Anatomies: A Cultural History of the Human Body

by Hugh Aldersey-Williams

  Edinburgh was not a large city, and the disappearance of familiar figures soon began to be remarked. Burke and Hare were almost exposed when some of Knox’s students identified their fifteenth victim on the anatomy table as a mentally retarded lad called James Wilson, well known about town as ‘daft Jamie’. Knox denied that it was him, but began the anatomy unusually that day by cutting away the face. The assassins were finally caught when the body of their next and last victim was discovered in their lodgings before they could get it out to Knox’s college. Hare escaped the death sentence by giving testimony against Burke, who, in a rich twist of irony, became one of the last murderers in Britain to be sentenced to death and dissection. His skeleton is on display today in the medical museum at the University of Edinburgh.

  Burke and Hare are infamous for their deeds, but an earlier episode in British anatomical history is possibly still more gruesome, and goes to the very top of the medical establishment. In 1774, William Hunter published The Anatomy of the Human Gravid Uterus, an illustrated atlas of the female reproductive system and the development of the foetus, based on twenty-five years’ work and the acquisition of at least fourteen fresh bodies of women who had died during childbirth or in various stages of pregnancy. How did Hunter get hold of these bodies? As we’ve seen already, heavily pregnant women tend not to fall ill (or to commit hanging offences), so fresh graves and the gallows would offer meagre rewards. As Hunter himself wrote: ‘the opportunities for dissecting the human pregnant uterus at leisure, very rarely occur’. Indeed, a major reason for writing the textbook was to give medical students an insight they were unlikely to be able to gain from actual dissections. Nevertheless, it might just be possible in a crowded city such as London, where Hunter worked, to arrange to have placed at one’s disposal more or less legitimately fourteen cadavers over a period of more than two decades. In 2010, however, an art historian named Don Shelton subjected Hunter’s Anatomy to a statistical analysis, and came to the conclusion that he must have worked from the bodies of more women than could conceivably have been sourced from ‘random resurrections’, and that some of them could therefore only have been obtained by a sustained campaign of murder.

  The weak link may have been William Hunter’s younger brother, John, who assisted him in his work. John went on to make contributions to many branches of medicine and is acknowledged as the father of scientific surgery. He may have been the first to use the word ‘transplant’ in relation to human tissue. His experiments in this field seem distasteful and misguided today: transplanting tissue from one part of the same animal to another – moving a spur from the foot to the comb of a cockerel, for example – as well as transplanting tissue between animals and between species.

  He also experimented by replacing his patients’ rotten teeth. Some human teeth may have been supplied by body-snatchers. But he got better results using living teeth, and in particular young second teeth harvested from children. Because second teeth are full-size, and so a typical boy’s tooth would be no smaller than a typical man’s, he recommended especially using teeth taken from girls for ease of fit. Even then there might be trouble achieving a match. In that case, wrote Hunter, ‘The best remedy is to have several people ready, whose Teeth in appearance are fit; for if the first will not answer, the second may.’ Dental transplantation became widespread until 1785, when it was established that a young woman had died of syphilis contracted from an infected implant. As one modern history observes, ‘Hunter seems to have been impervious to ethical criticism.’

  There is no doubt that both Hunters would cause some disquiet in today’s medical ethics committees. There is equally no doubt that they greatly influenced the teaching of obstetrics and helped to save many infant lives. Their reputation is high today: Glasgow’s Hunterian Museum and Gallery is named after William Hunter, while the museum of the Royal College of Surgeons in London is named for his brother John. Yet Don Shelton invites us to draw a parallel between them and Nazi scientists such as Josef Mengele, whose data obtained from experiments on Auschwitz concentration camp victims are also available for use by researchers, though frequently shunned. Others have raised similar objections to an anatomical atlas first published in Germany in 1943, which may have made use of bodies harvested from concentration camps. Its author, Eduard Pernkopf, was an enthusiastic Nazi, and some of the artists who produced its coloured illustrations signed their drawings embellished with the SS symbol. As with the Hunters, the moral problem is compounded by the fact that Pernkopf’s work is technically excellent, recognized as perhaps the best anatomical atlas since Vesalius. The atlas is still available today in a revised edition with new drawings added since the Nazi period and the offensive SS insignia deleted – except, apparently, in two instances which escaped the publisher’s notice.

