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Finding Humanity in the Macabre: Art and Medical Illustration Over Time The profession of medical illustration is one that few choose today. Master's degree
programs in medical illustration typically accept between 7 and 20 students each year
(Association for Medical Illustrators, 2016). It is not an easy job, though it is one that is in high
demand. Instructive medical art is used everywhere from textbooks to court cases, and it must be
constantly adapted and improved to reflect the present context. Artists must work closely with
scientists and physicians to create exceptionally detailed and accurate portrayals of anatomy.
They are registered and trained by professional health organization, and they must follow strict
educational requirements (Johnson, 2007). Modern anatomical images are clear, and highly
accurate to the human form. Nowadays, medical illustrators use cutting edge techniques like 3D
modeling, digital illustration, and HD photography to explore and depict the human body. These
high-tech representations are more science than art, after all they are images that are used to
instruct and explain. It follows that medical illustrations should be unambiguous, logical, and
devoid of artistic interpretation. This, however, was not always the way of things within the field
of medical illustration. In the early days of formal medicine, anatomical studies possessed a
fanciful quality that has seldom been retained in modernity. Medical illustrations weren’t simply
presentations of information; they were visually appealing works of art as well. The early
modern era, from around 1450 to 1750, saw the practice of anatomical illustration take on many
forms before it evolved into the clean, placid, scientific figures we see today upon opening a
medical textbook (Dream Anatomy, 2014). Anatomists drew humans dancing, farming, praying,
or otherwise performing everyday life tasks. These are scenes that are very recognizable aside from one major detail, the subjects of the images are flayed or skeletal. Sometimes they hold
their own skin in their hands as they strike a kinetic pose, sometimes they stand contemplating a
human skull. The medical illustrations from this time may seem macabre to modern eyes, they
imbue grisly, dissected corpses with humanity in a way that occasionally seems more reminiscent
of a zombie movie than a medical textbook. It is a humanity that has been stripped away over
hundreds of years in the field of medical illustration. Medical illustrations have unquestionably
become more accurate to the physical human form, however in the process many less tangible
human qualities have been stripped away. Early modern artist-anatomists brought their subjects
to life in a compelling, philosophical ways, that should not be forgotten or ignored by medical
illustrators today.
Today’s medical textbooks largely employ anatomical illustrations of a rigid person,
usually a male figure (Giacomini, 1986), in the “anatomical position” (standing straight, hands at
their side, palms forward) on a blank white background. They may not have skin, but they are
usually not upsetting to look upon. Their presentation is very clinical, clean, and lifeless.
Sometimes the images of muscles and viscera are abstracted to the point that they are not
attached to a human form at all. They simply float independently in a white void. This
presentation of anatomy could hardly be more different than the illustrations of 15th and 16th
century anatomists, such as Jacopo Berengario da Carpi, Charles Estienne, or Andreas Vesalius.
Jacopo Berengario da Carpi grew up helping his surgeon father with his bloody work
(Choulant & Streeter, 1920). Berengario used this experience as the basis of his explorations in
anatomy. Berengario prided himself on personally dissecting hundreds of bodies, a claim that not
many of his contemporary anatomists could make (Choulant & Streeter, 1920). From his
dissections, he created beautiful wood block illustrations of anatomized humans for the very first anatomical text that included full illustration, “Anatomia Carpi. Isagoge breves perclucide ac
uberime, in Anatomiam humani corporis” (Merlini, Tomba, & Vigano, 2003). Berengario’s
illustrations tend to show nude men standing in nature, pulling open their own abdominal
cavities for the curious anatomist to examine (Beregario da Carpi, 1460). One shows a woman,
draped on a chair near a window, a town is featured in the distance through the glass. Her eyes
are closed, it’s unclear whether she’s sleeping or dead, and her abdomen is cut open to reveal her
uterus. The design of the cut itself is highly reminiscent of a vulva. These illustrations of
Berengario, who was a known appreciator of fine art, are not the most medically accurate or
detailed (Choulant & Streeter, 1920). Due to the artistic medium, stamps made from carved
wood blocks, there were obvious limitations on medical accuracy. The woodcuts, however, are
beautiful in their simplicity, they employ strong lines and are almost impressionistic at times.
