Brooks, Abigail L.

Cowan, Scott W.

Isenberg, Gerald A.

Shahi, Niti

Yeo, Charles J.

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Surgery, Gibbon Society HistoricalProfiles Department of Surgery11-2016Remembering Dr. Henry W. Gray (1827-1861)and His Timeless Contribution to Modern MedicalEducation.Niti ShahiThomas Jefferson University, Niti.Shahi@jefferson.eduAbigail L. BrooksThomas Jefferson UniversityCharles J. YeoThomas Jefferson University, Charles.Yeo@jefferson.eduScott W. CowanThomas Jefferson University, Scott.Cowan@jefferson.eduGerald A. IsenbergThomas Jefferson University, gerald.isenberg@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/gibbonsocietyprofilesPart of the History of Science, Technology, and Medicine Commons, and the Surgery CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Surgery, Gibbon Society Historical Profiles by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationShahi, Niti; Brooks, Abigail L.; Yeo, Charles J.; Cowan, Scott W.; and Isenberg, Gerald A.,"Remembering Dr. Henry W. Gray (1827-1861) and His Timeless Contribution to Modern MedicalEducation." (2016). Department of Surgery, Gibbon Society Historical Profiles. Paper 46.http://jdc.jefferson.edu/gibbonsocietyprofiles/46Surgical HistoryRemembering Dr. Henry W. Gray (1827–1861)and His Timeless Contribution to ModernMedical EducationNITI SHAHI, M.D., ABIGAIL L. BROOKS, B.A., CHARLES J. YEO, M.D., SCOTT W. COWAN, M.D.,GERALD A. ISENBERG, M.D.From Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University,Philadelphia, PennsylvaniaI N 1858 SIR HENRY WILLIAMSON GRAY (1827–1861)revolutionized the study of anatomy and the practiceof surgery by publishing Anatomy: Descriptive andSurgical; the widely used anatomical textbook com-posed of a vast number of precise anatomical illus-trations. Dr. Gray, the Father of Modern Anatomy, inaddition to being a surgeon, lecturer, and curator atSt. George’s Hospital in London, recognized the needfor an affordable and accurate textbook for medicalstudents. Dr. Gray is credited with the authorship of thisanatomical masterpiece. It is only with the illustrationsof Dr. Henry Vandyke Carter (1831–1897), an Englishsurgeon, professor, and artist that Gray’s Anatomy isdistinct from previous anatomical textbooks. Dr. Grayand Dr. Carter’s intention was to produce a textbookbeyond the traditional study of anatomy and create an“application of this science to practical surgery.”1Sir Henry Williamson Gray was born in Belgravia,London, United Kingdom, without a trace of medicalheritage (Fig. 1). Thomas Gray, his father, was a pri-vate messenger to King George IV and his successor,William IV. Dr. Gray learned from his father how to beobservant and inconspicuous, two vital traits thatwould later shape the making of Gray’s Anatomy.2 Hewas one of four children, with two brothers and a sister.His sister and one of his brothers passed away ata young age. Dr. Gray was a language aficionado,speaking French, German, and Italian.1 In May 1845,he enrolled at St. George’s Medical School in London.All Dr. Gray was certain about was his desire toattend medical school, “it is almost as if Henry Graydid not fully exist as a flesh and blood being until thesixth of May 1845 the day he stepped inside London’sSt. George’s Hospital and signed his name to registeras a medical student.”2 He had a passion for anatomyand was said to be the “most painstaking and me-thodical worker.”1 Throughout medical school, he ex-plored his propensity toward anatomy by preparing hisown elaborate dissections to supplement his learning.In fact, he invested in writing an award-winning essaycomprised with illustrations of dissections entitled“Anatomy and Physiology of Nerves of the HumanEye.”1 During his final year of medical school, Dr. Grayeven became a postmortem examiner.In 1850, Dr. Gray became the House Surgeon toSt. George’s Hospital. Beyond anatomy, he had aninterest in embryology, leading to his work titled “TheGlands of Chicks.”1 