declined, he started putting paints on specific parts of his areas of his paint palette. So he memorized where the locations of the paints were and he would label the colors of the tubes because he had trouble with color vision. Finally, when he wasn't able to read or write anymore, in 1922, he agreed to have cataract surgery. So we know of the symptoms that patients typically have with cataracts, but the most interesting thing to me is the color changes that artists experience with cataracts. So the yellow pigment of a cataract acts as a filter and absorbs a short spectrum wavelengths of light. So mostly those blues indigos and violets. And this causes something called metamirism. So the world takes on this yellowish hue, but there's adaptation to this yellowish hue. The yellow becomes a new reference white and this is called metamirism, where two colors start to look very similar under certain lighting conditions. So you can see on this color spectrum above, it's like the normal color spectrum as we see it, and then the color spectrum through dense cataract below. So the blues and purples are really difficult to distinguish. They look almost black and this yellow and the white look very similar. And the whole world takes on this green and reddish color. And painters specifically paradoxically start to paint the blues and colors just more brightly, almost in a garish way, because they start to paint from memory rather than what they're seeing. Like for example, they know that the sky is blue and like water is blue. I found this interesting article by Marmore, who published a series of photographs showing how, like a simulation of how cataracts would have made Monet's vision appear. So this is pre-cataracts, moderate cataracts and dense cataracts, just photographs showing the progression of how his vision would appear. And also the corresponding paintings during the same time periods. So the Japanese footbridge is very clear here. He's very subtle colors, it almost looks realistic. And then as he develops worsening cataracts, the colors start to take on more of a contrast with each other, so deeper blues as he's trying to paint from memory and creating a starker contrast between the blues and the greens in this painting. And by this point in 1915, he'd already been painting these water lilies for over 20 years, so he knew what the colors were. Finally, as he developed even more dense cataracts, he, you can no longer tell what the image is really, and the colors take on like this green, sorry, the red and the yellow as well. So why did he take so long to have cataract surgery? Especially since we see this change in his remarkable change in his paintings. It's because at that time, other than couching, really extra capsular cataract extraction was the only method. And intraocular lenses hadn't been invented until the next century. So cataract surgery had a lot of complications. And especially for an artist who relied on knowing what colors he was looking at and stereopsis. So a fakia would cause significant hyperopia for these patients. And the corrective lenses that they would use would cause visual fields to be restricted and lines to be distorted. There was significant astigmatism for corneal incisions. There was diplopia from the anisoconia, especially when they had surgery in just one eye. And the colors just took on a whole different spectrum for these patients because they started to see an overabundance of blues after cataract surgery without the protection of the lens. So many painters did not take up painting again after they had cataract surgery. And Monet saw that his friends who had had cataract surgery were also sufferings from complications like uveitis or glaucoma at times as well. But he did end up deciding to have surgery. He was light perception after all in that right eye. And he had a three stage surgery, first an erudectomy, and then a few weeks later an extra cap extraction. And then he had a cap salatamine. He ended up with 2030 vision with correction, which is pretty good. But he still continued to complain of cyanopsia. I thought this picture of his glasses was pretty interesting. So they're kind of upside down right now, but in this picture. But the left eye was completely occluded because it had the worst cataract that hadn't had surgery. And the right eye had the correction for the hyperopia. This was to prevent diplopia. So how do we know that the change in his style towards the later in his career with the dense cataracts was actually due to cataracts, not just a stylistic choice on his own. This is because later in his career, this is during the last year of his life, he painted this beautiful painting of the rose bush. And it shows that he's returning to like a previous style of painting. So more realistic style, more subtle use of colors. And also after cataract surgery, he was just slashing and destroying his canvases that he painted during his cataract days. This is a finally a picture of Quodmone with the water lilies and he's smoking a cigarette there. He died in 1926 and continued to paint nearly up to the day of his death of lung cancer. All right, so the next painter I wanna talk about briefly is Camille Picero. So he was also a very prominent impressionist during this time. But he unfortunately suffered from chronic Dacrocystitis with viscular formation on the right eye. And this started mostly in his 50s. And it was a chronic condition that just plagued him on a daily basis if you look back at his journals. He mentioned it almost regularly, very regularly. His ophthalmologist was Daniel Parenteau in Paris. And he loved this ophthalmologist and relied on him for recurrent treatments of Dacrocystitis. Parenteau did caudery to help treat this, caudery of the fistula has tried to collapse the lacrimal sac and tried different injections into the lacrimal system including silver nitrate. And Picero did experience some relief of his symptoms for short periods of time, but continued to have issues. Parenteau also recommended specific environmental changes like try to avoid going outside, especially when you're having an acute attack or especially when it's cold or windy outside. And Picero did follow these recommendations. So he changed his style of painting and when he would go to the countryside. But he really loved painting rustic countryside scenes. So he would just resort to going to the countryside in the summertime and go to places where he could get direct access back to Paris where his ophthalmologist was in case he had an acute attack again. And eventually though, his attacks became more frequent and his condition a little bit harder to treat. So he resorted to changing his style of painting altogether. So instead of being in the outdoors, he would paint the outdoors while being indoors and looking out through windows. So his last series of paintings were actually of urban landscapes. This is what he's really known for. His views of Paris and Roux are just considered masterpieces. And there's definitely a change in the