The Treaty of Anatomy, Descriptive and Surgical Rafael Romero-Reverón Correspondence to Dr

Anatomy Journal of Africa. 2015. Vol 4 (2): 541 – 545. HISTORICAL GLIMPSE

Henry Gray (1827 -1861), The Treaty of Anatomy, Descriptive and Surgical Rafael Romero-Reverón Correspondence to Dr. Rafael Romero-Reverón. Department of Human Anatomy, José María Vargas Medical School, Faculty of Medicine, Central University of Venezuela. Member of the Venezuelan Society of History of Medicine. email: [email protected]

ABSTRACT Henry Gray (1827-1861), English anatomist and surgeon at Saint George's Hospital at London, most notable for publishing his treaty of Anatomy, Descriptive and Surgical. His career was developed at Saint. Georges Hospital, from medical student to demonstrator to lecturer of anatomy, and curator of the museum. He was Fellow of the Royal Society and Fellow of the Royal College of Surgeons. Key words: Henry Gray, treaty of Anatomy, Human Anatomy, Gray’s Anatomy.

INTRODUCTION The objective of this paper is to perform a Henry Gray was born in Belgravia, London, briefly review of Henry Gray 's contribution in England in 1827 and lived his entire life in his the field of human anatomy. The knowledge family's home with his widowed mother Ann, of human anatomy (from the Greek word near the Saint George's Hospital. Facts about ανατομία (anatomē), which means his personal life are quite few. Henry Gray "dissection") composes a fundamental pillar in came from a well off and well connected the extensive and complex field of medicine. family. He was one of four children of Thomas Human anatomy has historically been a Gray a private messenger to George IV and cornerstone in medical education and this is William IV, the family apparently had no the field of medical studies where students financial problems. Basically nothing is learn the fundamental language of medicine, recorded of his preparatory education (Hayes learn to develop understanding through 2008). His father's position as a royal experimentation and develop skills in solving messenger allowed him to secure professional several medical problems. Among the main training at Saint George's Hospital. where contributions in the field of learning and Henry Gray registered as a student at 17 years teaching of human anatomy in English old. on 6 May 1845 For those who knew him language, those made by Henry Gray, stand since he was a student, he was an extremely out. Little is known about Henry Gray’s life but persevering and disciplined learner and also a he was an outstanding anatomist notable for systematic worker. He seemed very early to publishing his treaty of Anatomy, Descriptive have paid considerable attention to anatomical and Surgical. studies. Henry Gray learnt his human anatomy by the priceless method of making dissections Henry Gray’s childhood and his medical studies for himself, that rendered him an in depth knowledge of human anatomy (Pearce, 2009). www.anatomyafrica.org 541

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He quickly got preference for research in observations Henry Gray refused much of the human anatomy rather than clinical practice. earlier writings on the embryological origin of While Gray was still a medical student he won each of these glands. From his paper he in 1848 the Royal College of Surgeons’ considered it to be confirmed that these, with Triennial Prize for an essay entitled “The the thymus, should be classified in one group, Origin, Connexion, and Distribution of the the ductless glands, a classification by no Nerves of the Human Eye and Its Appendages, means in general acceptance at that time, Illustrated by Comparative Dissections of the which has since developed into what are now Eye in the Other Vertebrate Animals.” Part of known as the endocrine glands. He classified this essay was incorporated into his later paper these three glands on the basis of the similarity on the development of the retina. of their mode of origin, their structure in the Henry Gray 's career as anatomist and surgeon first stages of development, and the mode in After completing his medical studies, Henry which their tissues develop throughout the Gray (Figure 1, above) remained at Saint fetal period (Hayes, 2008 and Pearce, 2009). George's Hospital. To become a staff surgeon With the support of a grant from the Royal at Saint George's Hospital, Gray first had to Society, Gray continued his researches on the pass the apothecaries exam, then an exam to spleen. These studies culminated with his obtain membership in the Royal College of paper titled, The Structure and Use of the Surgeons, and later a exam to become a Fellow Spleen, which was awarded the prestigious of the Royal College. He qualified as a member Astley Cooper Prize in 1853, which was given of the Royal College of Surgeons in 1850 after every third year by a judging panel that accepts Gray had presented his paper "On the manuscripts of original research on a development of the optic and uditoric nerves", predetermined part, pulled from a list that Sir and the same year he was appointed house Astley Cooper (1768 –1841) had drafted. The surgeon at Saint George’s Hospital. In 1852 he spleen was current topic of inquiry and his was selected demonstrator of anatomy. Later paper was published in 1854 (Richardson, in 1853 Gray was designated lecturer in 2008). In a historical introduction Gray anatomy a position that permitted him to reviewed most of the preceding earlier continue his research in surgical anatomy. previous writings on the spleen. His own Henry Gray was also curator of the Saint observations included the origin of the spleen George’s Hospital Museum. Gray’s career as a from the dorsal mesogastrium, often attributed surgeon and anatomist was oriented around to Johannes Müller (1801–1858) and early, if Saint George’s.Hospital but he was also not initial, descriptions of the closed and open surgeon to Saint James’ Infirmary (Richardson circulations, the lymphatics, and the nerves in 2008 and Hayes 2008). Besides his outstanding the spleen. He also performed chemical treaty of Anatomy, Descriptive and Surgical experiments and ligaturing on the blood of the Gray published several papers, the earliest of spleen. This is a work of 350 pages divided into which was “On the Development of the Retina four parts: development (embryology), and Optic Nerve, and of the Membranous structure, comparative anatomy, and Labyrinth and Auditory Nerve,” these physiology. Gray wrote others remarkable researches were almost exclusively on the papers as "An Account of a Dissection of an chick embryo. He clearly revealed that the Ovarian Cyst" (1853), "On Myeloid and Myelo- retina develops from a protrusion of the brain, cystic Tumors of Bone, Their Structure, a point then still being discussed. Gray also Pathology and Mode of Diagnosis" (1856) and presented one of the earliest major accounts of "Injured of the Neck" (1861). He also wrote the development of the layers of the retina. He papers in pathology and is reputed to have believed the labyrinth in the ear, develops in a made good progress on a major treatise on mode analogous to that of the retina. Gray’s tumors at the time of his death. In May other anatomical paper was “On the 31,1860 Henry was elected Fellow of the Royal Development of the Ductless Glands in the College in recognition of his contributions in the Chick,” in which he dealt with the suprarenals, field of anatomical studies. Gray was thyroids, and the spleen. On the basis of his candidate for the position of assistant surgeon

