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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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Pectoralis major

UPDATED: The pectoralis major muscle is the largest muscle in the anterior aspect of the thorax. It is thick and fan-shaped.  It attaches superiorly to the medial 2/3rds of the clavicle, and medially to the anterior aspect of the sternum and cartilages of the first to sixth or seventh ribs, extending inferiorly to attach to the aponeurosis of the external oblique muscle. Laterally, this muscle attaches to the lateral lip of the intertubercular groove (bicipital groove) of the humerus by a two-layered quadrilateral tendon which inserts each of the two heads of the muscle.

The superficial tendon attaches the clavicular head (red in the accompanying image), which extends between the intertubercular groove of the humerus and the clavicle. The deep tendon attaches the sternocostal head (purple in the accompanying image), which extends between the humeral intertubercular groove and the attachments in the sternum, costal cartilages, and the aponeurosis of the external oblique muscle. There is usually a well-defined interval between the two heads of the pectoralis major.

The pectoralis major is innervated by the medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C7).

This muscle is covered by the pectoral fascia. An extension of this fascia is the clavipectoral fascia. In both male and female, the mammary gland is situated anterior to and anchors to the pectoral fascia by a number of fascial ligaments known as "Cooper's ligaments"

When both pectoral heads contract as a unit, the muscle adducts. flexes, and medially rotates the shoulder joint and humerus, such as when swimming doing and Australian crawl. Testut & Latarjet (1931) describe three separate muscular segments to this muscle, a clavicular component, a superior sternocostal component, and an inferior sternocostal component. They state that the clavicular components is quite evident, but the other two, although difficult to see, are separate. The clavicular head draws the humerus forward, upward, and medially, such as when you reach for something in front and above you. The sternocostal head draws the humerus down, forward, and medially.

The second image in this article is from Testut & Latarjet (1931) and shows the direction of muscular fibers of the three segments of the pectoralis major.

The word pectoral arises from the Latin term "pectum" meaning "chest, breast". In its true meaning, pectoral or pectoralis refers to a "chest plate" or an "adornment of the chest".

Pectoralis major muscle - Red: clavicular head. Purple: Sternocostal head - Image modified from the original by Henry VanDyke Carter, MD. Public domain
Pectoralis major muscle
Click on the image for a larger depiction 

Pectoralis major muscle - Direction of the muscular fibers. Public domain
Pectoralis major. Direction of the muscular fibers
Click on the image for a larger depiction 

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015

First image modified from the original by Henry VanDyke Carter, MD. Public domain


Latissimus dorsi

The latissimus dorsi muscle is a large, wide, flat muscle on the posteroinferior aspect of the back. It has the shape of a triangle that has a base at the thoracolumbar spine and its apex in the axillary region.

This muscle has a wide origin by tendons that attach to the spinous processes of the lower six or seven thoracic vertebrae as well as those of the lumbar vertebrae, the sacral crest, and the posterior aspect of the external lip of the iliac crest. This created a wide fibrotendinous lamina known as the thoracolumbar fascia. The muscle also attaches to the external surface of the three or four inferiormost ribs and the inferior angle of the scapula.

From here, the muscle fibers converge superolaterally and twist anterosuperiorly to form a quadrilateral tendon that inserts deep into the bicipital groove (Lat: sulcus intertubercularis) of the humerus as shown by number 5 in the accompanying figure. There is sometimes a tendinous extension to the humeral lesser tubercle.

The latissimus dorsi extends, adducts, and medially rotates the shoulder joint, also known as the glenohumeral joint. Along with the teres major muscle they are known as the “handcuff muscles”, as this is the action of these muscles as the hands are brought together towards the back. The latissimus dorsi is innervated by the thoracodorsal (or long subscapular) nerve (C6, C7, and C8).

Latissimus dorsi muscle (1) - Testut & Latarjet 1931. Public domain
Latissimus dorsi muscle (1)
Click on the image for a larger depiction

The Terminologia Anatomica 2 proper name is “musculus latissimus dorsi”. The plural form is “musculi latissimi dorsi”. The name of the muscle is derived from Latin. Since “latum” means “wide”, “musculus latissimus dorsi” means the “widest muscle of the back”, quite a proper name. In other languages this is more evident. In Spanish, the name for the muscle is [músculo dorsal ancho] meaning the “wide muscle of the back”.

