The Art of Medicine

October 29th, 1941. Cold, autumn wind rustled the red sycamore leaves of East Baltimore. A few blocks from Johns Hopkins University, mourners crowded beneath the arches of the Cathedral of the Incarnation. To some gathered for the funeral, the thought of honoring the agnostic decedent in a sanctuary seemed distasteful. But there was no way around it. The grand space was the only location that could fit them all. Fifty-six honorary pallbearers attended the service, forty-one of whom the Baltimore Sun newspaper reported as doctors.

With Nazi mobilization across the sea, indiscriminate anti-German-American sentiment pervaded the country. Yet, on this Wednesday afternoon, while politicians decried “hyphenated Americans” as disloyal, while “liberty cabbage” replaced sauerkraut and public places banned Wagner’s symphonies— physicians, artists, musicians, and scientists filled the cathedral pews to celebrate the thoughtful life of a German immigrant named Max Brödel.

“There was in Baltimore a kindly, curly-headed man of quiet demeanor,” wrote Dr. Thomas Cullen four years later from Johns Hopkins Hospital. His letter was penned to the Bulletin of the Medical Library Association in 1945 and printed under the title “Max Brödel: 1870-1941. At the time of writing, medical textbooks and journals, historically illustrated by artists with no medical training or doctors with no artistic training, had transformed. No longer chock-full of dangerous mistakes, the modern drawings were anatomically correct— stunning in their realism.

“As the years roll by and this war-torn world finds itself again at peace we will gradually catch up with the things we have not attended to or have missed completely,” he wrote. While hard feelings toward Germany still smoldered from the ashes of war, Cullen stated—for the record—that this artistic revolution centered around one man; a German-American who sailed into Baltimore’s harbor at age twenty-four, his close friend and colleague of forty three years: Max Brödel.

The man he described revolutionized more than one branch of medicine, saved countless lives with his art, and catapulted Johns Hopkins doctors to the forefront of their fields.

 “The time was ripe,” Cullen explains. “Max came just as medicine and surgery were making greater strides than they had done in centuries.” 

Considered the father of modern medical illustration, Brödel developed an artistic technique in which he viewed every medical specimen under a microscope at low power (a magnification of x40), at medium power (a magnification of x100), and at high power (a magnification of x400). “The artist must know his subject so thoroughly that he can even shut his eyes and coax into existence a mental picture of great clarity,” he wrote in a medical journal months before his death.

At the curious intersection of art and science, at a time when new surgeries and treatments exploded in the medical community, Max Brödel, the “kindly, curly-headed man of quiet demeanor,” changed the world.

Low Power (x40): The Life

Brödel was born in the eastern German town of Leipzig in 1870. At six years old he began playing scales on the family piano. By eight his teacher gave him Beethoven’s Sonata Appasionata, which he plunged into, later telling Cullen he was overcome by “its beauty and stirring qualities.” Shortly after he revealed his talent for music, he also began to show an aptitude for art. When he turned fifteen, the Academy of Fine Arts in Leipzig accepted him into a program for a classical education in painting and drawing. 

“It was lucky for me to be poor,” he later said to warm laughter at a mentor’s birthday, “for I had to seek work during the summer vacations and other free hours.” In seeking this extra artwork, one of the great physiologists of the 19th century, Carl Ludwig, hired him to draw a magnified cortex of the brain, and Brödel began to study objects of science for the first time. Pleased with the first drawing, the renowned physiologist then asked him to produce fifteen drawings of the heart. Surrounded by Ludwig’s whirring inventions, Brödel observed surgeries, taking copious notes. One invention in the lab measured blood flow; another, a blood-gas pump, separated oxygen from blood cells. Ludwig even had found a way to bathe a frog heart in life-giving solution—sustaining the world’s first organ living outside a body. The summer’s immersion into science established roots that later grew into Brödel’s revolutionary illustrations.

