Medical illustration is a way of mapping and communicating complex anatomical structures found in the human body. This form of art is used to direct students in their dissection labs. It is used to teach anatomy without having a cadaver in front of you. It is used to diagnose patients, and solve court cases. Medical illustration allows the hypothetical to occur without the damage of applying it to the real world. Medical illustration has been a practice for as long as beings have practiced mark making. Medical illustration as a discipline consists of a rare grouping of other extant fields. Communication is key in the field of medical illustration, so is our initial understanding of the subject or the human body. Knowing Biology, Physiology, Neurology, Anatomy, and Histology. Extensive experience in artistic endeavors along with an understanding of aesthetics is crucial to achieving success in this field. Publication knowledge, Health promotion, Archeology, Anthropology, Chemistry, Linguistics, and Psychology add up to smooth and shape the field of Medical Illustration.
“A medical illustrator is a professional artist with advanced education in both the life sciences and visual communication. Collaborating with scientists, physicians, and other specialists,medical illustrators transform complex information into visual images that have the potential to communicate to broad audiences.”(AMI)
“These methods and skills range from advanced drawing, painting and sculpture techniques in tangible media, to functional concepts and techniques involved in the production of commercial and graphic art, to up-to-date computer graphic skills in still and motion media.”-(AMI)Medical illustration is a discipline of many disciplines. The knowledge required for this profession are vast and numerous, but it makes for a beautiful multidisciplinary study which blends together creating a language that cannot be spoken, only seen.
Red Mammoth (c. 35000 B.C)An illustration was found in the Cueva del pindal caves of Northern Spain in a small cave outside the town of Pimiango near the border of Cantabria. The illustration was of a mammoth painted with red ink.
“Prehistoric painters used the pigments available in the vicinity. These pigments were the so-called earth pigments, (minerals limonite and hematite, red ochre, yellow ochreand umber), charcoal from the fire (carbon black), burnt bones (bone black) and white from grounded calcite (lime white)”(WebExhibits).The people of the caves used lumps of clay-rich Iron, dried and crushed into a fine powder. They would then mix it with a binding agent such as animal fats, urine, water, vegetable juices, and albumen. There were many ways in which they would apply the paint, but in this case, it was probably the use of sticks to create a linear outline of a great mammoth using red ocher and dabbing in the heart possibly using their fingers. This illustration was likely used to teach young hunters the best place to injure the mammoth: the heart. Though there was little understanding of anatomy and physiology at that time, this was one of the first documented pieces of medical illustration.
Human DissectionIn order for physicians to understand the intricate workings of the human anatomy, without the use of current technologies, one would have to dissect a human being. There were private dissections performed for the discovery of an untimely death, called autopsies. There were private dissections for teaching young physicians as well. Public dissections were utilized in the Alexandrian school of medicine started by Erisistratus and Herophilus, but due to legal and religious reasons, it was prohibited in 200 AD. But public dissections were reintroduced by an Italian physician named Mondino de Luzzi in January 1315.
” Because material things are temporary, the human body was not studied. Anatomical dissection was considered to be blasphemous and so was prohibited (Gregory and Cole, 2002). At that time, anatomy was taught by professors who recited Galen’s texts (Dyer and Thorndike, 2000); however, during the 14th and 15th centuries AD, some professors in French and Italian universities began to use cadavers as teaching tools in their classes (Gregory and Cole, 2002). One of them was Mondino dei Luzzi (1275–1326), who reintroduced the practice of the Alexandrian School, emphasizing the importance of dissection by performing a series of public dissections in the early part of the 14th century.”(Elizondo-Omana, et al 2005)
Aelius GalenusWe start with one of the most established early physicians, Aelius Galenus (Sept. 129 AD- c. 210 AD). He influenced the development of many medical disciplines such as the study of; anatomy, physiology, pathology, pharmacology, and neurology. He is most well known for his theory of the four humors, which was used to determine the ailments of patient well into the middle ages. The four humors consisted of black bile, yellow bile, phlegm, and blood. His teachings set the stage for physicians and medical illustrators to take an interest in the pictorial documentation of medicinal discoveries. Starting with Erasistratus and Herophilos.
Erasistratus & HerophilosErasistratus, father of physiology and Herophilos, father of anatomy. Both were Greek physicians and created the first school of anatomy in Alexandria, Egypt. This was in the 3rd century BCE. They were also among the first physicians to utilize illustrations in their methods of teaching. Benjamin Mandel M.D shared in his presentation of historical medical illustration an image that was produced from the school of Anatomy in Alexandria, Egypt. Sadly the school was destroyed in a fire in 391 BC along with the exquisite library.
“It appears that he (Herophilos) wrote three treatises devoted to anatomy, one to midwifery, two each to the study of the pulse and to therapeutics, one to ophthalmology and one to dietetics. None of his works have been preserved, they disappeared with the destruction of the library of Alexandria.”(Reverón).There were five squatting figures, each displayed the different systems in the body. The images were semi-schematic in that the images had bold outlines, poor details, and many technical errors. The images were used for memorization purposes only, not for understanding how the parts sit together within the body.
Styles of Medical illustrative artThere are three distinct approaches to visually communicating information about the body; Naturalistic, Semi-schematic, and Schematic. Most of the illustrations found in antiquity are semi-schematic and schematic. Much like the early illustrations from classical antiquity. They are maximally simplified, purely symbolic, abstracted and are impossible to interpret due to the lack of context. these images were not by any means exact and were more just a theory of the physiology of the organs.
