150 years of Gray's: The iconic reference has spawned new generations

The box was filled with old medical books. It had been given to Kenneth E. DeHaven, MD, by his mother in 1965 after he graduated from medical school. The books had belonged to his great-grandfather, a doctor in northern Ohio.

One of the texts stood out for Dr. DeHaven, now a retired surgeon of 33 years and a professor of orthopedic surgery at the University of Rochester School of Medicine in New York.

The book was Gray's Anatomy.

"I was immediately drawn to that edition because I had used Gray's Anatomy in school, only a much later version," he said. "I looked through it, and then I looked through mine. That's when I realized that almost everything from that [older] edition was still in my 27th."

The inherited version was just the second American edition of Gray's Anatomy -- the famed anatomy text originally published in 1858 in England. The heavy text, which now retails for $199, celebrated its 150th anniversary with the September 2008 release of its 40th edition by publisher Elsevier.

Dr. Henry Gray and Dr. Henry Vandyke Carter labored long hours for 18 months to compile the original version, which was titled: Anatomy, Descriptive and Surgical.

Dr. Gray, who wrote the text, was 30 when the book was published. Dr. Carter, in his late 20s, did the illustrations, which were transferred by engravers onto wooden printing blocks.

"When Gray's Anatomy was written, it was intended solely as an atlas for the human body," said California-based author Bill Hayes, whose book The Anatomist tells the story of Drs. Gray and Carter crafting the original by doing dissections together. "It was intended to be a textbook for students in England. I don't think they had any idea of how popular it would become."

A brand identity

Gray's Anatomy has spawned everything from offshoot publications, such as Gray's Anatomy for Students and Gray's Atlas of Anatomy, to ABC's popular "Grey's Anatomy."

"It has survived the test of time," Hayes said. "[Gray's Anatomy] is to medical textbooks what Webster's is to dictionaries."

Dr. Gray died of smallpox three years after the first edition came out.

Before the text hit bookshelves, Dr. Carter headed to India as a medical officer with the East India Co. He spent the bulk of his distinguished medical career as a surgeon and anatomy professor in India.

As a teacher, Dr. Carter used Gray's Anatomy, Hayes said, but never created another anatomical illustration.

While its fame has increased dramatically, the iconic Gray's is no longer used as a medical text for beginners.

"You would never use the big Gray's in a first-year anatomy class," said Richard Drake, PhD, director of anatomy and professor of surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. "That is sort of the bible for anatomical knowledge, but it's much too big to be used in first-year medical school classes."

Drake and two others wrote Gray's Anatomy for Students, first published in 2004 and part of a growing line of anatomical references using the Gray's brand. These new references, however, don't use anything from Gray's Anatomy other than the brand name.

"Essentially what we did was move it into the different levels," Drake said. "We use the Gray's name because everybody recognizes it."

Meanwhile, the original Gray's has become Gray's Anatomy: The Anatomical Basis of Clinical Practice, marketed as a reference for physicians.

The 40th edition totals a whopping 1,551 pages -- more than double the original's size -- and includes 2,000 color illustrations. Unlike the original, it was assembled by a large team of medical professionals, illustrators and editors.

Susan Standring, PhD, DSc, became Gray's Anatomy editor-in-chief with the 39th edition. Initiating a new approach to the format, she changed the original version's systematic approach -- which breaks down whole systems of the body -- to a regional approach -- which maps and illustrates the body by regions.

Even though today's book has little resemblance to the original, Standring said the spirit hasn't changed.

Dr. Gray would say "Wow," she said. "I hope he would be pleased, and I hope Henry Carter would be pleased, even though none of the original text or illustrations are there. The basis hasn't changed."

Raymond J. Lanzafame, MD, agreed. The Rochester, N.Y., surgeon owns the 29th American edition of Gray's. He paid $29.50 for it in 1973, when he was a first-year medical student. He still consults it on occasion.

"If I want a formal, detailed anatomy and labeling, I would use Gray's Anatomy," Dr. Lanzafame said.

"I do have some electronic [references], but there's something about picking up a book and being able to thumb through the pages that's just not quite the same as other media."