Introducing Graphic Medicine

Ian Williams and MK Czerwiec, authors of today’s guest post, co-run the website They will present “Graphic Medicine and the Multiplanar Body” at our October 18th festival, Art, Anatomy, and the Body: Vesalius 500.

The 2010 Comics & Medicine gathering before Senate House.

The 2010 Comics & Medicine gathering before Senate House.

In the summer of 2010 a group of scholars, health care professionals, and comics artists gathered in Senate House, London. This brutal-looking art deco building, said to have inspired George Orwell’s “Ministry of Truth,” represented Gotham City Courts in the films Batman Begins and The Dark Knight. Those gathered, however, were not particularly interested in superheroes. They focused on graphic memoirs of illness, a modern phenomenon born of the counterculture in the 60s and 70s that has gathered momentum over the last 20 years.

Among the 75 delegates from around the world were the authors of this blog entry. The lead organizer of the conference was Ian Williams, a doctor and comics artist, creator of The Bad Doctor (2014, Myriad Editions). MK Czerwiec (pronounced sir-wick), aka Comic Nurse, has been making comics about her work in HIV/AIDS and hospice care since the late 1990s as a way of processing these caregiving experiences. We have now worked together for four years, talking and writing about the interplay between the comics and health care. We make comics, collaboratively and separately, and will give a talk on October 18th at “Art, Anatomy, and the Body: Vesalius 500” about Graphic Medicine, the field we helped pioneer.

The Bad Doctor. Cover by Ian Williams.

The Bad Doctor. Cover by Ian Williams.

MK Czerwiec teaching at Northwestern Feinberg Medical School. Still from BBC story by Katie Watson.

MK Czerwiec teaching at Northwestern Feinberg Medical School. Still from BBC story by Katie Watson.








Often when we describe Graphic Medicine, people say that comics must make an excellent educational medium for patients, especially those with poor literary skills and marginalized groups such as drug addicts, teenage mothers, or the mentally ill. While comics have certainly been used to reach these audiences, the idea behind this response is freighted with assumptions about comics, their target demographics, and the literacy skills or aesthetic proclivities of the social groups so named.

Stack of medically-themed graphic novels. Photo by Ian Williams.

Stack of medically-themed graphic novels. Photo by Ian Williams.

We regard comics as a sophisticated, rich, and adaptable system through which to explore the complex issues of health care. Our primary interest has been the use of graphic illness narratives to provide new knowledge about the illness experience and commentary on the pervading cultural conceptions of disease and health care. We are also interested in the psychological process of making comics. We have also been teaching using comics—both making them and reading them—in medical schools in the US and UK.

Binky Brown Meets The Holy Virgin Mary cover by Justin Green

Binky Brown Meets The Holy Virgin Mary cover by Justin Green

In 1972 Justin Green became the first comics artist to unburden his psychological troubles onto the page, creating Binky Brown Meets the Holy Virgin Mary. This inspired subsequent generations of artists to articulate their corporeal experiences in words and pictures, a process that Elisabeth El Refaie refers to as “pictorial embodiment.”1 More than 40 years later, the myriad comics titles that appear each year include stories of disease or trauma, known as “graphic pathographies,”2 in which the authors give highly subjective accounts of their own illnesses or caregiving experiences. The production of these works involves the repeated drawing of the author’s or subject’s body over a prolonged period, which may have interesting effects on how the artist perceives the body. The relentless decision-making process forces the artist to examine fears, suffering, anger, disgust, disappointment, and grief and distill the whole into a succinct series of sequential panels through which to transfer the narrative to the reader.

2014 Comics & Medicine poster. Art by Lydia Gregg.

2014 Comics & Medicine poster. Art by Lydia Gregg.

Since the London gathering, we have held international conferences in Chicago, Toronto, Brighton, and Baltimore. The movement is growing and what was initially viewed by some as a novelty interest is gaining respect in academia. As the nature of literacy changes, moving from the textual towards the image, comics is once again in ascendance, gaining new readers who might have previously dismissed the medium.






1. El Refaie, E. (2012). Autobiographical comics: Life writing in pictures. Jackson: University Press of Mississippi.

2. Green, M. J., & Myers, K. R. (2010). Graphic medicine: Use of comics in medical education and patient care. BMJ, 340, c863.

We Recommend . . .

By Johanna Goldberg, Information Services Librarian

This is part of an occasional series of blogs featuring research tips from NYAM librarians.

Are you looking for online sources on public health statistics, consumer health, or the history of medicine? Look no further than our recommended resources list.


A screenshot of our Recommended Resources page.

The featured resources I use most frequently include the NLM Drug information Portal and Drugs@FDA, listed under the Public and Consumer Health tab, which provide a wealth of information on drugs and supplements.

