Our Sponsors caatmsmtdad    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

Andreas Vesalius Bruxellensis (1514- 1564)

A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". Dr. Miranda


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Requesting help for a medical mission to Belize

Jackie Miranda-Klein is a contributor to this blog with several suggestions that have been published. Jackie has a Health Sciences Degree from University of Cincinnati, and she is currently enrolled in the Physician Assistant Program at Kettering College in Dayton, OH.  She has a passion for patient care and helping children.  She worked at both Cincinnati Children's Hospital and Nationwide Children's Hospital in Columbus.

Jackie is known for volunteering her work to the community and donating to several causes.  Through her program at Kettering College, she has been selected to join an international medical mission to Belize.  There, she will go with faculty and health care providers to give needed care and education to sick youth in Belize City and surrounding areas. 

 Jackie Miranda-Klein

Click on the image for a larger version. 

The trip itself is expensive, and Jackie must pay for her travel and expenses. To help with this, she just started a GoFundMe page where she hopes to reach US$2,500 to fund the trip and expenses.  She is currently researching worthy charities to donate any funds raised in excess of what is needed.  

Jackie is very dedicated to her studies and to the patients that are placed in her care. I am sure that she will do an excellent job in Belize and her patients will most surely remember her forever.

If you can, please donate to this great cause. Dr. Miranda.

UPDATE: Jackie's Mission to Belize GoFundMe page is up to 10%!! Every little donation helps...


GoFundMe page: "Jackie's Medical Mission to Belize"



Kabourophobia

Kabourophobia is the fear of crabs and lobsters.

The etymology of the word [kabourophobia] comes from the Greek word [καβουρης] (pronounced “kavouris”), meaning [crab], and the suffix [-phobia], also from the Greek, arises from the word [φοβία] (pronounced “fovía”)

Kabourophobia is an extremely rare phobia, but it was brought to the public’s attention when a modern pop singer stated that she was afraid of crabs. Also, a prank (maybe acted) was shown on video on the internet with a man surrounded by lobsters.

Kabourophobia is very specific, and it can also be a part of a wider phobia called ostraconophobia, which is the fear of crustaceans, adding shrimp, oysters, clams, crabs, lobsters, etc.

 Liocarcinus vernalis © Hans Hillewaert  via Wikimedia Commons

Click on the image for a larger version. 

An interesting point is that the word [crab] in Greek has another acception, that is the word [Καρκίνος] (pronounced “karkinos”), which is the root for the medical term [cancer].

We thank Jackie Miranda-Klein for her contribution suggesting this word. Please consider contributing to Jackie's medical mission to Belize by "clicking here".


Sympathetic / parasympathetic

The word sympathetic is the adjectival form of sympathy. This word arises from the Greek [συμπάθεια]and is composed of [syn/sym] meaning “together” and [pathos], a word which has been used to mean “disease”. In reality “pathos” has to do more with the “feeling of self”. Based on this, the word sympathy means “together in feeling”, which is what we use today.

How the term got to be used to denote a component of the so-called autonomic nervous system is part of the history of Medicine and Anatomy.

Galen of Pergamon (129AD-200AD), whose teachings on Medicine and Anatomy lasted as indisputable for almost 1,500 years, postulated that nerves were hollow and allowed for “animal spirits” to travel between organs and allowed the coordinated action of one with the other, in “sympathy” with one another. As the knowledge of the components of the nervous system grew, this concept of “sympathy” stayed, becoming a staple of early physiological theories on the action of the nervous system.

Jacobus Benignus Winslow (1669-1760) named three “sympathetic nerves” one of them was the facial nerve (the small sympathetic), the other the vagus nerve, which he called the “middle sympathetic”, and the last was what was known then as the “intercostalis nerve of Willis” or “large sympathetic", today’s sympathetic chain. Other nerves that worked coordinated with this “sympathetics” were considered to work in parallel with it. It is from this concept that the term “parasympathetic” arises.

Galen of Pergamum
Galen of Pergamon 
(129AD - 200AD)

 

Interestingly, the ganglia on the sympathetic chain were for years known as “small brains” and it was postulated that there was a separate multi-brain system coordinating the action of the thoracic and abdominopelvic viscera. The coordination between this “autonomous nervous system” and the rest of the body was made by way of the white and gray rami communicantes.

Today we know that there is only one brain and only one nervous system with an autonomic component which has a “sympathetic” component that is mostly in charge of the “fight or flight” reaction and a “parasympathetic” component that has a “slow down” or “depressor” function. Both work coordinated, so I guess Galen was not "off the mark" after all.

So, we still use the terms “sympathetic” and “parasympathetic”, but the origin of these terms has been blurred by history.

Sources:
1. "Claudius Galenus of Pergamum: Surgeon of Gladiators. Father of Experimental Physiology" Toledo-Pereyra, LH; Journal of Investigative Surgery, 15:299-301, 2002
2. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
3. "Medical Meanings:A Glossary of Word Origins" Haubrish, WS American College of Physicians Philadelphia, 1997
4. "The History of the Discovery of the Vegetative (Autonomic) Nervous System" Ackerknecht, EH Medical History, 1974 Vol 18. 
Original image courtesy of Images from the History of Medicine at nih.gov

Note: The links to Google Translate include an icon that will allow you to hear the pronunciation of the word.


Epistaxis

The medical term [epistaxis] refers to a “nose bleed”.

It is considered to be a Modern Latin term that originates from the Greek word [επίσταξη(epístaxí). The word is composed of [επί] [epi-] meaning "on", "upon", or "above", and [στάζει] (stázei), meaning "in drops", "dripping".

