This century old portrait is from the library of my Grant Medical College in Mumbai!
Who is he? How is he related to the famous Gray's Anatomy? How did he end up here?
A fascinating story from the archives of medicine!
The gentleman in this fine portrait is Henry Vandyke Carter. If you have ever seen earlier editions of Gray's anatomy, you will have noticed the gorgeous illustrations in them. Arguably, these illustrations made Gray's Anatomy a superlative text
The artist to those illustrations is Van Dyke Carter!
Instead of following convention of labelling structures outside the diagram, see how he labels them on the diagram itself, making out so easy to understand!
Also, he apparently directly engraved these, in a reverse mirror image, so they could be printed directly! Genius!
Also, he decided the fictional dissected subjects with compassion rather than the grotesque open eyed and open mouthed images prevalent back in the day!
However, it seems that as the book became famous, Henry Gray, flamboyant as he was, took all the credit and limelight, leaving the reticent genius Carter in the shadows.
See the name of Gray, Bold and larger font
This part of the story is even covered in the edition of Gray's that I (didn't) read! The 40th edition!
The other image is from Papa's edition of the book, which also takes cognisance of Carter's genius, even if hidden between lines
Frustrated, Carter came to Mumbai (the Bombay) to my institution! Grant Medical College! Here he served as the dean, and did some great work in an eclectic collections of fields
Seminal work on Mycetoma, Relapsing Fever, Leprosy, Kidney Stones!
List of deans of GMC, Mumbai. See number 7!
Coming back to our portrait! It's a beautiful portrait with Van Dyke Carter posing stoically. One may believe that with all the achievements, he moved on from Gray's Anatomy
But if you take a closer look at his bookshelf
You see this! Gray and Carter, in equal prestige on the spine of the book!
This along with a number of portraits will soon find their way into museum built on our campus!
There are so many more fascinating stories I have stumbled across from my century and a half year old Grant Medical College!
A young boy with severe progressive cerebellar ataxia, involuntary movements (posturing of hands), cognitive decline with seizures (including myoclonus).
His father had similar albeit milder symptoms, at an older age. Thoughts?
Let's break it down to the basics. Always start from Epidemiology! Progressive disorder that is affecting successive generations with suggestion of anticipation! that really narrows down the differential to select disorders
If Cerebellar symptoms are prominent, think Spinocerebellar Ataxias
If Chorea is prominent, think Huntington Disease
Our patient seems to have features of Cerebellum as well as Basal Ganglia, though
An illustration of the importance of pattern recognition in Neurology. At the outset, let me reveal this is a Myopathy. Try to note how this particular one is different from others. 10 years history
As with most myopathies, limb girdle weakness is present
But wait! Foot drop and prominent distal muscle weakness in a muscle disease??
And look at how strong the Quadriceps are! weak proximal and weakness with selective sparing of the quadriceps!
Distraught parents bring their son to you. They tell you that he has been having weakness of his left hand since 1 year. With wasting. No sensory symptoms. They have been told, Motor Neurone Disease . You look at his hand and smile reassuringly. Why?
First things first, the demographics don't fit ALS. He's a young boy. Secondly, The disease seems quite restricted. Third, no signs of upper motor neuron disease. Finally, this OBLIQUE AMYOTRPOHY is classical and clinches a diagnosis of HIRAYAMA DISEASE
Hirayama Disease typically affects young Asian males in their twenties. I have seen dozens of patients with Hirayama, never a girl (although case reports exist)
These boys tend to be lean and have long necks!
It is much more benign compared to ALS!
3. Look for colleges with super speciality rotations
4. Patient load should not be the only driving factor, as long has there are enough cases to learn, it’s just a number
5. Academics is good to have, but a motivated student can compensate for a lack of it IMO
6. There is nothing like the perfect residency, decide what you’re ready to compromise one
7. Don’t let your rank dictate your choice! Take up the subject you find engaging! Eventually however hectic it may seem, you will be glad you didn’t settle!
You are again asked to see a patient with GBS. A young man in his 30's, does not seem perturbed by his acute onset of weakness of lower limbs. He says he has been through it on many occasions before. This particular bout was triggered after a hearty meal at a wedding. Thoughts?
An important differential to GBS are the Channelopathies. This gentleman had low levels of Potassium, and correction of the same completely reversed his symptoms! On evaluation, he was diagnosed with a Channelopathy
Simplified Approach
Hypokalaemia is notorious to cause neurological weakness often mimicking GBS. However clinical pointers for it are
- Recurrent Attacks
- Triggered by Alcohol/Carbs
- No Bulbar/ Facial Involvement
-Preserved reflexes (Can have areflexia!)
-Rapid (to come and go)
-Normal CSF
Young boy w/ acute onset quadriparesis with areflexia, admitted to ICU with "GBS". You happen to glance at Urine Bag. something is off! The old urine is darker!? The patient is squealing with abdominal pain. Relatives tell you- seizures in the past
Thoughts?
This surely doesn't feel like a routine GBS. Young boy with seizures and abdominal pain, think of the Porphyrias!
Our patient probably has one of the acute Porphyrias. Confirmation of the type eluded us unfortunately since genetic analysis is expensive. Probably AIP
Neuro Porphyrias include 1. Acute Intermittent Porphyria (AD) 2. Hereditary Coproporphyria (AD) 3. Variegate Porphyria (AD) 4. ALA Dehydrates Porphyria