Reviving out-of-copyright medical illustrations for use in medical curricula.

Abstract

To the Editor, Clinical Anatomy:Amidst medical curricula that are undergoing radical reform,there is concern that anatomy teaching may be inadequatefor the standards of postgraduate residency programs (Princeet al., 2005; Fitzgerald et al., 2008). With the decreasingnumber of hours spent in anatomy and embryology laborato-ries (Craig et al., 2010), there also emerges a need for defin-itive and accessible illustrations for the education of medicalstudents. The illustrations contained in modern textbooksoften lack comprehensive detail, and are occasionally in needof correction. Moreover, the simplified style of modern medi-cal illustration has been described as a desired compromisebetween the professional and initiate (Strong, 2011).Medical students will often heavily utilize online resourcesprovided to them, given the portability of the material andthe ability to utilize it at their own convenience and pace(Nieder and Nagy, 2002). There are myriad potential difficul-ties with copyright in modern medical education, and anincreasing number of institutions have been subject to litiga-tion as a result of unauthorized use of copyrighted materialsin their printed and online modules (Gutman, 2011). We pro-pose that modernization efforts involving older, out-of-copyright material may represent a viable solution for thecreation of high-quality teaching resources.As digital archiving on Internet databases rapidly grows,there has been an unprecedented expansion in the availabil-ity of scanned out-of-copyright text and illustrations accessi-ble online. Consequently, there is an opportunity to utilizeand modify exceptionally-detailed, accurate medical illustra-tions. Here, we attempt to modernize these images for usein contemporary digital databases.Two scanned images were selected for modernization.The first, “Cloaca of human embryo from twenty-five totwenty-seven days old” from the 1918 edition of Gray’s Anat-omy (Gray and Lewis, 1918), was downloaded from Wikime-dia Commons (2014, September 6). The second, “Theforebrain section” from the 1920 edition of Ranson’s Anat-omy of the Nervous System (Ranson, 1920), was copiedfrom the Internet Archive (2010).Digitally-scanned online versions of the illustrations werecompared with hard copies to ensure correct attribution.Adobe Photoshop CS4 was used to clean up and sharpen thesource images, as well as remove the original label lines andbackground to yield an unlabeled base image. Subsequently,modernized labels were added, with improved positioning,clearer typeset and lines. In addition, additional hues wereadded behind the existing linework to define additional struc-tures. Legends were updated in keeping with changes in ter-minology and age estimates of embryonic stages. Thesemodernized images are presented (see Figures 1 and 2). Theillustrations are both enhanced with regards to clarity anddetail, while preserving the original focus. The figure legendsand labels were brought up to date with current conceptsand terms.There are no known copyright restrictions for the use ofthe human cloaca or the forebrain section illustrations in theUnited States and Canada as the original books were pub-lished before 1923 and the authors died [mt]50 years ago.Furthermore, as per Bridgeman Art Library v. Corel Corp(Bangle, 1999), the human cloaca illustration may be not besufficiently original to merit copyright in the U.S. because itis a drawing of a wax model by Keibel.Both images were made available under a Creative Com-mons licence. Four components of such a license exist, eachof which must be included or excluded. These are Attributon,ShareAlike, Noncommercial, and No Derivative Works. In thecase of our images, the former two were stipulated. Attribu-tion requires that one must give appropriate credit, provide alink to the license, and indicate if changes were made. Onemay do so in any reasonable manner, but not in any waythat suggests the licensor endorses them or their use of thematerial. Share Alike requires that if one remixes, trans-forms, or builds upon the material, this party must distributethe new work under the same or similar license as the origi-nal. For instance, we would be unable to apply legal termsthat restricted others from doing anything the license per-mits. Since Noncommercial and No Derivative Works condi-tions do not apply, one is free to copy and distribute thematerial in any medium or format, and remix, transform andbuild upon the material. This is legitimate for any purpose,even commercial.The availability of out-of-copyright materials from vener-ated medical texts represents a unique opportunity to mod-ernize old illustrations while preserving their high level ofaccuracy and detail. Updating of terminology that has sincechanged is feasible and worthwhile in service of the best pos-sible education in anatomy and embryology. The images con-tained within many anatomy and embryology texts of theearly 20th century were painstakingly prepared by physi-cians, scientists, and illustrators with an unparalleled appre-ciation for these domains.