A Brief History of Medical Illustration in Clinical Dermatology

Today medical photography is universally accepted as the best way to document and monitor dermatological conditions. Standardised full-body mole mapping views provide a baseline against which to evaluate changes in a patient’s presentation.

This is achieved by taking a series of establishing views which divide the body into sections, close-ups of moles or lesions identified by the dermatologist are then photographed at a higher magnification with a mm scale. The resulting images are then numbered and organised so that they can be easily viewed in a follow-up clinic or by patients self-monitoring at home.

UK based medical photographers adhere to the Institute of Medical Illustrator’s national guidelines on mole mapping photography; this ensures that views are standardised and consistent in all medical illustration departments.


IMI standard positions for mole mapping 1

mole_mapping_standard_positions

The first book to explore skin conditions was Girolamo Mercuriali’s De Morbis Cutaneis (the diseases of the skin), originally published in 1572. It was followed by Daniel Turner’s De Morbis Cutaneis, published in 1714. These publications led to dermatology being recognised as a medical speciality in its own right.

Robert Willan (1757-1812) was an early pioneer in this new field of dermatology. He identified eight classifications of disease: papulae, sqamae, exanthemata, bullae, pustulae, vesiculae, tubercula and maculae. In 1808 he published On Cutaneous Diseases, it was the first book to contain hand drawn dermatological illustrations. Thomas Bateman (1778-1821) finished compiling the categories of disease after Willan’s death and A Practical Synopsis of Cutaneous Diseases According To The Arrangement Of Dr Willan was published in 1813. 2


Porrigo favosa (disease of the scalp) affecting the face.

by Bateman and Willan 3

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Impetigo figurata pustules on hand.
by Bateman 4

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Willan understood the importance of medical illustrations as an aid to teaching the clinical attributes of skin diseases. He recorded the appearances of individual categories of lesions in great detail. The illustrations proved very popular and all future dermatological skin atlases and publications have included illustrations or clinical photographs. 5

The earliest known medical photograph is a calotype of a woman with a large goitre taken in 1847 by Scottish photographers Robert Adamson (1821-1848) and David Octavius Hill (1802-1870). They opened the first photographic studio in Scotland and predominately photographed studio portraits as well as landscapes and urban scenes. It has been suggested that the medical photograph was a one-off taken for a doctor they had photographed who had an interest in goitres. 6


Woman with goitre
by Hill and Adamson 7

earliest_goitre_photo_1847_hill_and_adamson

The first dedicated photographic atlas of dermatological disease was published in 1865 by Alexander John Balmanno Squire (1836-1908). Squire was chief of surgery and medicine for the British Hospital for Diseases of the Skin in London. He produced a three part series called Photographs (coloured from life) of the Diseases of the Skin. The atlas included 12 hand coloured albumin prints. 8

Squire wrote in his introduction:

“The great difficulty hitherto experienced in producing illustrations adequately portraying the various diseases of the skin, induced me to try if greater accuracy and more lifelike representations might not be obtained by means of photographs of the disease coloured from life by one of the best artists… soon became evident that excellent results were to be obtained by this means and that they might be rendered more widely available by publication”


Hand coloured albumin print
by Squire 9

squire_sqamae_clip

Squires’ publication was well received and photography became the accepted medium to document dermatological conditions. Over the next century medical photography developed into a distinct profession and photographic views were standardised. Clothing and jewellery were removed from frame and plain backgrounds were utilized. More importantly photographers began to respect a patient’s anonymity by only photographing the diseased area of the body and ensuring informed patient consent had been obtained.

 


References

  1. IMI National Guidelines – Mole Mapping Photography (www.imi.org.uk). Accessed November 19th 2016.
  2. Royal College of Physicians – Robert Willan and the History of Dermatology. (http://www.rcplondon.ac.uk/news/robert-willan-and-history-dermatology). Accessed November 19th 2016.
  3. Delineations of Cutaneous Diseases. (https://prettypotache.wordpress.com/2013/11/19/thomas-bateman-and-robert-willan/) Accessed November 19th 2016.
  4. Delineations of Cutaneous Diseases. (https://prettypotache.wordpress.com/2013/11/19/thomas-bateman-and-robert-willan/) Accessed November 19th 2016.
  5. A. Bernard Ackerman, M.D., Helmut Kerl, M.D., Jorge Sánchez, M.D., A Clinical Atlas of 101 Common Skin Diseases with Histopathic Correlation. Ardor Scribendi; 2000.
  6. McFall KJ. A critical Account of the history of medical photography in the United Kingdom: IMI Fellowship submission. (http://www.migroup.co.uk/wp-content/uploads/2013/05/A-critical-account-of-the-history-of-medical-photography-in-the-UK.pdf) Accessed November 20th 2016.
  7. McFall KJ. A critical Account of the history of medical photography in the United Kingdom: IMI Fellowship submission. (http://www.migroup.co.uk/wp-content/uploads/2013/05/A-critical-account-of-the-history-of-medical-photography-in-the-UK.pdf) Accessed November 20th 2016.
  8. Art and Medicine – Photographs (coloured from life) of the diseases of the skin. (http://www.artandmedicine.com/biblio/authors/Squire.html). Accessed November 20th 2016.
  9. Art and Medicine – Photographs (coloured from life) of the diseases of the skin. (http://www.artandmedicine.com/biblio/authors/Squire.html). Accessed November 20th 2016.

So what does a medical photographer do?

This is a question I am often asked by family and friends and it’s a difficult one to answer. It is also partly why I decided to write this blog, to give people a glimpse into the weird and wonderful world of a medical photographer.

The photography bit is easy, everybody knows what a photographer does but as soon as you go into any specifics you come up against two main problems:

1. The details can be quite gruesome and gory and can easily distress those with a weak constitution or low ‘gore’ threshold.

2. We are bound by privacy and confidentiality laws not to disclose any personal information about the patients we photograph.

So what does a medical photographer do? Well we pretty much photograph everything and anything in a hospital. Our main role is recording and documenting injuries and diseases in clinics, on wards and in operating theatres. The images are also used for teaching medical staff. We also undertake PR, location and staff portraiture in and around the hospital.

Our images are requested by doctors, consultants, child protection services, the police and solicitors to name but a few, the images can also be used as evidence in court.

Everyday is different we don’t know where we will be from one request to the next. I might get sent to burns theatre to photograph a serious burn injury then get called back to the photographic studio to record a series of intra-oral dental views. Then be asked to take photographs of a stillborn baby as a memento for the bereaved parents.

So as you can see medical photography is a pretty unique profession, yes you experience harrowing and distressing sights on a daily basis and see people at their most vulnerable. However it is a truly interesting, worthwhile and rewarding job and I wouldn’t change it for the world!