The Art of Medicine

Medical illustration is not a new concept. The first medical illustrators were seen in the renaissance period in Europe. Andreas Vesalius, a famed Belgian anatomist recruited a student of Titan (the famous Venetian master artist) and other artists to make illustrations for his book; De Humani Corporis Fabrica [1]. Similarly, realising the importance of anatomical illustrations, many physicians teamed up with artists to write and produce books with correct human anatomy and physiology.

So, the question that begs to be asked is- who are medical illustrators? Medical illustrators are in charge of making art that is both pleasing and scientifically correct. They help make the prose easier to understand and to read.

To be a medical illustrator, one needs to have a strong passion for both art and medicine. After the 12th grade (in science), one must pursue bachelors in design through institutes like National Institute of Design (NID) or MIT Institute of Design or; after MBBS, one can do a course Graphics/Animation and Design from private institutions such as Arena or MAAC. In the US, there are separate accredited masters in medical illustration at universities like Augusta University, in Augusta, Georgia; John Hopkins University in Baltimore; and the University of Illinois at Chicago or  University of Toronto in Canada.

As the demand for patient education increases, the demand for medical illustrators has also gone up. Medical illustrators work not only with medical and health professionals, but also with researchers, advertising agencies, pharmaceutical companies, personal injury lawyers, and the general public.

What are the different ways to draw medical illustrations? While drawing and painting is the most commonly known medium, recent advances in graphics and design has enabled the use of multiple software to draw both 2D and 3D images.

Often, in spite of having advanced computer technologies and softwares (like Adobe Photoshop), the first step to drawing a medical illustration is with pencil and paper. To start off, the artist requires: 1. Ruler and ruling pen 2. Pencil and eraser, 3. Coloured felt pens with fine tips or water coolers and a water cooler sable brush, 4. A tube of poster white, 5. Smooth illustration board (illustration board is superior to paper as it stands rough handling), which should be covered with a transparent cover to allow modifications and layering [2]. Some artists prefer using layout bond paper as it allows superimposition of drawings without bleeding of colours and allows for shadowing and gradations.

At this point, the artist has two options, the first one is to finish the sketch with water colours or pencil shading and then either photograph it with a 35 mm camera, tripod and either artificial lights or good natural light. The higher the quality of paint brushes and paper, the better the quality of the illustration. Sable hair brushes and smooth “hot press” watercolours produce the best images. Shading can be done with pencils of the entire range from 8B to 6H. The benefit of using water colours and pencil shading is to create an aesthetically pleasing diagram. For example, a gross, gory diagram of a tumour (or any disease) can be softened to be pleasing to the eye while also explaining to the viewer the prose. Paintings and pencil sketches are often used for patient education or pharmaceutical companies to explain the mechanism of action of drugs or instruments and devices [3]. In the current era, illustrators draw the diagrams on tracing papers, scan them and finish the drawings in various available illustration softwares. There are three major types of such software: Software designed to automatically create a wide range of charts and graphs from data that has been entered into a table or database (e.g.: Excel, Kaleidagraph, Deltagraph),

Software designed to permit drawing a relatively limited range of predetermined shapes and objects using graphic libraries to create diagrams (e.g.: Visio, Omnigraffle, Powerpoint), and Software designed to draw virtually any shape or object using highly sophisticated drawing tools (e.g.: Adobe Illustrator, Corel Draw, Macromedia FreeHand). But none of this was designed specifically for scientists, so they can be challenging to use. To make their lives easier, came BioRender. BioRender has a  library of around 30,000 life-science icons, which includes anatomical drawings and depictions of everything from SARS-CoV-2 virus particles to fruit flies. Users can resize, rotate and change the colour of those icons. But they cannot change their fundamental appearance, for instance to add or remove a protein domain. The library also includes icons for specific pieces of laboratory kit, making it possible to illustrate protocols with images of the actual equipment used. Researchers can also create icons representing specific structures in the Protein Data Bank, an open-access digital archive providing access to 3D structure data for proteins and nucleic acids. Unfortunately these softwares are pricey and can make a major hole in your pocket.

What are the free alternatives available to us? We have Inkscape which has an open source vector graphics package (. As well as the standard drawing and shape tools, Inkscape boasts a special spirals tool, a tool to create patterns and arrangements of clones, advanced object manipulation options, multiple filters (including bevels, textures, overlays and more), and some nifty fill settings. In short, there’s very little Illustrator can do that Inkscape can’t. Another is BoxySVG, which is a free tool for creating scalable vector graphic files that runs as an extension in Google Chrome. It comes with a good range of basic tools, including pens, bezier curves, text, basic shapes, stroke and fill, layers, ability to add type, groups, transforms and paths. Some other options include Vecteezy, Vectr, SVG-Edit and Canva.

In the last 20 years, increasingly powerful computer software and hardware has become available to the general public, and the now-pervasive ability to create digital images through electronic image archives, digital photography, scanning of paper or film and graphics software for charting and illustration, have meant that the once-arcane art of graphic design and medical illustration has become democratised and at least for many types of illustration, is no longer the province of the expert graphic artist. This is not to say that we can all become professional artists, but rather that the simpler tasks of medical illustration are now within the reach of the ordinary person with sufficient knowledge, tools, training and practice.

Poonam Nayak, MIMER Medical College
Rupali Sachdev, Grant Medical College, Mumbai

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