Ulm University Hospital, Mozartstrasse 22/1, Ulm D-89075, Germany
Lectures - International Congress Series 1254 (2003) 27–68
"Otorhinolaryngological aspects of handicapped children in visual arts"
Wolfgang Pirsig

In the last century, the removal of the obstructing adenoids had become very popular like this unpleasant method to examine a child's nasopharynx by the physician (Fig. 38). Here the aggressive examination had been photographed for a German ENT book. The physician is probing the child's mouth, thrusting his index finger deeply into the throat. In order that the child cannot bite the palpating finger, the examiner's other hand pushes the skin of the child's cheeks between the rows of teeth.

This brutal method of examination is seen through the eyes of the Austrian artist Helnwein in his painting, "The Operation" (Fig. 39). A girl, her left hand tied down, lies supine on an operating table, fully clothed. A tight leather belt about her thorax and arms has committed her to immobility. The gigantic steel tube, which coming down from above has filled the child's mouth, underscores this state of being tied down. The girl is forced, defenceless and totally awake, to endure this torture. In the background, we see a similar scene as in the photograph of the ENT textbook.

To this day, there is still controversy over when to operate on these fixed nasal deformities acquired during midfacial growth. The painting by Helnwein, entitled "Mean Child", depicts a terrified child who has just undergone a reconstructive operation to form a new nose from a frontal flap (Fig. 46). Blood drips from the tubes projecting from the reconstructed nose. A purulent scrap of granulation is seen in the left medial canthus, while a fresh scar from which the sutures have just been removed stretches from the angle of the mouth to the left ear. The flowered wallpaper in the background contains these words: disobedience allowed, taking pleasure in punishments, unchaste things, and other words which are connected with lines to the pathological alterations in the face. Do these harken back to the mediaeval belief that sickness is a punishment for greater or lesser human failings?