In Rembrandt’s Anatomy Lesson of Dr Nicolaes Tulp, painted in Amsterdam in 1632 and now in the Mauritshuis in The Hague, the dead man lies diagonally across the canvas and the living crowd toward his head. Tulp, in a broad black hat, lifts the muscles of the forearm with a pair of forceps, and with his other hand he seems to demonstrate the movement those muscles make. Seven men in ruffs lean in. In the lower right corner, at the dead man’s feet, a large book lies open.
W. G. Sebald, in the first chapter of The Rings of Saturn, noticed something about the painting that most viewers pass over, and once noticed it is hard to unsee. The surgeons, he observes, are not looking at the body. Their eyes go past it, toward the open atlas, where the body’s dreadful particulars have been tidied into a chart of parts, the mechanical picture of a human being that Descartes would soon make philosophically respectable. Sebald goes further and doubts that anyone present truly looked at the dead man. It is a hard reading, and perhaps an unfair one to the surgeons of Amsterdam. But it puts the anatomy book exactly where it belongs in the history of medical education: present even at the dissection, open beside the body, and competing with it for the student’s attention.
This essay is about that book, or rather that kind of book. Its title speaks of carrying anatomy books everywhere, and the image is true to the experience of a great many medical students, who know the particular weight of those volumes on a shoulder and the habit of opening them anywhere a few minutes can be found. I will not inventory particular editions, satchels or margins. The questions that interest me are about the kind of knowledge such books give. What does a flat page teach about a three-dimensional body? Why do anatomical names work the way they do? What happens when the body declines to resemble its picture? And why does some of what is memorised from these books outlast so much else that a medical education teaches?
Three Kinds of Book #
The phrase anatomy book covers at least three different instruments, and a student learns from each in a different way.
The first is the atlas, a book of pictures. Its knowledge is recognition: this shape, in this position, is the structure with this name. An atlas is consulted, not read; it is opened beside the body or beside a textbook, and the eye moves between them. The second is the descriptive textbook, which is made of sentences, and its characteristic sentence is relational. A muscle arises from one bone and is inserted into another. A nerve lies posterior to an artery, pierces a muscle, winds around a bone. A vein drains into another. The textbook’s knowledge is a web of such relations, and its prose, which can seem unbearably dry, is in fact a kind of verbal geometry. The third is the dissection manual, which is written in the imperative. Make an incision. Reflect the skin. Clean the fascia. Identify the nerve as it emerges. Its knowledge is procedural: it tells the student what to do in order to see what the atlas has shown and the textbook has described.
These three ways of knowing, recognition, relation and procedure, do not reduce to one another, and a student who has only one of them knows less than he thinks. A person who can name every structure in a picture may not be able to say what lies behind it. A person who can recite the relations may not recognise them in a real dissection, where nothing is coloured and everything is the same shade of preserved grey. A person who can follow the manual’s instructions may follow them without understanding why the structures are where they are.
Perhaps the most famous English anatomy, Henry Gray’s Anatomy: Descriptive and Surgical, published in London in 1858, had a second author in all but name. Its illustrations were made by Henry Vandyke Carter, who with Gray carried out the dissections at St George’s Hospital on which the drawings were based. The historian of art Martin Kemp has described the book as aspiring to “a simple descriptive mode of functional representation” that avoided the stylishness of the great Renaissance and Baroque anatomies, and so arrived at a style of its own. Carter’s drawings are plain and the names of the structures are set directly on them, so that the eye does not have to travel from a letter on the figure to a key at the bottom of the page. The name sits on the thing named. It is a small innovation and a profound one, because it collapses the distance between a word and a place.
Carter himself left for India in 1858, the year the book appeared. He became Professor of Anatomy and Physiology and later Dean of the Grant Medical College in Bombay, and made his name not as an illustrator but as a physician of tropical disease; among his papers is one on the cause of Madura foot, published in the Indian Medical Gazette in 1874. There is a pleasing circularity in the fact that the man who drew one of the most widely carried anatomies in the English language spent his working life teaching medicine in India, to students who would carry his pictures to places he never saw.
