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A Moment in History

Self-portrait, Henry Vandyke Carter, MD (Public Domain)
Self-portrait, Henry Vandyke Carter, MD (Public Domain)

Henry Vandyke Carter, MD
(1831 – 1897)

English physician, surgeon, medical artist, and a pioneer in leprosy and mycetoma studies.  HV Carter was born in Yorkshire in 1831. He was the son of Henry Barlow Carter, a well-known artist and it is possible that he honed his natural talents with his father. His mother picked his middle name after a famous painter, Anthony Van Dyck. This is probably why his name is sometimes shown as Henry Van Dyke Carter, although the most common presentation of his middle name is Vandyke.

Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857.  The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.

While working on the book’s drawings, HV Carter continued his studies and received his MD in 1856.

In spite of initially being offered a co-authorship of the book, Dr. Carter was relegated to the position of illustrator by Henry Gray and never saw the royalties that the book could have generated for him. For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr.  Carter never worked again with Gray, who died of smallpox only a few years later.

Frustrated, Dr. Carter took the exams for the India Medical Service.  In 1858 he joined as an Assistant Surgeon and later became a professor of anatomy and physiology. Even later he served as a Civil Surgeon. During his tenure with the India Medical Service he attained the ranks of Surgeon, Surgeon-Major, Surgeon-Lieutenant-Colonel, and Brigade-Surgeon.

Dr. Carter dedicated the rest of his life to the study of leprosy, and other ailments typical of India at that time. He held several important offices, including that of Dean of the Medical School of the University of Bombay. In 1890, after his retirement, he was appointed Honorary Physician to the Queen.

Dr. Henry Vandyke Carter died of tuberculosis in 1897.

Personal note: Had history been different, this famous book would have been called “Gray and Carter’s Anatomy” and Dr. Carter never gone to India. His legacy is still seen in the images of the thousands of copies of “Gray’s Anatomy” throughout the world and the many reproductions of his work available on the Internet. We are proud to use some of his images in this blog. The image accompanying this article is a self-portrait of Dr. Carter. Click on the image for a larger depiction. Dr. Miranda

Sources:
1. “Obituary: Henry Vandyke Carter” Br Med J (1897);1:1256-7
2. “The Anatomist: A True Story of ‘Gray’s Anatomy” Hayes W. (2007) USA: Ballantine
3. “A Glimpse of Our Past: Henry Gray’s Anatomy” Pearce, JMS. J Clin Anat (2009) 22:291–295
4. “Henry Gray and Henry Vandyke Carter: Creators of a famous textbook” Roberts S. J Med Biogr (2000) 8:206–212.
5. “Henry Vandyke Carter and his meritorious works in India” Tappa, DM et al. Indian J Dermatol Venereol Leprol (2011) 77:101-3


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"The Anatomist" - A True Story of Gray's Anatomy

As you know, I am interested in the history of Science, Medicine, and specially, Human Anatomy. Because of that and as part of this website we added a series called "A Moment in History". The objective was to create a series of articles to honor those individuals who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research including individuals who have contributed in different ways, but still added their life work to the advancement of medical knowledge.

One of the individuals who piqued my interest was Henry Gray, FRS author of one of the great teaching books on anatomy ever written, “Gray’s Anatomy”. This book was first published in England in 1858, later published in the USA from 1862 to 1990. The English Edition is still published and is now in its 42nd Eddition.

I started to look deeper into his life which, I learned with surprise, was not only very short, but obscure. Researching into Henry Gray’s life, I came about this book: “The Anatomist – A True Story of Gray’s Anatomy” by William (Bill) Hayes.

Bill Hayes started looking into Henry Gray’s life with the intent of writing a biography. He rapidly run into a wall. Besides a well-detailed list of academic titles and positions, degrees awarded, and scientific papers that he published. As the author states “what I had gathered about him would amount to little more than a Curriculum Vitae”. So, he starts a journey to uncover more data about Gray’s life and his well-known book.