Asian, and Middle Eastern Medical Illustration
Hunayn ibn Ishaq (809-873 AD)Hunayn ibn Ishaq was a Mesopotamian physician who produced an anatomical atlas on the workings of the eyes, it was titled Book of the Ten treatises of the eye. His work was used later in the middle ages by ophthalmologists. This semi-schematic illustration of the eye is rudimentary but quite accurate.The parts are all present, however, the parts of the eye are disproportionate. the image seems representational, though quite abstract. There is a success in that the drawing accurately depicts the parts of the eye, and can be used to navigate the physical eye of a patient. Ishaq was heavily influenced by the Greek physician Galen, and his illustration stays true to Galen’s style of teaching. Hunayn influenced another early medical illustrator, Ibn al-Nafis.
Ibn al-Nafis (1213-1288)Idn al-Nafis, (full name Ala al-Din Abu al-Hassan Ali Ibn Abi-Hazm al-Qarshi al-Dimashqi), was an Arab physician who made many contributions to the understanding of Pulmonary circulation.
Ibn al-Nafis“was the first person to challenge the long-held contention of the Galen School that blood could pass through the cardiac interventricular septum, and in keeping with this he believed that all the blood that reached the left ventricle passed through the lung.”(West).Nafis discovered and published the pulmonary circulation in 1242 in Commentary on Anatomy in the Canon of Avicenna when he was just 29 years of age. Avicenna (ca. 980–1037) was known by his Latin name rather than his actual name Ibn Sina and predated Ibn Al Nafis by approximately 200 years. contrary to popular belief
“the practice of dissection for medical teaching, was not prohibited in either the religion of Islam or the Islamic world. On the contrary, all the eminent Islamic physicians of that era stated that knowledge of anatomy leads to a deeper appreciation of God’s wisdom and omniscience.”(Abdel-Halim)Here we start to see the illustration of full-bodied subjects. This is stylistically described as a schematic. Notice that the figure is in a squatting position, this is most likely due to the fact that the cadaver was sat up on a stool for the illustrator. The figure is quite disproportionate, much like the majority of early medical illustrations. The veins and arteries are drawn without any true direction other than away from the body, which they in fact are. The organ structures within the body cavity are quite like the veins and arteries, in that the masses of the tissue are drawn proportionately, but the physiology is not quite developed.
Shou Hua (1304-1386)Moving to Asia now, Shou Hua’s book Jushikei hakki. The author lived in 1304-1386. You can tell that the image is quite minimal, and it lacks detail. This would not be useful to a physician in instances where the internal body needs a reference. However, in this specific photo, the acupuncture is the implied use of this reference table. The proportions of this figure are arguably inaccurate, but this style is pretty typical of early medical illustration. As for the full body image, we find that it would be difficult to pinpoint where these labeled areas are in relation to the anatomy. It seems there are no reference areas to the bones or muscles that could help us find the area that is indicated. Regardless, the use of indication lines in this specific illustration is before their time, as medical illustrators had not begun to utilize this technique until after the 1500’s. One boundary that makes this a difficult piece to understand is the language barrier. Japanese is not a common language for most. Though there is a translation, the title of the Atlas itself was graciously translated by the National Library of Medicine as Expression of the fourteen meridians.
Mansur Ibn Ilyas (1380-1422)An Iranian illustrator Mansur Ibn Ilyas, published his atlas titled Tashrih-i Badan-i Insan. In English, it means Anatomy of the Human Body. The Atlas was published in 1390 just a bit after Shou Hua published his. I read up about this particular artist and his inspiration, which brought me on a trail of rich middle eastern illustrators that I would have never found if not for this Author. Mansur Ibn Ilyas was from the providence of Fars in central Persia, modern day Shiraz, Iran. The illustrations from this book were commissioned by Zayn al-Abidin, a politician in the last Muzaffarid ruler of Fars. This particular illustration is concerning the arterial, and nervous systems. Notice the squatting figure, which I had mentioned previously. This is because the cadaver is commonly propped up on a stool during the dissections. This is another semi-schematic illustration, very common of the illustrations during this time period; the full body, disproportions, the description is written on the illustration as opposed to the indication lines. The indication lines are seen in the previous illustration above, which would point to the specific parts, freeing up space for the viewer to actually see the illustration and understand the significance of that structure. This illustration is a schematic drawing, with very disproportionate structures, basic shapes representing the face. As you can see, the head is a literal circle, with circular cheeks, and the proportions of the eyes, nose, and mouth being quite small in comparison to full size of the head. The vertebra is accurately labeled, but the positioning of them stacked on top of one another doesn’t give the viewer the best understanding of where the nerves connect to the peripheral nervous system (or spinal cord). The limbs seem to have an unnatural wave to them as if something was under the skin of the figure. Still, this illustration does show a map of some of the nerves, and where they protrude from the peripheral nervous system.
European Medical Illustrators
Magnus Hundt (1449-1519)Magnus Hundt was a German physician, theologist, and philosopher, and coined the term anthropology. He published an anatomical atlas called Antropologium de hominis dignitate, natura et proprietatibus, de elementis, partibus et membris humani corporis, in 1501. Hudnt’s atlas, commonly referred to as antropologium for short, contains 17 woodcut illustrations of human anatomy. A process of printmaking which allows the illustrator to make more than one print, allowing for multiple atlases to be published.
“these illustrations, by an unknown artist, are schematic ..”. “They do not appear to have been intended to correspond to anatomical reality. For example a woodcut of the body includes the names of all the external parts but makes no attempt to equate the anatomical terms with the parts they describe. Woodcuts like these are more like a visual way of listing the main organs, such as a table in a modern book might indicate relationships.”-(Christies)This print is pre-Davinci, so there was no such thing as a cross-section, which is what Hundt seems to have been trying to do. Perspective and the ability to draw from a foreshortened view had not quite been established yet. I was not understood conceptually until the Renaissance.