Looking for information on a health care provider? Try the New York State Physician’s Profile (if you are in New York) and the U.S. Department of Health and Human Services’ Hospital Compare, both listed under the Hospitals and Doctors tab.

I also often use County Health Ratings and Road Maps from the Robert Wood Johnson Foundation, listed under the Statistics tab. The tool allows you to find public health data at the state or county level, with measures including teen birth rate, adult smoking, and health care costs (among many others).

The list also includes sources for statistics on specific diseases (listed under the tab Statistics on Diseases), including the Centers for Disease Control and Prevention’s NCHHSTP Atlas, an interactive tool for accessing HIV/AIDS, viral hepatitis, tuberculosis, chlamydia, gonorrhea, and syphilis data.

We update the list quarterly (most recently on November 4, 2013), so make sure to come back to see what’s new.

Item of the Month: “Better Babies” on Things Which Are Bad For All Babies

By Johanna Goldberg, Information Services Librarian

When in the stacks recently, I came across two slim issues of “Better Babies: Infant Welfare and Race Progress,” one published in December 1921 and the other in April 1924.



While the title suggests an interest in eugenics, the two issues in our collection focus solely on ways to keep babies healthy, including articles on clothes for children, playgrounds and public health, the benefits of breast feeding, and disease prevention.

This last topic inspired the following list, published in the 1924 issue. As it is (coincidentally) Baby Safety Month, it seems appropriate to share it.

Which piece of advice is your favorite?

Uncle Sam, M.D.

By Paul Theerman, Associate Director

Health Almanac, 1920 front cover.

Health Almanac, 1920 front cover.

How to get the word out? For the last two hundred years, health has been as much about education and prevention as intervention and response. And so an intrepid young doctor in the U.S. Public Health Service (USPHS) latched onto using the almanac as a public health vehicle. Health Almanac 1920 (Public Health Bulletin No. 98; Washington, GPO, 1920) was a 12-page almanac entwined in a 56-page public health pamphlet. Amid checking for the phases of the moon or the times of sunrise and sunset, one could find short pieces giving warning signs for cancer, means to prevent the spread of malaria, the necessity of registering births, and how to build a good latrine. These and many other topics were all presented by “Uncle Sam, M.D.”; the almanac was free for the asking.

Uncle Sam Image 4--July right page

Health Hints and Notable Events for July 1920. Click to enlarge.

In the distant past, almanacs became linked to health through “astro-medicine” or “iatromathematics,” that is, medical astrology. Each of the signs of the zodiac was held to influence a system of the body, from Ares controlling the head to Pisces the feet, and so for everything in between. Almanacs were calendrical and astronomical, and in addition to marking sunrise and sunset, the phases of the moon, and religious holidays, they charted the day-by-day progress of the moon through the zodiac, with its supposed medical consequences. To this technical data, the most famous American almanac, Benjamin Franklin’s Poor Richard’s Almanac, added moralistic lessons and practical advice, wittily presented. Health Almanac 1920 provided these same features within the context of progressive secular government. The publication started with inspirational statements from President Woodrow Wilson, the Secretary of the Treasury, and the Surgeon General —who together formed the chain of command for the Public Health Service! Instead of a calendar of religious seasons and saints’ days, the almanac noted national days and significant events in the history of medicine and in “The Great War,” just concluded. Everywhere were health aphorisms: “Good health costs little, poor health costs fortunes” (from the back cover), and “Large fillings from little cavities grow” (April 20). Some “health hints” were quite flatly presented: “Every home should have a sewer connection or a sanitary privy” (July 20), and “Food, fingers, and flies spread typhoid fever” (July 31). Some were just to the point: “Be thrifty” (November 15) and “Wear sensible shoes” (December 18). Throughout, the almanac highlighted the role of the USPHS in promoting health.

Uncle Sam Image 2--back cover

Health Almanac, 1920 back cover.

The Health Almanac was published in 1919 and 1920—we have the 1920 edition—as was a parallel publication called the Miners’ Safety and Health Almanac, put out by the Bureau of Mines. Both were the brainchild of Dr. Ralph Chester Williams (1888–1984), then at the outset of his successful career with the Public Health Service. Born in Alabama and a 1910 graduate of the University of Alabama Medical School, Williams entered the USPHS in 1916 and was posted to the Bureau of Mines during World War I. Pulled into the Office of the Surgeon General, he edited Public Health Reports, served as Chief Medical Officer to the Farm Security Administration, as Medical Director of the USPHS’s New York City office, and starting in 1943, as Assistant Surgeon General and head of its Bureau of Medical Services. In that capacity he oversaw a third of the operations of the USPHS, including immigration inspection and USPHS hospitals. In 1951 the Commissioned Officers Association of the USPHS published his standard history, The United States Public Health Service, 1798–1950. At almost 900 pages, it dwarfs the Health Almanac 1920, but both show their author’s dedication to getting the word out about health and, not incidentally, about the agency that helped make that happen.

