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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5553_Библиотеки_им_академика_М_И_Перельмана
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phenomena. Building on advances in precision medicine, LifeTime
presents a case of data-intensive research. The monitoring required
for interceptive biomedicine does not only rely on an incredibly large
amount of data, but their analysis in terms of statistically evaluated
distributions and internal relations takes on a life of its own. Data-
intensive research is not just a question of magnitude but operates
with new levels of complexity. Data no longer simply refers to given
objects but shows and differentiates relations between them (Meunier
2022; Borck 2022). The “pathological” is no longer a given entity like
a tumor specimen in a pathological collection, a calcified artery or
necrotizing tuberculum, but constellations of parameters statistically
correlated with illness. By visualizing these data volumes as some
kind of pathological or organic quasi-tissue, even though the dots do
not represent biological particles but their fate in terms of health and
illness, figure 1 pathologizes and reifies mere correlations to medical
matter. Thus, even though current data-intensive precision medicine is
continuous with the molecular biomedical paradigm, the LifeTime
image raises the question of whether this transformation of
biomedicine ultimately evaporates and dematerializes the
conceptualization of the pathological. The image visualizes a futuristic
medicine in which diseases as proper, organ-based pathological
entities have ceased to exist, both conceptually and because this
medicine would intercept with the manifestation.
4
Zooming Out: On the History of Pictorial Rhetoric in Medicine
Section has zoomed in on the visual references in figure 1 and
followed these traces to specific types of scientific imaging by which
the figure garners credibility although it is an imaginary image. This
section now situates figure 1 in a broader tradition of didactic images
in medicine in order to better understand how images facilitate the
(re)conceptualization of human bodies and diseases.
We have already mentioned the purposeful scaffolding of the three
panels in figure 1, with their intricate change of representational
logics (from three-dimensional timespace to morphological structures
to dynamic processes). The skillful combination of visual codes and
image types clearly points to careful decisions and professional
crafting by the designers of the image. Yet, for the historian of
scientific visualization, the recognition of creative ingenuity, individual
training, and expertise can only amount to half of an answer, as the
question of the image’s persuasiveness requires a more
comprehensive contextualization. The combination of visualization
modes exhibited in the image can only claim to be successful if it
refers to established visual frames of reference for “naturalizing”
something artificial—and even utopian, as in our case (Steiner and
Engelmann 2023; Nyhart 2023).
One of the central concepts underlying the image is “disease
trajectory.” A quick PubMed search of the term shows that, while the
concept may have a long history, it only came into broader circulation
during the 1990s, increasing to over 1,000 publications per year since
the 2010s. Apparently, figure 1 then engages with a concept that is
quite specific, yet it represents a trend in the articulation of
pathological phenomena. For instance, a recent review on trajectories
of lung diseases (Stolz et al. 2022) in the leading medical journal
Lancet visualized them in far less sophisticated ways compared to
the LifeTime image, as it merely arranges different types of lung
diseases with their respective causes to segments of a circle in some
sort of pie chart. However, this image combines trajectories
also with some underlying histology and thus uses the systematic
blending of spatiotemporal relations with “zooming-in” effects for
visualizing the different groups, as well as their causes and underlying
pathology. Here, we use this image as a visual testimony and pictorial
link to what is probably the most significant visual tradition in
representing diseases and human pathology: Frank Netter (1906 –
1991) and his famous illustrated volumes on this subject. The
“Netter approach,” which he developed in collaboration with the
pharmaceutical company Ciba in the 1950s, relies not on a perfectly
“realistic” representation but on a careful combination of overview and
detail, highlighting the particular points at issue. The Lancet image
clearly engages visual strategies for which Frank Netter had
become famous since the end of World War and thus extends their
legacy into the twenty-first century.
FIG . 4A
FIG . 4B
FIG . 4A
FIG. 4A Causes of lung diseases together with their histopathology from Stolz et al.
(2022, 931, fig. 6)
FIG. 4B Pathological manifestations of pancreatic B-cell tumors from Netter’s Ciba
Collection of Medical Illustration, vol. 4 (Netter 1965, 158, section , plate 16)
Netter was already a successful commercial artist when he
entered medical school in the 1920s and reconverted to producing
illustrations when his Manhattan-based surgical practice failed in the
1930s because of the Great Depression, quickly attracting
commissions from the pharmaceutical industry as he combined
graphic skills with background knowledge in medicine and biology.
After World War , his collaboration with the Ciba company
developed into the famous Ciba Collection of Medical Illustrations,
thirteen volumes of altogether more than 4,000 illustrations and
reprinted late in his life as a six-volume set called Atlas of Human
Anatomy, which became “the best-selling atlas in American medical
schools” (Hansen 2006, 483).
