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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The ribs form the lateral bony wall of the thorax.  The ribs are paired and there are 12 pairs of ribs in the human thorax, most of them connecting the thoracic spine with the sternum. They are numbered from superior to inferior.

Ribs have different anatomical characteristics depending on their level. A typical rib has the following characteristics from posterior to anterior:

• Head: The head of each rib articulates with one or two ribs depending on their level. Typically ribs number 1,2, 10, 11, and 12 articulate with one vertebra, while the rest articulate with two vertebrae.

Thoracic rib, Posteroinferior view

Thoracic rib - Posteroinferior view.
Click on the image for a larger version.

Facets: These are the articular surfaces found in the head of each rib. They are covered by hyaline cartilage and form part of the costovertebral synovial joints. In the case of ribs 3 to 9, since they articulate with two vertebrae, they have two facets, each one called a demifacet, with an interarticular crest between them.

• Neck: A short, somewhat narrower portion of the rib that projects straight posterolaterally.

• Costal tubercle: A bony protuberance, usually with two components, one articular and one non-articular. The articular part of the costal tubercle presents with a facet that articulates with the transverse process of a thoracic vertebra.

• Costal angle: A sharp posterior curvature of the rib. The body when supine rests of these costal angles which deflect pressure from the thoracic spine.

• Costal body: The area of the rib anterior to the costal angle. In most ribs this oval-shaped region of the rib presents with an inferior and internal groove. This is the costal groove or costal sulcus. The corresponding level intercostal artery, vein, and nerve are found in the costal sulcus.

• Costal cartilage: All ribs have an anterior fibrocartilaginous component. Some of them attach directly to the sternum (chondrosternal joints), while some of them attach only to other costal cartilages (chondrochondral joints).

The 12 pairs of ribs are divided as follows:

• True ribs: Ribs 1-7, which attach by way of their costal cartilage directly to the sternum

• False ribs: Ribs 8-10, whose costal cartilage attach only to the cartilage of the superior rib, creating a lower border for the thoracic cage known as the costal margin.

• Free or "floating" ribs: Ribs 11 and 12. Their anterior cartilaginous end does not attach to sternum or other cartilage, so the end is free. The term "floating" although used, is a misnomer as these ribs do attach posteriorly to the thoracic spine.

There can be anatomical variations to the ribs, including the existence of extra cervical or lumbar ribs.

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