Gray's Anatomy The Beauty of Anatomy

We are our bodies.

We see the outside all the time

but that's less than half the story.

The surface, the exterior.

We know far less about what's inside.

Heaven forbid that we should actually see our insides.

Most people go through their life without getting a look

at their organs and for good reason.

My lungs and kidneys and heart, and bones and muscles,

arteries and veins - they do their jobs unseen.

But for the anatomists, the doctors

and artists who have struggled for centuries to understand how

our bodies actually work, getting inside, dissection, was vital.

In this five-part series,

I'll be investigating the beautiful synthesis between

discoveries in anatomy and the works of art that illustrate them.

As a scientist myself

and someone who is fascinated by anatomical images,

I want to find out exactly

how anatomy has inspired art and art anatomy.

And it's going to be my privilege to see some of the greatest

works of the art in the world.

Unquestionably the most famous anatomical

textbook in existence is Gray's Anatomy.

Published in 1858, the accuracy of its descriptions

and the beautiful clarity of its illustrations

made it an instant bestseller,

and more than 150 years later, it remains the most respected guide

to anatomy that has ever been produced.

The book was the result of the heroic efforts of two doctors -

Henry Gray and his illustrator, Henry Carter.

Henry Gray was 31 when he completed it,

and his illustrator was just 27.

At nearly 1,000 pages long, it was the most ambitious

exploration of the human body yet attempted.

So how did they do it?

And why did the two men fall out while the book itself

went on to become the iconic go-to authority on anatomy the world over?

For centuries, anatomists have studied the human body,

seeking new knowledge about how it moves and how it functions.

Along the way, their work has been seen as a celebration

of the handiwork of God

and has informed the practice of both medicine and art.

And at no time was this work more challenging than in the 19th century,

when something momentous happened to anatomy.

That something was the arrival of anaesthetic.

Before this, surgery had been a risky and excruciating last resort,

largely limited to superficial operations and amputations.

Anaesthetic changed everything.

It allowed surgeons to open up the living body

and perform longer, more complex procedures.

Procedures that demanded an encyclopaedic knowledge of anatomy.

Henry Gray was an ambitious young man,

and for him this was a call to arms.

The book that bears his name is the one I'm going to look at now

in the Royal College of Surgeons.

Gray wanted his book to furnish students

and doctors with the anatomical information

they needed to perform successful surgery in this new era.

The library here at the college has a first edition.

So, this is it. This is the anatomist's Bible.

The full title is "Anatomy - Descriptive and Surgical",

which is a lot less pithy than how it's become

universally known as, which is Gray's Anatomy.

That title is based on a series of lectures that Henry Gray

gave in the 1850s. And you can see the illustrator's name, Henry Carter.

And the whole thing is based on the dissections that

the two of them had done together.

Published in London in 1858.

Gray's Anatomy was original in its ambition which was to cover

the whole of the human body in an affordable

and accessible single volume for students and surgeons.

Earlier anatomy textbooks had been too small,

too large or too expensive.

Turning the pages gives you a real sense of the scale

of this project these two undertook.

There are 989 pages and just look at the list of illustrations.

There are so many and they are so varied.

It is slightly unwieldy in that regard.

The text gets slightly lost in these beautiful diagrams

and they are beautiful. Here is an illustration of the bones

of the left hand and the artist has shaded to give

a sort of 3D relief to really understand how they fit together.

All of this done within three years.

These stunning illustrations are wonderfully precise.

Carter has even avoided footnotes by skilfully integrating

the labels into the drawings themselves.

At times the artwork is reminiscent of the figures

depicted by the 16th century anatomist Vesalius.

But while Vesalius gave his bodies dramatic poses to

illustrate their passage through a landscape,

Gray and Carter were doing something very different.

Here's another one which is a particular favourite of mine.

It shows the veins and the arteries of the head and the neck.

This position is shown

because it's the best way to actually perform surgery.

And if you turn back a couple of hundred pages you can

see that this is exactly what Gray

and Carter are doing in this illustration with the head

and neck extended so you can see the exact point of the incision.

Gray's Anatomy is an amazing exercise in heroic restraint.

It's in cardboard covers. It's not a spectacular production.

You open up the first edition of Gray

and it goes straight into anatomy.

There's nothing fancy going on. There are no landscapes.

There's nothing outside the illustrations at all.

So it's a very, very different enterprise

and it's the first of the great heroic technical books which is

basically saying, "I'm not doing style. I'm doing content."

Now these are the original proofs for Gray's Anatomy,

the so-called India Proofs,

because they're printed on this very special paper called India paper,

which is kind of thin and opaque and particularly good

at rendering the exquisite detail

of Henry Carter's beautiful illustrations.

