The Anatomist: A True Story of Gray's Anatomy (12 page)

As for Carter, his dissecting proclivity was never more pronounced than during summer vacation back home. On top of fishing with his brother or walking and people-watching with his sister—seaside Scarborough swelled with vacationers (“trippers”) this time of year—he would spend many an hour performing dissections. Not on cadavers, mind you, but on local creatures, frogs and fish and such. In one nigh-maniacal marathon, he first dissected a single snail, then five more, then collected an additional half dozen for future disassembly. Oh, and p.s., “Snails not easily killed!” he noted boyishly in his diary. Though his relentless dissecting seems almost comical (and I can only imagine what his parents thought of this pastime), it also shows Carter’s seriousness of purpose, as he was, in effect, teaching himself comparative anatomy, the study of the similarities and differences in the structure of living things.

Following the 1850 summer break, he returned to London and performed what would become a ritual over the next few years: he immediately checked in with Henry Gray. I get the sense that seeing his friend after time away was a welcome, and perhaps even necessary, way to transition back into frenetic London life. Gray, like an affable older brother, clearly had a steadying effect on the anxious, temperamental Carter, and he was always encouraging and respectful of his talents.

Carter’s involvement with the spleen project came in two bursts. He created twenty-three paintings and drawings initially, but it wasn’t until April 1852 that the senior Henry again needed his artistic skills. This time, the focus was the spleen in animals. These drawings were done primarily at the Royal College of Surgeons, a two-mile (three-and-a-quarter-kilometer) walk from St. George’s, where Carter worked from the school’s extensive collection of preserved animals. And, no doubt, his knowledge of comparative anatomy proved useful, especially since Gray, by his own admission, had little experience in this branch of anatomy. But what made these drawings unlike any he had ever produced was that, once the batch was completed near the end of June, he got paid. Better than finding a fourth cusp on an aortic valve, this was H. V. Carter’s “
first
professional engagement” as a medical artist, and Henry Gray had made it possible.

Actually, make that “Henry Gray, F.R.S.”

Gray had been bestowed those three little letters just a few weeks earlier. On June 3, 1852, he was elected a Fellow of the Royal Society, a singular honor for a man of just twenty-five. His candidacy had been supported by a long list of Fellows, yet it was really Gray’s own work that had provided his highest recommendation. On earlier occasions, two of his scientific papers—one detailing original research on the development of the human eye, another on the spleen—had been read before the assembled Fellows, then discussed by the group, an experience that must have been as heady the second time as the first. Both papers were accepted for publication in the society’s prestigious journal,
Philosophical Transactions.
And shortly after being named a Fellow, Gray received a £100 grant from the Royal Society, to be used toward completing his investigations into the spleen, including, presumably, paying for his artist’s efforts.

Carter had recently acquired an impressive set of initials as well. On May 21, the day before his twenty-first birthday, he became a Member of the Royal College of Surgeons, having passed the extensive entrance exams. Now certified to practice surgery, Henry Vandyke Carter, M.R.C.S., still had to obtain an apothecary license in order to become a full-fledged physician. The apothecary exams would be coming up in October.

Carter, who had completed his required apprenticeship with Dr. Sawyer earlier in the year, had also moved out of the Sawyer home and acquired a new address. Joined by Joe Carter, who had come to London to study art and, if H.V.’s rantings are to be believed, to torment his older brother, had moved into an apartment on Upper Ebury Street. Though he now lived much closer to Henry Gray’s home, gone were the idle days of old. The demands on their time had become too numerous, Carter with his studies and exam prep, Gray with his many professional obligations and the looming deadline for the Astley Cooper Prize.

When that day finally came, it received a quiet mention in Carter’s diary. “See Gray,” he notes on October 13, 1852. “He has just finished his subject.” If Carter sounds weary, it is for just cause. Six days earlier, he’d “passed the
Hall
,” meaning he had earned his apothecary license; all his formal schooling was done. And six days hence, he would be setting his London life aside and leaving the country.

OCT
. 1852. “19 Tu. Last day in town. Today got passport & ticket. Back just in time to get things together in 2 carpet bags—one Mrs. Loy’s—leaving many important things, amongst others, my Bible, which much regret—”

Mrs. Loy? That’s his landlady.