In those days, Brödel described Ludwig’s lab as “the Mecca for medical men of all classes and all countries.” His drawings caught the eye of a visiting anatomist and embryologist, Dr. Franklin Mall, who invited Brödel and his talent to the brand new Johns Hopkins Hospital in Baltimore, Maryland. Brödel accepted Mall’s invitation and in the middle of winter, he sailed five thousand miles across the Atlantic Ocean to America. 

“I can see Max as he arrived in Baltimore harbor in January, 1894,” wrote Cullen, who was Brödel’s first friend at Johns Hopkins. “He was wearing a stiff black hat and the curly locks were welling out beneath the brim.” Cullen had just returned from a six-month internship in Germany himself. “Just as soon as Brödel reached Baltimore he began to talk English and I began to attempt to answer him in German,” he wrote. The two friends would speak in this manner for the next forty-three years. 

Fresh off the boat, Brödel rode by carriage to the redbrick Johns Hopkins Hospital. Mall took him to meet Dr. Howard Kelly, the thirty-six year-old head of the new Gynecology Department and one of the “Big Four” founding doctors of the new hospital. In 1894 the field of gynecology was in its infancy. Kelly, successfully performing abdominal surgeries deemed impossible by most medical communities, was gaining renown. Brödel found himself tasked with illustrating the lifesaving surgical procedures in Kelly’s first book, Operative Gynecology.  His first assignment was to draw Kelly’s cutting-edge procedure for repairing a prolapsed uterus.

He was soon in over his head.

Medium Power (x100): The Work 

“Each operating day [Max] would confer with the Chief; sometimes it was a specimen that Kelly wanted drawn, sometimes a new operation that was to be sketched,” wrote Cullen, who was also a surgical resident of Kelly’s.

“I worked hard but with little success,” Brödel confided to his colleagues later in a letter. “I felt sure I could draw what I understood but found it exceedingly hard to plan a picture so that any one, even a layman, could understand it.”

The physicians urged him to accept the help of a camera and he “obediently did so for awhile” until he realized that the “mere copying of a medical object is not medical illustrating at all, which, as every medical man knows, goes much deeper than that.” Brödel discovered that in order to draw an accurate rendering of an operation, he had to convey motion, pressure, placement of the sutures, and even the diseased parts of the affected organs. He began to dissect the pelvic and abdominal structures over and over, always without gloves so he could feel the textures of the tissues.

“It was lucky for me that Dr. Kelly had the remarkable gift of explaining with sketches,” Brödel later said. As their professional rapport grew, Kelly would explain the information Brödel needed to convey in just a few blunt lines of his pen.

“No drawing was made by me,” Brödel wrote in a bulletin to Johns Hopkins, “without original study through injection, dissection, frozen section, or reconstruction.” When variations in adult organs puzzled him, he turned to the earlier shapes of human embryology to explore organ form and function. While creating more than 154 medical illustrations for the first volume of Operative Gynecology, Brödel ran up against large, blundering gaps in the field’s medical knowledge. When no human or book could answer his questions, Dr. Kelly encouraged Brödel to head to the lab to investigate for himself.

On one occasion Dr. Kelly requested anatomical data about the blood supply to the kidney. Brödel and Cullen headed to the autopsy lab, where Brödel found a healthy-looking kidney, attached it to the tap, and flushed its delicate tubes with water. Cullen then watched Brödel fill the arteries with red dye, the veins with blue and the ureter with yellow. Next they prepared the kidney using methods Brödel learned in Ludwig’s lab and studied the result together.

“Various portions of the kidney reminded one of the branches of an apple tree, and all over these branches were minute apples,” reports Cullen. “They were the glomeruli or filters of the kidney.” Brödel pointed out a bloodless line in the delicate organ and suggested that surgeons could slice it along that course when extracting a stone, minimizing damage to blood vessels. Now called the Brödel bloodless line, it is still used by doctors today.

During this steep learning curve of the “wonderful Kelly Period” as he called it, Brödel discovered—or rather invented—a new type of illustrating. Frustrated with his inability to capture the “sparkling highlights that characterize wet, living tissue” with the usual tools, he created a new technique: the carbon dust method. This method, which uses filed carbon dust and dry brushes on heavy stipple board paper, marked a new era in scientific illustration that continues to this day.

