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Incredible and exciting good news!!!

Friends of Medical Terminology Daily:

As you know, we are part of an incredible quest to find the body of Andreas Vesalius, recognized worldwide as the Father of Modern Anatomy. His life and the story and legends about his death are part now of scientific fact and folklore.

The quest for the lost grave of Andreas Vesalius has been published in this blog several times. Many of the members of this group, such as Pascale Pollier, Theo Dirix, Dr. Sylvianne Déderix, Dr. Maurits Biesbrouck, etc. are contributors to Medical Terminology Daily.

The project has had several stages and you are welcome to follow the above links to the authors to read their contributions which clarify the scope and objectives of this quest, including Theo Dirix's article : "To put it in another way: where do we have to look for Vesalius's grave?"

Wax bust of Andreas Vesalius by Pascale Pollier Wax bust of Andreas Vesalius by Pascale Pollier. Click on the image for a larger depiction

The project next step is to perform a detailed research on the area where we suspect (actually know with a high degree of certainty) where the cemetery of the Church of Santa Maria delle Grazie used to be.

The problem was to obtain the permits to do the non-invasive radar scan of the grounds in the area... and this is the exciting news! Following is the press release:

"The Belgian School of Archaeology)in Athens (EBSA) just obtained the permission for a new archaeological project at Zakynthos in collaboration with the local Ephorate and Dr Merkouri, as well as the IMS in Rethymnon (Dr A. Sarris). The project, initiated and coordinated by Theo Dirix and Pascale Pollier, concerns the quest for the tomb of the Belgian anatomist, father of modern anatomy, Andreas Vesalius who died and was buried in the island."

Needless to say, we are all excited. Now we have to fund this research, and you can all help by contributing as little or as much as you can to the GoFundMe page. We are very close to our objective and this will allow us to pay the permits, rent the equipment and finally get a little closer to finding Andreas Vesalius.

Original photograph of the Church of Santa Maria delle Grazie in Zakynthos, Greece Original photograph of the Church of Santa Maria delle Grazie in Zakynthos, Greece. Click on the image for a larger depiction

Personal note: Click on the following link to collaborate with this incredible quest. I already did. Dr. Miranda


GoFundMe Campaign for the next stage of the project



Arterial circle of Willis

UPDATED: The arterial "circle of Willis" is a roundabout of arteries found at the base of the brain, allowing for collateral circulation at this level. This arterial circle has been described by many anatomists, but it was Thomas Willis (1621 - 1675) who described it in most detail, and he was the first to understand its function.

The circle of Willis receives blood from the two main paired arteries that provide blood supply to the head and brain: the carotid arteries anteriorly, and the vertebral arteries posteriorly.

This arterial circle is formed by the anastomosis of several arteries, paired and unpaired:

Anterior cerebral arteries: These paired arteries are one of the terminal branches of the internal carotid arteries. They provide blood supply to the medial aspect and part of the lateral aspect of frontal and parietal lobes of the brain

• Anterior communicating artery: A single unpaired small artery communicating both anterior cerebral arteries and providing potential collateral circulation between them

• Internal carotid arteries: These two bilateral arteries are one of the branches of the carotid artery found at the root of the neck. Its two main terminal branches are the anterior cerebral arteries and the middle cerebral arteries

Arterial circle of Willis (en.wiklipedia,org)
Image courtesy of www.wikipedia.org 

• Posterior cerebral arteries: These two arteries are formed by the bifurcation of the basilar artery, which itself is formed by the junction of the right and left vertebral arteries. The posterior cerebral arteries provide blood supply to the occipital lobe and part of the temporal lobe of the brain

Posterior communicating arteries: These paired arteries provide communication between the carotid and vertebral arterial territories 

Middle cerebral arteries: Although not technically part of the arterial circle of Willis, these paired arteries are one of the two terminal branches of the internal carotid arteries. The middle cerebral artery travels deep in the lateral sulcus (Sylvian fissure) of the brain and provides blood supply to the lateral aspect of the brain including the frontal, parietal, occipital, temporal, and insular lobes

The arterial circle of Willis provides all of the arterial blood to the brain. Cerebral blood flow in humans averages 55 mL per 100 g of brain tissue per minute. This is a about over 742.5 mL/min for the average 1350 g brain. Depending on the situation the brain will use between 15 to 20 percent of the total cardiac output, although by weight the brain is only about two to three percent of the average body weight. Incredibly, the brain uses more oxygen that most organs averaging close to 25% of the total oxygen needs of the body!

