Who Gets Drawn.
And What Medicine Forgot When It Stopped Drawing Her.
Anatomy is a visual science. For five hundred years, what doctors knew about a body was largely what somebody had drawn of it. So the question of who got drawn, and how carefully, is not an art history question. It is a clinical one.
When I was small I drew two kinds of things, and I never thought of them as different. Fantasy on one page: figures, other realms, worlds that do not exist. On the next page, technical drawings. Inventions, machines, how something would work if someone built it. Same pencil, same hand, same compulsion.
It took me years to notice that the adult world treats those as two separate activities. One is art. The other is science, or engineering, or at least something respectable. And yet the drawing is the same act: you look very hard at something, you decide what matters about it, and you put that on paper so someone else can see it too.
Which means every drawing is also a decision about what to leave out.
Part one of this series was about what art does to the body. Part two was about why we started making it at all. This last part is about the place where art and science have always been the same thing, and where that has mattered most for women: the anatomical drawing. Because for five centuries, medicine learned the body mostly through pictures. And when you look closely at who was drawn, how, and what got left off the page, you find one of the strangest stories in the history of science. It concerns an organ that was described accurately in 1844, then lost from the textbooks, then found again in 1998.
Anyone who has seen the women's faces I painted for the Diaries series knows I spend a lot of time drawing women. It turns out medicine did not.
Five Drawings of the Same Organ
The same anatomy, as it has been drawn across 180 years. Step through them in order.
Structures and dates from O’Connell and colleagues’ dissection work and review, and the first human nerve count by Uloko and colleagues. [3][4][5]
Before photography, before scanners, before microscopes that could record what they saw, the only way to transmit what a body looked like inside was to draw it. The anatomical plate was not an illustration of knowledge that existed somewhere else. It was the knowledge. What a physician in Paris knew about the liver was what a draughtsman in Padua had cut into a woodblock.
So the history of anatomy is, for long stretches, a history of drawings. Some of them told the truth against the authorities of their time. Some of them bent the truth to fit a theory. And some of them simply left things out.
Modern anatomy begins with a picture of a woman being opened. Andreas Vesalius published De humani corporis fabrica in 1543, and it is usually treated as the founding text of modern anatomy because it made the dissected body, rather than the ancient texts of Galen, the authority. Its title page shows Vesalius himself in a packed anatomy theatre, his hand inside the abdomen of a female cadaver. According to Meneghini and Meneghini's analysis of the frontispiece, she was a woman from Padua condemned to death, who tried to avoid execution by claiming to be pregnant. A midwife doubted her. She was executed, and the dissection was ordered in part to check her claim. [1]
The best anatomical drawings were evidence in their own right. Santiago Ramón y Cajal drew the nervous system cell by cell from his own microscope slides, and his drawings carried the argument that neurons are separate cells rather than one continuous net. Pablo García-López, Virginia García-Marín and Miguel Freire catalogued more than 4,500 of his preserved preparations alongside the drawings. Cajal's own account of his method was that the only liberty he took was to group cells from several serial sections into one image. [2]
And some drawings lied. Ernst Haeckel's famous plates of vertebrate embryos showed fish, chickens and humans looking nearly identical at an early stage, and they sat in biology textbooks for over a century. In 1997, Michael Richardson and colleagues compared real embryos across a wide range of vertebrates at that stage and found more than a tenfold variation in length alone, along with real differences in body plan. Haeckel's plates, they concluded, showed not a conserved stage but a stylised embryo. [6]
Three drawings, three relationships to the truth. Vesalius's corrected the authorities. Cajal's proved something nobody else could see. Haeckel's made the evidence look tidier than it was. There is a fourth relationship, and it is the one this post is really about: the drawing that was never made, or was made once and then quietly dropped.
When the Drawing Is the Evidence
Four cases. Four different relationships between a picture and the truth. Tap each.
The first three are the standard cases in any history of scientific illustration. The fourth is rarely included. [1][2][4][6]
In 1998, an Australian urologist named Helen O'Connell published the results of dissecting ten female cadavers, aged 22 to 88. Her paper framed the problem surgically: operations near the female urethra depend on accurate anatomy, and the descriptions in circulation were not accurate. The textbooks showed the clitoris as a small external point on a flat diagram.