At the age of 25, he was elected asa Fellow of the Royal Society, a distinctive honor fora young surgeon. As a Fellow of the Royal Society,Dr. Gray joined the ranks of the famed physicist IsaacNewton and microbiologist pioneer Antonie vanLeeuwenhoek.2 Dr. Gray further embraced his passionfor anatomy, when he became a lecturer of anatomyand curator of the museum at St. George’s Hospital.Dr. Gray’s compendium of anatomical texts extendedwith the achievement of winning the Astley CooperPrize for his dissertation “The structure and use of thespleen.”1 His multifaceted interests in research andeducation bridged anatomy with other essential disci-plines in medicine. In May 1848, the final year ofmedical school for Dr. Gray, Henry Vandyke Carterregistered to be a medical student at St. George’sHospital. At St. George’s Hospital, Dr. Gray andDr. Carter became acquainted with each other whenDr. Gray became Dr. Carter’s lecturer of anatomy. Theunusual duo shared a passion for anatomy. Their firstwork together was 380 pages, with 65 wood engrav-ings on the development, anatomy, and physiology ofthe spleen.1 This dissertation involved systematicmeasuring of the spleen at different ages. It was theearliest description of the lymphatic and nervous sys-tem and elaborated on histology and blood supply. Itdistinguished the spleen from adjacent anatomicalstructures and detailed the embryology of the spleen.Address correspondence and reprints requests to Scott W.Cowan, M.D., Department of Surgery, Thomas Jefferson Uni-versity, 1100 Walnut Street, 5th Floor, Philadelphia, PA 19107.E-mail: scott.cowan@jefferson.edu.1043In 1856, Drs. Gray and Carter began their collabo-rative efforts to create the most coveted anatomicaltextbook in history. Anatomy textbooks had been incirculation for more than 500 years. At the time,Quain’s Elements of Anatomy was a commonly usedtext and was undergoing revisions to its sixth edition.Dr. Gray and Dr. Carter stressed the utilitarian impactof their text, urging it would be useful after enteringthe professional world.3 Since 1847, the medical worldhad been in transition because of the compelling dis-covery of the first anesthesia, chloroform.2 Surgeonsnow had a need for retrieving a larger scope ofknowledge because anesthesia enabled surgeons toaccess deeper and previously unreachable anatomy.The making of the written masterpiece was a pains-taking process. Dr. Gray and Dr. Carter diligentlyworked for nine hours at a stretch.3 The exactingprocess involved dissections by Dr. Gray, Dr. Carter’smeticulous drawings by paper, transference of the il-lustrations by draftsmen, and lastly the engraving ofthe woodblock.4 It was only later on that Dr. Carterwould hasten the process by drawing the illustrationsdirectly on the woodblock. The primary intention ofthis textbook was “to supply an affordable, accurateteaching aid for people like their own students.”3Anatomy: Descriptive and Surgical, later known asGray’s Anatomy, distinguished itself from prior anat-omy textbooks in circulation by being “simple, well-illustrated and well-organized.”3 Dr. Carter’s drawingswere more conducive to learning than prior books dueto the direct labeling on anatomical structures.5 Figure 2illustrates Carter’s nomenclature system. Previousanatomy books such as famed texts by Quain andWilson had illustrations too miniaturized to be re-alistic.3 Dr. Carter innovated detailed, magnified il-lustrations compared with the standard rudimentaryand vague drawings in the circulating anatomy books.5Dr. Carter’s images were distinct and valued becauseof his highly skilled shadowing and drawing of sub-jects as if they were anesthetized. The first editionincluded over 400 anatomical drawings. The anatom-ical text was masterfully organized by Dr. Gray andDr. Carter’s subdivision into precise sections: osteol-ogy articulations, the muscles and fasciae, the arteries,the veins, the lymphatics, the nervous system andorgans of sense, the viscera, regional anatomy, andmicroscopial anatomy.1 Dr. Gray depended on thehelp of his friend Dr. Timothy Carter to serve as theeditor and propel the publication process. Their finalproduct doubly surpassed the scope of knowledge ofQuain’s Anatomy.Dr. Gray received full authorship of the textbookdespite Dr. Carter’s significant contribution. Dr. GrayFIG. 