First, Brödel would take a heavy paper covered with chalk or china clay. He would outline an image on tracing paper and then bring it into contact with the heavy paper, leaving an imprint of the overall form. Next he would take a dry brush and delicately layer carbon dust onto the outline as if he were painting. This created a rich sense of depth. As he worked, he lifted highlights out of the carbon dust with an eraser, etched in precise details using a scalpel, and darkened lines with black watercolor or carbon pencil. 

The illusion of the carbon-dust organs practically popping off the page was startling. So much so that a Hopkins nurse once tried to pick up a gallstone she thought Brödel had glued to his stipple board.

In a diary he wrote, “The only way to plan a picture is to leave paper and pencil alone until the mind has grasped the meaning of an object…copying a medical object is not medical illustrating. The camera copies well, and often better than the eye and hand…in medical drawing full comprehension must first precede execution.”

When volume one of Operative Gynecology was published in 1898, it propelled the up-and-coming Dr. Kelly into the forefront of American gynecology. And Brödel’s 154 illustrations—cutaway anatomical diagrams and step-by-step surgical procedures, many drawn from the surgeon’s perspective—advanced medical illustration around the world. Nothing close to their stunning realism and anatomical precision had ever been seen in print before.

Following his debut in Operative Gynecology, he drew and painted specimens for other Johns Hopkins physicians to expand his grasp of human anatomy, pathology and physiology. 

As his cutting-edge illustrations circulated to medical communities around the world they made Johns Hopkins physicians famous. 

High Power (x400): The Man

True to his musical roots, Brödel kept a piano, which he played frequently, in the hospital—in the center front room on the third floor. His friends and family described music as the balm of his soul throughout his life. In 1913, H.L. Mencken, the American journalist and satirist, invited Brödel to join his Saturday Night Club, a group of rowdy musicians and intellectuals that played music together for two hours every week, followed by boisterous conversation and beer.

As young friends, Brödel and Cullen would take long afternoon walks out in the country, then sit on a fence and read German. They went on hunting trips in the forests of Canada, one memorable outing featuring a one-armed guide, all three of them falling into a freezing brook at night, and a lynx pressing his face against the windowpane of the cabin where they subsequently took shelter. 

Sometimes on long walks with Cullen, Brödel hunted for artist’s conk mushrooms, fungi about a foot and a half wide, growing on the side of the trees. He’d take them home, dry them, and with a pin etch an intricate scene on their delicate white undersides. “These pictures he usually presented to his friends,” Cullen notes. “They were greatly admired and treasured. I have never seen their equal.”

Brödel was a great outdoorsman who fashioned his own fishing tackle. When Cullen would visit his sister in a nearby town, he’d often drop in on Brödel fishing at his wharf on the way home. 

“As soon as he saw me coming he would leave his rod and slip behind his boathouse to [his garden by] the shore; by the time I got there he invariably had a red and green bouquet to hand me, a fine bunch of young radishes. He had a new crop of these every week or two, and this was a regular ritual with him.” 

One day in 1899, after cutting his left, non-dominant hand while performing a dissection, Brödel’s arm became seriously infected. He entered Johns Hopkins Hospital as a patient and underwent multiple surgeries to separate his nerves from the scar tissue. Always the investigator, he mapped and illustrated his nerve damage while he healed. The surgeon who worked on him urged Brödel to publish his drawings, but busy with his other duties, he never did. They are now held with his other original illustrations at Johns Hopkins University. 

In 1900, when he was thirty years old and had been working with Dr. Kelly for six years, a “charming young lady” from Sandusky, Ohio arrived at Johns Hopkins. Ruth Huntington was a recent graduate of zoology and botany from Smith College. While in school, her notebook drawings impressed her professors so much that she began drawing botanicals for the Encyclopaedia of American Horticulture.    

