510 SAMJ VOLUME 69 12 APRIL 1986

History of Medicine

On the sexual intercourse drawingsof Leonardo da VinciA. G. MORRIS

.,

Summary

Leonardo da Vinci's marvellous anatomical drawingshave been praised by both artists and medicalhistorians over the centuries. Specific reference ismade here to Leonardo's drawings of the act ofsexual intercourse. It is shown that his illustrationsare not based purely on original observation. Rather,they are an attempt to illustrate and clarify anatomyand physiology as presented in the textbooks of thetime.

S Atr Med J 1986; 69: 510-513.

One of the most celebrated non-events in the history ofanatomy was the failure of Leonardo da Vinci (1452 - 1519) topublish his proposed anatomical textbook. Over a period ofmore than 20 years Leonardo accumulated at least 200 pagesof notes and drawings but he was not able to organize themanuscript into a publishable form. The artistic standard ofhis work has been praised by all who have viewed the pages,and some of his biographers have gone as far as to say theproposed book would have become the standard anatomicalreference well into the centuries following his death. Sadly, daVinci did not finish his book and the drawings and manuscriptswere lost to the world of scholars until the late 18th century.The publication of the first modern anatomical text had towait until the appearance in 1543 of De HlImani CorporisFabrica by Andreas Vesalius.

But are the praise singers of da Vinci truly justified in theiremphasis on Leonardo as a man so far ahead of his time?There can be no doubt that da Vinci was both marvellouslyobservant and imaginative in his diagrammatic presentation,and his engineering and artistic innovations are indeed great,but the anatomical knowledge demonstrated in his observationsis full of imperfections. Da Vinci's work is that of a brilliantartist whose anatomical observations were clouded by pre­conceived ideas, while Vesalius was a master of dissection whobroke new ground in the originality of his observations. To befair to Leonardo, it must be noted that his later works weremore accurate, bur many of the errors remain. O'Malley andSaunders 1 have described Leonardo's anatomical enterprise asthe 'revelations of a groping mind seeking emancipation fromdebased medieval Aristotelianism ... '. He came close to thisgoal, but complete freedom eluded him. Nowhere can this bebener illustrated than in his drawings of male and femaleanatomy in the act of coition. These pictures are a specialmixture of fact and fancy, an objective basis overlaid withtraditional theories.

Department of Anatomy, University of Cape TownA. G. MORRIS, PH.D.

Leonardo's anatomical backgroundPan of the folklore about Leonardo da Vinci is his reputation

for being a persistent dissector who anatomized numerous cadavers.Da Vinci himself declares in his notes that he dissected ten bodiesand Taiana2 quotes contemporary sources to indicate that thefigure may have been as high as thirty. O'Malley and Saunders l

have closely examined da Vinci's original notes and drawings tosee if they can verify these numbers and have come to thesurprising conclusion that Leonardo's experience was much lessthan is usually described. He did a full srudy of the body of an oldman, the 'centenarian', in Florence in 1503 and of a child of twoyears at about the same time. It seems likely that he also dissecteda second elderly male, a younger male, and a human ferus of about7 months post-conception. Other dissections were of parts ofhuman bodies; a head and neck during his first stay in Milan andperhaps a leg at a later date. He certainly srudied a number ofanimal cadavers and it is probably true that he observed humandissections performed by other people. The evidence thereforesuggests that da Vinci dissected only four or five individuals andthe remainder of his 'ten human bodies' were bits and pieces ofhuman material that he was able to obtain from time to time.

Even more important is the fact that Leonardo did not haveconstant access to dissection material during his career. The youngLeonardo resided in Florence from about 1470, first as an appren­tice to the famous del Verrucchio, and then as an artist in his ownright. The Florentine medical school had been moved to Pisa in1470 and it is unlikely that he could have participated in humandissections during these early years. The siruation was not muchbetter in Milan where he moved in 1482 or 1483. His patron,Lodovico Sforza, required his constant services as an engineer andmuch of Leonardo's spare time was taken up in designing monu­mental architecrure for the Duke. During this rime Leonardodabbled in anatomy, but the drawings that can be dated to thisperiod are very inaccurate. The poor quality suggests that da Vinciwas relying on textbook anatomy and his opportunities for dissec­tion must have been rare indeed.