Renaissance Artists’The Renaissance artist found themselves beginning to reject Galen’s authority and revisit the classical Greek art. These artists wanted realistic images that were accurate enough to understand the inner workings of the human anatomy i.e. muscles. Hieronymus Brunschwig (1450-1512), Jacopo Berengario da Carpi (1460-1530), Albrecht Durer (1471-1528), and Charles Estienne (1504-1564) were the next to publish their anatomical atlases. Brunschwig’s work was still very simple and more naturalistic. His style is much like the art from the middle ages, not quite a renaissance style, but the understanding of proportions is beginning to develop. Jacopo Berengario da Carpi was famous for his illustrations depicting the human form with its skin peeled back to show the muscles underneath. Jacopo seems to be coming away from the semi-schematic approach which was popular during the middle ages and heading in a more popular naturalistic style. However what we find in full-bodied figures is a lack of detail. This image is rich in detail, however, the image is too small for one to really see the details, and there is quite a bit going on within the image itself. There is a lack of understanding of the anatomy of the image, as the value is not consistent with the value structure seen in the leg muscles.
Charles EstienneCharles Estienne’s Atlas De dissection partium corporis humani libri tres was illustrated by possibly 3-4 different artists. Jean “Mercure” Jollat (1490-1550), Estienne de la Riviere (?-1569), Pietro Buonaccorsi (1501-1547). Each had a similar style, close enough for the images to match in the atlas. Estienne de la Riviere was the artist, and Jollat was the engraver. Some of the images from this atlas are very well executed. However, once more, the issue with using a full-bodied figure is the chance of losing the image into much detail in such a small space. The first image is a great example of a well-executed full figure. The value in the skeleton enough to distinguish the structures from the foreground, and really draw your attention in. The negative space has been taken up by a scenic view, which is typical of naturalistic illustrations. However, another illustration from the same text seems to lose the impressive value structure found in the skeletal illustration. This image depicts the musculature of the posterior view of the figure. The value structure is not as evident in this particular image, which is due to the intricate line work of the musculature, which can only be seen upon closer examination of the image.This particular image is an example of how the full-bodied figure can cause problems in how an artist executes their image. Naturalistic styles can help or hurt an image. In some cases, such as those from early Roman pictures, there is said to be “an overabundance of visual baggage.” and that the key is not to allow an overabundance of figures flood the scene giving “little chance for the focal point to receive adequate attention” (Loechel).
Leonardo da Vinci (1452-1519)
“On Sunday 26 April 1478, Giuliano de’ Medici was murdered as he attended High Mass in Florence’s cathedral of Santa Maria del Fiore…On 28 December 1478, he (Bernardo di Bandino Baroncelli) was hanged publicly in Florence. Bernardo’s public execution is famously recorded in Leonardo da Vinci’s pen-and-ink sketch of his hanging body. This is Leonardo’s first extant sketch of the body of a criminal.”-(Azzolini 147).Leonardo di ser Piero da Vinci was a scientist, mathematician, inventor, anatomist, painter, sculptor, architect, botanist, musician and last but not least, a writer. Leonardo began apprenticing when he was 15 under the hand of sculptor/painter Andrea del Verrocchio of Florence. In 1472 Leonardo became a master in the guild of Saint Luke, wherein, members were artists and doctors of medicine. He was given permission to dissect human corpses at the Santa Maria hospital in Florence, and later in Milan and Rome. His Medical illustration career started shortly after he painted The Last Supper, in 1491. He began his anatomical studies by reading books in print. Then after noticing that none of the texts made any sense compared with his own observations, he decided to write his own. Leonardo started from the inside of the body to the external. starting with the bones, ligaments, muscles, tendons, nerves, veins, arteries and then the skin. This process was repeated for an elderly man, a younger man, and a child. He was specific in his measurements of everything, bone, and skin width and everything in between. He focused on individual parts rather than a full figured approach. He developed an under shading technique that allowed for him to accomplish the three-dimensional look that gave him the success he needed in order to create a realistic image of the human anatomy. He decided, rather than focusing on one figure from life, to draw collectively the examples he had seen to create the typical form of the human anatomy. Leonardo is credited with creating spacial relationships between skeletal muscle and the bones. He implemented the idea of origin and insertion, where the muscle attaches to the bone and what it helps to move. Da Vinci focused on the function of the body and depicted living figures to show physiology. He also reduced superficial muscles to show the underlying structures. Da Vinci also, incredibly, invented the use of a cross-section, to show the bundles of the muscle in relation to its placement with the bone. Sadly, Leonardo da Vinci’s works were circulated for a while after his death in 1519, but they were not published until the 19th century.
Hans Von Gersdorff (1455-1529)Gersdorff published his anatomical atlas in 1517 called Feldbuch der Wundarzney. The book was illustrated with woodcut works attributed to Hans Wechtlin. Gersdorff was one of the most noted German surgeons during the late fifteenth and early sixteenth century. However little is known about him. Hans Wechtlin was a renaissance artist who worked primarily in woodcuts. One attribution to this artist, though not depicted in this illustration, is the use of indication lines which, as previously stated, free up the image for more important things, such as the figure in its entirety. This image is impressive, in the massive culmination of weapons piercing through the figure’s body. There is no information, however about how one would go about removing them.
Andreas Vesalius (1514-1564)Andreas Vesalius published the very first atlas of anatomy, De humani corporis fabrica, on the fabric of the human body in 1543. He is still one of the most influential men in medical illustrative history.