  No name is more closely linked with anatomy in the popular imagination than that of Gray. A few men in time become their books – Webster’s Dictionary, Roget’s Thesaurus – but rarely one about whom so little is known as Henry Gray. Webster’s and Roget are general reference works. So, in their day, were Baedeker’s guides and Bradshaw’s railway timetables. But why should everybody know about Gray’s Anatomy?

  Born in London on an unknown date in 1827, Henry Gray rose without trace. The first records of him show that he entered medical school at St George’s Hospital near the family home in Belgravia at the age of fifteen. He did so without having served the usual apprenticeship with an apothecary, suggesting that he had resolved to be a surgeon at a very young age. In a photograph taken by a student friend, he appears with a high forehead and wavy dark hair, somewhat lantern-jawed, with a mouth that dissolves at the corners, Mona Lisa-like. He has dark eyes with a straight gaze and dark eyebrows projecting low over them, giving him a hooded appearance with more than a suggestion of the Romantic poet. Gray quickly showed his mettle by winning important essay prizes – one on comparative anatomy, which was very fashionable at the time, in which he compared the optic nerves of all sorts of (edible) creatures, clearly taking what specimens he could get at the London markets. He followed this with another prize essay, on the spleen, which he converted into his first book in 1854. It was not a success.

  Undaunted, however, Gray and his publisher now reached for the broadest possible canvas – the whole human body. Despite its appellation, Gray’s Anatomy is not the work of Gray alone. It relies heavily on the drawings of one Henry Vandyke Carter, who also entered St George’s medical school young, a few years behind Gray. Carter too was studying to be a surgeon, and trying to make a little money on the side by illustrating zoological specimens for the famous naturalist Richard Owen, when Gray approached him to illustrate his new book.

  By 1855, when they agreed to work together, both men were qualified surgeons and held teaching positions at the hospital, Gray aged twenty-eight and Carter twenty-four. Their ambition was to produce a new kind of anatomy that would be modern, clear and affordable. The collaboration was necessarily close and prolonged, but not without tension. In the space of less than two years, working at the medical school’s dissection room in Knightsbridge, they dissected sufficient bodies to produce 360 illustrations. It is not known how the men obtained the cadavers because the hospital records for the period do not survive, but in general at this time hospitals relied on the bodies of those who died in workhouses and in their own wards. Whatever the truth, their debt goes unacknowledged. According to Ruth Richardson: ‘There is a silence at the centre of Gray’s, as indeed there is in all anatomy books, which relates to the unutterable: a gap which no anatomist appears to address other than by turning away.’

  The relationship between the two men is a fascinating one. Carter was aware early on of Gray’s rising star within the hospital. At first, the grammar school boy from Hull thought Gray and his set ‘snobs’, but he soon saw that he was ‘very clever and industrious’, ‘a capital worker’ and ‘a nice fellow’. Yet when Gray won the Astley Cooper Prize for his essay on the spleen, Carter notes that it was
gained at the price of ‘beating good men’. He both admires and envies Gray – he complains in his diary of Gray’s ‘Do it!’ approach when he himself cannot get started on things, and feels ‘emulous’ of Gray’s first book, to which he had contributed a few drawings. Yet he also despises him – Gray’s aim is ‘money’, and he is ‘not candid quite’ in making it clear that Carter will not be credited for his work. When they embark on the much larger, and ostensibly more equal, project of the anatomy, Carter calls the agreement reached for his illustrations ‘shabby’, but goes ahead anyway. Gray was to earn royalties of £150 for every 1,000 copies sold, Carter just a one-off payment of £150. When Gray saw the proofs of the title page with his name and Carter’s set in the same size of type, he struck through Carter’s name and instructed that it be set in a smaller size. In later editions, Carter’s name was reduced again, and by the seventeenth edition, published in 1909, it was gone altogether.