Looking for Health Information Online? Don’t start with Google.

By Johanna Goldberg, Information Services Librarian

This is the first of an occasional series of blogs featuring research tips from NYAM librarians.

We’ve all done it: You leave the doctor’s office and want to know more information about a new diagnosis or other health concern. So you go to your high-tech device of choice and search the Internet.

A NYAM Librarian conducts a PubMed search.

A NYAM librarian conducts a search in PubMed.










According to the latest Pew Internet research on the topic, 72% of Internet users went online to find health information in the past year. Of these people, 77% started by using a search engine.¹

But a general Internet search may not be the best way to find high quality health information online.

As we all know, anyone can put information online. Just because something is on a web page does not make it reliable. Fortunately, there are excellent sites that present a wide range of trustworthy health information.

When I look for health information online, I usually start with one of the following sites. If they link to other sources, I know the pages have been vetted:

This National Library of Medicine site provides authoritative information from government agencies and nonprofit organizations. It includes a very helpful drug and supplements guide.

Health information from the U. S. Department of Health and Human Services.

Centers for Disease Control and Prevention
The CDC is especially helpful when looking for trends and statistics.

National Institutes of Health
Each NIH Institute offers a wealth of consumer health information related to its area of interest.

There are other excellent options listed on our recommended resources page under the tab “Public and Consumer Health.”

Sometimes you do need to use a search engine. As I teach my Junior Fellows students, there are questions you need to ask to assess information found online:

1. WHO wrote it? Is it an organization or an individual? What is the person or organization’s bias?

2. WHAT makes them “an expert”? What kind of organization is it? Is it written by a patient? A healthcare professional working in the field? Is there a scientific or medical advisory board assessing the information?

3. WHERE is the author located? Is the website .org, .edu, .com, .gov? Each type of site has its own reasons for sharing information.

4. WHEN was the page last updated or reviewed? Health information can change quickly. The more current, the better.

5. WHY is the information on the Internet? Is the author trying to sell a product or service or raise money? Is it there to help patients and caregivers?

6. HOW does it look? Is it easy to read? Are there lots of advertisements? Are things spelled correctly? Does it make you uncomfortable in some way?

Want to know more about evaluating online health information? MedlinePlus has you covered.

1. Pew Internet: Health (23 April 2013) Retrieved May 22, 2013, from

Coughing, Sneezing, or Spitting Will Not Be Permitted

By Johanna Goldberg, Information Services Librarian

As the United States experiences high flu activity, we thought we’d look back on the 1918 flu pandemic, which lead to the deaths of 50 million people worldwide, including nearly 675,000 people in the United States.1

The first case of the so-called Spanish Influenza in the United States originated at Boston’s Commonwealth Pier on August 28, 1918.2 On September 3, it landed in nearby Brockton, Mass., where the disease became widespread by the middle of the month.

Brockton’s Volunteer Leaders

Ernest A. Burrill detailed the efforts of the city in Brockton’s Fight Against Influenza. One problem faced was a lack of food—sick parents could not cook for children, and residents were afraid to enter infected homes. A well-organized food department came to the rescue, preparing food at a community kitchen and delivering it to 388 sick people at its peak on October 10.2

Brockton officials established a field hospital to centralize medical staffing. “A tented city grew up over night,” and within days of its opening, patients moved from area hospitals to the tents. During its two weeks of operation, the field hospital treated more than 300 patients. The food department provided the makeshift hospital with “5 dozen ham sandwiches, 3 quarts chicken stew, 2 dozen cakes, 32 quarts of gruel, 27 quarts of broth, 35 quarts of milk, 9 loaves of bread, in addition to jellies, preserves, etc.”2

Brockton’s Field Hospital

The flu peaked in Chicago in mid-October. A month earlier, an ambitious public health campaign instructed residents to cover their mouths when sneezing and coughing.  In a 1918 report, Commissioner of Health John Dill Robertson wrote, “The danger of uncovered coughing and sneezing has probably been so thoroughly impressed upon the people of the City of Chicago that fruit will be borne from this source for years to come.”3 (Chicagoans, is this fruit still being borne?)

A poster from Chicago’s Public Health campaign, presumably released prior to the Health Department closing the theaters.

