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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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Conduction system of the heart

[UPDATED] The conduction system of the heart is formed by two components, one primary, intracardiac (within the heart itself), and one secondary, which has extracardiac and intracardiac components. 

The classic description of the conduction system of the heart emphasizes only the primary intracardiac system and refers to a group of specialized cardiac muscle structures that serve as pacemakers and distributors of the electrical stimuli that make the heart beat coordinatedly. It is important to stress the fact that this primary "conduction system of the heart" is not formed by nerves but rather by specialized cardiac muscle cells.

Components of the primary conduction system of the heart:

Primary conduction system of the heart

• SA node: The sinuatrial (SA) node is a small nodule of cardiac muscle tissue, somewhat horseshoe-shaped that is found at the junction of the superior vena cava and the right atrium. It receives blood supply from the SA node artery, a branch of the right coronary artery. Later research indicates that the pacemaker function of the SA node includes areas of the lateral wall of the right atrium which are involved in different heart rate speeds.

• AV node: The atrioventricular (AV) node is found at the junction of atria and ventricles in an area known as the "Triangle of Koch". Its function is to delay the electrical impulse passing from the atria to the ventricles by 1/10th of a second, enabling the sequential pumping action of the heart. The eponymic name for the AV node is "node of Aschoff-Tawara", and it receives its blood supply by way of the AV node artery, a branch that usually arises from the right coronary artery

• AV bundle: Also known as the "Bundle of His", this thick bundle of specialized myocardial cells is found in the interventricular septum. It divides into the right and left bundle branches

• Bundle branches: Sometimes known as the "crura" of the bundle of His, these two divisions of the AV bundle help distribute the electrical stimuli to the ventricular walls. The right bundle branch has an extension that crosses the lumen of the right ventricle, from the base of the anterior papillary muscle to the interventricular septum, forming a cord of tissue known as the "moderator band" or "septomarginal trabecula"

• Purkinje Fibers: These thin fibers are the terminal end of the conduction system of the heart and finish the distribution of the electrical stimuli to all parts of the ventricular walls

Although the structural components of the conduction system of the heart were known, it was Dr. Sunao Tawara (1873-1952) who discovered the AV node and described the connections between the components of what he called the "Reitzleitungssytem" (conduction system) of the heart.

A separate article on the secondary conduction system of the heart will be published shortly

Click on the image for a larger version. Image modified from the original: "3D Human Anatomy: Regional Edition DVD-ROM." Courtesy of Primal Pictures
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