  So Gray’s Anatomy it was. These are the words that appear on the spine of the first edition of 1858, although the proper title of the work is Anatomy Descriptive and Surgical. The publisher’s hope was that ‘Gray’s’ single handy volume would be compared favourably with the established multi-volume anatomies – Quain’s, Wilson’s, and so on. And it was. To the reviewer in the Lancet, Gray’s Anatomy was ‘a work of no ordinary labour, and demanded the highest accomplishments both as anatomist and surgeon, for its successful completion. 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.’

  It was indeed in presenting human anatomy for the needs of modern surgery that Gray’s made its lasting reputation. Gray laid his emphasis on what an operating surgeon would actually be likely to see when opening a patient up in order to carry out treatment. With major surgery becoming safer and the recent introduction of inhaled anaesthetics (Queen Victoria received chloroform during the birth of Prince Leopold in 1853), his timing was perfect. His prose is plain and workmanlike, graceless even, with no pretensions to grandeur. Carter’s drawings brilliantly fulfil the same brief. They are exceptionally bold – a happy accident arising from the fact that the engraved plates turned out to be over-sized for the book format. Gone are the Classical props and peekaboo antics of Vesalius and other traditional anatomies, Carter being blessedly unaffected by art school training. Instead, text labels appear directly on the drawings in order to help the student link the appearance and name of so many body parts. The art historian Martin Kemp likens Carter’s style – or lack of it – to engineering drawings. To me, his illustrations resemble an old department store catalogue or geographical features named on an Ordnance Survey map.

  Just three years after the Anatomy was published, at the home where he still lived with his mother, Henry Gray died of smallpox caught from his nephew. He was thirty-four. His book, of course, lives on, now in its fortieth edition, produced by a team of eighty-five editorial contributors and twelve illustrators in place of Gray and his single hired artist: Gray’s Anatomy has become Gray’s Anatomy.

  We began this tour of anatomical science with questions about the discrete existence of organs. Nearly 400 years ago, Helkiah Crooke could already write in his Microcosmographia, ‘The division of parts into principall, and lesse principall, is verie famous, and hath held the Stage now a long time.’ Those principal parts were the heart, the liver and the brain. Galen had counted the testicles as principal too, because of their role in procreation, but Crooke does not award them this high status because they are not essential for survival.

  But is the body meaningfully divisible into such parts? I may have body parts, but I cannot ‘part’, which is to say separate, any one part from the rest of my body without drawing blood. Are the parts, as Darwin believed species had to be, ‘tolerably well-defined objects’? Does this separation tell us much that is useful about the body, or does it tell us more about anatomists’ attitudes in exploring it?

  One body part more than any other shows how the human anatomy is still not fully mapped even now. The clitoris seems to have been known, lost, found, lost again and found once more during the course of 2,000 years of medical history.

  The difficulty might have been alleviated had there been more female anatomists. There were a few, especially in Italy where some of the universities gave influential positions to women. In the eighteenth century, Anna Morandi succeeded to her husband’s chair in anatomy at the University of Bologna. Her fine anatomical wax models were acquired by Catherine the Great of Russia, as were those of her French contemporary, Marie Marguerite Biheron, who taught John Hunter in London. A century later, Marie-Geneviève-Charlotte Thiroux d’Arconville studied anatomy in Paris, and translated an osteology textbook of Alexander Monro, the founder of a dynasty of Scottish anatomists. She also supervised the drawings for it, while taking steps to preserve her anonymity in the work. She ensured the inclusion of a female skeleton – regarded as highly optional in anatomies of the day – but regrettably allowed culture rather than biology to dictate its appearance. D’Arconville’s illustration has the broader pelvis of women, but a disproportionately small head and a sharply tapered ribcage, indicating either that she was unduly influenced by contemporary expectations of ideal feminine form or that she used a model who had spent her formative years in corsets. The d’Arconville skeleton became the pin-up of male osteologists everywhere.

