THE DRAWN BODY
by jared travnicek December 15, 2011
fortnightjournal.com
What is it that flows, breathes, pulsates, lives, grows, and dies within us? What makes us who we are? We as a species have a hard-wired curiosity; a desire to take things apart and see how they work.
My profession is a natural extension of our curiosity,
visual disposition, and desire to tell stories.
I see in medical illustration the desire to take apart, catalog, and describe how we work. My profession is a natural extension of our curiosity, visual disposition, and desire to tell stories. But modern medical illustration also includes one other major element: scientific rigor. I was drawn into medical illustration because I love science and art; for me, one cannot exist without the other. Looking into historical connections between science and art, we can follow a trail of immensely talented anatomists and artists to the Johns Hopkins School of Medicine where, in the gifted hands of Max Brödel, a distinct profession emerged.

To begin a discussion on medical illustration, we must first discuss anatomy. Let’s set the way-back machine to 4th century BC where Hippocrates, a physician and scholar, is teaching what is considered by many to be the fundamentals of modern medicine. His teaching touted the most advanced science of his day,which involved the concept of categorizing diseases (from acute, to chronic).

But there was a large gap in the knowledge of human anatomy at the time due to a fierce taboo against human dissection. According to medical historian Fielding Garrison, the continuity of Greek medicine declined after Hippocrates’ death, and medical innovations were greatly diminished. (Garrison, 1917) It would be over two hundred years before any great advancement in medicine was made. It was only when Galen came to prominence in the 2nd century BC that medical and anatomical innovation began to move forward again.

Galen was a great physician and philosopher who created what would become the principal anatomical text for the next 1500 years. However, through the view of a modern lens, this work in was many ways flawed. Galen wrongly used dissected monkeys, pigs and dogs to describe human anatomy. He believed that human anatomy was more or less directly translatable from these other mammals. The 16th century anatomist, Andreas Vesalius would later prove these assumptions incorrect in his seminal text De humani corporis fabrica (1543).

The first major advancement in medical illustration came after the invention of the printing press. A book called Fasciculus medicinae, printed in 1491,covered topics of medieval medicine from the treatment of wounds to pregnancy. Though this text was the first of its kind, it didn’t depict any internal anatomy. Most of the illustrations were of physicians and anatomists at work. One of the more fascinating illustrations shows a man with anthropomorphized astrological signs placed on different parts of his body. As the belief at the time was that planets and stars governed different regions of the body, this chart allowed physicians to treat symptoms based on time of year and region of the body.


Fig. 1 (click to enlarge)

Though this text did not feature any medical illustrations as we know them today, it created a benchmark for all future medical texts by extoling the benefits of accompanying illustrations.

I would be remiss in discussing medical illustration without mentioning Leonardo da Vinci. He began illustrating dissected anatomy in his journals around 1510.


Fig. 2 (click to enlarge)

Da Vinci created many accurate and beautifully-rendered anatomical sketches, but these illustrations were not printed during his lifetime. The first printed illustrations of anatomical structures would come a few years after Leonardo’s death in 1519.

These first printed medical illustrations contained a strange mix of posed, dissected cadavers staged within natural environments. They used humor and the macabre creating images such as human internal organs exposed through suits of armor, and a cadaver holding its skin after removing it with a knife as social accents.


Fig. 3 (click to enlarge)

During this time period, anatomical illustrations were not merely a literal translation of the human body. “The producers and audience for anatomical representation expected, even demanded, that anatomical illustration represent the human body morally, socially, theologically, theatrically, balletically, literally, erotically as well as scientifically.”1 De humani corporis fabrica by Andreas Vesalius was a book that not only represented this style of illustration, but also set the pace for all subsequent medical texts.
 
Vesalius was a professor at the University of Padua and a talented dissector. As a young man, Vesalius and several artists known only as “the workshop of Titian” produced a book that challenged Galen’s conception of anatomy. Their evidence was extremely convincing, because not only was he describing anatomy from direct observation of human dissection (instead of using animal analouges), but it was also illustrated in amazing detail.


Fig. 4 (click to enlarge)

The figures in Vesalius’ text held true to the illustration style of the era, with the dissected cadavers dramatically posed in ways that made them seem as though they were still living.
 