In 1499, da Vinci's Milanese patron was expelled from the cityby the French, and Leonardo embarked on a period of wanderingwhich took him from Milan to Venice and into the service of theinfamous Cesare Borgia. In Venice he had access to a medicalschool with a professional anatomist in anendance, but he doesnot appear to have taken advantage of the siruation. Finally inMarch 1503, da Vinci returned to Florence and began his periodof most active anatomical research. It was here that he met thecentenarian at the Hospital of Santa Maria Nuova and was at hisbedside when the old man died. Leonardo's active interest did notslacken when he moved again to Milan in 1506 and he was afrequent visitor to the Hospital Maggiore. The content ofanatomical drawings dated to this period testify to da Vinci'simproved knowledge and new-found originality of observation,and there can be no doubt that he had gained first-hand experienceas a dissector. Towards the end of his life Leonardo left Milan andjourneyed first to Rome, then to Florence, and finally to Frahcewhere he died in 1519.

The anatomical drawings of Leonardo da Vinci span the yearsbetween 1487 and 1513, but only in the laner half of this time didLeonardo have detailed knowledge gained through dissection. DaVinci's source of information in the early years could only havebeen gleaned from textbooks and, as a result, Leonardo spentmuch of his time producing drawings which tried to explain theconflicting viewpoints presented in these books. In his notes, daVinci lists his literary possessions and this gives us some idea of

SAMT DEEL69 12APRIL1986 511

Fig. 1. Torsos in coition, from sheet C III 2 recto.

the kind of texts he had read. Chief among Leonardo's referencebooks was a 1493 edition of Johannes de Ketham's Fasciculo diMedicina. 3 This was a compendium. of medical information thatincluded a complete translation of Mondino di Luzzi's AnOlhomia.Mondino's book, originally wrinen in 1316, was the text favouredby most medical schools and the Fasciculo edition was the first tobe published in Italian. Da Vinci's poor command of Latin madeearlier versions unavailable to him.' The Mondino publication wastypical of 15th cenrury medical books in that it was essentially anunchecked reissue of ancient anatomical manuscripts. Its onlyclaim to originality was in its dissection manual format, but theinformation it contained was based on Arabian writings whichwere translated from Arabic into Latin in about 1150. The mostfamous of these writers was Avicenna who in rurn had derived hisinformation from translations of Galen and pre-Galenic Greektexts. Ketham's version of Mondino was therefore a summary ofancient Greek knowledge fIltered through at least three majortranslations. By reading this book and others, Leonardo gainedaccess to the ideas of Hippocrates, Aristotle, Plato and Galen, butthese were intermixed with the later views of both Avicenna andMondino. Direct translations of the original Greek texts intoLatin and European secular languages were not available until1525, six years after da Vinci's death.'

The coition figuresIllustrations of figures engaged in sexual intercourse appear on

four pages of da Vinci's notebooks. Interest in these picrures hasalways been great and they were among the first of Leonardo'sdrawings to be described. C III 2 recto* depicts three pairs ofhuman torsos cut longirudinally to show the anatomical features ofthe genitalia. The largest figure (Fig. I) seems to be a preliminarysketch for a more complete drawing (described below). On the

*The pagination of da Vinci's notebooks is based on the number given them in their firstdetailed description. Da Vinci did not number his pages and the inheritors of the documentsmade no attempt to keep them in a specific order. The pages containing the sexual intercoursedrawings are all from Folio C published in six volumes between 1911 and 1916. I,) The romannumeral refers to the volume number and the specific page follows. Only rarely did Leonardouse one side of the page alone, so recto and verso refer to the front and back surfaces.

verso of this leaf is a diagram of the male and female generativeorgans in coition (Fig. 2). The quickly scrawled illustration is onthe corner of a page filled with mechanical drawings of cranes,pulleys and levers. C III 3 verso contains the largest and mostcomplex of the coition figures (Fig. 3). The style of the drawing isclearly based on the torso figures described above, but the anatomyis much more detailed. A small accompanying drawing of thepenis at the bottom of the page is presented here as Fig. 4. Thelast of the coition illustrations is a set of scattered sketches (C III12 verso) showing the sexual organs either in coition or separately.A group of these drawings are included here as Fig. 5.

Leonardo dated very few of his picrures, but the notes can besorted into a rough chronological order by means of progressivechanges in the paper, ink and pen used, and by the altered style ofhis handwriting over the years. O'Malley and Saunders' haveconsidered these clues and suggest that the preliminary coitiontorsos were drawn about 1493 or 1494, while the more complete

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Fig. 2. Generative organs during coitus, from sheet C III 2 verso.