Why the hasty departure? And where did he go? Well, again, Carter himself does not explain. As is the diarist’s prerogative, he doesn’t have to. The same rule does not apply to the letter writer, thankfully. Letters demand a narrative and very often provide an explanation. I therefore returned to the Carter archive, placing an order for 3 of the 116 surviving letters from H.V. to his sister Lily, who was nineteen months his junior. These three bear the postmark “Paris.” I requested scans this time, this time being impatient, and within days, via online delivery, I, like Lily Carter almost 153 years ago to the day, found myself opening mail from H.V.

October
23, 1852
Hotel de Seine
Rue de Seine
Paris

My dear Sister,

This is the first quiet evening I’ve had since I left town and I take occasion of it (as the French might say, if they spoke English) to quiet your apprehensions at home, to satisfy, in a measure, your curiosity.

But before he continues further, a caveat:

Do not anticipate, dear Lily, a detailed account of all I’ve seen and heard, nor yet, a chapter of horrors and oddities: what I write is meant for a succinct narration of facts and observations—so now to begin.

Fortunately, Carter does not stick to this game plan and proceeds with lively detail about his voyage by steamer and rail to Paris. On his first night there, two fellows he had met on the journey took him out on the town—and oh, Lily, what a time! “We supped at a grand café, a la Française, everything in great style such as you have never seen.” Then, in a sentence that does not come up for breath, he tells how the three strolled in the Palais Royal, “a most extensive pile of splendid buildings with a square and fountain and gardens in the middle, and gorgeous shops around, colonnades, and arcades all lit up in the most brilliant manner and crowded with chattering gay French folk—the whole is a
tout ensemble,
certainly not equaled in London, or the world.” Breath. “We were charmed.”

He seems almost drunk on the details, and it is somewhere between his descriptions of the tree-lined boulevards with their magnificent houses and his sharing his plans to go to the Louvre the next day that I recall why I went to Paris for the first time at his same age: to
see
Paris. That is reason enough, if not reason alone, to pack one’s bags. But Carter, it turns out, had also come to Paris with letters of introduction and a larger purpose: the man who had just finished his studies was actually continuing them.

As becomes clear in his second letter, he arrived in Paris just in time to get settled and make the opening ceremony for the winter session at the renowned La Charité Hospital medical school. Already, Carter had resumed a familiar routine. “In the morning I go very regularly to one of the great hospitals where the physicians and surgeons usually begin to visit at 8:00 or soon after. Then comes a lecture—a ‘clinique,’ we call it—then a walk to the ‘Laiterie’ (breakfast), where we arrive with a good appetite. In the middle of the day, I’m engaged at the lecture and dissecting rooms.” In addition, he regularly goes on rounds and attends lectures at Paris’s famed Hôpital des Enfants.

Part of me wants to say that making this trip was a very smart move on Carter’s part, a way to gild his résumé (not to mention, improve his French). But I know better. I have glanced ahead. And his daily entries soon leave no doubt that something else is going on here, something he would never share with his sister.

He had forgotten his Bible but brought all his demons with him. Like a storm that’s suddenly changed direction, Carter’s crisis of the soul has shifted from doubts about faith—the impetus for
Reflections,
a volume that is tellingly silent during this Paris period—to overwhelming anxiety about his professional prospects. Now that he has obtained his diplomas, he must make the transition from student to practitioner, yet Carter sees nothing but difficulties ahead. Rather than face them, he is in Paris, a fugitive from his own future. As he writes on New Year’s Day 1853, “The tolerable success and éclat of student’s progress at St. George’s is over. Then, knowledge was my sole aim; now, I must think of a livelihood.”

His is not an uncommon dilemma for a new graduate, but I suspect he is operating under the misconception that learning must end with earning a living. Though his “love of science and the higher branches of the profession” remains steadfast, Carter confides that he has “no interest whatever in the Profession.” He does not want to
be
a John Sawyer, a G.P. with an apothecary and an apprentice and so on. At the same time, Carter feels he still lacks the self-confidence, the inner oomph, “to strike high and risk the consequences,” meaning, to be an innovator such as Henry Gray, for instance.

“Perhaps [I] ought then to be content with a lower station,” he tells himself, “yet, and here seems the rub, my ambition is but just enough raised to cause inquiet…. This is the poison.” And the poison paralyzes.