What the Page Leaves Out #
Every anatomical illustration is a set of decisions about what to remove. That is not a criticism; it is the condition of being legible at all. A real dissection presents the student with a crowded, layered, uniformly coloured field in which nothing announces itself. Fat surrounds everything. Fascia, the sheets of connective tissue that wrap muscles and organs, binds structures together and has to be cleaned away before anything can be seen. Small vessels and nerves cross the field in every direction. The atlas clears all this. It removes the fat, thins the fascia to a line, omits the minor vessels, and paints what remains in a code that most atlases share: arteries red, veins blue, nerves yellow.
The code is so familiar to medical students that it becomes invisible, and it is worth saying plainly that the body does not use it. Arteries in a preserved body are not red; nerves are not yellow. The colours are a reading aid, as much a convention as the blue of the sea on a map, and they do the same work. They make a complicated territory navigable by suppressing most of what is actually there. A student who has learned anatomy from colour plates and then confronts the real thing experiences what every map-reader experiences on arrival: the ground is the same, and nothing looks the way it did on paper.
The page also removes depth, which is the hardest loss to repair. A drawing shows a structure from one direction. It may show several layers by cutting windows through the upper ones, or show the same region from the front and the side, but each view is flat, and the student has to assemble the third dimension in his head. The regulations that governed Indian medical education when I began, the Medical Council of India’s Regulations on Graduate Medical Education of 1997, ask that a student at the end of the anatomy course be able to comprehend “the normal disposition, clinically relevant interrelationships, functional and cross sectional anatomy of the various structures in the body,” and to “mark the topography of the living anatomy.” Each of those phrases names something the page cannot give directly. Disposition is position in space. Interrelationship is what lies next to what. Cross-section is the body sliced, as a scanner slices it. Living anatomy is the body moving, breathing and covered with skin.
The defence of the page is that it is the only practical way to begin. No one can learn the course of a nerve from a dissection alone, because the dissection shows one body once, partially, and then the body is changed by the act of looking. The page can be consulted endlessly, carried home, compared with the textbook, and returned to in the night before an examination. Its simplifications are the price of its availability. The danger lies in forgetting that a price was paid.
Whose Body Is Drawn #
The page removes something else as well, which is less often noticed because it is removed by default: the variety of the people whose bodies are being described. An atlas has to draw somebody, and the somebody it draws is a choice.
Two studies of modern textbooks make the choice visible. In 2017 a group at the University of Wollongong published a content analysis of 6,044 images, in which sex or gender could be identified, from seventeen major anatomy textbooks used in Australian medical schools and published between 2008 and 2013. Outside the sections devoted to sex-specific anatomy, the images were predominantly male, and the authors also found a lack of diversity in ethnicity, age and body type. The next year two sociologists at the Universities of Toronto and British Columbia analysed 4,146 images from four textbooks widely assigned in North America, among them an anatomy atlas and an edition of Gray’s Anatomy for students. The racial distribution of the people depicted roughly matched that of the United States. The skin tones did not: about three-quarters of the images showed light skin, about a fifth medium, and fewer than one in twenty dark.
These are studies of recent editions in other countries, and they say nothing directly about the books used in Indian medical colleges in the late 1990s. But they describe a tendency that any reader of British and American anatomies will recognise. The standard body of the page has usually been young, lean, male and light-skinned, and the other bodies have appeared as special cases: the female body in its own chapter, the old body under pathology, the heavy body as an obstacle to finding the landmarks. A student anywhere who learns from such books learns the normal from bodies that may not look like the people he will examine. The bones and nerves are indifferent to the colour of the skin over them. But drawn skin teaches the eye what an ordinary body looks like, and an eye trained on one kind of ordinary has to be retrained, on the job, to see the others.
