The first anatomical images in printed books in the sixteenth century were the result of a now well-known negotiation between art, enterprise, and the study of nature. There have been many valuable contributions made to our understanding of these images—their genesis and function—by historians of science, historians of the book, and historians of art and visual culture. In this presentation, however, I will reflect on anatomical images with the history of medicine specifically in mind.  I will argue that the early modern anatomist’s threefold distinction among historia-actio-usus served as the initial grammar of anatomical illustration. Examining the formal, investigative procedures of anatomists in the early modern period, at the precise moment when anatomical images became a standard feature of medical textbooks and works of natural philosophy, I will detail how the historia-actio-usus distinction helps us understand the existence of divergent images, competing agendas, and disputes over accuracy. Case studies will come from early modern and later editions of Galen, Harvey, and Descartes, as well as several more recent and non-Euro-Western anatomical illustrations.