In Chicago as in much of the country, “places of amusement were closed” at the peak of the pandemic. “This included theaters of all kinds, cabarets, dance halls, athletic meets, and everything of this kind. People were advised to go home and to get nine hours of sleep, on the theory that rest was the best preventive medicine that could be had. In fact, by cutting out all these night assemblages there was no place for the people to go and they had to remain home.”3

In addition, Chicago and other cities banned public funerals. In Chicago, only 10 mourners, not including clergy, could attend for fear of spreading the disease from the family of the deceased and through contact with infected premises.

Chicago churches, schools, and workplaces remained open, although clergy were instructed to keep services short and officials closely monitored school conditions. “Nothing was done to interfere with the morale of the community,” wrote Dill.  The Health Department did require closing, thorough cleaning, and subsequent inspection of places of public assembly.3

A selection of captions from Chicago newspapers.

Scientists had developed a vaccine for pneumonia, which often co-occurred with the flu in 1918, and health officials distributed 174,264 doses in Chicago once determining the severity of the pandemic.3  The Brockton report indicates that the New York City Health Department prepared a vaccine for the flu strain, but it was not yet available to them.2

While the current flu outbreak does not compare to the 1918 pandemic, we can learn from earlier experiences. Cover your mouth, do what you can to avoid contact with sick people, and be grateful that you can get vaccinated.

For more on the 1918 flu, visit


1. (n.d.). Pandemic Flu History. Retrieved January 17, 2013, from

2. Burrill, E. A. (1918). The story of Brockton’s fight against influenza. Brockton: Press of Nichols & Eldridge.

3. Robertson, J. D. (1918). A report on an epidemic of influenza in the city of Chicago in the fall of 1918. Chicago: Dept. of Health.

Voices from the AIDS Epidemic

By Johanna Goldberg, Information Services Librarian

State of Florida Department of Health and Rehabilitative Services, 1987.

State of Florida Department of Health and Rehabilitative Services, 1987.

Today, health care professionals can use multiple tests to detect HIV infection. Where available, drugs therapies allow people to live with HIV for many years before developing AIDS. Of course, this was not always the case. In commemoration of World AIDS Day on December 1, we are revisiting some of the voices published in the early years of the epidemic.

In 1982, 14 doctors presented their front-line experiences at an international symposium, the proceedings of which were published in book form the following year. Their frustration with their inability to successfully treat their young patients rings out clearly.

“Thirteen of 42 patients in our series have already died. Nationwide, half of the patients have died.” Half of their patients with “Pneumicystis carinii pneumonia (PCP) , the most common infection,” responded to the administered drug . “However, excluding three who are still being treated, only two patients who had PCP are presently alive, even though six recovered from their initial infection.” In the ten patients with Cytomegalovirus (CMV) infection, eight died. “Only one, a 22-year-old man with CMV pneumonia, has recovered.” As the authors go on to say, “treatment remains a knotty problem.”

At another symposium, also published in book form, Dr. Kevin M. Cahill, the senior member of the New York City Board of Health, applauded the efforts of individual doctors and nurses, in addition to the “superb work” of the Gay Men’s Health Crisis.  But he chastised the inaction of the “organized medical community.”

“When a fatal infection had struck down veterans attending an American Legion convention, health professionals across the country joined in the search for a solution. When women using tampons became ill with toxic shock syndrome, medical societies and research centers immediately focused their enormous talents on that problem. But when the victims were drug addicts and poor Haitian refugees and homosexual men, their plight did not, somehow, seem as significant to those expected to speak for the health professions. No major research programs were announced, and until it became clear that the disease could spread to the general population through blood transfusions, organized medicine seemed part of the conspiracy of silence.”

Where are we today? Even with so much knowledge about prevention, the CDC estimates that 50,000 people in the United States become newly infected with HIV each year; about 33,000 people receive AIDS diagnoses. In the United States, HIV incidence in people aged 13-29 rose 21 percent between 2006 and 2009.

Prevention education remains essential. Visit the CDC’s Act Against AIDS page or World AIDS Day’s website to find out more about current prevention and testing measures.

For a year-by-year timeline of the HIV/AIDS epidemic in the United States, visit

Cahill, K. M. (1983). The AIDS epidemic.  New York: St. Martin’s Press.

Centers for Disease Control and Prevention. (2012). Basic Statistics. Retrieved November 28, 2012, from

Gold, J. W. M., Armstrong, D., Sears, C. L., Henry, S., Donnelly, H., Brown, A. E., …Wong, B.(1983). Acquired Immunodeficiency Syndrome: Infection and Neoplasia in Homosexual Men and Intravenous Drug Addicts. In C. S. F. Easmon & H. Gaya (Eds.), Second international symposium on infections in the immunocompromised host (pp. 105–113). London: Academic Press.