He has, however, set into play a possible escape plan. Just prior to leaving for Paris, he had made a number of discreet inquiries about becoming a surgeon aboard a “packet,” or small cargo ship, traveling back and forth between England and India. The colony had become a major market for English goods, and hundreds of companies were operating vessels with fully staffed crews. In fact, one of the surgeons at St. George’s had promised Carter help in getting a “surgency” with an outfit called the General Screw Steamship Company. Such a job must have sounded far more exciting to him than hanging out his shingle back in London or Scarborough.

That the idea of leading a more adventurous life would have appealed to the twenty-one-year-old is reinforced by a rather large clue he left behind. It comes on the very first page of his new daily diary, bought and begun in Paris. On an otherwise blank page, Carter affixed an elegant calling card bearing only a name:

J. BELLOT, LIEUTENANT DE VAISSEAU

It meant nothing to me until I returned to his first letter to Lily. Of course! Bellot was the name of one of the fellows who had taken Carter out on his first night in Paris, “a Naval English-looking young officer,” he’d told his sister. In point of fact, Bellot was not English, as Carter soon discovered. But that was the least of it. After dinner and a good many glasses of wine, the men began discussing the latest news on Arctic exploration, and, as H.V. explained to Lily, “I burst into admiration of a French officer who accompanied the last expedition.” This man’s story had been in all the papers back home; he had become a hero to the people of England by volunteering in the search for Sir John Franklin, a celebrated English explorer and sea captain who had disappeared in the polar regions.

As Carter told his sister, he’d gushed and gushed about this brave French officer till, finally, “my friend stopped me and said he could not hear
himself
so praised—he was the very man,” Joseph René Bellot! (the “Bellot of the Papers,” as Carter would call him)—but so modest that no one would ever have guessed. “And we found him out by chance.”

Next morning, Carter and Bellot breakfasted together, then spent the day walking around Paris—the Tuileries, Place de la Concorde, and other sights—till, finally, the two parted ways, Bellot having his own journey to complete. The young adventurer left behind an indelible memory and a calling card that Carter would later put to use when starting his new diary on New Year’s Day. The name on the card would serve, in effect, as the epigraph for the next phase of his story—The Life of Henry Vandyke Carter, Volume 2—setting a bold tone for what was to come.

PART TWO
THE ARTIST

Man is only man at the surface.
Remove the skin, dissect,
and immediately you come to “machinery.”

—Paul Valéry (1871-1945)

Eight

S
OMEDAY I MAY WONDER WHERE I FOUND THE NERVE TO DO
this. It is just one hour after morning coffee, and I am helping to perform what is awfully close to a decapitation. We have turned our cadaver onto its stomach and have propped the chest on a block so that the head nods down, leaving the neck a clean downward slope. This is whiplash terrain, the thick, powerful muscles that help support the head, and I slice right through the three main ones: the longissimus capitis, the semispinalis capitis, and the splenius capitis (
capitis
meaning “head”). Kelly, the gang, and I take a few minutes to examine each fleshy cross section, then plunge ahead. Our ultimate goal is to dissect C1, the very top vertebra of the spinal column, a site of catastrophic neck injuries. Commonly called the Atlas, for the man of myth who held the world on his shoulders, this deeply embedded vertebra serves as the base for the globe that is the head. To reach it, we need to tunnel through several more layers of muscle.

I can see C4, like a subway token at the bottom of a meaty purse, but rather than stopping to finger it, I slice northward about six inches (fifteen centimeters). Now, Kristen, facing me on the opposite side of the cadaver, makes a horizontal cut across the base of the skull, connecting the backs of each ear. Where her line meets mine, we each begin peeling back the triangular flaps of scalp. Just like on my head, our truck driver’s hair is buzz-cut (as are all the cadavers’), to make tasks such as this easier. The skin feels as tough and bristly as animal hide.

Adding to the discomfort of the day, the school’s maintenance department is testing the ventilation system on this hot August morning, so all the windows are to remain closed for the duration of lab. In the still, thick air, it seems as if
we
are being put to the test rather than the air-conditioning. Everyone is sweating, making it smell like the gym of the dead. Pulling at the pocket of my scrubs, I make a poor man’s fan of my shirtfront. I am truly seeing the wisdom in the centuries-old policy of dissecting only during the winter months.

Think of this as an archeological dig,
I tell myself, trying to remain positive. True, this is probably more unpleasant than sifting dirt under a noonday sun, but at least we’re assured a discovery or two.