The latissimus dorsi is one of the 17 muscles that attach to the scapula. It also forms one of the borders of the lumbar triangle of Petit, potential site for a lumbar hernia.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010

Name the 17 muscles that attach to the scapula

UPDATED: The scapula is a flat, triangular bone that forms the posterior portion of the shoulder girdle. It is described with two surfaces, three borders, and three angles. The scapula attaches to the clavicle by way of the acromioclavicular joint and ligaments. . Seventeen muscles attach to the scapula and are listed here alphabetically:

1. Biceps brachii
2. Coracobrachialis 
3. Deltoid  
4. Infraspinatus 
5. Latissimus dorsi
6. Levator scapulae 
7. Omohyoid (inferior belly)
8. Pectoralis minor 
9. Rhomboid major 
10. Rhomboid minor 
11. Serratus anterior 
12. Subscapularis 
13. Supraspinatus 
14. Teres major 
15. Teres minor 
16. Trapezius
17. Triceps brachii (long head)

By surfaces, borders, and structures, these muscles group and attach as follows:

Anterior view of the left scapula.  Image in Public Domain, by Henry Vandyke Carter, MD - Gray's Anatomy
Anterior view of the left scapula.  Image in Public Domain, by Henry Vandyke Carter - Gray's Anatomy
Posterior surface:
1. Supraspinatus
2. Infraspinatus
3. Teres major
4. Teres minor

Scapular spine and acromion:
5. Trapezius
6. Deltoid

Anterior surface:
7. Subscapularis
8. Serratus anterior

Medial border:
8. Serratus anterior
9. Rhomboid major
10. Rhomboid minor
11. Levator scapulae

Superior border:
12. Omohyoid (inferior belly)

Medial border:
13. Triceps brachii (long head)

External angle:
14. Biceps brachii (long head)

Coracoid process:
14. Biceps brachii (short head)
15. Coracobrachialis
16. Pectoralis minor

Inferior angle:

17. Latissimus dorsi

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have to separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda
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
 

Coracobrachialis

The coracobrachialis muscle is a thin, elongated bilateral flexor muscle that extends between the coracoid process of the scapula and the humerus bone. It is the shortest of the three muscles that attach to the coracoid process, the others being the pectoralis minor muscle and the tendon of the short head of the biceps brachii muscle. The coracobrachialis muscle attaches by way of a tendon into the middle third of the medial surface of humerus between the origins of the triceps brachii and brachialis. Its tendon mixes with the tendon of the pectoralis minor.

The coracobrachialis id one of the three muscles contained in the anterior compartment (flexor compartment) of the arm, the other two being the brachialis and the biceps brachii.

The coracobrachialis muscle helps to flex and adduct the arm as well as to stabilize the shoulder joint, helping prevent dislocation. It receives innervation from the musculocutaneous nerve (C5-C7). This nerve, as it continues distally pierces the muscle and appears on its anterior aspect coursing inferiorly, The muscle is used when you reach with your hand and forearm to the contralateral aspect of your body, as in reaching to scratch your opposite ear, or doing a bench press.

Coracobrachialis muscle - Image modified from the original by Henry VanDyke Carter, MD. Public domain
Coracobrachialis muscle.
Click on the image for a larger depiction

It is found deep to the pectoralis major and anterior to the axillary artery and the brachial plexus. Along with the humerus and the short head of the biceps brachii, the coracobrachialis muscle forms the lateral wall of the axilla.

The coracobrachialis is one of the 17 muscles that attach to the scapula.

Note: The side image modified from the original in "Gray's Anatomy" by Henry VanDyke Carter, MD. Public domain. Animated image below by Wikimedia Commons - Anatomography [CC BY-SA 2.1 following Creative Commons attributes.

Anatomography, CC BY-SA 2.1 JP <https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en>, via Wikimedia Commons

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010


William J. Larsen, PhD


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

William J. Larsen, PhD (1942-2000). An American scientist, Dr. Larsen was a gifted scientist, consistently producing research at the forefront of cell, developmental, and reproductive biology. Early in his career he published a landmark paper that conclusively established mitochondrial fission as the mechanism of mitochondrial biogenesis. He went on to become the first to demonstrate the endocytosis of gap junctions. Moreover, his work on the hormonal regulation of gap junction formation and growth culminated in an authoritative review article in Tissue and Cell, “Structural Diversity of Gap Junctions (1988)”, which became a citation classic.

Throughout his 25 year teaching career, his sixty-seven peer reviewed publications—not to mention numerous invited reviews, abstracts, and book chapters—covered a wide range of research areas including adrenal cortical tumor cells, human ovarian carcinomas, preterm labor, cumulus expansion, oocyte maturation, ovulation, folliculogenesis, and in-vitro fertilization.

In addition to his many contributions to basic research, Dr. Larsen loved to teach and was much appreciated by his students. His exceptional ability was reflected in the four teaching awards he received as a professor at the University of Cincinnati.

William J. Larsen, PhDImage courtesy of
Dr. Larsen's family
Notably, he was the author of Human Embryology, a textbook for medical students that was the first to incorporate modern experimental research into a subject that had traditionally been taught in a strictly descriptive style. On its initial publication in 1998 it was hailed as, “a magnificent book…” by the European Medical Journal. With the release of the fourth edition in 2008, the book was renamed “Larsen’s Human Embryology” in recognition of Dr. Larsen's place as the originator of this revolutionary text. This book is today in it's 6th Edition.

