Doctor's Review: Medicine on the Move

August 23, 2017
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Dissecting Gray’s Anatomy

Medicine’s most mesmerizing textbook is also its most mysterious

The Ebers Papyrus. De Materia Medica. The Canon of Medicine. The Origin of Species... these are just four of the standouts among the many great medical and scientific texts known to exist. One, however, seems to hold a special place in the hearts and heads of medical students and average joes alike. After all, no other can match the magnitude, mystique and near-mythical status accorded to Gray’s Anatomy.

The book that brought the beauty of the human form to the masses, one meticulous image at a time, has been available in a current edition since 1858. The year 2008 marked the 150th anniversary of the textbook’s first printing; last September saw the publication of the fabled 40th British edition.

One wonders whether its author — who barely lived long enough to enjoy his achievement — would have been surprised at the seemingly eternal success of his exquisite labour of love. Though his name marks him as one, if not the most famous medical author, not much is actually known about the life of Dr Henry Gray.

Gray skies

He was born in 1827 to an aristocratic family. His father William was treasurer to King William IV and little Henry was actually born in Windsor Castle, growing up in London’s tony Belgravia district. He was a bright child and began medical studies at the age of 18 at St. George’s Hospital, the well-regarded teaching institute at Hyde Park Corner. He graduated at 21. His keen eye for detail led him to the field of anatomy and young Gray was identified immediately by his professors as a standout in the discipline.

After graduating, he took an appointment as a surgeon, anatomist and lecturer at St. George’s, where he would spend most of his all-too-short career. In 1852, at the age of 25, his peers elected him a Fellow of the Royal Society, the invitation-only group of illustrious scientists and scholars — an impressive feat for one so young.

From then on, anatomy became Gray’s sole focus. By nature he was motivated and outspoken, with an easy confidence that would soon serve him well in a very ambitious project. He probably came to the idea of writing his anatomy book because of the need for a single, portable, comprehensive volume on the subject. Previous works in the field were huge and heavy and completely inadequate for anyone wanting to carry a copy along with them on house calls!

The year was 1857, and fortunately, Gray would have an adequate — and at last, legitimate — supply of corpses on which to draw from, since the Anatomy Act of 1832 had finally put an end to the early 19th-century black-market body trade. Before this, religion and superstition restricted scientists, and particularly physicians, from learning and teaching from actual human remains; previously, the only bodies deemed deserving of this post-mortem sacrilege were executed murderers, as set out in a 1752 statute known as The Murder Act. Gray was therefore in the right place at the right time in mid-19th century London; he was allowed access to the city’s unclaimed dead bodies since he had a legitimate scientific use for them.

Anonymous artistry

But the man whose name this most formidable of textbooks bears is only half the story of its authorship. Somewhat ironically, the identity of the creator of those remarkable illustrations has, for the most part, slipped silently into the mists of medical obscurity. The man to whom this grave Gray’s injustice has been done is Dr Henry Vandyke Carter.

He was born in Hull, Yorkshire, on May 22, 1831, not into a family of doctors, but rather of artists... a heritage that he would one day honour most dutifully. His father, Henry Barlow Carter, was a well-known painter of English landscapes and maritime watercolours, and this no doubt influenced the young boy profoundly.

Though he came from a poor family, Carter was eager to study medicine, which he also did at St. George’s Hospital. He later studied comparative anatomy at the Royal College of Surgeons, but would ultimately spend a good part of his career in India, teaching anatomy and studying infectious diseases, eventually rising to the rank of Principal of Grant Medical College in Bombay. He died of tuberculosis in Yorkshire on May 4, 1897, known better for his expertise in tropical medicine and his position as an Honourary Surgeon to the Queen than for his contribution to one of the finest medical texts ever produced.

A match made in medicine

Although Henry Gray was a competent illustrator, he knew he needed a truly gifted technical artist to accomplish his vision for the work. Fortunately, he had met and befriended Carter while they were both at St. George’s and their collaboration quickly turned into medical magic. Though Carter was shy and withdrawn compared to the outgoing Gray, the pair worked well together, sharing both a passion for anatomy and a clear vision for the tome they were working to create. For 20 months straight, they toiled away, putting in the work required to create a classic.

Carter himself assisted Gray with dissections, meticulously recording every tendon, tissue, bone and muscle along the way. It was painstaking work; the patience required to produce the 363 images spread over 750 pages was considerable. They worked day and night, meticulously stripping their cadavers until the huge undertaking was accomplished. The end result was a sort of 19th-century version of the Human Genome Project, unravelling and recording the mysteries of life as they went. Each drawing, which was to form the basis for the engraving needed for printing, was big enough to be useful and clearly labelled so as to be of real help to students. Immediately upon their book’s completion, Carter left to join the Indian Medical Service and never really got to enjoy the fruits of his illustrious labour.

Perfect and published

The team’s text quickly found a home with publisher JW Parker & Son of West Strand, who wisely priced the new volume below its competitors. Gray’s Anatomy, Descriptive and Surgical — as it was first called — hit the shelves in 1858, and it became an instant best seller. Almost impossibly thorough, it was perfect, precise, even poetic. It received rave reviews in The Lancet and The British Medical Journal, however as it turned out, the mysterious inner workings of the human body did not only appeal to scientists and scholars, but also to everyone with a curiosity about what lay beneath the exterior of the human form. Since then, Gray’s Anatomy has been expanded upon and revised by a succession of preeminent anatomists and illustrators.

But what of Gray himself? In 1861, just three years after his book came out, he found himself killing two birds with one stone while visiting his sick nephew. The boy had contracted smallpox and was indeed dying, but Gray insisted on caring for him anyway. Ever the scientist, he also decided to study the effects of the disease on the anatomy. He ended up contracting smallpox himself and the brilliant anatomist died before his time on June 8, 1861. He was only 34 years old, and lived to see the second edition of his book published the year before.

The new millennium has seen a rebirth of sorts for this classic piece of medical literature. Although a constant stream of medical students have studied its pages over many generations and revised editions, lay people, it seems, have once again become fascinated with the art and ideas presented in the book. For example, the entire 20th edition, published in 1918, along with all 1247 of its magnificent engravings, is now available online (www.bartleby.com/107). The book is even sold at Target and Walmart... proof positive of its utter ubiquity.

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