Carter's drawings of Gray's Anatomy are very spartan.

They're almost in some ways austere.

They've been compared, and I think quite rightly, to the kind of

objectivity that we're familiar with in 20th century anatomical images.

The idea of a very unmediated,

clean, cool kind of mechanical objectivity.

What they do very effectively is to communicate a particular

kind of knowledge about the human body.

If you're trying to teach anatomy,

if you're trying to draw attention to particular aspects

of the muscle structure or the functioning of the intestines,

there's a certain amount of information you need to leave out

because it's distracting.

So what these drawings are, I think, is very functional.

And I think that is a great tribute to Carter's skill as an artist.

All of the illustrations in Gray's Anatomy were carefully

designed to showcase the things that the reader

most needed to know about the movement and anatomy of the body.

So this pose is very much like one of the classic Gray's Anatomy poses,

that it exposes a couple of muscles.

This is the tip of the trapezius which is a back muscle

and connects to the back of the skull there,

but this one here, called the sternocleidomastoid, originates

from the sternum, which is the breast plate here, and the clavicle,

which is the collar bone here...

What's interesting about this muscle here, the sternocleidomastoid,

is that it pushes your head away when you turn your head

rather than the other one pulling.

So, if Amy looks square on,

it's the one on this side pushing it in the other direction.

The painstaking care Carter put into his illustrations conveyed

this kind of information with a seemingly effortless simplicity.

But it was all the result of hard graft -

work that began with dissection.

So ambitious was Gray's project

that a vast number of dissections would be required,

all to be carried out by Gray and Carter themselves.

Gray and Carter were both doctors at St George's Hospital,

which used to stand on the site of that hotel over there,

the one covered in scaffolding, here at Hyde Park Corner.

Gray had come to start his training as a whippersnapper

aged just 15 years old.

And he joined one of the best hospitals in London.

There'd been a hospital here for over a century,

but St George's had recently had a make-over

and now boasted some of the finest doctors in London.

The young Henry Gray was handsome,

expensively dressed and fiercely competitive.

At 19, he was winning prizes in surgery

and by the time he was 23, his work was being read out

to distinguished audiences at the Royal Society.

Carter, meanwhile, was from a more modest background.

He was born and raised in Yorkshire

and couldn't afford to train as a physician,

so he qualified as an apothecary-surgeon,

what today we'd call a GP.

Carter had all the ambition of Gray, but none of the self-confidence.

Both men studied anatomy and learnt the art of dissection.

But that took place around the corner.

St George's dissection lab was located in nearby Kinnerton St

not far from what was then Harrods Grocery.

In November, 1855, Gray suggested that he and Carter should

produce a "Manual for Students".

Initially, Carter thought it was a good idea,

but probably too much work for him to consider it.

Even though Gray was pretty vague about his plans,

Carter was quick to realise that the sheer number

of dissections would be a huge undertaking.

Carter was no stranger to this kind of endeavour.

He had worked with Gray before on a book about the spleen.

So eventually, despite his reservations,

he agreed to collaborate on Gray's monumental new project.

The truth was that Carter was struggling a bit.

He didn't have Gray's connections. Gray had just been

invited by the Duke of Sutherland to be his personal physician

on his yacht on a round Britain trip.

Carter belonged to a more down-to-earth set.

He had advertised his services as a medical illustrator,

but nothing much had come in.

So the offer from Gray was a windfall.

Right, so this is the site of the original anatomy labs.

Gray and Carter would have come in here through these arches

and the bodies from round the back.

The dissecting rooms themselves had a huge glass barrel-vaulted ceiling

to let in the maximum amount of light.

But the whole place would have stunk of flesh-preserving alcohol

and decaying human bodies.

This extraordinary photograph shows students

and lecturers in the St George's dissecting studio in 1860.

Seated near the front, looking every bit the man in charge,

is Henry Gray, and beside him lies a body for dissection.

These men would have had a regular supply of body parts

from the hospital up the road,

but getting hold of a whole corpse was a different matter.

Between the 1750s and the 1830s in Britain,

the only legal source of bodies for dissection is the gallows.

Under the terms of the Murder Act in the 1750s, the punishment for murder

actually includes public dissection after you've been executed.

The supply from the gallows is nowhere near large enough

to meet the demands of this growing number of people studying anatomy.

So in 1832, the government passes a new Anatomy Act.

Under the terms of this act,

a new source is found for bodies for dissection.

These are the bodies of the poor.

Essentially, if you die in a workhouse,

under the terms of this act, and you are not claimed,

you will be taken for dissection.

What was once a hated and feared punishment for murder becomes,

almost overnight, a hated and feared punishment for poverty.

It's hardly surprising that human dissection had such a bad reputation.

