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 micro-scopically); 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 punctured 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 used 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. 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, 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.

As far as possible, the orientation of diagrams and photographs throughout the book has been standardized to show the left side of the body, irrespective of whether a lateral or medial view is presented; transverse sections are viewed from below to facilitate comparison with clinical images. Clinicopathological examples have been selected where the pathology is either a direct result of, or a consequence of, the anatomy, or where the anatomical features are instrumental in the diagnosis/treatment/management of the condition. Wherever possible, the new photomicrographs illustrate human histology and embryology. I recognise that re-orientating a great many of the illustrations from previous editions has created an enormous amount of work for the artwork staff, who were asked to reposition thousands of leader lines and their associated names. I am very grateful to Dr Michael Hutchinson for checking the accuracy of these changes. However, I have no doubt that eagle-eyed readers will alert me to any errors that may have slipped undetected through several iterations of proof reading of both text and figures.

The Lead Editorial team took the view that Gray’s Anatomy is not, and should not attempt to be, a source book for molecular biology, pathology, neuroscience, physiology or operative procedures. Moreover, space considerations mean that it is not an appropriate vehicle in which to rehearse experimental data, and preclude the level of descriptive detail that is found in highly specialised dedicated texts. Mindful of these caveats, reference lists have been provided at the end of all but a few very short chapters to guide further reading: the references have been annotated when the content of the paper or book is not evident from its title. A list of general texts and references covering material presented in more than one chapter, e.g. the distribution of angiosomes, or other basic medical sciences, is included on page xv.

I offer my thanks to the production team at Elsevier, initially under the leadership of Richard Furn (1999–2002) and latterly of Inta Ozols (2003–2004), for their guidance, professionalism, good humour and unfailing support. In what has truly been a team effort, it is difficult to single out individuals for especial mention, however I would like to place on record my heartfelt thanks to Alison Whitehouse, Colin Arthur, Martin Mellor and Lesley Small, for being at the end of a phone or e-mail whenever I needed advice. I am grateful to Guy Standring, my long-suffering husband, for his patience and tolerance throughout the last four years.

Susan Standring
August 2004