When I was a student at Guy’s Hospital Medical School, London, in the mid sixties, anatomy was regarded as one of the cornerstones of basic medical science. I remember using the 33rd edition of Gray’s Anatomy , not as a course book, but as a source of additional information and detailed illustration: it became an old friend. I still have my copy and often refer to it – indeed it was used when preparing some of the illustrations in this new edition
Almost four decades later, anatomy occupies a less prominent place within an overcrowded undergraduate medical curriculum. Paradoxically, over the same period, the need for detailed anatomical knowledge at the postgraduate level has increased dramatically, fuelled particularly by developments in imaging and computer-assisted three-dimensional reconstruction (both macro- and microscopically); anaesthetics; endoscopic surgery, and the miniaturization of instruments. Anatomists and clinicians have learned to look with a fresh eye at familiar structures revealed in new ways, e.g. the arthroscopic appearance of joint cavities; high-resolution CT images of the petrous bone; images of the coronary circulation during MRI-guided cardiovascular catheter-based interventions; radionuclide imaging of the thyroid gland.
As I write this, I have opened in front of me on my desk an English translation of Wilhelm Braune’s Atlas of Topographical Anatomy, which was published by J and A Churchill in 1877: it contains detailed woodcuts of plane sections of frozen bodies, and displays a level of detail comparable with that seen in the best modern atlases of sectional anatomy. The following passage from the translator’s preface to Braune’s Atlas (published in Liepsig [sic] in 1874) speaks about the fundamental place of anatomy in medicine. By means of the sections found in this Atlas the exact position and relations of the structures which must be divided or avoided in the course of an operation are indicated: and the track of a bullet or puncture wound suggested. At the same time they afford an absolutely correct representation of the intimate relations of the viscera of the thorax and abdomen. For clinicians who work at the cutting edge (quite literally) of medicine, the message has not changed over the intervening years – anatomical knowledge remains an essential item in their armamentarium.
The 39th edition of Gray’s Anatomy is radically different from earlier editions because the body is described in regions rather than in systems. In an ideal world, an anatomical reference book should contain both systematic and regional anatomy. In the real world, the editorial team for the 39th edition decided that a book which would be of the greatest benefit to practising clinicians should mirror their daily practice and describe anatomy in the way in which they use it, i.e. regionally. Talking to colleagues around the world, this view has been the one that we have heard most frequently. We have responded to these comments by updating and clarifying the text, and have also paid particular attention to issues of navigability and clinical relevance
The members of the editorial team who have worked with me in preparing the 39th edition brought a wide range of experience as academic anatomists and clinicians: I am indebted to them all for their dedication and enthusiasm. The Lead Editors – Harold Ellis, Jeremiah Healy, David Johnson and Andrew Williams – have been responsible with me for overseeing the revision of specific parts of the book, initially by drawing together relevant material from the various sections of the 38th edition, and subsequently by guiding and advising the Editors of the sections and chapters. They also helped me to take strategic decisions about the overall content and organization of the 39th edition. Thus, for example, we have included descriptions of the blood supply to the skin and muscles, on the grounds that they have surgical relevance when raising flaps for reconstructive surgery, and we have made extensive use of new imaging modalities. The Theme Editors, Caroline Wigley and Pat Collins, worked closely with all members of the editorial team to update microstructure and embryology respectively throughout the book.
The work of drilling down into the existing text, updating it and setting it in a clinical context, was undertaken by the Editors of the sections and chapters, a group of clinicians and anatomists (sometimes both) with a wealth of experience of teaching applied anatomy and neuroanatomy to medical and dental undergraduates and postgraduates. Editors and Specialist Contributors have provided new insights into topics such as the anatomy of the pelvic floor, inner ear, peritoneum, preimplantation embryology, assisted fertilization, spread of infection via fascial planes in the head and neck, smooth and cardiac muscle, wrist kinematics and kinetics, and the temporomandibular joint. Neuroanatomy has been comprehensively revised and now focuses on the human nervous system. The manuscript has been submitted to rigorous scrutiny by Specialist Reviewers (who commented on specific chapters), and by General Reviewers (who were able to comment on the text at first proof stage): their comments have been incorporated into the text. I am grateful to them all for their encouragement and suggestions