Book cover - The Anatomist by Bill Hayes
Book cover - The Anatomist by Bill Hayes 

Bill Hayes started looking into Henry Gray’s life with the intent of writing a biography. He rapidly run into a wall. Besides a well-detailed list of academic titles and positions, degrees awarded, and scientific papers that he published. As the author states “what I had gathered about him would amount to little more than a Curriculum Vitae”. So, he starts a journey to uncover more data about Gray’s life and his well-known book.
Henry Gray, FRS (Public Domain)
Henry Gray, FRS (Public Domain)
...... Henry Vandyke Carter, MD
Henry Vandyke Carter, MD

Part of his journey was to understand the importance of anatomy as a component of the medical curriculum, fueled by one of the few photographs that exists of Henry Gray. In this particular 1870 picture by Joseph Langhorn, Gray is in the anatomy laboratory at St. George’s Hospital with his students. Here is a Pinterest link to that photograph.

Bill Hayes was accepted as a participant in the anatomy laboratory for physical therapy students and later visited medical students in the anatomy lab. Just his observations and comments throughout the book on these activities is worth reading this book.

What is interesting is the lack of personal information on Henry Gray. To this date, we do not have information about his birth, either location or date. There is more information on his family that on the subject. Most agree that Henry Gray was born in 1827, but some propose 1825. Either way, there is no firm data. What we do know is that he died on June 12, 1861, having contracted smallpox most probably from his nephew Charles Gray. Henry Gray was 36 years old.

In his research, the author discovers Henry Gray’s collaborator and illustrator of the book: Henry Vandyke Carter, MD. Where Gray is obscure and with no personal information, Henry Carter writes a diary daily, and for some time he actually writes another diary that he calls “Reflections” on more personal and religious topics. Carter is a troubled, complicated individual blessed with incredible anatomical knowledge and drawing capabilities that can be seen throughout the book.

It is because of these diaries that we know Henry Carter and we can glimpse (almost at a distance) the character of Henry Gray, but it is not enough to elucidate his biography. In some ways it is like looking at an individual through a veil. You see him, but it is nebulous.

Much of the book is concentrated on Henry Carter, his life, his depression bouts, his self doubts and the work that he did illustrating Gray’s book. In some ways he is behind the scenes, and even though he did much of the dissection work and illustration, Henry Carter is mostly unknown to the anatomical world, as in may cases the medical illustrators are, with some notable exceptions.

Henry Carter is paid only 150 pounds for his work and even before getting paid he pays for a ticket to India where he accomplishes his objectives in life and in academia. Henry Carter eventually retires and comes back to England where he dies in 1897.

Bill Hayes and his partner visited rare book libraries at different universities and eventually go to London to visit areas and locations where Henry Gray lived and worked. There is a sense of accomplishment, but also a sense that we can almost touch the life of Henry Gray but fall short of seeing him.

The book ending is poignant, dealing with personal matters and thoughts on life and death. Eventually the author is very clear that the study of anatomy, although on dead subjects who donated their bodies to the universities is actually an activity that helps us understand life.

Bill Hayes is an awarded author of seven books, a frequent contributor to the New York Times and a photographer. More information about him and his activities at https://www.billhayes.com

Personal note: This is a book that I personally recommend and proud to add to my personal library. My one observation is that the author should have probably name the book “The Anatomists - A True Story of Gray’s Anatomy” as it is the story of the life of the two Henrys: Gray and Carter. In fact, I believe that Gray’s Anatomy could have been called “Gray’s and Carter’s Anatomy”, had history been slightly different – Dr. Miranda.

Sources:
1. “Henry Gray and Henry Vandyke Carter: Creators of a Famous Textbook" Roberts, S. J Med Biog 2000 8: 206-212
2. "Henry Gray, Anatomist: An Appreciation" Boland, F Am J Med Sci 1908 1827-1924
3. "The Anatomist: A True Story of Gray’s Anatomy" Hayes, B. Random House PG 2007

Rhomboid major

The rhomboid major muscle is found in the posterior aspect of the thorax between the spine and scapula. This muscle originates from the spinous processes of the thoracic vertebrae T2 to T5 as well as the supraspinous ligament at these levels by way of an aponeurosis that varies in width. It inserts on the medial border of the scapula, from about the level of the scapular spine to the inferior angle of the scapula by way of short tendinous fibers.

It adducts, elevates, and inferiorly rotates the scapula. It also helps to maintain the scapula flush with the posterior aspect of the thoracic cage. It is innervated by the dorsal scapular nerve (C4, C5), a branch of the brachial plexus.

