Near his basement workbench, Cox keeps a few skulls that he looks to for reference. He also has this skeleton he can check for accuracy.

Near his basement workbench, Cox keeps a few skulls that he looks to for reference. He also has this skeleton he can check for accuracy.

by Lou Mancinelli

From studying eighth-century medieval English to repairing bicycles to digitizing medical drawings in the 21st century, the path of Mt. Airy illustrator Birck Cox, 68, has led from the Pacific Northwest south to Georgia and northeast to Allens Lane in Mt. Airy.

If you’ve ever needed surgery that required a specific, likely unpronounceable operation, chances are the surgeon who performed the precise task learned what that area of the body looked like under the skin and bone, between the muscle and the nerve based on a medical illustration.

Just as much a part of a medical education as white lab coats are artists who serve as a surgeon’s picture scribe or illustrate a medical student’s textbook. Where once the sketches were pen and ink, today the digital era has transformed the industry.

In Philadelphia, consistent assignments generated by universities and hospitals have enabled Cox to further establish and solidify his career as a freelance medical illustrator. That’s what attracted Cox to East Mt. Airy in the first place when he moved there with his wife in 1994.

Prior to that time, Cox and his wife had been commuting for some time every day from Lancaster. People always ask Cox why photography or X-rays have not yet made the medical illustrator obsolete.

“Photography has had close to 200 years to do it,” he said. “The reality of it is, if that’s all we needed, if medical illustration was only to consist of normal anatomy seen in its regular position, it wouldn’t exist. But that’s not what people need.”

What doctors need is an illustration, or a guide, for how to remove a tumor from the neck, for example. Or how to fix an athlete’s torn ACL. Pharmaceutical companies use drawings to teach their staff how the drugs they sell work.

Anatomy has been a well developed academic subject since long before the first publication of “Gray’s Anatomy,” the quintessential English language anatomy textbook, in 1858. Still, “Gray’s” does not provide detailed photos of, say, brachial plexus in situ, near where the neck meets the shoulder. That’s an area of the body Cox has illustrated, however.

Cox works with brushes and watercolors, as well as pen and ink, computer and printer. He will scan a drawing into the computer, adding labels and any detail corrections on the screen.

He’s worked as a resident medical illustrator at universities, and his work has appeared in various textbooks. He has also created medical storyboards for a 3D-animation house, developed drawings for advertising and courtroom use and co-authored a book.

He also draws new inventions for medical device companies, such as the LAP-BAND®, which is used in bariatric surgery for morbidly obese patients. His speciality is the head and neck. Near his basement workbench he keeps a few skulls that he looks to for reference.

It all started quite accidentally. In his mid-20s he was working for a professor at a university in Portland, Oregon. The professor needed computer illustrations for an experiment. “I can do them,” Cox insisted.

This illustration of foot tendons, like all of Cox’ work, is so sharply detailed that it is very helpful to medical professionals.

This illustration of foot tendons, like all of Cox’ work, is so sharply detailed that it is very helpful to medical professionals.

It was around 1972, five years after he graduated from Reed College in his home state of Washington with an English degree focused on medieval English. Since the demand for medieval English experts in non-existent outside of academia, Cox was working as a bicycle mechanic, but he wanted to do something completely different. He felt he was not being sufficiently challenged.

For a year he mulled over what he wanted to do with his future. Eventually, Cox married the love for drawing his mother had nurtured in him as a youth with an interest in biology.

So Cox studied for a few years in the Portland area and then, in 1977, moved to Georgia, where he earned a masters degree in medical illustration from the Medical College of Georgia. He later moved to Virginia, where he worked at a medical school and met his future wife. The couple soon moved to Lancaster, where they lived for eight years, and from Lancaster to Mt. Airy.

Cox works on the computer “because it’s the fastest way to get the job done,” but for Cox, who’s thrived in the industry for over 30 years, it still starts with a pen and a piece of paper.

One thing his Mac helps him do is patch over mistakes or create more detailed areas in Adobe Illustrator, which he’s used since the mid-’80s, and drop them back into the larger image in Adobe Photoshop.

As an obviously talented artist, Cox has also ventured time and again into his own creative pursuits. He once tried a sort of comic strip. “It was a disaster,” he said. Sometimes he paints watercolor landscapes.

Nevertheless, he’s found his role. Everything new that comes out in medicine — and anything at all that happens in medicine — needs to be illustrated. “If it only exists as an idea or theory,” Cox said, “one of the ways people can solidify it is with a medical illustration.”

For more information visit www.bcillustration.com or the Association of Medical Illustrators (AMI) at www.ami.org.