Names as Coordinates #
Anatomical names look, to a beginner, like an arbitrary heap of Latin. They are better understood as a coordinate system, and the system starts with a convention that every student learns in the first days: the anatomical position. The body is described as if standing upright, facing the observer, arms by the sides, palms turned forward. Every term of direction is defined against that imaginary posture. Medial means nearer the midline, lateral further from it; proximal nearer the trunk, distal further away; anterior toward the front of the body in that position, whatever the actual body happens to be doing. A patient lying on his side with his palm turned down still has his thumb on the lateral side of the hand, because the description refers to the imagined standing body and not to the real one on the bed.
The convention sounds pedantic, and it is a small triumph of thought. It allows any two people who have learned it to describe a location without ambiguity, regardless of which way either of them, or the patient, is facing. Left and right are the patient’s, never the observer’s. A surgeon reading a note written by a stranger knows exactly which side of which structure is meant. The coordinate system makes anatomical knowledge transmissible.
The names themselves often carry their coordinates inside them. A muscle called supraspinatus lies above the spine of the shoulder blade, and its neighbour infraspinatus below it. Deltoid describes a shape, the Greek letter delta. Flexor digitorum superficialis describes an action, the digits it acts on and its depth. Some names carry history rather than geometry. The anatomical snuffbox, the small hollow that appears at the base of the thumb when the thumb is stretched back, is named for the habit of placing a pinch of snuff in it; the habit is gone, and the name persists as a precise address, a hollow bounded by the tendons that move the thumb, with the radial artery crossing its floor. A name of that kind is a fossil of a vanished way of life embedded in a working map.
The map itself has a history of negotiation. The first internationally agreed Latin anatomical nomenclature was published at Basel in 1895, and it was revised several times in the twentieth century. A revision of 1998, Terminologia Anatomica, was produced by the Federative Committee on Anatomical Terminology and approved by the International Federation of Associations of Anatomists, with recommended English equivalents beside the Latin. The vocabulary that students in the late 1990s were memorising was, in other words, being formally reissued as they memorised it. The fact is a reminder that the names in an anatomy book are agreements, not discoveries. They are the profession’s way of making sure that one structure has one address.
Ordinary speech has never needed that precision, and the contrast is instructive. In everyday Punjabi a single word, ਨਸ (nas), can stand for a nerve, a vein or a tendon, and so can ਨਾੜ (nāṛ), whose close relative ਨਾੜੀ (nāṛī) also names the pulse. When someone says that a ਨਸ has “climbed”, ਨਸ ਚੜ੍ਹ ਗਈ, he means a sudden cramp or a pulled sinew, and nobody listening needs to know which of anatomy’s several categories is involved. The vernacular groups by experience: a cord-like thing under the skin that can be felt, seen or strained. Anatomy groups by structure and function: a vessel that carries blood away from the heart, a vessel that returns it, a bundle of fibres that carries signals, a band that joins muscle to bone. A physician who works in two languages lives between these two maps, and needs both. The patient’s word tells him what was felt. The anatomist’s word tells him where to look. Neither is the more correct; they answer different questions.
Walt Whitman, in the ninth section of “I Sing the Body Electric,” made a poem out of an anatomy written almost entirely in the vernacular, and it belongs beside the textbook. The catalogue runs for dozens of lines:
Head, neck, hair, ears, drop and tympan of the ears, Eyes, eye-fringes, iris of the eye, eyebrows, and the waking or sleeping of the lids, Mouth, tongue, lips, teeth, roof of the mouth, jaws, and the jaw-hinges,
It continues down through “elbow-socket,” “arm-sinews,” “the lung-sponges, the stomach-sac,” and “the brain in its folds inside the skull-frame,” and it ends, after the bones and the marrow, with a claim no anatomy book would make: “O I say now these are the soul!” What is remarkable about Whitman’s list is not its piety but its grammar. He names movements as readily as parts: “the waking or sleeping of the lids,” “the continual changes of the flex of the mouth.” The atlas cannot show these. Its body is still. Whitman’s catalogue is a reminder that the body the student is learning to name is, in life, a body that moves, and that a name is a point on a map of something that never holds still.
