Development of a Book Project

"The Development of a Book: Childhood Injury" was previously published in the Journal of Biocommunication - Volume 6, Number 1, 1979. The book received the "Best Illustrated Medical Book" award at the 1978 annual meeting of the Association of Medical Illustrators. We proudly republish this article as a tribute to Neil and his work.



Pediatric Heimlich Maneuver - March 1979 JBC cover illustration by Neil Hardy


Pediatric Heimlich Maneuver - Neil's line drawing



It all began 11 years ago when my family and I moved to Westport, CT. On recommendation of our former pediatrician we chose Dr. Jack Shiller for our children; we could not have been more pleased for more than medical reasons. In conversations Jack had heard that I was a medical illustrator. He sent me a book he thought I might enjoy, Anatomy of the Newborn by Dr. Edmund Crelin.1

I reciprocated by giving Jack a book I had illustrated, Emergency Medical Guide (McGraw-Hill, 1963); he responded by saying he planned to write a book and wanted me to illustrate it. Years passed. Then, he did it! In addition to a busy practice and teaching obligations at Columbia University, Jack began writing Childhood Illness and, as promised, asked me to do the illustrations. I was delighted! With nothing more than the usual contract and a hand shake, we began. The resulting book was a fine one, but I found I had no control over the use and reuse of the artwork. Several more years passed. Once again Jack came up with a book idea. This one was titled Childhood Injury.2

Nosebleed. The compression of the nostrils and the length of time are shown in the most direct manner.

Older, wiser, and now armed with the preliminary draft of the proposed artist-client agreement being developed by the AMI, our negotiations took a different tack. I wanted to be part of the contract with the publisher and participate fully in the development of the book, as well as in royalties that might accrue. We tried to evaluate the relative contribution of text versus illustration and agreed on a 75% (author) and 25% (illustrator) split.

Our agreement was appended to the contract Jack already had with the publisher. We were now partners, and the work began. Something new was happening. No longer was this an author trying to buy a limited number of illustrations for his book, but rather two partners willing to prepare any number of illustrations necessary for their book. Because illustration is my full time business, and writing is Jack’s avocation, I received the greater part of the publisher’s advance, to be repaid before receiving any royalties.



The Illustration Process

Very rough sketches were prepared and inserted into the manuscript at the appropriate place. Jack had marked the manuscript where he thought illustrations should appear. I did likewise. We scrutinized each sketch, evaluating it’s importance to the text. Some sketches were discarded, others were changed, and some new ideas were added.

Next, the illustration board was prepared. A rectangle on the ledger paper represented a 50% enlargement of the print area of the page. By overlaying this template on each illustration board, and pricking the corners, I was able to quickly establish the maximum illustration size on as many boards as the project required; additional pinholes were placed, where indicated, for half-page illustrations. Most of my pen work is done on ‘Superior’ brand hot pressed illustration board,3 which has a nice ‘tooth’ and takes both inking and erasing well. Tight pencil sketches were prepared on scrap paper with close attention to detail required in the finished art. For figure work I use black-and-white Polaroid pictures; they are used as guides only and are invaluable when complicated poses are involved. My wife and children do a great deal of posing for me.

Jack suggested the inclusion of Blacks and Hispanics in addition to Caucasians, as they, too, are part of our readership. Because this book was prepared for a general audience, I wanted the drawings to be clean, crisp and simple. An effort was made to relate broken bones, viscera, etc. to the body surface. Arrows and X’s were frequently used to represent motion or draw attention to a specific area. Potentially unpleasant subjects such as laceration and burns were shown on blocks of tissue rather than the body. The sketches that had been prepared at a convenient size were now projected on to the illustration boards at the standard 50% enlargement; photocopies were made and sent to the publisher for planning page layouts.


The Polaroid was helpful here for the trampoline figures. My son, John, lay on the ground with his head and shoulders pressed against the wall. The picture was then rotated 90 degrees.

