The Anatomist: A True Story of Gray's Anatomy (21 page)

Gray was just as busy as his collaborator, if not more. He had to produce, on average, ten pages of text every week, on top of holding three separate jobs—lecturer on anatomy, curator of the Anatomy Museum, and surgeon to the St. George’s and St. James’s Dispensary—as well as fulfilling his duties as a member of the Pathological Society Council, the Royal Medical and Chirurgical Society, and the Royal Society.

One glaring difference between the two Henrys, however, was financial. While Gray was making a handsome living at the hospital, H. V. Carter, by contrast, was not being paid for either of his St. George’s jobs. The histology position came with no salary—he had taken it as a favor to Gray—and, shockingly, as demonstrator of anatomy, he had not been paid a pound in eight months (funding had dried up after his mentor Dr. Hewett retired). The disparity in income between them was even more pronounced in their respective contracts for the book. While Gray would be paid £150 for every thousand copies sold (an arrangement that would ultimately benefit four generations of Grays), Carter, who had negotiated his own contract with the publisher, would receive no royalties, only a onetime fee of £150. Why should he have accepted such an inferior arrangement? To him, it wasn’t—£150 was three times larger than the salary for a demonstrator—but finally, his own naïveté also played a role.

As for why Carter soldiered on at St. George’s, this was partly out of loyalty to Gray, I believe, and partly because he was well suited to soldiering. He also felt, at least initially, that his unpaid work might eventually pay off in his forming the right connections and, should Providence allow, a plum job. But now, he was clearly having second thoughts about staying on at St. George’s. A vacancy for curator of the Pathology Museum had opened up in March—a position equivalent to Gray’s at the Anatomy Museum—but, two months later, Carter still had not decided if he would even apply for it.

“I’m constantly imagining myself in another position—as surgeon in a small country village, or the like,” he confides to his diary. However, faced with endless drawing, he had begun to fear that “[I’m] losing much of the little practical professional experience I had.” This was a legitimate concern. Though he had recently earned his final certification to practice medicine, having passed the M.D. examinations in late November 1856, Carter had treated no patients other than his mother and done virtually no hands-on doctoring since he’d filled in for John Sawyer two and a half years earlier. Adding to his anxiety was the reality that, at age twenty-six, he was off to a late start in establishing a career.

“All my fellow students, and most since my time, have left the School and are settled in life,” he observes on another date. “Whenever I hear of their advancement, or meet them, [these] active men, there is a kind of stunning sensation or pang in one’s breast—and the same kind of feeling on seeing the younger students emerge into grown manly fellows.” Indeed, as Carter notes, the very pupils he had been teaching would be his competitors for the same jobs and, because of their youth, perhaps have an edge. The thought is almost too depressing for him to contemplate. What never occurs to him, ironically, and never would, is that the bane of his current existence—drawing—would end up making his name. For the moment, all he can think about is bringing this “quiet mechanical occupation” to a close and putting the anatomy book behind him.

And what about the author? During the same month, as Carter wallowed in his “languid state,” was Henry Gray over at 8 Wilton Street burning the midnight oil, finishing the last chapters of the book? Was the undertaking taking its toll on Gray as well?

Maybe.

Upon receiving Keith Nicol’s chronology, I turn at once to the year 1857, hoping for a revelation. There is none. Alas, Keith had not discovered a cache of Gray’s papers, a diary, or anything of the kind. In fact, Keith later tells me, he had found almost nothing about Gray’s personality or personal life during his research. Keith did, however, track down a small collection of letters written
to
Henry Gray (now in the possession of a distant relative). In these, a curious fact emerged. At the end of May 1857, Gray took a six-month leave of absence from St. George’s, during which he served as personal physician to George Granville Sutherland-Leveson-Gower, the second Duke of Sutherland, a seventy-one-year-old nobleman whose London home was a quick brougham ride away. The correspondence gives no hint as to why Gray would take this job, but to me, there’s an obvious explanation. It was not for money or prestige or the chance to rub elbows with royalty—granted, all nice inducements. No, to echo the two Henrys’ guiding principle, it was for practicality’s sake. With the Duke of Sutherland, Gray would have just one patient (the duke lived four more years, so I suspect his demands on the doctor were not extravagant), and this arrangement would give Gray the one thing he needed most: extra time. Freed of his usual responsibilities, he could bring his manuscript, at long last, to its end.