From the Flat Page to a Body #
Every student of anatomy has a structure that defeats him for a time, and for many it is the brachial plexus, the network of nerves that forms in the root of the neck and supplies the arm. Its textbook description is orderly: roots from the lower cervical and first thoracic spinal nerves join to form trunks, the trunks divide, the divisions regroup into cords named for their position around the axillary artery, and the cords give off the branches that run into the limb. Its diagram is a flattened tangle of lines, usually drawn as a sort of lopsided ladder. Neither description nor diagram looks like the thing itself, which lies in three dimensions, wrapped around a great artery, passing beneath a bone and between muscles. The task of learning it is not the task of memorising the ladder. It is the task of turning the ladder into a structure that can be seen, in the mind, from any direction.
That task has a name in psychology: spatial ability, and in particular the capacity for mental rotation, the ability to turn an object in the mind’s eye. A systematic review published in Anatomical Sciences Education in 2020 noted that earlier reviews had found spatial abilities to be correlated with performance on anatomy assessments, and reported that both instruction in anatomy and specific training in mental rotation improved students’ spatial abilities. The finding cuts in two directions. It means that some students start with an advantage, and that the advantage is not mysterious talent but a measurable skill. It also means that the skill can be trained, and that the study of anatomy is itself one of the ways of training it. The student who struggles with the plexus is building the very capacity whose absence makes it hard.
The book is only one of the means of that building, and the sensible view is that the means are complementary. The page offers names, relations and a standard picture. Bones, which can be held and turned in the hand, offer three dimensions without soft tissue. Models offer the soft tissue simplified. Dissection, which depends on the generosity of donors and is the subject of another essay on this site, offers the real thing in its mess and particularity. The student’s own body, and his classmates’, offer living anatomy: the pulses that can be felt, the tendons that stand out when a fist is made, the landmarks that will one day guide a needle. Imaging adds a fifth view, the body sliced, which the regulations of 1997 already expected students to begin to interpret. And there is a sixth, perhaps the most underrated, which is the student’s own drawing. A structure that has been drawn from memory, badly, and then corrected against the book, is a structure that has begun to exist in three dimensions in the mind, because drawing forces the choices that reading lets one evade: what lies in front, what passes behind, what crosses what.
The argument between those who think the book is obsolete beside real bodies and those who think it is sufficient for understanding them is, on this view, a false argument. The book was never meant to be the body. It is the index that makes the body searchable.
What Recitation Is For #
Anatomy is the most memorised subject in medicine, and it is easy to describe that memorisation with contempt. Another essay on this site, on the Krebs cycle, has already considered the case for and against rote learning in general, and I will not repeat it. Anatomy raises a narrower question. What, specifically, does a memorised list of anatomical names do?
The honest answer is that it provides retrieval cues. A student who can recite the branches of an artery, in order, with a mnemonic if necessary, has not thereby understood where they go or what they supply. But he has acquired a set of pegs on which understanding can later hang. When he sees a branch in a dissection, the name is available. When he reads a clinical description that mentions it, the name means something. When a teacher asks him to trace its course, he has at least a list to trace. Memorisation is the scaffolding of recognition, and recognition is the first stage of knowing anything. Anatomy has a long tradition of mnemonics to support it, some of them ingenious and a good number of them unprintable, and their persistence across generations of students is evidence that they do something real.
What recitation cannot do is reason. The regulations of 1997 contain, in their list of objectives for anatomy, a sentence that marks the boundary exactly. The student should comprehend the structure and connections of the nervous system, it says, and “be able to locate the site of gross lesions according to the deficits encountered.” That is a different kind of task. It asks the student to run the map backwards: to start from a loss of function in a living person, a weak hand, a numb patch of skin, a drooping eyelid, and to work out where in the body the damage must be. A list of names will not do it. Only a three-dimensional model will, one in which each structure has a position, a course and a territory, so that a fault at one point produces a predictable pattern of failure downstream.