512 SAMJ VOLUME 69 12 APRIL 1986

Fig. 4. Detail of penis, from sheet C III 3 verso.

anempt to include the Galenic view that the testes manufacturedsperm from the blood. He has therefore mixed Galenic andAristotelian arguments and has provided an appropriate anatomyfor both theories. An interesting omission in the male fIgure is theprostate gland. This organ is not mentioned in any of the medicalbooks available to da Vinci, and it does not appear in Leonardo'sdrawings of masculine anatomy.

The medieval and ancient Greek theoretical overlays are alsopresent in da Vinci's depiction of female anatomy. In Fig. 3 theuterus is rather poorly sketched and has a corrugated appearance.The cause of the corrugations becomes obvious when the chrono­logically earlier drawings (Figs 1 and 2) are viewed. Here theuterus is clearly made up of a number of cells. This strangeuterine morphology is drawn from the description of Mondinowho maintained the common medieval misconception of a wombwith seven chambers. Leonardo discarded this idea with time, andthe later drawing (Fig. 5) shows a uterus of more normal appear­ance. Even more extraordinary is the addition of a blood vessel inFig. 3 connecting the fundus of the womb with the breast.According to medieval thought, this hypothetical vessel carriedthe suppressed menstrual blood to the mammary glands where itcaused the enlargement of the breasts and the production ofmilk. I

,3 The absence of ovaries in the drawing reminds us again ofLeonardo's great confusion between Aristotelian and Galenictheories. The Aristotelian belief presented the fema1.e as just thesoil into which the male seed was planted and the "ovaries weregiven no reproductive role. In later years da Vinci subscribed tothe Galenic approach in which the female testicles (ovaries)produced their own sperm which intermingled with the masculinesperm in the uterus. An imaginary passage called the vasseminarium delivered the female sperm from the ovary to thecervical junction of the uterus and the vagina.

Two features about the depiction of the sex act itself are also ofinterest. The penis is shown by da Vinci to protrude through thecervix and into the uterine cavity in all drawings except Fig. 3,

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illustration is from about 1500. The scanered drawings of dis­embodied generative organs are later, perhaps around 1503 orshortly after. These dates imply that all but one of the drawingswas executed before da Vinci had obtained an appreciable know­ledge of anatomy through dissection. The drawings have majorimperfections in their detail, and in each case the errors are theresult of Leonardo's anempt to illustrate 'textbook' anatomy.

A brief glance at the male character in Fig. 3 reveals theamazing internal 'plumbing' designed by Leonardo to describeAristotelian physiology. He has drawn two canals in the penis, thelower of which is connected to the urogenital tract via the urethra,while the upper canal passes to the spinal cord by means of threevessels. The close-up of the penis (Fig. 4) demonstrates these twocanals in fIne detail. In ancient Greek writing, the 'essence' of ababy was provided by the 'universal seed stuff' of the male. 6 Thisprocreative ingredient was derived from animal spirit, a physio­logical material necessary for muscular activity. The animal spiritwas manufactured from arterial blood at the base of the brain andwas transferred to all parrs of the body through the nerves. Henceda Vinci's spinal connection to the penis. Aristotle taught that thetestes played no role in procreation other than to provide a saliva­like humor to lubricate the vagina during intercourse. Leonardoappears to have disagreed with this concept, and he has drawn alarge blood vessel passing from the hean to the testicle in an

Fig. 3. Figures in coition, from sheet C III 3 verso.

12 APRIL 1986 513

I. O'Mallcy 0, aundcrs JB. Uonardo da Vinci on rlu Human Body. 'IOW

York: Henry chuman, 1952.2. Taiana JA. The anatomical drawings of Leonardo da Vinci. In: Richardson

RC, cd. Abbollempo in ReviertJ. Amsterdam: Abbott niversaJ, 1970.3. Keel KO, Pedrerti C. Leonardo da Vinci: orpur of rlu Anatomical rudi.. in

rhe Col/ccrion of Her Majtsly rlu Q n ar Windsor Uurle. London: JohnsonReprint Co., 1979 - 1980.

4. Wallacc R. TIu World of Leonardo. Am terdam: Time-Life, 19 2.5. inger C. A Sharr Hillory of Anaromy from the Grub ro Harvey, 2nd cd.

'ew York: Dover, 1957.6. McMurrich JP. Leonardo da Vinci: TIu An romlfl. Baltimore: Williams &

Wilkins, 1930.

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and the uterus is consistently illustrated as being inflated. Thisembracing of the glans penis by the cervix and the expan ion of

Fig. 5. Generative organs during coitus, from sheet C III 12 verso.