The Anatomy Act had been passed over the heads of protesters who had

a deep mistrust of the anatomists, and a suspicion that it was their

own poor relatives that would find themselves laid out on the slab.

Because of this controversy, Gray and Carter had to be discreet.

That's why they had the bodies delivered

to the back door of the lab.

It was here at Kinnerton St that many of Carter's

meticulous illustrations were created.

He also drew at home, often working well into the evening.

At first, he drew on paper,

and his designs were then engraved onto woodblocks for printing.

But it was a slow process

so he learnt the difficult technique of drawing reverse images straight

onto the woodblocks themselves, saving both time and money.

Gray's Anatomy, including all its 363 illustrations,

was completed in July 1857.

It was a remarkable accomplishment but it had come at a price.

Gray and Carter had fallen out.

It was hardly surprising.

The two men had been working under enormous pressure

for two and a half years, and all their work for Gray's Anatomy,

all the text and all the drawings,

had to be done alongside their day jobs.

Looking at Carter's diary and the writing that he's had,

it was clear that although he was very happy to work with Gray,

from previous experience, he knew that Gray was very

slow in paying, for example.

He had done an enormous amount of work for Gray in his book

on the spleen, which won an award.

Carter was not acknowledged. Carter wasn't paid.

In return for his work, Gray had promised Carter a monthly fee.

It wasn't a king's ransom but it would help

cover Carter's living expenses.

Ultimately, Gray agreed to pay him £10 a month.

Whether he did actually pay him, we're not sure.

But certainly Carter complained that he was living on air

and he was clearly annoyed at the way in which he was being treated.

He worked incredibly hard for Gray.

Feeling aggrieved and ill-treated, and still in need of cash,

Carter decided to break with St George's

and take his career in a new direction.

He took and passed his exams for the Indian Medical Service, and accepted

a post as Professor of Anatomy and Physiology at a college in Bombay.

As he left for India, he could have had little idea of the blow

that Gray was about to deal him.

By now, the publishers had drawn up the proofs for the first edition.

Gray's own notes on these proofs give us

a very clear idea of how he saw Carter's contribution.

I suppose the most significant evidence

we have is the page proof of the first page of the first edition

where Gray had made some very significant changes in ink

to what Parker, the publisher, had prepared.

What Gray has done is to strike out Carter's name

and request that it's printed at a much smaller size, and he's also

struck out the first line underneath Carter's name which says that

Carter has just been appointed Professor of Anatomy in Bombay,

so that the only indication that the reader would have of Carter's post

is Late Anatomy Demonstrator, St George's.

So he has taken every effort that he can on the title page to demote

and downgrade Carter's significance in the book.

Well, as it happens, the publishers did come up with a compromise

but without consulting either of them.

Henry Carter didn't get his job title in India,

but the typeface in which his name appears is larger than Gray wanted.

Though, admittedly it is certainly smaller than Gray's.

The two men never collaborated again.

Carter made a great success of his career in India.

He identified a new fungal disease and advanced medical understanding

of diseases like leprosy, malaria and tuberculosis.

But for Gray, success would be short-lived.

This is 8 Wilton Street, in London's Belgravia,

just a stone's throw from the dissection rooms.

Henry Gray lived here with his mother and he also died here,

in June 1861, of smallpox, aged just 34.

What Gray and Carter had achieved was extraordinary.

The most comprehensive account of anatomy in Western history.

The medical journal, The Lancet

said that there wasn't "a treatise in any language, in which the

"relations of anatomy and surgery are so clearly and fully shown".

Gray's Anatomy became THE standard thing.

There were other textbooks in Germany and America,

but even on a worldwide basis, it became Gray's Anatomy.

It had that kind of authoritative ring,

so it kept selling and selling and selling.

Gray's Anatomy is now in its 40th edition

but it is no longer the book that Gray and Carter created.

As technology has advanced our knowledge of the body,

it has been repeatedly revised and added to, with extensive

new text and hundreds of new illustrations, with the result that,

at times, it seemed in danger of losing its visual coherence.

What happens with these great books

and textbooks is you get successive editors come in

and you've got the original thing and they say,

"We need to do a bit of this and we need to do a bit of that."

So there is a phase in the development of these books

where the original is still there but it's become corrupted in a way.

It's lost its unity.

It's lost its sense of what its central purpose is.

This is one of the reasons why Susan Standring, the editor in chief

of the 39th, 40th and 41st editions decided that after nearly 150 years

of changes, Gray's Anatomy needed a major overhaul.

So what did you decide to do in order to revamp Gray's?

Well, the 39th edition, we revised mostly the text

with some illustrations up to date.

The 40th edition we concentrated on the illustrations.

So there is a house style when we have our own bespoke diagrams.