This is where anatomy turns from memory into reasoning, and the transition is the real goal of the books. The student who can recite the plexus but cannot say which muscles would be weak if one cord were injured has memorised a diagram. The student who can answer that question has learned anatomy. The difference between them is not the amount of information they hold but its organisation. One holds a list. The other holds a map with roads on it.
The Body Declines the Diagram #
The anatomy book describes a body that no one has. Its illustrations show the usual arrangement, the one found most often, or sometimes simply the one the illustrator found most instructive, and it presents that arrangement with a calm authority that suggests it is how bodies are. Then the student meets bodies, and many of them disagree.
A small and harmless example makes the point better than a dramatic one. The palmaris longus is a slender muscle of the forearm whose tendon, in many people, stands out in the middle of the wrist when the thumb and little finger are pressed together and the wrist is flexed. In many other people it is absent, on one side or both, with no loss of function anyone notices. How many? A meta-analysis published in Clinical Anatomy in 2013, pooling twenty-six prevalence studies, put the overall rate of absence at about twenty per cent, higher than the figure of fifteen per cent commonly reported, and found that it varied greatly between populations: about four and a half per cent in the East Asian studies, about a quarter in the South and Southeast Asian and the Caucasian studies, and more than forty per cent in the studies from the Arab Middle East. A muscle drawn confidently in every atlas is, in other words, missing from one or both forearms in roughly one person in five, and the probability depends on who the person is.
The regulations of 1997 anticipated this kind of lesson. Among the objectives for anatomy is the requirement that a student “explain the developmental basis of the major variations and abnormalities.” That clause turns the textbook’s clean picture into what it really is: a central tendency, not a promise. Variation is not noise around the true body. It is the true body, of which the picture is a useful average.
The history of anatomy is in part the history of learning this lesson about books. For more than a thousand years European medicine took its anatomy largely from Galen, whose descriptions derived in large part from the dissection of animals, and teachers read his text aloud while assistants cut bodies that did not quite match it. The correction, associated above all with Andreas Vesalius and his Fabrica of 1543, came from trusting the body over the book. An essay on this site about print describes how the Fabrica‘s fixed woodcuts gave printed anatomy an authority of its own. Every anatomy book eventually becomes, for some reader, the thing that the body is supposed to resemble, and every generation has to relearn that the resemblance runs the other way.
The late twentieth century produced a striking inversion of the old problem. In 1994 the United States National Library of Medicine released the Visible Man, and in 1995 the Visible Woman: complete sets of cross-sectional images, photographic, CT and MRI, made from one male body and one female body, each willed to science, as the library’s own account records with thanks. The data sets were intended as a reference for the study of human anatomy and as material for testing imaging methods, and the library reports that some four thousand licensees in sixty-six countries were authorised to use them. A report of the library’s Board of Regents in 1998 described the project’s long-term aim as linking “visual knowledge forms to symbolic knowledge formats such as the names of body parts”, which is Carter’s idea of setting the name on the thing, carried into the digital age.
The inversion is this. For centuries the anatomy book drew an idealised average that no one possessed. The Visible Human data gave the world a reference made from two particular people, with every peculiarity of their particular bodies preserved in the slices. The problem of the standard body did not disappear; it changed form. Instead of an average standing for everyone, an individual did. Either way the student must make the same correction: whatever is drawn, sliced or modelled is one version of the body, and the patient will be another.
The clinical consequence is a habit of mind rather than a fact. A physician who expects the body to match the diagram will be surprised in ways that can matter; one who expects it to vary will look before assuming. The book’s most important lesson, which it cannot teach directly, is that it is a reference, and that the reference is not the patient.
Permastore #
The belief that some of what is memorised from anatomy books never leaves can be tested, and the evidence is both encouraging and sobering.