“His work, De humani corporis fabrica, appeared in 1542. It was realized that if certain artistic holdings should be skillfully abandoned, greater scientific value could be achieved in the illustrations. Here we see the c-operation of the practitioners of medicine and art, each wiling to yield something so that greater teaching value could be attained.”(Loechel 170).Straying away from the gaudy frames rich with distracting portrayals of botanical blossoms, focusing now on the figure itself. Woodcuts, which had been utilized until this point were now seen as awkward and disruptive to the potential of the illustration. The new tool was Lithography. Lithography allowed for greater attention to detail in textures, colors, and depth. This allowed illustrators, physicians, and printers to produce medical books in a higher caliber.
Juan Valverde de Amusco (1525-1588)Juan Valverde de Amusco was Vesalius’s plagiarist. As success rained down on Vesalius’s work, it became apparent to Valverde that Vesalius’s work was a stroke of genius. All but four of the images in Valverde’s Anatomia del corpo humano, 42 in total, were directly taken from Andreas Vesalius’s De humani corporis fabrica.
“Valverde admitted to having made use of Vesalius’s illustrations, and was explicit in his expressions of admiration for Vesalius’s achievement, while daring to put forward certain corrections.”(Ars Anatomica).
Bernardino Genga (1620-1690)Genga had a mind for classical medical texts, delving into Hippocrates’s works, and editing them too. Bernardino found himself engrossed in the preparation for anatomical specimens and felt a strong connection with the anatomy of ancient Greek and Roman sculptures. His fondness led him to the French Academy in Rome, where he taught anatomy to art students. Bernardino published his works Anatomia Chirurgica, a textbook for surgeons, in 1672. His book had multiple editions, one titled Anatomia per Uso et Intelligenza del Disegno, which was published a year after his death. Bernardino practiced surgery in the Hospital of Santo Spirito in Sassia and died there in Rome. His anatomical preparations were rendered by artist Charles Errard, and these renderings were in the highest likelihood, engraved by Francois Andriot, creating the Anatomia per uso et intelligenza del Disegno, which translates to Anatomy for design use and intelligence.
Adriaan van de Spiegel (1578-1625) and Giulio Casseri (1552-1616)Giulio Casseri Studied medicine at the University of Padua, in Padua, Italy. He started as the servant to another student, do to his lack of family wealth, then moved on to serve Fabricius ab aquapendente, chair of surgery and anatomy. Following Fabricius’s death, Giulio Casseri took over his place. Then Adriaan van de Spiegel took his seat as the chair of surgery and anatomy following the death of Casseri’s death. Before his death, Giulio began to create an atlas of anatomy, which he intended to illustrate the entire body. However, his plans were ceased by a dying Fabricius in 1616 due to a rivalry between them. Giulio never finished his works but left behind a large number of engravings which were intended for his atlas titled Magnus Opus. Spiegel had spent his life creating an un-illustrated textbook, which upon his deathbed, was commissioned to be finished. German physician Daniel Bucretius took on this responsibility, purchasing a grouping of Giulio’s 78 engravings from his heirs. He commissioned another twenty engravings by the same artists’ student, Odoardo Fialetti (1573-1638), and engraver, Francesco Valesio. This image shows the artist, Odoardo’s understanding of perspective. The foreshortening in the left leg of the figure is an exciting image, as it displays the abilities of the Renaissance artist. The Naturalistic style has become the dominant style of illustration during this time, bringing clarity to the discoveries made by the physicians. This is not just a credit to the artist abilities to illustrate complex figures, it is a testament to the physician/ illustrator relationship.
Renaissance Physicians, & IllustratorsThe Renaissance physician had a difficult job. Upon my research, I stumbled by an article by William E. Loechel, the director of the medical illustration section of Art designers, Inc. (Washington, D.C.) on the History of Medical Illustration. Loechel puts the physicians and artists of the Renaissance in a painfully accurate perspective. As Loechel puts it
“The physician or anatomist of this period had a titanic job on his hands to find an accomplished artist who would undertake to work on cadavers. One must remember that here were no preservatives used, and it was therefore remarkable salesmanship on the part of the dissector to persuade an artist to devote time to anatomical material. Few understood it; few cared to understand it; but many had to eat so they became free-lance medical illustrators.”(Loechel 169).
The Relationship Between Illustrator and PhysicianThe relationship between illustrator and physician was one that required physical and mental synchronization. A detail I couldn’t quite understand without reading an article on the Illustrious Anatomist. An article written by Carin Berkowitz enlightened me in understanding the relationship between the physician and the role of the artist. She included an excerpt from The explanation of Albinus’s Anatomical figures of the human skeleton and Muscles, written by Bernhard Siegfried Albinus. Albinus, admitting his attention to the artist’s craftsmanship, and a lacking attention to his accuracy to the figure explains
“For this end I employed an artist very skillful, both in drawing and engraving…For a great many years by-past, he has worked for very few besides myself; and for these last ten (most part of which he has been wholly employed in these tables) almost for me only. and he both drew and engraved them all by my direction. in the first place, I endeavored to make him understand, as well as possible, what it was to be drawn; and I was constantly with him, to direct him how everything was to be done, assisting him in the drawing, and correcting what was drawn. and thus He was instructed, directed, and as entirely ruled by me as if he was a tool in my hands, and I made the figures myself.”(Albinus).The artists were under constant control by the guiding hand of the physician. These artists were renowned for their abilities and their accomplishments in creating the exact thing in which the anatomist wanted. The artists who sought after the position of medical illustrator used a different term than what it is today. They called themselves natural philosophers. The natural philosopher of the eighteenth-century was controlled by patronage and attempting to distinguish themselves as true natural philosophers. However, due to the constant influence of the Anatomist, there was no credit issued to the artist of the anatomical atlases.
