Happy birthday, Gray’s Anatomy Adrian E. Flatt, MD, FRCS met Gray’s Anatomy for the fi rst time during the beginning of drew all the illus- September 1939.1 In that fi rst week World War II erupted trations. Gray came in Europe, I started as a medical student and bought my from a well-off Ifi rst copy of Gray’s Anatomy. We students were greeted by the and well-connected Regius Professor of Physic, who talked for an hour about the family and lived hand—hence my career choice—and then herded us into the with his widowed dissecting room to start cutting on a corpse. Unfortunately, mother near the my girlfriend was not assigned to my corpse, so I arranged an hospital. He was exchange with another of the few women students. Th is pro- politically adept voked a large notice: “Flatt will not enter this dissecting room.” and dedicated his So, off to see the professor. Pointing at me, he said, “Flatt, fi rst copy of Gray’s you are mixing sex with dissecting.” With some enthusiasm, I to the most senior replied “Yes, sir.” He burst out laughing and sentenced me to surgeon of the hos- go buy my fi rst copy of Gray’s Anatomy. He mentored me and pital in highly ap- kept a demonstrator’s job for me until I eventually got out of preciative words: the Royal Air Force. Th ereafter, I have collected a number of To Sir Benjamin anatomy books, amongst which I treasure a 6th edition of Gray’s Collins Brodie, Figure 1. The dissecting room at St. George’s published in 1872. I have taught anatomy continuously; I will BART., F.R.S., Hospital. Image obtained from Richardson’s book; shortly be 88 years old. reprinted with permission from St. George’s Hospital D.C.L., Serjeant- Anatomy Descriptive and Applied was fi rst published in Lon- Medical School. Surgeon to the don in the summer of 1858 by two young demonstrators of Queen, corresponding member of the Institute of France, this anatomy in St. George’s Hospital at Hyde Park Corner. Th e work is dedicated, in admiration of his great talents, and in building still exists but as a very expensive hotel where each remembrance of many acts of kindness shown to the author, room has its own butler who insists on unpacking your suit- from an early period of his professional career. case! Th ese two young men were very diff erent. Henry Gray wrote Sir Benjamin was his mentor and no doubt helped his rapid the text; he was 4 years older than Henry Vandyke Carter, who rise in the hospital staff . Gray appears in the classic photograph 1 of the dissecting room at St. George’s Hospital, which has been A note on sources: Signifi cant parts of this account are based upon the Eng- printed at the front of all editions of Gray’s, including the 40th lish author Ruth Richardson’s scholarly book Th e Making of Gray’s Anatomy (1). She is a historian attached to the Department of History and Philoso- edition (Figure 1). phy of Science at Cambridge University. She has kindly given me permission Gray was born in 1827. In his time, to be a medical student to quote from her excellent book, which describes the education of English in England, one had fi rst to go to Oxford, Cambridge, or some medical students in the 1850s and relates it to the times of Dickens and Ol- other university. In addition, one had to be a member of the iver Twist and the introduction of anesthesia in 1847. Church of England; followers of other faiths would not be ad- A diff erent book, Th e Anatomist, by American Bill Hayes, is a more per- sonal account (2). He has been described as “part science writer, part memoir- mitted. When I was accepted as a student at Cambridge in 1939, ist and part cultural explainer.” Hayes became fascinated by Gray’s picture in religion was no longer important, but what did matter was a dissecting room, which has appeared at the front of every edition including the current 40th. Hayes decided, “I would come to know Henry Gray by coming to know human anatomy.” Accordingly, he became an “observer” of From the Department of Orthopaedic Surgery, Baylor University Medical Center, the dissections being done by students at the University of California at San Dallas, Texas. Francisco. He adds little to the circumstances surrounding production of the Corresponding author: Adrian E. Flatt, MD, FRCS, Department of Orthopaedic fi rst edition. However, he writes extensively about Carter and the entries in Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas his diary. 75246 (e-mail: [email protected]). 