The encouraging part comes from an unexpected direction. In 1984 the psychologist Harry Bahrick published a study of memory for Spanish learned at school, testing 733 people whose schooling had ended anywhere from a few months to fifty years before. Their retention declined steeply for the first three to six years. Then it stopped declining. What remained after that period stayed essentially unchanged for up to thirty years before a final decline, and large portions of the original learning remained accessible for half a century, though most of the participants had hardly used their Spanish at all. Bahrick called this surviving portion permastore. Its size depended, above all, on how thoroughly the material had been learned in the first place: on the level of training and the grades received, rather than, so far as the data could show, on rehearsal in the years since. He found that individual items seemed to fall into two groups, those lost within about six years and those kept for more than twenty-five, with almost nothing in between.
The sobering part comes from studies of medical knowledge specifically. Eugène Custers, reviewing research on the long-term retention of basic science knowledge in 2010, concluded that across general and medical education roughly two-thirds to three-quarters of such knowledge is retained after one year, falling to a little under half the following year. In a cross-sectional study of Dutch students and doctors published the next year, Custers and Olle ten Cate found that scores on a basic science test fell from about forty per cent correct among students still in medical school to between a quarter and three-tenths among doctors after many years of practice. When they controlled for whether the knowledge had been used, unused knowledge seemed to be little affected for a year and a half or two, and then declined along a forgetting curve that flattened over time, reaching around fifteen to twenty per cent after twenty-five years or more.
Put the two findings together and the shape of an answer appears. Much of what is memorised from anatomy books does leave, and fairly quickly, unless it is used. Some of it stays for decades, and what stays is disproportionately what was learned most thoroughly. In anatomy, the most thoroughly learned material is usually the most structural: the coordinate system, the major regions and their contents, the courses of the principal vessels and nerves, the relations that were drawn and redrawn until they could be seen with closed eyes. Use then sorts the rest. Family medicine examines knees, shoulders, abdomens and necks constantly, and the anatomy of those regions is renewed by every examination. The anatomy of a region that general practice rarely visits fades to a name and a general direction, available to be relearned quickly from the book if it is ever needed, which is perhaps the most valuable thing permastore preserves: not the details, but the map on which the details can be found again.
It would be dishonest to claim, decades on, that any particular fact learned in the first year has never needed correcting. Anatomical nomenclature has changed, imaging has added views the old books did not have, and memory edits itself. What lasts is less a set of facts than a set of habits: to ask what lies next to what, to describe a location precisely, to expect variation, to check the book when the body surprises. Those habits were formed by the books, and they outlive the books’ contents.
The Weight of a Book #
Why carry such heavy objects everywhere? Partly for the obvious reason, that anatomy rewards repetition and every spare quarter-hour can be spent on it. But I think the habit also reflects something about the relationship between a student and his first serious books in medicine. An anatomy book is a companion and an authority at once. It holds what the student does not yet know and has to know; it is consulted, argued with, annotated, borrowed, lent. For a while it stands, in the student’s mind, for the whole of medicine, because it is the first thing in medicine that is too large to know and too important to leave behind.
The danger Sebald saw in Rembrandt’s painting is the danger of that authority. The surgeons look at the atlas because the atlas is orderly and the body is not, because the book confirms what they already expect and the body might not, and because looking at the page is easier than looking at the dead man. Every student of anatomy feels the same pull. The diagram is clean; the body is not. The book can be closed; the body has to be dealt with. And because the book is so useful, and so heavy, and so constantly carried, it is easy to come to believe that knowing the book is knowing the body.
The cure is not to put the book down. The surgeons in Tulp’s theatre would have learned little without their atlas, and no student learns the brachial plexus without a diagram. The cure is to use the book as the painting’s arrangement quietly suggests a book should be used: open beside the body, at its feet, in a supporting position, consulted and then set aside so that the eyes can return to what is actually there. A physician carries that relationship into every examination for the rest of his life. He brings a map he has memorised, much of it now permanently, and he lays it, as gently as he can, over a body that has never read it.