The use of  humor, theatrical poses and natural environments in medical and anatomical illustrations slowly faded over time. Illustration requests began to shift in the late 17th century with the publication of Anatomia humani corpis by Govard Bidloo (anatomist) and Gerard de Lairesse (artist). Gone was the time of whimsy and wit, and in its place stood a hyper-realistic style that was more scientific, clinical, and detached. 


Fig. 5 (click to enlarge)

“Dissected bodies and body parts are rendered in a harshly realistic detail. The viewer is spared nothing: we see the raggedness of the flesh and the prosthetics of dissection (pins, hoists, ropes, the dissecting table) and mutilated faces. The overall effect is at the same time ugly and beautiful…”2 The preference to increase the scientific value of an illustration by decreasing its elements of social context still exists today. Illustrations that combine anatomy and society didn’t disappear completely from our landscape, however; they have just been repositioned now into the arena of fine art. There had been a shift in the purpose of anatomical illustration. Instead of serving  a societal function, they were now visual representations of scientific values. But these images were also increasingly sensationalist, depicting bodies in a way that excited and shocked the viewer.

Up to this point in history of medical illustration, anatomists commissioned artists to produce their scientific texts. In the late 1700s this began to change. One well-known case is that of French printmaker Jacques Fabien Gautier D’Agoty. He used his mastery of the arts and employed anatomists to create Anatomie des parties de la génération de l’homme et de la femme(1773). This book depicted dissections in full color mezzotints, showing off D’Agoty’s mastery of color print technology. (Sappol, 2006)


Fig. 6 (click to enlarge)

Around the same time, Bernard Siegfried Albinus (anatomist) and Jan Wandelaar (artist) created a less graphic masterwork called Tabulae Sceleti e Musculorum Corporis Humani, which illustrated man using only dissections that closely matched classic Greek proportions. This text still placed many of the figures in theatrical poses surrounded by natural and fanciful environments, but the focus was now strictly on the accuracy of the anatomy. In some instances of later editions and unofficial reproductions of this text, backgrounds were completely removed in order to allow the raw and bare anatomy to stand on its own.


Fig. 7 (click to enlarge)

By the late 1800s, the field of anatomical illustration changed again, reaching a crucial milestone. In 1893, a man named Max Brödel moved from Leipzig, Germany to Baltimore, Maryland and began working with Dr. Howard A. Kelly at the Johns Hopkins Hospital. Nine years earlier, Max Brödel had been studying at the Leipzig School of Fine Arts, working for Dr. Carl Ludwig, director of the Institute of Physiology.

Brödel created anatomical and histological drawings for Dr. Ludwig, and “Although Brödel did not set out to be a medical illustrator, this fortuitous job set the course for his career.” (Patel, Couldwell, & Liu, 2011). In his career as a medical illustrator, Brödel would make significant contributions to the fields of gynecology, neurosurgery, otolaryngology and urology under tutelage of some of the most illustrious names in medicine. He did not think very highly of the medical illustrations at that time, saying they were “’cheap reproductions of poorly-made drawings’ done by untrained, self-taught artists who knew very little about medicine and even less about art.” (Patel et al.)

Fig. 8 (click to enlarge)

Brödel was known to take great care with the accuracy in his illustrations, and he “made no drawing without original study by injection, dissection, frozen section, or reconstruction.” (Patel et al.) Brödel was a master at pen and ink and carbon dust. His illustrations updated and set the standard for medical illustration techniques at the time. These techniques became very popular and were subsequently replicated by artists and illustrators around the world. Brödel wanted to pass these techniques on to a new generation of illustrators, so in 1911, with the help of Dr. Thomas S. Cullen, Brödel formed the Art as Applied to Medicine department at Johns Hopkins University.

It was the first of its kind in the United States. Brödel’s had high expectations of his students, requiring them to have the “ability to study intelligently, to observe accurately and to doubt the statements of authority.” (Patelet al.)

My introduction to Max Brödel was through an illustration that he created for Harvey Cushing, involving the transphenoidal approach for the removal of pituitary tumors.


Fig. 9 (click to enlarge)

It is a large pen and ink piece that sits directly outside a conference room at Johns Hopkins in the department of Art as Applied to Medicine. It shows a surgeon leaning over a patient whose body has been bisected sagittally. He is opening the patient’s mouth above the gums, and shining a light from a headlamp down onto the surgical field.

