The Anatomist: A True Story of Gray's Anatomy

by Bill Hayes

  Actually, this was Steve, whispering into my ear as I typed on the laptop.

  He had dug up a letter from Carter’s lawyer, Richard Spooner of Kent, England, who clarified, once and for all, the legal matters in the case of Carter v. Carter. His verdict? H.V. had no case against Harriet. At Carter’s request, Spooner had also asked Harriet personally if she would agree to a divorce.

  Without any hesitation she said that she never was really attached to any person except you—that she loved you dearly—would do whatever you wished and never spend a Rupee without your permission—and that she would prefer living with you although she might be coldly received or received not at all by the Bombay community.

  Spooner then adds his own two cents:

  I would venture to suggest to your consideration whether it would not be advisable to treat her kindly and let her live with you again. After a few years all former occurrences will be gradually buried in oblivion.

  DAY TWO AT the library dawns. Steve and I are joined by fellow hunters and gatherers at the large center table in the Poynter Reading Room. Although we exchange little more than nods of hello, I feel we could not be in more genial, civilized company. Directly across from us sits a middle-aged woman, both chic and bookish, who was also here all day yesterday. A Mona Lisa smile never left her face as she endlessly inputted from a stack of small medieval-looking tomes. Steve and I have decided—based on no facts whatsoever—that she is a historical romance novelist tracking down period details and atmosphere. The young married couple is back as well. They seem as passionate about each other as they do about tracing their genealogy. As for Steve and me, we still have our own little family history to sort out: Did H. V. Carter follow his lawyer’s advice (and Harriet’s wishes) and take his wife back? Or did he divorce her? And what happened to his daughter? In the second-to-last entry of his diary, he writes with great anguish about the child, “that poor infant, a sweet healthy babe.”

  Can I ever expect—hope—to see her again? Years ago, poor old grandfather Barlow, when he used to set me part of the way home from Dry-pool, would peer anxiously those dark Saturday nights under every passing woman’s bonnet—a scrutinizing gaze so peculiar and keen that, unobservant youth as I was, it almost appalled me. He expected—hoped?—to see the face of his own daughter—a creature of the town, notoriously public—

  Illegitimate.

  Am I ever to endure his…bitterness? But this is far anticipation—God knows alone our future rescue or doom. Every passing child wrings my heart.

  Among Carter’s papers, I come upon a small note that must have just about broken it. Dated 1867, it is written in a child’s scrawl: “Dear Papa come soon.”

  His daughter would have been six years old at the time.

  Did his heart begin to soften, finally? Did he ever find a way to forgive Harriet? The answer would be unknowable, it’s safe to say, were it not for one person—

  “My Dear Sister—”

  Yes, Lily, confidante to all, quiet keeper of all things. This batch of letters was not from H.V., however, but her sister-in-law, Harriet. Apparently, the two women had become close after Harriet returned on her own to England.

  “I wished to tell you that Henry is now the Principal of a hospital in Bombay,” Harriet writes to Lily in December 1879. You can hear the pride in her voice.

  Unfortunately, Lily’s side of the conversation is silent. Though 80 percent of the material in the Carter Papers comes from her, not a single letter in her own hand survives. Still, it is clear that Lily and Harriet were on very good terms.

  “Henry is so much engrossed in his book that we see little of him,” Harriet confides in a letter from January 1881. “I for my part shall be very thankful when the said book is in the press.”

  Only three of these sister-to-sister letters survive, none earlier than 1879, but in this small cluster comes a remarkable number of answers. First and foremost, Harriet and H.V. were never divorced, but they also never lived together again. Instead, the couple maintained an unconventional relationship that endured for more than twenty years. Other than a series of furloughs, H.V. remained in India, while Harriet and the children lived in Europe, including England, Germany, and Italy. Mother, father, and daughter apparently did reunite on occasion, spending a month together in Rome, for instance. And at least once in India, husband and wife spent time alone together, though in a town a good distance from Bombay and its late-Victorian mores. Was this a romantic rendezvous? As it should be, perhaps, the level of intimacy between the two is never defined.