Evidence and Editorial Note #
Documented findings. Public biography relied on: MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002; family physician. Medical Council of India, Regulations on Graduate Medical Education, 1997, anatomy goals and objectives (normal disposition, cross-sectional anatomy, living anatomy, locating lesions from deficits, developmental basis of variations): National Medical Commission PDF of the regulations with later amendments marked. Gray’s Anatomy of 1858, Henry Vandyke Carter’s role in dissections and illustrations, Kemp’s description of the book’s “simple descriptive mode of functional representation,” Carter’s departure for India in 1858 and his posts as Professor of Anatomy and Physiology and Dean of Grant Medical College, Bombay: abstracts of M. Kemp, Journal of Anatomy 2010;216:192–208, J. M. S. Pearce, Clinical Anatomy 2009;22:291–5, and J. R. Hiatt and N. Hiatt, Journal of the American College of Surgeons 1995;181:464–6 (PubMed). Carter’s 1874 paper on Madura foot: PubMed record, Indian Medical Gazette 1874;9:220. The Basel nomenclature of 1895 and Terminologia Anatomica (1998), by the Federative Committee on Anatomical Terminology with IFAA approval and English equivalents: abstract of D. Kachlik et al., Surgical and Radiologic Anatomy 2008;30:459–66. Spatial abilities and anatomy: J. Langlois et al., Anatomical Sciences Education 2020;13:71–79 (abstract). Palmaris longus agenesis: K. Yammine, Clinical Anatomy 2013;26:709–18 (abstract). H. P. Bahrick, Journal of Experimental Psychology: General 1984;113:1–29 (abstract); E. J. F. M. Custers, Advances in Health Sciences Education 2010;15:109–128 (abstract); E. J. Custers and O. T. ten Cate, Medical Education 2011;45:422–30 (abstract). Walt Whitman, “I Sing the Body Electric,” section 9: Project Gutenberg text of Leaves of Grass. Gender and other bias in images from seventeen anatomy textbooks used in Australian medical schools (6,044 images, 2008–2013 editions): R. Parker, T. Larkin and J. Cockburn, Social Science & Medicine 2017;180:106–113 (abstract). Race and skin tone in 4,146 images from four North American textbooks: P. Louie and R. Wilkes, Social Science & Medicine 2018;202:38–42 (abstract). The Visible Human Project (Visible Man released 1994, Visible Woman 1995; cryosection, CT and MRI images from one male and one female body, each willed to science; about 4,000 licensees in 66 countries; the 1998 Board of Regents statement quoted): U.S. National Library of Medicine, “The Visible Human Project” (nlm.nih.gov). Rembrandt’s painting (1632, Mauritshuis; Tulp, the forearm, the open book); Sebald’s reading in The Rings of Saturn (paraphrased, not quoted); the placement of labels directly on Carter’s figures; the anatomical position and terms of direction; the derivations of supraspinatus, infraspinatus, deltoid and flexor digitorum superficialis; the anatomical snuffbox; the brachial plexus; the colour conventions of atlases; the Punjabi senses of ਨਸ, ਨਾੜ, ਨਾੜੀ and ਨਸ ਚੜ੍ਹਨੀ; Galen’s reliance on animal dissection and the Fabrica of 1543: standard reference knowledge. Vendor representations. None.
Recollection and tradition. No particular book, edition, annotation, satchel, page or study habit of the author’s is described; the essay discusses the category of anatomy books. No teacher, classmate or examination is described. No hypothetical scene is used.
Analysis and forecast. The division of anatomy books into atlas, textbook and manual as recognition, relation and procedure; the reading of anatomical names as coordinates; the comparison of vernacular and anatomical vocabularies; the inference from recent textbook studies to the books of the 1990s, offered as a tendency rather than a finding; the reading of the Visible Human data as an inversion of the idealised atlas; the view that the methods of learning anatomy are complementary; the interpretation of the retention studies as preserving structure and habit more than detail; and the closing reading of Rembrandt’s arrangement are the author’s interpretation as of November 2026. The anatomical material is general description, not clinical instruction. Independence. This essay is not sponsored by any institution, company, health system or technology developer.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.