Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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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

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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Sinus of Valsalva

The sinuses of Valsalva are dilations related to both the aortic root of the ascending aorta and the root of the pulmonary trunk. These sinuses form part of the functional aspect of the corresponding aortic valve and pulmonary valve. Each one of these semilunar valves presents normally with three sinuses of Valsalva, although the sinuses of the pulmonary valve are smaller than those of the aortic valve.

One of the problems encountered when describing each sinus of Valsalva is the fact that the sinus itself is not a structure, but a space. This space is found between the corresponding valve leaflet (or cusp) and the arterial wall which presents with a concavity, thus creating the sinus. This concavity is important functionally as it allows the leaflet to “flutter” in the arterial stream without getting stuck to the arterial wall. Physiological studies on the presence of the sinuses of Valsalva indicate that they play an important role decreasing of minimizing the stress of the valve leaflets.

Aortic root of the ascending aorta open by dissection
Aortic root open. Click on the image for a larger version.
The dilation of the sinuses of Valsalva also creates a bulbous region at the origin of both the ascending aorta and the pulmonary trunk, the “root” of these arteries.  For a better view of this bulbous region, click here. The boundary between the bulbous sinusal segment and the tubular segment of the arteries is known as the sinotubular junction (STJ).

The accompanying image shows a human ascending aorta that has been cut open to show the sinuses of Valsalva (yellow arrows), and the three cusps (leaflets) of the aortic valve. These are the non-coronary cusp (NCC), right coronary cusp (RCC), and the left coronary cusp (LCC). The ostia of the coronary arteries are visible inferior to the STJ.

The sinuses of Valsalva are named after Antonio Maria Valsalva (1666 - 1723), an Italian physician and anatomist.

1. “Anatomy of the aortic root: implications for valve sparing surgery” Charitos EI, Sieveres, HH Ann Cardiothorac Surg 2013;2(1):53-56
2. “Clinical Anatomy of the Aortic Root” Anderson, RH Heart 200; 84: 670–673
3. “The Anatomy of the Aortic Root” Loukas, E et al. Clin Anat 2014; 27:748-756
4: "Stress Analysis of the Aortic Valve With and Without the Sinuses of Valsalva" Beck, A et al J Heart Dis 2001; 10 (1) 1-11
Image property of: CAA.Inc.Photographer: D.M. Klein 

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