Photography was invented at the back end of the industrial revolution and although there are many examples where it is used to illustrate medical conditions before the outbreak of World War II, it was only after World War II that departments of Medical Photography (as they were then called) began to emerge. The proliferation of such departments and of Medical Photography as a profession, therefore, coincided roughly with the succession to the throne of Queen Elizabeth II. Since this time the profession has witnessed major changes in both the equipment and methods used to capture and illustrate patients’ conditions and the areas of work covered by the profession.
The digital revolution of the late 20th and early 21st centuries saw changes in photography almost as significant as its invention during the industrial revolution. So significant and numerous were the impact of these advances on Medical Photography (which by then was gradually changing its name to Clinical Photography) and Illustration, that they can’t be covered in detail here and it is hoped this piece will be followed by others which will encompass the different changes experienced by Medical Illustration in general. So, this provides a brief, flying overview of changes to some photographic equipment and processes.
The cameras used by the early pioneers of medical photography were large format cameras where the sheet film used may have been as large as 10×8 inches. Smaller cameras then became available such as the Kodak Specialist half-plate where the film was smaller at 6 ½ x 4 ¾ inches. The black-and-white cut film was pre-loaded into double dark-slides and image composition and focus was carried out under a black cloth to exclude the ambient light. In the clinical studio, cameras were mounted onto a large sturdy tripod, or a vertical column stand which could be moved around on castors. Studio lighting was often provided by large floor-standing flash units receiving power from mains-fed powerpacks. When the flashes fired with a loud pop there would then be a hum as the powerpacks recharged. It must have been quite disconcerting for the poor patients.
Film processing would have been in deep-tanks (about 15 litres) and after processing and washing, the film was dried in a large metal drying cabinet before the resulting negative was printed. This involved using large-format enlargers and dish-developing the prints in trays, themselves usually contained within a long, shallow, lead-lined sink. Prints were then washed and dried on a Kodak rotary drying machine. Later, in the mid-1970s? prints were processed using roller processing and drying machines. Prints were dry mounted onto cards carrying the patient’s details and were then ready to be inserted into patient notes.
Camera and film formats became smaller as time went by, moving to medium format such as Hasselblad, which had removable 12 exposure film backs and then in the mid to late 60’s to 35mm. Although 35mm cameras had been around since the 1930’s, the advent of the single lens reflex (SLR) camera with the introduction to the photographic world of the infamous Nikon F in 1959, became a real game-changer for the profession, providing flexibility and portability.
Colour slide film was used which was ideal for teaching, as slides could be projected to audiences. Kodachrome became the standard for most departments. The films would have to be sent to Kodak’s labs in Hemel Hempstead. Kodak provided (at an additional cost) an ‘Urgent’ service for medical, police and scientific photographers, but it still took a long time for the ‘little yellow box’ to be returned by Royal Mail, at which point slides would have to be identified to match the patients, usually done by photographing a patient’s details before (and sometimes after as well) the clinical photos themselves. The mounted slides were numbered sequentially which made this task manageable. Photographing the patients’ details as a means of identifying images continues today.
The digital age marked the appearance of filmless cameras and the disappearance of darkrooms, developing tanks, print processors, slide processing machines and slide mounting machines (both of which had appeared in many larger departments meaning laboratories no longer needed to be used for processing), dry-mounting presses, tacking-irons, lightboxes, film, rotary glazers, drying cabinets, film clips, film cassettes, bulk film loaders and scissors. Most of the above were replaced by computers and digital printer and then the latter itself replaced by image management software, resulting in clinical photographs forming part of the patients’ digital online records.
The modern department of Medical Illustration is far less complex in terms of physical processes and equipment and in many ways, a less interesting place for a youngster on a visit for work experience, as so much of the work is undertaken on computer. Although the basic skills in capturing images remain the same, a different, and arguably, much less technical skillset is needed following photography than prior to the advent of digital photography. However, digital photography and mobile devices with cameras present their own complex challenges to clinical photographers in their role as image management champions within hospitals.
As mentioned in the beginning, this has had to be a very brief overview of one part of Medical Illustration and has not covered the changes in the production of teaching material, medical, video (cine originally), ophthalmic photography and graphic design. These, along with more recent advances in diagnostic aids such as thermography, dermoscopy and 3D photography will need to be covered in subsequent articles.
- Ralph Marshall circa 1960, surrounded by equipment in use at the time (curtesy of Cardiff & Vale UHB Medical Illustration)
- Clinical Photography 2022, surrounded by equipment in use today (Curtesy of Medical Illustration, University Hospitals Birmingham Foundation Trust) x2
- Camera equipment through the ages (Curtesy of Clinical Photography & Medical Illustration, Manchester University Foundation Trust)
- Hand held lighting equipment through the ages (Curtesy of Clinical Photography & Medical Illustration, Manchester University Foundation Trust)