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at Saint George's Hospital in 1861 but.he never the hospital staff (Gray 1974). Henry Gray assumed his new status because he died that wrote the original version of Gray's Anatomy year. with an audience of medical students and Gray’s treaty of Anatomy, Descriptive and physicians in mind, especially surgeons. Surgical Despite the existence of competing anatomical In 1858 when Henry Gray was only 31 years texts, Gray’s anatomy quickly became the old, and after almost a decade of research he standard reference work, a position which still published the first edition of his treaty of retains currently Gray's treaty of Anatomy, Anatomy, Descriptive and Surgical, which Descriptive and Surgical was created in covered 750 pages and contained 363 figures collaboration with Henry Vandyke Carter (Rifkin and Ackerman 2006). The arrangement (1831-1897), an anatomical artist and medical of the information and the close relation doctor and formerly a demonstrator of between the text and the illustrations were anatomy at Saint George’s Hospital, who Gray’s work and demonstrate his clear assisted him with dissections to get the most understanding of the fundamentals of his field accurate representation possible.and he of study. The Gray’s ability to present, to provided illustrations (Roberts 2000). Gray and students and practitioners alike, the practical Carter dissected unclaimed bodies during information which they needed in an accessible eighteen months from the mortuaries under form. This accessibility has been one of the the Anatomy Act of 1832 to explore human great factors in the Gray anatomy's success anatomy. Carter's drawings were then made and has influenced others writers of human into engravings by Butterworth and Heath. anatomy textbooks. The first edition of Gray's Carter made his meticulous line drawings Anatomy was dedicated to the most senior accented by shadow to create the appearance surgeon of the Saint George's Hospital Sir of depth. Because of Henry Vandyke Carter's Benjamin Collins Brodie (1783 –1862), illustrations, this treaty of Anatomy, Serjeant-Surgeon to the Queen and Descriptive and Surgical became superior to corresponding member of the Institute of any other human anatomy text around at the France. Sir Benjamin Collins Brodie was Gray’s time (Gosh 2015). mentor and no doubt helped his rapid rise in

Figure 2. Second cervical vertebra, or epistropheus, from above view. (Henry Vandyke Carter's Figure 3: Cover of Gray’s Anatomy 39th Edition. illustrationAdapted from Gray’s Anatomy. Anatomy Descriptive and Surgical 1918 Edition.