Netter certainly did not invent the visualization of disease, but
unlike images in the tradition of the anatomical or pathological atlas,
he did not focus on the body and its organs as observed in the
dissection theater. Instead, he highlighted anatomical or pathological
details together with some human activity, thereby contextualizing the
medical content with typical circumstances and blending nature with
culture into knowledge. This approach was meant to make it
easier to memorize clinically relevant aspects or important systematic
connections in medical knowledge. His signature was a functionalist
approach also in a different sense. He liberated himself from strict
conventions of complete anatomical comprehensiveness in order to
achieve better legibility and “intuitive” understandability by focusing on
visualizing the relevant details only. He prioritized the didactic function
of visualization over its accuracy in terms of Daston and Galison’s
mechanical objectivity (2007). He did not use these terms, which
were introduced into the academic debate only later, but he very
consciously developed this style on principles shared by other
medical illustrators:
I have seen many beautifully rendered illustrations in which the
artistic technique overpowers the message of the plate. In many
cases, artistic restraint in the general portions of the illustration
allows one to have a background against which to contrast the
areas of focus through the use of increased detail, rendering,
and contrast. (John A. Craig, quoted in Hansen 2006, 483)
FIG . 4B
His background in commercial illustration and his economic success
thanks to the collaboration with the Ciba company (i.e., not an
academic institution) may have helped him to establish the Netter
approach, but from very early on in his career, he had been convinced
that medical images function rather by their selectiveness than
comprehensiveness:
Strange as it may seem, the hardest part of making a medical
picture is not the drawing at all. It is the planning, the
conception, the determination of the point of view, and the
approach which will best clarify the subject that take the most
effort. (Netter 1949, quoted from Hansen 2006, 485)
As an illustrator, Netter did not just draw the specimen in front of him,
and the drawing was not the difficult part. Instead, he had to face a
series of representational decisions in order to “clarify” the image.
For Netter, “naturalness” was the effect of careful planning and
decision-making about “focus,” “plane,” and “point of view,” as he
explained:
By focus, I mean the amount of the subject to be included in the
picture. By plane, I mean the depth of the dissection. The artist
must decide at what depth or plane of the body he will make his
drawing. The term point of view is self-explanatory but must be
considered very carefully in planning an illustration. (Netter
1949, quoted from Hansen 2006, 485)
Nothing, of course, was “self-explanatory” in Netter’s images; on the
contrary, precisely the “self-explanatory” was the effect of his
mastery of visual craft and design.
Especially for the popular appeal of Netter’s Human Anatomy,
there is yet another important source, which in all likelihood can be
described as the founding scene for a popular human anatomy with
scientific standing: the German physician and science popularizer
Fritz Kahn (1888 –1968). Kahn did not collaborate with a
pharmaceutical company but with a publishing house attached to a
naturalists’ society. Even in his early pieces for the German weekly
Berliner Illustrirte Zeitung, Kahn had begun to demonstrate his
extraordinary potential for developing visual strategies for which he
would later become famous. A particularly spectacular example is his
employment of the zooming-in technique that not only moves between
scales of magnification but juxtaposes the entire human figure with a
single muscle and its microstructures as fibers to a visually
dramatized single image rather than a proper sequence. In
a similar vein, Kahn employed the blending of developmental time with
representational space to a single image for explaining Haeckel’s “law
of ontogenesis,” taking the visualization of cell lineages and
differentiation to cross-species comparison. Kahn’s images clearly
are fantastic, as they mix time and space with different
representational modes for arriving at a single visual interpretation of
biological form, function, and development.
FIG . 5A, 5B
FIG . 5C
FIGS. 5A–C Images from various publications by Fritz Kahn. and , comparison
of early image in Berliner Illustrirte Zeitung (here as reused in Man in Structure
and Function, Kahn 1943, 130) with later book cover (from Kahn 1922–1931, vol. 2)
using the same motif of perfecting zooming in to a single, integrated image
FIG. 5C Haeckel’s law of the ontological recapitulation of phylogeny (from Kahn
1943, 33, fig. 26) in a similarly integrated single image combining different species
(reptile, bird, horse, man)
Like Netter fifty years later, Kahn’s images were regarded as so
successful that the publishing house Kosmos commissioned the
heavily illustrated multivolume set Das Leben des Menschen (The
Life of Man, Kahn 1922–31) with the subtitle “Popular Human
Anatomy, Biology, Physiology, and the Developmental Biology of
Man” (our translation). With these books, Kahn perfected his style of
visualization to employ technological analogies for explaining organs
and their functions in images that carefully blended anatomical
structure, physiological theory, and explanatory technical models to
complex scenes of human “modern” life, i.e., contemporary culture
with radio, dance, motor cars, cinema, machines, etc. (figures 5,
5, 6, and 6; see von Debschitz and von Debschitz 2017; Borck
2007).
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