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A Moment in History

Dr. Jean-Francois Calot 
Original image courtesy of the National Library of Medicine

Jean-Francois Calot (1861 – 1944)

French physician and anatomist, Jean-Francois Calot was born in Arrens-Marsous, a small farming community of the Hautes-Pyrénées. He received his bachelor degree in 1880 at Saint-Pe de Bigorre,  and then continued to study Medicine at the University of Paris, where he worked as an anatomy prosector. His doctoral thesis “De La Cholecystectomie” (On Cholecystectomy) was published in 1890 and republished in 1891.

Although his main interest laid in orthopedics and tuberculosis, Calot’s name is eponymically tied to an anatomical landmark described in his thesis, the “Triangle of Calot”, a triangular area that includes the biliary ducts associated with the gallbladder and the vascular supply to the gallbladder. This is an important region because of the high number of anatomical variations found in the area.

There is a discrepancy between the original description of this triangular region by Calot and what is used today. For more information, click on this link to read more on the “Triangle of Calot”, also known as the “cystohepatic triangle”.

During his medical career Calot worked at several French hospitals including the Rothschild hospital where he became Chief of Surgery. He was also the Chief of Surgery for the Cazin-Perrochaud Hospital, and the Orthopedic Institute of Berck-sur-Mer

During his orthopedic career Calot published many books “Chirurgie et orthopédie de guerre”, “Les maladies qu'on soigne á Berck”, “Berck et ses traitements : les raisons de sa supériorit?”, but his opus magnus is the book “« L'orthopédie indispensable aux praticiens” (Indispensable orthopedics for practitioners).

Calot is also known for his treatment of tuberculotic abscesses, and a conservative approach to musculoskeletal tuberculosis. The surgical approach of the times was to surgically open and clean the tuberculotic bone. Calot is known to have said “Ouvrir la tuberculose, c'est ouvrir la porte d' la mort” (To open the tuberculosis is to open the door to death).

Continuing his studies and treatment of tuberculosis, on December 22nd, 1896 Calot presents the the French Academy of Medicine a study of the treatment of 37 patients with hyperkyphosis due to Pott’s disease, a tuberculotic spinal deformity, named after Sir Percival Pott. This method included traction and a brace. The second image shows this treatment. Dr. Calot is standing at the center, looking at the patient.

In 1900 Calot founded the “Orthopedic Institute of Berck” which today is known as “Calot’s Institute of Berck-sur-Mer”.

Dr. Jean-Francois Calot and the treatment of Pott's disease
Original image public domain courtesy of the Universite Paris-Descartes Histoire de la Santé

Sources:
1. “Calot's triangle” Abdalla S, Pierre S, Ellis H. Clin Anat. 2013 May;26 (4):493-501
2. “La Vie et l'OEuvre de Francois Calot, chirurgien orthopédiste de Berck” Loisel, P. (in French). Report presented at Société Francaise d'Histoire de la Médecine on 18 March 1987


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Ligament of Treitz



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The ligament of Treitz is formed by 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 (see image #1) has an unusual in structure in that it is formed by a tendon with two muscular ends  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.

Anterior view of the duodenum and the suspensory muscle of the duodenum
Click on the image for a larger version
Original image by Dr. Václav Treitz
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.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