way that he had to approach this because now instead of being at ground level and painting a landscape, he was at a higher level. And he had to get used to painting these oblique perspectives of cityscapes in a straight fashion. But he was very enthusiastic about painting in the cityscapes and not just the rustic landscapes. And he sort of just found beauty in everything that he painted. So it's really remarkable that he still continued to enjoy that. But unfortunately, about 10 years before he passed away, he did have a severe abscess that stopped him from painting further. And finally, the last person I wanna talk about is Edgar Degas. He needs no introduction. He's a very famous impressionist, but he actually preferred to be called an independent. Because of his academic training and his predilection towards doing realism, he didn't like to be called an impressionist as much. He also suffered from vision issues. So he had progressive central vision loss, mostly in his right eye compared to his left eye. And it started when he was 19, but was most significant to him by age 36. So during the Franco-Prussian war, he was helping to fight the war and he was doing target practice with a rifle. Closed his left eye, looked out of his right and saw that his vision has significantly declined in that right eye. He also had a lot of photophobia. So he's evaluated by many ophthalmologists during that time, including Libraeck himself. They diagnosed him with ophthalmia and kind of nonspecific things like choreoretinitis. And we actually don't have any medical records left of that time, unfortunately, for Edgar Degas. But we do have records of various letters that were sent and correspondences that hinted at choreoretinitis. So the cause of his choreoretinitis is not known. So his style of painting due to his condition and photophobia was different, possibly from other impressionists. He didn't like painting outdoors. He said, painting is not a sporting activity and he preferred to paint indoors. He has his famous ballerinas that he would paint. A lot of women that he would paint in various scenes in like cafes or operas, laundresses, he would paint family members. Only time he'd paint outdoors, he'd probably seen some paintings of horses, equestrian scenes, but he'd only got outside when they were overcast skies. This is a painting of his first cousin. The woman in here in this painting is Estelle. His first cousin Estelle lived in New Orleans and she also, she was interesting to Degas because she also suffered from vision problems. She had central vision loss starting from age 20 that progressed to blindness by age 30 and she also had significant photophobia. So there is an interesting article published, I kind of elicited over here, by Carcio Glue that asks, did Degas actually have inherited retinal dystrophy considering that he had another family member with a similar condition? There's speculation that he could have had maybe a cone rod dystrophy or stargards with just a rare form of inheritance. But it's all speculation at this point. During his early works, you can see here, while he was in New Orleans visiting his cousin and his family, he painted indoors a lot and he has a lot of detail in his scenes. He used depth a lot as well, so the room is very large and he placed figures at various levels in the foreground, mid-ground, and background and he didn't use a lot of bright colors at that time. The faces are also very clear and detailed. We can see how that changed over time. To compensate somewhat for his photophobia and his vision loss, he used specific glasses that were made specifically for him. So he would wear glasses that would occlude the right eye because it was essentially a monocular at this point because the vision in the right eye was so poor and he used a stenopic slit or pinhole glasses to help see, but this slit was about 15 millimeters long by 1.5 to two millimeters and helped prevent the, helped treat his photo or tolerate the photophobia better. He also was known among his models and his friends for never washing the windows in his house, like he refused to wash them because it helped dim the light a little bit more and always keeping the windows drawn. This is a painting of one of his later works, The Two Dancers in Yellow and Pink and there's definitely a lot of difference between this pastel versus the oil on canvas that we've seen on previous slides. So his work changed from being very detailed to being more coarse. He started to use, while he was painting, larger or thicker brush strokes and as his vision declined, he actually gave up oil on canvas altogether and instead of doing oil paintings, he would resort to using pastels and even brighter colors than before and it's thought that maybe he used brighter colors because color vision was declining as well. There are some studies that were published on evaluating how the thickness of his brush strokes increased over time as a way of estimating his visual acuity as we would do with the gradings. So how did he compensate for this vision loss and continue to make such beautiful artwork? So he used specific techniques. So he used a technique that we use for low vision patients called retinal eccentric fixation zone. Instead of having models sit for him for long periods of time and trying to look around and around his Gautomar central vision loss and make a picture, he would just take photographs and study the photograph in different chunks around his central vision loss and try to recreate that. He used a concept called parallax and parallax is a change in appearance of an object based on the point of observation that it's observed. So since he was monocular to help sort of recreate binocular vision, he would place mirrors around his models to help see them from different angles. Instead of observing a model from a static position and looking at him or her from a distance, he would actually walk around the model to be able to see from different angles how he or she looked. He also started to use statuettes, sort of recreations of the dancers or even horses so he could use tactile sensation to help create his drawings and paintings. But at the end of his career, he did give up painting altogether and started doing sculptures instead. And he particularly liked doing wax sculpture rather than bronze because he liked making a sculpture and then destroying it and starting all over again. That was fun for him. So his career was pretty remarkable considering the innovative ways that he found to deal with his visual deficiencies. And his contemporaries, including Renoir, said that de Gaulle did his best work when he was no longer able to see. So the works that he made in his later life were more popular and actually considered masterpieces for him as well. All right, so hope you found some of that interesting. This is a picture outside the Rijks Museum. I haven't been to France yet, but I've been to the Netherlands and this is a beautiful museum with a lot of famous Dutch artwork that I really enjoyed.