This is one of the most effective pieces of medical illustration I have ever seen. Not only is the surgeon rendered in copious detail; the instruments, anatomy and even the pillow the patient rests upon are also exquisite. But what makes this illustration truly amazing is that its message comes through crystal-clear: this is a surgeon looking at the area he is going to operate on. This is how he is entering, and where he is going. These tools comprise the technology that made the surgery possible. Brödel shows all of this without compromising his artistry. This piece constantly reinforced my desire to become a medical illustrator, and set a standard of excellence towards which I will continue to strive.

When I was accepted and matriculated into the Art as Applied to Medicine program, I was excited to find that the program focused on fundamentals such as draftsmanship and storytelling. Technology in the form of computer-based illustration and animation software were seen just as tools to deliver these essential skills.

Inspiration in the Art as Applied to Medicine department was never in short supply. Not only did outstanding contemporary illustrators teach us; we also had an easily accessible library of original artwork by Max Brödel and other masters in the field. In this library is a piece by former head of the Art as Applied to Medicine department Ranice Crosby that describes the fetal arterial supply. This illustration does what any great piece of medical illustration does: beautifully and simply communicate a complex set of ideas.


Fig. 10 (click to enlarge)

The soft color palate and equally soft use of tone create a rich image with outstanding depth. The networks of vessels are meticulously drawn and rendered with deftness and agility. All of these attributes create a beautiful piece of effective storytelling.

Why did I become a medical illustrator? At the core, medical illustration is the art of increasing scientific understanding through visual storytelling. Medical illustrators take complex scientific ideas and distill them into teachable moments. We continue to fulfill curiosities, and tell the story of what makes us who we are.

***

Jared Travnicek is a medical illustrator based in Indianapolis, Indiana. He currently works as a neurosurgical illustrator at Goodman Campbell Brain and Spine. He holds a Master of Arts in Medical and Biological Illustration from the Johns Hopkins University School of Medicine, and a BA from Iowa State University in Biological and Pre-Medical Illustration. Jared is an award-winning member of the Association of Medical Illustrators.

NOTES

1 Garrison, F. H. (1917). An introduction to the history of medicine, with medical chronology, suggestions for study and bibliographic data. (2nd ed.) Philadelphia: Saunders.
 
 
2 Patel B.A., S. K., Couldwell M.D., Ph.D, W. T., & Liu M.D., J. K. (2011). Max Brödel: his art, legacy, and contributions to neurosurgery through medical illustration. Journal of Neurosurgery, 115, 182-190.
 
 
3 Sappol, M. (2006). Dream anatomy. Bethesda, Md.: U.S. Dept. of Health and Human Services, National Library of Medicine, National Institutes of Health; pgs. 19, 28. 

FIGURES

FIG 1 - Johannes de Kethan, Fasciculus medicinae, National Library of Medicine
National Library of Medicine Online Archive & National Library of Medicine Historical Anatomies Online

FIG 2 - Coronal section through skull showing sinus cavities; Leonardo da Vinci

FIG. 3 - Anatomia del corpo humano by Juan Valverde de Amusco; National Library of Medicine
National Library of Medicine Historical Anatomies Online

FIG. 4 - De corporis humani fabrica libri septem by Andreas Vesalius; National Library of Medicine
National Library of Medicine Online Archives &
National Library of Medicine Historical Anatomies Online

FIG. 5 - Anatomia humani corpis; National Library of Medicine; National Library of Medicine Historical Anatomies Online

FIG. 6 - Anatomie des parties de la génération de l’homme et de la femme; Jacques Fabien Gautier D’Agoty; National Library of Medicine
National Library of Medicine Historical Anatomies Online

FIG. 7 - Tabulae sceleti et musculorum corporis humaniby Bernhard Siegfried Albinus; National Library of Medicine; National Library of Medicine Historical Anatomies Online

FIG. 8 - Max Brödel; Original photograph by J. H. Schaefer is in the Walters Collection of the Max Brödel Archives, Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

FIG. 9 - Surgical Experiences with Pituitary Disorder by Max Brödel. Original illustration #75 in the Walters Collection of the Max Brödel Archives, Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland , USA.

FIG. 10 - Cardiovascular System of the Fetus in Utero by Ranice W. Crosby. Original art is in the Crosby Collection of the Max Brödel Archives, Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland , USA.