  Harriet, it turns out, was not the only bearer of news about H. V. Carter and family. Lily also received delightfully chatty letters from her niece, Harriet and H.V.’s daughter, Eliza Harriet “Lily” Carter. In one of the four surviving letters, we hear for the first time about her half brother, Harriet’s heretofore unnamed son, John, who was a couple of years older. Around age twenty, John ran off to Australia, perhaps seeking his fortune in the gold trade. “Let us hope that no news is good news, and that he is doing well in Australia, for we think he is still there,” Eliza tells her aunt. “We often hear of boys who behaved in a similar way and yet came to no harm.” John’s ultimate fate is unknown.

  A charming instance of her father’s acting fatherly comes in a letter dated October 3, 1878. Writing from Switzerland, Eliza and her mother are en route to Florence, where she would spend the winter studying Italian and taking painting and voice lessons, she tells her “Auntie” Lily, “to try and satisfy dear Papa’s wishes in occupying my time in ‘the pursuit of knowledge.’” Her groaning lifts right off the page. From the sound of it, H.V., in spite of his absence, was trying to instill in Eliza his own love of learning, and she was reacting with all the enthusiasm of a typical teenager.

  By this point, Carter’s work for the Indian Medical Service had taken him out of the classroom entirely, and in his midforties, he had found his true calling in life: independent medical research. This seems such a natural fit for Carter, but only in hindsight. When he had received his first copy of the Anatomy, he confided to his diary that he could never take on such a huge project again, unless working under a “ruling mind” such as Henry Gray—a natural leader, someone able to see the big picture, to use a modern phrase. Of himself, Carter wrote, “[I] analyze life on too small a scale.” What he meant as a putdown, however, I see as his great gift. Carter’s ability to focus on the small, to break things down, to mentally dissect—the same ability that made him so miserable on personal inspection—is what made him such a precise anatomical artist and such a natural researcher. This man who so firmly believed “I can’t” is now recognized by medical historians as a pioneer, the first scientist to apply modern methods of scientific research to the investigation of tropical diseases.

  CARTER’S FIRST SIGNIFICANT finding as a researcher dates back to 1860, when he was still teaching at Grant Medical College. His clinical observation of a condition known at the time as “Madura foot” had deeply troubled him. The disease seemed to afflict only poor Indian laborers, who, for reasons unknown, developed enormously painful and disabling masses in their feet and/or hands. No treatment was effective, short of amputation. Puzzled, Carter began examining surgical specimens with the microscope he had brought with him from London, and he became convinced that the culprit was a fungus of some kind. Since the laborers worked in their bare feet or with bare hands, the organism, Carter theorized, must be entering through cuts in the skin. Though unable to prove this by growing cultures of the fungus, he published his research, and two decades later, his theory was confirmed. Madura foot eventually came to be known by a new name, “Carter’s mycetoma.”

  After five years at the college, Carter was relocated one hundred miles south of Bombay to the district of Satara and was appointed the “civil surgeon” (chief medical officer) and superintendent to the “gaol” (jail). He spent nine years here. Not one letter written by Carter survives from this entire period, giving the spooky impression that he
had been locked away himself, but the reality is, he kept himself as busy as possible. On top of his other duties, for instance, he volunteered for what sounds like a daunting task: analyzing data that had been collected on eighty-two hundred Indian lepers but was simply gathering dust in government files. The result of his work, published in an 1871 Bombay medical journal, helped to dispel a number of misconceptions about the dread disease, whose true cause (a mycobacterium) was still unknown. No, he concluded, external factors such as local geography and topography were not relevant to etiology, and even though the afflicted were almost always the poorest of the poor, neither was poverty. As historian Shubhada Pandya recently noted, “Carter took pains to point out that want and deprivation were consequences rather than precedents of leprosy.” Carter also soundly refuted the imperialist notion that poor hygiene among the “natives” was to blame. On the contrary, he noted without condescension, the Indian people bathed once a day—just like you and me, he seemed to imply—and “personal cleanliness is not neglected.”

