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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Ligament of Treitz

The ligament of Treitz is a fold of peritoneum over the suspensory muscle of the duodenum. This muscle is also known as the "muscle of Treitz" or "musculus suspensorius duodenii". This muscle was first described in 1853 by Dr. Václav Treitz. 

The muscle has an unusual in structure in that it is formed by a tendon with two muscular ends (see image #1) of dissimilar embryological origin and function. The superior muscular component is skeletal (voluntary) muscle and arises as a slip of muscle (Hilfsmuskel) from the right esophageal crus of the respiratory diaphragm, as well as muscular and ligamentous fibers arising in the region of origin of the celiac trunk and superior mesenteric artery. The inferior portion of the muscle is smooth (involuntary) muscle and has been described as continuous with both the longitudinal and circular muscle layer of the intestine at the duodenojejunal junction.

The ligament of Treitz is an anatomical landmark used by anatomists and surgeons to denote the duodenojejunal junction and the point where the small intestine passes from retroperitoneal duodenum to intraperitoneal jeunum. Surgeons use the ligament of Treitz to measure the jejunum to decide where to perform an anastomosis.

Suspensory muscle of the duodenum 1. skeletal muscle 2. tendon 3. smooth muscle
Click on the image for a larger version
Original image by Dr. Vaclav Treitz
Click on the gray bar below the image to see the original sketch published by Dr. Václav Treitz in his 1853 publication "Ueber einen neuen Muskel am Duodenum des Menschens" (On a new muscle in the duodenum of man). The 'muscle of Treitz" is marked by an arrow.

Clinical anatomy, pathology, and surgery of the gastrointestinal tract are some of the many lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.

Sources:
1.
"Clinically Oriented Anatomy" Moore, KL. 3r Ed. Williams & Wilkins 1992
2. "The origin of Medical Terms" Skinner, AH, 1970
3. "The suspensory muscle of the duodenum and its nerve supply" Jit, I.; Singh, S. J. Anat. (1977), 123, 2, pp. 397-405
4. "Anatomical and functional aspects of the human suspensory muscle of the duodenum." Costacurta, L. Acta Anat (Basel). 1972;82(1):34-46
Image property of:CAA.Inc. Artists:Dr. E. Miranda and D.M. Klein