The importance of the arterial circle of Willis is that beyond this point the arterial supply to the brain becomes terminal, that is, there are little or no anastomoses between the bifurcating branches exposing the brain to ischemia and necrosis should there be an arterial stenosis or stricture. The circle of Willis is an area prone to aneurysms, with over 27,000 cases yearly in the US.

For an image of the vascular territories of the brain, click here.

Clinical anatomy, pathology, and surgery of the brain and spinal cord are some of the lecture topics developed and delivered by Clinical Anatomy Associates, Inc.

Thanks to Jackie Miranda-Klein for making me review this post and update it!... and congratulations to Jackie for starting her Physician Assistant Master's degree at Kettering College. Dr. Miranda.


Mandibular canal

The mandibular canal is a long, bilateral canal which runs along and within the mandible. This canal transports the inferior alveolar neurovascular bundle. The mandible is known vernacularly as the “jawbone” or “lower jaw”.

The mandibular canal starts on the medial surface of the mandibular ramus at the mandibular foramen (Figure A, arrow) descends anteroinferiorly through the body of the mandible until it ends in the mental foramen at the buccal (anterior) surface of the mandible, usually in the area between the premolars (Figure B, arrow).

Before exiting, the canal forms an “anterior loop” projected anterior to the mental foramen prior to changing its direction back and outwards in direction to the buccal plate (Figure C, red line). This last portion of the canal is called the “mental canal”.

A frequent anatomical variation is the presence of a bifid mandibular canal (recent studies indicate it has a prevalence of around 16%).

Different anatomical studies show that the mandibular canal not only finishes at the mental foramen, but it could divide itself giving an incisive canal which runs anteriorly onto the incisal region (Figure C, yellow line). When it doesn’t continue as an incisal canal, the neurovascular elements go anteriorly through the cells of the spongy bone tissue.

The presence of this Incisal canal has surgical relevance, and knowledge of its exact location and anatomical parameters has a high importance on reducing complications of surgical procedures in the mental area such as dental implants, bone lesions removal and bone harvesting among others, all which could damage the incisal canal and the neurovascular bundle inside it.

With the latest use of CBCT (Cone Beam Computed Tomography) technology to evaluate anatomical structures, the presence of this canal has showed to be high (92-100%) and its length can vary from reaching only the premolar area or even the central mandibular incisors in the least of cases.

Lithopedion Clark,JG 1897
Click on the image for a larger depiction

Sources:
1. Haas LF, Dutra K, Porporatti AL, Mezzomo LA, De Luca Canto G, Flores-Mir C, Corrêa M. Anatomical variations of mandibular canal detected by panoramic radiography and CT: a systematic review and meta-analysis. Dentomaxillofac Radiol. 2016;45(2):20150310.
2. Kong N, Hui M, Miao F, Yuan H, Du Y, Chen N. Mandibular incisive canal in Han Chinese using cone beam computed tomography. Surg Radiol Anat. 2016 Nov 11. [Epub ahead of print] Int J Oral Maxillofac Surg. 2016 Sep;45(9):1142-6.
3. Rouvierre H, Delmas A. Anatomía humana: Descriptiva, topográfica y funcional. Cabeza y cuello. Volumen 1. 11° ed. España: Masson, S.A.;2005. P. 114.
4. Von Arx T, Lozanoff S. Clinical Oral Anatomy: A Comprehensive Review for Dental Practitioners and researchers. Switzerland: Springer; 2016. P 323- 390
 
Image by Dr. Fernanda Cortes.


Lithopedion

This word originates from the root terms [-lith-], which arises from the Greek word [λίθος] meaning “stone” and the term [-pedion-] (or [pædion]) which is also Greek [παιδί] meaning “child”. In simple terms this would mean a “stone child”.

Strangely enough, “stone children” or lithopædia are rare cases found in nature, and have been described in humans since early times, the first one by Abū al-Qāsim (Abulcasis) in the 10th century.

When found, it is usually a fetus of more than 12 weeks of estimated age. This is because a younger fetus, if it dies, will usually be reabsorbed by the mother’s body. Usually they are ectopic pregnancies where the fetus dies and is calcified, turning into “stone”.

Technically there are three types of lithopaedia:

1. Lithokelyphos: Only the surrounding fetal membranes calcify. The fetus decomposes and is absorbed, while the calcified membranes protect the mother from the effects of necrosis.