  If one were looking just at H. V. Carter’s curriculum vitae, his interest in leprosy would seem to have sprung directly from that mound of raw data. Perhaps he had also encountered cases in Satara, one might surmise. But, in fact, a casual mention in his diary a decade earlier shows that Carter had begun looking into leprosy long before. From a public health perspective, there were certainly compelling reasons for him to study leprosy, but I am sure it resonated in a personal way as well. Leprosy is invoked many times in the Bible—the prophet Elisha bathing a leper, the parable of Lazarus, Jesus and his disciples healing the afflicted—and the chance to make an impact on the lives of lepers would have struck him as a worthy, Christlike endeavor.

  After completing his term in Satara, Carter was granted a three-year furlough, which he used to conduct a fact-finding mission on how cases of leprosy were managed in other countries. He traveled to western Turkey and southern Europe but spent much of his time in Norway. During this remarkably productive period, 1872—75, Carter also wrote two influential books, both of which he illustrated: a monograph on mycetoma (1874) and a volume on leprosy (1874), one of the first scientific treatises on the disease. What makes this latter book historically significant is Carter’s advocacy for the findings of a fellow scientist, Gerhard Hansen, whom he had met during his furlough. Hansen, a Norwegian physician, had accumulated convincing evidence that leprosy was caused by an acquired bacterial infection and was not, therefore, a hereditary disease, as was widely believed and reported at the time. Carter’s book included translations of two of Hansen’s latest research papers (the first time they would appear in English), which helped disseminate the findings to a broad scientific audience.1

  Six years later, H. V. Carter had the stage to himself. The setting was London, August 1881. At age fifty, he stood before an audience composed of the leading scientists of the day, delegates to the seventh International Congress of Medicine, Louis Pasteur, Robert Koch, and Joseph Lister, among them. These men were his peers. (And they were exclusively men. Queen Victoria, fiercely opposed to equal rights for women, had threatened to withdraw her royal patronage if any “medical women” were admitted to the congress.) Carter, now the principal of Grant Medical College, head physician of the Jamsetjee Jeejeebhoy Hospital, and a surgeon-major in the Indian Medical Service, had earned a spot in “the genus” above, to borrow his earlier phrasing, whether or not he saw himself thusly. He had been invited here to give an address on his recent discovery of the organism that caused “relapsing fever,” an often deadly illness that had swept through Bombay during the Great Indian Famine of 1877, and on his related findings on another blood-borne bacterium. This body of research, which would become the subject of Carter’s next book, a treatise of nearly five hundred pages, had already cemented his reputation as one of the world’s leading experts in epidemic disease. By now, the fact that H. V. Carter was the original illustrator of Gray’s Anatomy, currently in its ninth edition in England, had become just a footnote in his career.

  H. V. Carter, artist and date unknown

  Despite the prestigious setting, Carter’s moment in the spotlight must have been rather bittersweet. In his personal life, he was now very much alone. Harriet had recently died (apparently suddenly, though the cause and date of her death are unknown), and during his twenty-three years away from England, Carter had lost not only the few close friends he’d once had but family members, too. Both his father and brother had passed away—Joe at just thirty-five and only three months after marrying his longtime love. And now, his own health was poor. While investigating the nature of relapsing fever, he’d “had the benefit,” as Carter once wryly put it, “of repeated personal experience of this fever.” What’s more, he had contracted pulmonary tuberculosis. But the trip would at least end on a high note. After spending several weeks in London, he would take the train to Scarborough to see his dear sister, now Mrs. William Moon and the mother of a small brood.

