One of the great painters of the late 19th and early 20th centuries, John Singer Sargent was a realist guided by an excruciating attention to detail. Sargent, it's been said, would often go to great lengths in making a perfect piece of art.

William H. Welch witnessed this perfectionism firsthand while he sat in a London studio for one of the artist's masterworks, The Four Doctors, which depicts the founders of the School of Medicine.

Sargent's 1906 portrait of SOM founders William H. Welch, William S. Halsted, William Osler and Howard A. Kelly, which hangs in the Welch Medical Library, is showing signs of age.

At the Jan. 19, 1907, unveiling of the painting, Welch, the school's first dean, recalled a seminal point in the portrait's creation, when Sargent put down his brush and threw up a hand in bewilderment, saying, "It won't do. It isn't a picture."

Sargent felt the composition was lacking something, and upon contemplation came up with a possible solution. He asked the four distinguished physicians if they had any reservations about the introduction into the background of a large, old Venetian globe, an object housed in the artist's other studio. The subjects had no misgivings and the globe was promptly delivered days after. Unfortunately, the globe was so massive it could not fit through the studio door. Undeterred, Sargent simply directed that the doorway, and a good chunk of the wall, be chopped to permit the object's entry.

At the next sitting Sargent swiftly drew the globe's silhouette, stood back and brightly remarked, "We have got our picture." Or so he thought, as he would later add to the background a replica of El Greco's St. Martin and the Beggar painted by Jorge Manuel Theotocopouli, El Greco's son. It is believed that the work, part of Sargent's own collection, was used to add a vertical perspective.

Today, Sargent's The Four Doctors, which hangs in the West Reading Room of the William H. Welch Medical Library, has begun to show signs of age. The image has darkened as a moderate amount of dirt has built up on the surface, the frame and canvas stretcher are slightly warped, and the edges of the canvas have become clearly visible.

"It's a dark painting to begin with, and has darkened considerably over the years," said Nancy McCall, an archivist at JHMI's Alan Mason Chesney Medical Archives, who is leading an effort to restore the painting. "The work needs help; you can barely make out the full figure of St. Martin, looking at it today."

A study of the painting's condition was concluded this past June. Arthur Page, who conducted the study, said the immense portrait--10 feet 9 inches in height and 9 feet 1 inch in width--is basically overdue for a tune-up.

"For a painting this size and age, it's not in bad condition at all, and certainly not in any peril," said Page, of Washington-based Page Conservation Inc. "However, nothing has been done to it in the past 25 years. That means atmospheric soot and grime have been allowed to build up. And, if you look up close, you'll notice ripples in the canvas that are related to how it was originally attached to its stretcher. We want to try to take those ripples out."

The plan is to take the painting down, clean it with an aqueous solution, reattach the canvas to its stretcher, touch up the frame and then add an additional liner to cover the edges of the painting.

McCall said it's an extremely time-consuming and costly job but one that is well worth doing.

"This painting is truly an icon of the School of Medicine," McCall said. "It is rich in historical significance, both in terms of the history of art and the history of the medical institutions. Not to mention it's also a brilliant, and very large, example of a work done by a renowned master."

The painting is an oil-on-canvas portrait of the School of Medicine physicians: Welch, William Osler, William S. Halsted and Howard A. Kelly. The Four Doctors took Sargent nearly a year to complete, grouping his subjects over and over again before he began painting. It was, in fact, one of the odd occasions when the four posed together; Sargent often had the doctors come to his London studio one at a time.

The work was commissioned by Mary Elizabeth Garrett in 1906. Garrett, a noted philanthropist of her day, was familiar with Sargent as he had earlier painted her portrait, a work commissioned by the university's board of trustees to honor the funds she gave to establish the School of Medicine. The Garrett portrait also resides in the Welch Library's West Reading Room.

An American raised in Europe, Sargent (1856-1925) made his fortune and reputation by painting portraits of the rich and famous of his day. Woodrow Wilson, Theodore Roosevelt, John D. Rockefeller and Robert Louis Stevenson are among those who sat for him. In later life, Sargent was a prolific landscape and figure artist, producing more than 1,000 oils and watercolors.

McCall said Sargent would undoubtedly be pleased to learn that strides are under way to preserve his hard work.

McCall was certainly pleased when she telephoned The Gazette on Jan. 25, just prior to deadline, to relay the news that she had received funding for the restoration effort. An anonymous donor has agreed to cover the painting's complete conservation cost. Edward Miller, dean of the School of Medicine, says he would like the work completed by June, in time for the biennial meeting of the Johns Hopkins Medical and Surgical Association.