If you have ever opened a medical textbook, you have most likely seen one of James Perkins' illustrations at some point in your training.
Ivan Damjanov, author of Pathology for the Health-Related Professions (1st ed.), described him as "a talented artist [who] transformed my sketches and concepts into computer art," adding, "I consider him a magician.” Contributors to Netter’s Illustrated Pharmacology wrote, "We knew this book was going to attain its goal when we began to work with James Perkins."
But how does one become a medical illustrator, how does the "magic" happen, and what is its legacy? We asked the man himself...
You trained as a scientist rather than an artist. What initially drew you in that direction?
As a kid, I was obsessed with dinosaurs and fossils — and I never really grew out of that. For a long time, I assumed that fascination would become my career. I planned to be a vertebrate paleontologist, get a PhD, and probably teach in academia. With that goal in mind, I earned a bachelor’s degree at Cornell University, double-majoring in biology and geology, and then went straight into a PhD program.
What made you start questioning the academic path you were on?
I began my PhD at the University of Texas at Austin, but after a while I started having doubts. I took a year off and worked at a science museum — a very hands-on, family-oriented place. Then I decided to give academia another try, entered a PhD program at the University of Rochester in New York and stayed on that track for four or five years.
I loved what I was learning. I loved the classes. But I didn’t enjoy the research side of things at all — the grant writing, chasing funding, the whole publish-or-perish mentality. I’d passed my qualifying exams, written a dissertation proposal, and even started my research, but I realized that a lifetime of grants and papers held no appeal. Once I accepted that, I knew it was time to step away.
How did medical illustration first come onto your radar?
While I was still in my PhD program, I knew that a lot of vertebrate paleontologists supported themselves by teaching anatomy. That inspired me to study gross anatomy at the University of Rochester Medical School alongside first-year medical students.
That was the first time I ever encountered medical illustrations — and the first time I even realized that medical illustration was a profession. Seeing that work was a real eye-opener and made me start exploring whether that might be a path for me.
You had a strong science background — but what about the art side of things?
I had always done artwork for fun. I was always drawing and doodling. But as an undergraduate double-majoring in biology and geology, I had so many labs that I could never fit in a studio art class, even though I wanted to. The same thing happened in graduate school — there just wasn’t time. So by this point, I hadn’t done any serious artwork for about ten years, and I honestly wasn’t even sure I could still draw.
Still, I started looking for ways to combine those two interests — science and drawing. And I consider myself very fortunate, because right in my backyard was the Rochester Institute of Technology, which offers a master’s degree in medical illustration — the same program where I now teach. I took some night classes in art, partly just to prove to myself that I could still draw, put together a portfolio, and was accepted into the program. I completed my master’s degree in medical illustration in 1992.
What was your first step into professional medical illustration after graduating?
After finishing my degree, I moved to Atlanta, Georgia, and was hired by a small studio called DesignPointe Communications who did contract work for a wide range of major medical publishers.
At the time, those publishers included names like Saunders, Mosby, Churchill Livingstone, and Academic Press — all separate companies back then, long before they were folded into Elsevier. We were working for these individual, competing publishers, which made for an interesting mix of projects.
Was there a project from that period that really stood out to you?
Absolutely. While I was at DesignPointe, I worked on the first edition of Ivan Damjanov’s book, originally titled Pathology for the Health-Related Professions. In later editions — the second, third, and fourth — they dropped “related” and it became Pathology for the Health Professions. That project was a pretty big deal for me.
What made it especially exciting was that, according to someone I knew at Saunders, it was the first book they’d produced where all the artwork was created entirely using digital media. At the time, that was genuinely innovative — and it felt like being part of a real shift in how medical illustration was done.
What kind of range did you have in those early publishing projects?
It was incredibly broad. While I was at DesignPointe, I worked on all kinds of textbooks — a nursing skills manual, a phlebotomy text, an anesthesiology book. I also created all the artwork for the 28th edition of Dorland’s Illustrated Medical Dictionary. I suspect that artwork has since been replaced, because they seemed to redo the illustrations with every new edition, but that particular edition was mine.
I also worked on several surgical atlases, including an atlas of video-assisted thoracic surgery, and contributed some illustrations to Campbell’s Orthopedics, which is a very well-known, multi-volume set. That variety was a great education in itself.
Where did your career take you after DesignPointe?