2. Lithokelyphopaedion: Where the membranes and the fetus calcify.

3. True lithopedion, also known as “lithopedion proper”, or lithotecnon. The most common presentation when found, only the fetus is calcified.

The incidence of lithopedia is estimated close to 1.8% of ectopic pregnancies. The following images are of a lithopedion case described by Bainbridge in 1911 and include an X-Ray of the lithopedion.

Lithopedion Clark,JG 1897
Lithopedion Clark,JG 1897
Click on the image for a larger depiction

Lithopedion. Bainbridge, WS 1911
Lithopedion 
Click on the image for a larger depiction
Lithopedion. Bainbridge, WS 1911
Lithopedion
Click on the image for a larger depiction

Sources:
1. “A rare case of Lithopedion” Clark, JG John Hopkins Hospital Bulletin Volume 8 (1897) 221-228
2. “Lithopedion, Report of a case with a review of the literature” Bainbridge, WS. Am J Obstr V65 (1911) 31 – 52
3. “Chilean woman carried calcified foetus for 50 years” BBC News
4. Blog: James Edwards Hughes “The Lithopedion”


Marcia Crocker Noyes (1869 - 1946)


The following article is taken and modified from the Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it.


Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore...

Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]

Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.

The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogues still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

Marcia Crocker Noyes
Marcia Crocker Noyes
Click on the image for a larger depiction

Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!

Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.

Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.

Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.

In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.

The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.

Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]

 Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.  
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding


Interesting discovery in an Ex-Libris

For centuries, book owners and collectors have used bookplates to identify their books and their collections, a tradition that seems to be falling in disuse. Not me, I have one that you can see here.

Bookplates (also known as Ex-Libris) can be a tantalizing study, and finding an interesting one is part of what makes an old book a journey of discovery. Every detail in an old book is important. Who owned it? What is their story? Did they leave personal notes within the pages of the books? I have found prescriptions, personal notes, medical shopping lists, and in some cases corrections to the book itself! One of the most interesting cases of this is Vesalius' Annotated Fabrica!

Bookplates are personal. In many cases, they depict the coat of arms of the owner’s family, sometimes a motto that drove the book’s owner, and in some cases a humorous jab at something. They are very personal.

While researching my series of articles on Dr. Ephraim McDowell, I ordered the book “EPHRAIM MCDOWELL, FATHER OF OVARIOTOMY AND FOUNDER OF ABDOMINAL SURGERY. With an Appendix on JANE TODD CRAWFORD”. By AUGUST SCHACHNER, M.D. Cloth, 8vo.A p. 33I. Philadelphia, J. B. Lippincott CO., I921. A great book, I finished reading it overnight!

What interested me was the bookplate on the book frontis, a picture of which I placed in this article. It is from the Library of the Medical and Chirurgical faculty of the State of Maryland, and has a legend that states "Purchased through the William Osler Testimonial fund for the advancement of Medicine”. It depicts a physician (probably Hippocrates) taking the pulse of a patient.

Osler MedChi Ex-Libris
Osler MedChi Ex-Libris
Click on the image for a larger depiction

Further research indicated that this bookplate was created to honor Sir William Osler by the Maryland State Medical Society and that Dr. Osler’s books never had personal bookplates. MedChi (Maryland State Medical Society) commissioned this plate that depicts the four seals of the universities with which Osler was affiliated: McGill in Montreal, University of Pennsylvania in Philadelphia, Johns Hopkins in Baltimore and Oxford in England. The images are flanked by two rods of Asclepius.This Ex-Libris was designed and drawn by Max Brödel (1870 – 1941) a famous medical illustrator who worked at the Johns Hopkins School of Medicine in Baltimore and illustrated for Harvey Cushing, William Halsted, Howard Kelly, and other notable clinicians. Brödel was a personal friend of Osler. The bookplate was such a hit that doctors from all over the country requested copies of it, which the librarian at the time Ms. Marcia Crocker Noyes,  sent but with the request of receiving the requestor’s own bookplate. You can see all of them in the attached linksin the "Sources" section.

An old book is important not only because of its content, but also because of its provenance. You know where you are going to start reading it, but you never know where are you going to end in researching it. Dr. Miranda.

Sources:
1. Ex Libris: The Bookplate Collection, Part I MedChi
2. Happy Birthday, Sir William! MedChi
3. The bookplate that never was McGill University
4. The Osler Library of the History of Medicine: McGill's Medical Memory. Lyons C Mcgill J Med. 2011 Jun; 13(1): 90.
5. The MedChi Collection of Bookplates
 
6. Max Brödel & MedChi