His stellar scientific career would be enough for most people, but Dr. Larsen pursued his numerous and varied interests with such extraordinary passion, energy, and skill that he seemed to have more hours in a day than the ordinary person. He was fascinated with the American Southwest and studied and collected traditional arts and crafts of the Hopi, Zuni, and Navajo peoples. He was a woodworker who built three harpsichords and a fortepiano for his wife, and, with his two children, over 100 pieces of gallery-quality furniture. In addition, he loved to regale his friends, colleagues, and students with jokes and stories, and to share his love for gourmet cooking.

The William J. Larsen Distinguished Lecture Series

An annual lecture series was created for the Department of Cancer & Cell Biology at the University of Cincinnati to honor Dr. Larsen's research which was at the forefront of cell developmental and reproductive biology. This series recognizes forward-thinking research scientists in the field of developmental biology and asks that they share their research and findings with students and faculty of the University of Cincinnati, College of Medicine.

Personal note: I had the opportunity to meet and attend Dr. Larsen’s embryology lectures as he and I worked in the Anatomy, Embryology, and Histology program at the University of Cincinnati Medical College. Unfortunately, I never had the opportunity to have Dr. Larsen sign my personal copy of his book. He is sorely missed, Dr. Miranda

Sources:

1. "The William J. Larsen Distinguished Lecture Series" University of Cincinnati, College of Medicine.
2. https://www.larsenbooks.com
3. 2022 Larsen Lecture Series brochure (download here)
4. Dr. Larsen's family personal communications


“The King’s Anatomist” – The Journey of Andreas Vesalius

“In 1565 Brussels, the reclusive mathematician Jan van den Bossche receives shattering news that his lifelong friend, the renowned and controversial anatomist Andreas Vesalius, has died on the Greek island of Zante (today’s Zakynthos) returning from a pilgrimage to the Holy Land. Jan decides to journey to his friend’s grave to offer his last goodbye…” Thus begins the saga and the book the “King’s Anatomist”.

In June 2022 during the annual American Association of Clinical Anatomists (AACA) meeting in Fort Worth, TX, I was lucky to bid and win this, one of the latest books on Andreas Vesalius. This book, written by Ron Blumenfeld, MD. proved to be not only a great read, but also an quite historically accurate story. Let me explain this statement.

The book belongs to the genre of Historical Fiction, where the author does detailed research on a topic and then writes on accurate background but adds fictional characters and situations. Sometimes, as in this book, it follows a mystery that slowly unravels leading to shocking situations. To be fair, the author does explain what is not necessarily quite historically accurate, so as to leave no doubt about what is real or not.

The book is enthralling, the plot well developed, and the description of the academic environment, the details of the scenery for the travelers, the pettiness of war, etc., is not only interesting, but also portrays the times during the life of Andreas Vesalius in such a way that I felt transported there. It was very difficult to put the book down until I finished it.

 The King's Anatomist - Book by Ron Blumenfeld MD
The King's Anatomist - Book Cover
Click on the image for a larger version

Ron does a great job getting us a little bit closer to who was Andreas Vesalius, the child at school, the youngster, the anatomist, the friend, the father, and the husband.

I should probably stop here and let you decide on the book for yourself without giving too much away. I strongly recommend this book and hope that you will enjoy it as much as I did. You can visit Ron’s website here to buy his book.

On a side note, Ron and I both attended the 2014 “Vesalius Continuum” meeting in the Greek island of Zakynthos. This meeting celebrated the 500th anniversary of the birth of Andreas Vesalius. Part of the book he wrote is based on the discussions and presentations at this meeting.

Following are some excerpts of Ron’s bio and website in his own words:

“I’m a native New Yorker, pediatrician and health care executive who reunited with his inner writer in retirement. I surrendered the pleasure of writing columns on various topics for my local newspaper in Connecticut to focus on my debut novel, The King’s Anatomist”

“There always was a writer cooped up inside me, but he got loose only after I retired. I had permitted him to show up only in school classes, health and business writing, and newspaper columns, but I realize now that I kept him on a short leash because I was afraid of him – afraid of his disruptive potential and afraid of what he would look like to the world. But at this point in my life, I got past those excuses and let him out to see what he could do.

The King’s Anatomist, it turned out, was an ideal writing project, anchored in facts, but with ample room for creativity. Thank you, Andreas Vesalius, for being such an interesting guy.”

Thank you, Ron, for signing and dedicating my personal copy of your book. It will have a nice place in my library. Dr. Miranda.

Should you want to look for more information on Andreas Vesalius in this website click here.