In 1995, I moved to another company in Atlanta, but this time the work was very different. We created medical exhibits for attorneys to use in the courtroom — things for personal injury, medical malpractice, and product liability cases.
We’d build large, highly visual exhibits to explain medical concepts to juries, and I loved that work. It was creative, fast-paced, and very audience-focused — and a lot of fun.
What would you describe as your big break?
Ivan Damjanov recommended me to Vinay Kumar, one of the contributing authors to the Robbins Basic Pathology series. I started working on the last edition that Stanley Robbins wrote before he died.
Ramzi Cotran took over the series, which then became Robbins and Cotran Pathologic Basis of Disease. I illustrated five editions of each of those books over a span of about 25 years.
How did you make the transition from industry back into academia?
In 1998, a faculty position opened up here at the Rochester Institute of Technology, where I’d earned my master’s degree. It gave me the opportunity to come back to Rochester — and I’ve been on the faculty for about 28 years now.
I’m a full-time, tenured full professor in the medical illustration program, but I’ve always continued to do professional work on the side. One of the nice things is that the projects I take on — especially well-known or prestigious titles — also count toward my scholarly work. So I get to stay active professionally while still being fully engaged as an educator.
What have you learned about yourself through teaching others?
I don’t really think of myself first and foremost as an artist. I think of myself as a scientist who draws — someone who uses visuals to communicate complex science. And I think that perspective comes through in my teaching.
Content critique comes naturally to me. I can confidently tell a student if their anatomy is wrong, if the cell biology is off, or if the science itself isn’t accurate. The thing I struggle with most is critiquing pure art skills. I don’t have a lot of formal training in the arts, so it’s difficult for me to look at someone’s drawing and tell them how to make it more aesthetically refined.
What does your creative process look like when you start a new illustration?
It usually starts with an initial conversation — for textbook projects I like to talk with the author or publisher about the style they’re looking for, the workflow, and how approvals will happen. The level of direction varies — sometimes authors send very detailed instructions or even a rough doodle for me to interpret, and other times they’ll just say, “We need an illustration of apoptosis,” and give me the freedom to develop it on my own.
I always ask for the manuscript, because I want to read exactly what they’re trying to teach and make sure the illustration supports that. Almost every project requires additional research on my part — sometimes just to refresh my knowledge, other times to really get up to speed on a topic I’m less familiar with.
Once I start creating, everything is digital. I used to send rough sketches back and forth before finishing an illustration, but I stopped doing that years ago. Now it’s easy to make changes later, so the process is much more fluid.
What has been your most challenging commission?
One of my favorites was also one of the most challenging: Netter’s Atlas of Neuroscience. The authors gave me a tremendous amount of latitude. They might say, “Illustrate the blood–brain barrier,” and one of them would send me a stack of review articles — essentially everything that was known about the topic — and then leave it to me to figure out how to visualize it.
The same thing happened with the third edition, when they wanted to add a whole series of full-page plates — one on astrocytes, another on microglia, another on oligodendrocytes — all the different cell types in the central nervous system. Again, I’d get review articles as a starting point, read through them, and then begin sketching. In those cases, I did start with pencil sketches, partly to get my ideas down and partly because the concepts were so complex that I wanted feedback from the authors before moving to a finished illustration.
Those projects were challenging because they were so open-ended and research-intensive — but for me, that’s also what made them fun.
Are there any illustration opportunities still on your wish list?
I sometimes think it would be incredibly rewarding to take the kind of work I do on individual illustrations and apply it to an entire book project. Medical illustrators do much more than just create pretty pictures to decorate a text — we should be an integral part of developing the whole art program, from establishing the visual style to doing the research and even proposing what illustrations are needed.
I’ve done that kind of work for many books, but usually on an illustration-by-illustration basis. I’d love the opportunity to work with authors right from the outset, plan an entire book together, and be responsible for the art program from beginning to end — obviously with their input on the subject matter and content. Being able to see a project through in that way, from start to finish, would be incredibly satisfying.
What has been the most rewarding aspect of your career?
For me, the most rewarding part of being a medical illustrator is understanding its enduring contribution to medical education. This legacy is summed up beautifully in a quote I saw in an obituary for Stanley Robbins: "It is fair to say that every American physician trained in the last four decades of the 20th century can mark their education by which edition of Robbins they read."
The work I’ve done on the books of Stanley Robbins and Ivan Damjanov, and for the Netter's series, really has trained generations of physicians. I take a great deal of pride and satisfaction in that.
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