The Terminologia Anatomica name for the muscle is musculus rhomboideus major.

The rhomboid major is one of the 17 muscles that attach to the scapula.  

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Morris' Human Anatomy" Pearce, J. (1942) Blakiston Co. Philadlephia USA
6. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010

Image modified from the original by Henry VanDyke Carter, MD. in the book "Grays's Anatomy" by Henry Gray FRS. Public domain

Rhomboid major muscle. Image modified from the original by Henry VanDyke Carter, MD. Public domain
Rhomboid major muscle
Click on the image for a larger depiction


Omohyoid

The omohyoid also known as the musculus omohyoideus is the most lateral of the infrahyoid muscles, the others being the sternohyoid, sternothyroid, and thyroid muscles.The omohyoid is a long muscle formed by two muscular bellies (superior and inferior) and an intermediate tendon.

The inferior belly originates from the superior margin of the scapula, near the superior transverse ligament of the scapula. Sometimes, as a variation, the tendon of the inferior belly originates directly from this ligament. The inferior belly passes medially, posteriorly, and slightly superiorly towards the intermediate tendon. The medial aspect of this belly is deep to the trapezius muscle.

The intermediate tendon is held in place by a strong extension of the middle layer of the cervical fascia. This extension has firm attachments to the first rib and the posterior surface of the clavicle.

Along with the other infrahyoid muscles, the omohyoid muscle depresses the hyoid bone. Each belly receives a separate branch that arises from the ansa cervicalis (C1, C2, and C3).

Note: The image in this article was taken from the book "Tratado de Anatomía Humana" by Testut and Latarjet. The illustration was made by George Devy, a famous French painter who specialized in anatomical illustrations (? -1902) and the engraving was made by a Swiss artist, Edmond Boulenaz (1859-1905). This image is in the Public Domain and has been edited by us.

Omohyoid muscle - Image modified from the original. Public domain
Omohyoid muscle.
Click on the image for a larger depiction

The inferior belly of the omohyoid is one of the 17 muscles that attach to the scapula.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010
6. "Petite histoire de l'iconographie anatomique" Huard, P; Imbalt-Huart, MJ Communication présentée à la Société Française d'Histoire de la Médecine, le30 septembre 1972.
7. https://www.anatomicalterms.info


Brachialis

UPDATED: The brachialis muscle is a skeletal muscle attached proximally to the anterior surface of the humerus and distally to the coronoid process and tuberosity of the ulna. It is one of the three muscles in the anterior compartment of the arm (flexor compartment), the other two being the biceps brachii and the coracobrachialis.

It is a strong flexor of the elbow found deep to the biceps brachii. Because it does not attach to the radius, the brachialis muscle does not participate in the pronation and supination of the forearm.

The brachialis is supplied by branches of the brachial artery and by the recurrent radial artery.

The innervation of the brachialis muscle is a point to be discussed. Most modern books of anatomy state that this muscle is innervated by the musculocutaneous nerve (C5, C6, and C7). Older and more detailed books state that this muscle has a dual innervation. A 2011 research paper published in Spanish (see Sources #6) describes this dual innervation. The proximal portion of the muscles is indeed innervated by the musculocutaneous nerve, but the distal portion (in 90% of the cases) is innervated by muscular branches that arise off the radial nerve. The radial nerve (C5, C6, C7, C8 & T1) is a branch of the brachial plexus.

Following is an excerpt from the "Trail Guide to the Body" by Andrew Biel: "Ironically, (because it is deep to the biceps) the brachialis girth only helps the biceps brachii to bulge further from the arm, making the brachialis the biceps' "best friend"

Brachialis muscle - Image modified from the original. Public domain
Brachialis muscle.
Click on the image for a larger depiction

Personal note: The research paper that describes the double innervation of the brachialis muscle was done at my alma mater, the University of Chile, and the authors' listing includes two of the contributors to this blog, Professors Claudio Molina and Cristian Uribe. Dr. Miranda

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010
6. "Doble Innervacion del Musculo Brachial en la Poblacion Chilena" Claudio Molina; Cristián Uribe; Álvaro Heras; Cristián Astorga;Jorge Lemus & Alberto Rodríguez. Int. J. Morphol, 2011. 29(4):1207-1211. A PDF copy of this paper is available here.

