Frank H. Netter, M.D.

Artist, Physician, and Influential
Master of Human Anatomy

Looking at the art of medical illustrator Frank H. Netter, M.D., it becomes abundantly clear that beauty is, indeed, not just skin deep.

Perhaps the most accomplished and influential medical illustrator of the 20th century, Dr. Netter produced almost 4,000 paintings of human anatomy, physiology, and pathology, as well as illustrations of groundbreaking discoveries in medicine that occurred during his lifetime. His work has documented everything from the first computerized axial tomography (CAT) scanners to the first artificial heart transplantation procedure.

With a career spanning more than 50 years, Dr. Netter's medical illustrations are standard reference materials in medical school libraries around the world. In 1989, he culled his vast body of work to produce the quintessential anatomy textbook, the Atlas of Human Anatomy. Since its publication, the Atlas has enjoyed a reputation as the number-one anatomy reference in medical schools. It is the text that second- and third-year medical and allied health students recommend most to first-year students.

Born to be an artist, Frank Netter was trained as a surgeon. He used his knowledge of medicine to understand a subject; he used his talent as an artist to explain it. And as someone who experienced the demands of medical school first-hand, he knew what students needed to learn and used his artistic gift to teach effectively.

Dr. Netter's drawings not only define and clarify anatomical structure, they also emphasize the beauty, rather than the morbidity, of anatomy. It is the marriage of science and art that characterizes his work. This blend of disciplines is also reminiscent of the contributions of Leonardo da Vinci and Michelangelo, as well as collaborations that took place during the Renaissance, such as that between the anatomist-physician Andreas Vesalius and the artist Jan Stefan van Kalkar of Flanders, a favorite pupil of Titian. In fact, in a 1991 New York Times article, Dr. Netter was described as "medicine's Michelangelo."

"Each Netter illustration masterfully unravels a medical riddle. Their stringent clarity, stunning accuracy, and startling beauty illuminated the path of learning for each of us," says Dr. Frederick Kaplan of the University of Pennsylvania. "Few people have taught more students, and few have extended their influence across so many generations and specialties."

"Being a doctor himself, Dr. Netter had a special insight into medicine," says pioneering heart surgeon Michael DeBakey, M.D., Chancellor Emeritus and Olga Keith Wiess, Professor of Surgery at Baylor College of Medicine. "He makes anatomy come alive. When you look at his illustrations you can almost see the muscles contract and the lungs take in oxygen. His work depicts not just the structure, but the functionality of organs in an animated, direct manner that is reminiscent of the work of Leonardo da Vinci."

"Dr. Netter's contribution to the study of human anatomy is epochal," DeBakey continues. "He has advanced our understanding of anatomy more than any other medical illustrator since the 16th century, when Vesalius introduced drawings based on cadaveric dissections."

Netter's Emergence as an Artist

Dr. Netter embraced art at an early age. As a child growing up in New York City, he preferred visits to the Metropolitan Museum of Art to playing ball with other children, and would lose himself in the paintings of Velasquez, Sargent, and other masters. As his fascination with the human form began to grow, he started to closely observe how people looked, how they moved, how they positioned their bodies. His ability to capture these physical nuances later became a signature of his work.

"I always tried to make [the person in the painting] look like a living patient, with the proper facial expression and so forth - to show that this is not a machine we're dealing with," said Dr. Netter. "We're not repairing a television set when we're treating these patients." His sense of humanity and empathy for patients distinguishes his paintings from those of other medical illustrators.

He continued to draw throughout his youth, later studying art at New York's National Academy of Design. Dr. Netter was eventually able to support himself as a commercial illustrator, contributing to such popular publications as the Saturday Evening Post, Colliers, and The New York Times. It was during this period that he became friendly with Normal Rockwell, an artist with whom he has often been compared.

But Dr. Netter's mother never supported her son's desire to be an artist - she wanted him to become a doctor and feared that the Bohemian lifestyle of an artist would lead him to ruin. When she died, he honored her memory by enrolling in the New York University Medical College.

Although he was now a medical student, Dr. Netter never stopped drawing. During class he would sketch along with his professor's lectures. "I found that I could learn my subjects best by drawing," he said. "I used my drawings to educate myself."

Dr. Netter's professors took notice of his unique talent and often hired him to illustrate their textbooks and research papers; a sideline career that he continued throughout his schooling, internships and residency.

He then took a job in a private surgical practice in Manhattan. But it was the middle of the Great Depression, and even the surgery business was slow. So Dr. Netter continued to supplement his income as a medical illustrator, and soon dropped his surgical practice altogether.