What you're seeing is what the anatomist,

the clinician wants you to see.

It's bringing to the forefront the elements that you need.

And that visual style, is it something that's evolved from

the previous editions, or have you returned to the source

and used those Carter images as a template?

No, the only Carter image that I retained in the 39th was a little

tiny one of the developing sacrum

but I had to get rid of that for the 40th edition.

-Why?

-Because it was really so old-fashioned.

It just didn't look right.

You have to go with the times, I think.

In fact most of the images now,

or many of the images are just that, they're images, MRI, CT.

The major thing that's new is that we have a very large

online component and that allows us

not only to add additional text in the form of

commentaries, but all manner of 3D imaging that we couldn't add before.

They're all ways of trying to inform the reader.

Anatomical text is very dense. It's not boring but it's dense

and it needs something to help the reader understand and appreciate

the relationships, and how better to do that than with images,

and if those are moving images and animations, that's even better.

Gray's Anatomy's transformation from a textbook of drawings

based on first-hand dissections, to an encyclopaedia of the most

up-to-date diagrams, X-rays, scans and photographs seems to encapsulate

the changing relationship between art and anatomy.

In the past, artists and anatomists, from Leonardo Da Vinci,

to Andreas Vesalius,

to Henry Gray,

they all had to perform their own dissections

to discover and record knowledge about the human body.

But the invention of new forms of medical imaging means that artists

can now gather all the information they need

without getting their hands on corpses.

Today, Richard Tibbitts is the lead artist on Gray's Anatomy.

It's his job to take all this knowledge and imagery

and create the next generation of the book's illustrations.

You talk to anybody about medical illustration,

from all walks of life, and everybody knows Gray's Anatomy.

The chance to bring it forward for future generations of medics

to learn from is just a fantastic opportunity.

Our drawings, eventually somebody will read the text

and hopefully gain the information from our drawings

that will further them in their medical career.

Gray's is still a gorgeous feast of anatomy

and detailed medical knowledge,

but I'm left wondering whether, now more than ever,

it represents the end of traditional anatomical art.

Did art and anatomy part company a long time ago?

Or is it just that the traditional relationship has changed?

Draw quite a confident scale, if you would, on your paper,

and really give these curves...

Eleanor Crook is a 21st century anatomical artist.

She teaches students how to create their own anatomically themed art.

But she's also part of the scientific community,

making anatomical models to be used in medical schools

all over the country.

Eleanor, do you see your work as being more educational or artistic?

What is the relationship between the two of them?

Well, I see myself as a sculptor first and foremost.

And a lot of what I do has accurate anatomical information in it

that people could learn from.

But when I'm making it, I'm really thinking about it as an artwork.

This piece you're working on now is very much like a Vesalius,

the 16th century anatomist.

Even some of the muscles that you've removed,

that's something that Vesalius does a lot in the Fabrica.

Is that one of the key influences?

Yes. That depicting of the flayed man as still alive,

and in a sense helping to show off his anatomy.

He wasn't the first to do that,

but that's one of the things that makes his book so memorable.

How do you see anatomical art these days?

Has there been a split, the two separated, anatomy, art?

I would've said yes 15 or 20 years ago.

But I think particularly the rise of new imaging technologies

for the body have given artists a completely new field to work within.

There's a very great number of contemporary artists working

with microscopic imagery, or scanned imagery.

Do you think that is a renaissance of...

well, of the actual Renaissance, and the study of the body at that time?

Do you think we're coming back to that

sort of sensibility of thinking about the body?

I think I would feel comfortable describing it that way, yes.

-A new renaissance.

-Mm.

Today, technology is pushing anatomical artwork in new directions.

Artists are engaging with the body at a cellular level

and exploring its hidden fabric,

creating art that is inspired by microscopic imagery, scans and DNA.

While the source material may have changed, they are still

working with anatomy and are extending its artistic potential.

It's a new chapter in the long

and fruitful relationship between anatomical investigation and art.

In this series, I've been able to explore

over 600 years of anatomical art.

Along the way, there have been ground-breaking discoveries,

medical breakthroughs, and a fair few controversies.

But for me, one thing stands out from it all.

Whether they were motivated by a desire to depict

God's handiwork or to understand the science of the body,

these anatomists and artists all believed passionately that

only by seeing for themselves could they uncover the truth.

They were like the great explorers who discovered new continents

and mapped them.

And in recording their knowledge and discoveries, they have left us

with a gallery of wonderful art that still has enormous value

even if some of the features depicted are no longer thought to be correct.

The beauty of anatomy is that there is always something new

to discover about ourselves and something amazing to illustrate.

Anatomy has at times been politics, sometimes theology,

and often theatre, but it has always been an art.