I HAD NEVER
heard a single unflattering word said of Henry Gray. Then I spoke with Charlie Ordahl.

“Over the past couple centuries, anatomists like Gray have been like the monks of the Catholic church, re-creating the same illuminated manuscript,” he tells me after lab one day. Dr. Ordahl—“Charlie, please”—is one of the eight anatomy instructors. “It’s the whole scribe-type tradition,” he continues. “Very honorable. But that mentality is what makes anatomy as a science such a failure. Nothing changes, decade after decade. Textbooks are the same. It’s taught in the same way—with cadavers, all on-the-table, same position. The same memorizing in the same order of all these parts you’re never going to see again.”

Little did I expect that the mere sight of my copy of
Gray’s Anatomy
would provoke such a prompt mounting of a soapbox. But Charlie can stand on the book itself if he desires. I am quite enjoying his diatribe. “So, why do you think that is?” I ask, urging him on. “Why has nothing changed?”

“Well, it’s partly the power of a paradigm,” he resumes. “Anatomy is like gravity, to most scientists. You don’t question it.” In addition, he notes, after William Harvey discovered the circulatory system in the early 1600s, there wasn’t really much
new
to discover in the body. It had all been found. “Anatomy became encrusted; it lacked a raison d’être.”

Charlie may sound like a newcomer, one of the new breed of computer-simulation-loving anatomy instructors, but he is actually an old-timer, a white-haired bear nearing retirement age. “So if the field is rusted over,” I ask, “what is the point of teaching it this way?” I look around the lab, gesture at one of the cadavers. “Is it just tradition?”

“Sure, that’s a big part of it. But the
real
deal is, you can’t do medicine without it. You have to have that basic understanding of anatomy. Of course, I think you can make it a
lot
more streamlined. Teach it in a much more focused way. Doctors don’t remember any of this stuff. Ninety percent of what we throw at them doesn’t stick.”

It’s a good thing Dana’s not in earshot, or these two might be headed for a smackdown.

I ask how he would propose anatomy be taught.

“Well, for example, you can make a case for studying anatomy solely from the perspective of connective tissue.”

“You mean like fascia?”

“Yeah. Fascia. Ligaments. Tendons. Mesentery. Connective tissue
organizes
the body. It gives you a clear organizational
structure,
especially in the limbs. If you know your deep fascia compartments—posterior, anterior, and so on—you’re set. You don’t need to memorize every muscle and nerve. Likewise, you can use connective tissue as your highway for looking at
all
the systems and parts.

“Plus,” he goes on to say, “it makes sense from an embryological point of view to focus on connective tissue. It’s one of the first things to develop in utero. It surrounds every nerve fiber. Every muscle cell. It’s what holds the body together. And, of course, over a lifetime, it changes. In fact, some people say aging is connective tissue becoming tighter.”

Now that’s a novel way to look at getting old.

“Most of us don’t give our connective tissue any thought,” I point out. “It’s not like bones or muscles. You’re not even aware you have it.”

Charlie grins. “Right. Well, you would if it were missing.”

How true.
Everything is connected. Every word Charlie had just said, it strikes me, could be applied more broadly. One can think about life solely in terms of different kinds of connective tissue: The attachments to family and friends that sustain you. The relationships that anchor you. The bonds that tighten with age. On some deep, unseen anatomical level, connectedness is vital. Without it, you would fall apart.

SHORTLY AFTER HENRY
Gray said his temporary goodbyes to St. George’s, H. V. Carter said goodbyes of his own, only his were for good. “Have now taken some decided steps which have severed my connection with the Hospital,” he reports on July 27, 1857. “No longer Demonstrator. Did not apply for the curatorship, though had good interest. Indeed, the thing is done and I am not quite certain how wisely, but the monotony and uselessness of my present life, as I have myself made it, was the final inducement. And yet, I have no fixed plan for the future—one occupation gone and none other selected: Was this prudent?”

No, certainly not, he knows. But Carter felt he had no choice; the time had come to leave St. George’s. This was much more than a professional crisis; it ran deep and personal. Increasingly over the past year, he had been questioning his purpose in life but was again and again coming up empty. For instance, in a remarkable passage written six months earlier, in January 1857, Carter had examined this emptiness with a dissector’s eye. “My life, as I too much anatomize it, daily, or hourly, is far from happy…. God is hidden. Christ, I know not…. I am full of indolence, lonely, uncheered and unassociated, unaided, without plans or purposes and like a thing only looked at.”