They also showed facets of human anatomy that had not previously been explored, and even
corrected a few long held anatomical beliefs (Merlini, et al. 2003). There is a sense of wonder
present in the way the men pictured pull open and examine their own bodies, it seems to reflect
the wonder of the anatomist, who does the same. The act of studying the human body was clearly
seen as a beautiful endeavor, worthy of aesthetically pleasing artistic representation.
Charles Estienne was an anatomist who, like Berengario, utilized woodcut illustrations
for his anatomical figures (Dream Anatomy, 2014). His De dissectione partium corporis featured
somewhat bizarre, though extremely lavish woodcuts. Estienne began his work before Andreas
Vesalius, but did not finish until after Vesalius completed his famous de Fabrica (Choulant &
Streeter, 1920). His work was also not as revolutionary as Vesalius’, he made no large effort to
improve on accepted anatomical ideas (Dream Anatomy, 2014). Nevertheless, the images he
produced were much more detailed than Beregario’s, and very full of imaginative humanity. One woodcut shows a skeleton standing on a hill overlooking a harbor and a town (Estienne, 1569).
The skeleton is covered in a delicate web of tendons, and it is holding its own lower jawbone,
contemplatively looking on. The viewer is reminded that the skeleton was once a living man,
capable of contemplating their own existence. Another illustration of Estienne’s shows a naked
man draped over a dissection table (Estienne, 1569). The table is outside, two spectating men
point at the anatomized man from a parapet. The man’s head is face down, with the top of his
skull cut off so that one can view his cranial cavity. This image reminds the viewer of the act of
dissection. This drawing of a body is not an abstract symbol, a man truly died, and was dissected,
to be drawn this way.
Andreas Vesalius, took the art of anatomy to a new level. Not only did he commit himself
to scientifically accurate representations of the human body, he did so in a masterfully artistic
and beautifully detailed way (Dream Anatomy, 2014). In 1542 Vesalius finished the first edition
of his masterpiece, De Humani Corporis Fabrica (Ball, 1910). His discoveries overthrew many
of the accepted Galenic ideas about human anatomy, and the illustrations in his book reflected
this newfound accuracy (Porter, 1997). While Vesalius himself did not draw the illustrations he
utilized, he oversaw their creation obsessively (Ball, 1910). He also felt that the artist or artists
charged him too much for their services and Vesalius found them rather unpleasant to deal with,
therefore he omitted their names from the final copy of De Fabrica (Ball, 1910). This is
unfortunate, because the work of these artists elevated anatomical medical illustration
immensely. Extraordinarily detailed woodcuts show figures in meaningful poses. In one, a
skeleton standing on a bluff, looks to the sky with a pained expression (impressive for a fleshless
person). The skeleton leans against a spade, perhaps digging its own grave (Vesalius, 1543). This
skeleton is much more detailed and biologically accurate than any skeleton drawn by Estienne or Berengario. It also features emotion, there is a story being played out in one frame. This drawing
succeeds in being captivating while also anatomically informative. A series of drawings in the
Fabrica feature a man with no skin, showcasing his musculature. With each successive drawing,
more of his muscles are flayed off. Finally, we see the figure leaned against the wall of a ruined
building, he is mostly skeleton with a few bits of muscle still attached, his lower jaw and sternum
have been removed. The ruination of his body is reflected in the ruination of the building he
leans against, a direct metaphor (Dream Anatomy, 2014).
The propensity of anatomists to bestow life onto the most certainly dead in medical
illustrations continued into, and perhaps reached peak popularity in, the 17th century (Dream
Anatomy, 2014). During this time society at large became obsessed with individuality, theatre,
and performance. In turn, anatomical illustrations reached peak emotion, wit, and comic
exaggeration (Dream Anatomy, 2014).
