You Could Look It Up (51 page)

Writer Ammon Shea performed a similar experiment with the
Oxford English Dictionary
, pointing out, “If you were to sit down and force yourself to read the whole thing over the course of several months, three things would likely happen: you would learn a great number of new words, your eyesight would suffer considerably, and your mind would most definitely slip a notch.”
19
He offered his book-length account of his efforts,
Reading the OED
, as “the thinking person's CliffsNotes to the greatest dictionary in the world,” but he had to admit it is also “an account of the pain, headache, and loss of sanity that comes from spending months and months searching through this mammoth and formidable dictionary—and pulling together all of its most beautiful and remarkable words.”

CHAPTER
20

MODERN MATERIA MEDICA

Staying Healthy

Medical information was first written down because its volume had grown beyond the bounds of the individual healer. As the centuries passed, the volume of accumulated medical knowledge only increased. The scientific revolution brought empiricism to health, and clinical trials let practitioners figure out whether a treatment was more or less likely to lead to a cure. Meanwhile the rise of scientific journals and the systematic collection of data made medical knowledge both more accurate and more specialized. Reference books had to work hard to keep up.

Comparing two major works on health separated in time by one long lifetime highlights the differences between Victorian confidence and modern anxiety over what constitutes health. These two works—one focusing on physical, one on mental health—trace the evolution of ideas about the relationship of the mind to body and explore the kinds of authority with which specialists made claims about both.

Few Victorian textbooks have inspired prime-time soap operas, but one legendary guide to human anatomy has become so famous over the centuries that its name is now proverbial.

One of the longest-lasting medical references in history had as its
declared mission “to furnish the Student and Practitioner with an accurate view of the Anatomy of the Human Body, and more especially the application of this science to Practical Surgery.”
1
Surgery was undergoing exciting changes in the 1850s. Anatomical education in England improved by leaps and bounds when the Anatomy Act of 1832 made it possible to get cadavers for dissection as part of a medical education without having to depend on grave robbers. And the availability of anesthesia—both ether and chloroform had been approved for use in the 1840s—was allowing surgical interventions that would once have been impossible.

Henry Gray—“diligent and hard-working, focused, clever, ambitious”—was born in 1827 and was eager to be recognized as a great surgeon at St. George’s Hospital in London.
2
Beyond that, we know next to nothing about him; he left virtually no traces of his private life. We do not even know where he attended school, only that he was a London surgeon and that the most famous of all anatomy textbooks bears his name.
Gray’s Anatomy
is not entirely Gray’s; he provided the text, but the woodcuts—among the most useful features of the book, and the most distinctive—were provided by a colleague, another surgeon, named Henry Vandyke Carter. We know much more about Carter, who kept a detailed diary in tiny handwriting from the time he was fourteen. Carter came from a less privileged background; he could not easily afford a university education, so he trained first as an apothecary and used his income from that, combined with money he earned as an illustrator, to advance his education. He was devastated when he failed his surgical exam the first time, but a year later he passed with honors.

We know from Carter’s writings that the two men met in 1850, when both were working at St. George’s Hospital. Having discovered that Carter was an accomplished illustrator, Gray sought his assistance on an essay he was writing, eventually published in book form as
The Structure and Use of the Spleen
(1853). Carter was glad of the payment, but he was wounded when he saw the published book: Gray had neglected to credit his contribution. “See Gray’s Book on Spleen takes no notice of my assistance,” he noted in his diary, “tho’ had voluntarily promised.” Despite his Victorian stoicism, his fragmentary comment, “rather feel it,” leaves no doubt that the omission rankled.
3
It was only the first of a series of struggles between the two for prominence.

Gray aspired to write a truly comprehensive one-volume guide to human anatomy, superseding all the other books on the market. In November 1855, Carter made a note of a conversation: “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 simple artist.”
4
Carter was slow to agree to the project. Though he had already qualified as a surgeon and apothecary, he was still completing his MD degree. He was also probably still smarting from his treatment on the earlier book. Gray’s offer of £10 a month for fifteen months, though, seems to have tipped the balance in Carter’s
mind, and he began in January 1856. Once they decided to work together, they moved quickly—from planning to publication in less than three years. They worked together on dissections, Gray taking notes while Carter made sketches. Dissections were no simple matter in the 1850s. They had to be done in winter, because cadavers would decay too quickly in the summer, but daylight being shorter then, they began work as soon as the sun rose high enough. Still they worked systematically through the body, preparing materials for the definitive work on human anatomy.