  Carter did subsequently return to Bombay and resume his responsibilities with the college and hospital, but following his retirement at age fifty-seven in July 1888, he came back to Scarborough for good. Brigadier-Surgeon H. V. Carter, M.D., was granted the honorary rank of deputy surgeon general for his “eminent service to medical science” and appointed honorary surgeon to the queen. He bought a large house within a stone’s throw of Lily’s, and within a few years, he had a new family of his own to fill its many rooms. In December 1890, at age fifty-nine, he married Mary Ellen Robison, twenty-five years his junior. The couple had two children, a son named Henry Robison (born 1891) and a daughter, Mary Margaret (1895). But Carter’s late-blooming happiness was cut short. He had never fully recovered from tuberculosis and died at home on May 4, 1897, just shy of his sixty-sixth birthday.

  OUR TIME IS almost up. We have been here four days in a row and are going home tomorrow. The library is closing in twenty minutes. The romance novelist has gone, leaving just Steve and me at the table. Still, we speak in whispers, purely out of respect for the reading room itself.

  Sue, our favorite Ms. Wheat—a Mary Tyler Moore with an English accent—delivers two last archival boxes, one for each of us. We have already read everything—every page of every extant item, down to Henry Vandyke Carter’s last will and testament—but we cannot leave London without seeing H. V. Carter’s actual diary.

  The second volume is slightly larger than the first, as if he had splurged on the extra half inch, but, my word, they are both so small. How did he fit so much life onto such tiny pages?

  “Thank goodness we saw this on microfilm first,” I say to Steve, “or I don’t think I’d have gotten much past the first page.”

  Carter’s handwriting, an endless series of trembling lines, looks more like an EEG reading, one that only we know how to interpret. There is his opening note on the fate of his first diary, how he’d had to destroy some of those early pages, followed on the next page by his peppy epigraph: “Let the same thing, or the same duty, return at the same time everyday, it will soon become pleasant,” which has always struck me as absurd.

  Both volumes have been rebound, replacing what must have been tough original covers, for the pages show little wear and tear. Carter himself was not just neat but freakishly neat. There are no stains, scarcely a smear, and not a single dog-eared page. None of the ink has ever run, as if the man never shed a tear.

  Steve and I trade volumes. I turn to Carter’s last diary entry, written on January 9, 1862, such a bleak, unhappy time. “The unfolding of the future—the immediate future—remains, and the present hardly improves,” it begins. The entry is a page long, the tone desultory. You can tell his heart’s not in it anymore. “Working incessantly—the only relief,” he writes in his closing paragraph.

  It’s a wonder that the diary has survived, I cannot help but feel, that the volumes weren’t destroyed, whether purposely or inadvertently, or lost; a small miracle, perhaps even Providential, that they ended up in my hands.

&n
bsp; I carefully thumb through the diary one last time. As the thousands of words fly by, it is not a line of H.V.’s but instead one of Joe’s that comes to mind:

  What is past—the past—does not, nor will it, detach itself and remain where it was (or where it might have been intended to have remained) but it must bring itself forward, and smilingly, or otherwise, present itself as an old friend.

  Seventeen

  LAST NIGHT I HAD ONE OF MY REOCCURRING DREAMS. NO, NOT the one where I’m doing house chores with celebrities, but the dream of flunking my high school geometry exam. It’s a classic anxiety dream, in which I have completely forgotten that the final exam is today—right now, in fact—and I have not studied at all. In a variation on the theme, however, this one was set not at Gonzaga Prep but instead in UCSF’s Cole Hall. Upon waking, I felt panic and relief—such a sour mix of emotions—then bemusement. What I’d had was a sympathetic anxiety dream, I realized. Tomorrow is the med school anatomy final, you see, and today, I am helping Meri study for it.

  We meet at 3:00 P.M. and find the lab filled with fellow cramming students. Dana, Kim, Dhillon, Charlie, and the other teachers move among them, tutoring small groups. Our table, number 24, has been taken over by a group of guys studying our cadaver’s shoulder joint, so Meri and I find a spare prosection of a leg to work with. This is one sorry-looking specimen. Were it not already dead, I would say it looked studied to death. Well-utilized is perhaps the better phrase. I can’t help wondering how many students over the years have performed the anatomical equivalent of musical scales on this severed leg, calling off the sequence of muscles, nerves, arteries, and veins.