In the 1631 works of Giulio Casserio, artist Odoaro Fialetti created anatomical
copperplate engravings that utilize comedy as well as elegance in their art. They are anatomically
exact pieces with extremely detailed backgrounds that would have been quite an expense to
produce (Choulant & Streeter, 1920), In one image a man flirtatiously lifts his abdominal skin to
reveal the tissue and organs below, much like someone lifting their skirt. In another, a pregnant
woman’s belly is dissected to resemble a flower, with skin and muscle imitating the petals of a
lotus and a fetus sitting at the center. It is a very beautiful, if somewhat macabre, image. The
woman in question is smiling, she seems carefree and her pose suggests playful movement.
Similarly to Casserio, anatomist John Browne illustrated anatomized figures dancing or
striking theatric poses in the late 17th century (Dream Anatomy, 2014). While Browne was
known to plagiarize material for his books (Loukas, et al. 2010), he nevertheless produced original and entertaining anatomical illustrations. One such illustration for his work A Complete
Treatise of Muscles depicts a clearly upper class man leans against an ornate pedestal (Browne,
1681). His upper body is flayed to illuminate the muscles of his shoulders and chest. This image
is something of a lie, as anatomists did not dissect the upper class, they relied on the bodies of
the poor or criminal. In another illustration, a naked woman has her back facing the viewer
(Browne, 1681). She is coquettishly lifting her skin away from her back muscles, as if giving the
viewer a glimpse of something illicit. This is the sort of comedy and liveliness that defined
anatomical illustrations from this period. However, soon this silliness would be replaced by
stoicism.
Moving into the 18th and 19th centuries, anatomists began to remove all extraneous
artistic elements from medical illustration (Dream Anatomy, 2014). Elements such as metaphor,
background art, emotional expression, and lifelike poses were distractions. Artistic flair did
nothing to further anatomical education, in the minds of scientists. Two schools of thought
emerged during this time. One was that anatomical figures should show nothing but the body and
the tools of dissection. This meant no more bucolic fields or ornate towns for cadavers to dance
and play within, only motionless dissection slabs, their true homes. The other style popularized
during this time was that of high reality. This involved emotionless anatomical figures on blank
backgrounds, the details of their dissection obfuscated. These figures are clean, idealized, and not
reminiscent of the actual experience of dissection nor the lived experiences of humans.
Anatomists Govard Bidloo and John Bell fell into the first camp, while the likes of William
Hunter, Paolo Mascagni, and many others fell into the second (Dream Anatomy, 2014).
Govard Bidloo was a dutch anatomist whose anatomical illustrations represent something
of a transitional stage in the field (Dream Anatomy, 2014). He was committed to representing the reality of dissection, meaning he included all the gory details of the anatomizing process within
his drawings. While anatomical images today are sanitized of all reference to the dissection
process, Bidloo included the ropes, nails, saw marks, and knives that went into preparing his
reference cadavers (Govard Bidloo, 2009). However, while Bidloo included these reality laden
illustrations in his work, he also tended to include a few fanciful drawings as well. For example,
alongside his unflinchingly realistic illustrations of flayed flesh pinned with nails, he includes an
image of a skeleton walking across a room holding its own death shroud (Bidloo, 1690). This
type of illustration is known as a memento mori or “reminder of mortality” (Dream Anatomy,
2014), and is like Vesalius' illustration of a skeleton digging its own grave or Beregario’s
skeleton contemplating its own jawbone.
While Bidloo represented a stepping stone in anatomical illustration, Scottish anatomist
John Bell placed himself firmly in the “harsh reality” camp. Bell believed that the practice of
drawing anatomical figures imaginatively was condemnable (Dream Anatomy, 2014). He
claimed there was a “continual struggle between the anatomist and the painter, one striving for
elegance of form, the other insisting upon accuracy of representation." (Dream Anatomy, 2014).