Govard Bidloo (1649-1713)Govard Bidloo was a poet, and a playwright until he answered his true calling in life as a professor of anatomy at the Hague in 1685. Govard accepted another position He as a Dutch golden age physician, and was the physician to Henry the third, King of England, who was born Dutch. Govard remained his physician until he died in his arms in 1702. Govard worked with artist Gerard de Lairesse (a Dutch golden age painter and art theorist, on his anatomical atlas titled Ontleding des menschelyken lichaams, translated means Dissection of the human body. Originally, this work was title Anatomia humani corporis,
“published in Amsterdam in 1685, containing 107 copperplate engravings. Like so many large and expensive anatomical atlases of the time, the work was not a financial success, and in 1690 he published a Dutch translation entitled, Ontleding des menschelyken lichaams, using the same plates.”(NLM).Neither of the editions sold well, so Bidlo’s publisher sold 300 of the extra printed plates to an English anatomist William Cowper.
“Cowper published the plates with his own, English language text in Oxford in 1698 under the title, Anatomy of the humane bodies, without mentioning Bidloo or the artists of the original plates.” -(NLM).If you look down at the image below, you will notice that the image is the same, but the words in the circular section are both in a different font, and style. Bidloo’s version matches the style of etching used in throughout the rest of the image, whereas Cowper’s looks as if he wiped it away and stamped his information there.
“A number of vitriolic exchanges took place between Bidloo and Cowper, including several pamphlets published in each anatomist’s defense. Cowper claimed, without much evidence presented, that the plates were not Bidloo’s at all, but that they were commissioned by Jan Swammerdam (1637–1680) and that after his death Swammerdam’s widow had sold them to Bidloo.”(NLM).This atlas was the first large-scale atlas since Vesalius’s De Humani Corporis Fabrica in 1543.
“The images of the brain and the nerves were particularly useful to the seventeenth–century researcher and physician as they showed structures in much greater detail than would have been possible in a smaller book. However, the text came under considerable criticism, as it did not contain much explanation of the figures. ” (Swift).It was popular to use full-bodied figures in medical illustrations, but the level of detail would always decline. Though his atlas lacked a physiological description, the book worked well as a guide for surgeons to locate the specific muscle groups. Indiana University published a site devoted to medicine and anatomy in William Harvey’s time, whom I will be mentioning at a later point in this paper. Wherein this sight an anatomist named Anton Nuck comments on Bidloo.
“Anton Nuck described the work as follows: “that Mons. Bidloo, a skilful chirurgeon (Surgeon) of Amsterdam, had newly shewed him above 100 anatomical figures of the parts of a man as big as the life, ingraven on copper, with a description of the parts, but not of their use.” (Swift).Bidloo was actually a huge success with his atlas, thanks to the skill of Gerard de Lairesse, and his two engravers Abraham Blooteling (1640–1690) and Peter van Gunst (ca.1659–1724).
Jan Van Rymsdyk (1730-1790)Rymsdyk was not a physician, he was the creator of William Hunters Anatomia uteri humani gravidi tabulis illustrata (The anatomy of the human gravid uterus exhibited in figures). He also was the leading artist in William Smellies atlas A sett of anatomical tables, with explanations, and an abridgment, of the practice of midwifery. He also did some illustrations for Charles Nicholas Jenty. The majority of Rymsdyk’s work was for physicians, a fate he seemed to have regretted.
“Jan van Rymsdyk’s first assignment as a medical illustrator seems to be for William Smellie’s Sett [sic] of Anatomical Tables, published in 1754. This was a visual companion to Treatise of the Theory and Practice of Midwifery and contained 26 (out of 39) plates drawn by Van Rymsdyk. The plates are much more detailed an life-like than other more schematic illustrations of the era, and it was probably because of this assignment that William Hunter commissioned Van Rymsdyk to illustrate his great book on obstetrics.”(Horgmo).There was definitely something different in his hand. He illustrated for about 40 years and changed the course of medical illustration history. But he was never quite compensated for his time and talent, according to William Andrews from the association of medical illustrators.
“For all the notoriety of this magnificent atlas, Rymsdyk was so miserably poor that he was glad to wear the cast off clothes of Mr. Wm. Baratt, surgeon. Rymsdyk also illustrated books by William Smellie, Charles Jenty and Thomas Denman. Thus, in a career spanning 40 years, this one artist illustrated the seminal works that became the foundation for modern obstetrics. Denman said of him, “There is so much truth and elegance in the drawings executed by Mr. Rymsdyk they may be considered as patterns for all future artists.”(Andrews).“Though the anatomical depiction of the 16th and 17th centuries tended to present whole bodies, often moving as though they were living, the figured in the 18th century (particularly female anatomies) anatomical atlases are often shown piecemeal, as parts rather than whole.”(Dittrick Museum). Over the past two decades, before Rymsdyk entered the scene, most illustrations were still typically full-bodied and lacked detail due to the size of it all. Rymsdyk’s work was really ahead of his time, paying such close detail towards his subject matter, and the accuracy. What we do know, is this; he illustrated the image with pastels, white chalk, and red Conte crayon, and then passed his masterpiece to the engraver who seemed to get all the credit. Though little is known about this man, we know he was dedicated to showing his impeccable craft through the hours he spent with a cadaver, still without the use of preservatives.
