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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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Commotio Cordis

I have received several questions regarding this term and its meaning, because of the cardiac arrest suffered on the field by the Buffalo Bills defensive player Damar Hamlin while playing the Cincinnati Bengals on January 2nd, 2023.

For those who were watching the game, close to the end of the first quarter Hamlin blocked another player in what looked like a normal and standard play. Immediately after, Damar Hamlin stood up and immediately collapsed. The video can be seen here. The player was treated on the field and later reports indicated that he had suffered a cardiac arrest and was treated with CPR (manual cardiopulmonary resuscitation), the use of an AED (Automated External Defibrillator) and oxygen. The player was intubated and was considered to be in critical, but stable condition.

The consensus is that Damar Hamlin suffered a ventricular arrhythmia, which allowed the heart to beat erratically, but not be able to pump blood, which is why he had to be defibrillated using the AED.

The cause for this is an uncommon (30 cases per year in the US) but known situation known as Commotio Cordis, a ventricular dysrhythmia caused by a sudden hit to the sternum in a particular location*. It has been seen in baseball and softball players where the pitcher is hit in the sternum by a fast ball coning from first base. Also seen in lacrosse players. In most cases this happens in younger individuals where the four sternabrae that form the body of the sternum have not yet completely ossified, making the sternum and lower costal cartilages quite flexible, being able to “bend in” when hit directly and compress the heart.

As some of you may know, I am a 7th Degree Black Belt in Goju-Ryu Karate. This type of punch to the sternum is one of the many techniques used in advanced Martial Arts. In most cases this punch will slow down an opponent, but it does not cause Commotio Cordis. It is a technique that should only be practiced under very close supervision. In fact, this technique was thought to be legend and was called “the touch of death” in China.

An example of Commotion Cordis caused by a Karate move can be see in the following video. Look at the hand of the practitioner on the right and the devastating consequence that follows. Please note the similarity of the situation in this video and what happened to Damar Hamlin. There is a lapse of time between the commotio cordis cardiac arrest where the athlete gets up or walks followed fainting and unconsciousness.

The words are Latin. Commotio means “agitation or commotion”. Cordis means heart. The conditions to cause Commotio Cordis need to be exact, as the heart needs to be in ventricular repolarization, when the heart ventricles are starting to refill with blood. The "window" for a sternal hit to cause Commotio Cordis is very small.

For additional information please visit StatPearls at https://www.statpearls.com/ArticleLibrary/viewarticle/19761