Gray’s Anatomy: an iconic medical textbook

by D. Marsh, France

David MARSH, PhD
Servier International
Medical Publishing Division
50 rue Carnot
92284 Suresnes Cedex

In Victorian Britain, medical students and their professors gleaned anatomical knowledge by dissecting the cadavers of executed felons. But the number of capital offences on the statute books was decreasing, and with it the supply of bodies: hundreds of executions yearly in the seventeenth century, fifty or so in the eighteenth. By the 1820s, this supply and demand imbalance prompted so-called “resurrectionists”— to wit body snatchers—to unearth the recently buried and sell them to medical schools. Others, like Burke and Hare in Edinburgh, went further and murdered people to sell their fresh corpses for dissection. They were aped in London by two burkers, as they came to be known, whose trial was covered by Charles Dickens, then a young reporter. In Oliver Twist (1838), Dickens alludes to corpse procurement since in the tomb of the eponymous hero’s mother, who dies giving birth in the workhouse, ‘there is no coffin,’ in other words she was one of the “unclaimed” of the 1832 Anatomy Act. Intended to end illegal trading in cadavers, the new law allowed authorized parties to sell unclaimed (within forty-eight hours of death) bodies to medical schools. This prompted one prescient opponent to argue that since the Act did not ban the sale of corpses, it would ‘convert every workhouse-keeper into a systematic trafficker in dead bodies.’ Prisons, madhouses, and hospital mortuaries also supplied anatomists with corpses, as did the capital’s hovels, blighted as they were by cholera until Dr John Snow, through ‘his visionary work in deducing the mode of transmission of epidemic cholera’ (The Lancet), showed that the cause was not miasma, as widely believed. Mephitic vapors there were though, emanating from the sewage-laden River Thames, which future Prime Minister Benjamin Disraeli called ‘a Stygian pool, reeking with ineffable and intolerable horrors’ during “The Great Stink” of 1858.

In that year, as civil engineer Joseph Bazalgette set about revolutionizing London’s sewer network, Henry Gray (author) and Henry Vandyke Carter (illustrator) published Anatomy: Descriptive and Surgical, the fruit of countless hours of painstaking dissection and drawing at St George’s Hospital Medical School. In its pages, Carter and Gray’s book bore witness to the nameless who in death unwittingly contributed to our wealth of anatomical knowledge and who in so doing acquired posthumously a value to society denied them during their poor, brutish, and often short lives.

Shrewdly timed to arrive in the bookshops at the start of the new academic year, Anatomy: Descriptive and Surgical was published in late August 1858. The recently ended bloodbath of the Crimean War had brought emergency surgery to public attention, and Gray and Carter’s book offered a comprehensive review of anatomical knowledge in which the surgeon’s art was placed center stage. The book addressed the reader as a future surgeon, explaining the importance of anatomical detail, exquisitely rendered in Carter’s fine drawings, which were what we might now call the book’s unique selling point.

St Georges’s Hospital, London; the dissecting room with
students and lecturers, including Henry Gray (front row,
third from the left). Photograph (1860).
© Wellcome Library, London.

The Right Auricle and Ventricle laid open, the Anterior
Walls of both being removed. In: Gray H, Carter HV.
Anatomy Descriptive and Surgical (1858). London, United
Kingdom: JW Parker & Son; 1858.

Left: Henry Gray. Engraved from a portrait photograph taken in the late 1840s or early
1850s by H. Pollock. © Wellcome Library, London.
Right: Henry Vandyke Carter. Self-portrait (circa 1870). © Wellcome Library, London.

Its single tome sold for 28 shillings, which in today’s money is roughly equivalent to the price of the latest, 2015 edition (∼185 €), and was ten per cent cheaper than its rival, Jones Quain’s three-volume Elements of Anatomy, the standard textbook of the day, first published in 1828. Gray and Carter’s book appealed because of its clarity and legibility—book-size images, many fullpage, captions that prompted one reviewer to write that the mind never doubted which structure was indicated, the subtext being that until then anatomy textbooks had been plagued by this very problem. Anatomy: Descriptive and Surgical could also fit snugly in a greatcoat pocket, had an exhaustive index and list of illustrations, and treated anatomy, and the dissected bodies depicted, in a dignified way that contrasted with Quain’s sometimes gruesome images.

In print ever since its first edition in 1858, and officially renamed Gray’s Anatomy in 1938, Gray and Carter’s book is now in its 41st edition (2015) and remains the definitive reference work on human anatomy in the English-speaking world.■