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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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Arterial circle of Willis

UPDATED: The arterial "circle of Willis" is a roundabout of arteries found at the base of the brain, allowing for collateral circulation at this level. This arterial circle has been described by many anatomists, but it was Thomas Willis (1621 - 1675) who described it in most detail, and he was the first to understand its function.

The circle of Willis receives blood from the two main paired arteries that provide blood supply to the head and brain: the carotid arteries anteriorly, and the vertebral arteries posteriorly.

This arterial circle is formed by the anastomosis of several arteries, paired and unpaired:

Anterior cerebral arteries: These paired arteries are one of the terminal branches of the internal carotid arteries. They provide blood supply to the medial aspect and part of the lateral aspect of frontal and parietal lobes of the brain

• Anterior communicating artery: A single unpaired small artery communicating both anterior cerebral arteries and providing potential collateral circulation between them

• Internal carotid arteries: These two bilateral arteries are one of the branches of the carotid artery found at the root of the neck. Its two main terminal branches are the anterior cerebral arteries and the middle cerebral arteries

Arterial circle of Willis (en.wiklipedia,org)
Image courtesy of www.wikipedia.org 

• Posterior cerebral arteries: These two arteries are formed by the bifurcation of the basilar artery, which itself is formed by the junction of the right and left vertebral arteries. The posterior cerebral arteries provide blood supply to the occipital lobe and part of the temporal lobe of the brain

Posterior communicating arteries: These paired arteries provide communication between the carotid and vertebral arterial territories 

Middle cerebral arteries: Although not technically part of the arterial circle of Willis, these paired arteries are one of the two terminal branches of the internal carotid arteries. The middle cerebral artery travels deep in the lateral sulcus (Sylvian fissure) of the brain and provides blood supply to the lateral aspect of the brain including the frontal, parietal, occipital, temporal, and insular lobes

The arterial circle of Willis provides all of the arterial blood to the brain. Cerebral blood flow in humans averages 55 mL per 100 g of brain tissue per minute. This is a about over 742.5 mL/min for the average 1350 g brain. Depending on the situation the brain will use between 15 to 20 percent of the total cardiac output, although by weight the brain is only about two to three percent of the average body weight. Incredibly, the brain uses more oxygen that most organs averaging close to 25% of the total oxygen needs of the body!

The importance of the arterial circle of Willis is that beyond this point the arterial supply to the brain becomes terminal, that is, there are little or no anastomoses between the bifurcating branches exposing the brain to ischemia and necrosis should there be an arterial stenosis or stricture. The circle of Willis is an area prone to aneurysms, with over 27,000 cases yearly in the US.

For an image of the vascular territories of the brain, click here.

Clinical anatomy, pathology, and surgery of the brain and spinal cord are some of the lecture topics developed and delivered by Clinical Anatomy Associates, Inc.

Thanks to Jackie Miranda-Klein for making me review this post and update it!... and congratulations to Jackie for starting her Physician Assistant Master's degree at Kettering College. Dr. Miranda.

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