With this Bell asserted his belief that anatomy cannot be both aesthetically pleasing and
biologically accurate. Like Bidloo, Bell’s illustrations include the tools of dissection. Bell’s
sketches for his Engravings of the bones, muscles, and joints, illustrating the first volume of the
Anatomy of the Human Body, have a dark tone. They are harsh, there is no smoothness, or clean
lines present in the anatomy (Bell, 1804). There are certainly no fanciful backgrounds or lively
poses. Bell’s work represents a turn in the tide against frivolity and lightness in anatomical
drawings, his illustrations are raw and uncompromising in their realism. However, his drawings
are not the orderly, unblemished medical illustrations we know today. William Hunter was an anatomist who portrayed high realism illustrations within his
work. His most famous work, The Anatomy of a Human Gravid Uterus, utilized a minimalist,
realistic style while depicting fetuses in utero. Tangentially, the women depicted in this
anatomical work were likely body snatched by graverobbers, as visibly pregnant women were
not executed for crimes during that time (Barnett, 2014). Unlike Cassiero before him, Hunter
takes no artistic license while depicting gravid wombs, there are no flowers or playfulness.
Hunter believed that only images which depict exactly what the anatomist himself saw, with the
unnecessary tools of dissection omitted, will be helpful to future students (Dream Anatomy,
2014). One such image, a copper engraving carved by Jan van Riemsdyk, depicts the dissected
womb of a woman who died late into her pregnancy (Hunter, 1774). The image depicts only
what is essential. Just the womb, and the external genitals of the woman are visible. There is no
effort put into humanizing the subject. The background is entirely blank. The illustration is
detailed to the point that it is almost photographic, and would certainly be very helpful for an upand-coming obstetrician, if not artistically or emotionally inspirational for them.
Paolo Mascagni was an anatomist whose work featured hand painted, brightly colored
copper plates (Dream Anatomy, 2014). Mascagni made great strides in understanding the
lymphatic system. He developed new methods to view precise anatomical details during
dissection (Eimas, 1983). His work was rather expensive in his day, and considered to be more
appropriate for practicing surgeons/physicians than beginner students, due to the immense detail
included in the anatomical illustrations (Choulant & Streeter, 1920). His figures are presented
with no background art, and the bright colors contrast against each other to make differentiating
anatomical features easy. The color of these figures may not be exactly what the anatomist sees
when cutting into a body, but they certainly make complex anatomy more comprehensible. They make anatomy clearer than the true reality. Mascagni’s Anatomia universale del Paolo Mascagni,
shows images that may seem rather familiar to anyone who has taken an anatomy to health class.
One example of such an image is that of a flayed man who stands against a white background, all
his muscle groups are very visible and colored bright red (Mascagni, 1833). He has a blank
expression and is assuming a rigid pose. This image exemplifies the style of medical illustration
which became popular in the 1800’s, and stayed popular into the present day.
Perhaps the most famous text on anatomy is that of Gray’s Anatomy, first published in
1858. It’s images are plain woodcuts, often uncolored, on plain white background. They are
prized in the medical world precisely because they lack opinion or personality, they are
untouched by any emotional bias (Barnett, 2014). This mechanical objectivity is what was, and is
today, prized in medical illustrations. The anatomical illustrations of the early modern era were
much too philosophical, stylized, and, perhaps, too lifelike to meet the requirements of scientific
objectivity the medical field requires of its students today. Anatomical illustrations, beginning in
the late 18th century, are extremely detailed, but they are not full of life the way earlier
illustrations are. Berengario, Estienne, Vesalius, Casserio, and Browne used illustrations that
placed anatomized bodies in familiar situations or contexts. These were instructive illustrations
of cadavers, but the cadavers were also people who could dance, work, joke, and philosophize
like any other. Bordin and D’Ambrosio write in Medicine in Art, “Medicine and medical
care...have in themselves an artistic dimension indispensable to ensuring that the scientific
dimension does not engulf the humanity of its patients, that medicine and medical care do not
reduce individuals to nothing more than their diseases.” (Bordin & D'Ambrosio, pg. 7). In other
words, it is important to not become so mechanically objective with medicine that one forgets the
humanity of the patient. Medical art that has the spark of life, like those early anatomical illustrations, help remind us that cadavers were people once. This humanization prevents
detachment, it causes the viewer to think about the cadavers as living breathing people, who died
and were subsequently dissected. A sanitized image of chest muscles on a blank white
background reduces the humanity of the subject to an exquisitely drawn slab of meat. Images
like that, though very popular in modernity, are less likely to trigger an empathetic response in a
burgeoning medical student. This is unfortunate, as empathy is an important factor in medicine.