Henry Vandyke Carter (1831-1897)Artist of the grand Gray’s Anatomy, probably the most famous of all the anatomical atlases out there, Carter found himself credit less at the end of this endeavor.
The success of the book is credited to Carter’s Illustrations, but also the fact that they came from woodcuts, a fairly renaissance method of illustration. It was cheap, and simple compared with the newer technological advancements in photography. Henry Gray and Henry Vandyke Carter spent countless hours during those 18 months, working on the corpses of the poor who lived in the workhouses. A law was passed to stop “body snatching” a term that means stealing bodies from freshly dug graves. Unfortunately, there weren’t enough hanged convicts in England to supply all the young medical students, so the government passed a law allowed for bodies found in a workhouse, or hospital, of a person who has not enough to pay for their own funeral, will be used as cadavers for the medical students. This is where they found their subjects.
“Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857. The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.”(MTD).
“Throughout the creation of Gray’s, the two friends worked both separately (Gray on the text, Carter on the surgical anatomy illustrations) and as a joint enterprise; for a duration of at least 18 months they carried out the dissections on corpses from St. George’s Hospital and London’s workhouses, on which the text and illustrations were based. By necessity, the duo would have worked closely together on a daily basis in the dissection room at Kinnerton Street, in confined space for prolonged periods.”(Royal College of Surgeons of Edinburgh).Still, despite the success it received, Carter was left as the nameless contributor until 1901. This made him quite bitter towards Gray.
“For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr. Carter never worked again with Gray, who died of smallpox only a few years later.”(MTD)There are currently 41 editions of Gray’s anatomy being sold all around the world. Gray’s anatomy was a success in their day and in ours.
Joseph Vimont ( 1795-1857)Very little is actually know about Joseph Vimont, except his studies at the Faculté de medicine de Paris, from which he graduated in 1818 with a dissertation on ophthalmia, extreme inflammation of the eye, especially conjunctivitis. However, it isn’t known how in particular Vimont got involved in Phrenology. Phrenology became a significant field of study where Vimont studied in the 1830’s. Phrenology is a pseudoscience in which the belief is that certain mental faculties and character traits are indicated by the configuration of the skull. or in simpler terms, the structure of one’s skull determines one’s intelligence and character. Below is a list of the idiosyncratic Viennese physician Franz Joseph Gall’s (1758-1828), basic tenets:
The Brain is the organ of the mind.
the mind is composed of multiple distinct, innate faculties.
Because they are distinct, each faculty must have a separate seat or “organ” in the brain.
The size of an organ, other things being equal, is a measure of its power.
The shape of the brain is determined by the development of the various organs.
As the skull takes its shape from the brain, the surface of the skull can be read as an accurate index of psychological aptitudes and tendencies.
Many works were published about phrenology, but Vimonts book was simply one of the best of his time. The title of Vimont’s atlas Traité de phrénologie humaine et comparée translates to Treatise on Human and Comparative Phrenology. It was illustrated by a countless number of artists, of which had great skill, but were never quite given the recognition they deserved. The only information that is available about the art produced is the lithographer who etched them for the publication process; Godefroy Engelmann.
“Other movements can be said to have found their beginnings in phrenology, however, such as Broca’s studies of brain localization, the study of the human animal (anthropology), and the study of the “races,” which eventually led to many eugenics and ethnic purity movements. Indeed, Vimont’s own work compares the crania of people of various ethnicities, as well as people with various talents and personality disorders.”(NLM).
Godefroy Engelmann (1738-1839)a franco-german lithographer created the 133 plates used in Vimont’s atlas. Engelmann died in 1839 from a tumor in his neck, in the same town in which he, was born in, the border of France, Germany, and Switzerland. In 1835 Engelmann went to Munich Germany to study Lithography, a German invention. Later, the following spring he founded La Société Lithotypique de Mulhouse, Lithotypic society of Mulhouse. He opened his own workshop in Paris in June 1816 and is largely credited with bringing Lithography to France. He even published his own treatises on Lithography called Traité de Lithographie.
Max Brödel (1870-1941)Max Brödel started out at the Anatomical Institute in Leipzig Germany, illustrating various bodily functions and organs. A famous physician, Carl Ludwig would approach him and urge him to the Institute of Physiology at the University of Leipzig.
“With Leipzig an epicenter of medicine, Brödel met many visiting scholars, such as anatomist Franklin Mall, who urged Brödel to bring his talents to the new Johns Hopkins School of Medicine.”(The JHU Gazette).Max Brödel revolutionized the art as applied to science, creating the first medical illustration department. A book published about Max Brödel offers some insight on the father of Medical illustration, providing a charming description of the man who started a career that would change the world. The book titles Max Brödel(1870-1941) and underneath that, Director of the First Department of Art as Applied to Medicine in the World. As previously mentioned in a quote regarding Phrenology”…in and the study of the “races,” which eventually led to many eugenics and ethnic purity movements.”(NLM) Some views in science helped foster a movement with grim intentions. Germany during the 1870’s was fighting a major war between the Second French Empire and Prussian-led German Forces. This war caused much unification for Germany as a country, solidifying it while building tension and hostility which was a leading cause of World War One. This seems irrelevant for this discussion on Brödel, however, the information supplies an understanding of what is to come in the future of medical illustration.
