Applying Art to Medicine

Part 4 of 6 in a series of articles chronicling medical illustration from antiquity.

Medicine entered the twentieth century having ascended from an incredible age in medicine. The study of human pathology led to the development of many new, still employed technologies, including the stethoscope, anesthetics and X-rays. LEONARDO’S sketches were in possession of the Royal Collection at Windsor Castle, and large print editions were available. Illustrators of this age documented pathology and anatomy, while focusing on clear, scientific depictions of the body for clinical and surgical application. Flayed corpses had been retired in favor of precise, systematic illustration highlighting each organ and structure individually, a theme reminiscent of LEONARDO.

The United States entered the century about to revolutionize medicine, and the philosophy of medical illustrations would undergo substantial change.

Max Brödel

Max Brödel

MAX BRÖDEL (1870-1941 CE) is without doubt the most influential man to medical illustration of the last century. Between 1886-1893 CE, BRÖDEL received his education at the Academy of Fine Arts of Leipzig, with supplemental lectures at the University of Leipzig, specializing in lithography. The first anatomical illustrations BRÖDEL created were for German physiologist CARL LUDWIG (1816-1895 CE). Among the other physicians BRÖDEL worked for in Leipzig was CHRISTIAN BRAUNE (1831-1892 CE). BRAUNE refined techniques to display cross-sectional anatomy, notably by freezing a corpse, sectioning the body, and illustrating the structures. These sections would prove vital to understanding the precise location and relation of internal structures to physicians, who would not see such representation until the development of computed tomography and magnetic resonance imaging. This body of work, Topographisch-anatomischer Atlas, was developed between 1867-1872 CE with artist C. SCHMIEDEL, before BRÖDEL began his studies. BRAUNE worked on several other volumes after this publication, and commonly employed lithography to print his images, implying BRÖDEL contributed to some extent.

BRÖDEL accepted work as a medical artist for DR. HOWARD KELLY (1858-1943 CE) at Johns Hopkins University in 1894 CE. A year prior to this accord, four men, DRS. KELLY, WILLIAM WELCH, SIR WILLIAM OSLER, and WILLIAM HALSTED founded the school of medicine at Johns Hopkins University. Over the course of that decade, KELLY would enlist two other illustrators from Leipzig with the help of BRÖDEL: HERMAN BECKER (d.1927 CE) sometime between 1895 and 1896 CE and AUGUST HORN (d.1910 CE) in 1898 CE. BRÖDEL and BECKER illustrated for KELLY in the department of gynecology; BECKER specialized in microscopic illustration; while HORN illustrated for HALSTED and later KELLY.

Sagittal section of hypophysectomy procedure showing the Killian incision

Sagittal section of hypophysectomy procedure showing the Killian incision

Medical education in the United States at the end of the nineteenth century adopted the importance of medical illustrations in the classroom. By 1890 CE, almost all subjects in medicine incorporated illustrations into their lectures, but physicians noted the infancy of the field. Due to the inability to cost effectively and easily produce the images needed for lectures, professors turned to either gross pathological or microscopic specimens displayed through a projection microscope. In 1907 CE, BRÖDEL acknowledges this inefficiency and, in his eyes, inability of artists.

In a public address to the Section on Surgery and Anatomy of the American Medical Association at Atlantic City, New Jersey in June 1907 CE, BRÖDEL addresses the poor state of medical illustration and begins hypothesizing the solution. According to BRÖDEL, the problem rests in the artist’s inability to understand the specimen and frequent, superficial modification of older images to fulfill the physician’s request. The physician is to blame for not possessing an aesthetic taste to reject poor, plagiarized medical illustrations. The solution to BRÖDEL is clear: “teach the artist more medicine” and “teach the scientist more art.” While BRÖDEL realizes the importance of art to the physician in recalling a case, and taught for many years to both artists and physicians, he appreciates a physician cannot be dual trained. Subsequently, BRÖDEL devotes his emphasis to the artist.

After his public decree, the Art Department at Johns Hopkins Medical School, the first such department in the world, would soon open its doors. BRÖDEL attests the success of the department to three men: DR. THOMAS CULLEN, the man whose dream was to secure and transmit BRÖDEL’S skills to new generations at Johns Hopkins; DR. KELLY, who served as his mentor; and HENRY WALTERS, the philanthropist who endowed the department. The department opened its doors in March of 1911 CE, and very quickly physicians, medical students, and artists filled the halls eager to learn the trade of a medical artist.

Temporal bone illustration drawn with the aid of the camera lucida

Temporal bone illustration drawn with the aid of the camera lucida

A retrospective article self-authored by BRÖDEL in the last year of his life summarizes his personal experiences and observations through his career. Similar to LEONARDO and VESALIUS, BRÖDEL opposed the established authority of the field predating his tenure. His contribution to employ a strict educational model for medical illustration would redirect the careers of stock artists and transcend them into medical artists. As part of his educational model, BRÖDEL provides very clear qualifications for applicants; fields in need of illustrators; and the determination of artists compensation.

BRÖDEL sought to connect the fields of art and medicine through better education. His success would usher in a new era of medical illustration, and is just one of the innumerable accomplishments of modern medicine in the twentieth century. Before moving to contemporary illustration, we reflect on BRÖDEL’S two most important attributes for a successful medical artist: “keen interest in science, in nature, and in all living things” and the “ability to study intelligently, to observe accurately, and to doubt statements of authority.”

Next: Digital art, a new Renaissance

References

Brödel, Max. “How May Our Present Methods of Medical Illustration be Improved?.” The Journal of the American Medical Association 49.2 (1907): 138-140.

Brödel, Max. “Medical illustration.” Journal of the American Medical Association 117.9 (1941): 668-672.

Clarke, Carl D., Ph.D. Illustration: Its Technique and Application to the Sciences. Butler, MD: Standard Arts, 1949.

McIntosh, L. D. “The Value of Illustration in the Lecture Room.” The Journal of the American Medical Association 14.25 (1890): 897-900.

Rifkin, Benjamin A., Michael J. Ackerman, and Judith Folkenberg. Human Anatomy: From the Renaissance to the Digital Age. New York: Abrams, 2006.

Thornton, John Leonard., and Carole Reeves. Medical Book Illustration: A Short History. Cambridge: Oleander, 1983.

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