Note: The side image modified from the original by Anatomography, CC BY-SA 2.1 JP <https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en>, via Wikimedia Commons following Creative Commons attributes.


Biceps brachii

The musculus biceps brachii is a long muscle found in the anterior, aspect of the arm and is one of the three muscles contained in the anterior compartment (flexor compartment) of the arm, the other two being the brachialis and coracobrachialis muscles.  It is composed by two muscular heads, one long (lateral) , and one short (medial) that originate superiorly from separate tendons that attach to the scapula. These two heads join to  form a single long, oval-shaped belly with a single tendon that crosses the elbow joint and attaches to the radius. 

The short tendon of the biceps brachii passes anteromedial to the shoulder joint and attaches to the coracoid process of the scapula by way of a tendon that mixes with the tendon of the coracobrachialis muscle.

The long cylindrical tendon of the biceps brachii is found in the intertubercular (bicipital) groove (Lat: sulcus intertubercularis) of the humerus, and passes between the greater and lesser tubercles of the humerus, entering the articular cavity of shoulder joint, and continues superiorly to insert in the supraglenoid tubercle of the scapula.

The distal, common tendon of the biceps brachii courses inferiorly and attaches to the radial (bicipital) tuberosity of the radius. There is a well-defined bursa between the radial tuberosity and the biceps brachii tendon that allows for movement of the tendon.

Biceps brachii muscle - Image modified from the original, Wikimedia Commons. Public domain
Biceps brachii muscle.
Click on the image for a larger depiction

Also, a flat, fascial extension of the tendon, known as the bicipital aponeurosis extends inferomedially to blend with the antebrachial aponeurosis that covers the epitrochlear muscles of the forearm (pronator teres, flexor carpi radialis muscles). The brachial artery passes between the tendon of the biceps brachii and the bicipital aponeurosis in the anterior aspect of the elbow joint.

The biceps brachii crosses both the shoulder and the elbow join. As such, its functions will depend on which joint is fixed and which one is not. This muscle flexes the elbow, supinates the forearm, and flexes the shoulder.

It is innervated by the musculocutaneous nerve (C5,D6) which is a branch of the brachial plexus. It receives arterial supply by way of muscular branches that arise from the brachial artery.

The name of the muscle literally means "two heads" as the prefix "bi" means "two" and the Latin term "-ceps" means "head".

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have to separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda

The side image modified from the original via Wikimedia. Public domain. Animated image below by Wikimedia Commons - Anatomography [CC BY-SA 2.1 following Creative Commons attributes.

Niwadare, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010


Pectoralis minor

The pectoralis minor muscle is a small triangular muscle found deep to the pectoralis major in the anterior aspect of the thorax.

This muscle originates from three fleshy bellies that insert into the superior border and anterior surface of the third, fourth and fifth ribs. The muscle fibers converge superolaterally to insert into the inferomedial aspect of the coracoid process, of the scapula, where the tendon of the pectoralis minor intermingles and fuses with the tendon of the coracobrachialis muscle.

The pectoralis minor lies immediately anterior and covers some of the structures of the axillary region, the axillary artery and vein and some of the components of the brachial plexus. In fact, the pectoralis minor muscle is the landmark that divides the axillary artery into its three components: proximal (between the first rib and the medial border of the pectoralis minor). middle (deep to the pectoralis minor), and distal (between the lateral border of the pectoralis major and the inferior border of the teres major muscle). Thus defined the pectoralis major forms part of the anterior wall of the axilla.

In conjunction with other muscles, the pectoralis minor helps to maintain the scapular and shoulder joint in position. If the scapula is fixed, the pectoralis major assists to elevate the anterior thoracic wall during forced inhalation. The pectoralis minor also works as a depressor of the scapula and shoulder joint, abducts the scapula, and rotates the scapula.

Pectoralis minor muscle (26) - Testut & Latarjet 1931. Public domain
Pectoralis minor muscle (26)
Click on the image for a larger depiction

The pectoralis minor is innervated by the medial pectoral nerve (C8.T1), a branch of the brachial plexus. Some of the fibers of the medial pectoral nerve perforate the pectoralis minor to provide nerve supply to a portion of the pectoralis major. The pectoralis minor is one of the 17 muscles that attach to the scapula.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010