“There’s C3,” says Cheyenne over Kristen’s shoulder.

“And here’s C2.”

We are just about to enter the suboccipital triangle, an area of dense muscle beneath the backmost lobe of the brain, when—

A throat clears.

Like a raven-haired cat, Dr. Topp has suddenly materialized at the foot of our table. “Today is your day,” she says, and we know exactly what that means: a pop quiz, of sorts, with an anatomical twist. The group has just thirty minutes to put together a class presentation on the “functional anatomy” of a specific movement. As for the topic, that’s up to Dr. Topp. Last week, she had Casey’s group analyze “deep respiration with upper extremities fixed,” meaning the classic just-finished-a-marathon position—bent over at the waist, hands propped against the knees. Two weeks earlier, Robyn and her team were given “the iron cross,” that astonishing strength maneuver performed by male gymnasts on the stationary rings. Another day, it was the mechanics of a yawn.

And this time: “I want you to dissect…”—Dr. Topp pauses a moment—“a push-up.”

Off come the rubber gloves as Kelly, Kristen, Cheyenne, and Sam head to the big chalkboard at the back of the room. As each student’s grade hangs in the balance, I will serve only in a support capacity. I pull the cover over the cadaver before joining them.

Having spied on other groups as they prepped their presentations, I know that my table mates have a lot to do. They must figure out the exact sequence of muscles, nerves, and joints used in executing their assigned movement, which is anything but a simple task, especially given the half-hour time constraint. On the other hand, the time constraint is good training, forcing each of them to think on their feet, just as they would when assessing a new patient.

The four of them decide to break the assignment in two. Kelly and Kristen claim the upward motion of the push-up—the push away from the ground—while Cheyenne and Sam take the downward movement, which sounds like an excellent plan but rapidly proves otherwise. They realize that the two actions don’t happen in isolation and each duo will be doing too much overlap. So, scratch that. The group regroups. Just as the body works together to create a movement, the team must work together to break it down.

They start from the top, literally. In the push-up start position, they determine, holding the wrists stable requires four carpal extensor and flexor muscles and three spinal nerves. Maintaining slight elbow flexion relies on the triceps brachii, anterior deltoid, serratus anterior, and several thoracic muscles, plus the radial, axillary, and long thoracic nerves, as well as spinal nerves C5 through C8 and T1. Holding the neck steady and level requires another ten nerves and muscles.

At eighteen minutes and counting, the chalkboard is a madman’s cell wall.

As they focus on the next step, lowering the body toward the ground, they get stuck—
really
stuck—unable to agree on which back muscles are, and which are not, involved.

“Maybe I should do a push-up for you,” I volunteer.

All four look at me as if I were a cooling breeze.

Ten push-ups later, things start clicking, and not just from my shoulder joints. The lats, the traps, the pecs, both major and minor, all come into play. Click, click, click. The scapula, humerus, and glenohumeral joint join the list—

“And we can’t forget to mention gravity!” Sam interjects, more impassioned than I have ever seen him. To the scritching sound of chalk on a blackboard, the group has transformed from an anxious lot to a confident one. I have no doubt whatsoever that they will nail their presentation. And, sure enough, they do.

Though I hate to play favorites, I must concede that my favorite in-class presentation does not come until two weeks later. It is “the queen’s wave,” as analyzed by Adrienne and company. Watching these four energetic young women deconstruct this signature of royal reserve is a delight. Somehow, the white lab coats and ponytails add to the charm. I also find the movement itself fascinating; it barely squeezes into the dictionary definition of the word
wave,
for the fingers do not wag. Rather, the queen’s wave is an upright hand performing what looks like a slow stirring of the air.

Such subtlety does not come simply, as the team explains. In one motion, the clavicle elevates, the scapula rotates, and the shoulder abducts, all in service to the arm as it rises fluidly into the air. At the same time, the hand cups and the forearm supinates ever so slightly. The queen, remember, waves with the back of her hand rather than the palm. Of course, the greeting is impossible without a great interplay of muscles and nerves, but what really makes this movement majestic, it strikes me, occurs in the carpal region. In other words, it’s all in the wrist, which must be held perfectly still, as if it were an anatomical exemplar of monarchical stability. This is where a wave becomes a wave becoming of a queen.

