Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their 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.

You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment.


We have 287 guests online


A Moment in History

Marcia Crocker Noyes
(1869 – 1946)

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... This is certainly an article that can be called "A Moment in History"

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 catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

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]

Marcia Noyes handwriting

NOTE: This article has been modified from the original 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. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.

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


 "Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

Click here for more information


bookplateink.com

 

 

 

This article is coauthored by Randall K. Wolf, MD and Efrain A. Miranda, PhD


Cardiac Rhythm Control Schematic
Cardiac rhythm control system

Can there exist a unified theory that deciphers the mechanisms for cardiac arrythmias and  atrial fibrillation (AFib) that can also explain the results of various catheter-based and surgical-based treatments? Based on anatomical and physiological study of the heart and it’s nervous system, we believe the answer is yes.

While we have learned not to expect everyone to be persuaded by the argument we will be presenting, we suggest, nevertheless, this argument does deserve careful and dispassionate consideration for it provides a model which explains results in the treatment of AFib, and should not be ignored. The epiphany that shed light on a possible unifying mechanism came during multiple cases of left atrial electrical testing during minimally invasive surgical pulmonary vein isolation (PVI) in patients who had multiple previous catheter-based PVI ablation procedures. 

Over the years we have evolved our view of the anatomical structures and processes that control the beating rhythmic activity of the heart. Additional and complementary information can be found following the links in the article.

First, we need to define two terms in reference to the heart: “Intrinsic” and “Extrinsic”. An intrinsic structure is found within the boundaries of the heart, that is, within the parietal pericardium. Extrinsic means that the structure about is found outside the parietal pericardium.

The most well-known intrinsic component is what we know as “the conduction system of the heart”. The classic description of the conduction system of the heart emphasizes this cardiomyocyte- based  component and refers to a group of specialized cardiac muscle structures that serve as pacemakers and distributors of the electrical stimuli that make the heart beat coordinately. It is important to stress the fact that this primary "conduction system of the heart" is not formed by nerves, but rather by specialized cardiac muscle cells. Probably the reason so much emphasis is placed on the conduction system of the heart is the use of the electrocardiogram as a clinical diagnostic tool since William Einthoven (1860 - 1927) introduced the EKG in 1901.

The second (quite complex) component of this system has been forced to take a secondary place, and in many cases ignored. We refer to the modulating activity on the heart by the autonomic nervous system (ANS), with its two subsystems, sympathetic and parasympathetic.

Unlike the conduction system of heart, which is purely intrinsic, the cardiac autonomic system is both extrinsic and intrinsic. The classic architecture described is a two-neuron system, where an extrinsic preganglionic neuron located in the central nervous system (CNS) connects with an extrinsic postganglionic neuron found in the sympathetic chain and ganglia located in the superficial and deep cardiac plexuses close to the aorta and pulmonary trunk.

The cardiac ANS has an intrinsic component formed by ganglionated plexi (GPs) and nerves found within the walls of the myocardium and in epicardial areas of the heart which contain fat. The main location of these GPs is close to and around the great vessels. These ganglionated plexi are the basis for the complex rhythmicity responses of the hear. In fact, several researchers call these intracardiac plexuses the "Little Brain of the Heart". Failure of the ganglionated plexi are the basis of many cardiac arrythmias, including atrial fibrillation.

The inclusion of the cardiac ganglionated plexi into this picture has led us to propose a different ANS organization for those organs that have rhythmicity, be it a beat (heart) or peristalsis (digestive system, ureters, urethra, etc.). For a more detailed explanation follow this link to another article on this topic

These cardiac intrinsic ANS component are responsible for the complex reflexes that increase or decrease both the heartbeat and the force of contraction of the heart muscle in response to variations in volumetric pressure in the atria and chemical variations in the blood caused by alcohol, caffeine, drugs, dehydration, etc.  A more detailed explanation can be found in the following Houston Methodist DeBakey CV Live video. Click on the video to start it or you can go directly to YouTube by clicking here. The main content start at 2 minutes:

 

The cardiac ANS has important communication with the brain centers responsible for mood and emotions. It is important to note that emotional response is linked to visceral activity (glands and viscera), and this includes the heart. 

Also, the ANS/GPs complex is not separated from the higher functions of the forebrain. Cechetto (2005) explains how the forebrain (conscious) activity influences the spinal cord and the ANS by pathways that include the limbic system, insula, amygdala, and lateral hypothalamus. These pathways and communications can certainly explain arrythmias caused by stress and anxiety and pathologies such as the “broken heart syndrome” (Takotsubo cardiomyopathy).

 Note: "Broken heart syndrome" or "stress cardiomyopathy" is also known as "Takotsubo cardiomyopathy". This is because the shape of the heart in this condition changes and resemble a Japanese octopus (tako) trap (tsubo). For more information on this condition, click here.

Sources and references

1. Kawashima, T. The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution. Anat Embryol (2005) 209: 425–438
2. D. F. Cechetto, "Forebrain Control of Healthy and Diseased Hearts," Chapter in "Basic and Clinical Neurocardiology", J. Armour and J. L. Ardell, Eds., Oxford University Press, 2004.
3. Kandel ER, Koester JD, Mack SH, Siegelbaum SA. Principles of Neural Science. 6th ed. New York, NY: McGraw Hill; 2021.
4. Standring S, ed. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London, UK: Elsevier; 2021.
5. Haines DE, Mihailoff GA. Fundamental Neuroscience for Basic and Clinical Applications. 5th ed. Philadelphia, PA: Elsevier; 2018.
6. Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021.
7. Purves D, Augustine GJ, Fitzpatrick D, et al. Neuroscience. 6th ed. New York, NY: Oxford University Press; 2018.
8. Felten DL, Maida MS. Netter’s Atlas of Neuroscience. 4th ed. Philadelphia, PA: Elsevier; 2021.
9. Wolf, RK; Miranda, EA. Minimally Invasive Surgical Treatment of Atrial Fibrillation: A New Look at an Old Problem. 2024 Operative Techniques in Thoracic and Cardiovascular Surgery. 
10. Takotsubo Cardiomyopathy Harvard.edu