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The year 2008 sees the 150th anniversary of the publication of Gray’s Anatomy. The book is a rarity in textbook publishing in having been in continuous publication on both sides of the Atlantic Ocean, for so long. One and a half centuries is an exceptionally long era for a textbook, and of course the volume published now is very different from the one Mr. Henry Gray first created with his colleague Dr Henry Vandyke Carter, in mid-Victorian London. In this introductory essay, I shall explain the long history of Gray’s, from those Victorian days right up to today.

The shortcomings of existing anatomical textbooks probably impressed themselves upon Henry Gray when he was still a student at St George’s Hospital Medical School, near London’s Hyde Park Corner, in the early 1840s. He began thinking about creating a new anatomy textbook a decade later, while war was being fought in the Crimea. New legislation was being planned which would establish the General Medical Council (1858) to regulate professional education and standards.

Gray was twenty-eight years old, and a teacher himself at St George’s. He was very able, hard-working, and highly ambitious, already a Fellow of the Royal Society, and of the Royal College of Surgeons. Although little is known about his personal life, his was a glittering career thus far, achieved while he served and taught on the hospital wards and in the dissecting room (Fig. 1


Fig. 1  Henry Gray (1827–1861) is shown here in the foreground, seated by the feet of the cadaver. The photograph was taken by a medical student, Joseph Langhorn. The room is the dissecting room of St George’s Hospital medical school in Kinnerton Street, London. Gray is shown surrounded by staff and students. When the photo was taken, on 27th March 1860, Carter had left St George’s, to become Professor of Anatomy and Physiology at Grant Medical College, in Bombay (nowadays Mumbai). The second edition of Gray’s Anatomy was in its proof stages, to appear in December 1860. Gray died just over a year later, in June 1861, at the height of his powers.

). (1)

Gray shared the idea for the new book with a talented colleague on the teaching staff at St George’s, Henry Vandyke Carter, in November 1855. Carter was from a family of Scarborough artists, and was himself a clever artist and microscopist. He had produced fine illustrations for Gray’s scientific publications before, but could see that this idea was a much more complex kind of a project. Carter recorded in his diary:

Little to record. Gray made proposal to assist by drawings in bringing out a Manual for students: a good idea but did not come to any plan … too exacting, for would not be a simple artist. (2)

Neither of these young men was interested in producing a pretty book, or an expensive one. Their purpose was to supply an affordable, accurate teaching aid for people like their own students, who might soon be required to operate on real patients, or on soldiers injured at Sebastopol or some other battlefield. The book they planned together was a practical one, designed to encourage youngsters to study anatomy, help them pass exams, and assist them as budding surgeons. It was not simply an anatomy textbook, but a guide to dissecting procedure, and to the major operations.

Gray and Carter belonged to a generation of anatomists ready to infuse the study of human anatomy with a new, and respectable, scientificity. Disreputable aspects of the profession’s history, acquired during the days of bodysnatching, were assiduously being forgotten. The Anatomy Act of 1832 had legalized the requisition of unclaimed bodies from workhouse and hospital mortuaries, and the study of anatomy (now with its own Inspectorate) was rising in respectability in Britain. The private anatomy schools which had flourished in the Regency period were closing their doors, and the major teaching hospitals were erecting new purpose-built dissection rooms. (3)

The best-known student works when Gray and Carter had qualified were probably Erasmus Wilson’s Anatomist’s Vade Mecum, and Elements of Anatomy by Jones Quain. Both works were small – pocket-sized – but Quain came in two thick volumes. Both Quain’s and Wilson’s works were good books in their way, but their small pages of dense type, and even smaller illustrations, were somewhat daunting, seeming to demand much nose-to-the-grindstone effort from the reader.

The planned new textbook’s dimensions and character were serious matters. Pocket manuals were commercially successful because they appealed to students by offering much knowledge in a small compass. But pocket-sized books had button-sized illustrations. Knox’s Manual of Human Anatomy, for example, was a good book, but was only six inches by four (17 × 10 cm) and few of its illustrations occupied more than a third of a page. Gray and Carter must have discussed this matter between themselves, and with Gray’s publisher JW Parker & Son, before decisions were taken about the size and girth of the new book, and especially the size of its illustrations.

The two men were earnestly engaged for the following eighteen months in the work which formed the basis of the book. All the dissections were undertaken jointly, Gray wrote the text, and Carter the illustrations. While Gray and Carter were working, a new edition of Quain’s was published: this time it was a ‘triple-decker’ – in three volumes – of 1740 pages in all. Gray and Carter’s working days were long, all the hours of daylight, eight or nine hours at a stretch – right through 1856, and well into 1857. We can infer from the warmth of Gray’s appreciation of Carter in his published acknowledgements that their collaboration was a happy one.

The Author gratefully acknowledges the great services he has derived in the execution of this work, from the assistance of his friend, Dr. H. V. Carter, late Demonstrator of Anatomy at St George’s Hospital. All the drawings from which the engravings were made, were executed by him. (4)

With all the dissections done, and Carter’s inscribed wood-blocks at the engravers, Gray took six months’ leave from his teaching at St George’s to work as a personal doctor for a wealthy family. It was probably as good a way as any to get a well-earned break from the dissecting room and the dead-house. (5)

Carter sat the examination for medical officers in the East India Company, and sailed for India in the spring of 1858, when the book was still in its proof stages. Gray had left a trusted colleague, Timothy Holmes, to see the book through the press.

Gray looked over the final galley proofs, just before the book finally went to press. Timothy Holmes’s association with the book’s first edition would later prove vital to its survival.


The book Gray and Carter had created together, Anatomy, Descriptive and Surgical appeared at the very end of August 1858, to immediate acclaim. Reviews in the Lancet and British Medical Journal were highly complimentary, and students flocked to buy.

It is not difficult to understand why it was a runaway success. Gray’s Anatomy knocked its competitors into a cocked hat. The book holds well in the hand, it feels substantial, and it contains everything required. It was considerably smaller and more slender than the doorstopper with which modern readers are familiar. To contemporaries it was small enough to be portable, but large enough for decent illustrations: ‘royal octavo’ – nine-and-a-half inches by six (24 × 15 cm) – about two-thirds of modern A4 size. Its medium size, single volume format was far removed from Quain, yet double the size of Knox’s Manual.

Simply organized and well designed, the book explains itself confidently and well: the clarity and authority of the prose is manifest. But what made it unique for its day was the outstanding size and quality of the illustrations. Gray thanked the wood engravers Butterworth and Heath for the ‘great care and fidelity’ they had displayed in the engravings, but it was really to Carter that the book owed its extraordinary success.

The beauty of Carter’s illustrations resides in their diagrammatic clarity, quite atypical for their time. The images in contemporary anatomy books were usually proxy labelled: dotted with tiny numbers or letters (often hard to find, or read) or bristling with a sheaf of numbered arrows, referring to a key situated elsewhere, usually in a footnote which was sometimes so lengthy it wrapped round onto the following page. Proxy labels require the reader’s eye to move to and fro: from the structure to the proxy label to the legend and back again. There was plenty of scope for slippage, annoyance and distraction. Carter’s illustrations, by contrast, unify name and structure, enabling the eye to assimilate both at a glance. We are so familiar with Carter’s images that it is hard to appreciate how incredibly modern they must have seemed in 1858. The volume made human anatomy look new, exciting, accessible, and do-able.

The first edition was covered in a light brown bookbinder’s cloth embossed all over in a dotted pattern, and a double picture-frame border. Its spine was lettered in gold blocking:

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