One of the great liberties of keeping a diary, I believe, is the freedom to indulge in self-pity without self-consciousness—to record “a thousand despondent thoughts,” as Carter once put it, without worrying about anyone’s keeping count. But with his January 1857 entry, a dangerous shift had occurred, in my view. He was beginning to suffer a profound loss of self. As if referring to himself as “like a thing only looked at”—an object, a specimen—wasn’t a large enough tip-off, he boiled the feeling down to chilling effect in early May, a month after his mother’s death: “Am daily becoming
anonymous
.” No one knew him, he felt, and, worse, he no longer knew himself.

In spite of his despondency, I have never gotten the sense that suicide crossed his mind. Deep down, he was too God-fearing. What’s more, he felt a responsibility to his brother and sister, as well as to those at St. George’s who depended on him—students, instructors, and not least Henry Gray. But with Gray’s departure at the end of May, Carter was freed somehow to make a bold move of his own. Still, he made sure, first, to fulfill his last professional obligation. And sure enough, in the same July 27 entry in which he reported his severing ties to St. George’s, H. V. Carter made an equally significant announcement, speaking for himself and his collaborator: “The Book is finished.” The sentence is a sigh of relief. Though he doesn’t pat himself on the back, in the moment while the pen is still warm in his hand, he is clearly feeling up. He closes the entry with, “Health is good. I trust, I hope, and hope in trust.”

The mood does not last. Though he is no longer a slave to the anatomy book, the feelings of isolation become even more intense. Everything that had kept him tethered to the world is gone. Sounding panicky, he writes on September 3, 1857, “My situation is entirely critical and I as passive as ever in the tossing waves.” He begins to sink. However, as Carter so eloquently puts it, “At times of depression, memory always excels.” And suddenly he remembers, or so it seems, an escape plan he had once hatched: India. Dazzling, exotic India: a place where men went to make their fortunes, to reinvent themselves, to serve their country. India: a nation in the midst of a violent revolt against the
Raj
(British rule) that would come to be called the Indian Mutiny.

FIVE MONTHS LATER,
Lily Carter of Scarborough, Yorkshire, receives in the post her brother’s diplomas, for safekeeping, and the following note:

[London, February 1858
]

Dearest Lily,

I feel there is a great change of life coming, which cannot be altogether prosperous. My dear, we must be patient and enjoy the present while we can…. I pray you may ever be happy.

Goodbye, dear Lily!

Your affectionate brother,
H. V. Carter

I shall write whenever possible—tell Joe I have by no means forgotten him.

PART THREE
THE ANATOMIST

No man should marry until he has studied anatomy and dissected at least one woman.

—Honoré de Balzac,
The Physiology of Marriage,
1829

Fourteen

I
LEAVE FOR LONDON JUST AS H. V. CARTER LEAVES IT BEHIND
.

“Did at the [rail] station sharp pangs of regret,” he admits to his diary, a printout of which I have brought along to read on the eleven-hour flight.

The train takes him to Southampton, where he books his passage to India: £95, notes. The boat, a paddle steamer named the
Sultan,
sets sail the following day, February 24, 1858. “Left at 2
P.M
. Weather fine and water smooth. Troops on board. Fast officers, slow passengers, 3 ladies and 2 children, about 30 in all. Ship full.” The thirty-five-day, sixty-two-hundred-mile voyage includes stops in Gibraltar, Malta, and Alexandria. They follow the path of the Nile south to Cairo and see the pyramids at Giza, then trek overland by train and caravan to Suez, where he and the other passengers board a second steamer, this one bound for Bombay, Carter’s final destination. “Arrive here safe and almost well,” he jots on March 29, clearly relieved to be back on terra firma.

By the time my plane lands at Heathrow, a good fifteen months have passed. It is May 15, 1859, exactly one week before Carter’s twenty-eighth birthday, and I have reached the portion of his diary that, in part, brings me to London: a gap of two and a half years, a significant period in the history of
Gray’s Anatomy.
But the gap in Carter’s story is small compared to the void that is Henry Gray. I still know so little about the man that he is becoming less rather than more real to me. I have come to flesh out Gray’s ghost.

Though this is my first time in London, the sights I most want to see are not on the standard double-decker bus tour. I therefore have come with my own set of maps—nineteenth-century and present-day—and, as important, my own personal map reader and navigator, Steve. As for my lab partner, I have left Kolja in the capable hands of Meri during my week away.