Huntington had been invited to Johns Hopkins by Dr. Mall, the same physician who’d recruited Brödel. As soon as she arrived at Mall’s laboratory Brödel dropped in to pay his respects to the new artist in residence, showing her his carbon dust method. They soon discovered their mutual love of music. “Naturally,” reports Cullen, “it was not long before Brödel thoroughly appreciated Miss Huntington’s unusual ability both as an artist and as a musician.” They worked on illustrations and began to play the piano together. One summer day in 1902, Dr. Kelly invited Huntington and Brödel to his summer camp on Ahmic Lake in Canada. The two artists paddled over to Birch Island, about half a mile from the Kelly camp, returning late that day looking very happy. Around the campfire later that night, Dr. Kelly announced their engagement to “the jolly group.”

A few years later, the new couple returned to Ahmic Lake to build their own camp, and Cullen and his family followed suit. Cullen and his wife would “spend very happy evening[s]” playing cards with the Brödel’s at least once a week. “Max was invariably my partner,” Cullen wrote in his letter to the Medical Library Association. “Who usually won is a secret, but one thing is certain, Max and I often lost.” The Brödels had four children: Elizabeth, who became a scientific illustrator for New York Hospital; Ruth, who died at age three from scarlet fever; Carl, who became a geology professor at Johns Hopkins University; and Elsa, who wrote creatively and pursued fashion in addition to raising a family.

Brödel continued illustrating at Johns Hopkins for seventeen years, creating thousands of pictures for books authored and co-authored by Dr. Kelly in gynecology and on diseases of the kidneys, ureters, and bladder.

In 1910, when Brödel was forty years old and in the prime of his medical illustrating career, Dr. Kelly retired and finalized his last publication, which included 357 illustrations by the artist. Together, the two men had changed the scientific illustration game, but now funding for Brödel’s work was ending. Upon the famous gynecologist’s retirement, Brödel received an urgent invitation to join the staff of one of the finest private clinics in America, the Mayo Clinic. 

“I was tempted to go elsewhere,” Brödel wrote in a letter to his colleagues, “but my roots were deep in the ground and I was loathe to leave Johns Hopkins.” His friends suffered similar reactions. 

“I was worried sick at the thought of my friend’s departure,” wrote Cullen. “One day at camp I walked down to my tent, pulled out an old corncob pipe, filled it and struck a light and dreamed. I dreamed of a department of art as applied to medicine in the Johns Hopkins Medical School. Here artists who wanted to make medical art their life work could get training.”

Cullen tracked down and convinced a hardheaded businessman and art collector named Henry Walters to fund a fledgling school. When Cullen met with Walters in New York, the financier told him, “I am not interested in medical illustrations; I took twenty lectures in medicine at Harvard and nearly vomited my boots up. However, I appreciate the value of medical illustration and will give the Department of Art as Applied to Medicine $5,000 per year for three years.” He requested to remain anonymous. 

Four days before the Mayo Clinic required Brödel’s answer, Cullen received an acknowledgement letter from Walters and called an emergency luncheon with the Johns Hopkins president and Board of Trustees at forty minutes notice. Cullen then went in-person to Max and Ruth Brödel to tell them the funding came through for them. “Thus,” he wrote, “the Department of Art as Applied to Medicine came into being.” 

It was the first medical illustration program in the world.

The Department opened in 1911, with Brödel at its helm. Five students enrolled—both men and women—to, as Brödel described in a bulletin to Johns Hopkins, “study the subject in the form of pictures, not in words.” Brödel required his students to begin every drawing in the dissection room, gaining anatomic and histologic knowledge first “with their own hands, slowly and thoroughly.” Only then would he allow them to put pen and pencil to paper. In the bulletin he explains:

“[The program’s] purpose is to bridge the gap existing between art and medicine, and to train a new generation of artists to illustrate medical journals and books in the future and spare them the years of trial and disappointment of their self-taught predecessors.” 

