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Gray's Anatomy

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We are our bodies.

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We see the outside all the time

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but that's less than half the story.

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The surface, the exterior.

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We know far less about what's inside.

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Heaven forbid that we should actually see our insides.

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Most people go through their life without getting a look

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at their organs and for good reason.

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

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arteries and veins - they do their jobs unseen.

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But for the anatomists, the doctors

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and artists who have struggled for centuries to understand how

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

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In this five-part series,

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I'll be investigating the beautiful synthesis between

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

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As a scientist myself

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and someone who is fascinated by anatomical images,

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I want to find out exactly

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how anatomy has inspired art and art anatomy.

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

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works of the art in the world.

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Unquestionably the most famous anatomical

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textbook in existence is Gray's Anatomy.

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Published in 1858, the accuracy of its descriptions

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and the beautiful clarity of its illustrations

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made it an instant bestseller,

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

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to anatomy that has ever been produced.

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

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Henry Gray and his illustrator, Henry Carter.

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Henry Gray was 31 when he completed it,

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and his illustrator was just 27.

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

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exploration of the human body yet attempted.

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So how did they do it?

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

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

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For centuries, anatomists have studied the human body,

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

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

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of the handiwork of God

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and has informed the practice of both medicine and art.

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

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when something momentous happened to anatomy.

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That something was the arrival of anaesthetic.

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

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largely limited to superficial operations and amputations.

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Anaesthetic changed everything.

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It allowed surgeons to open up the living body

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and perform longer, more complex procedures.

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Procedures that demanded an encyclopaedic knowledge of anatomy.

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Henry Gray was an ambitious young man,

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and for him this was a call to arms.

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

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in the Royal College of Surgeons.

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Gray wanted his book to furnish students

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and doctors with the anatomical information

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they needed to perform successful surgery in this new era.

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The library here at the college has a first edition.

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

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

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

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universally known as, which is Gray's Anatomy.

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

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

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And the whole thing is based on the dissections that

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the two of them had done together.

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Published in London in 1858.

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

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the whole of the human body in an affordable

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and accessible single volume for students and surgeons.

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Earlier anatomy textbooks had been too small,

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too large or too expensive.

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Turning the pages gives you a real sense of the scale

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of this project these two undertook.

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

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There are so many and they are so varied.

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It is slightly unwieldy in that regard.

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The text gets slightly lost in these beautiful diagrams

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

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of the left hand and the artist has shaded to give

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

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All of this done within three years.

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These stunning illustrations are wonderfully precise.

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Carter has even avoided footnotes by skilfully integrating

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the labels into the drawings themselves.

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At times the artwork is reminiscent of the figures

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depicted by the 16th century anatomist Vesalius.

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But while Vesalius gave his bodies dramatic poses to

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illustrate their passage through a landscape,

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Gray and Carter were doing something very different.

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

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

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This position is shown

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

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

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see that this is exactly what Gray

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and Carter are doing in this illustration with the head

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

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

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

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You open up the first edition of Gray

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and it goes straight into anatomy.

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

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There's nothing outside the illustrations at all.

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So it's a very, very different enterprise

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

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

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

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the so-called India Proofs,

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

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which is kind of thin and opaque and particularly good

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at rendering the exquisite detail

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of Henry Carter's beautiful illustrations.

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

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They're almost in some ways austere.

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

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

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The idea of a very unmediated,

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clean, cool kind of mechanical objectivity.

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What they do very effectively is to communicate a particular

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kind of knowledge about the human body.

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If you're trying to teach anatomy,

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if you're trying to draw attention to particular aspects

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of the muscle structure or the functioning of the intestines,

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

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because it's distracting.

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

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

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All of the illustrations in Gray's Anatomy were carefully

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designed to showcase the things that the reader

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

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

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that it exposes a couple of muscles.

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

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and connects to the back of the skull there,

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but this one here, called the sternocleidomastoid, originates

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

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which is the collar bone here...

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

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

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rather than the other one pulling.

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So, if Amy looks square on,

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

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The painstaking care Carter put into his illustrations conveyed

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this kind of information with a seemingly effortless simplicity.

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But it was all the result of hard graft -

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work that began with dissection.

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So ambitious was Gray's project

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that a vast number of dissections would be required,

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all to be carried out by Gray and Carter themselves.

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

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

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

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Gray had come to start his training as a whippersnapper

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aged just 15 years old.

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And he joined one of the best hospitals in London.

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

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

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and now boasted some of the finest doctors in London.

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The young Henry Gray was handsome,

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expensively dressed and fiercely competitive.

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At 19, he was winning prizes in surgery

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

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to distinguished audiences at the Royal Society.

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Carter, meanwhile, was from a more modest background.

