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 Len Lear

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 because of 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.

And there is a pretty good chance that the illustrations relied on by surgeons were drawn by Birck Cox, 70, a resident of Mt. Airy for 23 years.

“Computers, for me, have become an integral part of the process,” Cox told us last week. “I still start with a pencil sketch at the drawing board, scan the sketch into the computer, change it, add labels, etc., then after it is approved, redo it in ink or in color, then scan that, make changes, add labels, etc. If nothing else, that process makes it easier to fix errors and blots before sending the work out. Everything I do starts as a pencil sketch but leaves my hands as a computer file.”

Cox' specialized talent is extremely painstaking and requires the highest levels of artistic skill, so it is not surprising that he refers to himself as semi-retired. “I have stopped taking on certain kinds of work, e.g., books and medical-legal courtroom art, to reduce my workload,” he said..  “Courtroom art can be a minefield, with very high stakes and a potentially crippling schedule. Who needs that at my age? So I can work at closer to my own pace and now with a large backlog of previous work in the same area (otolaryngology), from which I can draw. When you’ve done a few thousand drawings of the head and neck over a period of 10 years, there’s likely to be a sketch somewhere in the files that will help with what you are working on right now.”

Cox' interest in this highly pressurized field arose when he landed an entry-level job after college in a medical research institute and the PhD he was working on needed some illustrations of the experimental setup he was using. He did not realize that meant he would be doing the illustrations himself, but he was so pleased with the results that he began taking art courses (this was in Portland, Oregon) and exploring the idea of going into medical illustration.

“I wasn’t absolutely certain until I had two years of art school behind me, put together a portfolio for the grad school programs, sent it out and was turned down. At that point I became determined to get into it, beavered away in school for another year and got in on the second try.”

Cox wound up with a job at the Medical College of Virginia, but a job with better prospects appeared at the Hershey Medical Center (of Penn State U.). Birck was newly-married, “and my wife, who is Asian, wasn’t comfortable living in small, conservative Hershey, so we

chose a house in larger but equally-conservative Lancaster, PA.”

The move to Mt. Airy in 1994 came because, after seven years in Lancaster, Cox' wife got a job in Philadelphia and was spending a lot of time commuting, so they started looking for a house in

the city. “She wanted to live in a racially diverse part of town, looked into it, and the obvious

choice was, and still is Mt. Airy. Plus, it didn’t hurt that Philly had five medical schools at the time and roughly the same number of medical publishing houses.”

People often ask Cox why photography or X-rays have not yet made the medical illustrator obsolete. “That question is rude, but it does come up a lot when I tell people what I do,” Cox replied. “Have you ever looked at intra-operative photos of surgery? Bearing in mind that I actually know what the subject matter looks like, about 60% of the photos that docs send to help me interpret their writing are frankly incomprehensible.

“There are ways to make photos work well to describe a procedure, but it simply isn’t done in this country. It is done well in the UK, but the medical photographers there are armed with a lot more medical and anatomical know-how than their colleagues in this country. The simple answer is: yes, it would be possible to use photographs to illustrate parts of a surgical series, but there’s more to the job than that.

“Consider this possible scenario: You are a medical photographer. A busy surgeon materializes at your front desk and says: 'Hello, I’m Dr. Important, from Cardiology, and I need some slides, stat. I want to show a comparison between a PDA and a PFO, and what happens with blood mixing in each situation. Full color, and I need them by noon on Monday. Can you do it (it is currently Wednesday)?'

“But the question is 'Why are illustrations more useful than photographs?' One good reason is that the illustrator can happily ignore many of the details that would be included in a photograph and simply not bother including them ... There are lots of tricks to draw or evade attention and point out what the illustrator wants the viewer to see. An illustrator can use themwith ease. End of rant.”

For more information visit www.bcillustration.com