Gray was the motive force for the project, and he secured a publisher. He had already published his essay on the spleen with John Parker, so Parker was the obvious choice to publish the
Anatomy
. But, having done that work, Gray abruptly walked out in the middle of the project when he accepted an invitation to serve as personal physician to the Duke of Sutherland on his private yacht. He got a leave of absence from his hospital duties, providing the remainder of his contributions to the book by mail and leaving Carter to handle the details of production.
5

The work is structured systematically: under the broad head “Osteology” comes a series of introductory articles—“General Properties of Bone,” “Chemical Composition of Bone,” “Structure of Bone,” and so on—followed by sections on the major classes: the spine, the skull, the thorax, the pelvis. Within each of those classes are more specific entries: “The Spine” opens with “General Characters of the Vertebræ” and “Characters of the Cervical Vertebræ,” followed by “Atlas,” “Axis,” “Vertebra Prominens,” and on through the bones of the spine. Sometimes an entry is even more specific: under the broad head “The Lymphatics” is an entry on “Cerebrum”; under “Cerebrum” comes “Boundaries of, and Parts forming the Lateral Ventricles”; under that comes “Thalami Optici.” As befits a clinical book, the tone is always clinical: the sections on “Male Generative Organs” and “Female Organs of Generation” have no time for moralizing on the one hand or tittering on the other. The language is never vulgar; Latin takes the place of the vernacular when the subject gets too explicit. But neither is there any shying away from delicate matters: “The
SCROTUM
is a cutaneous pouch, which contains the testes and part of the spermatic cords. It is divided into two lateral halves, by a median line, or raphe… .”
6

The book features detailed drawings—hand-colored in some editions—of the sex organs, the sort of thing that distressed nineteenth-century moralists. Carter’s illustrations, made directly onto the woodblocks that would be used to print the images, are exemplary, providing just the right balance of naturalistic detail and schematic clarity. Carter introduced an innovation to anatomical illustration by putting his labels directly on the parts they identify, rather than relying on a clumsy system with numbers and arrows. The drawings are beautifully engraved, presumably by someone on the publisher’s staff. But the illustrations provoked last-minute panic when someone discovered that the woodblocks were almost an inch too large to fit on the paper size they had chosen.
7
Recreating the images was out of the question, as was moving to a larger page size. Fixing the problem involved frantic scrambling to rearrange the pages and reduce the captions whenever possible; if no other option remained, they would have to trim the woodblocks themselves.

A more delicate problem arose after the book was in proof. On the first proof of the title page, both contributors’ names appeared in the same size of type, though Carter’s appeared well below Gray’s; already the hierarchy of the contributors was being asserted. Gray, however, was not content. In marking the proof he crossed out Carter’s name and qualifications and added a notation for the typesetter: “Type size of the name below,” that is, smaller than his own. Where Carter’s new job title, a prestigious professorship, appeared, Gray crossed it out, adding explicit instructions—“To be omitted”—and his authorizing initials, “H.G.” The message was clear: this was to be H.G.’s
Anatomy
, not H.G.’s and H.V.C.’s
Anatomy
.
8
To add injury to insult, Gray never paid Carter any of the royalties he had earned.

The book appeared in summer 1858, in time to be adopted in medical schools for the upcoming academic year. Gray and Carter were stung by one early bad review—“low and unscientific in tone … inconsistent with the professions of honesty which we find in the preface… . A more unphilosophical amalgam of anatomic details and crude surgery we never met with”—but most of the other notices were strong, and sales were good. The review in the
British Medical Journal
is typical, calling
Anatomy Descriptive and Surgical
“far superior to all other
treatises,” and “a book which must take its place as
the
manual of Anatomy Descriptive and Surgical.” A review from 1869 listed
Anatomy
among the essential books for medical students.
9

The book brought together the best information on anatomy and physiology the age had to offer, and it quickly became the standard book in the field. The medical knowledge did Gray himself little good; he died at age thirty-four of “confluent smallpox” in June 1861. Carter’s post-
Anatomy
career was more fortunate. He took a position as principal of Grant Medical College in Bombay, India, where he did groundbreaking work on the nature of leprosy. But the book remains one of the classics in the field and has never gone out of print. When the thirteenth edition appeared in 1892, an advertisement declared that “
Gray’s Anatomy
has been the standard work used by students of medicine and practitioners in all English-speaking races.” The ad quotes the
Cleveland Medical Gazette
—“Teachers of anatomy are almost unanimous in recommending ‘Gray’ as the standard work”—and the
University Medical Magazine
—“the recognized text-book for the great majority of English-speaking students of medicine … the most perfect work of its kind extant.”
Gray’s Anatomy
is now in its fortieth edition, the work of eighty-five (properly credited) experts. Though none of Gray’s text or Carter’s illustrations remain, for generations of medical students, getting their copy has been a professional rite of passage.