We have explored thus far where medical illustrations have been and where they are today, but what remains is the future of the field. The digital format has become, and will remain, a permanent fixture among medical artists. Where the artists themselves see the field gravitating towards is animation.
Medical animation, a topic possibly warranting its own chapter, traces back to the First World War. Two pioneers of the field, JOHN BRAY, of Bray Studios in New York, and PAUL TERRY, an army lieutenant connected with the Army Medical Museum, explored animation as a means of medical education. Bray studios produced smooth animations on human reproduction for the Public Health Service, while TERRY developed reels to educate troops, one such example was An Operation for Femoral Hernia. Further advances in audio synchronization expanded this field to surgical operations, pioneered by Chicago Lying-In Hospital physician DR. JOSEPH DeLEE. DeLEE chose cesarean section as his first film study, incorporating cinematography and animation: this being the first truly scientific film, as well as first film to incorporate animation.
Over the past years, medical artists have been receiving more requests for animated illustrations (AUSTIN). This demand attributed to the client’s, and therefore audiences’, desire to see a dynamic, rather than static, object (AUSTIN). Animating images places further requirements on the artist to either learn how to animate or collaborate with animators (AUSTIN). These larger projects will necessitate more collaboration versus the single artist model experienced by medical artists today (BUCK). As predicted by artists, highly trained illustrators will assume a directive role becoming coordinating liaisons between a team of illustrators, animators, and scientific experts (BUCK). As previously explored, new generation, CT scanners provide information in three-dimensions plus motion. Physicians already employ three-dimensional virtual models in diagnostics, preoperative planning, education and training. This field of virtual medicine plans to enter into telemedicine for remote diagnosis. The role for illustrators will be to present this data clearly and creatively to enhance understanding for medical professionals, students, and the public, similar to how their predecessors translated two-dimensional radiographs.
Three-dimensions will also remain ahead in the repertoire of illustrations. Artists today have already experienced pressures to adopt computer-aided design programs to generate such illustrations (AUSTIN). The end-user demands the ability to manipulate an object to experience multiple perspectives (AUSTIN). The advent of sophisticated mobile computing via smartphones and tablet computers will continue to accelerate this demand as medical professionals already possess the capability to recall electronically entire textbooks on-demand. In addition, mobile applications have begun to cater the desire of viewing anatomical sections; a new educational model is beginning to gel.
Further progress into three-dimensions may raise concerns about the older, two-dimension historical illustrations detailed earlier. The bulk of these incunables and texts remain stored in historical medical libraries. The College of Physicians of Philadelphia houses one such library, with over 340 thousand volumes (BROGAN). The challenge these libraries accept is how to continue access to older volumes without deterioration (BROGAN). The solution, not surprisingly, is digitalization of the collection (BROGAN). The process has already begun. Through a grant-funded consortium of medical libraries, the Medical Heritage Library has collected digitalized editions of historical medical texts and journals prior to 1923 CE to distribute freely with the public via the internet (BROGAN). Among many libraries in collaboration with this service are the Cushing/Whitney Medical Library at Yale University, the National Library of Medicine, and Augustus C. Long Health Sciences Library at Columbia University. This endeavor is the library’s primary goal, as pressures mount to provide and maintain an adequate environment for the physical editions (BROGAN). Texts and journals chosen for digitalization from the library’s collection meet two requirements: printing prior to 1923 CE and degree of accessibility through other outlets (BROGEN). The main objective is to increase the level of access to this precious knowledge without compromising the condition of the volumes (BROGAN).
The fate of medical illustration both past and present exists in the digital oasis. Artists can expect the digital information from diagnostic imaging to guide their portfolios, while historical illustrations translate from physical documents into a digital code of zeroes and ones. Challenges still face the artist in protecting their work, and the libraries to preserve their volumes. Ventures such as the Medical Heritage Library hope to disseminate electronically further the work of artists shadowed by great men, like VESALIUS, hoping to quell a feeling of insulation felt by some medical artists even today.
There have been many great physicians throughout the history of medicine. Behind many of these physicians has been an artist to breathe creative life into their ideas. The transmission of medical information is one that is largely visual, whether visualizing an anatomical structure or the schematic of a biochemical pathway. An image helps to affirm a statement of fact, serving as a static reminder one can easily recall at appropriate moments. The artists responsible for illustrating modern medicine command praise seldom granted. Open a textbook and inside will be at least one image a medical artist conceived from a skeletal thought.
The field of medical illustrations summarizes into a series of revitalizations. After the advent of the printing press during the Italian Renaissance, medical images would enter the hands of more and more students and physicians. VESALIUS would ultimately enter more dissection theaters than any contemporary would in his day, propelling his ideas forward. BRÖDEL redirected the focus of how artists trained in medical illustration, strengthening and preparing the field with more professional education, which soon encountered information never before conceived. The Digital Age redefined the skills medical artists attain, how information used to research new projects is obtained, and introduced a new dimension to illustrate, or better yet animate.
Despite the extent to which digital medical illustration becomes, preserving and remembering historical illustration is equally important. Philanthropists have begun to tackle this issue by funding large-scale digital ventures. However, the value historical medical images provide to understanding the evolution of medicine must not be forgotten. Each image of the past is a record of thought. They signify the highest degree of knowledge at any point in time, and in some cases, the educational model transmitting that knowledge. For many anatomists and artists, the techniques and images of their predecessors influenced their own work, and at some level should affect ours. Our progress in medicine does not come from blindness of our past. Famous physicians, such as DR. HARVEY CUSHING, devoted much of their career in acquiring and transmitting these historical texts. The simplest of diagrams, dating to even before the Middle Ages, alludes to much more than what presents on the surface, and from which we connect with our past in medicine, beyond ordinary words.
There have been many more anatomists and artists who are not described in this work. From here, there is hope a spark ignites to pursue a personal investigation of those individuals. The names of some men in this chapter should ring familiar with anatomical structures, which bear their name. These structures honor the men whose valor and genius have contributed greatly to the field of medicine. Understanding the man behind the label creates a special bond to the past each time that structure is relevant in a case. Therefore, the next time you open a medical text and see a medical image, remember someone, at some point in time, created that image, and appreciate the historical breadth. Medical illustrations are our past, present, and future; worth more than a thousand words.
Warm, special thanks extend to medical artists Mike Austin, Todd Buck, and Dr. Frank Scali for their valuable insights into their humble and rewarding craft, and to Annie Brogan, Librarian at the Historical Medical Library at the College of Physicians of Philadelphia, for her esteemed opinion. Their excitement for this project contributed to its success.
Austin, Mike. Telephone interview. 20 Sept. 2012.
Brogan, Annie. Personal interview. 25 Sept. 2012.
Buck, Todd, MAMS, FAMI. E-mail interview. 10 Oct. 2012
Clarke, Carl D., Ph.D. Illustration: Its Technique and Application to the Sciences. Butler, MD: Standard Arts, 1949.
Székely, Gábor, and Richard M. Satava. “Virtual Reality in Medicine.” British Medical Journal 319.1305 (1999): 1-4