“Brödel was drafted into the army, November 8, 1890, to serve two years. Through the good offices of Geheimrat Carl Ludwig, Prince George of Saxony ordered that Brödel serve only one year with arms and that he devote the second year to artistic activity for the regiment. In 1892 Brödel returned to Leipzig to free lance in fine art and anatomical and physiological illustrations. Negotiations to come to America began in 1891 but because of misunderstandings, resulting from lost correspondence, Brödel did not arrive in Baltimore until January 18, 1894.” (CULLEN).Upon arrival, Brödel spent the next 17 years devoting his life to medical illustration as a prospective career. Paving the way for the young medical illustrator at Johns Hopkins University in Maryland, to help change the course of medicine and the method of teaching. He worked for three doctors Harvey Cushing, William Halsted, Howard Kelly. Brödel was an investigative illustrator. While working for doctor Howard Kelly, Brödel found himself putting tubes into a kidney to clear out the remaining fluids injecting the arteries of the kidney with red, veins with blue, and ureter with yellow. It is seen where the blood passes off in the glomerulus. Brödel also created a suture that was known as Brödels Suture and commonly used for a prolapsed kidney. Brödel also invented a very important illustrating technique that has aided artist across the different artistic disciplines. The method was called the carbon dusting technique. It allows for all the vivid details of living tissue. It allowed for highlights, shadows, and textures. The printing presses were not quite capable of printing in color just yet, so Brödels technique helped elevate the detail of his illustrations. Most illustrators before Brödel had little understanding of biology, as we heard from Albinus previously during the discussion of the relationship between the artist and the anatomist. Brödel fully understood that there is a lack of the comprehension of a piece if the artist doesn’t understand what his subject is about.
“The artist must first fully comprehend the subject-matter from every standpoint: anatomical, topographical, histological, pathological, medical, and surgical. From this accumulated knowledge grows a mental picture, from which again crystallizes the plan of the future drawing. A clear and vivid mental picture always must precede the actual picture on paper.”(Brödel).Brödel was an outstanding medical illustrator, however, He was a great teacher, and leader. His most significan legacy was creating the first school of medical illustration.
“In 1911 he became the director of the Department of Art as Applied to Medicine. As the new department’s sole instructor he proved himself to be an outstanding natural teacher. Other medical illustration programs sprang up across the United States and Canada. Graduates of Brödel’s tutelage and the other schools would transform medical illustration into a profession, leading to the formation of the Association of Medical Illustrators in 1945.”-(AMI)
The Association of Medical Illustrators (AMI)
“On July 10, 1944, Muriel McLatchie visited Chicago and met with a group of medical illustrators at the University of Illinois Medical School. They were known as the Nucleus Committee of Five. This Committee was composed of medical artists representing five geographical sections: East (Muriel McLatchie), West (Ralph Sweet), North (Tom Jones), South (Jack Wilson or Elon Clark), and Canada (Marie Wishart). The Nucleus prepared a Constitution and By-laws, applied for a Charter, designed an application form for new members, and enlisted 4 more medical artists from each geographical section for a total of 20 members by the summer of 1945.”-(AMI)Max Brödels’ students went on to form what stands today as the Association of Medical Illustrators, the hub for medical illustrators in the United States. They started their meetings in There are currently four schools on the North American Continent, previously there were five, however, one of the schools has left the pool. Each of the schools only has these programs because of Brödels teachings, for it was his five students who started the programs. The previous quote from the association of medical illustrators allows us to view the five major illustrators and professors as the founders of AMI.
Eduard Pernkopf (1888-1955)Eduard Pernkopf was an anatomist at a time which is now a sensitive scar on world history.
“Eduard Pernkopf created a classic anatomy atlas during World War II. He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror.”-(Riggs)Pernkopf started out in life showing an interest in music, however, after the loss of his father, the village doctor, he found he was direly needed as a physician. He attended school at the University of Vienna’s medical school in 1907. He became a member of the Student Academic Fraternity of Germany. The group was strongly influenced by the German Nationalist persuasion. He received his degree in medicine in 1912, then for the next eight years he taught anatomy at various institution throughout Austria. During World War I, Pernkopf served as a military physician for one year. He returned home to Vienna and worked as one of Hochstetter’s assistants. Lecturing to first and second-year students on the peripheral nervous and cardiovascular systems and such. It wasn’t until he arrived back home in Vienna that he quickly rose through the ranks in academia. He became the Associate Professor in 1926, another two years he was a full professor. In 1933 He joined the Nazi Parties foreign organization. The annexation of Austria into the Third Reich known as the Anschluss was about the time Pernkopf became an SA, Storm Trooper. Previously, Pernkopf had formally succeeded Hochstetter as the Anatomical Institute Director in 1933, then became the dean of the medical school in 1938. He then held a position of power above the entire department. Requiring all Medical faculty to declare their ethnic lineage as either Aryan or non-Aryan, an action which provided the Nazi Regime with a list of those who refused to provide their ethnic background. This information dismissed 77% of the faculty. Automatically, all Jewish faculty was removed, as well as the list of those who refused to provide heritage. It is difficult to approach such a sore subject in a matter such as this, however, I feel that it is necessary to talk about this part of medical illustration history.
“Some of these were deported to concentration camps like Theresienstadt and Dachau, in which only a few survived. Others committed suicide and the fate of others are unknown. In his official speech to his selectively chosen faculty, Pernkopf reminded them of their professional duty “of eliminating the genetically unfit and defective . . . by sterilization and other means” (Ruiz. Pernkopf Anatomy Atlas, 2007).”-(AHRP)Pernkopf published an atlas of his own in 1933, illustrated by his Nazi artists. It was called Atlas of Topographical and Applied Human Anatomy. The artists who featured their illustrations were Erich Lepier, Ludwig Schrott, Karl Endtresser and Franz Batke.
