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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

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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Coronary sinus

The coronary sinus is a venous structure that receives blood from the coronary circulation and returns it to the right atrium of the heart. It is found in the atrioventricular sulcus and receives all the veins of the heart (small, middle, great and oblique cardiac veins, and others), with the exception of some anterior cardiac veins that may empty directly into the right atriumThere are small venous valves at the point where most of these veins enter the coronary sinus.

Unlike most veins, the coronary sinus in the human has an evident layer of smooth muscle that may become the source of ectopic foci of atrial depolarization, causing atrial fibrillation.

The opening of the coronary sinus into the right atrium is called the "ostium of the coronary sinus"

Human heart - open right atrium
There is discussion as to where the coronary sinus begins, as there is sometimes a gradual dilation of the great cardiac vein and a clear-cut boundary cannot be seen.  Ludinghausen (1992) proposed to  use as a boundary the point where the oblique vein of the left atrium (vein of Marshall) enters the coronary sinus. A this point there is a small valve called the "valve of Vieussens".

The ostium of the coronary sinus, where it empties into the right atrium,  is characterized by the presence of a semilunar fold or band of tissue called the "valve of Thebesius". This valve may be absent (as in the image), it may be small, large, trabeculated, or cribriform. The presence of a large or cribriform valve of Thebesius may encumber the attempt at retrograde cardioplegia.

The image shows an human heart dissection, where the right atrium has been opened and the following structures exposed and labeled: Fossa ovalis, ostium of the coronary sinus, pectinate muscle of the atrial appendage, and the opening of the tricuspid valve.

Sources:
1. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
3. "Myocardial coverage of the coronary sinus and related veins" Ludinghausen M, Ohmachi N, Boot C. (1992) Clin Anat 5:1-15

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