1. Portrait of Dr. Henry Gray. Available at: http://www.sciencemuseum.org.uk/broughttolife/people/henrygray.aspx.Accessed July 30, 2015.FIG. 2. The upper vascular systemengraving from the first edition ofGray’s Anatomy. Available at: https://www.rcseng.ac.uk/museums/hunterian/images/grays-anatomy/grays_anatomy_image.jpg. Accessed July 30, 2015.THE AMERICAN SURGEON November 20161044 Vol. 82was paid 150 pounds per every thousand copieswhereas Dr. Carter only received a onetime payment.3Embittered by Dr. Gray’s refusal to pay him royalties,Dr. Carter joined the Bombay Medical Service. In1858, Dr. Carter returned to his passion for medicaleducation when he assumed the position of Professorof Anatomy and Physiology at Grant Medical Collegein India.3 Later in his lifetime, Dr. Carter pioneered theresearch and study of leprosy and mycetoma, a chronicgranulomatous fungal infection below the skin.3Gray’s Anatomy received high acclaims with its firstpublication in Britain. The British medical journal, TheLancet, not one to easily give praise, professed thatGray’s Anatomy was “the best anatomy treatise in anylanguage and called Henry Vandyke Carter’s illustrationsperfect.”2 The reviews stressed “the logical arrangementof the subject matter, the inclusion of practical pointsdirected toward stimulating the student, the effectivenessof the illustrations, their originality and clarity and theclose correlation between illustrations and text.”1 How-ever, there were several criticisms from American jour-nals for the oversimplification and lack of color of theillustrations for medical students. Even the journals thathad critiques praised Dr. Gray for his efforts.The textbook was popular and desired beyondBritain. A Philadelphia publisher made arrangementsto secure its publishing in America just one year later.By the next year, Dr. Gray began working on a secondedition. Gray’s Anatomy has been widely consideredas one of the most famed books in the English lan-guage and as the sole medical text known by its name.2Nearly 160 years later with 40 editions,Gray’s Anatomyremains as the forerunner in anatomical texts inmedical schools worldwide. With millions of copiessold and its translation into more than a dozenlanguages, Gray’s Anatomy has been educatingmedical students for generations. Despite beingpublished in Britain by three British doctors, Gray’sAnatomy has had a worldwide impact for genera-tions of future physicians. It has never gone out ofprint. Gray’s Anatomy is the cornerstone of anatomyand hence surgery, serving as the rite of passage forall medical students alike as the quintessential“medical bible.”REFERENCES1. Goss CM. A Brief Account of Henry Gray, FRS, and HisAnatomy, Descriptive and Surgical: During a Century of its Pub-lication in America. Philadelphia: Lea & Febiger, 1959.2. Hayes B. The Anatomist: A True Story of Gray’s Anatomy.New York: Ballantine Books, 2008.3. Standring S. Gray’s Anatomy, 40th Ed. Edinburg, Scotland:Churchill Livingstone/Elsevier, 2008.4. Netter F, Friedlaender GE. Frank H. Netter MD and a briefhistory of medical illustration. Clin Orthop Relat Res 2014;472:812–9.5. Ghosh SK. Evolution of illustrations in anatomy: a studyfrom the classical period in Europe to modern times. Anat Sci Educ2015;8:175–88.No. 11 DR. HENRY W. GRAY, FATHER OF MODERN ANATOMY ? Shahi et al. 1045

Remembering Dr. Henry W. Gray (1827-1861) and His Timeless Contribution to Modern Medical Education.

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Remembering Dr. Henry W. Gray (1827-1861) and His Timeless Contribution to Modern Medical Education.

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