Content-based image retrieval (CBIR) from specialized collections has often been proposed for use in such areas as diagnostic aid, clinical decision support, and teaching. The visual retrieval from broad image collections such as teaching files, the medical literature or web images, by contrast, has not yet reached a high maturity level compared to textual information retrieval. Visual image classification into a relatively small number of classes (20-100) on the other hand, has shown to deliver good results in several benchmarks. It is, however, currently underused as a basic technology for retrieval tasks, for example, to limit the search space. Most classification schemes for medical images are focused on specific areas and consider mainly the medical image types (modalities), imaged anatomy, and view, and merge them into a single descriptor or classification hierarchy. Furthermore, they often ignore other important image types such as biological images, statistical figures, flowcharts, and diagrams that frequently occur in the biomedical literature. Most of the current classifications have also been created for radiology images, which are not the only types to be taken into account. With Open Access becoming increasingly widespread particularly in medicine, images from the biomedical literature are more easily available for use. Visual information from these images and knowledge that an image is of a specific type or medical modality could enrich retrieval. This enrichment is hampered by the lack of a commonly agreed image classification scheme. This paper presents a hierarchy for classification of biomedical illustrations with the goal of using it for visual classification and thus as a basis for retrieval. The proposed hierarchy is based on relevant parts of existing terminologies, such as the IRMA-code (Image Retrieval in Medical Applications), ad hoc classifications and hierarchies used in imageCLEF (Image retrieval task at the Cross-Language Evaluation Forum) and NLM's (National Library of Medicine) OpenI. Furtheron, mappings to NLM's MeSH R - (Medical Subject Headings), RSNA's RadLex (Radiological Society of North America, Radiology Lexicon), and the IRMA code are also attempted for relevant image types. Advantages derived from such hierarchical classification for medical image retrieval are being evaluated through benchmarks such as imageCLEF, and R&D systems such as NLM's OpenI. The goal is to extend this hierarchy progressively and (through adding image types occurring in the biomedical literature) to have a terminology for visual image classification based on image types distinguishable by visual means and occurring in the medical open access literature.