After all, a sick patient is not simply a disease to be cured, and a body is not just flesh. A good
doctor gets to know their patient’s lives to best help them heal and feel safe. While the field of
medical illustration has certainly made great technological strides and leaps in anatomical
understanding, perhaps medical illustrators today could benefit by looking to the past for creative
inspiration. References
Association of Medical Illustrators. (2016) What is a medical illustrator? Retrieved June 08,
2017, from http://www.ami.org/medical-illustration/learn-about-medical-illustration
Ball, J.M. (1910). Andreas Vesalius, the Reformer of Anatomy. Medical Science Press.
Barnett, R. (2014) The Sick Rose: Diseases and the art of medical illustration. London: Thames
and Hudson, LTD.
Bell, J. (1804). Engravings of the bones, muscles, and joints, illustrating the first volume of the
Anatomy of the Human Body. National Institute of Health.
Berengario da Carpi, J. (1460) Anatomia Carpi. Isagoge breves perclucide ac uberime, in
Anatomiam humani corporis. National Institute of Health.
Bidloo, G. (1690). Ontleding des menschelyken lichaams. National Institute of Health
Bordin, G., D’Ambrosio, L.P. (2009). Medicine in Art. Los Angeles, CA: Getty publications. Browne, J. (1682). A compleat treatise of the muscles, as they appear in humane body, and arise
in dissection: with diverse anatomical observations not yet discover'd : illustrated by near fourty
copper-plates, accurately delineated and engraven. National Library of Medicine.
Choulant, L., Streeter, E.C. (1920). History and Bibliography of Anatomic Illustration in Its
Relation to Anatomic Science and the Graphic Arts. University Chicago Press.
Dream Anatomy (2014). Retrieved June 08, 2017, from
https://www.nlm.nih.gov/exhibition/dreamanatomy/index.html
Eimas, Richard. “The Great Anatomy of Paolo Mascagni.” The University of Iowa Libraries
Special Collections and University Archives. The University of Iowa Libraries, Apr 1983. Web.
17 Mar 2014. <http://www.lib.uiowa.edu/scua/bai/eimas.htm>.
Giacomini, M., Rozee-Koker, P., Pepitone-Arreola-Rockwell, F. (1986). Gender Bias in Human
Anatomy Textbook Illustrations. Psychology of Women Quarterly, 10, 413-420.
Merlini, L., Tomba, P., Vigano, A. (2003). Beregario da Carpi, a pioneer in anatomy,
rediscovered by Vittorio Putti. Neuromuscular Disorders, 13, 421-425.
Govard Bidloo (2009) Retrieved June 09, 2017.
http://www.indiana.edu/~liblilly/anatomia/bidloo.html
Johnson, A. (2007). Current and Future Education of Medical Illustrators. Journal of Visual
Communication in Medicine, 30, 108-109.
Loukas, M., Akiyama, M. Shoja, M.M., Yalcin, B., Tubbs, R.S., Cohen-Gadol, A.A. (2010). Joh
Browne (1642-1702):anatomist and plagarist. Clinical Anatomy, 23, 1-7.
Mascagni, P. (1833) Anatomia universale del Paolo Mascagni. National Institute of Health
Porter, R. (1997). The Greatest Benefit to Mankind. New York:Harper Collins Ltd.
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