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He was born and raised in Yorkshire

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and couldn't afford to train as a physician,

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so he qualified as an apothecary-surgeon,

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what today we'd call a GP.

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

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Both men studied anatomy and learnt the art of dissection.

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But that took place around the corner.

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

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not far from what was then Harrods Grocery.

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

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produce a "Manual for Students".

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Initially, Carter thought it was a good idea,

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but probably too much work for him to consider it.

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Even though Gray was pretty vague about his plans,

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Carter was quick to realise that the sheer number

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of dissections would be a huge undertaking.

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Carter was no stranger to this kind of endeavour.

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

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So eventually, despite his reservations,

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

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The truth was that Carter was struggling a bit.

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

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invited by the Duke of Sutherland to be his personal physician

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on his yacht on a round Britain trip.

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

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He had advertised his services as a medical illustrator,

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but nothing much had come in.

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So the offer from Gray was a windfall.

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

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Gray and Carter would have come in here through these arches

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and the bodies from round the back.

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

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to let in the maximum amount of light.

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

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and decaying human bodies.

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This extraordinary photograph shows students

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

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

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

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These men would have had a regular supply of body parts

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from the hospital up the road,

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

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Between the 1750s and the 1830s in Britain,

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

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

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actually includes public dissection after you've been executed.

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The supply from the gallows is nowhere near large enough

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

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

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Under the terms of this act,

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a new source is found for bodies for dissection.

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These are the bodies of the poor.

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Essentially, if you die in a workhouse,

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

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you will be taken for dissection.

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

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almost overnight, a hated and feared punishment for poverty.

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

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

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

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

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

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That's why they had the bodies delivered

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to the back door of the lab.

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

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meticulous illustrations were created.

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

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At first, he drew on paper,

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and his designs were then engraved onto woodblocks for printing.

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But it was a slow process

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so he learnt the difficult technique of drawing reverse images straight

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onto the woodblocks themselves, saving both time and money.

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Gray's Anatomy, including all its 363 illustrations,

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was completed in July 1857.

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

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Gray and Carter had fallen out.

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It was hardly surprising.

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The two men had been working under enormous pressure

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

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all the text and all the drawings,

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had to be done alongside their day jobs.

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

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

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from previous experience, he knew that Gray was very

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slow in paying, for example.

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

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on the spleen, which won an award.

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Carter was not acknowledged. Carter wasn't paid.

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

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

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cover Carter's living expenses.

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

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

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But certainly Carter complained that he was living on air

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

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He worked incredibly hard for Gray.

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

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Carter decided to break with St George's

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and take his career in a new direction.

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

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

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

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that Gray was about to deal him.

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

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Gray's own notes on these proofs give us

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

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I suppose the most significant evidence

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

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where Gray had made some very significant changes in ink

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to what Parker, the publisher, had prepared.

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

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

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

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Carter has just been appointed Professor of Anatomy in Bombay,

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

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is Late Anatomy Demonstrator, St George's.

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

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and downgrade Carter's significance in the book.

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

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but without consulting either of them.

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

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

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

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The two men never collaborated again.

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Carter made a great success of his career in India.

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He identified a new fungal disease and advanced medical understanding

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of diseases like leprosy, malaria and tuberculosis.

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But for Gray, success would be short-lived.

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

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just a stone's throw from the dissection rooms.

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

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in June 1861, of smallpox, aged just 34.

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What Gray and Carter had achieved was extraordinary.

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The most comprehensive account of anatomy in Western history.

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The medical journal, The Lancet

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

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

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Gray's Anatomy became THE standard thing.

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There were other textbooks in Germany and America,

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

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It had that kind of authoritative ring,

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so it kept selling and selling and selling.

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Gray's Anatomy is now in its 40th edition

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

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As technology has advanced our knowledge of the body,

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it has been repeatedly revised and added to, with extensive

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

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

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What happens with these great books

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and textbooks is you get successive editors come in

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

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

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So there is a phase in the development of these books

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

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It's lost its unity.

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

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

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

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

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

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

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with some illustrations up to date.

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The 40th edition we concentrated on the illustrations.

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

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What you're seeing is what the anatomist,

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the clinician wants you to see.

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

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

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the previous editions, or have you returned to the source

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and used those Carter images as a template?

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

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tiny one of the developing sacrum

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

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-Why?

-Because it was really so old-fashioned.

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It just didn't look right.

0:21:540:21:56

You have to go with the times, I think.