The term was first used by Hippocrates, but only as [στάζει] , to denote dripping of the nose, and was later changed to [επίσταξηto denote “dripping upon”. The term itself does not include or denote that the blood loss is from the nose, but its meaning has been implied and accepted for centuries. The plural form for epistaxis is epistaxes.

Skinner (1970) says that the term was first used in English in a letter by Thomas Beddoes (1760-1808) in a letter to Robert W. Darwin (1766-1848) in 1793. Robert Darwin was an English physician, father or Charles Darwin (1809-1882) author of “The Origin of the Species”.

Sources:
1. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
2. "Medical Meanings - A Glossary of Word Origins" Haubrich, WD. ACP Philadelphia 

Note: The links to Google Translate include an icon that will allow you to hear the pronunciation of the word.


Kiesselbach's plexus

Kiesselbach's plexus is named after Dr. Wilhelm Kiesselbach (1839 – 1902), a German otolaryngologist. It is an area in the anteroinferior aspect of the nasal septum where several arteries from different origins meet and anastomose.

This arterial plexus is also known as the "locus Kiesselbachii", Kiesselbach's triangle, or Little's plexus, or Little's area. This area of the anteroinferior nasal septum has a propensity for epistaxis or nasal bleeding. In fact, close to 90% of nose bleeds (epistaxes) happen in this area.

in this region, terminal branches of the anterior ethmoid artery, greater palatine artery, sphenopalatine artery and superior labial artery anastomose forming an anastomotic circle. The anastomoses are numerous enough to form a plexus.

Kiesselbach's plexus
Click on the image for a larger view

There is a secondary area where epistaxis may happen, but this is a venous nose bleed. This is Woodruff's plexus, a venous plexus found in the posterior aspect of inferior turbinate on the lateral wall of the nose. 

Thanks to Jackie Miranda-Klein for suggesting this post. Jackie is studying for the Physician Assistant Master's degree at Kettering College. Dr. Miranda.


Halsted’s “Rules of Surgery”

In my many years working with medical industry, surgeons, and surgery, I have heard many times that such and such surgical technique follows “Halsted’s Rules of Surgery”. The problem is that only two of these “rules” were mentioned and never did I receive an answer while working with Ethicon and Ethicon Endosurgery, and never did I receive an answer as to where could I find the reference regarding the other rules, if they even existed.

I recently read a great 1957 book by Samuel James Crowe, MD (1883-1952), titled “Halsted of John Hopkins; the man and his men”. Dr. Crowe lived for one year with Dr. William Stewart Halsted (1852-1922) and his wife as a medical student at John Hopkins. He was also an intern for Dr. Harvey Cushing, and although he wanted to follow Cushing into neurosurgery, Dr. Halsted placed him in charge of the newly created department of otolaryngology at John Hopkins, a position he did not want. Dr. Crowe went on to become a world-wide renown otolaryngologist.

Here are Halsted’s “Rules of Surgery” as explained by Dr. Crowe, based on Halsted’s research, experiments, and observations (with my own notes and comments):

1. Wounds are resistant to infection when no bits of tissue have been:

a. torn with clamps 
b. torn by the rough handling of retractors 
c. devitalized by hastily and carelessly applied ligatures

HalstedWilliam S. Halsted
mouseover for
Samuel J. Crowe

Note: this follows the ancient rule of “primum non nocere”: first and foremost, do not harm

2. Wounds or parts rich in blood vessels usually heal without any visible granulation, even when no antiseptic precautions have been taken.

3. Incisions should be closed carefully and gently, layer by layer

4. The approximating sutures should never put the tissues under tension, since tension interferes with the blood supply and may cause necrosis

Note: Tension-avoidance surgical techniques follow this, one of the prime rules of surgery.

5. The end of the forceps used to pick up bleeding points should be small, to avoid crushing and destroying the vitality of surrounding tissues

Note: This observation led to the creation of fine, multiple toothed thumb forceps used today in cardiovascular surgery , such as the Cooley, DeBakey, Castaneda, etc. type forceps.

6. A drain is essential when there is necrotic tissue and infection

7. Silk should never be used in the presence of infection

Note: This makes sense. Since silk is an organic material, infected tissues will react to the presence of this extraneous material causing more inflammation, and the phagocytic cells in the tissues will destroy the silk and its capacity to hold the tissues together

8. The silk (suture) employed should never be coarser (larger gauge) than necessary and it is well to employ a suture a thread that is not stronger that the tissue it holds

9. A greater number of fine stitches is better than a few coarse ones

Note: This also makes sense. Halsted was known to be extremely meticulous and he could place a hundred stitches of fine silk thread where other surgeons would place a lesser number of coarser stitches. Using a larger number of fine stitches distributes the approximating tension of the sutures over a larger area, thus reducing the chance for suture dehiscence.

10. Avoid when possible the combined use of silk and catgut in a wound

11. For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, silver wire serves admirably

Note: Remember the times when these guiding principles where laid. Nylon, polypropylene, and other synthetic absorbable and non-absorbable sutures had yet to be discovered. Today the same dictum would probably say “For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, a synthetic non-absorbable suture material serves admirably”

It must be noted that Halsted never called the above the “rules of surgery”, rather they are observations that have become guiding principles. These have influenced the world of surgery to this day.

SIDE NOTE: It has been said many times that Dr. Halsted was the first to use rubber gloves. This is not true, Dr. Crowe says that “it was an evolution rather than a happy thought” and it involved his wife Caroline Hampton. This will be the subject of another article.