For me the best part came next: the inking. Usually I use Gillott #290, #291 and #303. On this project I decided to try the Castell T.G. #000. The easy flow of ink without having to constantly dip into a bottle was a plus, but I was unhappy with the monotony of the line weight. To alter this, I sometimes used two or three lines together to vary the line weight and add emphasis. I felt this resulted in a more relaxed style. Inking was done over the pencil lines, which were subsequently erased.

Next, leader lines were added and the corners of the plate were marked. On a registered tracing paper overlay I printed any call outs which were to be set in type and pasted up by the publisher. A total of 108 plates were delivered to the publisher. All required a standard reduction of 33 1/3%.


The long bones of the body. A Polaroid picture of my daughter, Heather, helped identify bony landmarks to aid in drawing the skeleton. The body was altered quite a bit to give a symmetrical appearance that could not be achieved in a quick photo.



This illustration is to show the location of lymph nodes affected by insect bites. An attempt was made to make the boy’s face pleasing to the reader.



During my 20 years as a medical illustrator I have been involved in over 40 book projects. In 10 of these I was responsible for all or most of the medical drawings, and each book represented a sizable commitment in time. Therefore, I am convinced that both the author and illustrator must understand all aspects of the collaboration. Financial matters and other responsibilities should be discussed and finalized in writing before the project commences. Then the main goal, the creation of the best written, best illustrated book possible, can be achieved.

This was a satisfying project. The author gave me a chance to be a real part of the development of this book. This fact, plus the recognition by my peers is very meaningful to this free-lancer.

The lines indicating pain are comic bookish, but they help draw the eye to the fractured metacarpal.




1. Professor of Anatomy at Yale University Medical School.

2. Published by Stein & Day, New York; 255 pages, 1977, $8.95. This title received the “Best Illustrated Medical Book” award at the Annual Meeting (1978) of the Association of Medical Illustrators (AMI).

3. Purchased at Arthur Brown & Bro. Inc., New York.



Editor's Note

As noted within the 1979 JBC article, Neil often used his own children (Heather and John) as models and Polaroid references for many of his medical illustrations. This especially was true for his book Childhood Injury. What Neil did not share in his article, was that he occasionally included his children's initials somewhere within his illustrations as a way to show his fatherly love and to acknowledge their participation. Neil often would "hide" these initials in a peripheral area of the drawing, almost as if he were challenging the viewer to locate them. One can image the delight that Neil had in showing Heather and John their own initials "hidden" within the small figures of the published books.

A. Heather's initials "HH" were included in Neil's Pediatric Heimlich Maneuver illustration that was used as JBC's cover illustration in March 1979. In the enlargement below, one can easily see a stylized "HH" (for Heather Hardy) located near Neil's own signature in the lower left portion of the drawing. This cover illustration also appeared in Childhood Injury (Figure 1-4, page 28).

B. John Hardy's initials "JH" also appear in a few of Neil's illustrations. In the Pediatric Choking figures in Shiller's Childhood Injury, John's stylized initials "JH" appear behind the ear in both choking illustrations (Figure 1-5B, page 31).

C. John's initials also appear in the Vocal Cord figure in Shiller's Childhood Illness. Neil cleverly hid John's initials "JH" within the texture of the hair above the right ear in this illustration (Figure 11, page 90).

D. Heather's "HH" appears in the Administering Medicine figure in Shiller's Childhood Illness (Figure 5, page 43).

E. John's initials "JH" appear in the Convulsion figure in Shiller's Childhood Illness. Neil cleverly hid John's initials "JH" within the texture of the hair above the right ear in this line illustration (Figure 4, page 39).

Gary Schnitz
JBC Board Chair

A. Neil placed Heather's initials "HH" near his own signature in the Heimlich Maneuver drawing. Heather's "HH" shares a common vertical stroke.

B. In the pediatric choking drawing, Neil placed John's initials "JH" behind the ear. Note that the individual letters in "JH" share a common vertical stroke.

C. In Childhood Illness, Neil cleverly staggers John's initials "JH" within the hair above the ear.

















D. Heather's initials "HH" appear on her shorts.


E. John's initials "JH" also appear in his hair on the top of his head.




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