0:21:560:21:58

In fact most of the images now,

0:21:580:22:00

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

0:22:000:22:03

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

0:22:060:22:09

online component and that allows us

0:22:090:22:11

not only to add additional text in the form of

0:22:110:22:13

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

0:22:130:22:19

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

0:22:190:22:22

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

0:22:220:22:26

and it needs something to help the reader understand and appreciate

0:22:260:22:31

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

0:22:310:22:34

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

0:22:340:22:38

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

0:22:380:22:43

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

0:22:430:22:47

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

0:22:470:22:53

the changing relationship between art and anatomy.

0:22:530:22:56

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

0:22:570:23:02

to Andreas Vesalius,

0:23:020:23:05

to Henry Gray,

0:23:050:23:07

they all had to perform their own dissections

0:23:070:23:09

to discover and record knowledge about the human body.

0:23:090:23:12

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

0:23:170:23:20

can now gather all the information they need

0:23:200:23:23

without getting their hands on corpses.

0:23:230:23:26

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

0:23:280:23:32

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

0:23:320:23:35

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

0:23:350:23:39

You talk to anybody about medical illustration,

0:23:410:23:43

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

0:23:430:23:47

The chance to bring it forward for future generations of medics

0:23:470:23:51

to learn from is just a fantastic opportunity.

0:23:510:23:53

Our drawings, eventually somebody will read the text

0:23:560:24:00

and hopefully gain the information from our drawings

0:24:000:24:04

that will further them in their medical career.

0:24:040:24:07

Gray's is still a gorgeous feast of anatomy

0:24:160:24:20

and detailed medical knowledge,

0:24:200:24:22

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

0:24:220:24:25

it represents the end of traditional anatomical art.

0:24:250:24:29

Did art and anatomy part company a long time ago?

0:24:290:24:33

Or is it just that the traditional relationship has changed?

0:24:380:24:42

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

0:24:420:24:46

and really give these curves...

0:24:460:24:47

Eleanor Crook is a 21st century anatomical artist.

0:24:470:24:51

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

0:24:510:24:56

But she's also part of the scientific community,

0:25:000:25:03

making anatomical models to be used in medical schools

0:25:030:25:06

all over the country.

0:25:060:25:07

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

0:25:090:25:13

What is the relationship between the two of them?

0:25:130:25:15

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

0:25:150:25:19

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

0:25:190:25:23

that people could learn from.

0:25:230:25:25

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

0:25:250:25:28

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

0:25:310:25:35

the 16th century anatomist.

0:25:350:25:37

Even some of the muscles that you've removed,

0:25:370:25:40

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

0:25:400:25:43

Is that one of the key influences?

0:25:430:25:45

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

0:25:450:25:50

and in a sense helping to show off his anatomy.

0:25:500:25:52

He wasn't the first to do that,

0:25:520:25:54

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

0:25:540:25:58

How do you see anatomical art these days?

0:25:580:26:01

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

0:26:010:26:05

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

0:26:050:26:08

But I think particularly the rise of new imaging technologies

0:26:080:26:11

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

0:26:110:26:15

There's a very great number of contemporary artists working

0:26:150:26:18

with microscopic imagery, or scanned imagery.

0:26:180:26:22

Do you think that is a renaissance of...

0:26:220:26:25

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

0:26:250:26:29

Do you think we're coming back to that

0:26:290:26:31

sort of sensibility of thinking about the body?

0:26:310:26:33

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

0:26:330:26:36

-A new renaissance.

-Mm.

0:26:360:26:38

Today, technology is pushing anatomical artwork in new directions.

0:26:450:26:50

Artists are engaging with the body at a cellular level

0:26:510:26:55

and exploring its hidden fabric,

0:26:550:26:57

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

0:26:570:27:01

While the source material may have changed, they are still

0:27:020:27:06

working with anatomy and are extending its artistic potential.

0:27:060:27:10

It's a new chapter in the long

0:27:100:27:12

and fruitful relationship between anatomical investigation and art.

0:27:120:27:16

In this series, I've been able to explore

0:27:210:27:23

over 600 years of anatomical art.

0:27:230:27:26

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

0:27:290:27:33

medical breakthroughs, and a fair few controversies.

0:27:330:27:36

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

0:27:360:27:39

Whether they were motivated by a desire to depict

0:27:390:27:42

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

0:27:420:27:47

these anatomists and artists all believed passionately that

0:27:470:27:51

only by seeing for themselves could they uncover the truth.

0:27:510:27:55

They were like the great explorers who discovered new continents

0:27:580:28:02

and mapped them.

0:28:020:28:03

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

0:28:030:28:06

with a gallery of wonderful art that still has enormous value

0:28:060:28:10

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

0:28:100:28:14

The beauty of anatomy is that there is always something new

0:28:170:28:21

to discover about ourselves and something amazing to illustrate.

0:28:210:28:25

Anatomy has at times been politics, sometimes theology,

0:28:250:28:29

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

0:28:290:28:33

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