For one of his course demonstrations, Brödel would place two articulated skeletons directly behind large panes of glass. He’d then pose two live, nude models beside each skeleton—one a heavyset man and the other a lean one. To his students’ amazement, he would proceed to draw on the glass with colored crayons, building each skeleton up with nerves, veins, arteries, tendons, muscles, and lastly covering it with flesh, until it resembled a portrait of the model standing beside them.

Between 1911 and 1940, which Brödel described as “very happy years,” he trained over two hundred medical illustrators. But the beginning of World War I brought the first wave of anti-German sentiment to Brödel’s doorstep in Baltimore. Public schools across the country scrubbed the German language from their curriculums. In the backlash of suspicion against them, many German immigrants Americanized their names. And during the war Brödel was no longer allowed to cross the Canadian border to visit his cabin for summers with his family. 

“Max had a very unpleasant time of it in World War I, and would’ve suffered almost as much in World War II if he had lived,” wrote his friend and fellow Saturday Night Club member, Menken in his diary. “The war was taboo at the club…we had two Jews among the members, a Czech, and Americans of widely varying views… we played through the four years without a rift.”

When Prohibition surfaced in the 1920s, a stubborn Brödel used his knowledge of bacteriology to cultivate yeast lines for homemade German beer. Mencken wrote, “Brödel labored long and hard over these bootlegged jewels…in this humanitarian work [he] had the aid of various Johns Hopkins colleagues, including Stanhope Bayne-Jones, who was associate professor of bacteriology in 1923 and 1924.”

When the Great Depression hit and his pupils struggled financially, Brödel kept them in school by assigning them housekeeping tasks for the department in lieu of tuition. He and Ruth frequently invited them over for dinner for a boost in spirits and a home-cooked meal. With the rise of Hitler in 1938, anti-German sentiment rebounded, and to Cullen’s sadness, Brödel was again prevented from visiting Lake Ahmic.

In 1940, the seventy-year-old Brödel retired from teaching, and was immediately contracted by Johns Hopkins’ Surgical Department to draw specimens of the inner ear. Willard Goodwin, one of his prior students and a doctor at Johns Hopkins Hospital, would stop by his new, sunny office.

“I often used to visit him,” wrote Goodwin, “to see what he was doing, and to be cheered by his unfailing wit and charm… He showed me his many dissections [of the inner ear], his beautiful sketches; and for the first time, I think, I began to understand how it really worked. As he pointed out, all the classical textbook drawings were far from really accurate; and with his detail and perfection he was setting out, at something over seventy years, to set them right.”

In 1941 Brödel fell ill with pancreatic cancer. During his stay in the hospital for exploratory surgery, his physicians complained about the hordes of visitors coming to see him. Goodwin wrote, “When the word passed that ‘Papa’ was in the anesthesia room…we went in to see him. He didn’t recognize us at first…so I pulled my mask down and smiled very hard and chatted with him for a little while, holding his wonderful knotted hands as we talked. He was a little scared, as we all were, but defiant and chipper and joking, brave and strong. I loved him then as never before.”

Three days later on October 25th, just before midnight, Max Brödel passed away. Cullen stayed with his body during the autopsy.

In 1945, the same year Cullen wrote his letter to the Bulletin of the Medical Library Association to memorialize the man behind the remarkable illustrations, many of Brödel’s former students joined together to found the Association of Medical Illustrators. Between 1941 and 1952, they started eight medical illustration programs in the U.S. and Canada.

In his letter Cullen wrote, “I have given you this glimpse of Max Brödel to show you that he was no dreamer, that he was very capable in solving small difficulties as well as large ones, and that he was an ideal and most loveable companion. He was absolutely fearless and most unconventional. Nobody ever had a better or truer friend.”

In 2011, Johns Hopkins’ Department of Art as Applied to Medicine celebrated its one hundred year anniversary. The commemoration included a massive art exhibit of Brödel’s original work, international speakers, beer brewed from Brödel’s own recipe, and music he wrote for the Saturday Night Club.

“Although he left us in 1941,” concluded Cullen in the letter, “he still lives in his many drawings, in his many students, and in a personality that will be remembered as long as any of his old friends live.”