“The source of Pernkopf’s Atlas illustrations was the macabre spoils of Nazi murder; the slaughtered bodies of men, women, and children.”(AHRP)Years after the atrocities had ended, efforts were eventually made to approach the atrocities that had taken place. A statement was mailed to the University of Vienna:
“it is therefore within the individual user’s ethical responsibility to decide whether and in which way he wishes to use this book.” (Hildebrandt, 2006).Today, the officials of the Univerisity of Vienna are attempting to retrace the past and seeking buried information, in hopes that they might aid the next generation to approach these atrocities. Third generation students and scholars are morally outraged and seeking full access to the documents and locations of the victims’ remains. They hope to properly bury the victims and memorialize them.
Frank H Netter M.D. (1906-1991)My favorite of all the Medical illustrators, Dr. Netter has illustrated over 4,000 illustrations to meet the demand of Doctors. He came across medical illustration due to his mothers wishes that he become a doctor. Little did she know, there was money to be made as an artist during the great depression. He started illustrating his studies and sometimes made some money illustrating commissioned pieces for his professors. He opened his own private practice in NYC, but continued his painting. One of the best misunderstandings that could have happened was a mishap on communication between an advertising manager and him. He was asking $1,500 for a series of five pictures, however, the advertising manager thought he meant $1,500 for each piece, so he bought the lot for $7,500. After that, Netter gave up the practice and continued as a medical illustrator. He started a relationship with CIBA a pharmaceutical company in 1936, illustrating a fold out human heart to promote the medicine Digitalis. He was also known for his part in advertising Novocain. But Netter created something far more important, his little green books. His Atlas of Human Anatomy was published in 1989 and is considered a staple in medical education.
“Netter did practice medicine briefly but, as Francine writes, “the demand for Frank’s sable brush grew faster than the demand for his scalpel.” His portraits, drawings of body parts and, at the behest of pharmaceutical companies, images of new drugs and how they worked were simply too vivid and unique to ignore. In 1934, Netter saw his last patient.”-(The Atlantic)Netter worked for the Ciba-Geigy pharmaceutical company producing captivating illustrations that would help to demonstrate how a specific drug worked.
“A remarkably long marriage was born. Over the next five decades, Netter worked with the company, later known as Ciba-Geigy, to produce the Ciba Collection of Medical Illustrations and the Clinical Symposia, beautifully illustrated books that depicted both normal anatomy as well as the pathology associated with specific diseases.”- (The Atlantic)Netter would spend most of his time researching his subject and planning how he was going to execute his illustration, but once he figured out how he wanted it, it didn’t seem to take as much time. He would start sketching in pencil, then he would copy it, and develop the image with watercolor and gouache, a thinker form of watercolor essentially. He would use opaque paints, colored pencils and pastel for the finished product, giving it the accuracy associated with Frank H Netter. One very important detail that is worth mentioning, is the text that followed the image. Netter did not write it directly onto the painting. He used a thin, plastic sheet as thin as paper called Mylar, and overlay it onto the image. This protects the original image as well as offers the artist a chance to change the position of the text and indication lines. Frank Netter provided the world with many illustrations to learn from and is the Michaelangelo of Medicine.
In conclusion:In truth, it took until Max Brodel established his reputation 1894 to gain recognition for the study to become a true Discipline. But this Multi-disciplinary field had quietly and humbly existed without the implication of a title. Throughout medical Illustrative History, our understanding of the human body has grown and changed. The ability of the artists has transformed stiff squatting figures, into living beings with a window to their inner workings. Learning what works and what doesn’t with the scale of the figures, using part to part rather than a full figured model with little information to be seen. The technologies associated with printmaking and mark-making have developed into more intricate techniques that allow us to make illustrations that seem lifelike, rather than the primitive and crude misrepresentations. Such technologies like the Woodcut process, Lithographs, and modern printing, have formed an illustrative story about our evolution and our place in the world. The art styles Schematic, Semi-Schematic, and Naturalistic have evolved and can be utilized properly where they are needed. The wealth of information has accumulated enough for me to even create this document, though, from the earliest history, we are lacking in understanding the origin of some illustrations. Proportions have become more realistic as opposed to the awkward lumps and bumps in place of musculature. Indication lines applied rather than the distracting placement of text on top of the drawing itself. and the invention of Cross-sectioning, thanks to Da Vinci, has advanced our ability to communicate with the student, patient, and public. Medical Illustration was and still is an uncharted territory, with room for improvement and experimentation, granted not room for Pernkopfs experiments. The Disciplines found throughout this intricate history have presented themselves as important to the growth of this field. The contributions made by many of these illustrators and anatomists have been unparalleled in our ability to learn and thrive as a species. The constant questioning and pushing of boundaries have taught us that nothing is quite concrete, the truth is still out there. Who knows, maybe there is some truth behind Phrenology, and perhaps the four humors is a valid point to consider. There is so much more for the next generation of medical illustrators to document. New pharmaceuticals that have questionable side effects, dealing with today’s Opioid addictions, cancer research, and Alzheimers. We may look back at the groundwork that is laid for us, and learn from our curious ancestors. There is a wealth of information hidden in the decades that have come and gone. It is the future decades that will have to take the ancient and crumbling scripts endowed to us by our predecessors and find meaning when the present offers none. Always pushing to understand the greatest questions, Why? How? If this were to happen, then what? Communication is key in the field of medical illustration, so is our initial understanding of the subject. Extensive experience in artistic endeavors along with an understanding of aesthetics is crucial to achieving success in this field. Publication knowledge, Health promotion, Archeology, Anthropology, Chemistry, Linguistics, and Psychology add up to smooth and shape the field of Medical Illustration. But the greatest Discipline is a generous helping of curiosity.
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