342 Proc (Bayl Univ Med Cent) 2009;22(4):342–345 one’s ability to translate a page of In 1853, when Gray was Latin prose, which at that time I 26 years old, he entered a com- could do, thereby proving I was petitive essay competition for a “gentleman.” the Astley Cooper prize. He In Britain, in the early 1940s, won the prize of 100 pounds there were three paths to becom- and published his work as “Th e ing a physician. The first and structure and use of the human easiest exams were those of the spleen.” Th e book is an impres- Worshipful Society of the Art sive 350 pages divided into four and Mystery of Apothecaries parts—development (embryol- of the City of London, an im- ogy), structure, comparative portant ancient city guild. Th e anatomy, and physiology. He next was exams conducted by the Figure 2. Henry Gray, from a con- Figure 3. Henry Vandyke Carter, employed Carter to draw over Royal Colleges of Surgery, Medi- temporary photograph. Reprinted self-portrait. Reprinted with 50 illustrations, a number of cine, Obstetrics, etc., and fi nally with permission from Wellcome permission from Wellcome Library, which were later used in the the most difficult exams were Library, London. London. Gray’s book. Gray, however, those of the universities. Many omitted any thanks or credit to of us took the Apothecaries exam, since it was wartime and the Carter for his excellent drawings. A copy of this book still easiest way to become a practitioner. Th e fi rst two types were exists, but no trace of its drawings has been found. really trial runs before the tough university examinations. In 1855, Gray discussed the possibility of jointly publish- To become a staff surgeon at St. George’s Hospital, Gray ing A Manual for Students with Carter. Carter’s pay for the would fi rst have to pass the Apothecaries exam, then an exam to drawings in the book on the spleen had been intermittent obtain membership in the Royal College of Surgeons, and later and incomplete, and he was timid about asking for all his a diffi cult exam to become a Fellow of the Royal College. Th e money. Th is time, Gray probably promised prompt payment. same route existed until recently; nowadays the Apothecaries However, Carter hesitated and fi nally told Gray he was fed can no longer grant a license to practice medicine. up with not being paid “the full sum” for earlier work and Gray started dissecting in 1842 at age 15 and is thought to that if he was to work on the new book it could not be on have advanced his age to 17 when registering as a student at the old footing. St. George’s Hospital. Th ere is no record that Gray ever passed On December 9, 1855, Gray off ered 10 pounds per month a university examination. He is described as being a fi ne-look- for 15 months to Carter, but he worried because he regarded ing, slightly dandyish young man who was a competent and Gray as “very shrewd.” On January 31, 1856, Carter capitu- hardworking surgical trainee (Figure 2). When he was 21, he lated and started work on the drawings even though he was got prizes in surgery and clinical surgery. He later became a concentrating on studying for his London University medical member of the Pathological Society of London and a member degree. of the Royal College of Surgeons. In 1852 he was made a gov- Richardson pointed out that from their experience as stu- ernor of the hospital. dents and later as demonstrators, they both knew what should Henry Vandyke Carter, however, had a father well known be in the book. It had to be well organized, simple in plan, as a marine artist and a deeply religious, nonconformist moth- well illustrated, and aff ordable to students. Th e illustrations er; they lived in the north of England on a limited income. had to be clear and the parts clearly labeled. He was a shy, diffi dent nonconformist bachelor (Figure 3). In the early editions, all illustrations were drawn on paper When he was 14, his grandmother gave him a diary, and he and then carved into wood blocks by skilled men known as started a habit of recording his thoughts, concerns, and views “woodpeckers.” Th is process was needed to transfer the draw- on everyday life. He kept writing throughout his lifetime at ings in reverse onto the wood so that they appeared facing the St. George’s Hospital and for a time later. It is clear that he correct way on the printed page. Carter was such an excel- hoped to have a deep religious life but he felt he lacked faith.