JUST AS A
chance encounter with Joseph Bellot “gave an éclat” to H. V. Carter’s “entrée into Paris,” as he had told Lily, a brush with royalty brought his stay to a memorable close. On Sunday, January 30, 1853, two days before Carter packed his bags for home, he joined the crowds lining the streets for the grand procession of Napoleon III and his betrothed on their way to Notre Dame to be married. The forty-four-year-old emperor, a nephew of Napoleon Bonaparte, had chosen as his bride a Spanish-born beauty named Eugénie, who was almost twenty years younger.

“Whole scene exciting. All Paris out,” Carter reports in his diary.

The festivities continued into the night. The City of Light shone as never before, with the Place de la Concorde aglow with “electric lights” and “illuminations very brilliant everywhere.” Even so, it was Carter’s glimpse of Empress Eugénie earlier in the day that still burned most brightly: “Nose aquiline, chin small, upper lip [a] little curved,” he notes, with an artist’s eye for detail. Watching her greet the throngs, Carter had not seen joy in the twenty-six-year-old’s lovely face. Instead, “expression quiet and resigned.”

Drawing upon this memory, he would create a portrait of Eugénie shortly after getting home. But first things first. As per tradition, he marked his return to London life by checking in with Henry Gray. They met up in the Dead House and swapped stories, Carter reports in his diary, he of his Parisian adventures and Gray of his own encounter with royalty of sorts. No less a luminary than Dr. Caesar Hawkins had paid him a recent visit, Gray told his friend. Hawkins, who was known around St. George’s as “the Emperor,” not for lording about the place but for the great respect in which he was held by hospital staff (not to mention his imperial-sounding first name), had heaped upon Henry some glowing praise: your anatomical preparations, he told Gray, “are a credit to England.” (Hawkins was certainly qualified to make such a pronouncement. Not just one of the hospital’s chief surgeons, he was also the newly retired president of the Royal College of Surgeons and would one day be named sergeant-surgeon to Queen Victoria herself.) Though the doctor’s compliment had come a couple of days earlier, it is clear through Carter’s recounting that his friend was still floating on air.

Gray had also just been named head of the Anatomy Museum, a well-deserved promotion in Carter’s eyes. Gray “is well-placed as curator and fully alive to his advantages,” he writes that evening. “Envy him.” Not that he was wallowing in self-pity, mind you. On the contrary, Carter, who’d scarcely had time to resettle into his old flat, was already taking decisive steps in shaping his own destiny. While still waiting to hear back from the steamship company, he had decided to pour his energy into his artistic work. His first move was to assemble a portfolio of his anatomical drawings and paintings—a “specimen” of his work, as he called it. As a student, he’d never had the time or inclination to promote himself as an artist for hire, or the financial need. Sure, occasional jobs had come to him through Gray and other faculty, but, simply happy to contribute, he had nearly always done the work for free. As of now, that policy would have to change.

Carter, ever the anxious soul, had not made this decision lightly. For guidance, he’d turned to Prescott Hewett, one of a handful of father figures in his life. It seems that the question he brought to Dr. Hewett was not whether he
could
make money as an anatomical illustrator but whether he
should.

Propriety told him no. Wouldn’t he be “encroaching” on other artists’ territory? This concern stemmed from H. V. Carter’s upbringing, I believe. As the child of a working artist only now finding fame, he knew firsthand what a struggle it could be to make a name for yourself, to become established. He would not want to threaten another artist’s livelihood or, for that matter, to be viewed as a dilettante—a physician who simply dabbled.

Dr. Hewett absolved Carter of these concerns, assuring him that drawing was in fact a “perfectly legitimate” enterprise.
By all means, young man, use your talent!
And like a racehorse on Derby Day, he was off and running.

True, he did stumble right out of the gate—Carter’s first job prospect fell through, leaving him “disappointed and put out”—but he recovered quickly. The next day, in fact, less than two weeks after returning from Paris, he showed his portfolio to three separate doctors, all of whom promised him work.

“Hence,” he writes with brio that night, “have regularly set up as a
Medical Artist
and have little doubt, D.V., (
Deo volente,
or, God willing) [that] in a little time might make it pay well.” Carter sounds full of confidence, as well he should be, and yet he cautions himself never to lose sight of his top priority: “The exercise of the profession is the chief end…of [my] medical education,” and “the artist’s position is but subsidiary.” He adds,
“Pro tempore!”
meaning “for the time being.”