Novartis and Netter: A Prolific Partnership For More Than Half a Century

At the time, the pharmaceutical industry was transforming the medical field by developing new medicines that were changing clinical practice. Industry leaders were looking for ways to communicate to the medical profession about these new drugs.

The partnership between Dr. Netter and what was then Ciba Pharmaceutical Products began in 1936 (Ciba later became Ciba-Geigy Corporation, which merged with Sandoz on January 1, 1997, to become Novartis). As Dr. Netter's lifelong patron, Novartis commission him to create The Ciba Collection of Medical Illustrations, an encyclopedic series of more than a dozen volumes on the anatomy, physiology, pathology and histology of the human body, system-by-system. According to experts on Dr. Netter's work, this series is considered "the most perfectly executed program of promotional service to medicine ever put forth."

While The Ciba Collection of Medical Illustrations was a significant contribution to the study of anatomy, Dr. Netter considered the 1989 Atlas of Human Anatomy his crowning achievement and referred to the book as his own "Sistine Chapel."

Unfortunately, the Atlas was to be his last masterpiece; Dr. Netter died two years after its publication, at the age of 85. In July 2000, Novartis sold the rights to Dr. Netter's work to Havas MediMedia and its subsidiary, Icon Learning Systems. In August 2005, the rights were sold by Icon to Elsevier.

The Forefathers of Anatomy - A Brief Retrospective

To better appreciate Dr. Netter's impact on medical education and the field of anatomy, one must look at his contributions in the context of those of other artists and anatomists, who, like he, combined art and science.

The study of anatomy dates all the way back to the ancient Egyptians, but the art of medical illustration did not emerge until the Renaissance. Artists such as Leonardo da Vinci and Michelangelo were the first to use human cadavers to learn the body's form. In fact, Leonardo's notebook contained some of the most beautiful and accurate medical illustrations of his time, but he died before he could compile them into a full text, as he had planned. The work was misplaced, and was only rediscovered and published in the last century.

Fortunately for science, one of Leonardo's contemporaries, Andreas Vesalius, was able to produce a lasting emblem of his scientific genius: De Humani Fabrici Libri Septem (De Fabrica). Published in 1543, the only known, completely in-color, first edition of the book was recently auctioned at Christie's in New York.

An anatomist, physician and professor, Vesalius pioneered the dissection of human cadavers to study anatomy. It was this experience that revealed to him the errors of the work of Claudius Galen, a physician of the Roman period whose anatomical theories, based on his dissections of animals, had been universally accepted and used until the Renaissance.

Since Vesalius was not an artist, he commissioned Titian's student Jan Stefan van Kalkar of Flanders and other Renaissance artists to produce the illustrations in De Fabrica. Vesalius worked closely with the artists to reach a level of aesthetic beauty and scientific accuracy that had never been achieved before.

De Fabrica was the standard anatomy text for centuries, supplanted only when technological discoveries revealed new understanding about human anatomy. The invention of the compound microscope in the 17th century greatly enhanced anatomical studies, and the discovery of X-rays in the 19th century by German physicist Wilhelm Conrad Roentgen enabled anatomists to study tissues and organ systems in living animals.

In recent years, new technology and medical breakthroughs have sharpened our ability to see and understand the human body. CAT scans, ultrasound, and especially magnetic resonance imaging (MRI) have enabled scientists to virtually enter the living human body. By emitting nuclear radio waves and "listening" to the body's electromagnetic transmissions, MRI technology can generate thin-section images of any part of the body from any angle, without surgical invasion.

It is these recent technological advances that necessitated a revision of the Atlas. Working in the Netter style, Novartis-sponsored artist Carlos Machado, M.D. updated a number of plates to be consistent with knowledge gained largely through the use of medical imaging techniques used to study anatomy in living subjects (rather than in cadavers). Dr. Machado has also added cross-sectional views, now believed by anatomists to be essential to students' understanding of anatomy, especially in the interpretation of new imaging techniques.

Once, speaking quite objectively about the power of "pictures" in the illustration of medical concepts and procedures, Dr. Netter said, "Pictures are hard taskmasters - they force us to think clearly and logically. One can write or talk around a subject one is not quite sure of, but one can scarcely leave blank spaces in the middle of a picture; the picture must fit together properly." We offer Dr. Netter's own statement as a fitting tribute to this genius and his legacy of beautiful, power illustrations, all 4,000 of which, indeed, "fit together properly."

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