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The artistic and the diagrammatic combine treaty is still published under the title Gray's impeccably with Carter's added innovations of Anatomy and is widely appreciated as an the anatomical terms appearing on the parts extraordinary and authoritative textbook for themselves (Figure 2). Unfortunately, Henry medical students (Pearce 2009). It has to date Vandyke Carter never received any credited seen thirty nine editions in United Kingdom and neither royalties for his painstaking work. The thirty seven editions in the United States. It has literary style apparently was greatly polished been translated no more than a dozen by the assistance of Timothy Holmes, who also language, been pored over generation after was editor of the third (1863) through ninth generation of medical students, and sold (1880) editions of the Gray’s anatomy. A major millions of copies. Gray's Anatomy has never Holmes innovation, which greatly aided the been out of print in more than 150 years. It has success of the book was the introduction of been reprinted and revised by varying teams of remarks on surgical anatomy into an English anatomists It is a practical textbook that would textbook of anatomy. Holmes probably more remain useful long after the student entered than any single person over the next twenty their professional world. Gray's Anatomy main years help keep Gray’s legacy alive. The relevant point would be its emphasis on reviews of the first edition of Gray's Anatomy surgical anatomy. Henry Gray was working on in the medical press were excellent. Within a the second edition of his treaty of Anatomy, week, The Lancet review called it “a work of no Descriptive and Surgical when he ordinary labor” and commented that it caught smallpox from his nephew and although “demanded the highest accomplishments both he had been vaccinated, Henry Gray died at the as anatomist and surgeon for its successful age of 34 on June 13, 1861 in London, 3 years completion… . There is not a treatise in any after the first edition of his treaty was language in which the relations of anatomy and published (Richardson 2008). At that time, it surgery are so clearly and fully shown.” The was common practice to burn everything in the British Medical Journal characterized Gray's as room of a smallpox victim. Thus, no written “far superior to all other treatise on anatomy, records of Gray exist. He was buried at a book which must take its place as THE Highgate Cemetery in London ( Hayes 2008 manual of Anatomy Descriptive and Surgical,” and Pearce 2009). Henry Gray was a pioneer (Hayes, 2008). After Gray's death, a second and a prodigy of modern descriptive and British edition appeared in 1861 by the editor surgical human anatomy. He had an J.W. Parker,with a number of revisions and outstanding career at Saint Georges Hospital corrections by Gray and with 32 additional from demonstrator to lecturer of anatomy and illustrations, 27 of them by JG Westmacott also curator of the museum (Netter and (1811-1884). An imprint of this English first Friedleander 2014). A precisely illustrated edition was published in the United States in work, Gray’s treaty of Anatomy, Descriptive 1859, with slight alterations, in which an and Surgical is as beautiful as it is practical, and extensive index was added and a number of is still highly valued as an authoritative small errors in the British volume were textbook in the field of human anatomy. that corrected, edited by Richard James Dunglison has influenced and instructed many student of who also edited the next four editions.. Colored medicine over more than 150 years . Gray’s pictures were introduced in the eleven edition Anatomy has undergone many refinements in1897, by its editor T. Pickering Pick. The book and revisions throughout the years, but it is was retitled Gray's Anatomy in 1938.The thirty substantially still the same brillant work. five edition of 1973 edited by Peter Williams Despite the aforementioned efforts to keep and Roger Warwick contained substantial Gray's Anatomy readable by students, when changes: over 780 new pages appeared and the 39th edition was published, students were many illustrations were added, the text was in identified as a secondary market for the double columns. The references were textbook, and companion publications such as introduced by Professor Susan Standring also Gray's Anatomy for Students, Gray's Atlas of in 1973 and she is currently the editor of the Anatomy and Gray's Anatomy Review have also Gray’s Anatomy 39th edition (Figure 3). This been published in recent years.

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REFERENCES 1. Gosh S. 2015. Evolutions in Anatomy illustrations: a Study from Classic Period in Europe to Modern Times Anat Sci Educ; 8. p. 175-188. 2. Gray H. 1974. Gray’s Anatomy. Anatomy Descriptive and Surgical 1901 Edition. Running Press. p. 1257. 3. Hayes B. 2008 The Anatomist: A True Story of Gray's Anatomy. New York: Ballantine Books. p. 272 4. Netter FN, Friedleander G. 2014. Frank H. Netter MD and a brief History of Medical Illustration Clin Orthop Relat Res 472: 812-819. 5. Pearce J. 2009. Henry Gray's Anatomy. Clin. Anat. 22:291–295. 6. Richardson R. 2008. The Making of Mr. Gray's Anatomy: Bodies, Books, Fortune, Fame. New York: Oxford University Press; p. 322. 7. Rifkin B., Ackerman M. 2006 Human Anatomy (From Renaissance to the Digital Age). HNA books, New York, p.297-306. ISBN o-8109-5545-8. 8. Roberts S. 2000. Henry Gray and Henry Vandyke Carter: creators of a famous textbook. J Med Biogr. 8:206-12.