After crashing heavily, Steve and I caffeinate heavily and head straight to Hyde Park Corner. Here, the Grand Entrance of Hyde Park meets the Wellington Arch meets the western edges of Green Park and Buckingham Palace Garden. Here, tourists stop dead in their tracks and wrestle with ill-folded maps, Steve and I being no exception in this regard. Here, we find St. George’s Hospital.

From the outside, the structure looks almost exactly as it does in early nineteenth-century engravings, and the hospital name remains chiseled in the cornice. But if there are any doctors inside, they are on vacation; the building is now a luxury hotel. We cross to the north side of the busy intersection to get a better angle for a picture.

St. George’s Hospital, as it appeared in Henry Gray’s Day

Henry Gray spent sixteen years in that building, nearly half his life,
I tell myself as Steve gets artsy with his new digital camera. No, make that fifteen and a half years, if you subtract the six months with the Duke of Sutherland. Gray, I recall, returned from his leave and resumed his St. George’s duties on the first of December 1857, at which point the anatomy book was well into the production stage. Early the previous month, in fact, John Parker Jr. (the son in John W. Parker and Son) had informed the author and the artist of a problem with the engravings: some of the woodcuts were too large for the book. In Carter’s account, perhaps overly self-castigating, he and Parker shared blame for the error. “His neglect is as great as my ignorance at least. Gray will clear himself.” To the satisfaction of all three, fortunately, a solution of some sort was found, and production proceeded without further delay. By the time Carter left for India, Gray was likely already reading page proofs, as the book was set to be released in August, just six months away.

With the writing behind him, Gray could recommit himself to one of his long-standing responsibilities—serving on the St. George’s board of governors, which, in a roundabout way, would end up having a profound impact on his romantic life. At the March 24, 1858, board meeting, he and the other governors approved the hiring of a new assistant apothecary named Hugh Wynter, and it was likely through young Hugh that Gray was introduced to Miss Elizabeth Wynter, Hugh’s sister, who in time would become Henry’s fiancée.

The same building as it appears today

The longer I stare at the building, the more distracted I become by the cars and buses and traffic lights. But going inside the hotel ends up being a big mistake—like accidentally deleting an entire file of pictures on your computer. In these plush surroundings, it is no longer possible to envision any part of Henry Gray’s life having taken place here.

Steve and I decide to take a walk.

Ten minutes, four blocks, and three map consultations later, we stand just outside the covered entryway to what was once No. 9 Kinnerton Street (the street name and numbering have long since been changed). The building itself is set about half a block back from the road. Though the weathered brick exterior is definitely original, we can tell that the spacious, vaulted anatomy lab on the top floor no longer exists, perhaps a victim of the Blitz or simply renovations. The building now houses posh residential flats.

We walk through the narrow passageway that students in Gray and Carter’s day likened to an ear canal and head to the eardrum, or front door. At the moment, I feel less like a student and more like a proselytizer.
Do the people who live here know who once walked their floorboards?
A small part of me is tempted to press one of the dozen door buzzers and invite myself in for a chat. I would talk not only about Henry Gray and H. V. Carter but about Timothy Holmes, a charismatic St. George’s man who creeps into their story. Holmes, who shared demonstrator duties in the lab during Carter’s tenure, was, by all accounts, a larger-than-life character—a one-eyed surgeon, a lover of theater, a terror to anatomy students. Holmes helped his friend Henry Gray read and edit the hundreds of page proofs for the first edition of
Anatomy, Descriptive and Surgical.
But more important, Holmes served as editor of the book for seven consecutive editions following Gray’s death. He, probably more than any single person over the next twenty years, helped keep Gray and Carter’s legacy alive.

Rather than disturbing the Kinnertonians, Steve and I exit the ear canal and keep walking. The neighborhood is filled with fine Georgian homes, and I find that, by lifting my line of sight just above car level, it is easy to imagine we are in another time—the mid-nineteenth century, to be precise. Jet lag no doubt enhances the effect.

Checking our nineteenth-century map and following Henry Gray’s likely path home, Steve and I wind our way around the crescent-shaped Upper Belgrave Street. Although I’ve often had trouble getting inside Gray’s head, I feel certain I know how he felt while taking this walk on September 11, 1858: in a word, elated. The first review of his book had been published. Of “Mr. Gray’s ‘Anatomy,’”
The Lancet
editors declared, using the abbreviated title by which it would become known, “we may say with truth, that there is not a treatise in any language, in which the relations of anatomy and surgery are so clearly and fully shown.” Indeed, “it is impossible to speak in any terms excepting those of the highest commendation. The descriptions are admirably clear, and the illustrations, copied from recent dissections, are perfect.”

