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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. Click on the link below to subscribe to the MTD newsletter. If you think an article could be interesting to somebody else, feel free to forward the link of the article. Should you want to use the information on the article, please follow the CAA, Inc Privacy and Security Statement found at the bottom of this page. You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment. |
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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
"Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.
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Esophageal hiatus hernia
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UPDATED: An esophageal hiatus hernia (also known as a hiatal hernia) is caused by a dilation of the esophageal hiatus and its component structures, the phrenoesophageal membranes (ligaments). Since the intraabdominal pressure is higher than the intrathoracic pressure, abdominal contents -usually stomach and greater omentum- can herniate through the dilated esophageal hiatus into the mediastinum, the central region of the thoracic cavity. This presents as a hernia sac whose walls are formed by endothoracic fascia, phrenoesophageal membranes and parietal peritoneum. There are two main types of esophageal hiatus hernias. Type I is known as a "sliding hiatal hernia" and is characterized by a complete ascension of the esophagogastric junction and abdominal esophagus into the thoracic hernia sac. This is usually accompanied by a typical "hourglass image" in a radiographic assessment, and also presents with gastroesophageal reflux disease (GERD). Type I esophageal hiatus hernias are more common. Type II esophageal hiatus hernia is known as a "paraesophageal hernia" and represent about 5 - 15% of esophageal hiatus hernias. In this case, the esophagogastric junction maintains its anatomical position inferior to the respiratory diaphragm, but the fundus and body of the stomach, along with some greater omentum herniate alongside the esophagus into the mediastinal region of the thoracic cavity. Although there can be GERD, this type of hernia usually presents with little symptomatology, and when it does, symptoms are related to ischemia or partial to complete obstruction. There are variations of type II hernia, which are classified as Type III and IV. Type IV, although rare, will include other viscera in the hernia sac, including colon, spleen, or even small intestine |
Images property of: CAA.Inc. |
| The accompanying images above depict a Type I esophageal hiatus hernia. The superior image shows the hernia in situ where the stomach and greater omentum are still in the hernia sac. The inferior image shows the contents reduced and the abdominal esophagus being pulled into the abdominal cavity. The dotted line shows the dilated esophageal hiatus that needs to be repaired to prevent recurrence of the pathology.
The image below answers a question by Victoria Guy Ratcliffe, who asked via Facebook "What would it be if it feels like you've got a blockage right at the level of the heart? That's too high for a hiatal hernia, isn't it? " The image answers the question. It shows a dissection of the left side of the thorax. The anterior thoracic wall and the left lung have been removed. The heart is immediately superior and anterior to the esophageal hiatus, and the hernia sac of a Type I esophageal hiatus hernia is seen immediately posterior and in contact with the heart. Whether this means that you will "feel" the hernia, it is up for debate, as all these structures have visceral innervation. Most probably, a well-developed Type II esophageal hiatus hernia might interfere with swallowing at this level, causing the sensation she mentions. Thanks for the question, Tori.
For additional information: "Approaches to the Diagnosis and Grading of Hiatal Hernia" Kahrilas et al Best Pract Res Clin Gastroenterol. 2008 ; 22(4): 601–616. |
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