What she found was a three-dimensional structure several centimetres deep. O'Connell, Hutson, Anderson and Plenter described a tissue complex projecting 3 to 6 centimetres from the bony landmarks, with paired crura running along the pubic arch and paired bulbs of erectile tissue sitting behind the body. The urethra was surrounded by erectile tissue on every side except the back, where it met the vaginal wall. They recommended renaming the "bulbs of the vestibule" as the bulbs of the clitoris, and concluded plainly that the standard anatomical descriptions were inaccurate. [3]
In 2005 the same group put it together with MRI. O'Connell, Sanjeevan and Hutson reviewed dissection, MRI, three-dimensional reconstruction and histology. They found that textbooks still lacked detail, included inaccuracies, and offered only flat single-plane diagrams of a structure that is multiplanar. And they noted something remarkable about the history. The most comprehensive and accurate description of this anatomy had been published by the German anatomist Georg Ludwig Kobelt in 1844. Modern research had confirmed his work rather than surpassed it. [4]
The first actual nerve count came in 2023. A figure of 8,000 nerve endings circulated for years, in textbooks and in the press. Uloko, Peters and colleagues at Oregon Health and Science University noted that no study had ever counted the nerve fibres innervating the human clitoris. They did it, using samples of the dorsal nerve from seven patients having gender-affirming surgery, and estimated around 10,281 fibres. The research team said the old 8,000 figure was believed to have come from livestock studies. [5]
The anatomy was never hidden. It was drawn once, correctly, and then drawn smaller in every book that followed, until the drawing was all anyone remembered.
And the pattern is not limited to one organ. When researchers go back and count who appears in the pictures medicine teaches from, the same shape keeps turning up.
Who Is on the Page?
Medical textbook images, counted three ways. Each dot is one percent.
Skin tone and race figures from Louie and Wilkes, 4,146 images across four textbooks. Sex figures from Parker and colleagues, 6,044 images across seventeen textbooks. [7][8]
The knowledge existed. The drawing decided whether it survived.
Sit with the sequence. In 1844, an anatomist publishes a complete and accurate description of the clitoris. For the next century and a half, anatomy textbooks give detailed accounts of the penis and a flat dot for its female counterpart. In 1998, a surgeon dissects cadavers and reports that the standard descriptions surgeons rely on are inaccurate. In 2005, her review states that modern methods have confirmed a description that was already 161 years old. In 2023, someone counts the nerve fibres in a human for the first time, and finds the number everyone had been quoting may have come from cattle. [3][4][5]
None of this was a gap in knowledge. It was a gap in transmission. Kobelt's work was in the literature the whole time. What failed was the chain from a published finding to the drawing a medical student learns from, and that chain has a direct consequence: surgeons operating on the vulva, the urethra and the pelvic floor risked learning from images that did not show the structures they could damage. O'Connell's 1998 paper was written with exactly that surgical risk in mind. [3]
And it is not a closed chapter. Parker, Larkin and Cockburn analysed 6,044 images across seventeen major anatomy textbooks published between 2008 and 2013. The human body in those images was predominantly male, except in the sections specifically about sex. Women appeared where their reproductive organs were the subject, and receded where the subject was simply a body. [7] Louie and Wilkes found the same structure on a different axis: four major medical textbooks looked broadly balanced by racial category, but only 4.5 percent of 4,146 images showed dark skin. [8]
This is what the art-and-science question is actually about. Not whether anatomical plates are beautiful, though many are. Whether the person holding the pencil drew you, and drew you in enough detail that the next person could find you.
A few honest limits
The nerve count is a first, and firsts are small. Uloko and colleagues counted fibres in samples from seven people, all transmasculine patients having gender-affirming surgery. That was the ethical route to fresh tissue, and it is a reasonable one, but seven is a small number, and whether prior testosterone exposure affects the count is an open question the study was not designed to answer. The figure is also a count of fibres in the dorsal nerve, which is not the same thing as the "nerve endings" the old figure claimed to describe. [5]
O'Connell's 1998 study dissected ten cadavers across a wide age range, two fresh and eight fixed. Fixation changes tissue, and ten bodies cannot capture the full range of human anatomical variation. Her later MRI work in living volunteers is part of why the finding is trusted, but anatomy papers of this kind are descriptive rather than statistical. [3][4]
The textbook analyses have dates. Parker and colleagues looked at books published between 2008 and 2013, and Louie and Wilkes at four textbooks used in American medical schools. Newer editions and e-learning platforms may look different, and some have been revised since. What these studies show is the state of the teaching material at the point when a large share of today's practising doctors were trained. [7][8]
And on Vesalius: the story of the woman in the frontispiece comes from historical reconstruction, not a modern case file. The Meneghinis' reading is well sourced in the archival tradition around the Fabrica, but it is history, with the uncertainty history carries. [1]
If you were taught from a flat diagram, and most of us were, the accurate picture is a three-dimensional structure with crura along the pubic arch, bulbs behind the body, and the urethra wrapped in erectile tissue. The researchers now often describe the region as a single connected complex rather than separate parts. Knowing that is not trivia. It is the vocabulary you need to ask a precise question in a clinic.