Though they had no quibble with the
Anatomy
per se, the editors, as if anticipating the book’s success, felt compelled to issue a word of warning on anatomy texts in general: “No book, however ably written and accurately illustrated, can ever enable the student to dispense with the necessity of the actual dissection of the human body, and the study of disease at the bedside…. The student who trusts solely to books, however excellent they may be, will find himself, in the hour of trial, theoretically learned but practically inefficient.” With that said, the review of the 782-page
Anatomy, Descriptive and Surgical
closed on a high note: “As a full, systematic, and advanced treatise on anatomy…we are not acquainted with any work in any language which can take equal rank with the one before us.” And what a steal at twenty-eight shillings!

It is the kind of review a writer dreams of bringing home to Mom. Which is exactly what Henry did, I have no doubt. At thirty-one, he was the last of the Gray children still living at the family home with their widowed mother, Ann, now sixty-six. Thomas, the eldest, had been married for thirteen years and, by this point, had fathered eight of his ten children. Though barely a breath is known of Henry’s two older sisters, Elizabeth and Mary, they were both presumably married by this time. Tragically, Henry’s only younger sibling had died three months earlier. At age twenty-seven, Robert Gray, a seaman aboard the merchant vessel
Indomitable,
had perished at sea on May 23, 1858.

Steve and I approach the south end of Wilton Street and take a left.

We find Henry Gray’s home not by the number on the door but by a plaque embedded in the mustard-colored brick on the second story, one of the London County Council’s distinctive round markers designating a historical landmark:

HENRY

~GRAY~

1827–1861

ANATOMIST

lived here

I had hoped we might be able to convince the current occupants to let us take a look inside, to creak the floorboards and see where Henry Gray had once resided, but clearly, no one lives here anymore. Through a ground floor window, Steve and I glimpse what looks like an abandoned renovation project. Most tellingly, the doorbell has been removed from its socket, leaving a hole in the doorframe. I rap on the door anyway—once, once more.
Oh, give it another try,
I tell myself.
Maybe the world’s slowest carpenter is inside.
“Hallooo!” I add in a friendly voice. “Hello?”

I notice another small sign of disrepair. Where a big brass house number had once obviously been nailed to the front door, as on the other homes along the street, one is now simply scribbled, a faint penciled 8. With a few strokes of an eraser, one could wipe it away. It seems like an all too apt metaphor for Gray himself: here at home one day in June 1861, gone the next, taken, virtually overnight, by sudden illness.

Steve and I cross to the other side of the street to take in the whole façade of the building. I remind myself that Gray spent countless fruitful hours within writing the book that would bring him a kind of immortality. During the last big push to complete the work, Carter often visited on Saturdays. He stood on that doorstep, rang the bell and greeted Mrs. Gray, I’d imagine, then joined Henry in his office, where they passed the afternoon working.

For all the time they spent together, I wonder how well they really knew each other. In particular, how well did Carter let himself be known? Compared to someone as “naturally clever” and accomplished as Henry Gray, a man who seemed to belong to a different “genus” altogether, Carter felt inferior. As he once put it, “The genus is not my natural one. I belong to another generic division of men—the one
below
.” Heaven help him, H. V. Carter believed himself to be ordinary.

The sad thing is, I don’t think Henry Gray saw him this way at all. In his preface to the book, Gray calls Carter “his friend,” which, granted, is not terribly revealing on its own. But he did leave behind one other clue as to his true opinion of H. V. Carter, and it is hidden in plain sight. In identically sized type—no doubt in accordance with his wishes—the spine of the first edition of the book reads:

GRAY

ANATOMY

CARTER

Henry saw Henry as an equal. They were and would always be two men linked by anatomy. If Carter noticed Gray’s gesture, however, he never mentions it in his diary. But then, if he saw the excellent reviews the book had garnered, not only in
The Lancet
but in the
British Medical Journal,
among others, he does not say so either. And if he were aware that sales were brisk, that the first edition of two thousand copies was well on its way to selling out, and that an American publisher had already bought the rights to the
Anatomy,
he keeps it all to himself. All of which has left me wondering, how exactly did he feel about the book?