  The clitoris was known to the Greeks, regarded either as an imperfect version of the male penis or, in a fanciful analogy with the uvula and the throat, as the guardian placed at the entry of the uterus. This understanding then seems to have been lost in translations of the medical literature from Greek to Arabic and Arabic to Latin during the post-Roman and medieval periods. Falloppio rediscovered the clitoris as a definite body part in the sixteenth century, although it was Falloppio’s rival Colombo who published first, adding his own significant observation about its role in generating sexual pleasure. Vesalius, however, was unimpressed. He told Falloppio: ‘you can hardly ascribe this new and useless part, as if it were an organ, to healthy women.’ He insisted that the clitoris was no more than a pathological feature found only in ‘women hermaphrodites’.

  The clitoris disappeared from much of the anatomical literature again during the nineteenth century – labelling deleted, for example, from some American editions of Gray – owing to social (male) discomfort about female sexuality. According to Helen O’Connell, an Australian urologist, the worst offender was Last’s Anatomy, a present-day textbook popular with students cramming for examinations. In other medical textbooks, it is still often adumbrated as the ‘female equivalent of the penis’, and given cursory schematic treatment perhaps showing no more than the external appearance. A sectional drawing, if included at all, is likely to be one through the mid-plane of the body from front to back of the sort that suffices to show the centrally located functional attributes of the penis, but which does not fully represent the three-dimensional internal extent of the female organ.

  The more recent ‘discovery’ and description of the ‘G spot’ reveals similar difficulties. In the decadent Berlin of Marlene Dietrich and Kurt Weill, a gynaecologist by the name of Ernst Gräfenberg made his reputation with the invention of one of the first intrauterine contraceptive devices. He escaped from the Nazis in 1940 and eventually set up a private practice in New York, where he was able to pursue his researches into the female orgasm. He did not live to see the term ‘G spot’ coined in his honour in 1980, and, more to the point, did not in this work himself ever refer to any kind of ‘spot’, only to a ‘zone’, involved in female ejaculation. Of course, the G spot is not new except as a cultural construction. Some believe it exists, and others don’t, even now.

  What the debate sadly shows is that we seem incapable of moving on from the explorer mentality in our investigations of a human body that must, for our convenience, be composed of discrete parts with clear boundaries, like countries, and precise spots where import
ant physiological events are concentrated, like their capital cities. In this sense, we have turned the physical geography of the body into a political geography.

  The Head

  At the clowns’ church, Holy Trinity in Dalston, north London, I meet Mattie Faint, who oversees his profession’s dwindling register of members. He is a professional clown himself though dressed in mufti today. The register is not a paper list, but a collection of eggs. There are dozens of them lined up in a cabinet on the wall in a dedicated area of the church. Each egg has been painted, usually in black, red and white to resemble a particular clown, and many have a little felt or conical papier mâché hat on them. A few have a protuberant nose, stuck on like a redcurrant. Some convey signs of the performer’s natural appearance beneath the trademark slap – with painted-on crows’ feet or facial creases. I look for famous names in the ranks, and locate Grimaldi – a white face with big, friendly eyes. He has big red triangles for cheeks and three tufts of orange hair. Mattie’s favourite is Lou Jacobs, who introduced the laughably under-size clown car to the circus ring and whose most distinctive feature is the eyebrows that arch across his face like the McDonald’s sign.

  The Clown Egg Register is not a joke. It has a serious purpose as an official roster of practising clowns. To be a clown you have to wear make-up – otherwise you’re just a stand-up comedian. Traditionally, clowns keep their personal make-up even though they may refresh their act. ‘As a clown, unlike actors, you’re looked at for who you are,’ Mattie explains. ‘You’re not waiting for a role.’ So if you’re a clown, your egg is indeed a record of professional identity. Once or twice, an egg has even been exhibited in court to resolve cases of infringement. I find it a happy variant on the unsmiling mug shots by which the rest of us are obliged to identify ourselves.