O'Connell framed her 1998 findings around surgical safety. If you are facing surgery in this region, it is entirely reasonable to ask your surgeon which structures and nerves are at risk and how they plan to spare them. A good surgeon will welcome the question. This is not medical advice about any particular procedure, only a prompt to ask.
The next time you read a health guide, an app, a textbook or a symptom checker, look at the images before the text. Whose body is the default? Whose skin shows the rash? Which chapters do women appear in? You will start to see the pattern Parker, Louie and Wilkes measured, and once you see it you can ask whether the text carries the same assumption.
I started this series wanting to understand a sensation in my body when I stand in front of art. I am ending it with a sharper sense of why the two kinds of drawing I did as a child were never different. Every anatomical plate in this post was an artist's decision about what mattered enough to put on paper. Vesalius's woodcutters, Cajal at his microscope, Haeckel smoothing his embryos, the illustrators who drew a dot where Kobelt had drawn an organ. Art and science were the same hand, making the same choice.
That is also why the faces on my wall matter to me more than I expected when I first painted them. They are not anatomical. They are not evidence of anything. But they are women drawn carefully, by someone who wanted to look at them for a long time. It turns out that for most of the history of medicine, that was rarer than it should have been.
Across three posts, then: making and looking at art changes measurable things in the body. The urge to make it is as old as anything we can call human. And the drawing is never neutral, because whoever holds the pencil decides who gets seen. The practical version is the one I would leave you with. Look carefully at your own body, and do not assume that anyone before you drew it properly.
All three parts, in order.
- Art and longevity. What happens in the body in front of a painting, and what the cohorts found.
- Art and evolution. The 73,000-year habit, and why nobody agrees on why we started.
- Art and science. Who gets drawn, and what medicine forgot. You just read it.
Much of The Art of Female Health is an attempt to redraw the map: to put the female body back into the picture at the level of detail it was always owed. If this post made you want to see your own anatomy properly, that is where to go next. nammu.academy/book
References
- Meneghini, A., & Meneghini, N. (2021). The frontispiece of Vesalius’ Fabrica. Pelviperineology, 39(3), 99–104. https://doi.org/10.34057/ppj.2020.39.03.006
- García-López, P., García-Marín, V., & Freire, M. (2010). The histological slides and drawings of Cajal. Frontiers in Neuroanatomy, 4, 9. https://doi.org/10.3389/neuro.05.009.2010
- O’Connell, H. E., Hutson, J. M., Anderson, C. R., & Plenter, R. J. (1998). Anatomical relationship between urethra and clitoris. The Journal of Urology, 159(6), 1892–1897. https://doi.org/10.1097/00005392-199806000-00031
- O’Connell, H. E., Sanjeevan, K. V., & Hutson, J. M. (2005). Anatomy of the clitoris. The Journal of Urology, 174(4 Pt 1), 1189–1195. https://doi.org/10.1097/01.ju.0000173639.38898.cd
- Uloko, M., Isabey, E. P., Peters, B. R., et al. (2023). How many nerve fibers innervate the human glans clitoris: A histomorphometric evaluation of the dorsal nerve of the clitoris. The Journal of Sexual Medicine, 20(3), 247–252. https://doi.org/10.1093/jsxmed/qdac027
- Richardson, M. K., Hanken, J., Gooneratne, M. L., et al. (1997). There is no highly conserved embryonic stage in the vertebrates: Implications for current theories of evolution and development. Anatomy and Embryology, 196(2), 91–106. https://doi.org/10.1007/s004290050082
- Parker, R., Larkin, T., & Cockburn, J. (2017). A visual analysis of gender bias in contemporary anatomy textbooks. Social Science & Medicine, 180, 106–113. https://doi.org/10.1016/j.socscimed.2017.03.032
- Louie, P., & Wilkes, R. (2018). Representations of race and skin tone in medical textbook imagery. Social Science & Medicine, 202, 38–42. https://doi.org/10.1016/j.socscimed.2018.02.023
Kobelt’s 1844 description is cited here through O’Connell and colleagues’ 2005 review rather than directly. The claim that the older 8,000 figure derived from livestock studies was made by the Oregon Health and Science University research team when the 2023 count was published.