Medical Terminology Daily (MTD) is a blog prepared by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its 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 
Edward Jenner
Edward Jenner 
(1749-1823) 

English physician and surgeon, Edward Jenner was born in Berkeley, Gloucestershire. His training included a seven year apprenticeship to a surgeon. He then moved to London where he completed his training at the St. George’s Hospital with John Hunter. Jenner became Hunter’s assistant for anatomical dissection and research. After finishing his studies, he returned to Berkeley.

During Jenner’s time smallpox was a disease with high mortality and terrible complications that could leave a patient blind or scarred for life. Of most interest to him was local lore that related that farmers and milkmaids that contracted cowpox could not contract smallpox, even when in direct exposure to smallpox. Cowpox is a viral infection of cows causing only minor discomfort and complications when acquired by a human. 

In 1796 Jenner was visited by Sarah Nelmes, a patient with smallpox-like signs on her hands. Jenner diagnosed cowpox instead of smallpox and discovered that she was a milkmaid. Sensing the need for additional research, he inoculated a young boy by scratching the boy’s skin and then rubbing some of the material exuding from Sarah’s pustules. The boy developed cowpox.

A month and a half later Jenner exposed the boy to smallpox. The boy did not develop any signs or symptoms of smallpox. The new era of vaccination had started.

In spite of his success, the spread of this new technique was slow and not easy, with many detractor and critics. In the end, Jenner was honored for his discovery. In 1980 the World Health Organization formally declared the erradication of smallpox from the world. Individuals are not vaccinated against smallpox anymore and only a few samples of the virus exist in restricted laboratories in the world.

In the pages of “Medical Terminology Daily” we explain why the process is called “vaccination” and also the role that Jenner’s discovery had in the “Royal Philanthropic Vaccination Expedition” to the New World.

Sources:  
1. “Edward Jenner and the history of smallpox and vaccination” Riedel, S Proc (Bayl Univ Med Cent). Jan 2005; 18(1): 21–25
2. “Edward Jenner and the eradication of smallpox” Willis NJ Scott Med J. 1997 Aug; 42(4):118-21.


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Corona Mortis

Important for inguinal hernia anatomy and surgery, this term is Latin from [corona] meaning "crown' and [mortis] meaning "death'; the "crown or circle of death". The corona mortis (blue arrow) refers to an anatomical variation1, a vascular anastomosis between the obturator and the external iliac vascular systems that passes over Cooper's pectineal ligament and posterior to the lacunar (Gimbernat's) ligament. 

In some cases, the corona mortis is the actual obturator artery that arises from the inferior epigastric artery instead of the internal iliac artery. It can also arise from the external iliac artery. In both cases, it has been called an "aberrant obturator artery". This could be a misnomer, as this anatomical variation can be present in up to 25% of the cases. When present, the corona mortis  can be injured when a surgeon looks to enlarge the femoral ring by opening the lacunar ligament. This vascular structure could even be endangered in a laparoscopic procedure for inguinal of femoral hernia repair and a staple or tack is driven blindly into the pectineal (Cooper's) ligament.

Corona Mortis (A)Image property of: CAA.Inc.Artist: M. Zuptich

Berberoglu states that "although these tiny anastomoses... have been described in classical anatomy textbooks, these texts neglect to mention that theses anastomoses can be life-threatening".

In some rare cases, the corona mortis (aberrant obturator) artery coexists with the normal obturator artery.  Although called a [corona], this anatomical structure is an incomplete circle. In the image, the [corona mortis] is labeled "A".

Sources:
1. Rusu et al: "Anatomical considerations on the corona mortis" Surg Radiol Anat (2010) 32:17–24
2. Berberoglu et al: "An anatomic study in seven cadavers and an endoscopic study in 28 patients" Surg Endosc (2001) 15:72-75